Meet America’s uninsured: Tales from a divided healthcare system

‘I don’t know what we would have done without the clinic . . . They just give you the help you need’

Patients attend the Remote Area Medical Clinic which treats the poorest in America, those squeezed out by ‘the punishing health system’. Photograph: Suzanne Lynch

Patients attend the Remote Area Medical Clinic which treats the poorest in America, those squeezed out by ‘the punishing health system’. Photograph: Suzanne Lynch

 

It’s shortly after 5.30am on Saturday morning and on the outskirts of the small town of Emporia in rural Virginia, it is still the black of night.

Outside the Greensville County High School, the inky shadows of people begin to come into view as the first specks of dawn creep into the sky. Quietly standing together in small groups, some wear blankets, many have been waiting here for hours.

They are here to attend the Remote Area Medical clinic (Ram), a mobile facility that provides free healthcare to those in need. This weekend’s clinic is only one taking place across the country – a similar clinic is accepting patients about 1,200km west in rural Tennessee. But the aim is the same – to deliver dental, vision and other specialist care to those who have been locked out of America’s punishing healthcare system.

Glancing at the groups of people who are waiting patiently for the doors to open at 6am, is like looking at a slice of American life – here are the poor and marginalised, from all races and backgrounds, the dark underbelly of the American dream.

Many have been here since the previous afternoon, sleeping in their cars in the assigned parking lot, to make sure they get a space in line.   Ram, which has been running pop-up medical facilities since 1985 across America, operates the same system in each location. Patients are permitted to queue in assigned parking places from midnight the previous evening. At 3am, officials begin distributing tickets and at 6am clinic doors open, with patients called in chronological order according to their ticket numbers.

Earl and Anita Thorpe are among those waiting outside the front door of the school for their numbers to be called. They arrived at the parking lot just after 11.30pm the previous evening and slept in their car.

“Last year we got here at 10 minutes to midnight and parked where we found a space, but we were quite a way from the parking lot so we were like number 175. This year we got one of the first tickets,” explains Anita as she listens out for her number. She is here for vision care, while her husband Earl is here to get some dental work done. Anita is proudly sporting  a “Grace Community Fellowship” T-shirt, a reference to her local church. That’s where she first heard about the Ram clinic. She says that the care she received last year when she first visited for dental work was essential.

“I don’t know what we would have done without the clinic. It’s a good system. They treat you and don’t ask questions. They just give you the help you need.”

Stephanie Jefferson and Tyunga Ruffin attend the Remote Area Medical Clinic at Greensville County High School. Photograph: Suzanne Lynch
Stephanie Jefferson and Tyunga Ruffin attend the Remote Area Medical Clinic at Greensville County High School. Photograph: Suzanne Lynch

Inside, the school buildings and yards have been sub-divided and arranged into a makeshift healthcare facility. The centerpiece is the gym hall which has been converted into a communal dental surgery. Modern dental chairs and cleaning facilities are set up in the in this sterilised  area, a small army of dental practitioners ready for the first patients of the morning. Among the services offered are dental cleanings, fillings and extractions as well as dental X-rays. As patients arrive at the hall to get treated, some only have a few teeth left, others are using it as an opportunity to get a niggling tooth problem seen to.  

Stephanie Jefferson and her friend Tyunga Ruffin were among the first in line, having arrived at the school car park at 4pm the previous evening.

The women, who were among the first in the door after their numbers are called shortly after 6am, receive an initial consultation and are then sent to the triage station where their weight, blood pressure and other measurements are taken. Here, the triage work is being undertaken by pharmacists and pharmacy students, many of whom have travelled that morning from Virginia’s capital, Richmond, about 50 miles away. These include fourth-year pharmacy students Leighton Thumm and Taylor Ferguson who are dealing with Stephanie and Tyunga. As she explains, one of the big tests is for cholesterol and diabetes. Stephanie and Tyunga are given the all-clear, then directed to the dental and vision sections, the real purpose of their visit.

Optometry services are the second most popular services after dental. As he awaits his first patient of the day in one of the darkened classrooms which are functioning as an eye clinic, Eric Luntz explains why he has come here for the weekend. The 31 year-old eye doctor has come all the way from Connecticut. He learned about Ram through Vosh, a New York-based association that provides vision services to needy patients.

Like all the volunteers, he is not getting paid, but says the experience is hugely fulfilling. “It sounds like a cliche but I enjoy giving back. It is nice to be able just to do optometry – not to have to worry about money and billing patients, but instead just focus on the work.”

