Aug 2, 2017 By Chris Togneri
The sun has not risen when hundreds of people gather before the barbed-wire fence. Some have been here for days. Entire families packed into small cars and drove here from all over the country. Many set up tents; those without tents slept slumped over in their cars or on blankets on the ground.
Now they hold pieces of paper with printed numbers, praying that theirs is low enough to ensure entry. They have traveled too far and endured too much to be denied. Elderly people in wheel chairs, young adults with babies in their arms, toddlers clinging to their parents’ legs—all stare beyond the fence at floodlights illuminating old wooden buildings and large canvas tents.
Lacy Holbrook stands among them. Her baby daughter sleeps in a stroller at her fingertips. An elderly woman in the crowd approaches.
“What time is it?” the old lady asks knowingly.
Holbrook looks at her watch. “4:35,” she says.
“No, no,” the old lady says. “I mean, what number do you have?”
Holbrook’s is 420. The stranger holds up her card: 158. She places it in Holbrook’s hand and takes the higher number in exchange, explaining that she wants Holbrook and her baby to get in before she does. Holbrook doesn’t know what to say. The old lady mixes back into the crowd.
At 5 a.m. sharp, a man who speaks with a British accent and wears a beige uniform emerges from the shadows of the entrance. Before him is a sea of tired and frightened faces. He tries to ease their anxiety.
“General boarding,” he says to soft laughter. “First class only.”
Then he calls numbers: One, two, three, and all the way to 50. The first group steps forward, every one pausing to thank the man as they pass. Many whisper into his ear or embrace him. They walk through the entrance and follow a path of splintered concrete between two head-high metal fences. Outside, the others watch them slip from view.
It is a scene that would not be out of place in Jordan or on Europe’s Mediterranean shoes. Yet it unfolded in a small corner of America called Wise, Virginia, from July 21 to 23, at a temporary clinic offering free health care.
“We have great technology — if you can afford it,” says Stan Brock, the man with the British accent. “But millions and millions of people in this country simply cannot afford it. That’s why you’re seeing huge crowds like this.”
Brock, who starred in the old television show “Wild Kingdom,” founded Remote Area Medical, or RAM, in 1985 after noting a lack of affordable health care in Guyana, where he had been injured while living with the Wapishana Indians. His focus quickly shifted to the United States, however, when he realized that the need here was just as urgent.
As politicians debate and our president tweets about the best way to approach health care for Americans, Brock and his army of volunteers march the country and do what the government is either unable or unwilling to do: They make sure anyone within their reach has access to health care.
“It’s obviously the fault of the two principal parties that don’t seem to be able to agree on the best way to do it,” Brock says as he sits in the RAM Command Center, a trailer in the parking lot outside the Wise Fairgrounds. “The Affordable Care Act didn’t fix it, didn’t make any difference to the size of the crowds we see all around the U.S. Then I read the House version and that’s not going to do it. And then I read the preamble, a couple hundred pages, to the Senate version and that’s not going to do it either.”
The system is broken, Brock says. But no one in government seems to be listening.
That leaves RAM and clinics like this one in Wise—where 2,000 people receive free medical, dental, and vision care—to serve as “the voice of the people,” he says.
Americans Are Getting Desperate
What the people want appears to be changing. A recent Bloomberg poll shows that 35 percent of Americans cite health care as their main concern, followed by unemployment and jobs (13 percent), terrorism (11 percent), immigration (10 percent), and climate change (10 percent). Only 6 percent of the 1,001 respondents surveyed July 8 through July 12 cited the country’s relationship with Russia as their top concern.
Other polls show increasing support for a government-funded national health-care system. Democrats are beginning to take notice. On ABC’s “This Week,” Senate Minority Leader Chuck Schumer said his party was too timid in the 2016 presidential election, and that Democrats need to rebrand themselves and pitch a new message to Americans. Supporting single-payer is suddenly an option, Schumer said.
But like so many who’ve succeeded in the political class, Schumer—a member of Congress for 36 years—appears to be chasing Americans, not leading them: A Pew survey in June suggests that 60 percent of U.S. citizens now believe the federal government should ensure health care coverage for all Americans, the highest level of support for such a system in nearly a decade. At the RAM clinic in Wise, support for universal health care is nearly unanimous.
