Remote Area Medical: Making Global House Calls
About 50 years ago, Stan Brock, founder and president of Remote Area Medical (RAM), lived with the Wapishana Indians. In their isolated area in the upper Amazon basin of South America, access to healthcare meant a 26-day walk. He endured the same privations they did. He contracted malaria and dengue fever, and he had other medical problems, all with no treatment available. Brock survived, but during his 15 years living with the indians, he saw others die.
Brock went on to star in the television series Wild Kingdom, but he never forgot what life had been like in the rainforest and the suffering he had witnessed.
RAM is Born
Motivated by his experiences, he came up with the concept of an all-volunteer healthcare program that would provide free services to people in need in remote parts of the world. In 1985, RAM was born, with a mission to provide free medical, dental, vision, and veterinary care to underserved people living in isolated areas within the United States and around the world.
Today, RAM includes hundreds of volunteer doctors, dentists, ophthalmologists, optometrists, veterinarians and support staff, who participate at their own expense in weekend expeditions to bring health services to needy people. Based in Knoxville, Tennessee, 60% of its expeditions are in rural parts of the United States, mainly in Virginia, Kentucky, and Tennessee. RAM volunteers treat people who are unemployed or have no health insurance.
RAM also operates expeditions to Guyana, South America, its main overseas focus. It provides an air service to fly medical personnel to remote areas to supply treatment to indigenous people, and it runs a cervical cancer and women's health program.
RAM carries out its expeditions only in areas where it has been invited. Local groups such as the Lions Club and churches help sponsor RAM in their areas, and the clinics are held in schools, community centers, fairgrounds, or convention centers. RAM brings its own equipment, supplies, and volunteers and sets up its clinics at the site.
View from a Volunteer Ophthalmologist
One of RAM's many volunteers is Dr. Paul Wittke, an ophthalmologist who practices in Knoxville and two nearby towns. He has worked with RAM for about 20 years. After hearing of a RAM expedition to Mexico, he decided to take part and completed two expeditions there. Dr. Wittke then started volunteering for local missions in the United States. He says his incentive was "to use my God-given talents to help serve the community and other people who needed help." Dr. Wittke, who is active in his church, says his Christian values motivate his work.
Dr. Wittke's work in the US is confined to Tennessee, since other states don't recognize out-of-state medical licenses. In Tennessee, however, the law allows out-of-state doctors to volunteer within the state, so medical professionals from around the US and Canada work for RAM in East Tennessee and Appalachia.
On a typical expedition, vision patients are registered in the vision clinic. If glasses are needed, the patient will have his or her eyes measured before seeing the doctor and get a prescription. Glasses are made on site at a RAM laboratory so the patient will have a pair of glasses upon leaving. The ophthalmologists and optometrists also provide an eye exam and check for glaucoma, cataracts, and retinal disease. The vision checkup and the eyeglasses are free.
In Guyana, the conditions are less accommodating. RAM volunteers bring their own sleeping bags, tents, food, and purified water on the expeditions, which are held in March and November. Living conditions are basic. "It's camping, is what it is," maintains Dr. Wittke. Flatbed trucks are used to transport people, but adventurous volunteers have parachuted out of airplanes with their supplies into the jungles where the villages are located. Clinics are set up at schools and churches in these villages. In addition to carrying in as much as they can of medical supplies and equipment, the vision team brings three or four suitcases of eyeglasses collected by the Lions Club to donate to the patients.
Another foreign expedition that Dr. Wittke participated in took place in India in 2000. A team of ophthalmologists, a general surgeon, and a physician traveled to four or five different locations to provide their services. He characterized the reception given to RAM on expeditions by the local populace as positive. "They're very happy to see us." He described the Guyanese they serve as being "very appreciative" of the eyeglasses, sunglasses, and baseball caps brought to them.
A Volunteer Dentist Fills a Need
Dr. Jim Jenkins, a dentist, has only recently begun working with RAM. He started in March 2008, inspired by a 60 Minutes television show's segment on RAM. On a Friday afternoon, he called RAM to offer his services and was told that he was needed immediately. Dr. Jenkins said, "I had to fax my license on a Friday afternoon at 1:00, and I drove all night. I got down there Saturday morning about 2:00 a.m...and I started to work. That weekend I was beat." Now he participates on expeditions once or twice a month.
