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My Day Home at the 2008 Remote Area Medical (RAM)

by Lewis Loflin

Remote Area Medical August 2008 in Wise has again set a new record for showing the massive poverty in our region. It has, along with other recent issues, proven the utter hypocrisy and indifference of public officials in our area. While millions of tax dollars are spent on a bewildering array of pork-barrel waste, thousands go without even basic services. This year I went Wise to see for myself what was going on and not rely on various conflicting local news reports and political propaganda. I spent the opening day in Wise and had a look at the place. I grew up in Norton, which is five miles away and I attended vocational school in Wise. I believe it's time reveal what the press ignores.


Looking from Flag Rock towards Norton

I got off work from a night shift at eight that morning and was on my way to Wise by nine. It's a 1-2 hour drive from Bristol, Virginia coming up U.S. 23 from Kingsport. Wise County in fact has a very good highway system with U.S. 23 and U.S. 19, but the promised jobs and economic development never occurred. The good jobs for those lucky enough are in government, including three prisons, Clinch Valley College, local school systems and county, state, and federal bureaucracies. Some people estimate that as much one-third of the population of Wise County works for the taxpayers. Add in welfare and transfer payments, perhaps two-thirds live on tax dollars.

These government jobs in particular pay much higher wage scales and include benefits than most private sector jobs. The Bristol Herald Courier in January 2008 under the Freedom of Information Act compared the salaries of public officials across the region to those of every day working people. The gap in many cases was enormous in addition to them receiving medical and dental benefits. This is where Remote Area Medical fills the void caused by government programs and lack of a middle-class private sector..

Studies show the area actually has less uninsured than many regions of the nation. A lot of people, as much as 60% are already on government health care such as Medicare and Medicaid according to the local healthcare CEOs I spoke to at a recent town hall given by Congressman Rick Boucher in 2009. But Medicare/Medicaid don't pay for dental care or eyeglasses nor will Obamacare.

As I came up U.S. 23, I stopped and took some pictures of Powell Valley (see below), just outside Norton. Coming into Norton and looking off to my left, all the massive strip-mine damage of my childhood had grown over. It did look better, but seemed empty and sterile. One could take a right on visit Flag Rock Recreation Area on High Knob in Jefferson National Forest. Nice place to visit, for more information see www.wisecountychamber.org.

Entering Norton I turned left and passed by John I Burton High School. Going downtown I passed by the new 119 room Norton's Holiday Inn at the site of the old Jefferson Motel. The Holiday Inn finished off a project began by the late George Hunnicutt who left standing a rusting steel eyesore for about two decades. It was a welcome change, but I hated seeing the Jefferson reduced to a parking lot. I worked there nights and weekends while in high school. In fact the whole town looked much nicer than when I left about 30 years ago.

But there was something troubling in all this beauty. Before 10 AM on a Friday morning Park Avenue (main street) was nearly empty. Perhaps all the traffic was diverted with the completion of U.S. 23. Driving through downtown a lot of old businesses was gone, several buildings were also gone, and the local bank had changed hands again.

I skipped taking U.S. 23 to Wise (built on a strip mine) and took the old road by Norton Elementary School. Leaving town I passed the Dairy Queen and the associated shopping center that had long replaced the old coke ovens. This road in the past was often clogged with coal trucks. In fact I hadn't seen a coal truck since I got to Wise County. (Nor coming back.)

After driving by the Guest River section I soon came back to U.S. 23 that now had a red light. There was a massive new Wal-Mart off to my right. Take a left and one can see another big retail complex along with some more new motels. I went directly ahead and took the old road to Wise about three miles away. In this section on the left between this old road and U.S. 23 is the home my late aunt used to live in.

My cousins Cathy and Teddy, along with my sister Connie and I would all hake over the then uncompleted U.S. 23 and climb around the strip mines and deep mines now covered by the new shopping center. One of the new motels I mentioned is built on the site of a pond that once was full of small fish. We used to go fishing there, but always threw them back. The pond was gone with most of the coal trucks.

One thing we always knew in Norton and Wise was whose daddy worked in the mines. The average pay was $100 a day at a time when minimum wage (1974) was $2 and hour. By the 1970s the digging of coal with a pick for $15 a week was long gone. Machinery made coal removal much safer and easier. (And faster!) Their families always had the best cars, boats, motorcycles, and you name it. Their kids often waited for their time in the mines because jobs were passed between families. The rest of us were often sort of second-class and had to learn to do things on our own and live within our means. Money has always been a dividing line in our culture, and the coal miners were king. We even had a car dealership called King Coal Motors. (They're also gone.)