“In Canada, if I need help I can walk into a doctor’s office and get help. Like it should be,” says Ron McGrady, 33, of Mt. Carmel, Tennessee. McGrady works in carpentry, but says he cannot afford health insurance for himself or his family. That’s why he and five others piled into an old white Pontiac and drove 90 minutes to Wise. “Our government is supposed to be for the people, by the people. Well, we are the people.”
“And we need to be heard,” says Ron’s friend, Randall Smith, a former building inspector who says he suffered four heart attacks, qualified for a $700 monthly disability check, then discovered that health care would cost $800 a month. “The system is backwards. We need to get these people in America to see what’s really going on. I mean, we’re the middle class, and we’re here.”
Neither Medicaid Nor Obamacare Is Helping Us
Bill and Murleen Smith were the first to arrive in Wise. The residents of Big Stone Gap, Virginia arrived on Wednesday, two days before the gates opened. They have many doctors to see, so they wanted to make sure they got low numbers. Now, with time to kill, they share small talk with volunteers and constantly check on each other’s well-being: Do you have enough water? Do you need something to eat? How are you feeling today, sweetie?
Bill, 71, is an Army veteran. He has weight issues and relies on an electric wheelchair, which keeps getting stuck in the loose gravel areas of the parking lot, forcing him to heave his body to standing and push the chair to areas offering better traction. Bill has Medicaid, but that doesn’t cover dental or vision, and that’s why he’s here.
Murleen, 55, is trained as a certified nurse assistant, a qualification she earned years ago while caring for her comatose former fiancé after he suffered a work-related brain injury. He passed, then she met Bill, whom she affectionately calls “my big boy” while reaching out to rub his ample belly. Murleen is here because she recently suffered five heart attacks—four minor, one major—over a two-day period. She has eight stents in her heart, 12 in her leg, and no health insurance. She says she tried to enroll in the Affordable Care Act, but coverage would have cost $895 a month, “and sorry, but that ain’t gonna happen.”
“Because of my heart issues, I am no longer an asset to anybody. I’m a liability,” she says as she and Bill find shelter from the mid-90s heat in their air-conditioned camper. “That makes me unjobable.”
Her only health care comes at the annual RAM clinic in Wise. She knows she should see a doctor regularly to monitor her heart issues, but, she says she can’t afford it. This is her fourth RAM clinic. Asked what they would do without the free clinics, Bill answers: “Without. Without. We would do without.”
Murleen is a sweet woman with a laugh always at the ready and an endless supply of jokes. While removing her shirt for a breast exam, she told a news photographer that she has “more rolls than the Pillsbury Doughboy,” but nearly every other one-liner is unsuitable for public consumption. She says her joyful disposition, despite everything, is a direct result of her marriage to Bill.
“Was there enough shade over there for you?” Bill asks with genuine concern the moment she returns from her latest doctor’s visit.
“Yes,” she says, gently touching his arm. “There was.”
But her joie de vivre is not only the biproduct of Bill’s love. For Murleen, finding happiness in life is a way of self-treating her heart problems in a system that prevents her from letting doctors do so.
“I could sit here and cry a million tears but it would just make me sick,” she says. “My life depends on me being happy. I have to be happy.”
It’s not always easy. Take today, she says. Around lunchtime, Murleen watched a RAM volunteer carry dozens of brown bag lunches into the crowd. Murleen didn’t need the food; others clearly did. A group of children swarmed the volunteer.
“I mean, they ran to him like he was Santa Claus,” Murleen says, her voice quivering. “I watched them and I thought, ‘These kids are starving.’”
Murleen pauses. This is not good for her heart. But she can’t stop herself.
“Those children are hungry,” Murleen says. “I can’t stand to see anybody hungry. I can’t do that. It bothers me to see people in need. Yeah, we need stuff, but we’re blessed. We’re blessed.”
Bill sits next to her, nodding sadly. Neither speaks for several moments.
How About a Dog and Pony Show At This Clinic?
Brock has a solution to the country’s health-care problems: Get every politician in America to visit a RAM clinic. Just one, he says. That’s all it would take.
“I tried to get Mr. Trump here during the convention, and (Hillary) Clinton, because I knew that if they’d come they’d be so overwhelmed by what they saw that it would be a major thing on their platforms,” Brock says. “If he can’t come, send his son or his daughter or Kellyanne what’s her name, the lady who seems to have an answer for anything, because I think she’d add a woman’s touch to it. If she mingled around with all these people at 5 o’clock in the morning, she’d say, ‘Hey Donald, you know what? If you fix this, you’re going to be reelected in four years’ time. If you don’t fix it, you ain’t going to get reelected, because the people I’ve seen here today are the people who put you in the White House.’”
