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Helping those in need a weekend at a time

Knoxville, Tenn.—Remote Area Medical, a mobile relief organization based here, has quietly been helping people, flying into inaccessible spots around the globe to provide medical, dental, vision and veterinary care.

Since 1992 , RAM has been helping patients in the U.S. who can't afford medical, dental and eye care—hundreds and thousands at a time—using volunteer health care professionals who might travel across the U.S. to participate or help in their own communities.

Stan Brock, RAM's septuagenarian founder, developed a vision for his mobile relief organization while he lived in the Amazon rain forest with the Wapishana Indians—where he watched many suffer pain or death for ailments routinely treated in countries like the United States.

Baby boomers may remember the English-born Mr. Brock as the adventurer featured on the 1960s television series, "Wild Kingdom." He tangled on camera with wild animals of all sorts in the world's wildest most remote areas for Americans to watch in the comfort of their living rooms.

In 1985, Mr. Brock founded RAM. Since then his organization has conducted 545 expeditions to help people in need, and he's been involved with every one of them.

In 1992, RAM got a request to hold an expedition in Hancock County, Tenn. And RAM has been holding U.S. expeditions—primarily in Appalachia—ever since, dubbing the U.S. arm the Rural AMerica Program.

"We had one dentist and we lugged a 400-pound dental chair to the site. From there, someone else gave us another 400-pound dental chair but we started losing volunteers because they had bad backs," Mr. Brock joked. "Then we got some donations to buy portable dental chairs."

RAM now transports up to 36 portable dental chairs for each of its expeditions, plus all the other hardware needed to equip a dental clinic. Most expeditions run one-and-a-half to two days over a weekend.

A small expedition, he says, offers medical, dental and vision care to 600-700 patients; a large clinic sees more than 1,000.

"A mega-expedition, like ones we've had in New Orleans after Hurricane Katrina or recently in Wise, Va., treats many thousand patients." According to the RAM Web site, the Wise expedition, held July 25-27, gathered 1,584 volunteers who provided 5,586 services to 2,670 patients, for a total value of care of $1,953,291, making it possibly the largest free medical clinic held in the U.S.

Mr. Brock says RAM has seen the need for medical, dental and eye care at its U.S. expeditions grow steadily since 1992. RAM patients in the U.S. are primarily adults who fall into the category of the working poor or the underinsured—people who put off getting health care services because it takes too much of a bite out of their budget.

He was one of several panelists who testified April 15 before the House Ways and Means Committee Subcommittee on Health on "The Instability of Health Coverage in America."

"I told them that we see a lot of adults who don't have health care coverage or are underinsured," said Mr. Brock. "These are people who have not had the opportunity, because of hardship or lack of education, to see a doctor or a dentist. They are all clamoring to get their teeth fixed and their eyes fixed. There is a huge need for dental and vision care. And they also need their overall health problems addressed.

"Another pet peeve of mine," he added, "is that doctors can't cross state borders and provide free care. There is not one state from which we haven't received dozens of requests to bring a RAM expedition. In Tennessee, there is a completely open door policy. Volunteers just need to sign up, roll up their sleeves and get busy. Sometimes volunteers just walk in the door and we didn't know they were coming."

RAM, he said, draws "magnificent volunteers from all over the U.S. who pay their own expenses to come. Nobody's getting paid."

He said RAM's executive director Karen Wilson calculated that, excluding their fuel costs, they were treating a dental patient for about $3.85—no matter what services are provided—and providing an eye exam and glasses for about $3.65.

"Why? Because nobody's getting paid. We get thousands of frames donated, a certain amount of dental supplies, although we have to buy most of our dental supplies. My pockets ran dry years ago. It all comes from donations. This is not rocket science. It runs on autopilot."

In fact, Mr. Brock doesn't receive a salary, doesn't own a home and has been known to sleep on a mat on the floor at RAM sites instead of getting a hotel room. And his volunteers admire him for his single-minded dedication to helping humanity.

The hardest part of his mission, Mr. Brock said, is that the RAM expeditions can't see everyone who comes and stands in line in hopes of being treated.

"Sadly, we can't see them all," said Mr. Brock. "We sometimes turn hundreds of people away. It's lousy for me because that's my job."

Remote Area Medical's director of dental services is Dr. John Osborn from Knoxville. He says his relationship with RAM and Stan Brock began when he got a phone call from Mr. Brock several years ago, asking him if he would consider volunteering at an expedition.

