A NOT-SO-REMOTE AREA MEDICAL EXPEDITION By Rick Held In the first place, how does one find oneself needing

to drive a couple hours and wait literally half a night and a full day with hundreds of other medically needy people, just to get a tooth pulled? When oneself is myself, explaining this gets a little tricky because one is usually writing about anyone else but oneself. So, a caveat: All you readers and keepers of The Secret, The Power, The Law of Attraction, The Money; all you positive thinkers and manifesters of desire and masters of the universe; all you Life-Is-Gooders and Oprah-lovers, be forewarned: I am about to acknowledge the n-word, not only in my personal life, but also in the larger social fabric. But don't turn away just yet. Unlike more famous social critics like Rush and Glen, negativity is not my stock in trade. In fact, I have considerable professional training in neutralizing if not flipping negativity on its head. As a social studies teacher in the public schools, my main job could have been summed up as modeling that old Johnny Mercer song (Accen-tu-ate the positive/E-lim-in-ate the negative...). Yet any teacher who does not deal in reality is not a teacher but an entertainer at best, a public enemy at worst. I endeavor to be neither, so welcome to Slipping Into Poverty 101, featuring a field study for a unit entitled Health Care Sort Of. Notwithstanding my low-to-no income status, I am at least afforded a certain acceptance and freedom of movement among my middle class peers with middle class jobs, as long as I keep it upbeat and behave as if it's all good. Even if it ain't all good. Understandably, some of my beloved compatriots have a low tolerance for the personal details of my economic downturn. So do I, for that matter. And who wants to be seen as the Eeyore in the room? When asked how it's going, I don't say I'm in major student loan debt for the teaching job I lost two years ago, my power has been shut off three times, I'm three months behind on my mortgage, and I'll be on my hands and knees scrubbing paint off of a floor tonight for eight bucks an hour. I just say, Good. Much less of a buzzkill that way. And yet I am able to say in good conscience that things are good things that matter even more than money. There is nothing like hard times to sort out who your truest, most precious friends are. This would include the ones who came to my rent party in December, when I made gumbo for everyone and they passed around the jar that would contain most of my mortgage payment before the night was over. You know who you are. I love you. The last time I saw a doctor or a dentist was the last time I had a real job, the kind with a forty to fifty hour week and health insurance and a pension. That was two years ago, when I taught U.S. Government and Economics at a public high school. Not that I have not been working since then just that since my contract as a public school teacher was not renewed due to budget cuts, the work that has been available has never paid much more than what health insurance costs. Since reverting to underemployed/low-income status, Tenn Care has been an absolute blessing in terms of coverage for my teenage son and

daughter, but not being pregnant or under nineteen years old renders their dad ineligible for health care paid for by the Volunteer State. Stan Brock was the last person I would ever have dreamed would land in Knoxville to live, much less set up a base of operations to deliver free health care all over the globe. Stan was one of the coolest white guys on seventies TV. I watched him every Sunday on Mutual of Omaha's Wild Kingdom, hosted by white-mustachioed Marlin Perkins. Wild Kingdom might have been TV's first animal reality show that wasn't about hunting them down and whacking them. That never meant that khaki-clad Stan was some wussy kitten-cuddler. The episodes were more like animal rescue operations in the wild, with Stan wrestling a crocodile or python to relocate them farther away from people, or running down a bear cub to get him back to his injured mama (Marlin usually stayed in the jeep with the gun). Apparently Mr. Brock decided his own species also needed ongoing rescue operations. He founded Remote Area Medical in 1985 to deliver basic medical aid to people in the world's inaccessible regions, according the website. Mr. Brock developed a network of doctors, nurses, dentists, veterinarians, and technicians who go on RAM expeditions at their own expense. Meanwhile RAM delivers and sets up equipment and supplies for each event, which lasts two or three days. While RAM does expeditions to India, Nepal, Africa, the Caribbean, and South America, according to the website 60% of their service is in Appalachia. This may have something to do with the fact that RAM maintains a hangar at Knoxville's Downtown Island Home Airport for a handful of Cessnas, as well as a DC 3 that dropped troops over Normandy in World War II. The last RAM expedition in Tennessee was in Pigeon Forge, just about a month ago (The next one is at First Baptist Church in Clinton on April 30 May 1). Between the loose upper molar, chipped lower filling, and my inability to read anything smaller than 14 point font without Dollar Store reading glasses that also give me slightly double vision, I decided to give it a go. Below are the field notes. <><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><><> 1:30 am Even at my advanced middle age, something about Friday nights will not allow me to get to sleep before 11:30 pm. Knowing I am getting up at 1:30 to drive over an hour to a high school to stand in line at a Remote Area Medical event to get a tooth pulled, a filling, and an eye exam does not make for sound sleep. Some kind of internal alarm has me vertical at 1:30. 2:20 am Sandwiches, coffee, blankets, and coats loaded in the car, we pull out of my South Knoxville driveway, heading for Pigeon Forge. Kay, who needs an eye exam and new glasses, slides in the Funkadelic CD, closes her eyes and and settles into the passenger seat. 3:30 am After missing a couple turns and retracing our route, we make out the unlit sign for Pigeon Forge High School. We find our first camo-clad soldier at the parking lot entrance, waving us in. Another camo guy waves us into a parking spot at the end of a row of cars. In another minute the van that followed us in is parked next to us. We get out of the car and see in the pre-dawn that we are in the overfill lot and it is filling up fast. I make out at least two hundred cars. Before we get more than three steps from the car, a

