This land is your land...

Several months ago, thousands of people descended into a tiny town in search of cures for their many ailments.  Patients came from all over the mid-Atlantic region, and waited in the hot sun for hours upon hours just to be seen by medical professionals.

Perhaps you read about this regional phenomenon in the NY Times (Article 1) or Washington Post (Article 1, Article 2) back in July when they were originally published.  Or maybe today, you got a wild hair and decided to Google "Remote Area Medical, Virginia"... and were surprised that months after the event occurred, articles were still being written in the Post, Times, Huffington Post, and others.  At least, I was surprised by that when I made that search today.

So what is Remote Area Medical?  RAM, for short, is a 501c3 organization that was created in 1985 by Stan Brock, a name you may be familiar with if you watched Wild Kingdom in the late 60's and early 70's.  The organization was not developed specifically for Southwestern VA, and it isn't just mobile clinics for people to get free medical care-- in fact, RAM is an international organization that provides services including medication to people in Guyana, disaster relief with mobile clinics and volunteers, and free or discounted veterinary care (like spay/neuter, microchips, and rabies vaccines among other things) for people living in impoverished areas.  In their own words, "Remote Area Medical’s mission to prevent pain and alleviate suffering is fueled by donors and volunteers who support the operation of mobile medical clinics that deliver free, high-quality vision, dental, and medical services to children, individuals, and families who do not have access or cannot afford a visit to a doctor. Since 1985, RAM’s Corps of more than 100,000 Humanitarian Volunteers, comprised of licensed dental, vision, veterinary, and medical professionals, have treated more than 700,000 individuals and 67,000 animals, delivering $112 million worth of free health care services." 

In addition to the huge influx of patients, medical staff come from all over the country ranging in experience from seasoned medical professionals to dental students from VCU.  Some stay in dorms on the campus of UVa-Wise while others rent hotel rooms and eat at local establishments.  Over 3,000 patients, medical personnel, and volunteers come together one weekend a year to receive and provide legitimate medical care.  The majority of people seen at the RAM clinic in Wise need glasses or dental care; abscessed teeth, teeth with cavities, and sometimes moderately healthy teeth are removed to make dentures a possibility for hundreds of patients each day.  On one hand, what a great way for medical and dental students to learn first hand about so many facets of medicine-- sure, the act of treatment, but also about the cycle of poverty, about Medicaid, the working poor.  On the other hand, how is it that the richest country in the entire world has to set up shop at a fairgrounds and treat patients in livestock barns?  

There are a lot of answers to this question, and none of them are easy.  First off, many people around here blame POTUS #44 for the downturn of the great economic driver of this region, coal.  Without those big corporations whose mission was to completely destroy planet earth, rape the land, find a way to use fossil fuel to keep the lights on, many people are without jobs, and therefore without health insurance.  (Disclaimer:  The coal industry has been on a downturn since the 1970s.  I had the privilege of seeing Elliot Eisenburg of www.graphsandlaughs.com speak in May at the Southwest Virginia Economic Forum, and he shared graph after graph providing evidence that this is true.  His presentation also included the fact that while this region still has coal, it is the wrong type of coal for the needs of today.  He suggested that wishing for the coal industry to come back is the same as rearranging deck furniture on the Titanic.  In addition to the previous disclaimer, it is important to note that when many of these multi-billion-dollar coal corporations left this region, many of them declared bankruptcy for the sole purpose of not having to provide retirement benefits or health insurance to the many people who gave their bodies to the industry for decades.  And finally, these same companies will fight tooth and nail with thousand-dollar-an-hour lawyers to prevent former coal miners from receiving black lung benefits because it's cheaper to fight than to pay to help suffering men die in peace.)  In case it's not clear enough, I do not agree that POTUS #44 is to blame for the demise of the coal industry for the sheer fact that he was in 4th grade in 1971, and it's highly unlikely that a brown kid in Hawaii had any effect on the coal industry or really, even knew what coal was.   

So what's the reason so many people here visit a barn once a year for a pap smear?  Most likely, the reason many of these people do not have health insurance is because Virginia did not vote to expand Medicaid benefits after the ACA passed in 2010. Governor Terry McAuliffe requests expansion each year, and each year that portion of the budget is denied.  19 other states also rejected the opportunity to expand Medicaid, so we're not alone, but on average, those states have an uninsured rate of 10.5%.  And Virginia by no means has the highest uninsured rate in the nation (9%)-- that distinction belongs to the great state of Texas, where everything is bigger, at a whopping 16% uninsured.  (More on Medicaid Expansion).  To be fair, Medicaid expansion did not save the day for every state... there are a few states who still have a higher percentage of uninsured people than those living in states without the expansion... but the point is, at least those states are trying to help their poor rather than saying "You really are not that important, so we are banishing you to a barn and hoping you don't get a staph infection after we remove all of your teeth."  

The great poverty myth is that people are lazy and they are at fault for their poorness.  But the honest truth is, poverty is cyclical-- the people getting medical care at RAM will probably have children who will also receive medical care in a barn because that's what happens.  I was talking to a 14-year old today about her future, and she felt very strongly that she doesn't want to be like her mom or her older siblings because she wants "to be productive, do something for myself, and change the world."  Fortunately, she is super smart, so those wishes aren't impossible.  But what about kids like her who are academically average or below, raised by the TV, and stuck at home eating processed junk and drinking soda all day?  What chance do those kids have?  There are books about this-- when I worked at Barnes and Noble I was always really interested in the books in the "Rich Dad / Poor Dad" series, which suggests that rich people teach their kids things about money that the poor do not.  And honestly, how is someone who doesn't know about mutual funds supposed to teach their kids about the best ways to invest their money?  Or a more realistic example-- how is a mom who lives off of a government check and food stamps each month, money which is used to pay for rent, groceries, utilities, and gas, supposed to teach her children about putting money into a savings account?  How is she supposed to say, "Remember, pay yourself first!" when she has 4 kids to feed and clothe?  

In the 4 years Meg and I have lived in Wise, we have had conflicts each weekend of RAM and have not been able to attend.  But our goal is to volunteer in 2018 so we can help those who need it most, but also so we can give back.  We are so fortunate in our lives; we have full-time jobs with salaries and benefits, and a savings that we are able to comfortably add to each pay period.  We have a very consistent life, which is so much more than I can say for many who show up at RAM each summer.  

My next dental appointment is going to be in a cushy office in the South Park region of Charlotte-- there's a mall down the street with stores like Louis Vuitton, Neiman Marcus, Apple-- where's your next dental appointment going to be?  I guarantee it won't be in a barn.