The first sound you hear is the high-pitched wheeze of 60 dentists’ drills buzzing inside of open mouths. Splayed out on a show floor generally reserved for millionaire athletes and rock bands are: a hundred dental chairs; five RVs filled with X-ray equipment; mammogram machines; a 60-person triage station; rubber gloved paramedics; long picnic tables of surgical equipment; and about 1,000 recipients of free healthcare. Since last Tuesday and until tomorrow, the Forum in Inglewood is the biggest free healthcare clinic in Los Angeles. The bill will be picked up by the Remote Area Medical Expedition, a 1,300-person volunteer effort of medical professionals. RAM got their start treating villagers in the Amazon in 1985. Now they have ventured to the first world—their first time treating patients in Los Angeles.
At 2 a.m. on Friday, people started to line up for treatment. Most patients are local. Some drove in from San Francisco and a few folks came from Nevada. It’s not a destitute crowd. Many are working families, though some attendees hail from shelters. Hundreds slept on the sidewalk outside of the Forum to be granted access around 6 a.m.
The patients are mostly black, Latino, and Korean residents of L.A.’s working class suburbs like Compton, Hawthorne and Boyle Heights. They are service workers, seniors, immigrants and children who have not seen a doctor since the day they were born.
* * *
The majority of people came to get their teeth fixed. During the first two days of service, RAM dentists have put in 947 fillings.
Dawna and I sat in the bleachers of the Forum. She is small woman with a nut-colored tan and sun-bleached hair. Dawna was about to be the 425th dental patient seen today. Dawna “was conceived on Venice beach” and currently lives in her van by the Venice boardwalk. She has been diagnosed with bipolar disorder and anxiety. She takes her meals at a shelter. She can no longer chew food because of impacted incisors. Ten years ago, however, Dawna worked as a home health in aide in Texas and Alaska.
“When I eat,” Dawna said, her hands clutching her jaw, “my gums bleed. I’m in pain all the time.” She tells me that she hopes that the dentist will just pull her front row of teeth out.
They will. Crowns, caps, and fillings are expensive procedures that require follow-up, which patients can’t afford. Most the dentists working on the floor are going to yank a bad tooth rather than try to restore it. By Saturday morning, RAM dentists had removed 471 teeth.
* * *
According to the registration volunteers, most RAM patients seeking medical attention suffered from chronic conditions: high blood pressure, heart disease, diabetes. These are all conditions that spur other medical aliments. If patients who suffer from chronic conditions were able to receive care early and often, treatment would be less costly as conditions would be less severe.
If government makes it easier for people to get free medical services, the argument goes, too many people will come clamoring for those services and the demand will bankrupt any publicly-funded program. In healthcare wonk circles, this is called the ‘woodwork effect.’ People will come out of the woodwork seeking costly, perhaps unnecessary, services if they are widely offered. After speaking with some of the registration staff charged with categorizing every patient who walked through the forum’s doors, the woodwork theory becomes suspect.
In front of the shuttered refreshment stands, Mary is waiting behind a card table that doubles as an intake desk. She has worked as an RN for 23 years and is volunteer triage nurse this afternoon.
“Many doctors don’t accept Medicaid because they don’t want to attract that kind of population into their offices,” Mary said. “It’s about American entitlement. You know, the haves and the have- nots.”
Mary is a labor and delivery nurse at Long Beach Memorial hospital. Her hair is pulled back in thick French braid and a stethoscope adorns her neck. “People who can afford insurance or have good employer medical plans don’t want to share a waiting room with people who don’t," she said.
* * *
There is a new demographic attending the RAM Expedition this summer: the recession patients. Jan, a nursing administrator for RAM, said that there has been an uptick in young, laid-off workers seeking dental and vision care. “Most young people think they’re invincible,” Jan said, “until they realize they need glasses to drive.” Most of the young recession refugees can’t afford dental or vision plans.
Even if their parents policies offer them coverage, the co-pay for glasses and wisdom teeth extractions are out of their price range. Today, the optometry line is divided between seniors and people under thirty.
* * *
“Also, can you remove my lip ring? It was a stupid idea.” Jennifer, a high school student, said to her volunteer dentist, who has already outfitted Jennifer with a hygienic bib.
Jennifer does not look 17. She looks like a trendy twentysomething in chunky glasses, kitten-heel flats, and her hair tied off to the side. She is a senior in high school and her father is a longshoreman at the Long Beach port. While she is getting her teeth cleaned, Jennifer’s boyfriend Lewis comes over with a paper bag in hand. The two arrived at 3 a.m. Friday morning.
Lewis, who stayed awake while Jennifer slept against him on 90th street, had a physical, an optometry test and a filling put into his canine tooth. Inside of Lewis’ paper bag was acne medication. Lewis’s employer, a limo company, does not offer health insurance and he can’t afford it. He and Jennifer met a year ago on Myspace and came to RAM because, according to Lewis, he wants to make sure they “stay healthy so they can stay together for a long time.”
Lewis put on his new pair of prescription glasses and grinned at Jennifer as she got her teeth drilled.