Brock is flanked by his chief executive officer, Jeff Eastman, also clad in RAM’s beige uniforms that resemble military garb. Eastman says every politician who visits is thunder-struck by what he or she witnesses. Party affiliations don’t matter, he says. Everyone is affected. Those who come find hard-working, middle-class Americans who drive hours or days to camp out or sleep in their cars, just to get the health care they need but cannot afford.
“It’s hard to believe this takes place in America,” Eastman says. “It’s your favorite waitress, your convenient store clerk, your teacher in school, the guy who drove your kids to school on the bus. These are our neighbors. If we had one in (your home town), you’d recognize some of the patients in the parking lot.”
Despite the obvious need, many states have laws that impede RAM’s efforts. Brock has spent decades trying to change those laws. He started with Tennessee, which in 1995 adopted the Volunteer Health Care Services Act to allow health care providers to cross state lines to volunteer their services. Still, most states don’t allow out-of-state doctors to practice, Brock says, even for charity. Over the years, he has lobbied and convinced a dozen other states to change their laws, and it’s improved RAM’s efficiency levels, Brock says, but more needs to be done.
“Which is another reason Mr. Trump, who seems to like making laws with a stroke of the pen, needs to sign an executive order to allow doctors and nurses and dentists to cross state lines to provide free care for the underserved as long as their license is not under any kind of judicial review,” Brock says. “When a bunch of dentists and eye doctors register for one of our events, we run their history on our computer and we know if they’ve been up to any shenanigans and if they are we don’t let them come. (The law changes) have been enormously helpful to what we do …. That’ll make a big difference if they change that law.”
Of course, such an order would be a mere Band-Aid. Asked why not just fix the whole thing rather than a small piece, Brock seems confused by the obvious nature of the question: “Well, of course,” he says. “Of course.”
A Health Vacation Of a Different Kind
There are 70 free RAM clinics a year across the country, 869 in its history, and in Wise, many attendees bring their entire family, including young children. While here, they do what they can to make this place feel less like the refugee-style health care camp it is, and more like a vacation, a Woodstock for people in need of new teeth, new eye glasses, annual mammograms and checkups. Only, instead of listening to bands, they listen to an army of volunteer health care providers.
“It’s been fun,” says Ron McGrady’s little sister, Jayden, 11. “I get to spend time with my family and sleep outside.”
The McGrady family could not afford tents, so they laid blankets on the ground and slept under the stars. And it was working out—until a thunderstorm rolled through around 3 a.m. Sunday. Startled awake, they and others gathered up their wet blankets and piled into their cars, where they tried to fall back asleep despite being soaked and hot in their auto-turned-sauna. They remained in the car until 4:30 a.m., when it was time to line up again outside the front gate.
The McGrady’s three-day “vacation” to this parking lot outside the Wise Fairgrounds netted each of them the only dental, vision, and medical care they’ll be fortunate enough to experience until next year, plus free school supplies and clothes for the kids. When volunteers passed out free food, they pounced. They played games, set out folding chairs, and even had an unexpected brush with nature, like any other camping trip.
“I was sitting right over there,” says Jessica McGrady, 32, pointing to a corner of the parking lot that pushes up against the tree line. “They started yelling, ‘Snake! There’s a snake behind you!’ But I was too tired to move, so I just kept rolling my tobacco. Next thing I know, I hear stomp, stomp, stomp! And he”—she points to family friend Randall Smith—“was holding a four-foot black snake in his hands.”
“It was just sunning itself, right over there,” Smith says with a toothless grin. He had his teeth pulled three years ago, unaware that the $2,500 price tag did not include dentures. In addition to getting his heart checked, he’s hoping to get fitted for new teeth. “I got my eye on a ribeye,” he says. “I can’t wait to eat a steak again.”
Jessica finishes the story about the snake, and her gaze wonders to the sprawling parking lot and tree-covered hills surrounding the clinic. As if speaking to herself, she says she needs a bunch of teeth pulled, that it’s unfair of people to equate tooth loss with drug abuse, that they say “mean things” about her even though she has never used. Rather, Jessica says, she suffers from a calcium deficiency because Lord knows milk is so expensive these days.
Mid-sentence, she loses interest in telling her own story, lowers her head and refocuses on rolling a cigarette.
“I can’t wait to go home and take a shower,” she says to no one in particular.
