at least, after my experience of today, which I am still processing, that is what I hope I can offer you.
I am in Wise County Virginia. I am staying about 2-3 miles from the Wise County Fairgrounds at the home of va dare, who was kind enough to offer me hospitality, so I could volunteer at the annual event that is Remote Area Medical and Missions of Mercy co-sponsored. And, and this is relevant to my experience, is a major effort of the Virginia Dental Foundation.
I thought I had some concept of the healthcare crisis. Having written about this annual event, in a diary titled This may break your heart - and it should, I thought I was prepared for my volunteering.
I was not. Today I spent from 7 AM to 5:30 PM - with only about 3 minutes off - working in dental triage with outstanding dentists trying to process as manhy patients as possible. My heart was broken time and again, and my spirits were lifted by the dedication of all who volunteered.
And I was angered and ashamed at what I saw, which is the only reason I am attempting to explain in this diary.
I saw people in their twenties coming in to have multiple extractions, as the only way to stop the pain that they could afford. I saw people in their 40s and 50s asking for all their teeth to be pulled, in the hope that eventually they might be able to get dentures.
Let's stop. Before we go any further, there are cultural issues, where people consume large amounts of Mountain Dew, use too much tobacco, do not do basic dental hygiene. I know all that. But in Wise County the average income in around 13,000/person. There is no public transportation to get to a dentist, even if you had dental insurance, which most people do not. And the dietary issues that contribute to poor dental health are readily visible in other ways, such obesity, Type II diabetes, and other problems.
Health care in this nation is not merely an issue of getting insurance for everyone. There has to be access to care. There has to be basic nutritional education, and basic nutritional support, or we will be dealing with serious medical and dental problems downstream that are far more expensive to treat, and which rob us of the productivity of many who should be in the primes of their lives.
Today I was a paper pusher, but in the best sense of the word. I worked with outstanding dentists - people whose personal lives are rich. One is man who is heavily involved with Trout Unlimited, and who has helped get fish tanks into schools as an important way of focusing student learning. Another has been president of the Dental Association. Another has decided to run for House of Delegates here in Virginia, and when her campaign manager wanted her to skip this event Carol Pratt made it clear that her commitment to this service came first.
I handled the forms, writing down the instructions of the dentists, in some cases, signing their initials for them. I had to learn the appropriate abbreviations, to be able on occasion to hold up X-rays while a doctor examines the teeth. My job was to assist in any way that could allow the dentist to screen and evaluate more people. I had to keep an eye out on things like high blood pressure, or certain kinds of medication, or if a complete check of allergies and medicines had not been taken (fortunately rare). At times one doctor would be working two chairs simultaneously, and we might have only 4 chairs in use with two doctors. At other times we had 7 dentists and 8 or 9 chairs being used to screen patients. We had to ensure they got the proper tagging - wrist bracelets for the procedure for which they would heading - extractions, fillings, cleaning. As the number of people waiting to be screened grew, and the backlog of work expanded, sometimes we had to ask which of multiple choices the patient most wanted, because we could only offer one out of a bevy of things to address multiple problems.
By the end of the day we were screening, telling them to come back early tomorrow for xrays and then they would be able to get their extractions, or their fillings.
I arrived at 6 AM this morning. Already there were no further slots for people seeking vision exams, they were already gone. While setting up on Thursday they began to register people and in some case begin treatment, even though officially the doors did not open until 6 on Friday - some friends of mine were already doing registration by 5:30 this morning. But then, some people had been camping out since Tuesday, hoping to guarantee getting treatment.
I said I was angered and ashamed. We have politicians who oppose offering access to meaningful medical care, who will fight with our teeth and their nails against a public option, for whom the contributions of the insurance companies are more important than the basic medical and dental health of the American people. That angers me. So does reading that Rep. Virginia Foxx thinks no American goes without health care, believing that in a crisis anyone can go to an emergency room. Well, I am in rural America. There is no public transportation. Many people do not have cars. How do they get to that emergency room? And why, pray tell, should they have to wait until it is an emergency before having their medical needs addressed?
Consider this event as a giant emergency room. Remember that the term for what I was doing was triage. I want you to think of the origin - deciding what should happen with military casualties. And remember that there were three categories. Category one is those needing immediate treatment. category two is those who can wait but will receive treatment. And the last category? Those for whom there is nothing we can do but ease their pain, because they are going to die.
