Lucian Perkins

Photographer/Filmmaker

Remote Area Medical

Location: Washington, DC

Nationality: USA

Biography: Two-time Pulitzer Prize-winner Lucian Perkins is an independent photographer and filmmaker based in Washington, D.C. Lucianâ€™s focus on documenting human-interest stories encompasses daily life and social issues... read on

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Remote Area Medical (RAM), gave free care to over 2,000 uninsured and underinsured Virginians at their annual event here. Virginia is one of the 20 states that have opted out of the Affordable Care Act's Medicaid expansion, shrugging off nearly 700 million federal dollars because of Republican opposition. That refusal has left some 400,000 Virginians, many of whom have lost their jobs in the area's ailing coal industry, without access to affordable health insurance.

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RAM founder, Stan Brock begins allowing people into the clinic's makeshift tents. Hundreds of people, many of them with their children in tow, have spent the entire night waiting outside or in their cars to get treatment, and they push forward and crowd the entrance.

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Just before sunrise, Tim Bass of Coeburn, Va., stands by his car at the Wise County Fairgrounds. His wife and children sit inside. The Coeburns, like many other families, spent the night in their car to make sure they'd get tickets. Bass needed dental and eye work done. "I'm disabled and it is really hard for people these days," he said. "If it wasn't for this, I'd have to suffer."

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Two women wait for their numbers to be called as they wait before sunrise in the rain with hundreds of other people for free medical care.

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Before the first wave of people was allowed in on Friday morning, day one of the clinic, they were asked how many needed dental care. Almost everyone raised his or her hand.

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The vast majority, more than 70 percent of the thousands of people lining up to be seen by RAM's volunteer medical practitioners are there seeking free dental work and eye care. At this clinic alone, hundreds of people had all of their teeth pulled. They then put their names into a denture lottery, hoping to be picked to receive a set of false teeth next year when RAM returns. This year, forty-six people from a list of over 700 were selected.

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A patient waits to have some teeth pulled. Dentist Wallace Huff of Blacksburg, Va., who is a frequent volunteer at RAM, said, "We got a lot of 18- and 20-year-olds who are going to lose all of their teeth, and it is the most heartbreaking thing in the world." Had Medicaid expansion passed, most of these young people would have received health insurance for the first time in their lives.

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People wait their turn to have cavities filled.

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But sometimes the dental and eye work distracts from more serious problems. People are "so focused on getting their teeth fixed and their eyes attended to, that they're not looking for general medical care, even though we provide it and they all need it," Brock said.

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Many suffer from diabetes, heart disease, obesity and other diseases, but cannot get the proper follow-up treatment for their conditions. "It's heartbreaking to see people go without insulin for six months or a year," Teresa Gardner, executive director of the clinic that hosted RAM, said.

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Teresa Gardner, executive director of the clinic that hosted RAM, recalls attending the funeral of an uninsured 28-year-old woman who had died of cervical cancer. A decade earlier, she'd had abnormal pap smears. By the time she was able to see a doctor about her pelvic pain, the undiagnosed cancer in her cervix had metastasized to all her organs. 'We have an OB/GYN working with us," Gardner said, wishing that the young woman had known about the free clinic. "She didn't have to die at 28. Some of this stuff is so avoidable."

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Virginia Gov. Terry McAuliffe shakes hands with people waiting to have dental work done at the Wise County Fairgrounds. McAuliffe came to highlight his fight with the Republican-controlled Virginia legislature, which voted against the Medicaid-expansion portion of the Affordable Care Act.

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RAM has been coming to Wise, Va., for 15 years now. And, Brock says, "unless Congress can do something about dental care and vision care for these millions of people, RAM will be holding these events far, far into the future."