Appalachia and Beyond: Health Care in America

47 million Americans do not have health insurance. 25 million more are under-insured. In the coal mining towns of Appalachia, one of the most impoverished areas of the country, 13.6 million people live without health insurance.

Remote Area Medical (RAM) is a nonprofit organization established to provide medical care in third-world countries. But in the United States, the cost of health insurance has become so high, and the need for care so great, that over half of RAM's free clinics are now in the U.S.

Every summer, RAM comes to the Wise County, Virginia, fairgrounds to hold its largest U.S. clinic, providing close to 3,000 people in one weekend with free dental, vision, and medical care. Most of these people would go without this vital care if it were not for RAM; they simply could not afford it.

People drive hundreds of miles and wait for hours, even days, sleeping in their cars and tents outside the fairgrounds gate. Still, at the end of the weekend, some people are turned away.

A family sleeps in their car after arriving in the early morning hours, hoping to be among those admitted to be seen. Because of the high volume of people in search of free medical care, hundreds arrive the night before the clinic opens, sleeping in their cars in the parking lot or pitching tents outside the fairgrounds gate.
  
Hundreds of people gather in the morning at the gate of the fairgrounds waiting for their numbers to be called. If they make the cut-off, they will be among those who receive free medical, dental and vision care that day.
  
A man holds the tickets that will get him and his family into the gate of the fairgrounds to receive free medical, dental and vision care. Thousands arrive and receive numbered tickets, then wait and hope that their numbers will be called.
     
  
An injured man waits for his number to be called to be let through the fairgrounds gate to receive health care.
   
Looking into the fairgrounds, a man waits for his number to be called.
  
After hearing her number called, a mother shows her ticket to a RAM volunteer as she and her daughter enter the fairgrounds for care.
     
  
Sheets provide privacy in converted horses stalls used as makeshift exam rooms.
  
A sister keeps her brother company as he receives dental care.
   
Dentists, oral surgeons, and assistants perform surgery to patients under a makeshift tent inside the fairgrounds.
     
  
Hundreds of people gather in the morning at the gate of the fairgrounds waiting for their numbers to be called. If they make the cut-off, they will be among those who receive free medical, dental and vision care that day.
  
As numbers are announced, a family waits among others, all hoping theirs will be called before the cut off for that day.
  
A woman who received medical care sits inside the fairgrounds.
     
  
Even storage rooms are converted to makeshift care areas. Here an optometrist checks a patient's vision.
   
Patients sit in line waiting for an eye exam. The dental and vision tents are the busiest at the clinic, as many insurance groups do not cover these two health care needs.
   
A woman offers comfort to her son as they wait in a long line to receive vision care. After waiting outside the gate, patients must wait again in the grandstand until spaces open in the lines outside the various medical areas. People wait many hours, some even a full day, only to be told to come back the next morning.
     
  
A young man offers comfort to his companion as they wait to be seen by a dentist. After waiting outside the gate, patients must wait again in the grandstand until room opens in the lines outside the various medical areas. People wait many hours, some even a full day, only to be told to come back the next morning.
   
On the final day of the clinic, a mother holds her daughter as they wait outside the gate, hoping to be among the last to be admitted. In the end they were turned away, as time ran out for this year's clinic.