Yet even then the miners stayed in trouble. "Wildcat" meant more here than a big cute kitty. Wildcat strikes sometimes shut down mines for months. The most absurd incident I remember was in nearby Appalachia over a miner not getting his birthday off. Strip mining exploded in the 1970s ravaging vast areas of Wise County, such the Dorchester section I passed when I entered Norton.

These were non-union jobs and paid good money too while it lasted. What the miners never realized is this was the final stage of coal removal. Many just never learned to manage their money and a lot of cars, boats, and motorcycles ended up back at the bank. That's how everybody knew a strike on or a mine closed. This also bred an atmosphere of political corruption as coal bosses and miners were at each other throats.

But in the 1070s welfare had not yet become a self-perpetuating industry it is today. It's not fair to say people of Wise County and Norton were bad, far from it. Nobody ever starved because family or churches or even complete strangers would step in. People grew gardens, worked all kinds of odd jobs. Kids, like myself mowed yards and did all sorts of jobs before the fast food industry came in. Working was respected, even for the lowest paying jobs.

And the wealthy were not really the monsters one might think, particularly the local ones. One of my friends for example suffered severe burns in an accident. One coal operator stepped in at his owns expense with his private plane and flew him to the Charlottesville burn center. That saved his life. Churches were always to be found delivering food baskets at Christmas; we got them all the time.

At school the PTA and other organizations were there to get us shoes if we needed them. The Lions Club helped people with glasses. There's really of lot of great things about Norton and Wise County, it's really a good community. (Note that Norton is an independent city from Wise County.)

By 10:30 A.M. I was at the Wise fairgrounds off Hurricane Road. Built on an old strip mine, little had changed since my days at the nearby (new then) vocational school I graduated from. (This was for high school students. I passed by the local manpower center still operating for adults.) The parking lot was packed, but I was lucky the press had reserved parking and got a press pass.

Nearby is Clinch Valley College. I picked up my press kit and I.D. before entering. I watched as an old car was circling around trying to find a place to park. It was an older Ford escort style vehicle with four occupants, two of them children between the age of five and ten. They had old cloths, but they were clean and the kids seemed well behaved. It had Virginia plates.

One issue brought up in the local press was the cost of gas, which some worried might cut into attendance. It never did as 1500 tickets were gone by opening at 6 A.M. and hundreds had been turned away according to volunteers I spoke to later. I decided to do a brief walk around and look at cars and licence plates. Most of what I saw (75%) had Virginia tags and made up most of the those there even though Wise is an hour or less from Tennessee, Kentucky, and West Virginia.

While in other years there may have been more people out of state, it's clear the vast majority this year are Virginia residents. (Wise County borders Eastern Kentucky.) Another factor to note is the cars/trucks themselves. Like the car hunting for a parking place earlier, most were late model and I have to wonder how some of them even passed Virginia inspection. We can do away with the "welfare Cadillac" myth. While a volunteer told me about one woman that came from Cleveland, Ohio, it's clear that most of this great multitude were local people. 200 had registered the day before.

In 2006 RAM had set its 7th world record. According to their press packet there were 7917 "patient encounters" that included 5379 medical procedures; 970 vision; 1411 dental; total dollar value $1,260,037.00. This started from a mere 1888 "encounters" and $205,555.00 in service in 2000.

On my way through Wise I passed the decaying and unused Wise Inn (see below) slated to receive $8.1 million in government money because to quote a local economic developer, "it attempts to build on the explosive growth at UVA-Wise, the Crooked Road, and the total lack of "quality" lodging in our region.

It's a small scale Martha Washington Inn, and it has to be self-sustainable.
" He claimed that only $2 million public dollars would go into this, but paperwork from the Virginia Tobacco Commission claims that nearly all of it will be public funds. So the new Holiday Inn isn't good enough. None of the people here ever benefit from it.

In the article Mountain Money: Federal tax dollars miss the mark in core Appalachia in 1999 the The Columbus Dispatch has revealed that Wise County is among the top ten Appalachian counties getting pork grants to the tune of $53 million. That $53 million in Appalachian Regional Commission grants has produced nothing anyone can measure for the average person. They are also funding the Wise Inn project with another $500,000.