‘We’re Part of…America That Has Been Forgotten’
The people here are making the best of it, yes, but desperation and resentment simmer just below the surface. Their patriotism is ferocious and undisputed. These people lovetheir country. But they despise their government.
“Congress, our president, everyone in the government — they have the best health care anyone can get,” Murleen Smith says. “They don’t have to worry. As for us, we’re a bunch of pissed off people because we’re part of the structure in America that has been forgotten. … You know, this wasn’t Carter, this wasn’t Reagan, Nixon, Bush or Clinton. It wasn’t any of them. It was all of them. They’re trying to get to the White House, like it’s some big bull fight they’re trying to win. But they’re just making everyone else lose.”
Most of the people interviewed for this story voted for Donald Trump for president. They don’t care about his policies, tweets, or banal comments on French parades. When you’re making $700 a month and insurance costs $825, you just want someone to blow it all up and start over. This is what blue states don’t understand, and how far off liberals and pundits are when they cast Trump voters—especially those in poor southern states—as racist, clueless, or both.
Some are. But the majority of people here don’t blame Democrats or Republicans for their health woes. They blame politicians. Every last one of them. At this clinic and others, U.S. citizens from all walks of life come seeking help and spitting fire against a system they believe has left them behind. This isn’t a collection of heroin addicts. They are veterans, disabled people, working-class Americans, all of whom caution that anyone outside of the richest Americans are one mistake, one work accident, one heart attack from having to visit a clinic just like this one.
“It’s like a spider web,” Murleen says. “You think you’re working your way out and then you find, oh my God, I’m right back in the middle. To us, it seems like different ethnicities are able to get better services and I don’t understand why that is. I’m glad they can. I don’t think anybody should be without medical care. But they shouldn’t leave people out.”
Back at the McGrady camp, Ron and Randall move away from the kids so they can openly discuss their dark views on politics.
“Our children are watching. They see what’s happening,” Ron says. “United we stand? Well, we need to stand up. We’re divided as a country. People talk about race …”
“It ain’t race,” Randall interjects. “They just try to divide us on issues like race, because they know if we all got together, we ain’t going to stand for this.”
Of course, for some, it is about race. One middle-aged woman, when asked if she blames Obama for the country’s health-care woes, looks around to see if anyone is listening. Confident she is in the clear, she leans in and whispers: “I don’t know why y’all didn’t stick a piece of dynamite up that nigger’s ass.”
She smiles, bids adieu, and saunters off to the dentistry tent.
What America Would Find If They Did Come To Wise
What if they did come? What if every politician in the country took one visit to a free RAM health care clinic? What would they find?
In Wise, Virginia, they would find people lining up the day before their treatments for their numbers. They would find those people admitted 50 at a time, then shuffling through the darkness to their first stop: the grandstands of the outdoor rodeo arena, where children in a strange place find comfort by touching the mane of a therapy horse that leans willingly over the railing. They would watch those groups of 50 walk into a tent after they are given the green light, sit down before a volunteer, hand over their registration papers, and listen to instructions on what to do next.
They would find animal stalls, still reeking of cow and horse manure, that have been cleaned out and turned into makeshift doctors’ offices; buildings that once housed chicken coops turned into darkened eye examination stations; a massive open-air tent with dozens of portable dentistry chairs and many more volunteers reaching into the pained mouths of eternally grateful patients. If they looked hard enough, they would find a plastic container with the words “Feed me teeth” written on the side and 4,000 extracted teeth—darkened and decayed on the top, bloodied yet white at the root—sitting in a solution inside.
They would find woozy patients with mouths full of gauze, pop-up pharmacies, booths offering pamphlets on tobacco cessation and cancer prevention. They would find hundreds of volunteers who arrive at 4 a.m., every day and drive from as far away as California and Massachusetts. They would find Linda Lafontaine, a middle-aged woman from Washington DC with no optometry experience taking a crash course on how to use complicated equipment to test people’s eyes.
“My background is in finance,” Lafontaine says on the first day of the clinic. “But I drove down from DC because I am so blessed in my life. When much is given, much is required. If I can’t take a week out of my life to help people who need it, what the h-ll am I doing?”
She looks around to make sure no one can hear her, then whispers: “When you come to something like this, you assume everyone is going to be super poor. They’re not. They’re just people. Like you and me. It’s just that they can’t afford health care. It’s very humbling.”
