At 74 and 76, Patty and Stu Wineman aren’t likely to camp out in line to buy concert tickets or the hottest new toy or video game. But there is something the couple is eager to wait all night for: health care.
Last October, the Winemans were first in line at the pop-up Remote Area Medical (RAM) clinic when it visited Pahrump, Nevada—a community in the southeast corner of Nye County about 60 miles west of Las Vegas and 60 miles east of Death Valley.
RAM is a Tennessee-based nonprofit that provides free, quality health care to underserved and uninsured individuals. RAM’s corps of more than 135,000 volunteers—licensed dental, vision, medical and veterinary professionals—has treated more than 785,000 individuals and 68,000 animals, delivering $135 million worth of free care.
“The first year (2016) I got there around 1:30 a.m.,” says Patty Wineman. “I found out you need to get there a lot sooner.”
In 2018, Wineman took her place at the head of the line shortly after lunch the day before the clinic opened. With a Harlequin romance in hand and a chair to rest in, she was content to pull an all-nighter.
“I have no complaints,” she says. “Yes, you have to wait a long time. So be it. It’s free. That’s the way I feel about it.”
Every October, hundreds of people line up to seek treatment from the pop-up clinics at the Nye Communities Coalition campus. At 3 a.m. each clinic day, organizers estimate how many patients health care providers can serve and hand out tickets to those in line. While few are turned away, patients sometimes have to prioritize one treatment over another. At 6 a.m., clinic gates open.
Coalition CEO Stacy Smith says her organization teams with more than 15 partners to host the gargantuan events that have provided free medical, dental and vision services for around 450 people each of the past three years.
While patients only see the hive of activity at the clinic three days a year, the behind-the-scenes preparation is an all-year endeavor with planning meetings, advance recruitment efforts, grant writing and more.
The clinic taps resources from the entire community. From the Disabled American Veterans and local law enforcement to the Nye County School District and Valley Electric Association, everyone steps up, loaning equipment, fundraising and contributing labor.
Students studying in dentistry and medical programs and professors from the University of Nevada Las Vegas and the College of Southern Nevada pitch in too.
Smith says there’s no way the Nye Communities Coalition could pull off the event on its own.
“All of us have skin in the game,” she says. “That’s the way it is in rural communities. No agency tends to have enough resources, so it always takes all of us. Across the board, we are medically underserved for primary care, mental health and dental.”
Smith adds that the relatively new community lacks many of the safety nets that a more established community might have. Plus, Nye County—and especially Pahrump—tend to be transient and lack stability. The senior population is large but not wealthy, and many younger workers are in mining or construction, which have highs and lows.
“It’s just that general boom and bust that many people think is gone in the West but still exists for many of us,” she says.
In many medically underserved areas, the services patients need are often a few miles away in neighboring communities, but that’s not the case in Pahrump.
“If you don’t have a working vehicle, you’re not going to get to Las Vegas from here,” she says.
RAM representative Robert D. Lambert says Pahrump’s clinic last year was the organization’s 970th clinic, and RAM recently celebrated the milestone of launching its 1,000th clinic.
Lambert says in 2018, RAM provided care for 45,566 patients at more than 90 clinics around the world. Although they only have about 40 staff members, RAM tapped the talents of 17,837 volunteers to provide care valued at $15,386,013.
RAM ships in supplies and equipment, provides core personnel to help run the clinics and posts staffing needs in an online forum to attract medical professionals willing to help.
Pahrump clinic co-chairman Ryan Muccio says RAM provides vital support, but the 10 to 12 core team members that come from RAM are just the foundation of a massive volunteer effort. For each of the three days it runs, the Pahrump clinic requires 150 to 200 volunteers—from doctors and nurses to kitchen staff. Muccio says 95% are recruited from Pahrump and Las Vegas.
“The majority came from just pounding the pavement and going into doctors’ offices and telling them about it and asking if they’d join,” Muccio says, noting that some volunteers “catch the RAM bug” and follow the organization around the world.
Dr. Carl DeMatteo, a semi-retired internist and infectious disease specialist for Dartmouth-Hitchcock in New Hampshire, travels with RAM whenever he can. When he’s the lead physician at a RAM clinic, the organization helps with travel expenses. When he’s not, he pays costs himself.
