Patients gather outside the Virginia-Kentucky Fairgrounds for their turn to enter the Remote Area Medical (RAM) Health Expedition in Wise, Va., July 24, 2009. Photo by Paul Morse for AARP Bulletin Today

At the very moment when bills for health care reform are making a perilous journey through Congress, at least 2,500 of America's millions of uninsured and underinsured people waited this weekend in predawn Wise, Va., in the heart of Appalachia, to get the only medical care they've had in at least a year.

One woman needed a painful tooth removed. Another sought a mammography. An elderly man, his arms scarred from diabetes, was desperate for dental work and glasses.

They brought only themselves. Money, insurance cards, even identification were not required.

Susan, 52, who withheld her last name drove 44 miles from Gate City, Tenn., and spent the night in her car to have a cavity filled, endure one extraction, get a hearing exam and new glasses. It was her first visit for medical services in a year. She’d already waited six hours and was prepared for more.

The free care, the biggest effort of its kind in the United States, was provided by Remote Area Medical, now in its 10th year of staging clinics in Wise, a tiny town of 3,200. From small beginnings in 1985, RAM, headquartered in Knoxville, Tenn., has organized 575 health fairs in the United States, expanding to serve tens of thousands of mainly rural people.

The 1,700 men and women from RAM who converged on Wise, all unpaid and uncompensated, included some 1,000 medical professionals and about 700 other volunteers from medical centers and universities, a score of civic and charitable groups as well the Virginia National Guard.

Treated in tents and chicken coops

They spent Thursday setting up medical equipment in tents and buildings and chicken coops on the Kentucky-Virginia Fairgrounds just outside Wise. Among hundreds of items: 75 folding dental chairs, with compressed air lines to run tooth drills, electric power for bright dental lights and vacuum lines for suction.

“It’s a lot of gear,” said Darryl Pearlman, a dentist who drove 385 miles from Richmond and was busily assembling a dental station. 

By the time everyone was finished in about a dozen hours, the fairgrounds had been converted into a massive field hospital. Anything and everything was in place for treating tooth decay, making dentures, performing minor surgery such as tumor removal, testing for cardiovascular disease, detecting diabetes, and checking cholesterol. Also available were complete eye exams, pap smears, chest x-rays and a laundry list of other tests and treatments for all kinds of ailments.

Complicated procedures weren’t done on the fairgrounds. Those more critical patients—in danger of imminent heart attack, for example—would be transported by ambulance to local medical facilities; pediatric surgery was in a hospital in nearby Norton.

In a matter of minutes, the scene swarmed with patients who were quickly seated in “holding areas”—the horse arena—and in neat rows of tightly packed chairs in waiting rooms. Many were in wheelchairs, others leaned on canes and walkers. Young and old, even infants in the arms of grandmothers, they came dressed in shorts and shirts and baggy pants. As one patient left a waiting area, the others would move one seat to the left, like musical chairs. There were no raucous noises, only the mild din of air conditioning systems, fans and quiet chatter.

Sleeping in cars, camping out in tents

Many patients had slept in vehicles or tents to receive numbers and be first in line at 5:30 a.m. Friday when a gate opened and “Number One!” was called by Stan Brock, RAM’s founder and its driving force. By 7:35 a.m., 800 people had streamed in—children with mothers, grandparents,  farmers, disabled coal miners and retired railroad workers.

All the jargon swirling in the current congressional-White House medical care debate—preexisting conditions, affordable quality options, deficit neutrality, bending cost curves—meant little to these people. All they knew was that they were on the verge of being examined by caring professionals who could make them feel better.

One was Mark Hartzell, sleeping in his car after arriving from Johnson City, Tenn., and, as he said wryly, “looking forward” to a wisdom tooth extraction.

Paul Carter, 72, retired and a diabetic from nearby Big Stone Gap, Va., showed up for RAM last year but collapsed from waiting in the heat 10 hours. He accepted that: “It’s first come, first served.” This year, he was one of the first up, but he lived with a sad thought. His granddaughter, Gabrielle, age 7, died the previous week after difficulties stemming from premature birth. “A precious angel,” he said. “She couldn’t walk or talk. We buried her Wednesday. The only good thing is she’s up there now with no more suffering or pain.”

Patients included the insured and uninsured 

Some were insured through employers or Medicare or Medicaid, Veterans Administration or such private carriers as Blue Cross Blue Shield, but none of it was adequate. For those who had it, insurance neither covered what they needed (dental and vision) nor was it affordable with 20 percent and 30 percent copays and huge deductibles. “I can’t afford what insurance requires,” said one patient in her 60s.  Insurance “doesn’t do me any good at all,” agrees Bobby Honaker of Honaker, Va., a retired railroad worker from a town 76 miles away founded by his great-grandfather.

Many patients leaned conservative in their politics and ironically, though they were getting health care free in a fairground, didn’t want the federal government doing anything about it. “All they’ll do is mess it up beyond what it is already,” said one patient. “Let ‘em stay out of it and stop spending what we don’t have.”

RAM had always lived on lean budgets of $100,000 or less a year. A staff member routinely carried mail to the U.S. Post Office and paid for postage from her own money. It still uses a vintage DC3 for some cargo transport, for example. But everything changed in March 2008, when Scott Pelley hosted a segment about RAM on 60 Minutes.

“By 8 p.m. when the program was over,” recalled Jean Jolly, RAM’s volunteer coordinator, “money was flowing in. It was wonderful. The 60 Minutes people said this would change our lives, and they were right.” Total giving in two days was around $1.5 million, with money still flowing in months later. Later, Pelley himself and members of the 60 Minutes crew did volunteer work for RAM.

For Stan Brock, 73, known to older Americans as the ruggedly handsome cohost of television’s Mutual of Omaha’s Wild Kingdom (1963-1971), the new money means a wider reach for RAM. The organization used the windfall for a 22-year-old Beechcraft King Air airplane and such medical equipment as machines to check for eye disease. And it’s also going after bigger urban markets. After Wise, RAM heads for a massive urban clinic at the Forum in Englewood, near Los Angeles, from Aug. 11 to 18. And it’s also considering Chicago.

Emotional experience

The emotional impact of thousands of people lining up for basic health care is sometimes too much even for RAM’s veteran staff. “I spent half the day crying,” said one worker, who didn’t want her name used.

“What you see here is a community pulling together to help each other. It’s really pretty inspiring,” said Scott Syverud, M.D., the doctor who ran the clinic and is also an instructor at the University of Virginia. 

Still, the issue of medical insurance reform for this country hung over this year’s health fair. Brock is adamant that change must come. “Health care in America is the privilege of the well insured and the well endowed,” he said.   

John S. DeMott is a former writer for Time magazine.