Sitting before you is a person who is about to have all her teeth extracted, that is, all those that have not already been extracted. She won't be able to get this until tomorrow, because we cannot take the necessary xrays until then. So she will sleep in her car tonight, if she can sleep, then come in, get xrays, have her teeth pulled, and we have no ability to offer dentures. Perhaps she can go into the lottery for next year to get dentures. And until then? Please, imagine what your life would be if that is how you had to live for one year, or even more.
People have to have hope. if the only hope is that they can get their teeth pulled for free, are we denying them something important?
It is wonderful that all these skilled professionals give of their time. large numbers of dental students from VCU and UVa are here. Dental assistants volunteer, as do ordinary folk like myself. They come from other states to do what they can. And even though there are multiple similar events taking place during the course of the year, Wise is a focus, both because it is in the heart of an area that is hurting, literally hurting, from untreated basic needs - that includes nutrition as well as medical and dental care.
That goes further - there were free clothes, free children's books.
And everywhere there was press. I heard a crew talking in German. I saw a Japanese videographer. There were print reporters, radio reporters, local TV crews.
There were politicians making appearance, both Democratic and Republican. Carol Pratt was there as a medical professional, not a political candidate. And Governor Kaine volunteered and registered people.
The world and the nation have an opportunity. They can absorb the press coverage and be ashamed and angered that such an event is necessary. This is the tenth year of this particular event. Today we processed 1600 people. I am told in previous years 1,000 in a day would be a lot. And still we could not even address any of the needs of some who came, merely screening them and telling them to come back tomorrow.
We can be proud of the generosity of the American people, those individuals who serve at events like this, corporations and community associations that provide services and equipment, fraternal groups like the local Lions Clubs who feed the many volunteers, the local hotels who offer a very reduced rate for volunteers.
BUT IT SHOULD NOT BE NECESSARY. SO MANY AMERICANS SHOULD NOT HAVE TO DEPEND UPON SUCH GENEROSITY.
I just shouted. No, I SCREAMED. I wish I could be like Peter Finch in Network, in the performance which earned him a posthumous Best Actor Oscar - because I AM MAD AS HELL - and we should not be taking it any more.
I have often argued that we need to totally rethink American public education. My scope was too limited. After my experience today, I know that we need to totally rethink American medicine, including health education, nutrition, exercise, the way corporations are able to hook people on destructive habits of eating and drinking.
We need better access to basic health and dental care, perhaps in schools, or in communities.
Those doctors and dentists willing to volunteer at an event like this should also be willing to take medicare and medicaid patients, and then leading the charge to change the system.
As for some in positions of political leadership, who are unwilling to do the hard work of helping the American people? I wish we had the ability to recall Federal elected officials, because I would happily sign on to the effort to remove any and all who will not step up to the crisis.
It is, as President Obama noted, a financial crisis. Having people resort to Emergency care is expensive. The loss of productivity due to bad health is even more expensive.
But more than a financial crisis, it is for me a moral crisis. We are saying to too many of the American people that they are not worthy of our respect, that they are less than equal to others, perhaps because they live in poor rural communities that we have all but abandoned, or inner cities from which some are willing to wall off their own lives.
We can talk about many aspects of American life that need to be fixed.
In the meantime, people are dying. Getting all your teeth extracted because the only dental care you can afford is RAM at Wise in July is a kind of death, not dissimilar from that of an Aids carrier, if you can remember in the movie Philelphia, where Andy, the character played by Tom Hanks tells the lawyer played by Denzel Washington about the social death that precedes the actual physical death.
This diary is perhaps a screed. It is a SCREAM. It is a cry.
Tomorrow I will again spend 10 hours or more helping with dental triage. Sunday morning I will do the same. I am not a dentist, but it is help I can offer the professionals who are trying to make a difference.
Perhaps if a few people read these words and respond, I can help make more a difference by writing. I hope so.
I am angry and ashamed. But I am also honored to have worked with the dedicated professionals and ordinary folk volunteering here.
And I am honored by the trust of those who come to us for help, the ordinary folk whose lives have for too long been ignored. IT is good that we pay them this attention. It is not enough.
I feel no peace right now, but it is always my hope, so again I end as I almost always do.
Peace.