"It was different in those days," said Dr. Osborn. "It was more like working in a MASH unit. Now it's moved on to the next level, with modern, portable equipment and good lighting. It's a lot like working in a regular dental office or clinic."

Dr. Osborn joined the organization's board and helps with planning, equipment purchases and any dental problems or questions that arise. He might coordinate with local authorities about practice regulations, sometimes spending 10 or 15 hours a week to prepare for an expedition. Other times he gets a last-minute call to fill in where a dentist might be needed for a weekend clinic.

"I probably do six or eight clinics a year," said Dr. Osborn, who fits his volunteering into a life that includes a busy dental practice, a family and a racing team he and his brother started: Chili Pepper Racing. The Web site (www.chilipepperracing.org) says the racing team "was formed in 2002 to serve as a vehicle to raise monies and awareness for the charities, at no cost to the charity, through racing." RAM is one of the charities the racing team supports.

A few years ago, RAM experimented with a program to bring medical, dental and eye care house calls to homebound people in remote areas via motorcycles, Dr. Osborn said. "Moving stuff on the motorcycles was great, but it really limited what kind of dental equipment I could bring."

The best things about being a RAM volunteer, he said, are learning and friendship.

"At the end of a day, volunteers feel like old friends. You get pretty close in a day or two. And I've never been to a clinic when I didn't learn a new way to do something. It's a great learning experience. It's a lot of work, but it's an awful lot of fun."

In March, Dr. Howard W. Silbersher, Princeton, N.J., said, "I was watching '60 Minutes,' minding my own business, and I saw a segment on RAM. I said to my wife, 'I don't know where this is, but I'm going.' And I went. ['60 Minutes' correspondent] Scott Pelley inspired me to go."

A general dentist with a practice in Washington Crossing, Pa., and clinical assistant professor of cariology and comprehensive care at New York University College of Dentistry, Dr. Silbersher is also a seasoned volunteer. His efforts include spending a week at the Operation Blessing clinic in New Orleans, a facility established to serve hurricane victims.

Dr. Silbersher spent all day Saturday and a half-day Sunday volunteering at RAM's expedition in Harrogate, Tenn., May 31 and June 1. A total of 306 volunteers from 19 states—including 17 dentists—saw 678 patients and rendered 1,060 services valued at $130,435. Dentists at the clinic logged 736 extractions, 144 fillings and 61 cleanings.

"It was physically demanding, mentally challenging and spiritually uplifting," said Dr. Silbersher. "The first day I saw 25 or 30 patients for surgical extractions and none of them were simple. The next morning I saw another 18 or 20 before I had to leave to catch my plane. It's challenging to keep your focus. But the patients make it worthwhile. These are modest, humble people who sometimes drive 200-300 miles to get treatment because they are in pain. The patients were so polite and thankful and the RAM people and volunteers were very magnanimous, helping people in need right here in the U.S."

In Pike County, Ky., Judge Executive Wayne T. Rutherford and Social Services Commissioner Carol Napier heard about RAM and thought it would be a model that could bring much-needed health care to the county.

"Our local component society (Kentucky Mountain Dental Society) was in on the early discussions about holding a RAM expedition here," said Dr. O. Andy Elliott II of Prestonsburg, Ky., ADA second vice president. "I had heard a little about RAM in the past, so I started doing some research and it looked like an excellent program to get involved in."

Once dentists learned how the program worked, it started to snowball, said Dr. Elliott.

Dr. Elliott said he was truly impressed by the level of organization offered by RAM. "They know what they're doing. This expedition used local providers to treat local people and that was an important part of the success of the Pikeville program. RAM brings all the infrastructure—mobile chairs, handpieces, materials and so on—and as they get more national exposure, they receive more donations that allow them to expand.

"We had health care professionals doing mission work in their own back yards. We had across-the-board participation and I've joined the committee for next year. I took my entire office staff with me and they are ready for next year, too. We really got a lot more out of it than we put in."

Also attending the expedition as a reporter was Dr. John A. Thompson, editor of the Kentucky Dental Association's publication KDA Today. His article is featured in the July/August issue.

"It was huge. They are still talking about it," said Dr. Thompson. "They treated 441 dental patients and they are going to do it again next June. The community bought into it hook, line and sinker."

Dr. Thompson said he went to the event not knowing quite what to expect. "Seeing the volume was overwhelming in itself. It was just like a mission to the Amazon, but it was in our own back yard."

