It's 5:30 a.m. on a summer morning, and in the pre-dawn darkness a man, carved walking stick in hand, knapsack on his back, arrives at the Wise County, Va., fairgrounds.
Robert Ellis has walked 15 miles, through the night, to get here. But he isn't here for a summertime fair.
"I really need my teeth fixed. They are really bad. And my hearing," Ellis says. "I don't know which one's worse, my hearing or my teeth."
For this weekend, the fairgrounds have been turned into a one-stop-shopping, outdoor medical clinic. Remote Area Medical has arrived for its annual visit to Wise, bringing free dental, eye and medical care to this remote southwest corner of Virginia.
"I didn't have enough gas to put in my truck to get here, so I told the old lady I would just walk," Ellis said. "I got up at 12:30 this morning, got ready and started walking."
Ellis joins some 2,500 other people who over the course of three days line up in the wee hours of the morning in the hopes of getting free medical care. Many want their teeth checked or even pulled, others need their eyes examined, but some, like Sheila Johnson, are also looking for specialized medical care.
"I have a lot of trouble with my lungs right now and I need to see a pulmonary specialist, so this was my only option," she said.
Stan Brock started Remote Area Medical in 1985 after years of working deep in the Amazon, where health care was 26 days away by foot.
"They might as well be on the moon for the opportunity that they have to get the care that they need," Brock says of the isolated community where he once lived and worked.
Brock began bringing health care to remote corners of the world such as Haiti, Africa, India and Guyana, but after setting up his headquarters in Knoxville, Tenn., he quickly realized that pockets of the United States were severely underserved and filled with people who couldn't afford health care.
"You've got 40 or 50 million people that are in this category that don't have insurance and can't get the care that they need or they can't afford it," Brock said.
The RAM event in Wise is now one of the largest "expeditions" as Brock calls his clinics. He's held more than 700 around the world, helping more than 550,000 patients in this country alone.
"It's always an amazing sight, isn't it? That here in America at 5 o'clock in the morning, with rain threatening, there are 1,500 people out there," Brock said, standing by the entrance gate overlooking the crowd on the first morning. "It's sort of the one time opportunity that they know they can afford to get the care that they need. ... It's a pretty sad sight."
Teresa Gardner was born and raised in Wise and now runs the local free clinic, The Health Wagon.
"The economy here has hit a downturn. We've had a lot of mining layoffs, which is really the only industry here," Gardner said. "It's just incredible the desperation that people have for health care."
Gardner first invited Stan Brock and RAM to Wise 14 years ago and helps organize the 1,400 dentists, eye specialists, doctors and volunteers who all donate their time and expertise. Approximately 80 dental chairs are fully manned, as well as 16 eye examination stations.
At Wise, RAM has "all the different specialists, all the way from cardiology, OB-GYN, pulmonology, nephrology, dermatology," Gardner said. "It's a really good opportunity for the patients to come out and get some very good care that they wouldn't otherwise have access to."
Patients like Robert Ellis, who like everyone else who comes to RAM is first put through a triage process during which he is screened for high blood pressure, diabetes, and other possible undiagnosed conditions. Careful questioning can reveal a potentially serious problem.
"They are going to check my heart out and stuff. See about that feeling I've been having," Ellis says. "I've been having chest pains lately. Not often. It's starting to come more often."
His visit to the dentist and hearing aid tent will have to wait while he first sees a cardiologist.
According to Gardner, every year they save lives, sometimes right in the triage line.
"You find people having strokes, heart attacks, elevated blood sugars. We do a lot of emergency care here on sight," she said.
In fact, six people over the course of the weekend are found by the mobile X-ray unit to be walking around with broken limbs.
"Even though the care here is quality care, we don't need to be doing this in the world's richest country," Brock says. "I would rather be back in Haiti, in India and Africa, and where this organization began in the Amazon than doing it here in the world's richest country. But I don't see this ending anytime soon."
RAM is mostly funded by donations and receives no government funding.
"We rely on those $5 and $10 checks from the public," Brock says. "And not from the patients, I might add. Absolutely not from the patients."
RAM also relies on its army of volunteers, many of whom have been coming for years and travel on their own dime to come.
Anna Rollins has been coming since she was 8 years old.
"I just started doing statistical work. Eventually I moved up to being a [dental] assistant," she says. "And now I am looking at going to hygiene school."
Dentist Scott Miller makes sets of dentures for patients who have not had any teeth sometimes for years.
"It's the only thing that I can do that I can change somebody's life, like that," Miller said, snapping his fingers. "It's great. Rewarding. And it's what brings me back every year."
Dr. John Osborne, the dental director for RAM, summed it up. "For me it's really the most basic thing that I went to dental school for."
Brock said he would be able to hold more events around the country and help more patients if states would be less strict about allowing volunteer doctors from other states to practice temporarily within their borders.
"People come all the way from Florida, all the way from Michigan, all the way from Wisconsin, New Jersey ... because we're not allowed in those states because they won't allow doctors to cross state lines," he said.
It is the thought of having to turn away people that haunts Brock.
"This means if you don't have [enough] volunteers at an event of this size you are going to be turning hundreds and hundreds of people away."
Luckily for Robert Ellis, he wasn't turned away and the 15-mile walk was worth it.
"They changed my blood pressure medicine. I had my hearing checked. I'm going to need hearing aids. They fit molds on both my ears. Thank god. I needed that."
Over the course of three days in Wise, RAM helped 1,200 dental patients, pulled 4,000 teeth, grinded lenses for 900 pairs of glasses and in total provided more than $2 million dollars worth of health care. All free of charge.
"It doesn't matter where you go in the United States you are going to find huge numbers of people that either dont have access to care because it's an underserved area or in most cases they can't afford to go to the dentist, they can't afford to go to the eye doctor," Brock said. "So they are going to be relying on the kinds of services we provide."
Teresa Gardner's local free clinic, The Health Wagon, will be doing follow up care for months. "We don't want to diagnose something and then leave them there hanging. We want to be sure we get them the follow up that they need," she said.
And she has already picked out the dates for RAM to come to Wise next year. "We will start planning for next year from today."