"Last year's Wise County RAM, the largest such event in the nation, tallied well over 8,500 patient encounters to provide over $1.4 million worth of free health care services...(RAM) implemented a change in how patient encounters are tabulated this year, and the 5,184 patient encounters tallied for the most recent event is a new record." (Times-News 2008)

After passing through the gate and onto the fairgrounds, if one didn't look too close, it was more like a carnival. All of the "mobile" health, dental, etc. other organizations were there. So was the Wise County Health Department and the ever present Lion's Club, but most of the providers were outsiders. What I wanted to know is who was there and why.

What gets little press is the number of organizations and people that come there not to deliver health services, but to simply help out. One family came from a church in Midlothian near Richmond. Their van was stacked to the ceiling with "shoeboxes" of small toys, candy, drinks, etc. just to give away to kids. (Note the four people in the picture below.) Another group came with art/crafts and entertained kids while their parents were waiting for various services. Another group brought a mountain of stuffed toys kids rummaged through, while two ladies and others rummaged through boxes of donated sunglasses by the Lion's Club tent.

BB and T Bank set up a snow cone stand where it turns out, according to them, all the ladies liked the cherry flavor. (As did the lady pictured below.) I got an orange myself and it was great in the scorching heat. The ladies at the Imagination Library stand were really great and I even got one of their little bear books. By noon it was really hot and some people had been there for two days before waiting for RAM to open. According to press reports, there were over 1700 volunteers there over the weekend. I think the number was inflated.

Typical of most of the people and the children I saw there is the black lady (below) and her two grand daughters. They are clean, most of the kids there were clean and well behaved. Her son was getting dental work I think. She was a little wary at first of my press credentials, but smiled up when I explained I grew up in Norton and there wasn't anything she couldn't tell me about welfare or social services. (This is not to imply she was on anything, I never asked and don't believe she was.) In fact the idea of the dirty ignorant hillbilly is a myth for the most part. People can be poor, but that doesn't mean they don't have pride. I just didn't notice any of this "beaten down" look we often hear about, but some seemed to be sad. One girl I noticed, she looked about 19 and a little overweight, but clean in a nice dress, seemed about to cry. She was waiting for some dental work.

But most seemed cheerful and very grateful for what they were getting. One volunteer mentioned some people were here from last year. One little girl was showing off her new glasses while another volunteer rode around in a four wheeler handing out bottled water. Many sat under tents and chatted. I talked to one lady I'll call Angie.

Angie had her two kids with her, both girls. "They are my life and I'll do anything for them." I didn't want to pry into her personal life, but it was like wanted me to know she wasn't a loser it seems. "I work two part time jobs and mom watches my girls, but it's so hard," she said. The two girls are on Virginia Medicaid and that covers the kids medical, but she has no insurance. Typical of many of the new "service jobs" they seldom pay enough to live on much rather prosper. I asked what do they say at social services? She answered, "I go down and spend two hours filling out paperwork for food stamps, then I can get $20 worth." Her story is familiar because anyone that does work has that used against them. There is a rabid hatred at times towards those forced to ask for help. It's a stigma here and don't let anyone fool you, welfare is hell.

Most of those I've known would do anything to get off of it, but with the failure of millions of tax dollars to create any real jobs outside government and government contractors, this leaves little hope for working people like Angie outside RAM. This was confirmed by another volunteer I'll call Pam. Pam is a nurse and she lost her job at the Wise Hospital. She got lucky and landed a job at one the new prisons. "The people have so much hope when the government brings in a new industry, only to have it pull out and have their hopes crushed." She said she wanted to return some of her good fortune to her neighbors.

We discussed nearby St. Paul with it's new highway and a collection of shell buildings that change companies like clockwork. They get millions in corporate welfare, use temp agencies to avoid paying any benefits, then pull out. They are often not required (and often discouraged) from paying above 150% of minimum wage. (About $7-$8 an hour.) The corporate welfare packages have no enforcement provisions because as one public official informed me, it would make recruiting them almost impossible. By the way, the $2 an hour minimum wage of 1974 adjusted for inflation is $9.26 in 2007.


Gov. Kaine as he appeared at taxpayer funded "tourism" attraction in nearby Scott County. He was singing an dancing and had a real good time. This is part of the "Crooked Money Road" tourism scam that got over $1 million tax dollars and produces nothing for the typical Scott County resident. He visits these right after he leaves RAM.

