I write this partway up the mountainside, in a small motel called the Appalachian Inn, where my room is small but comfortable. It has a shower, but not a bath, which my aching legs could really use. I am again volunteering at a RAM-MOM medical and dental fair in Appalachia.
We were supposed to set up this afternoon. In dental triage we saw well over 100 people, perhaps over 150, with many getting x-rays so that early tomorrow morning we could start treatment.
I saw some familiar faces among the dentists, met some new ones, and talked with Stan Brock, founder of RAM (and you can use the link to volunteer, contribute, or learn more).
And at a time when some on the Hill still pretend to argue that we do not need major medical reform in this country, I yet again come face to face with the reality that gives the lie to that hackneyed political rhetoric.
Grundy is in Buchanan County - not far from where W VA and Kentucky meet on Virginia's Western border. Its most notable appearance in the news in recent years was a shooting at the Appalachian School of law several years back. There is also a pharmacy school in this county seat, which has a population only a bit over 1,000. The county has a population of around 27,000, it is the poorest county in Virginia by median household income, and one of the 100 poorest in the US. Median household income is in the range of 22,000, and per capita at around 12,800. The population is almost 97% White.
The people we were seeing were almost all white, and poor. I could describe the poor state of their dental health, but I would merely be repeating what I said about what I saw in Wise. Some of those we see are local, others have traveled from West Virginia and Kentucky. Some are sleeping in the cars tonight,in the parking lot of the school where we are set up.
This will be a smaller event than Wise, and it is shorter - tomorrow and Sunday morning are available for treatment.
Two of the dentists with whom I worked in triage this evening were from out of state, one from West Virginia, the other from Southeastern Indiana. We again have dental students from Virginia Commonwealth and medical students from UVa.
Working with dentists gives me a different perspective on the health care crisis. Too often, as I have previously noted, we do not properly consider dental health as a part of overall health. Many who have insurance do not have insurance for their dental care. It is apparent that untreated dental issues are at least as widespread - actually, probably more widespread - than are untreated medical conditions. People do after all go to hospital emergengy rooms when they are quite sick or break a leg, but many can be in edcruciating dental pain and seek no treatment of any kind, because there is nothing available - until they come to a Mission of Mercy and seek out free dental care - by which time perhaps all we can do is pull many or somteims all of their remaining teeth, because they are too far gone to be able to save, or the bone loss will no longer hold the teeth.
I remember that many here responded to my diaries from and about Wise arguing that Remote Area Medical ought to do an event in Washington DC. I have some news on that front, after talking again with Stan Brock. He has met with the board that oversees DC medical issues, and they are open to the idea. And he will testifying before Henry Waxman's committee, he thinks this coming Thursday.
One issue of doing events such as this, or the recent fair at the Staples Center in Los Angeles, is the problem of allowing out of state medical professionals to volunteer. Apparently there is a part of the Federal tort reform that says that states are not supposed to restrict out of state medical professionals from volunteering at events where no one is paid for providing services, but states are still allowed to require a registration process that can be time consuming and discouraging. Brock told me that while RAM treated around 6,500 in Los Angeles (and he will send me the exact numbers and this was all medical, no dental, and thus by far the largest such event this country has seen), he could easily have treated another 3-4,000, but he could not get the permission for out of state volunteers to help out. Thus he had to turn people away, even though he had space to treat them, because he did not have enough medical personnel.
RAM-MOM should not be necessary. It is wonderful that doctors and dentists and those studying for those professions and even ordinary people like school teachers are willing to give of their skill, time, and energy to try to make a difference. But we cannot even make a dent in the backlog of those with untreated medical and dental problems, untreated because we still argue over access to medical treatment - unlike the rest of the civilized world, we do not see it as a basic human right. We have those willing to argue political theory, or justify large profits for corporate shareholders and salaries for their executives at the cost of millions who might be fully treated were those moneys redirected to something more humane.
I have friends who are doctors and dentists. They are entitled to make a decent living. Most do far better than that. Many are even more angry at insurance companies than are we ordinary folk, because with insurance companies controlling the rating agencies medical personnel get shafted on the standard-setting for reimbursement. It is one reason an increasing number of doctors are becoming radicalized enough to seriously advocate for a single payer system.
I will not now address the merits of different methods of financing, or of delivery of medical and dental services. I am tired. I have to be up at around 4:30 to be on site at 5:30 when patients start to come in.
Rather, I want to use my remaining words on something far more important. So long as Wise and Grundy and similar fairs in Los Angeles and Houston are necessary, our society is failing in a basic moral responsibility, to care for those in need. To consider any other value as more important is to pervert the discussion. It is to ignore the plight of our fellow human beings - and I do not care about their immigration status: we are not asking for proof of citizenship or residency.