stocky female camo sternly informs me, Stay in the car and you'll get a number. We oblige. 4 am Another camo guy taps on my window. I roll it down and he hands me two small squares of orange paper with numbers printed on them: 367 and 368. Still in a pre-dawn fog, I stupidly ask, How many people are ahead of us? (What I meant to ask was, How long before we get in?) Uh, 366, comes the flat reply from the camo guy. He then tells me the doors upen at 6. I thank him, roll up the window, start up the car and turn on the heater. Kay turns on the radio. The only station that comes in is playing some kind of semi-tolerable contemporary rock. After we recline our seats and spread the blanket over us, some of the lyrics floating out of the radio begin to land: You are re-made. You are redeemed. He is your ticket in the door... Kay and I look at each other, then at the numbers I laid on the console. Sneaky Christian rock station, I declare. Kay straightens up her seat back and puts Funkadelic back in. 4:45 am Need to pee. Now that I have my numbers I am hoping the camo lady will not make me stay in the car anymore. No sign of her when I get out of the car. I scan the terrain for options. In the far parking lot I make out a row of porta-potties and head in that direction. As I get closer the long lines of people come into view in front of the plastic outhouses. I detour for a line of trees in the shadows across the street. 5:00 am Settled back in the car, I give Kay a field report. Mostly she wants to know what kind of shape the outhouses are in. I reluctantly admit I have no intelligence to offer in that regard, other than the lines were long. Wish me luck, she says as she gets out of the car. 5:25 am Kay returns with a smile on her face: Soon as I got over there a guy parked next to the outhouses told me which line was for the cleanest one. The Christian rock lyrics float through the car again as she takes Funkadelic out of the CD player: The least of these are the best of these... 6:04 am We hear stirrings outside and get out of the car to check which door has the line. Across two parking lots we see a mass of bodies huddled around a side entrance to the school. No one appears to be getting in yet. It's cold out and we have a high number, so we get back in the car. Crank the engine again and turn on the heat. 6:35 am Without getting out of the car, or even opening a window, we get the first report on how fast the intake is going. I look at the passenger in the van next to us, from where a camo guy just walked away. She looks back at me through her closed window and says with muffled authority, They're on 150. I give her a thumbs-up. I look over at Kay, who is just turning away from the people in the car on the other side of us, who just volunteered the same information to her through closed windows. One fifty, we chime simultaneously. Independent verification. Must be true. 6:50 am - 180, I hear someone in the parking lot announce loudly. My eyes open to dim daylight. 7:00 am - They're on 220, calls out the camo guy walking behind us through the parking

