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.

"When was the last time you saw a regular doctor?"

"It's probably been 12 years."

She discusses her diabetes and gets a stick test for her blood sugar. She hasn't eaten since the previous night, but at 263, her blood sugar is far above the normal level -- about 100. "It was 400 last night," she says. "I took the insulin, but nothing works."

Last year, the Health Wagon nurses started urging Yates to come to the 2007 clinic, to see specialists and get the tests she needed to better understand her problem. But she had to put off the trip when Lonnie became seriously ill. "I ignored myself for a long time," Yates says. Now she realizes that too many people are counting on her for her to falter. "I've got to be there for my children, my grandchildren and my husband."

When Yates arrives at the medical barn and sees the makeshift examination rooms partitioned off with sheets, a smile of admiration spreads across her face. This is a place after her own heart: "It shows you can make do with less and get it done."

In a surgical tent behind the medical barn, Vincent Voci, a plastic surgeon from Charlotte, removes a disfiguring cyst from a man's cheek.

The cyst is the size of a large egg, but it is not what brought Chester White here from Bristol, Tenn., an hour away. He actually came to see a dentist but learned he could see a dermatologist while he was waiting. The cyst comes cleanly out of the shell of skin where it had been growing for eight years. Then White's adult son comes from the dental tent and also has a cyst removed from his face.

Voci stitches up the torn and bleeding finger of a young man who was working on a tin roof. And he removes what appears to be a slow-growing basal cell carcinoma from a woman's face.

Patients who learn they have cancer, heart disease or diabetes often face major barriers getting the follow-up care they need, even with the ongoing help of the volunteers. Some patients are sent to local doctors who agree to provide the care for free. But area hospitals and health-care providers are already overwhelmed by the number of sick and uninsured people who need treatment but cannot pay, Claudette Dalton says. "We can't stretch resources any thinner," she says. "You can't keep your office or hospital open without some paying patients."

Follow-up care is often available through the University of Virginia Health System in Charlottesville, home to the largest contingent of medical volunteers here. But Charlottesville is about a six-hour drive from Wise.

"These folks still have a lot of large cracks to fall through in getting follow-up care," says Karen Wilson, the executive director of Brock's organization. "Sometimes it's an easy task. Sometimes it's difficult. Sometimes you fail. That's the reality."

Out in the field, Joseph Smiddy, a pulmonologist from Kingsport, is doing chest X-rays in the trailer of a truck he customized to serve as a mobile clinic for the early detection of lung cancer. He went to truck driving school to learn to drive the 18-wheeler. Now he visits remote areas, such as Wise, where he grew up.