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Published On December 5, 2014

POLICY

A Tragedy of Rural Proportions

A new documentary explores health care inequality in rural America, and why the Affordable Care Act isn’t enough.

Stan Brock was once best known as the co-host of TV’s Wild Kingdom. In 1985 he founded Remote Area Medical, a non-profit organization that would deliver basic medical assistance to the world’s most inaccessible regions. The initiative was inspired by Brock’s travels in the developing world, but the organization soon discovered health care needs in the rural U.S. that were both profound and endemic. About 80% of its operations now take place here. 

A new documentary, Remote Area Medical, offers a snapshot of this lost population. Poverty, disappearing hospitals and gaps in health coverage still leave rural citizens in the lurch, even in the age of the Affordable Care Act. Brock and filmmakers Jeff Reichert and Farihah Zaman discuss the challenges of caring for this population.

Q: Your mobile medical clinics can attract thousands of people. Those massive clinic events feature heavily in the film. What brings people there? Is basic health care in such short supply? 

Stan Brock: About 70% of those who come to our clinics are in serious pain related to problems with their teeth. It doesn’t matter where it is in the United States, it’s the same story. Another large percentage are there because they can’t see well enough to function properly. They need an eye exam and a pair of glasses, which we make for them on the spot.

These needs are sorely overlooked. When the uninsured or the underinsured have some type of medical condition—whether they fall down and hurt themselves or they have the flu or pneumonia—they go to an emergency room and get care. By law, many of those places can’t turn them away. But you cannot go to the emergency room at the hospital and get your teeth fixed or get an eye exam and a pair of glasses.

 

Q: Aren’t they covered by Medicaid?

SB: We treat thousands of people who are either Medicaid-eligible or on Medicaid. The problem with Medicaid seems to be finding a dentist or an eye doctor who takes Medicaid patients. We also see people that the current system doesn’t serve well. Some are homeless. Some are unemployed. Some have some type of insurance but the co-pay is too high, or their insurance doesn't cover dental, and it doesn't cover vision. 

 

Q: Have you seen any change since the Affordable Care Act? 

SB: The Affordable Care Act, well-intentioned as it is, does not seem to provide an avenue for dentistry and vision care and eye glasses for adults. Until that happens, Remote Area Medical will continue seeing these patients in huge numbers. We have seen absolutely no change in the attendance at our clinics since the Affordable Care Act came into being. 

 

Q: What sparked the idea of a documentary? ?

Farihah Zaman: Jeff Reichert and I were just absolutely stunned—both in terms of the depth and extent of the need we saw at the clinic, and by the care and kindness that we saw in the volunteers. We had no medical background. Jeff's aunt, who is a retired nurse, had volunteered at a Remote Area Medical clinic and said, '”Listen, now I understand something about the health care crisis that I never understood before.” 

 

Q: Was it hard to get clinic patients to talk about their backgrounds?

FZ: Particularly in Appalachia, people were savvy about stereotypes and were very cautious about how they would be represented. It was clearly difficult for them to get over their pride and go to the clinic in the first place, but then to talk to somebody—and on camera—was a big step. Luckily, some were grateful to offer us more context as to why this crisis is happening. 

Jeff Reichert: There's a lot of pride in this community, and, yes, many of them are in pretty dire straits. But in many cases, people told us that they were working — really, really hard, sometimes in multiple jobs, piecing together a living in places where industry has largely left.

 

Q: The film shows people who have tried to treat themselves. Do you see this often?

SB: The idea that I had for this organization occurred when I lived in the upper Amazon region on the border of Brazil and what used to be British Guyana. We were 26 days on foot from the nearest doctor or dentist or any kind of health care facility. The Indian tribal people regularly had to pull out their own teeth in the most brutal ways because the pain and suffering were so intense. People in the United States who simply cannot afford to go to the dentist have the same terrible tooth decay and pain. They also resort to pulling out their own teeth. This is not unusual for us to see. 

 

Q: What surprised you most in making this film? 

FZ: I always thought, of course, it would be horrible to live without health care, to be in so much pain. But it goes so far beyond that. If you are in pain all the time, how are you going to do your job properly? If you don't have glasses and can’t see, how are you going to get hired for a job? And that makes you at even more of a disadvantage to take care of your family. 

 

Q: What should audiences take away from Remote Area Medical?

FZ: We want to inspire compassion for what it really is like to live without health care. The debate has become so politicized, and so oriented to policy, that I think sometimes it loses sight of the human beings that are actually living and struggling. We don't tell people how to vote or the policies we think would be the best solution. We want to go back to that basic idea—can we let people live like this?