Remote Area Medical Clinic Looks Different, But Mission Remains Same | Coronavirus

Eufemia Didonato

At first, he doesn’t want to give his name.

Sitting in his low-riding Honda Accord that, maybe years ago, was blue but now is just layers of rust atop more layers of rust, he pulls his mask down to take a drag off a cigarette.

“What the hell,” he says, pulling his mask back up, blowing smoke through the fabric. “It’s Dale, but you ain’t getting my last name.”

He laughs. Dale is friendly despite the secrecy, says he’s been thrown through the wringer over the past 13 months.

“Then thrown against the rocks afterward,” he says.

The COVID-19 pandemic took his job. Years of neglect and going without a dentist for “God knows how long” are in the process of taking three front teeth. He never could afford a dentist, he said — not with bouncing around between odd jobs here and there, lacking reliable insurance, he guessed, for the past 20 years. Quickly pulling his mask back down, the problem teeth are blackened husks, almost translucent, though they don’t hurt much anymore.

“But, I’d like to tear into a steak,” he says.

That’s why he’s here, spending his Saturday sitting in his Accord miles away from his “somewhere outside Circleville [W.Va.]” home, waiting to get his teeth looked at and “maybe see if I can get new glasses.”

He’s at the right place, with the Remote Area Medical clinic set up Saturday and Sunday at the Rockingham County Fairgrounds, a place that includes eye exams and where lenses for those glasses are cut in a converted race-car hauler.

It’s all free. The dental exam, the eye exam, the mammograms, the medical exams. All of it. And that’s the draw for Dale and others who began to fill up the parking lot at 12:01 a.m. Saturday. They wait in their cars, walking to the entrance at the Exhibit Hall where their temperature is checked and they’re screened for the virus that changed everything, including the work and patient flow at the renowned traveling medical marvel.

The inside of the fairgrounds’ Exhibit Hall, where Dale’s teeth could be pulled and maybe replaced by dentures, looks cut from the reels of a Hollywood sci-fi thriller. Each individual dental space encased in plastic and zipped to a seal, all connected by clear tubing to HEPA filters.

“Warned you it would look different,” says Mindy Cooper, RAM’s communications manager, camera hanging around her neck.



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A patient receives dental work during a Remote Area Medical clinic at the Rockingham County Fairgrounds Saturday.




On The Inside

Poppy Green, senior clinic coordinator, surveys the scene — a maelstrom of music playing over a radio, constantly moving volunteers, cleaning crews scurrying about and patients, some wide-eyed, rimming the scene in metal chairs or being walked to one of the clear tents for an exam.

“When COVID-19 first hit, we realized we had to protect our patients, protect the community, protect all the volunteers,” Green says. So the traveling clinic shut down for a bit and used that time to reevaluate all of its processes.


Gone are the sardine-packed exam stations, replaced by the tents — fogged and disinfected after each use, a red sign hung outside to let volunteers know the time it will be ready again. Like a “Back By” sign hanging outside a storefront.



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Remote Area Medical volunteer Mary Dlisan, of Marion, arrange clean tools for dental procedures during a clinic at the Rockingham County Fairgrounds Saturday.




Of course, the way to stay safe has slowed the process and took some adjusting to.

“But, if that means servicing them safely and protecting their health and well-being, we’d rather do that than push them through,” Green says.

He looks around at the controlled chaos in front of him: tents getting fogged, patients being guided back and forth, some volunteers carrying buckets filled with dental waste — lovingly called the “Bucket Brigade,” Cooper says — and the music still playing from a radio behind the doffing station, where doctors change their clothes after each patient.

“We’re ready to go live on the moon after this,” Green says, laughing. “We got this, we’re ready to go. This is so different, it takes adjusting. But, in the end, I feel more comfortable, it gives you that bubble vibe.”



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An array of tents, all connected to air filtration systems because of COVID-19 safety protocols, protect the rest of the Rockingham County Fairgrounds Exhibit Hall from dental patients and staff during Remote Area Medical clinic Saturday.




The vibe of Remote Area Medical, founded in 1985 by Stan Brock, should be well-known. Brock, a former British cowboy and co-host of the “Wild Kingdom” television show, according to his New York Times obituary, died at the age of 82 in 2018. RAM, which originally operated in British Guiana, expanded to the United States in 1992.

Since its founding, the Rockford, Tenn.-based nonprofit has served 863,700 patients — 76,604 in 2020. Over the weekend, its haulers turned the Rockingham County Fairgrounds into a medical compound with Cooper, wearing a safari-esque outfit reminiscent of Brock’s signature garb, playing host.

“I’m tired,” she apologizes, not sure if she has reeled off all the services the clinic is offering. Stepping outside, she stops at the Salvation Army truck with coffee ready to be poured. She grabs a cup, offers it up and pours herself one, adding two packets of cream. She’s trying to hunt down Kim Faulkinbury, clinic coordinator, who eventually pulls up in a golf cart.



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Tools and instruments are cleaned during a Remote Area Medical clinic at the Rockingham County Fairgrounds Saturday.




Faulkinbury is also on the hunt, looking for a patient. Faulkinbury apologizes then speeds off.

“Always moving,” Cooper says, lifting her mask to sip her coffee. “She’s awesome.”

A former community journalist in Oregon, Cooper, a Knoxville, Tenn., native, longed to move back home and be closer to her family. RAM is meaningful in East Tennessee and meaningful work “is really important to me,” she says, finally taking a break, kicking her legs up on the seat of a wooden picnic bench.

“It’s really easy to be on board with the mission every day, you know,” she says. “To provide free health care to people in need? It’s not really hard to want to do that.”

She pauses, wipes her nose and takes another sip of coffee.

