Remote Area Medical: Healing the Third World—and the U.S.
RAM’s free medical clinics highlight the desperate need for affordable health, vision, and dental care in the United States.
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“Why are you here? Where does it hurt?” Those are the standard questions asked of patients who seek care at Remote Area Medical (RAM) health clinics, held on an ongoing basis in Third World countries—and in rural and urban communities in the United States. At one time, RAM’s mission was limited to sending teams of volunteer caregivers to remote parts of the world, places where doctors were few and far between. Today, RAM focuses on providing free care to Americans who can’t afford to see a doctor or dentist, thereby doing what it can to fill the enormous gaps that have opened in the U.S. health care system.
On the weekend of February 19-20, 2011, hundreds of RAM volunteers—internists, OB/GYNs, dentists, optometrists, students and administrative volunteers—came together at McGavock High School in east Nashville to provide free services for more than 1,500 individuals in need. [See photos on Failure magazine’s blog.] Most of the men and women who came seeking treatment could be described as middle class or members of the working poor—and either uninsured, or more likely, underinsured. The vast majority sought dental care or an eye exam and glasses, which suggests that many had medical insurance, but were without dental and vision coverage, both typically offered separately at additional cost.
“The people who attend our clinics are typically working people,” confirms Volunteer Coordinator Laura Kirschenmann, who left the corporate world to come work for RAM, a non-profit that is funded entirely by private donations. “They don’t meet the stereotype of people in the ‘system,’” she continues, challenging the notion that the patients are looking for a “free ride.” While the care is free, in terms of time and convenience, it comes at considerable cost.
In Nashville, prospective patients began lining up more than 12 hours before the first-come, first-served clinic opened at 6 am on Saturday, everyone hoping to have arrived early enough to receive a numbered slip of paper that would give them the opportunity to be seen before the end of the day. Many individuals slept in their cars, patiently waiting through the night for the opportunity to have their teeth cleaned, or their cavities filled, or to get prescription eyeglasses. Some sought basic medical care; others came for a mammogram, Pap smear, or HIV test.
As is the case with all of RAM’s Tennessee clinics, members of the Tennessee State Guard provided security. The dozen or so guardsmen wore camouflage uniforms, making for a powerful visual, and contributing to the air of seriousness surrounding the proceedings. But according to local organizer/nurse practitioner Joe Fanfilipo, security problems are an uncommon occurrence. “It’s pretty orderly. People don’t want to cause a ruckus. They want to get helped,” he notes. Fanfilipo is one of RAM’s “core volunteers,” and participates in expeditions both inside and outside the U.S. His first trip—to Haiti in 1996—came while he was still in college (“my mom didn’t sleep for those two weeks,” he says), and he’s remained devoted to the organization ever since.
The driving force behind RAM is founder Stan Brock, whose personal experiences inspired him to create the organization in 1985. Brock, now in his mid-seventies, grew up living amongst Wapishana Indians in a remote part of the Central Amazon Basin, and one fateful day he was badly injured after being thrown from a wild horse. To make matters worse, he subsequently contracted malaria. “The nearest doctor was 26 days away—on foot,” he says, recalling that when he told this story to Apollo 14 astronaut Edgar Mitchell, the intrepid space explorer exclaimed: “When I went to the moon, I was only three days from the nearest doctor.”
Naturally, the lack of access to medical care was a life and death issue for the local tribesmen, who were hamstrung by ailments that could easily be cured by modern medicine. Brock promised himself that he would one day address the issue, though his plans didn’t come to fruition right away. First, he would become recognizable to millions, serving as co-host and associate producer of Mutual of Omaha’s Wild Kingdom, a wildly popular weekly nature show that aired on NBC in the 1960s and early ’70s.
These days, Brock is a 365-day-a-year RAM volunteer, living in the abandoned Knoxville school that the organization calls home, and spearheading expeditions to countries like India and El Salvador, as well as American cities like Los Angeles, Oakland, and Sacramento, not to mention rural communities like Pigeon Forge, Tennessee.
To date, RAM’s operations schedule has been driven largely by legal considerations. According to Brock, the lion’s share of the expeditions are held in Tennessee largely because the Volunteer state was the first to allow licensed professionals to cross state lines to provide free services, a critical consideration when trying to secure commitments from enough volunteer doctors and dentists to treat hundreds or thousands of patients at a time. (At a clinic in Los Angeles last year, RAM treated more than seven-thousand individuals.)
Notably, this highly-effective, mobile group claims no political or spiritual affiliation. “I don’t comment on political issues, because it’s not for me to appear to be taking one side over the other,” stresses Brock, a British citizen, “but I would like a change in the rules for doctors and dentists to be able to cross state lines to provide free care.” If nothing else, that would enable RAM to begin serving communities in areas outside its current reach.
Yet despite having helped hundreds of thousands of individuals in the course of the 632 expeditions RAM has conducted over the years, Brock is always thinking about the people he hasn’t yet helped—or had to turn away due to lack of time or resources. “The toughest thing is turning people away,” he says, getting choked up at the thought. It’s especially agonizing in countries that RAM rarely visits—like India, where Brock once encountered mothers holding their children up in the air, in a last gasp attempt to have them seen. “At least here [in the U.S.], we can give a ‘priority note’ to someone for a future clinic—possibly one nearby,” he says.
Perhaps not surprisingly, RAM expeditions have attracted some remarkable patients over the years. “In Knoxville, we once had a pregnant woman who was #92 in the eye line, and she started having contractions. She refused to leave for the hospital until she got glasses,” begins Brock. She was escorted to the front, but even so, her eye exam had to be cut short because the baby was coming. The story has a happy ending though. “She had a baby boy that day—and got her spectacles. It’s just sad that her priority that day was getting a pair of glasses,” he laments.
Thinking back, Brock also recalls encountering a patient in Guatemala who earned a living as a security guard, this in spite of the fact that he couldn’t read the huge “E” on the top line of the eye chart. Unfortunately for said guard, RAM doesn’t have the capacity to make glasses on international expeditions, so he had to take whatever they had on hand in his prescription. That turned out to be a pair of comically-oversized, rhinestone-studded frames—the kind of glasses Elton John might have worn on stage in the 1970s. The guard was demonstrably grateful nonetheless, as are almost all the patients, who often hug their doctor or dentist—and sometimes shed tears of joy—following their exams.
Fortunately for those in need, Brock has no plans to curtail his far-ranging efforts, noting that the work he is doing beats sitting around watching TV, or being retired. He’s quick to emphasize that he has something in common with the many people who come to his clinics. “I’m one of them,” he notes. “I don’t have insurance either.”