Virginia Gov. Tim Kaine showed up again this year, making this his second time as governor and four times total. To quote Gov. Kaine,

"This really is an important thing. We like that we can show how big-hearted Virginians are, but even more importantly, it puts the spotlight on access to health care in this nation. I think it is an embarrassment for the country. I can't help but think how it's a shame that Virginians provide me, with their taxes, health insurance as their governor. I'm ashamed to know they provide health insurance for their governor, and many of them can't afford it for themselves. Yes, that is embarrassing. We definitely need a system for universal health care in this country. We would be a stronger society if we had a health care system that truly serves all." (and he) "is trying to do some things, like dramatically increase Medicaid reimbursement rates."

What he is referring to is how Virginia controls Medicaid cost: they just don't pay the doctors. This has resulted in many doctors in our region refusing to take Medicaid and dumping their patients. He also claims to have provided some money to the Southwest Virginia's Health Wagon, etc. according to various news reports. This was nothing but part of a blatant political stunt. He is being considered at the time as a running mate for Senator Obama in the 2008 election.

Governor Kaine has overseen the transfer of millions of tax dollars in an orgy of pork-barrel waste that delivers nothing to the working poor that RAM services or average citizen trying to survive. When I appeared before the Tobacco Commission hearing in Bristol, Virginia July 31st, I brought this issue of healthcare problems across the region and what I saw in Wise.

Their paperwork revealed that in one pork-barrel program they are diverting annually $140,000 form the Virginia Dept of Aging (VDA) and $25,000-$30,000 form the Dept of Medical Assist. Services to something called "The Oxbow Corporation" to, in their words, "to develop a tourism project...(to) display the work of SW Virginia artisans and sell postcards, greeting cards, and T-shirts..." I stood up and asked just what do these kinds of projects do to provide anything for the working poor of our region? I was told that these projects, "improve the quality of life" of all citizens. Guess this is proof of that claim.

They really believe this? Who is "all" supposed to mean? That's another part of the culture and it seems Gov. Kaine has bought into it. If the problem is denied or ignored, it doesn't exist.

They in fact refused funding the Mount Rogers Health District mobile medical unit that would have helped thousands of residents such as those served by RAM. Their reason? "Although the project illustrates a positive partnership between the Health District and local industries to improve the health of 2,500 - 3,000 employees, a request for operational support to expand healthcare services to schools and churches along with employers is a low priority for TICRC funding. Staff recommends no award."

To close this, I say thanks to the wonderful people at RAM for the residents of Southwest Virginia. You are loved and appreciated by those you serve. They deliver what political corruption and class warfare can't deliver, simple basic healthcare. If national healthcare that Gov. Kaine calls for operates like Virginia Medicaid and economic development in Wise, Virginia, RAM is the only hope these people will ever have.

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All the kids I saw were well behaved.
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Special people and searching for sunglasses.
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Smiles and special thanks to these folks.
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Click any picture for the full size.

The Health Wagon

University of Appalachia College of Pharmacy

Virginia Department for the Deaf and Hard of Hearing (VDDHH)

U.S. Health Care Gets Boost From Charity RAM on CBS News

Patient Advocate Foundation

(Above) The Old Wise Inn (a few miles from RAM) is slated to receive over $8 million tax dollars. What is the logic behind this? To quote the Virginia Tobacco Commission, "the Inn is expected to be an upscale lodging, restaurant, and meeting facility designed to support regional tourism, education, and economic development efforts." Yet they opened a new 104 room Holiday Inn in nearby Norton. They claim this will create 30-40 low wage service jobs, assuming it ever proves economically viable, which it has failed to so in the past.

Perhaps $1 billion has been spent on these kinds of projects over the last 20 years under the guise of job creation, while RAM reveals the results for the average person year after year. This year looks like the 9th consecutive record. Many of those seeking services at RAM do work and hold these of jobs already. The real winners are the agencies and contractors getting the money. Other grants (some already approved) include Virginia Dept. of Housing and Community Development $700,000; ARC $500,000; VCEDA $1.2 million; $3,820,000 in "Historic Tax credits." Note that affordable housing is also in desperate need in Wise County.

The government just doesn't get it.

See Worlds Apart by Cynthia Duncan
Empty Platitudes on the Poverty Tour by Bill Bishop

 

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