“I just knew I wanted to be part of something meaningful.”

‘Saying Yes’

Outside, sitting on the bench, surrounded by golf carts zipping back and forth between exhibit halls that are now medical bays, Laura Trull never imagined any other answer coming from RAM other than “yes.”

She knew there was a need in Harrisonburg, Rockingham County and its environs. “Always wanted to have a clinic here,” she says. “Back in 2017, started telling people I wanted to have a clinic here.”



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A large selection of eyeglass frames are arranged on tables for patients to pick through after receiving eye exams during a Remote Area Medical clinic at the Rockingham County Fairgrounds Saturday. After selection, lenses are cut on-site and vision patients leave the clinic with a new pair of eyeglasses.




That’s when those people she was telling started to agree.

“I think the need is pretty obvious when you spend any time with any people who have any type of struggle,” says Trull, a social worker and professor with James Madison University’s department of social work. “If you spend any time around people with any kind of challenges, you’re going to bump up against the fact that they had to make a decision to choose something over health care for financial reasons.”

A 2019 study in the American Journal of Public Health found that 66.5% of bankruptcies in the United States were due to medical expenses and their immediate impacts, such as time lost at work.

“That motivates me to make sure we offer the clinic,” Trull says.

2019 was the first year RAM came to Harrisonburg-Rockingham County, and Trull — the community host group coordinator — was instrumental in making that happen. A volunteer for seven years with RAM, she went online and filled out an application to begin the process. She never had any doubt the organization would see the need as well.



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A tent for dental procedures is cleaned and disinfected during a Remote Area Medical clinic at the Rockingham County Fairgrounds Saturday.




“I don’t ever recall thinking they wouldn’t come,” she says. “Never even occurred to me that they would say ‘no.’”

That’s when Trull’s calm demeanor leaves her for a moment and the passion for the plight comes out. She sits up straighter, leans in on the bench top and jabs her finger into the table to make each point. Like her, RAM is in the business of saying “yes.”

“When we can say yes …”

Jab.

“… when we can get in one more …”

Jab.

“… when we can do one more thing, when we can go to one more place, you say yes as often as possible and very infrequently do we regret that,” Trull says. “So I knew if they could come, they would.”

She sighs and relaxes back into the picnic-bench seat.

“It was my job to move obstacles out of the way to make sure they would come without hesitation.”



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A placard notes when a self-contained tent with its own air filtration system will be ready after cleaning for its next dental patient during a Remote Area Medical clinic at the Rockingham County Fairgrounds Saturday.




Those obstacles, as always, include money, space, time, energy. The list goes on and on. The on-the-ground stuff that doesn’t get photographed and rarely gets interviewed by documentary crews. Securing the fairgrounds for two days, making sure volunteers have a place to stay, having the rescue squad on site, a police presence and collecting community resources that help patients keep up with their health care after the visit. The goal is simple: making sure everybody leaves better off than they arrived.

Everybody was also leaving with a green bag in their hand. Inside is a meal, and plenty of literature on the resources offered by the community.



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A patient receives a COVID-19 vaccine during a Remote Area Medical clinic at the Rockingham County Fairgrounds Saturday.




“A bag literally full with resources,” Trull says.

Normally, all that literature would be on site and in-person, but that was pared back this year due to the COVID-19 pandemic. Though there were plenty of tables lining the Exhibit Hall that served as a check-in, triage, educational center and a last-minute addition — Johnson & Johnson one-dose COVID vaccines.

Strength In Peers doing HIV testing. Blue Ridge Free Clinic with a booth, following up on the RAM’s lab work. The Virginia Department of Behavioral Health and Developmental Services’ REVIVE! Training — holding workshops instructing people how to administer Narcan to reverse an opioid overdose and providing the drug and the kit.

“It’s very important,” says Michele Thomas with the Virginia Department of Behavioral Health and Developmental Services. “Folks that come to RAM are usually the uninsured or the underinsured and these are the folks we want to reach the most. Provide them with the training and how to replace the drug, God forbid they have to use it.”

The Blue Ridge Free Clinic, scheduled to open its doors in Harrisonburg on Monday, was also there to introduce itself.



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Patients are checked in and triaged at the Rockingham County Fairgrounds during a Remote Area Medical clinic Saturday.




“Dovetailed perfectly,” says Susan Adamson, a nurse practitioner and board chair of the free clinic. “One of the reasons we worked so hard to make sure we could be open [Monday] was because we knew there were going to be patients identified here, at RAM, as having diabetes or having hypertension that is out of control or needing other services.”

On Saturday, the clinic, which will be housed at the Zapanta Professional Complex, was signing up patients for Monday appointments.

“RAM identified [the medical issue],” Adamson says, “now [the patients] can be navigated right toward us.”

Hours Later …

Mindy Cooper, eyes tired but enthusiasm not waning, says goodbye. She’s off to take more photos, visit more patients and maybe grab more coffee.

The tour over, there’s nothing left to do but head out into the parking lot, the number of cars having melted away as the day went on. Dale’s maybe-once-blue-now-rusty Accord was still there, the driver’s side window open as the sun began to bake its seats. Missing its occupant, who was inside the hall, either in a dental chair or getting his eyes tested.



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Patients line up outside the Rockingham County Fair Exhibit Hall Saturday to check in for a Remote Area Medical Clinic Saturday. Some patients arrived in the early hours of the morning after the parking area opened at midnight to secure their appointments.




A family set up a picnic blanket and sat around on lawn chairs five spots over, waving away inquiries to talk with smiles. The meal done, they packed the chairs into the minivan, nodding as they drove away, red dust kicking into the air before the tires hit the paved entrance road.

Dale’s car, in the second row from the exit, sat alone.

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