Uninsured in Rural America

The evening decends over the Appalachian Mountains near Norton, Va., on Wednesday, July 19, 2017.
Justin Merriman/American Reportage

Tuesday, July 18, 2017 – Wise, Va.

I pulled into Wise, Va. on Monday, July 18. It’s a small town, around 3,000 people in the historic coalfields of Virginia – the heart of Appalachia. I am here to cover the Remote Area Medical Clinic (RAM), a non-profit organization, delivering healthcare to impoverished, isolated and underserved people.

For three days, the Wise County Fairgrounds in Southwest Virginia will become the largest pop-up health clinic in the United States and will serve 2,000 people who will travel to the clinic from 15 states seeking dental, vision, and medical care. As the Nation is engaged in a great debate on health care, this feels like the epicenter of it all. The clinic is not just necessary for the people who will make the trek here; it’s vital. “It’s a godsend,” says Jim Dishman, 61, of Trammel, Va, a forgotten coal town with 100-year-old small homes, their paint peeling and cracked, remnants of a more prosperous time when coal was king. “Coal mines are all that kept it going and all that will keep it going,” says Dishman, who lives on disability. He was once a patient at RAM and had all of his teeth pulled at his last visit to the clinic.

Jim Dishman, 61, stands near his friend’s home on Tuesday, July 18, 2017, in Trammel, Va. Dishman, who lives on disability, was a former patient at Remote Area Medical Clinic (RAM), where he had all his teeth pulled. “It’s a godsend,” he says speaking of RAM. “It really helps a lot of people.” Justin Merriman/American Reportage

Arriving a few days early, I headed out into the surrounding communities to learn more about the area. For me, it’s as important to get to know the people and places I’m covering, as it is making photographs. As I drove along a winding road that led out through lush-green hills that folded into large mountains, I passed a large garden with two flags flying high on spindly poles. One flag was a Trump: Make America Great Again flag, the other a NRA flag. In the middle of the garden, Ron Dingus, 77, sat on an aluminum chair tending to his tomato plants. “We need rain,” he muttered in his thick southern accent, “You could walk through there and not get any dirt on your shoes it’s so dry,” he said pointing to the cracked soil. I photographed him for a while as he tied up his tomato plants and used a small knife to cut dead parts off the plants.

Ron Dingus, 77, tends to his tomato plants in his garden near his home on Tuesday, July 18, 2017, just outside of Wise, Va. “We need rain,” he muttered in his thick southern accent, “You could walk through there and not get any dirt on your shoes it’s so dry,” he said pointing to the cracked soil. I photographed him for a while as he tied up his tomato plants and used small knife to cut dead parts off the plants. His father, like many in the area, worked in the coal mines. “He worked in the mines for over 40 years and had black lung so bad he couldn’t breath,” said Dingus. “That’s enough to make me not want to poke my head underground,” he said with a smile and chuckle. Justin Merriman/American Reportage

He walked over to a few metal chairs near his truck and invited me to have a seat in the shade. He said he liked when people would stop to chat because it gave him an opportunity to sit in the shade and drink a cold Pepsi. Dingus used to work for Pepsi. He drove the delivery truck in the area and remembered when it was just a small flat-top truck hauling glass bottles that could be recycled. His father, like many in the area, worked in the coal mines. “He worked in the mines for over 40 years and had black lung so bad he couldn’t breathe,” said Dingus. “That’s enough to make me not want to poke my head underground,” he said with a smile and chuckle.

Wednesday, July 19, 2017 – Wise, Va.

The sun had just crested over the distant mountains as I drove back to the fairgrounds. I wound my way from my hotel through the quiet town. The main street in Wise is small but holds all the charm of a southern town.

I found the fairgrounds and the make-shift clinic further along than yesterday. Volunteers had just started arriving, still sleepy and worn out from the previous day’s work, some walked around clutching their morning coffee, others found refuge in pockets of shade from the already beating sun.

Jack Garvey, 17, a volunteer from Clarendon Hill Presbyterian Church helps set up the Wise County Fairgrounds for the upcoming Remote Area Medical Clinic (RAM) on Wednesday, July 19, 2017 in Wise, Va. The three-day clinic is the largest pop-up medical clinic in the United States and will serve more than 2,000 people who cannot afford private healthcare. Justin Merriman/American Reportage

Across the grounds, dozens of tents sit scattered. A row of wheelchairs line the side of a barn. Behind one building a group of volunteers from a church in the suburbs of Chicago cut cantaloupes with members of the Lions Club, who provide all the meals for the volunteers.

