The Congressional debate over health care reform appears to be over for the moment but, for many Americans, it is still an all-consuming concern.
Perhaps nowhere was that more apparent than at a Knoxville, Tennessee, community center on a recent cold, wet Saturday morning. That's where a medical charity called Remote Area Medical (RAM) was running a free clinic.
A day of care starts before sunrise
The health care event wasn't scheduled to start until 6 a.m. But when RAM volunteers arrived at 3 a.m., they found hundreds of people already waiting in line. Many had slept in the parking lot overnight, desperate to see the charity's dentists and doctors.
RAM volunteers soon had everyone out of the cold and damp. Blood pressure and other vitals were quickly taken along with a brief medical history, and then the doctors, who volunteer their time, did an initial health screening.
Most of these people have jobs and many have health insurance, but their plans don't pay for extras like dental and vision care.
RAM has more than 50 dental chairs set up and all are soon full. Volunteer dentist Danny Chacko says the poor, whether working or not, simply can't afford to pay for expensive procedures like having a tooth pulled.
"An extraction in most offices runs anywhere from $100 to $150. So if you have five teeth taken out, that's $500. And who's got $500 in a year's time, let alone a month's time?"
Knoxville resident Kristi Luethke is a perfect example. Her teeth are in poor shape and most of the front ones are gone altogether. "It's embarrassing," she says."It's put me in depression. I've always been told throughout my life that I had a beautiful smile. So that's all I'm lookin' to gain back, is to be able to look somebody face-to-face and show my smile."
After struggling to find dental care for years, she's chosen a drastic solution. She's going to have all her teeth removed and replace them with dentures. She's getting married in April and hopes to have her new smile in time for the wedding.
In a dark corner at the far end of the community center, eye specialists are performing various vision tests. Ophthalmologist Paul Wittke says the RAM clinic can grind out more than 300 pairs of new prescription eye glasses a day.
"That's our biggest thing I think. We help a lot of people out with their glasses," says Wittke. "Being able to see again, you know, have a job and hold a job, which they can't do right now because they can't see well enough. It's a big help for our patients."
Bringing doctors to patients
British adventurer Stan Brock was working as a cowboy in a remote part of the upper Amazon when he recognized the need to provide health care in the world's poorest, most isolated communities.
"I got badly injured by a wild horse," he recalls, "and one of the other cowboys said, 'Well, the nearest doctor is 26 days on foot from here.' It was about that time that I had that inspiration maybe we ought to bring those doctors just a little bit closer."
That's what he's been doing since he created RAM in 1985, sponsoring hundreds of health care expeditions all over the world.
RAM opened a U.S. office more than a decade ago, initially just to raise funds for its overseas efforts. But one day Brock got a call from officials in a nearby county in Tennessee, where the only hospital had just closed. They asked if RAM could do anything to help. Brock loaded a couple of dental chairs into the back of a pickup truck, rounded up some volunteer doctors and went to see what could be done.
"After that we got a call from the county next door, and next door to that, and pretty soon we were doing it every week." The Knoxville clinic is RAM's 590th health care mission.
The challenge: finding enough doctors
Doctors in the U.S. cannot practice medicine outside the states where they're licensed.
But several out-of-state doctors volunteered here in Knoxville. Several years ago, the Tennessee legislature passed a law, at RAM's urging, that provides a temporary medical dispensation. Doctors traveling to the state to provide charity care are welcome to do so.
Brock notes it's the only law of its kind in the United States. He thinks it should be replicated throughout the country. "Unfortunately it's not, so it makes it very difficult when we go to other states, to be able to come up with enough volunteers to meet the kind of need you see here."
Dentist Danny Chacko has lost count of the number of RAM expeditions he's volunteered for but he puts the number at around 70 or 80. He has no intention of stopping anytime soon and encourages others to volunteer as well. "Let's not forget the people that need this kind of care. Because the people that need this care…that could just as easily be one of us sitting in that chair."
Although it began its expeditions in South America, today, most of RAM's clinics are held in rural communities in the United States.
But its international work continues. It operates an air ambulance in Guyana and has run training programs for community-based animal healthcare workers in Guyana and Kenya. After the earthquake in Haiti, RAM began sending teams of nurses, pharmacists and X-ray technicians to Port-au-Prince to help relief efforts there.