Thousands of people in the coal mining country of southwestern Virginia waited up to eight hours through storms and muggy heat this weekend to get free medical attention from volunteers gathered at a county fairground.
At least 73 people slept in cars overnight, and a handful pitched tents around the fairground in anticipation of the long lines, said Tony Roberts, 49, a Wise County resident who organized 202 Lions Club volunteers. More than 800 volunteers ran the clinic, sponsored in part by the Remote Area Medical Volunteer Corps.
On Friday alone, Terry Dickinson, 62, of Richmond and nearly 60 other volunteer dentists extracted about 1,300 teeth at the fifth annual free comprehensive health screening at the Wise County Fairgrounds. They also completed about 550 fillings and 125 teeth cleanings that day.
"They look at their teeth fatalistically," Dickinson said of the clients in a telephone interview. Many people who came to the clinic lack health insurance and had never visited a dentist before.
"Their dad, grandfather, uncle all lost their teeth," said Dickinson, executive director of the Virginia Dental Association. "That's what happens to you. That's just life."
About 3,600 people received medical attention, including vision and hearing screenings, Pap smears and electrocardiograms at the annual clinic, which began at 6 a.m. Friday and ends this afternoon.
"It's a fairground that would ordinarily have chickens or cages or pies or jars of jam," said Claudette Dalton, an anesthesiologist at University of Virginia hospital in Charlottesville and medical coordinator of the clinic.
Although a few children came to the clinic, most patients were adults or senior citizens who cannot afford medical care from a local provider.
Volunteers who interviewed patients said many of them are former miners who took positions as part-time clerks at Wal-Mart and other local businesses after mine jobs disappeared.
Some volunteers who have participated in medical missions in developing nations compared the area's health profile with what they have seen in the world's poorest countries.
"It's sadder to me the conditions we see here because we have [good] health care here," said Audrey Snyder, an associate professor at the University of Virginia School of Nursing who has also volunteered in El Salvador and India.
Health professionals pointed to preventable diseases and conditions, such as tooth loss and cervical cancer, as evidence of the disparity in services available to rural populations relative to those in more urban settings.
"It's because they don't have that economic margin to make routine care or preventive care choices," Dalton said.
"They don't have an advocate. They don't have a Ryan White," said Dickinson, referring to the Indiana teenager for whom HIV/AIDS health care legislation is named. "But, they're not the complaining type."
At last year's clinic, a doctor found that a woman had cervical cancer. She was treated at a nearby hospital.
"In the U.S., there should not be anyone who gets it," said Kathie Hullfish, a University of Virginia assistant professor of obstetrics and gynecology.
It's very common to see women who have not had a Pap smear to detect pre-cancerous abnormalities "in 10, 15, 20 years," Hullfish said.
The federal Centers for Disease Control and Prevention recommends Pap smear exams every one to three years.
In developed countries with strong screening programs, rates of cervical cancer are low. In the United States, nearly 11,000 new cases of invasive cervical cancer will be diagnosed in 2004, and about 3,900 women will die of the disease, according to American Cancer Society projections. About 270,000 women were found to have breast cancer in the United States in 2003, and nearly 40,000 died.
As Dickinson worked on teeth Friday, a man asked him to go to his pickup. In it was a freshly baked blackberry cobbler made by the man's wife. Dickinson, who has volunteered for the past five years, had treated the woman last year.
"They may not have a lot of money, but they can sure bake a mean cobbler," he said.