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RAM in northern California

May 9, 2011
A four-day free health clinic hosted in northern California on April 1-4 was the 639th “expedition” undertaken by Tennessee-based Remote Area Medical (RAM).

“It’s a partnership: They know we are out here to help them. And, we wouldn’t be doing this if it weren’t for them.” — Elizabeth Xiu Wong, RDHAP (Dental Hygienist in Alternative Practice)

by Elizabeth Xiu Wong, RDHAP

A four-day free health clinic hosted in northern California on April 1-4 was the 639th “expedition” undertaken by Tennessee-based Remote Area Medical (RAM). Everyone is a volunteer, including the founding director of operations, Stan Brock, a pioneer Amazon bush-pilot with looks resembling a no-nonsense Crocodile Dundee.

Thousands of people seeking free health care had camped out to get access to dental, medical, and vision treatment from volunteer professional health providers. By 3 a.m., they would have endured hot sun and cold winds in the parking lot hoping to be issued a number to be let into the clinic halls at Cal Expo in Sacramento, Calif.

After waiting all night for their number to be called, each sleepy person pointed to either the mouth or the eye; they indicated to Stan Brock what hurt most. The teeth won eight out of 10 times. This daily hand count later would predict the 82% to be seated on patient chairs inside the mobile dental clinic. Out of 3,556 registered, 2,947 wanted dental treatments, keeping the volunteer dentists and hygienists busy for four days. Saturday alone hit an incredible all-time one day RAM record in its 26 year history by delivering dental services to 932 patients.

Volunteering as the supervisor of the dental hygiene station, I managed the scene from two viewing locations. From the gallery level above, I could pan both the medical clinic run by Tzu Chi (Buddhist Medical Foundation) on the left with their two mobile dental vans separating on the right the dental clinic hosted by the California Association of Oral and Maxillofacial Surgeons. Dozens of members from the Sacramento District Dental Society and other California dentists had passed the word around for volunteers to man the 60 chairs for fillings/extractions. Alongside this group were 30 additional chairs set up by Tzu Chi for the dental hygiene team.

The immense exhibit hall buzzed along like a scene from Grey’s Anatomy on a wide-screen TV! The close-up viewpoint was peering into a patient’s mouth full of abscessed teeth, root tips exposed to the apex, and infected periodontal tissues last seen in our textbooks. One oral surgeon kept asking me every day to click intraoral close-ups with my camera.Whether managing in the pit of the clinic floor or holding the cell phone against the ear of director Stan Brock on a newspaper interview, I was running on adrenalin. I knew that Dr. Donald P. Rollofson, chair of the dental clinic along with oral surgeon Dr. Russell Webb must be searching for me to monitor the endless lines.Hundreds of patients scooted on metal folding chairs toward the next open dental chair. The first stop was triage, where the patient’s chief concern may not match up with the diagnosis. Wants vs. needs. Tough decisions, when the neglect has been years too long. Fillings? Extractions? Cleaning? Patients could only choose one. Third molar extractions were simple compared to unsalvageable teeth needing full quadrant/arch extractions.Dental hygienists often stopped mid-treatment if the removed ledge of calculus revealed only retained root tips. If no abscess or pain, keep going. Otherwise, we could route the patient to a Nomad hand-held X-ray unit or to the DDI Panorex machine. We let the patients keep these printouts, encouraging them to seek a future dental home.Each story told below would spell out only a few sentences in the volumes of sad stories. Keep in mind that there was no single profile to fit these patients streaming into the RAM free clinic. Read between the lines, and you will discover that they do share one thing in common: their smiles of appreciation as they give thanks to the large, compassionate force of dental professionals who volunteer their services at Cal Expo.Hattie
My first of four days was the most memorable. Hattie, a homeless woman with a tracheotomy from throat cancer, was not able to receive treatment due to her complex medical conditions and drug allergies. She waited overnight sitting on her walker and now was pushing it toward the exit gate. I was called over to give her a rinse of mouthwash. Leaning forward to hear through her whispers and raspy breathing, I asked her what she came to have checked. She woefully told me that her mouth and lips were just healing after radiation treatment at the hospital a week ago. She also had fallen, breaking off a front tooth.
Since the hygiene station had no handpieces, I had decided early on for the group to polish with toothbrushes that is the least we could offer to Hattie. What she gave us in return was much, much more. She told us through sign language how happy she was to receive a basic cleaning. Surrounded by the video camera crews, she now grinned like a movie star, not ashamed by her uneven smile.As I wheeled her out to the vision clinic, she pulled me close to say that she was one-eighth Chinese. I wrote down the book about a pioneer lady whose similar biography is written in A Thousand Pieces of Gold. When she said, “She is worth that much! My great-grandmother was sold in America for two sacks of grain,” I nearly fell over! That was the subtitle of the book. Over a decade ago, I had displayed a photo documentary at the governor’s office in the State Capitol. The pioneer’s name was Polly Beamis. Could I be supplying a face and history about her long lost relative who was only told through generations of family legends?Gavin
Still another different profile emerged in a young couple I had met while they waited in line the night before clinic doors open. Because his ex-wife was a dental hygienist, Gavin called her on his cell phone for me to ask her and friends to come out to volunteer. During the ultrasonic scaling on his girlfriend, he became my assistant. Using very scientific terms to describe the toxins in plaque, he tried to reassure her that it was okay to have pain now but the gums heal after the subgingival calculus is removed.Nathan
How much pain can one endure before he seeks out treatment? The night before as he posed for a photo, Nathan told me he was looking forward to a dental cleaning. He made a comfortable bed from the bench seat removed from his truck. During treatment, the hygienist had to call over a dentist to help remove the stitches embedded in his lower lip. He was so fearful of being numbed that he chose to have her remove the sutures without anesthesia. It was back in December that a pit bull bit him on the face.Retired nurse
At the end of the fourth day, I pitched in to finish the last of the lucky patients. Many hundreds of others had been turned away. She was a retired nurse volunteer from the medical triage station. The dentist had just removed a bone chip from the soft tissue around the mesial lingual surface of a lower crown. When I hand scaled to avoid this tender spot, I felt the implanted bridge rocking side-to-side.This discovery made her worry even more about the other quadrant with a second implant waiting for a bridge. She wondered out loud, “How much money would all this cost?”This profile demonstrates how you can never tell who cannot afford to maintain even basic dental care.Patrick
There will be countless other stories told by every single volunteer meeting patients on those four days at the mobile RAM free clinic in Sacramento. I give the medal of honor to the bravest of the bravest: Those who chose to endure waiting in line for a second sleepless night immediately after full arch extractions, to complete the extractions in the remaining arch. For them, they decided that the few sleepless overnight waits paired up with days of post-op pain was a better option than facing a lifetime of failing health.
Patrick wrote his appreciation in this text message: Hi..hero…I am in line again..c u in the am. I hope u and those fab people inside know wht unbridled joy they hv given the last 3 days…I hv seen people lv crying..with their head tilting just bit more upward..u guys make it easier 4 people 2 live and feel human again ... we r granting each of u 3 wishes..
Closing comment: Why do we volunteers deserve three wishes, while the patients could only choose one dental procedure? Elizabeth Xiu Wong, RDHAP, is a dental hygienist in alternative practice based in Sacramento, Calif. She can be contacted at [email protected].