The activity is slow but steady. I wander in and out of the tents, barns and buildings on the property. I find photographing to be slow but I’m patient. I spend most of my time in conversations about the situation here.

Volunteers from Clarendon Hill Presbyterian Church in Clarendon Hills, Ill. (from left to right) Thomas Monson, 16, Nikki Salbego, 17, and Gretchen Perez, 29, help set up tents at the Wise County Fairgrounds for the upcoming Remote Area Medical Clinic (RAM) on Wednesday, July 19, 2017 in Wise, Va. The three-day clinic is the largest pop-up medical clinic in the United States and will serve more than 2,000 people who cannot afford private healthcare. Justin Merriman/American Reportage

Pat Adams a volunteer from Boston holds a clipboard as she helps set up medical exam rooms in a small building. Bedsheets hang from wooden clothespins pulling colorful tapestries back to reveal old exam tables tucked behind. “RAM is incredibly vital,” says Adams who is an associate member of the Medical Missionaries of Mary. She pauses and continues, “All things considered we should not need this in the United States.”

As the day passes there is no shortage of work. The church volunteers, mostly teenagers, continue constructing tents, moving bleachers, setting up garbage cans and other tasks.

Volunteers Roberta Spencer of South Bend, Ind., left, and Pat Adam of Boston, Mass., right, set up exam rooms at the Wise County Fairgrounds for the upcoming Remote Area Medical Clinic (RAM) on Wednesday, July 19, 2017 in Wise, Va. The three-day clinic is the largest pop-up medical clinic in the United States and will serve more than 2,000 people who cannot afford private healthcare. Justin Merriman/American Reportage

When most of the volunteers break for lunch, I head back to the hotel to do some work on the computer, download cards and charge batteries (and of course stop by Bojangles, a local fast-food restaurant to get some fried chicken, rice and a biscuit).

After a couple of hours, I returned to my car, the front passenger seat filling with empty water bottles and fast food wrappers.

Pulling into the fairground yet again, I notice an older recreational vehicle parked in the corner of the parking lot. Murleen Smith, 55, and her husband, Bill, 71, had arrived a couple of hours ago. They didn’t have to travel far. They live in Big Stone Gap, Va., not far from Wise.

Murleen Smith, 55, of Big Stone Gap, Va., laughs with her husband, Bill, 71, as they sit near their recreational vehicle on Wednesday, July 19, 2017 at the Wise County Fairgrounds in Wise, Va. The two are the first to arrive at the fairgrounds for the Remote Area Medical Clinic (RAM) which will open to patients on Friday at 6:00 a.m. Over 2,000 people are expected to converge on the fairgrounds to seek medical, dental and vision care. “We live in the land of plenty, the home of the free and the brave and there is still so much need,” says Murleen who will attend RAM this year for the fourth time. “I’m 55 years old. I’ve tried to get Obamacare. For me it’s $800 a month. There’s no way to afford insurance and there’s no way to live without it,” she says. Having suffered five heart attacks in a period of two days, being diagnosed with diabetes and having to take copious amounts of medications, Murleen says she counts on RAM. “Basically you wait all year for this to come around,” she says. Justin Merriman/American Reportage

The two are the first to arrive at the fairgrounds for the Remote Area Medical Clinic which will open to patients on Friday at 6:00 a.m. I stood and talked with them for the better part of an hour, perhaps even longer. Despite the sweltering heat and their own health issues, the two bantered back and forth and laughed at each other’s stories.

Having suffered five heart attacks in a period of two days, being diagnosed with diabetes and having to take copious amounts of medications, Murleen says she counts on RAM. “Basically you wait all year for this to come around,” she says.

“We live in the land of plenty, the home of the free and the brave and there is still so much need,” says Murleen who will attend RAM this year for the fourth time. “I’m 55 years old. I’ve tried to get Obamacare. For me, it’s $800 a month. There’s no way to afford insurance and there’s no way to live without it,” she says.

Kaitlen Hagy, 3, of Lee County, Va., is illuminated by the screen as she waits with her grandparents, Dean and Thelma Rohrig, near their car where they plan to spend the night in the parking lot of the Wise County Fairgrounds on Thursday evening, July 20, 2017 in Wise, Va. They are waiting for the gates to open tomorrow morning at the Remote Area Medical Clinic (RAM) at the fairgrounds. Justin Merriman/American Reportage

Friday, July 21, 2017 – Wise, Va.

As I write this I’m sitting in the front seat of my car, the door open just slightly, my feet propped up and out the window, the light from the laptop casting a blue hue on me as the sun’s final moments slip behind the dark horizon making rise to night. Behind my car sits my small two person tent. I typically would just sleep in my car, but with these long-hot, days it’s nice to have a place to stretch out and rest my back, though I expect I’ll only get a few hours of sleep.

