Each summer a pop-up clinic in Wise County, Virginia providing free medical, dental and vision care attracts thousands of people from a multi-state region — along with journalists eager to write about the healthcare needs of poor people in Appalachia.

British philanthropist Stan Brock founded Remote Area Medical (RAM) in 1985 and has since enlisted more than 100,000 volunteers to deliver more than $112 million worth of free health care services to 700,000 individuals and 67,000 animals at mobile clinics around the country.

About 2,500 people were treated at this year’s clinic at the Wise County Fairgrounds. Brock said he was asked to bring the clinic there two decades ago, and it’s been held annually since.

The Wise County clinic is not the only one set in Appalachia, but it receives outsized attention for its location in the heart of Southwest Virginia coal country and its illumination of the challenges facing rural healthcare systems across the United States. Patients in need of care flock to the clinic from communities in Virginia, Kentucky, West Virginia and Tennessee.

Health systems in that region have been hard-pressed by declining revenue and over the last few years have pursued a merger that will could affect services for decades to come — but the potential merger probably likely be settled until September.

In the meantime, people start lining up the night before for a chance to get long-running medical issues resolved at the Wise RAM clinic.

“The thing about the Wise, Virginia phenomenon is that it’s outdoors on a fairground, which gives it a unique atmosphere,” said Brock. “When you read the coverage of all of these things — in every case, I think they talk about why should people in the world’s richest country be having their care in a chicken coop and horse barn? It’s the fact it’s out there in the middle of a field, and these people have to undergo the hardship of waiting outdoors — not even in the shade, often in the rain — that all adds to the drama.”

Those images, painted in prose and photographs, are beamed out to audiences around the world.

Journalists often focus on the people waiting in the parking lot. The New York Times story on the 2017 clinic started there, as did coverage from an Australian outlet. Others, such as Bristol’s WCYB, the Washington Post and the UK Daily Mail opened with scenes of patients describing their ailments to doctors and nurses. The Bristol Herald Courier and Roanoke Times both led with people receiving dental care — a popular scene that’s been used in years past by journalists as well.

The sheer size of the RAM clinic and the scope of suffering by those attending provides much of the lure for journalists wanting to put a face on the challenges facing the country’s healthcare system. The pain is real, and the clinic has grown over the course of multiple presidential administrations. In 2009, the first year of President Barack Obama’s administration, NPR and the Huffington Post were among the outlets covering the RAM clinic in Wise County. In 2013, filmmakers produced a documentary when the RAM clinic set up at Bristol Motor Speedway.  

This year, the political hook was two-fold: A new president, whom Brock said should have been visiting the Wise clinic, and a Virginia governor’s race with a doctor as candidate, who did visit.

The years of coverage of the Wise County RAM clinic feel like an overwhelming accumulation of untreated illness and proof of the gaps in the nation’s healthcare system. With Congress in session and the Senate majority pushing for a vote on repeal of the Affordable Care Act, neither the clinic nor the stories that accompany it will likely be going away anytime soon.

Creative Commons License

This article was originally published by 100 Days in Appalachia, a nonprofit, collaborative newsroom telling the complex stories of the region that deserve to be heard. Sign up for their weekly newsletter here.