Pikeville dentist Dr. Bill Collins was the first to volunteer for the expedition, and ended up being the dental coordinator for the event June 28 and 29, heading up the efforts of 125 dental volunteers—including 35 dentists; dental students, faculty and Dean John S. Sauk of the University of Louisville School of Dentistry; 25 local dental hygienists and hygiene students from Big Sandy Community and Technical College and ULSD; and office staff and family members of the volunteers.

The dental school dean, faculty and student volunteers, he said, "were true heroes. This is dentistry's future and they portrayed it well. We virtually had to make students leave to eat, because otherwise they wouldn't take breaks."

Dr. Collins says he signed on "because my wife Pam, my dental assistant, office manager and boss, said it was a good idea." He and Pam traveled to Tennessee for the Harrogate expedition to get a feel for what it would be like.

"I did nine extractions on one patient, and then we saw her later that night at a local restaurant. She gave me a big hug and she told me this was the first time she'd been able to eat in months. She said 'it might hurt a little now, but I'm not in pain anymore.'

He worked both days in Pikeville on three hours sleep, and had blisters on both feet the size of quarters from running around making sure everything was running smoothly. But he's not complaining.

"It's really doing dentistry at its best," Dr. Collins added. "You actually see how you are helping patients."

Dr. Collins says his life experience might give him a different perspective on how important programs like RAM can be.

After high school, he joined the U.S. Air Force. After five years of service, he returned to Pikeville and started work for a heavy equipment dealer as a mechanic.

"I was fired six years later for organizing a union, so I went back to school," said Dr. Collins. "I majored in biology and chemistry and graduated in three years with a 3.98 GPA. I was accepted at the University of Louisville School of Dentistry in 1987. I graduated in 1991 and came back to Pikeville. I went into an old practice that was producing a gross of $40,000 a year. The equipment was 30 years old. My first year out I made less than $200.

"In 1999 my practice burned from arson. It was Oct. 15, I had just paid my taxes and paid the last equipment payment and I had to start over again. It took six months to settle with the insurance company and I was again destitute. I am now in a thriving practice.

"You see, these people we are treating with RAM are my people, I have been in their shoes, I know what a toothache is with no money to see a dentist. I know what aspirin on a tooth feels like, I know what it means to have a tooth extracted because you can't afford endodontic therapy. This is where I came from and I have not forgotten those that are still there. They have made my practice and it is to them I owe my success. This is why when Stan Brock and Judge Rutherford offered the opportunity to give back I did so. These are my Appalachian people, they are proud Scot-Irish heritage and do the best they can for their families and do not ask for much, these are the poor working people of Appalachia."

A few weeks before the Pikeville RAM expedition, he added, a 28-year old mother-to-be came to his office.

"She had only four teeth, two canine and two central incisors on the maxillary arch. Between the centrals and canines she had fabricated two pieces of acrylic that were wedged in place that she called her partials. My heart went out to her. I extracted her teeth and RAM paid for the denture I made. The appearance change was dramatic. When I seated the denture she broke down and cried. He husband came back and said 'Now we can go to Shoney's to eat.' My heart again broke. This meant so much to them. It gave her an opportunity to go back into the public eye. It allowed her to seek a better job.

"With all that said, this is what RAM is all about. It is worth more than all the dollars you will ever put into your pocket. It is a feeling that you cannot describe."

Dr. Collins says they are already contemplating some changes for next year's RAM expedition. Following up on an idea from Dr. Elliott, the planning committee will ask the KDA Foundation to purchase 10 portable dental chairs and hopes to fund 10 more through Forward Pike County, a charitable arm of the Pike County Fiscal Court. With 20 extra chairs and working two shifts each day instead of one, he hopes they can treat significantly more patients, plus use the expedition as a model for a disaster preparedness plan in their community.

On the second day of the Pikeville expedition, Dr. Collins found a handwritten note left by a dental patient.

"Thank you," it read. "I've seen you weary with faltering steps but you kept working. I've seen you put your needs aside to meet those of another. I've seen love."

For more information about Remote Area Medical, to volunteer for an upcoming expedition or to make a donation, visit the Web site: www.ramusa.org.

Reminder: check on licensing rules before volunteering in another state

Regulations for dental professionals interested in providing dental care in a state other than the one they are licensed to practice in vary from state to state.

For specific requirements to practice in another state, check with the state dental board before volunteering. The ADA Department of State Government Affairs can provide assistance. Call toll-free, Ext. 2525 or e-mail govtpol@ada.org.