The past two days have been a blur. Having watched the Remote Area Medical (RAM) clinic set up and then open early this morning, I’m still not sure I can process all I’ve seen and heard in the last 48 hours. While many have covered this clinic in the 18 years of its existence, this is my first time seeing it.

Stan Brock, the founder and president of Remote Area Medical (RAM), waits by a gate to allow people to enter at the RAM clinic on July 21, 2017 at the Wise County Fairgrounds in Wise, Virginia. The three-day event provides dental, medical and vision services to uninsured and underinsured people. Over 2,000 people from as far as 15 different states are expected to attend the clinic. Justin Merriman/American Reportage

It’s a strange experience, and it is in many ways unimaginable that this is taking place, let alone so needed. My mind is flooded with the stories I’ve been told, and I’m unable to stop on one and reflect on it. All of them rush over me, particularly in these late hours of the day, alone in my car, surrounded by so many others, sprawled out in cars, tents, in the back of trucks, in chairs and some on the damp-cold ground.

Long before daylight tomorrow, as they did today, well over 1,000 people will line up at a gate of the fairgrounds to hear their number called and enter the clinic.

A man has his teeth pulled at the Remote Area Medical (RAM) clinic early Friday morning, July 21, 2017 at the Wise County Fairgrounds in Wise, Va. The three-day event provides dental, medical and vision services to uninsured and underinsured people. Over 2,000 people from as far as 15 different states are expected to attend the clinic. Justin Merriman/American Reportage
Ashley Fields, left, 25, of Castlewood, Va., waits with her mother, Barbara Street, 49, in the parking lot of the Wise County Fairgrounds, where they spent the night to get free healthcare at the Remote Area Medical (RAM) mobile clinic on Saturday morning, July 22, 2017 in Wise, Va. The three-day event provides free healthcare to uninsured and underinsured people.
Justin Merriman/American Reportage
A person has their eyes examined at the Remote Area Medical (RAM) mobile clinic at the Wise County Fairgrounds on Saturday, July 22, 2017 in Wise, Va. The three-day event provides free healthcare to uninsured and underinsured people.
Justin Merriman/American Reportage
Linda Hill, 43, of Churchill, Tn., looks at the head of her three-year old niece, Katiana Garbart, as she waits with others in the parking lot of the Wise County Fairgrounds for her number to be called to enter the Remote Area Medical (RAM) mobile clinic early Saturday morning, July 22, 2017 in Wise, Va. The three-day event provides dental, medical and vision services to uninsured and underinsured people. Justin Merriman/American Reportage
People line up at the Wise County Fairgrounds to get free healthcare on the final day of the Remote Area Medical (RAM) mobile clinic on Sunday morning, July 23, 2017 in Wise, Va. The three-day event provides free healthcare to uninsured and underinsured people. Justin Merriman/American Reportage
Wanda Crawford, 52, of Kingsport, Tenn., sits in her car as her daughter smokes on the hood and granddaughter sleeps in the back seat in the parking lot at the Wise County Fairgrounds on the final day of the Remote Area Medical (RAM) mobile clinic on Sunday morning, July 23, 2017 in Wise, Va. The three have camped in the parking lot for three days and spent last night in the car during a thunderstorm. They have several hours left to wait until they can pick up their free glasses and head home.
Justin Merriman/American Reportage
Marvin Phillips, 61, of Clintwood, Va., waits in the parking lot of the Wise County Fairgrounds where he plans on spending the night, as he waits for gates to open at the Remote Area Medical Clinic (RAM) on Thursday evening, July 20, 2017 in Wise, Va. Phillips, a former coal miner, hopes to have dental care provided by the clinic. Justin Merriman/American Reportage
A man sleeps in the bleachers at the Wise County Fairgrounds as he waits to get free healthcare on the final day of the Remote Area Medical (RAM) mobile clinic on Sunday morning, July 23, 2017 in Wise, Va. The three-day event provides free healthcare to uninsured and underinsured people. Justin Merriman/American Reportage
People wait in the parking lot for their numbers to be called to enter the Remote Area Medical (RAM) clinic early Friday morning, July 21, 2017 at the Wise County Fairgrounds in Wise, Va. The three-day event provides dental, medical and vision services to uninsured and underinsured people. Over 2,000 people from as far as 15 different states are expected to attend the clinic.
Justin Merriman/American Reportage

 

More images from Justin’s work in Wise, Va., can be found here.

Archive images from previous coverage of Remote Area Medical 2015 and 2009 can be found here.

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