lot. This could be worse, says Kay, who then reclines her seat all the way back. I do the same after turning off the car. We share the blanket. 7:30 am - They're on 300 comes from somewhere outside. I un-recline my car seat. 7:40 am We get up, get out, lock the car and head for the huddled masses across the far parking lot. We follow the flow of folk toward the knot of souls at the side door. As we crest the knoll just before the door, we encounter a backflow of bodies making their way back to their cars. All the faces in the backflow betray some version of bummed-out, ranging from aloof resignation to pissed. Some add color commentary: All this friggin way for what?...I knew this was BS...I thought I was gettin glasses mama... One of the women heading back to the parking lot makes an unofficial announcement to no one in particular, but to the people generally heading toward the door: They ran outta glasses. Kay stops. I stop. A pause, then she says I'll just get my teeth cleaned. OK. We resume our pace. We come upon about a hundred people congregatiing around a single brown metal door manned by a camoflaged doorkeeper. After glancing inside every minute or two he calls out a few numbers. An indescribable look of anticipation, and maybe even hope, on a hundred faces. People emerge from the crowd bearing their little orange squares. He checks the numbers, steps aside and lets them in. Somewhere in the distance I swear that Christian rock station is bleeding through. I always thought the gates were pearly. And who knew St. Peter wore camo? 7:50 am Sargent Peter calls our numbers. We slide into a hallway flooded with people and long tables and rows of occupied chairs along the walls. The lady at the first table welcomes us and asks if we're here for an eye exam and glasses. We tell her we heard there were no more glasses, which she confirms. She tells us that if we come back at 9 o'clock tonight we would have a good chance of getting in at midnight for an eye exam and glasses. Sounds great, I say disingenuously, but I also need a tooth pulled, and a filling. Kay tells her she wants her teeth cleaned. The welcome lady points us toward the intake tables along the hallway wall. Just find a seat and someone will take your information and your blood pressure. 8:10 am After my blood pressure is taken and noted on my pink paper, the nurse hands me the paper and tells me to go to the other nurse down the hall, who is waving at us. On my way to the nurse I pass Kay, who is still getting her BP taken. See you there, she tells me. 8:15 am When we reach a critical mass of dental patients, the nurse leads us down a long hallway through a sea of people to the other end of the school. The collective whirring of a couple dozen dental drills is an almost soothing sound as you walk into the gym - until you realize it is the collective whirring of a couple dozen dental drills. The basketball court has been transformed into a massive beehive of scrub-clad, face-masked, headband-lighted dental drones hunched over open mouths, retrieving supplies, or cleaning equipment and instruments. A ten foot long table off to one side is a full-spread buffet of stainless steel forceps, scalers, probes, tweezers, drill bits, and dental mirrors. Next to the instrument buffet is the cleaning station to sterilize dental tools before they go back onto the buffet. It is not immediately apparent where the drugs are.

8:20 am - We are directed toward the lady in the yellow shirt who is waving at us at the other end of the gym. On the way over, I notice three handmade signs above three separate bleacher sections: Cleanings, Fillings, and Extractions. The lady stands at the foot of the last two unmarked sections. She tells us we need to wait in line in these last two sections to get our teeth evaluated by a checkup dentist. We sit at the bottom of the right section and move up, row by row, as everyone else moves up. After we get to the top row of the right section we move over to the top row of the left section when that row moves down. Then we move down a row at a time in the left section until we get to the bottom row and get our turn at the check-up chair. 8:50 am Moved up one row. No sign of Kay. 9:00 am Text: Me: Where r u? Kay: Gave me something for high bp and put me in a quiet room. Me: U ok? What did they give u? Kay: Shrooms. Want some? Kay (1 minute later): Klonopin 9:40 am Moved up four more rows. I begin talking to Curtis. He is from McCreary County, Kentucky, where he tells me the largest city is Whitley City. He says it's four hours from here, taking four different roads I have never heard of. He and his uncle and his sister and her boyfriend came for various medical and dental problems. He needs to get a loose molar pulled, as do I. Curtis has shoulder-length brown hair; a beard about three fingers long. He's wearing blue jeans, a blue jean jacket, and a Beech Nut baseball cap. 10:15 am We move over to the left section of bleachers. I'm starting to get hungry. I scope out the clinic scene below me to take my mind off the fact that I haven't eaten since we left my house. Curtis points out one guy who has been laid out in one of the twenty-six dentist chairs since we first got in line. I point out another one who hasn't moved since we walked in the gym. An elderly lady on her way to a dentist chair trips and falls over a bundle of extension cords. She is immediately retrieved by three people and helped to a chair. 10:25 am Kay finds me in the bleachers. She pulls an apple out of a paper bag. Pointing to the Cleaning bleacher section on the other side of the gym, she says, They want me to wait over there til they check my blood pressure again. They're handing out bag lunches in the hall. I ask Curtis if he wants me to get him some lunch. Sure. I'll save your spot. 10:30 Menu: Chicken salad sandwich white bread. It comes with a banana and an apple, peanut butter cheese crackers and a Nutri-grain bar. I take two bags and follow Kay to a bleacher seat in the Cleaning section. I ask how she feels. A little light-headed, but OK. Except they're telling me they can't even clean my teeth until it goes way down. They said they would come back and check it again. I ask her if she didn't tell me a couple months ago that the last time she saw a doctor he said her BP was too high. Yep, she confirms. And I lost thirty pounds since then. I feel like going outside and have a smoke don't even say it. 10:40 - I return to find Curtis one row down from where I left him. I squeeze by five people in the row to get back to the seat he saved for me. I hand him the bag lunch. He