Perhaps you can think of it this way. In the carpet bombing of the economy and the government by a system that has multiple health care lobbyists for each elected member of Congress, these people are the collateral damage from which to many avert their gaze, and pretend that the impact of the reality those we treat (and those we cannot treat) must endure, while others get rich at their expense, and at the expense of the soul of this nation.
I am tired. Tomorrow I will be on my feet for perhaps 10-12 hours, helping process as many as we can. By my volunteering the dentists can see more patients, treat more dental injuries, lessen a bit more the pain and suffering with which so many arrive.
And they arrive with hope, do not forget that. They arrive with hope, with faith that they are not completely abandoned by the rest of America, that their needs are of concern to at least a few, that they will not be left to suffer without any chance of easing pain, saving teeth, being given a chance at some dignity.
Words cannot come close to describing the experience of participating in an event like this. I could post pictures, but they would not fully inform even the careful and conscientious viewer of the full reality.
Michelle Obama was criticized for saying that for the first time in her life she was really proud of America. Then perhaps I will be criticized even more, because I go to Wise, I come to Grundy, and I find that I am ashamed of America. I am ashamed of political leaders who bloviate about political philosophy or try to gain political advantage and forget what this really should be about, which is person, real person, real pain, real suffering - that we allow to continue unabated as we bicker about political details.
I am a teacher. I wish I had a head cam so that all of my students could see as I see, here in Grundy and as I did in Wise. That they could hear what I hear, the combination of hope and desperation, both wrapped up in pain, fear, and suffering.
Please do not try to talk me down. You will not succeed. I am here. I am experiencing this, albeit only as a visitor, a volunteer trying to make a difference.
In October of 1962 those of us alive lived through the Cuban Missile Crisis. Living as I did just outside New York City I knew that if the blockade let to an exchange between the USSR and the US I probably would not survive. Many people had strong reactions. Bob Dylan crammed a lot of ideas and images into a song called A Hard Rains a gonna Fall I use to sing it, back in the days when I played guitar and would occasionally do a set in coffee houses in suburban Philadelphia or Greenwich Village, somewhat later that decade.
Dylan wrote his words in a different context than that of which I write in this diary. Yet I think the final verse speaks to where I find myself right now:
Oh, what'll you do now, my blue-eyed son?
Oh, what'll you do now, my darling young one?
I'm a-goin' back out 'fore the rain starts a-fallin',
I'll walk to the depths of the deepest black forest,
Where the people are many and their hands are all empty,
Where the pellets of poison are flooding their waters,
Where the home in the valley meets the damp dirty prison,
Where the executioner's face is always well hidden,
Where hunger is ugly, where souls are forgotten,
Where black is the color, where none is the number,
And I'll tell it and think it and speak it and breathe it,
And reflect it from the mountain so all souls can see it,
Then I'll stand on the ocean until I start sinkin',
But I'll know my song well before I start singin',
And it's a hard, it's a hard, it's a hard, it's a hard,
It's a hard rain's a-gonna fall.
Dylan's expression of the hard rain clearly has connections with fears of a nuclear exchange, thankfully no longer the imminent threat it was some 47 years ago next month. Many might wish to apply that term to the looming ecological crisis that some in this country seem too dense to realize is rushing towards us, and which may already be irreversible.
I prefer to apply those words in a different sense - that we are increasingly as a people, a society, losing our souls.
Where hunger is ugly, where souls are forgotten,
Where black is the color, where none is the number - words that to me speak powerfully of what I encounter as I realize the chasm between the lives of the people we are trying to help the direction of this nation as seen in the political debates in places like the Senate Finance Committee and among the talking heads on television.
And these words become for me a mandatory, something I must do: And I'll tell it and think it and speak it and breathe it,
And reflect it from the mountain so all souls can see it,
Then I'll stand on the ocean until I start sinkin',
But I'll know my song well before I start singin',
Why? Because having seen what i have seen, having experienced what I have experienced, have learned what I have learned, in Wise and in Grundy, to do otherwise would be to abandon my own humanity.
And maybe, just maybe, if enough of us tell it and think it and speak and breathe it, if we reflect from the mountain so that all souls can see it - if they have eyes to see and ears to hear and are willing to use either - maybe then, the final lines will not be a prediction of what I fear is happening: And it's a hard, it's a hard, it's a hard, it's a hard,
It's a hard rain's a-gonna fall.
And it's a hard, it's a hard, it's a hard, it's a hard,
It's a hard rain's a-gonna fall.
I have no peace, but I wish for peace, for those we treat, for those we cannot, for the soul of this nation before we lose it irretrievably.
Peace.