Pharmacy student Justine Field talks to Stephanie Jefferson who is attending the High School clinic. Photograph: Suzanne Lynch
Pharmacy student Justine Field talks to Stephanie Jefferson who is attending the High School clinic. Photograph: Suzanne Lynch

Money is not something that comes up here at the clinic. Ram receives no taxpayer money but is instead entirely funded by private donations. “About 74 per cent come from individual donors, the remaining 26 per cent from corporations or foundations,” explains Jeremy Writt a fundraising and communications specialist for Ram. “It comes from people who are compelled to give, who want to support our mission which is to  prevent pain and alleviate suffering, whatever your circumstances.”

That was the founding mission of Stan Brock, the American who founded Ram in 1985. The idea to establish pop-up clinics derived from Brock’s own experience. While living in a remote area of Guyana in South America he suffered an injury, but the nearest medical care available was a 26-day journey away. He then discovered that many of the local tribes had been almost wiped out because of a lack of access to medical care. But the focus of the organisation soon switched closer to home. “The original plan was to focus on developing countries but we quickly realised that there were people here in America dealing with so-called ‘third world’ access to healthcare,” says Fritt. The first clinic was established in rural Tennessee in a poor area in the foot of the Appalachians. Last year Ram ran 61 domestic and 16 international clinics.

Part of the ethos of the organisation is a no-ask policy. Patients are never asked to produce documentation or papers when they present themselves. I ask is this a policy to ensure that undocumented immigrants have access to the services. “No, the policy is not based on immigrants, it’s based on the ethos which is that people should get quality service whether they paid something for it or not. I don’t need to know your name, or where you come from or where you were born to help you alleviate that suffering. We’re essentially neighbours trying to help neighbours so that people can live productive lives and not be shackled by whatever medical ailment they have.”

While Ram’s ethos is one of meritocracy and healthcare provision for all, it stays away from politics, and says it is a non-political organisation.  

Nonetheless, the very existence of clinics such as these throws into stark relief America’s healthcare system which, despite Obamacare, continues to lock out millions of Americans who can’t afford health insurance or who fall between the cracks in coverage.  

Despite the enactment of then president Barack Obama’s Affordable Care Act in 2010, much of the provision of healthcare in the United States is determined at state level. Here in Virginia, for example, the state legislature has refused to expand Medicaid – the federal system that offers healthcare to low-income people. Moreover, several Republican-controlled states – backed by the Trump administration – are challenging Obamacare in court and scored a significant victory earlier this year when a Texas court ruled that the Act was unconstitutional.

On this Saturday morning in Emporia the inequities of the system are evident everywhere.

Many of the patients here, for example, have Medicaid – the federal health programme for people without private health insurance – but this doesn’t include dental coverage.

Earl and Anita Thorpe arrived at the parking lot of the makeshift clinic just after 11.30pm the previous evening and slept in their car. Photograph: Suzanne Lynch
Earl and Anita Thorpe arrived at the parking lot of the makeshift clinic just after 11.30pm the previous evening and slept in their car. Photograph: Suzanne Lynch

Others are denied full coverage from other state programmes. Sam, aged 65, and his wife Cindy are here mainly to get Cindy badly-needed dental work. Sam served in the US military, including in Vietnam briefly, and receives the veterans’ healthcare package. But the coverage is basic, he explains. “They quoted me $170 (€152) for a tooth extraction,” he says incredulously in his soft southern accent. “We can’t afford that, especially when she needs three or four and maybe more work,” he says, pointing to his wife, her face streaked with worry and pain as she waits to be seen.

But while the clinic may be reluctant to talk politics, many of the patients gathered here are not.

Many of Ram’s clinics operate in lower socio-economic regions – areas of the country that voted for Donald Trump 2016.

Earl and Anita Thorpe, who I meet in the queue, are proud Trump supporters. They’re not alone.

This is despite the fact that the Trump administration is fighting the Affordab le Care Act in the courts and failed to repeal and replace Obamacare – a key election pledge – in 2017.

One 79-year-old woman tells me that she’s a big fan of the president. “I think he’s one of the best we’ve ever had, and I can remember as far back as Roosevelt.” Like others she learned about the clinic through her local church. She says she read a book on Donald Trump who made her better understand the president. “His heart is in the right place,” she says, noting that his mother used to read bible stories to him as a child. “I believe God prepared him through her years ago.”

In particular, she supports his policy on immigration.

“I don’t see how we can handle all of these people coming over. If they came in legally that would be one thing. A lot of people talk about the children, but I have learned that the parents are renting these children out to the drug cartels to get them across the border. The Democrats too have just gone crazy.”

As for next year’s election – where medical care is likely to be a key policy issue for voters – she is 100 per cent sure that she will vote for Trump.

“I think he’s done a lot for our country. I really do,” she says, despite the fact that she is waiting in line for free medical care. “I mean none of us are perfect, and he has his faults like everybody does. But he’s going to get my vote.”

Donald Trump couldn’t have put it better himself.

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