Stan Brock, the founder of Remote Area Medical, gets ready to call out more numbers for those waiting at dawn (most had been there since the day before) to be let in the fairgrounds for treatment at last year’s RAM clinic. (Michael S. Williamson/The Washington Post)

When the Virginia-Kentucky District Fair returned to Wise County recently, it brought funnel cakes and whole families smiling — a sight not too common here in the coalfields.

This week, another gathering on the Wise County fairgrounds will see thousands of people standing in the bright summer sun: the 16th annual Remote Area Medical clinic. Some of those same families and their friends will be among those who travel to Wise not for fun rides or local band favorite Folk Soul Revival but for something lacking in this county, this state and this country: access to health care.

And taking pictures with these downtrodden folk will be our politicians. Local representatives of southwest Virginia will travel to the fairgrounds to stand on a coal bucket and assure us they’re fighting against President Obama and the “war on coal.” These politicians won’t mention that with their votes to block Medicaid expansion, they ensured that the lines at RAM won’t be getting any shorter. But hating Obama in these parts is good politickin’.

If, as locals like to say, “coal keeps the lights on,” the lights have been getting pretty dim over the decades when you consider the price of natural gas, mechanization and a naturally dwindling energy source. The coalfields are dark these days. Clouds of poverty, unemployment and poor health hang over us.

While there’s no feeling quite like coming home to these mountains, you can’t help but notice the suffering behind these Appalachian walls. Good health isn’t exactly plentiful here. Folks who live in this area are far unhealthier than those in the rest of Virginia. According to the local mobile clinic that travels around Wise and a few other surrounding counties providing free care in between the clinics, we’re much more likely to die from things such as heart disease , pulmonary disorders or unintentional injuries. We’re also 50 percent more likely to die from suicide.

At 25 years old, I have a list of health issues that stem mostly from bouts with Hodgkin’s lymphoma as a child. I’m lucky that I can stay on my parents’ insurance for another year. Thanks to my hardworking mother, a nurse, and my stepfather going into the mines, I’ve always managed to have the care I need.

While I might be in line at RAM next summer, I’m fortunate now. Others aren’t as lucky. My aunt, a single mother of two, works full time at a nursing home and makes too much to qualify for Medicaid. She is a breast-cancer survivor who hasn’t had screenings or scans in several years because she can’t afford them. A few years ago, my grandfather, a retired miner and electrician, joined those who camp out at the fairgrounds to ensure a favorable number in the RAM clinic lines.

I’ve always been optimistic, with a hope that things would change. I used to think, “If they just saw what was happening here, they would do something about it.” Every year, however, the national media flock to the place I call home and tell the world about our suffering. And another year goes by.

The people who can change this don’t care. The entire southwest Virginia delegation, Republicans who have thousands of people in each of their districts who could be helped, proudly voted against Medicaid expansion.

This week, they will come to Wise County and shake the hands of people reaching out in need while standing in that hot July sun. In the coming months, they will go to the RAM clinics for nearby Buchanan and Lee counties, which lost their only hospital a few years ago.

This I’ve learned: One cannot compromise with people who have a compromised conscience.

I still love this area. It’s an Appalachian love story — with more than its share of heartbreak and tragedy.