From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel.


And I'm Madeleine Brand.

President Obama travels to southwest Virginia on Wednesday. There, he will continue stumping for his health care overhaul. If the president had visited this past weekend, he would have seen a graphic example of gaps in the health care system. In Wise, Virginia, about 2,700 uninsured and underinsured people lined up for free vision, dental and medical treatment at the county fairgrounds.

As NPR's Howard Berkes reports, some of them arrived three days early to be sure they would not be turned away.

HOWARD BERKES: The first carload pulled in Wednesday before dawn and they weren't alone for long.

Unidentified Woman: We started calling out numbers at 5:00 in the morning. If you're not here when your number is called, we have to skip over you. Are you staying the night?

BERKES: By Thursday night, hundreds of cars, vans and pick-ups were pulling into the grassy field, beyond the barns and animal stalls at the Wise County Fairgrounds in Virginia's Appalachian Mountain. Black numbers on yellow slips reserved a place in line for the opening of the gates at 5:00 Friday morning. Fifty-two-year-old Otis Reece of Gates City, Virginia brought the whole family: his wife, daughter, son-in-law and three grandchildren.

Mr. OTIS REECE: I came here because of health care - being able to get things that we can't afford to have ordinarily without an out-of-pocket. And being on a fixed income, this is just fantastic situation for us to have things done we ordinarily would put off.

BERKES: Reece had a six-figure income representing an international industrial supply firm, until an accident left him disabled. That was five years ago. He has Medicare, but it doesn't cover everything, and he cannot afford his share with the bills. So, he and his family are here for dental, vision and hearing exams and treatment. Grandson Jacob has his own agenda.

JACOB: Tomorrow, I'm going to see the doctor to get my ear and my nose fixed.

BERKES: That's a battered nose and an infected and oozing ear.

Mr. REECE: We're willing to sleep in pickup trucks or whatever we have to do to the cars and deal with the elements and except to - at least get some kind of health care.

BERKES: The care at this annual Remote Area Medical expedition, or RAM as it's called, is free, because hundreds of doctors, nurses, dentists and technicians donate their time. Instruments, lab work, X-rays, drugs, lenses, frames and supplies are also provided free. And 1,000 volunteers pitch in with logistical help. RAM expeditions have landed in India, Nepal and Guyana. But they're also necessary here, says RAM founder Stan Brock.

Mr. STAN BROCK (Founder, RAM): There's no doubt about it, there is a Third World right here in the United States. Here, in the world's richest country, you have this vast number of people, some say 47 million, 49 million, that don't have access to the system and that's why it's necessary.

(Soundbite of fairgrounds)

BERKES: It's close to 5:30 in the morning on Friday morning. It's still dark. There is an endless line of cars that we can see at the entrance to the fairgrounds here. And most of these people are probably not going to get treated today. They've already handed out close to 1,600 tickets. They're reaching capacity here, and they haven't even opened the gates yet.

(Soundbite of bullhorn)

Mr. BROCK: Thirty-seven, 38, 39.

BERKES: It's still dark when the gates open. Stan Brock uses a buzzing bullhorn to announce the numbers to a crowd of hundreds. Number 39 is Loretta Miller, who had four hours sleep sitting behind the wheel of her red minivan. And she's thrilled to be getting in. She took the time to put on makeup, tie her blond hair back in braids and dress up in a white lace tunic. Miller's RAM treatment last year was dramatic.

Ms. LORETTA MILLER: They'd done a ultrasound and told me that my gallbladder was enlarged and was ready to burst and it could kill me. So saved my life. They told me if I hadn't got help when I did, literally I could've died.

(Soundbite of fairgrounds)

Unidentified Dentist: Okay, need the suction now.

BERKES: Miller is back to get her teeth fixed. She spends more than five hours in dental chairs. An abscessed tooth had to be pulled, two others needed new fillings, this one's getting a root canal. Miller is a divorced hairdresser with two kids and no insurance. She'd been in pain for weeks. And the rest of her health was at risk, according to Terry Dickinson, who directs the Virginia Dental Association and the RAM dental effort here.

Dr. TERRY DICKINSON (Executive Director, Virginia Dental Association): The infection in the mouth certainly has been shown to have an effect on systemic diseases. So it's really critical that these folks be able to get infected teeth out and the infection treated in the mouth because it's going to help them with their overall health.

BERKES: Dentistry is the biggest demand at RAM. It's 8:15 on Friday morning and there are dozens and dozens of dental chairs set up here. It feels like a field hospital on a battlefield. There's 50 to 100 people being worked on here right now. But there are hundreds more waiting outside. And there will be hundreds more tomorrow. And there will be hundreds more on Sunday.

Dickinson expects his dentist volunteers to pull close to 4,000 teeth during their 30 hours of RAM work. Terrible teeth, obesity, smoking, high blood pressure and diabetes are common among the people seeking help here. That raises an important question: Are they at fault for their poor health?

Dr. DICKINSON: There's enough blame to go around for everybody. I think patients certainly have to have personal responsibility for what they're putting in their mouth. But we also are trying to create a better access care system. How are you going to get providers, whether it be dentists or physicians or anybody else, into these areas where economically these communities are struggling?

BERKES: Especially when dental and medical schools saddle graduates with $100,000 of debt or more. RAM founder Stan Brock has another perspective that those with good insurance buy their way out of bad habits.

Mr. BROCK: The rest of the population are not exactly in the best of shape themselves. I mean, they're eating well, and therefore they're putting on weight, and therefore they've got heart disease and the rate of diabetes in this country is going up. But in the case of the well-to-do and the well-insured, they can afford to take care of it.

BERKES: At the end of her long day with dentists, Loretta Miller is still numb with Novocaine, but grateful for the care she couldn't afford.

Ms. MILLER: It's well worth the drive and the wait. You get tired and stuff, but you think about all the trips and the money it would've cost to have all this done, I couldn't have had it done. I'm ready to go in the morning. Get me some glasses so I can see.

(Soundbite of laughter)

Ms. MILLER: See what they've done.

(Soundbite of laughter)

BERKES: It's now well past noon on Sunday. The drapes have come down from the sanitized horse stalls used for medical exams. Workers are moving optometry equipment out of the poultry building. And the dental chairs are finally empty. RAM organizers say everyone who came was seen - about 2,700 people. They spent about $250,000 for care worth about $1.5 million, and they have eight more expeditions planned this year from Virginia to Los Angeles.

Howard Berkes, NPR News, at the Wise County Fairgrounds in Virginia.

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