“I just love the organization,” he says. “I love working with patients. I love working with folks who aren’t getting a fair deal from the American health care system. It’s just very rewarding. The people who volunteer are wonderful folks.”
While some health providers come from a distance, others help with planning year-round. Pahrump-based Nurse Practitioner Sherry Cipollini oversees women’s health at the Pahrump clinics.
Cipollini says she’s seen myriad diagnoses at the clinic, including high blood pressure, diabetes, heart disease, chronic illnesses and abnormal pap smears. They even caught a case of breast cancer. Cipollini also talks to patients about birth control and safe sex.
Case workers are on hand to help people apply for health benefits. The Nye Communities Coalition has secured a women’s health grant to help provide follow-up care.
“There are so many barriers to care, and this helps break down those barriers and gets care to people who wouldn’t otherwise get it,” Cipollini says. “A lot of these people haven’t seen a provider in years, and they’re afraid. They don’t even realize there are resources available.”
Muccio says it’s not just people who don’t have insurance that RAM serves.
While some are homeless or jobless, many have insurance but can’t afford deductibles or co-pays.
“There was a small business owner last year who couldn’t afford the deductible for the dental work his family needed,” Muccio says. “There are so many stories—things they’ve caught, things they’ve helped people with. It’s truly amazing.”
Dr. John Quinn and much of the staff from Smiles for Life Family Dentistry volunteer at the Pahrump clinic every year. Quinn initially learned about RAM through a former classmate.
“I did it on a whim, and when I arrived there were so many patients and only two of us dentists,” he says. “So they asked me to stay the next day and the next.”
At the last clinic, he says they had three dentists plus dental students and assistants pitching in. Together they saw about 100 patients, which is 10 times what he sees on a regular day in his Las Vegas-based practice. Quinn says nine years in the Army National Guard helped prepare him to serve crowds. Among the common ailments he sees at the clinics are severe gum infection and infected teeth.
“I don’t think they have fluoridated water out there because it’s on well systems,” Quinn says. “They generally have less access to dental education and treatment, so things are pretty far gone by the time we see them there.”
Quinn says RAM brings in first-rate supplies to meet the community’s needs.
“Generally, when you go to one of these triage clinics, it’s very low budget—really crummy materials—but RAM actually has really great stuff.”
Dr. Michael Kozlowski, an optometrist, and his wife, Roni, a registered nurse, drive in from Glendale, Arizona, to volunteer at the Pahrump clinic every year.
“If we find ocular disease, we’re also equipped to be able to address that,” Kozlowski says. “We’re not just doing refractions and giving prescriptions for glasses. We’re actually doing complete ocular health examinations.”
RAM brings ocular exam equipment and a mobile lab to cut the lenses and dispense eyeglasses right away. Kozlowski says that ensures people who have unstable housing situations don’t have to worry about missing notifications to pick up their glasses at a later date.
“Patients can have their glasses right away and begin seeing better when they walk out of the building,”
Kozlowski says. “They have a really nice selection of frames, and patients can get single-vision or multiple-vision glasses—whatever they need.”
Kozlowski says a lot of people try to make do with reading glasses from a drugstore or even a family member’s glasses.
“The fact that they can get a pair of glasses made to their prescription as good as they would get from any optometrist is really a gift,” he says.
The RAM clinic is scheduled to return to Pahrump October 4-6. It’s rare for RAM to continue to visit an area every year, but Smith says RAM officials recognize the need and the passion of the community.
“Their heart’s in the right place,” she says. “They’re all about service, and they go where the need is.”
While Smith is grateful to everyone who helps make the RAM clinic possible, she says she appreciates the clients most.
“They are so patient, so tolerant and understanding and so appreciative,” she says. “I’ve literally watched people have every tooth pulled out of one side of their mouth, and they show up and line up back the next day to get the other side done. The strength and grace that they have while they’re getting this done, I just can’t tell you how much I respect them.”
GET INVOLVED. To donate to RAM or inquire about volunteering as a licensed health care provider, medical or dentistry student or general-support volunteer, visit ramusa.org.
ABOUT THE SERIES: This Ruralite-produced initiative spotlights health challenges in rural communities, efforts to address them and the unsung heroes behind the work. The series receives support from the M.J. Murdock Charitable Trust, which funds projects and programs in Alaska and the Northwest. The sponsorship helps fund journalism that makes a difference. Send us story ideas at firstname.lastname@example.org.