On a typical RAM expedition in the US, people needing care will begin to congregate at the site on Friday. Usually 500 to 1000 people appear for treatment. Many will camp out all night, winter or summer, to ensure that someone sees them. About 250 to 500 volunteers, administrative as well as medical, take part in the process of getting patients seen. Registration starts at 6:30 on Saturday morning on a first come, first served basis, and the doctors determine what kind of care the patient needs.
For the dental patients, dental hygienists perform teeth cleanings, oral surgeons perform extractions, and general dentists, like Dr. Jenkins, do extractions and fillings. The work doesn't end till usually 6:00 pm or until all the patients are taken care of on Saturday. If there's an overflow, patients are seen on Sunday, and the doctors work to get all the patients treated.
"The problem is, we never have enough [time] to get them all done. And that's my saddest time," Dr. Jenkins said. "The feeling you walk away on a Sunday night is mixed emotions. I couldn't do the last 20 people. They had to be turned away, but what about the 75 I did do? They'll hug you, they'll kiss you, they'll make you cry."
Dr. Jenkins recalls in particular a 39-year-old woman in Cleveland, Tennessee who had never been to a dentist. She had only 16 teeth, and they were decayed down to the roots, infected, and discharging pus. She had been treated by RAM before and had five teeth removed. Dr. Jenkins agreed to remove the teeth that were hurting her the most. Since the patient had abscesses, he asked her what she did for the pain. She told him, "Well, I take a coat hanger, I open it up, I get a blow torch, and I heat it up and stick it up in the middle of my tooth." Dr. Jenkins decided to take out 16 roots on the patient and alleviated her pain.
Since RAM's Appalachian patients do not receive regular dental care, if any, Dr. Jenkins and the other dental volunteers see dental problems to which they are not usually exposed, such as cancer and leukoplakaia, a precancerous condition derived from chewing tobacco or using snuff. If the condition continues, it leads to cancer of the mouth. For the dental student volunteers who work on expeditions, it is genuinely a learning experience.
Volunteering as a Way of Life
Dr. Vicki Weiss, an optometrist from Virginia, has been with RAM for 10 years and has treated patients with glaucoma, cataracts, diabetic retinopathy, macular degeneration, and conditions associated with coal mining. Volunteering is not new to her, as she and her husband worked with Volunteer Optometric Services to Humanity (VOSH) while in school and had a chance to participate in missions to Central America.
Dr. Weiss was introduced to RAM through a patient, and she works on expeditions in Virginia and Tennessee. Her most recent clinic was in Buchanan County, Virginia, where the RAM volunteers treated about 325 people over the weekend. "I've always done this kind of work. It's pretty much why I went into optometry," she said.
Conditions for Dr. Weiss vary at the different expeditions, but she tries to replicate the office environment as closely as possible. She says that an interesting and fun feature of her work with RAM is the opportunity to work with other practitioners she doesn't know and with whom she has never worked.
In working with patients, she sees people who are unemployed and don't have health insurance or those who are underinsured. She remembers a patient who couldn't afford a new pair of glasses and had been wearing the same worn glasses for eight years. She also remembers the family who came from Tennessee to Virginia to seek treatment. Another group of patients Dr. Weiss sees are in their twenties and thirties who are injured and aren't working or who have a lot of health conditions. She characterizes these patients as "generally very nice and lovely." Like Drs. Wittke and Jenkins, Dr. Weiss sees patients who are happy and excited to see them.
Since RAM only provides treatment on a temporary basis, follow-up care for those who need it is an important part of their mission. RAM doctors usually do not practice in the local area, so nearby doctors have to be found to provide care on a regular basis. This can be easy or hard, depending on the location.
Reaching More People
Drs. Wittke, Jenkins, and Weiss all plan to continue working with RAM. Besides his work on expeditions, Dr. Jenkins is also collaborating with a Pennsylvania legislator to help bring RAM into the state. Because of the exposure it received on 60 Minutes, RAM has seen increased financial support and increased interest in bringing its mission to areas nationwide. The organization is planning to expand to Virginia, Maryland, and the District of Columbia.
Of RAM's foreign expeditions, one will be taking place in Guyana in November 2008 for two weeks. Three cataract surgeons will be performing surgeries on board a Navy hospital ship. Other sites that RAM will work in include Honduras and Africa, where the volunteers will work with members of the Masai tribe.
About the Author
Shyla Nambiar is a freelance writer based in Atlanta, Georgia.
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