Hidden Hurt

The Healing Fields

VIDEO & PHOTOS: Hundreds of uninsured and underinsured Americans flock to Wise County, Va., every year to seek treatment at a makeshift field hospital operated by the Remote Area Medical Volunteer Corps.

Brock often pilots crucial supplies himself in a donated World War II vintage C-47 cargo plane. He and his volunteers brave extreme conditions, civil unrest and piranha-infested waters to bring basic medical treatment, dental and eye care, and even veterinary services to remote towns and villages in Haiti, Guatemala, Nepal and Guyana. He says he can't count the number of nights he's spent away from his home in Knoxville, Tenn., a 90-year-old schoolhouse he rents from Knox County for $1 a year that also serves as the volunteer corps' headquarters.

Because he lives in Tennessee, Brock has become increasingly focused on the plight of the poor in his own back yard -- Appalachia -- where many people in places such as Wise County go for years without seeing a doctor or dentist.

This is coal country, with an economy that has ridden a boom-and-bust cycle from the arrival of the railroads in the 1880s to the passage of the Clean Air Act almost a century later. The richest seams of coal have dwindled, and many of the remaining jobs have been replaced by mechanization. According to the latest figures from the U.S. Census Bureau's American Community Survey, the poverty rate in Wise County is 19.2 percent -- more than twice that of the rest of Virginia. The per capita income is only about $14,000 a year.

Life is tough here. "I don't want to say it's harder here than any place else," says Sister Bernadette Kenny, a nun from the Medical Missionaries of St. Mary, "but it's damned hard. Pain is pain."

Kenny is a registered nurse who has been ministering to the needs of the people in these hills and hollows for years. Her mobile Health Wagon, which treats more than 2,400 people a year with funding from private foundations and patient donations, is a welcome sight as it trundles along the local roads.

It was Kenny and a fellow Health Wagon nurse, Teresa Gardner, who persuaded Brock to bring his volunteer medical corps to Wise after helping him at a clinic in Tennessee in 2000. They told him how badly their patients needed access to specialists, dentists and eye doctors. From the early 1980s to 2000, the Harvard School of Public Health has found, life expectancies in Appalachia have dropped for both sexes.

In Wise County, "there are patients literally dying of diabetes," says Gardner. The specialists who can help them are a two-hour drive away in Kingsport, Tenn., she says, "if you have insurance."

But many don't, which is why the three-day clinic at the county fairground has become such a huge event. On Thursday night, after the volunteers have finished setting up, Gardner peers out of the fairground office command center. Darkness has settled over the mountains. Hundreds of patients have lain down to sleep. Others continue arriving throughout the night.

Linda Yates, a compact woman of 60, gets here at 2 a.m. She's looking for answers.

She's the daughter of a coal miner, the mother of seven children and a grandmother. She is also a day-care provider and foster mother to countless children, who come to her from the Dickenson County social services department, often with special needs, sometimes without even a change of clothing. She feeds them and dresses them and teaches them for however long they stay with her. She speaks of each with a fierce maternal protectiveness. "If they come into my home," she says, "they will be loved."

Yates and her husband, Lonnie, a disabled mine supervisor, left their small house in the tiny community of Birchleaf, Va., at midnight. They wanted to get here before the clinic opened so Linda Yates would be able to see the doctors on Friday. To make the trip, they had to line up two babysitters to care for the 11 children in their house. They rarely go anywhere overnight.

Yates looks around at all the tents and people camping, grateful to be here. Her foster children all have Medicaid. Her husband, a 61-year-old military veteran who has survived two kidney transplants, and who is battling skin cancer, gets much of his care through Veterans Affairs benefits. But she has no health insurance, and three years ago, she was diagnosed with diabetes at a free screening event.