Creating a Volunteer Medical Corps for America

Wise County, Va., may be one of the most picturesque places in America. Nestled in the Appalachian Mountains, it is home to more than 40,000 people, who make their homes in towns with names such as Big Stone Gap, Toms Creek, Crab Orchard, and Cranes Nest. It sounds idyllic, but many of the people here and in surrounding communities and states are hurting. They can't afford dental, eye or primary medical care services. Some are on disability from working in the region's coal mines. Some are underinsured. Some simply don't know what help is available. Some have no insurance at all. And on July 25, 26 and 27, more than 2,500 of them came to the Wise County fairgrounds to seek help from doctors, eye specialists and dentists who volunteered with Remote Area Medical. (Article continued below...)

Since 1985, RAM volunteers, about 37,000 strong, have provided more than $33 million in free care on some 600 expeditions around the country, but mainly in the medically underserved areas of Tennessee and Virginia. They've made more than 70,000 glasses and have extracted nearly 110,000 teeth. And their vets have seen about 64,000 animals. RAM founder Stan Brock believes there is still a lot more work to be done. Brock, best-known for his stint as the animal-wrangling co-star of the iconic television show "Wild Kingdom," is no stranger to living rough. He grew up in the Central Amazon Basin and spent 15 years as general manager of the 4,000-square-mile Rupununi Development Company Dadanawa Ranch in Guyana. Brock started RAM to provide care to people in Third World countries. Today, about 60 percent of the group's care is provided to folks in rural America. He spoke to NEWSWEEK's Joan Raymond about why he set up camp in the United States. Excerpts.

NEWSWEEK: How did you become interested in medical care?
Stan Brock: I lived with the Wapishana Indians in the Central Amazon Basin for many years. We didn't have health care. The nearest town was more than 30 days' walk. When I was 17, a horse damn near killed me and I had to get medical care. I knew from that point on that someday I would do something to bring care closer to these wonderful people, but the need for health care for everyone just kept getting bigger. I mean, there's nearly 50 million people in the U.S. without any kind of coverage, and I don't know how many who are underinsured. All you need is one catastrophe, a job loss, and those numbers swell.

How many programs do you run?
We go on about 15 expeditions a year. We have programs in Guyana, working in women's health, to try and help prevent and treat cervical cancers. And we provide education and treatment for other women's health issues. We've been in Mexico, Peru, East Africa and other places. And in the U.S., our biggest event is the Wise County expedition, but we also do programs in Kentucky and Tennessee. Last year in Wise County alone, we had 5,616 patient encounters in two and a half days. That's a conservative value of care of $1.6 million and change.

Are you surprised by the turnout in the United States?
I don't know if surprised is the right word. I'm humbled that these people entrust their care to us, but I'm also saddened. These are good people who have just fallen through the cracks of a health care system. They don't have the money to buy their services, especially dental, and if they are employed, many plans have deductibles that are too high for these people. If you're a child in this country, chances are good that you will have coverage. It's the adults, these young adults and middle-aged adults, that need the most help.

Is it tough getting volunteer medical help? 
At first, no one knew who we were. Then a 60 Minutes program aired earlier this year, and we've been on everyone's radar. We do get a lot of volunteer medical personnel and others. At Wise County last week, we had about 1,800 volunteers.

Is it a problem providing charity care in the U.S.?
The biggest problem we have is licensure; it's easier for a U.S. doctor to go to Guyana and provide care then it is to cross state lines and provide charity care. We ran into problems when we tried to help after Hurricane Katrina. I recently testified in front of the House Ways and Means Committee [in April 2008] and told them the biggest impediment to providing free care is that volunteer health providers holding licenses in one state are not allowed to provide free care in another state. The good news is that the state of Tennessee changed this back in 1995. They have the Volunteer Health Care Services Act, which means that volunteer medical help and veterinarians licensed anywhere in the U.S. can come into Tennessee to provide free care. There was a resolution back in 1997 to try and see if other states could adopt the Tennessee model. As far as I know, it never got out of committee.

Do you think people have misconceptions about the folks that turn out for your program?
Absolutely. I don't think people realize how easy it is to lose health care coverage. And I don't think people realize that dental care isn't usually covered for adults who get [government] aid of some sort. The majority of people we see aren't substance abusers or lazy. They are just hard-working people looking for help. They are in pain from rotten teeth, broken teeth. They can't afford routine care, and things can get out of hand quickly for them. It's a vicious cycle.

People have limited money, and what are they going to spend it on—food or a filling? By the time we see people, sometimes the best thing to do is an extraction. The teeth are so far gone, or if they could be saved, how is someone who has limited funds going to put gas in their truck and drive a good distance and pay money for continual upkeep? These people are hurting, and then they can't eat right because their mouths hurt. It's horrible. A lot of times their eyeglass prescription is so bad they can't see well. And they can't afford to see a doctor and get a new one. We have women who haven't had PAP smears in years, let alone a mammogram.

What happens if a professional discovers something serious, say a potential cancer?
We make arrangements for follow-up. Sometimes it's frustrating. People's phones get disconnected or they have to move to find work. I have a bunch of eyeglasses from previous events that were [never picked up] and I'm still trying to find the people.

Is this just a problem among the Appalachian underserved?
No, absolutely not. Throw a dart on the map of the U.S. and you'll find a need. We get calls from everywhere. I was talking to people in Cleveland, Ohio, last week.

What's your solution?
That's the big question. I'm a British citizen, but I'm not advocating that the U.S. follow Britain's national health service plan. I'm not sure that can ever happen in the U.S. I mean, it took a war for it to happen in Britain. But we need to make it easier for practitioners [to be] allowed to cross state lines to provide free care for those in need. The system of free care that RAM has developed and proven throughout all these years could be replicated throughout America. If practitioners were allowed to cross state lines to provide free care for those in need, and had some type of protection against malpractice, I think we could do this anywhere in the U.S.

Do you ever get frustrated?
I get frustrated that we have to turn people away. Every year, there's a family that just gets to you. This year it was a family of four. The mom and dad had two little girls who were clutching raggedy teddy bears. The mom and dad needed dental care, but they came after we closed. Fortunately, there was still a dentist [around] and we reopened for them. But somewhere, there's someone who came and we couldn't help. People line up early, but you only have so much time. You only have so many resources. Sometimes I just want to cry. Sometimes I do.

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