digs in. We are ten rows from the bottom, which is the last row before getting to sit in one of the two evaluation chairs. For hours we have been watching two very friendly dentists ask the patients who finally make it to the chairs to open wide so they can assess each mouth and write down a treatment plan on each patient's pink sheet. This is for the downline dentist, who will actually work on the teeth. 11:15 We are two rows lower. Curtis and I have been trading notes on the scene laid out before us on the basketball court. Twenty-six reclining dentist chairs, each with its own retractable overhead light, are lined up along three long rows of tables piled with all manner of supplies, instruments, needles, and drugs. There are four basic types of people walking around on the canvas-covered court (all the patients are laying back on the chairs). They are distinguished by their garb. There are the dental workers dentists and assistants in their opaque yellow vinyl scrub smocks and headband lights mounted as third eyes on their foreheads. There are the plainclothed volunteers cleaning up with their red plastic biohazard bags, getting and bringing stuff, and helping elderly patients get where they're going. Alot of them are wearing Bikers for Jesus jackets. Then there are the camouflageclad Tennessee National Guards sprinkled throughout. If they are packing they have gone to some length to conceal that fact. Neither Curtis nor I have seen a weapon on anyone since we came in, well before dawn. The last type are walking around the makeshift clinic with clipboards, wearing khaki shirts with wing-and-parachute insignias on their pockets. As you get closer to these you can make out the word RAM within a first-aid cross. So these are the Remote Area Medical staff. 11:25 Julie, who sits on the other side of me from Curtis, is just finishing her sandwich. She mentions that her grandma was at the last RAM, which was in Knoxville about six weeks ago. I ask how many RAMs has she has been to. This is my first one, but my grandma has been to the last four. There's a certain doctor that she likes, so my mom was taking her whenever RAM was in the area. Now she's in a nursing home. 11:45 A RAM staffer catches my eye because, along with his wings and parachute on his shirt pocket, he has epaulets on his shoulders and a couple hash marks on his sleeves. He's the oldest staffer on the floor and very unassuming despite his extra decorations. He doesn't talk to anybody as he heads for a wall outlet where a phone and charger are plugged in. His gaunt face looks vaguely familiar as he unplugs the charger and puts the phone in his pocket. As he glances around the gym before going out the door, it clicks: Stan Brock! And he's gone. 12:20 pm We are six rows from the bottom row, where the two friendly dentists call on people two at a time to sit in the checkup chairs. All of the getting up and down is starting to wear on certain people who are stepping over the benches and shuffling up and down the bleacher rows much slower than they were this morning: elderly, people in obvious pain (some in their mouth, but some in their legs, which apparently won't be looked at today), and a number of very overweight folks. The morning smiles have faded into looks of resignation or determination, or somewhere in between. 12:30 pm The first friendly checkup dentist leaves the gym. 12:35 pm The second friendly checkup dentist leaves the gym. He doesn't tell anyone

when or if he'll be back, as far as anyone can tell. 1:00 pm - Still no checkup dentist. We assume they are getting lunch, but I can't help but wonder aloud why the RAMmers don't have a couple stand-in checkup dentists to keep the line moving during lunchtime. Those words are the closest anyone gets to grumbling. 1:15 pm I notice Kay has somehow bypassed the checkup line and is now reclining in a dentist chair with someone picking away at her teeth. Good job, Kay. 1:20 pm Again I overhear someone behind me mention the website. It said these twoday free medical stations are set up all over the world. South American jungles; ghettoes in India. I guess we're lucky we don't live there. Still no checkup dentists. 1:33 pm Both of the checkup dentists return, friendlier than ever. Our line resumes its slow crawl. 2:20 pm The pace has really picked up and its my turn at the checkup chair. I meet Bruce the very friendly checkup dentist, who came in from Greensboro. He says he volunteers for these RAM expeditions a couple times a year. OK. Let's see what you've got. I tilt back and open wide. Bruce probes for a few seconds. Extract 14 and fill 30. The assistant writes on the crumpled pink sheet I gave her. Bruce then pulls out. Man, you've got great teeth except for that molar and you need that filling. I hate that we can only do one or the other for you today. So I need to pick? Yep. It's getting late and we've still got a long line. The filling is still partially intact, so I say the molar. Cool, says Bruce. Just show the lady over there your pink sheet and you're good to go. I thank Bruce and am trying not to kick up my heels for finally getting down to business and not having to sit in the bleachers anymore. I show the lady my pink sheet. The lady shows me more bleachers. The Extractions section, with about twenty five people already sitting in line. WTF to say the least. I just can't bring myself to do this again right at the moment. I go outside for a walk around the Pigeon Forge High School campus (Go Tigers), hit the Men's room, get a drink of water, wiggle my loose molar and go get in line again. Just then, Kay appears out of nowhere with the most beautiful smile I have ever seen on another human being. I think to myself It could be worse. 3:35 pm Hi, I'm Erica. Let's go back to the chair and take care of you. 3:44 pm Erica gives me my first shot of Lidocaine in my upper palate. Despite my toes curling up in apprehension, it's just a little pinprick, and soon I am, yes, comfortably numb. Erica tells me the dentist should be by soon to extract the molar. 3:55 pm No dentist in sight. Erica asks if I'm numb. I'm not sure, and I know if I say this she will give me another shot. I'm surprised that I don't seem to care. I ask her for another shot. No problem. 4:07 pm Still no dentist. Maybe one more shot, Erica. She is so good at this that my toes no longer curl as she asks me to open wide. 4:30 pm - He's just finishing up someone else and you're next. How are you doing? I

