Where Poverty Makes Sick

During the Remote Area Medical (RAM) clinic up to 100 dentist chairs are worked on at the same time: fillings, extractions and cleanings. 140 million people in the US have no dental insurance.
In Henderson, Tennessee, William Smith gets his last six teeth pulled. The treatment is free; however for a set of dentures he must still save 2,500 dollars.
The volunteering dental students get the pulled teeth collected for their practice purposes at their universities. Dentists from Remote Area Medical pull several hundreds teeth during the weekend clinics.
In the early morning hours patients wait in the rain for the doors to open for medical treatment at 6 o’clock.
The dental health of many people in the US is devastating. It’s being called an „Oral Health Crisis“. As the cheapest solution is often to pull the teeth many young people are already losing their teeth.
Amanda Amezcua suffers alongside her husband who gets four teeth pulled and fillings in others. At a regular dentist it would cost 20,000 US Dollars.
Disability is wider spread in rural regions of the US than in urban areas. Since the age of 18 Amanda has been disabled. Her family of four lives on a network of support: disability payments, food stamps and family support.
Robert Brown lost sight in one eye due to a work-related accident. Consequently he couldn’t keep his position. Surgery could repair the damage to his eye, but without a job he can’t afford the treatment.
Actually, he is homeless; however, he was allowed to set up a small shack on a farmer’s property. He exchanges his labor for a small space on the farmland.
“My job as his mom is to make sure that my son got a roof over his head. My salary is that I can live with him under it. We have no more than his SSI.” Debbie Brown cannot work as she doesn’t have daytime care for her son Casey.
Casey is 31 years old. He is mentally at the level of a three-year-old child and suffers from autism and epilepsy.
Appalachia is home to 25 million people. 1.2 million of them live in distressed counties. RAM estimates there are 180,000 people in urgent need of access to health care.
The patients sleep in their cars overnight. They arrive at least one day early to the clinic for better chances to get treatment. The worst case is they have to wait a year for the next clinic.
For many people in the US, dental as well as vision treatment is a financial burden. RAM makes prescription glasses after the exams directly on site.
Patients wait all day long in the row for their treatment. RAM serves up to 2,000 people at the weekend clinics with health care for free.
Child mortality is regarded as an important indicator for the state of a society. Infant mortality in the US is relatively high for an industrialized country at six in one thousand living births.
It’s the first visit at a RAM clinic for Stella Garland, who gets her first pair of glasses. Although she has health insurance, dental and vision is not included
94.6 percent of the US is rural open space. Only ten percent of all physicians work in those areas, where almost a fifth of the US population lives.
For the six members of the Love family the yearly RAM clinic taking place in nearby Grundy, Virginia, is a fixed appointment every year.
“Mama Love“, the family’s grandmother, suffered from a heart attack. Despite having health insurance she must pay 20 percent of the resulting costs from her scant pension.
James Love supports his family by hunting and breeding livestock. Although all family members work, they still depend on the food pantry. The jobs pay too poorly and are mostly part-time.
Tim Cope and Samantha Brown want to make everything possible for their four children. They skimp on their own health. They drove 450 km to one of the RAM clinics, after Tim had pulled one of his own teeth and filled another with superglue.
The four children of Tim and Samantha’s patchwork family lack nothing. Thanks to Obamacare, all children up to 18 years old are eligible for health insurance, regardless of their parents’ income.
On Halloween the children have collected vast amounts of sweets. Tristan celebrates it the following days, dressed in his costume, in front of the television with chocolate and chewing gum.
Tim Cope (left) had to give up his well-paying job due to rheumatism. For eight dollars an hour the saddle factory near his place of residence offers him work. In the rural area it is difficult to find a job.
Lions Club volunteers examine the eyes of children at many schools. They want to prevent visual impairment due to financial circumstances from remaining undiagnosed as it can hold people back in life with lasting effects.
For uninsured people many diseases often remain undiagnosed, such as diabetes. The burden of the people living without health care often overwhelms them when they get the chance to see a volunteering physician.
Richard Williams lives with his wife Tamy Ann and their friend Vella in an old trailer. They have no income but trust in God’s help. Richard suffers from cancer, which is not being treated, because he has no health insurance.
The clinic in the elementary school isn’t even set up yet, when the first patient has already put up his tent and waits to make sure that he is going to get the medical treatment he needs.

(German below)

33 million people in the United States of America have no health insurance. Among other things with the promise to reform the health care system US President Barack Obama won his election campaign in 2009. But despite ‘Obamacare‘ particularly in rural areas, many people have no access to basic medical care. The regulations for the newly mandatory insurance are complicated. They must rely on charitable institutions such as ‘Remote Area Medical‘ (RAM), where physicians work as volunteers. Temporary clinics are built for a weekend for example in schools. Some patients wait for days in lines to make sure they get free treatment.


In Appalachia – in the eastern USA – the need is greatest. An estimated 180,000 people in various circumstances are excluded from regular health care.


Wo Armut krank macht

Bis heute haben 33 Millionen Menschen in den USA keine Krankenversicherung. Unter anderem mit dem Versprechen einer Gesundheitsreform hat US-Präsident Barack Obama 2009 seinen Wahlkampf gewonnen. Doch trotz ‘Obamacare‘ haben besonders in den ländlichen Regionen der USA immer noch viele Menschen keinen Zugang zu grundlegender medizinischer Versorgung. Die Regelungen zur neuen Versicherungspflicht sind kompliziert. Sie sind auf Hilfsorganisationen wie ‘Remote Area Medical‘ (RAM) angewiesen, bei denen Ärztinnen und Ärzte als Ehrenamtliche arbeiten. Provisorische Kliniken werden dafür beispielsweise für je ein Wochenende in Schulen errichtet. Die Patientinnen und Patienten stehen teilweise tagelang an, um sich kostenlos behandeln zu lassen.

In Appalachia, einer Region im Osten der USA, ist die Not mit am größten. Geschätzte 180.000 Menschen in verschiedensten Lebenssituationen sind dort von regulärer Gesundheitsversorgung ausgeschlossen.