Come and Look. Please
Maybe the politicians would walk the parking lot and note the license plates representing 24 states and DC for this one event. Maybe they would learn more about the 2,000 patients treated here, how only 33 percent are unemployed, but 64 percent haven’t seen a dentist in the past year.
Or maybe, just maybe, those politicians would leave the clinic for a while, drive into the mountains and see with their own eyes that the hopelessness found at the Wise clinic extends far beyond the fairgrounds. They could visit any number of dying Appalachian towns tucked into small “hollers” throughout these steep hills. In places like Trammel, they could witness true despair in the form of burned-down houses bookending the odd inhabited dwelling.
In nearby Dante (pronounced by locals as Daaant), they could instruct their taxpayer-funded chauffeurs to stop just long enough that they might walk the town center where a mural reading “A legacy built on coal” overlooks the charred remains of an old train station. If they came that far, they would be forced to note the train tracks leading out of town, where containers brimming with coal once travelled three, even four times a day.
Today, those train cars are empty and idle. Hundreds, if not thousands, of them sit for two solid miles along the five lines leading into Dante, a graveyard of sorts announcing the pervading misery of this region. About a mile outside Dante the tracks run by a church with one sign reading “If you think it’s hot here, imagine hell!” and another reading “No big trucks or heavy equipment on pavement, please.” But no big trucks pass.
If the politicians came, what they would find here is the best and worst that America has to offer. The best, because of volunteers such as Lafontaine and Sierra Tisdelle, a 20-year-old college student who volunteered to make prescription eye glasses even though she had no training to do so until the morning she arrived.
The worst, because this place exists. In the United States of America. In the year 2017.
The World Health Organization ranks the United States 37th among the globe’s best health care systems, two spots ahead of Cuba, but lagging behind Costa Rica (36), Dominica (35), Chile (33), Saudi Arabia (26), and Columbia (22). France is number one.
The only way to fix it, says Brock, is to get those politicians here and make them see. Only then, he says, will those who were elected to lead finally do so.
“What I’d like to suggest to Mr. Trump is that he convene a blue-ribbon panel, not of politicians, but a blue-ribbon panel of medical people and economists and attorneys because of reading through the darn boilerplates, and see what’s happening above us since we’re sitting at number 37 in the world rankings,” Brock says. “Look at those countries above us and cherry pick the best facets — take a look at all of them. Then they’d come up with the best health care in the world.”
Wistfully, he adds: “We need to get him out here.”
‘We Know We’re Not Going to Get Out of This Alive’
It’s the last day of the RAM clinic and, against her best interests, Murleen Smith starts talking about her neighbor back home, a kind and pretty woman named Gale.
Gale is a little old thing, Murleen says, and she once had it all: A beautiful home and a wonderful marriage to a loving husband who owned a NAPA Auto Parts store in town. But five years ago, everything fell apart: Fred, her husband, died suddenly. Soon after, the store burned down due to faulty wiring. Then last year, Gale was diagnosed with terminal cancer. She has no health insurance and little money saved.
“The sweetest lady there ever was,” Murleen says.
“Just a good ole southern girl,” says Bill, who has been Gale’s neighbor for 47 years and, despite his health problems, has mowed her lawn every week since Fred passed.
“She’s talking about Fred a lot,” Murleen says. “She’s talking about life with Fred and she’s talking about life without Fred. She knows her time is coming. And it pains me. It makes me so sad. I can’t imagine life without her. That baby is something else.”
Now Bill is fighting back tears. And Murleen is failing to adhere to her self-prescribed medicine of being happy.
“We know we’re not going to get out of this alive,” she says. “We’re just hoping our health care will at least let us be a little happy while we’re here. But I don’t see that happening … I don’t see that happening.”
During her three days in Wise, Murleen has had her heart checked, visited a gynecologist, had a mammogram performed, received new eye glasses, dentures, and a shot in her shoulder to help ease the pain of a torn rotator cuff. She was busy, and she had to be, because unless “something drastic happens” she won’t see a doctor again for a year, back here at the Wise Fairgrounds, when the RAM clinic returns.
“That’s just the way it is,” she says with a shrug. “It’s not that I’m cheap. It’s just that this is what I have to do. You know, you see stuff on TV and they try to make us look like stupid hicks. We’re not. We’re just normal people trying to make it. But we have no opportunities. You can’t live a fast-paced life in a turtle neighborhood. All we want is to belong. And we feel like we’ve been left out.”
She turns and walks slowly away, back to her camper. Murleen Smith is eager to get back home with her “big boy.”