tell her I'm worried the shot might wear off. You can have another, she says encouragingly. OK, I say. 4:45 pm After four shots of Lidocaine, an older brown-skinned dentist appears with a fair-skinned guy. They both peer into my gaping mouth as the brown-skinned dentist speaks in a thick Indian cadence that only lets me understand every third word. The fair-skinned guy probes around my tooth, wiggles it, and says Should come right out. The Indian dentist says the only sentence I will ever completely understand from him: You think so, eh? He sounds unconvinced but nods at the fair-skinned guy, who already has the pliers at the ready. He says, You just let me know if I need to stop, as he acquires a purchase, gives my tooth a little twist, and rocks it back and forth as he pulls. There is pressure but no pain...pop...and it's out. -------------------------------------------------Before the RAM expedition, the last time I went to a dentist I waited twenty minutes to get in the chair. I waited twenty more minutes for the dentist to come in and pull out my wisdom tooth. The filling was a little tricky and took a bit longer - about forty five minutes. The office was a ten minute drive from my house. It was a morning appointment and I was back home before noon. This of course was back in the day when I had a real job and a dental plan. This was back in the day when I didn't have to pick between a filling and an extraction because there are one hundred more people waiting behind me, some of whom will have to make the same snap decision. It is the same seat we sit in when we find ourselves picking between keeping the lights on and buying food or prescriptions. But make no mistake, we don't ever get used to it. We just go back to work, such as it is. What else can we do? How do you get any kind of free medical or dental care, and then mention that it was not enough, without sounding ungrateful for what you got? The first thing to say is that RAM Day confirmed that I am definitely not alone in considering it a blessing to get care that I can't pay for even partial care. Every day my tongue curls around the gum where my loose and painful molar used to be, and every day I want to shake the hands of Erica and the dentists and Stan Brock and every RAM volunteer. During that day in the bleachers I also felt a fairly consistent sense of gratitude and appreciation for RAM from my fellow patients. Thank-you so much and God bless them for doing this were woven throughout the long day. People were fairly worn after untold hours in the parking lot and eight hours in the bleachers, but never did I hear a complaint. Not once. Which brings us to the second point, which is that while no patient pays money to get RAM care, the care is not free. There is the cost of gas, at almost four dollars a gallon, and a tank or more of it for those who are two hundred miles or more away, of which I met a few. There is also the cost of lodging and food for those outliers. And there is the cost of time. While having RAM set up on weekends enables more working people without health insurance to get care, spending your Friday night in a parking lot and all Saturday in the bleachers is not the most relaxing weekend to be had before grinding it out again on Monday. The time cost is clearly too steep for most children. There were few to be seen.

As a former teacher of U.S. Government and Economics, I was paid to promote America as the greatest chance on earth to make dreams come true, even for the hard-working least of us who remain (left behind?) in the public achools. So it goes against my grain to admit that our social and economic system is quite ill, to say the least. Yet any teacher who does not deal in reality is not a teacher but an entertainer at best, a public enemy at worst. The reality is that, even with the critical services delivered by RAM, our social and economic fabric is still waiting for some basic attention, care, and healing, as are a growing number of its people. That would include the thousand or so I spent half a night and a full day with to see a doctor or a dentist in a Pigeon Forge high school gym last month. And later this month in Clinton, that line is not likely to be getting any shorter. For the sake of the manifesters and the masters and the Oprah-lovers, I will now put the nword in its proper perspective by for now I will spare the world my heaviest-handed conclusions about U.S, Government and Economics. Suffice it to say that Office visit How many seen per day what doesn't get treated kids describe maladies circuit attentive/concerned/respectful/cheerful