Medical assistant Liz Rosales administers a shot to James Fields at the Arlington Free Clinic on Monday in Arlington County. (Matt McClain/The Washington Post)

One by one, the winning lottery numbers were called, 20 Arlingtonians who suddenly had a shot at medical care they could not afford anywhere else.

More than 90 patients-in-waiting had lined up outside the Arlington Free Clinic for the drawing — whites, blacks, Hispanics and Asians, many with children in tow. All had little money and big medical worries. All waited to see if this was their day.

“Was that D-3? What was the letter?” someone asked.

“Z as in zebra,” answered Jody Steiner Kelly, director of clinical administration. A person in the crowd exhaled audibly.

Then Kelly called: “Y-2.”

“This is good, so good,” Paschal Nash of Arlington County said after winning a spot in a lottery that allows her to be treated at the Arlington Free Clinic. Nash has lupus and also suffered a stroke. (Matt McClain/The Washington Post)

Paschal Nash, 53, half-rose out of the seat of her walker as the people around her made little cries of happiness. She clutched a ticket labeled “Y-2.”

“Excited? You just don’t know,” the unemployed construction manager said later, a smile creasing her face. “This is good, so good.”

Being chosen in the monthly lottery can be life-changing for those who are poor and without health insurance in Arlington, one of the nation’s wealthiest counties. Each month, about 100 people line up for the chance, a multilingual mix of hope, desperation and determination.

“They could be me, they could be anyone I know and love,” said Jyl Pomeroy, who started at the clinic as a volunteer years ago and is now nurse manager of its mental-health program. “It’s not fair, in my view, that this many people have to struggle every day to survive.”

Last year, volunteers at the clinic helped enroll about 100 applicants in insurance plans through the Affordable Care Act, and they expect to do the same this year. But not everyone qualifies, especially in Virginia, which has declined to expand Medicaid coverage to 400,000 low-income residents. So the clinic remains in demand.

Sandra Leonard Kyle, a breast-cancer survivor and former teacher, arrived in 2011, having lost her job and her health insurance. She’s been treated for diabetes and high blood pressure at the clinic, as well as thyroid problems.

“I had run out of meds. I knew things were out of whack,” Kyle said. “Thank God, and the clinic, I made it this far.”

Naseem Jan looks up at registered nurse Margie Badman after getting a shot at the Arlington Free Clinic on Monday. (Matt McClain/The Washington Post)

The clinic was founded 20 years ago after leaders of the Arlington County Medical Society asked a young radiologist named Joseph A. Backer to chair the society’s indigent-care committee. He said he would, but only if the society members would volunteer at a free clinic.

Backer borrowed a handbook that described how to set up such a clinic and talked the principal at Thomas Jefferson Middle School into letting him use the nurse’s office as an exam room one night a week.

The pharmacy was a janitor’s closet, stocked with sample medications. People waited for appointments on chairs in the hallway.

Executive Director Nancy Sanger Pallesen, who will retire at the end of December after leading the clinic since its founding, kept the medical records in her basement during those first few years. She realized almost immediately that her clientele’s medical needs were complicated; women needed obstetrics and gynecological services, and both men and women needed cardiologists.

So Backer and a host of others began recruiting. The clinic now has 32 paid staff, and 550 volunteers who are the heart of the operation. They range from former patients who have become clerks to pharmacists and psychiatrists, nurse practitioners and pathologists, oncologists and dermatologists, radiologists and surgeons.

The clinic — one of more than 50 free clinics in Virginia — prides itself on providing “whole-person” care for more than 1,700 patients, meaning that regardless of what brings people in, they can get treatment for any physical or mental health need. Spanish-speaking interpreters are always available, and there are also volunteer translators in many other languages.

With an annual budget of $2.75 million, most of it from grants and private donations, the clinic is highly rated by Charity Navigator and the Greater Washington Catalogue of Philanthropy.

“They’ve made themselves a critical component of the safety net,” said Nicole Lamoureux, executive director of the Alexandria-based National Association of Free and Charitable Clinics.

Clients have to be Arlington residents over 18, without insurance, who have lived in the United States for at least a year and qualify as low-income. Full-time college students are not eligible, because they usually can get medical care on campus. About half of the clinic’s patients come through the lottery; the other half are sent by Virginia Hospital Center, which does all of the clinic’s lab and radiology work.

Stephen Hugh arrived from the hospital on June 13. He had had a stroke and was diagnosed with diabetes, high blood pressure, aphasia and other ailments.

Hugh lost his insurance along with his accounting job three years ago and had simply stopped going to the doctor. Throughout his stay in the hospital, he worried about the mounting medical bills.

“I ordered an orange for lunch, because I figured an orange was the cheapest thing they had,” he said. A hospital social worker recommended that he go to the free clinic after he was discharged.

He said he was pleasantly surprised by the bright cheerfulness of the office suite, on the ground floor of the new Halstead building at Columbia Pike and Walter Reed Drive.

“They greet people by name,” Hugh said. His medical team “targeted my blood pressure, diabetes and blood cells. . . . My diet changed dramatically. I’m better.”

Kyle, the former teacher, participates in one of the patient support groups at the clinic focused on coping with chronic disease. She will turn 65 in a few months and become eligible for Medicare — simultaneously losing her eligibility for the free clinic. The staff there has promised to help her find new medical specialists.

“I’m going to hate to leave,” Kyle said. “I know I have to, but I’m going to hate it.”

Next week, Nash will make her first visit to the clinic since winning the November lottery. She will go over paperwork with the staff to prove her eligibility for services and find out the date of her first medical exam.

Nash, who has lupus, has suffered from a herniated disc since a car accident in January. In April, she had a stroke and lost a portion of her eyesight. November was her third attempt at the lottery.

“I worked all these years, and to not be able to have medical care when you need it is hard,” she said. “I’m really thankful they are here.”