Critical care

I was hustling up and down the concrete steps in section 10 of the L.A. Sports Arena, when a man in a Lakers cap said to me, "You oughta stop running around so much and get off that bad knee."

I looked at him. "How'd you know I have a bad knee?" I asked.

"I can tell by looking at you," he said, "'Cause I got one of my own. You got to slow down if you're gonna be doing this all day."

From April 27 through May 3, the Remote Area Medical Clinic is open for business at the Los Angeles Sports Arena - a shabby and venerable old event facility near downtown. A Knoxville, TN based private non-profit medical charity, RAM provides free medical care to thousands of people, at no cost to taxpayers or government.

Here are dental stations where people can get fillings, have teeth extracted, have limited emergency procedures performed, and get their teeth cleaned. People can see pediatricians, have diabetes screening, mammograms, pap smears, and other services. There are eye exam stations and glasses will be made and fitted on site.

According to statistics on the organization's site, 6,349 people were issued wristbands allowing them to receive medical care. Of those, 2,260 people had received care by the end of the day yesterday.

The clinic called upon medical professionals to volunteer their services. They also called for general volunteers to help with line control and helping patients find their way.

The L.A. Sports Arena

Last August, during the height of debate over the proposed health care reform bill, the Remote Area Medical Clinic held a similar event in Inglewood, at the old Forum. The contrast between the virulent rhetoric opposing health care reform and the sight of thousands of Americans lining up to receive health care they couldn't otherwise afford was startling.

What was this monumental and important effort? When I heard that RAM was returning to Los Angeles this spring, I signed up to volunteer.

Non-press cameras were not allowed due to patient privacy so this is my only photo of the event.

My shift began at 5:30 AM. I was sent to the entry area, and assigned as a patient escort.

The patients were admitted starting at 6:00 AM. While most people needed multiple types of care, they were told to prioritize - did they want to see a doctor first or a dentist? Or get an eye exam? We escorted groups of people down a long escalator that led to the lower arena floor, and then directed them to the waiting area for their first priority.

Photo from the Los Angeles Times

The lower arena floor was filled with dozens of giant RVs that served as specialty dental or ophthalmology labs, mammogram stations, eye-glass workshops or other medical labs. Thick electrical cables snaked across the floor to power these trailers up. Curtains or folding screens enclosed spaces where people could have blood drawn for HIV tests. Rows and rows of tables ranged up and down the concrete floor, next to portable dentist chairs. Dental techs in gauzy lemon-colored robes, doctors and nurses in colorful scrubs, and volunteers in our white tee-shirts roamed the floor. Formations of folding red chairs - the waiting areas - teemed with people sitting quietly, resigned to a long wait - they were patients, indeed, in both senses of the word.

For the next couple of hours, I moved quickly. It was easy to pick out patients from volunteers, because they clutched a sheaf of papers colored pink, blue and white.

By 10:00 AM, the waiting areas on the arena floor were full, so overflow waiting areas were set up in the upper concourses of the Arena. People were asked to sit in order of arrival. Volunteer runners would arrive from below to escort groups of ten or twenty down to the floor as space opened up. I was in charge of the overflow Dental Reception area.

This was a little different from my earlier duties - Instead of leaving people within sight of the dentist they had come to see, now I had a crowd that stayed with me for a long time. As the overflow area filled up, people grew increasingly dismayed as they realized how long their wait would be. I had to explain the rules - to keep people in line without cutting, or keep people from getting on one anothers' nerves.

As the wait grew longer, people had to make choices that were sometimes agonizing. Should you wait two hours in Dental to have that aching tooth pulled? Or should you take your child to the pediatrics line first for an immunization, and risk losing the chance to relieve your pain? We triaged people with elevated blood pressure to the Medical area - yet some desperately needed glasses. A caregiver had placed her charge, a mentally retarded woman, in the Dental area while having her own diabetes screening. The lengthy separation had made the dental patient anxious. Volunteers were dispatched to reunite the women.

Some folks couldn't walk the steep concrete stairs of the seating area. We kept a row at the top for those folks, and asked them to use the buddy system to remember their place in line

I got to know people as they remained with me. Some were friendly, others glum. Some were annoyed. Still others were helpful - a lady named "Arlene"* who used a scooter for mobility stationed herself at the top of my stairway and sternly corralled newcomers until I could seat them.

A big guy who looked like trouble didn't want to sit in line with others. He sat off to himself listening to his I-pod, and kept bantering with me as I ran up and down. Finally one of the older ladies asked me for some water, so I asked Mr. Trouble if he would mind going to fetch a glass of water for the lady - after that, he helped direct traffic for me.

Every half hour or so, twenty of my charges were escorted to the lower floor. There were old folks, families with kids, young people. Our Team Leaders expected us to treat everyone with respect - people were "sir" or "ma'am" and when we referred to them they were "gentlemen" or "ladies." We kept families together in rows. We tried to answer questions if we could. We refused to discuss rumors. We pointed out locations of bathrooms. We handed out sandwiches donated by Subway.

The Remote Area Clinic was founded to bring medical care to isolated Third World areas and remote rural areas where medical resources are scarce. Yet as medical costs soar and the number of people without health insurance increase in the United States, the need is just as great in our biggest cities as it is in the headwaters of the Amazon where RAM began. It's a disgrace that people in America have to line up and wait six or more hours so that ten-year-old children can see a dentist for the first time in their lives.

This spring's clinic has its challenges. The number of volunteers are down. One problem is a legal one - the state of California currently does not allow out-of-state practitioners to serve here. Legislation to correct that is pending. But volunteers are critically needed. Because of the lack of volunteers, some people may be turned away, even after waiting so patiently for so many hours.

If you live in Los Angeles, and have some free time between now and May 3, visit the RAM Volunteer Registration website and consider volunteering. If you are a dentist or a dental technician, they need you. If RAM is coming to your city in the upcoming months - consider volunteering. You won't regret it.

The Advil is for my aching feet

I lasted until 1:30 PM before I was urged to take a break - and my aching feet and legs kept me from arguing. On the way down to the lunchroom, I passed the dental area, and there was "Arlene" on her scooter. "How are you doing, did you get checked out?"

She was fine - she'd had her examination and was now waiting for a prescription to be filled. "I want to thank you," I said, "for helping me out up there."

"Oh now, baby, everyone's doing such a good job, it's only right I gotta help out too." Bless you, "Arlene".

*I have edited this to change the lady's name, to protect her privacy.