Free healthcare in Appalachia

July 24, 2012

By Mark Makela

July 20, 3:30am; Wise, Virginia. Early morning darkness covered the hills and valleys. Despite the rain 500 people had already lined up for free medical and dental care. You know it is a unique shoot when your assignment begins here.

The day before I had driven 10 hours from Philadelphia to get to the Remote Area Medical (RAM) three-day clinic in southwest Virginia. RAM has been providing free healthcare since 1985 for uninsured and underinsured Americans and for people worldwide. This would be their 674th expedition. RAM began as a parachuting operation in the Amazon founded by the humanitarian, Stan Brock.


I knew that there was positive foreshadowing when my first frame was of a bemused chihuahua named Bella standing on her hind legs with her owner.

The mood would shortly take on a far more serious tone. Witnessing horrific health cases, one after the other, was a heartbreaking experience. People came from 14 states seeking care, and an estimated 1,700 patients were admitted for treatment the first day. A 20-year-old had 20 teeth extracted. A mother of two who lost her job due to poor eye sight came for eye care and glasses. A three-year-old had to undergo oral surgery for a root canal and front teeth extraction. These were just a few of the heart-wrenching health cases I observed. There was a chronic pattern of poor oral hygiene and due to patients’ extreme dental pain they asked for teeth extraction instead of teeth repair. Saddened, I felt sympathy for these individuals and a complete disbelief at their individual health situations.

Having lived in England for the last six years I was provided free medical and dental care there. Coming back to the States this spring, it has been difficult to hear the health care discussions and raging debates in Congress, as well as, to see the prohibitive high costs of health care insurance. It is understandable why more than 50 million Americans, one in six, are uninsured.

As is often the case in photojournalism, being granted access into people’s lives is a gift. This was certainly the case in this, an emotionally intense environment, as I had to earn people’s trust to allow me to photograph them under duress and painful treatments. It was extraordinary to see the gathering of such generosity with hundreds of healthcare professionals and volunteers donating their time and expertise to this worthy cause. Realizing that there was an immense need for medical care and seeing that it was met by Remote Area Medical was uplifting. I felt privileged to have documented the day.

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