Brenda Clayton had been awake for more than 24 hours. On Friday she worked a shift from 7 a.m. to 3 p.m. at McDonald’s, and then met up with her sister so both could camp out overnight in a car parked at Gadsden City High School.
Clayton spent years without any medical coverage at all, even though she has worked at McDonald’s for 15 years.
“If you can’t afford it, you can’t afford it,” Clayton said. “I’m barely able to pay the bills as it is. When I walk into the grocery store these days, I want to cry.”
Remote Area Medical, initially set up to reach isolated parts of the globe, now delivers care to those in need in the United States. The clinic promised free care to anyone on a first-come, first-served basis. The clinic did not require photo IDs or proof of insurance. Patients signed simple forms and chose dental, vision or medical services.
The sisters arrived at 11:30 p.m. Her sister, Wanda Adcock, said the siblings entertained themselves with board games and gin rummy. Clayton won almost every hand. Then they talked until the sun surfaced early the next morning.
“We actually had a really good time,” Adcock said.
Clayton needed an eye exam and new glasses and wanted to make sure she received free care at the two-day pop-up clinic organized by RAM and the East Central Alabama Area Health Education Center.
At a little after 6 a.m., the two women entered the school, which had been converted to a kind of field hospital for the medically needy. Two gyms held 60 dental chairs – each encased in its own plastic tent and equipped with a ventilation unit.
Clayton headed to the auditorium, where she stood in the aisle, covering one eye and struggling to read the letters on a chart. She had not had an eye exam in at least 10 years and her vision had gone downhill. The 53-year-old can’t see well enough anymore to drive at night and had noticed new white spots near her cornea.
Clayton slipped behind the curtain and onto the darkened stage, where a row of optometrists clicked through lenses for patients who hadn’t seen clearly in years. After Clayton’s exam, the doctor wrote a prescription for bifocals, and another dilated her pupils and found early signs of cataracts. As for the white spots, he told her not to worry. They appear after exposure to sunlight and probably wouldn’t cause any problems.
Which is good news for Clayton. Her daughter bought her a health insurance plan just this year after a bout of COVID sent her to the hospital for a week. The plan covers care for her lingering heart issues and preexisting thyroid disease, but it doesn’t cover dental or vision.
Adcock takes care of her younger siblings since her parents died. She tried to sign up Clayton for free clinics around Attalla, where they live, but many required too much paperwork.
“Some of the stuff they require is kind of crazy,” Adcock said.
Before she got health insurance, Clayton would skip doses of thyroid medication.
“Then basically everything in her body tries to shut down,” Adcock said. “She would go to the hospital, and they would set her back up with medicine until she ran out again. It’s like a cycle.”
Ever since her hospitalization for COVID, Clayton said she has struggled with irregular heartbeat and chest pain. Her doctor told her not to return to work, but she needed the paycheck and went back anyway.
“Every day I go to work, I hurt,” Clayton said. “My heart hurts. It hurts to breathe. I can hardly walk.”
Clayton and Adcock were hardly the only ones who waited overnight to receive care at the clinic, which is the first of its kind for Alabama. About 200 cars sat in the parking lot when doors opened at 6 a.m.
Jodi Thompson, 35, said she has been on Medicaid her entire life. But the public health insurance program for kids, pregnant women and disabled people in Alabama does not include dental coverage. Thompson said she has never seen a dentist and pulled down her mask to show a row of discolored bottom teeth.
“I’m kind of scared,” she said. “I want to cry because I don’t know what I’ll be able to eat after this.”
The dental clinic had hundreds of volunteers, including three prosthodontists who specialize in complex cases that require restoration and replacement of the teeth. They could create partials for missing teeth and even a few digitally printed dentures.
Despite her fear, Thompson said she was grateful for the service.
“It has affected me a lot,” Thompson said. “Not being able to smile like other people.”
Tracy Salter said she operates a halfway house for women in Benton, Tenn. Many of her residents need dental and basic medical care. They can get both at RAM clinics, which offer pap smears, as well as the other services. Salter said she keeps tabs on the organization’s schedule and travels the region to get care for her residents. They drove two-and-a-half hours to be among the first in line when doors opened at 6 a.m.
“A lot of the people I see have used a lot of meth,” Salter said. “They have bad teeth and can’t eat. They can’t see. A lot of them have never had a pap smear.”
Donna Freeman also needed new glasses. She last had her eyes checked in 2015, when she had a job with health insurance. She had to quit to take care of her ailing mother, which left her with no coverage options at all.
“I went to sign up for marketplace insurance, but they quoted me $500,” Freeman said. “They should do something for people who have to do caregiving for their elderly parents. There’s all kinds of help for her, but there’s nothing for me.”
Remote Area Medical was initially founded in 1985 by pilots and physicians with the goal of bringing medical care to isolated areas of the globe, but immediately began getting requests from rural parts of the United States. In Alabama, about 10 percent of residents have no medical coverage at all. Many of those with health insurance don’t have supplemental policies for vision and dental.
The clinic that took place at Gadsden City High School had originally been planned for March 2020. The pandemic canceled it and organizers could not reschedule for another two years.
Chris Hall, CEO of RAM, said the clinics shut down completely for about a month and a half and then adapted to pandemic precautions. He said some dental services now take about three times longer than they used to as volunteers sterilize areas between patients.
“It took us about three years of planning to get here today,” Hall said.
Volunteers from across the state and country deliver care at the clinic, which opened at 6 a.m. Saturday and Sunday. Students and faculty at the UAB Schools of Dentistry and Optometry provided much of the care.
Dr. Lewis Mitchell, a graduate of the UAB School of Dentistry and practicing dentist in Gadsden, said many rural areas in Alabama have great needs and few dentists to provide care. Mitchell said he would like to see similar clinics in other parts of the state.
“We’re going to do a lot of good,” Mitchell said. “But we can only do so much good in two days.”
The vision clinic can make glasses on site for many patients, but Clayton’s bifocals would need to be mailed in about three weeks. Her last stop was an orchestra room where volunteers measured the distance between her pupils and steered her toward a selection of frames laid out on a folding table.
After she settled on a pair, Clayton and Adcock left to go home. But Clayton said she wasn’t sure whether she would be able to fall asleep. A combination of pain, depression and anxiety kept her up most nights.
“When you worry, you can’t sleep,” she said.
Her new glasses meant one less thing to worry about. Next time, they hoped to bring their brother.
“There’s so many people who need help but can’t get it,” Clayton said. “It’s really tough.”