By Debra McCown
Reporter / Bristol Herald Courier
Published: July 25, 2009
WISE, Va. – It's not yet 5 a.m., but people are emerging from their cars, a few scurrying to pack up tents and camp stoves, bustling to be ready, hoping to have the opportunity to receive health care.
As wisps of pink sunlight began coloring the clouds, the masses huddle at the gate under a misty dawn, waiting for their numbers to be called.
The grassy parking lot is full. Beyond the fence, the cars are stacked up for miles. A snake of headlights is visible in the semi-dark along the curvy length of Hurricane Road, waiting to access the Wise County Fairgrounds.
These are the modern-day breadlines: people desperate not for food, but for health care.
"We are working taxpaying jobs, paying taxes, and we can't get insurance because we make $6.55 an hour," said Laura Head, 32, of Rogersville, Tenn., the first person in line Friday for the first day of the Remote Area Medical clinic, an annual three-day event offering free medical care. "This is really a great beneficial thing, but it doesn't have to be this way; we could all have insurance."
A single mother of three who mows yards and moves trailers for a living, Head said she arrived at the fairgrounds Tuesday, to camp out at the fairgrounds until the health fair began Friday morning. Her motivation was simple: severe, constant pain.
Close to two years ago, her boyfriend smashed her teeth, she said – but, without the $6,000 needed to have the teeth pulled she has endured infection after infection, making literally 100 visits to the emergency room for antibiotics and pain medication.
She's been billed between $240 and $290 a visit, she said – and, even after racking up bills far higher than the cost of extracting the teeth, she was stuck with them.
"I wanted my teeth fixed and I wanted my health problems to be taken care of," she said when asked why she took such great lengths to be first in line. "I wanted to make sure mine got done."
Scott Syverud, an emergency room doctor at the University of Virginia who came to volunteer at RAM, said Head's problem is not unique; dental pain is the most common complaint at American emergency departments.
"I see it every day and every night," Syverud said. "This is what I see in the emergency department every day, it's just bigger here. It's harder to ignore."
The lack of access to health and dental care is not an Appalachian problem, he said – it's a problem all across the nation.
"Emergency rooms act as the safety net in this system," he said, "and that's at the breaking point."
Even as a national health care reform bill is prepared for debate in Congress, more than 1,400 volunteers descended on Wise on Friday, with hundreds more signed up for the weekend – but even they were not enough to help everyone seeking care.
"We've never had the traffic problem that we had this morning," said Teresa Gardner, executive director of the Health Wagon, the local organization that coordinates the event. "It's a record-setting day for sure."
The work will continue today and Sunday.
Stan Brock, the founder of RAM, said 1,600 numbers were given out Friday to people seeking care – compared with 1,200 last year on the first day. He said the event here has grown every year.
"It's been like this for years and years and years," Brock said. "This is not a recent phenomenon, and it's not peculiar to Southwest Virginia. ... Two weeks from now we'll be in Los Angeles, Calif. – same problem."
The RAM event, in its 10th year in Wise County, is based on a model designed for the third world, Gardner said – but it's needed right here in Virginia.
"Our success is a failure of the health care system," she said. "We'll get breast cancer [diagnoses] most likely, cervical cancer, lung cancer ... about 40 to 50 percent of the patients will require follow-up."
She said she knows of a young woman, 19 or 20 years old, who is dying of cervical cancer for the simple reason that she didn't have the money for follow-up care after an abnormal screening result.
Paula Meade, a nurse with the Health Wagon, said she often sees patients who have cut back on their blood pressure medication or other needed care because of cost – and, as a result, come to her with permanent organ damage and worsening health.
She said with economic troubles and rising bills, more people are trying to cut corners – and often they do it with their health, meeting short-term financial obligations at the expense of long-term well-being.
"This is not the solution," said R. Edward Howell, CEO of the UVA Health System, who also was at the event Friday. "I've been registering patients and they all ask the same question: 'Can I get it all in today, or am I going to have to sleep in my car and come back tomorrow?' That's not the way to do it."
Howell said the solution to America's health care situation is a complex problem with a complex set of solutions: More patient responsibility for health, more health care workers, more access in remote areas, some mechanism to enable people to pay for care.
There is no simple, easy solution, he said – but he's glad Washington is engaged in the conversation.
Meanwhile, the people here are busy doing their best to fill in the health care gap.
As the morning sun crested over the mountain Friday, the fairgrounds were bustling – people filling rows of chairs in the waiting line as volunteers in medical scrubs shared goodies and information.
"We recommend that you brush for two minutes every day," Tori White, a third-year dental student at East Tennessee State University, told those in a growing line of patients waiting their turn for dental care. "And then we ask you to floss every day because a lot of bacteria like to hide between your teeth."
White said a lot of the dental problems people face could be prevented with education – sometimes something as simple as an explanation on the importance of brushing teeth daily to prevent decay.
While many patients here said the government could do more to help them with medical and dental care, others said they were just glad for the chance to get help now, to stop their pain.
"I'm grateful to be here," said Jerry Moore, 42, of Big Stone Gap, as we waited in a long line for dental care. "It's a wonderful place."