This man has come to the rescue of nearly 200,000 poor Americans who can’t afford to see a doctor. So who is Stan Brock — and why has a penniless 72-year-old Brit devoted his life to solving the US healthcare crisis?
It’s nearly 6am on a Saturday in early February and pitch-black on the fringes of the Smoky Mountains in Knoxville, Tennessee. A tall, lean man with thick grey hair in a weathered leather bomber jacket and khaki uniform strides over to the metal gate where a crowd has gathered. Hundreds of people, shivering and wrapped in blankets, push gently forward, each clutching a tiny paper ticket.
Some are elderly. Some have teeth chattering and are aching so badly that they can barely stand. Most have slept in their cars. The man before them is about to call out numbers. He will provide assistance. He will end their suffering.
“Okay, folks,” he shouts, his breath visible in the frigid air, “we’re going to bring in the first 50.”
He stands bone-straight, hands clasped behind him. A British voice, sonorous and genial, silences the crowd. He begins calling out numbers. One by one they step forward. Through the open gate, up the small paved hill and into the building. They move at different paces. A few are limping, others are skipping, and one woman in her twenties and wearing flannel pyjama bottoms and bootee slippers is jumping for joy as she races indoors. They have not won something. Nor are they the first to arrive for a concert or a state fair. They are excited because soon they will have the chance to see a doctor, a dentist or an ophthalmologist. All they have been given is the opportunity to have their basic healthcare needs met. No payment necessary. No questions asked.
For the next two days, the Jacobs building will house the 561st Remote Area Medical (Ram) expedition. In just a few short hours its empty structure will be transformed into a mammoth field hospital.
Less than 24 hours earlier, the Ram trucks arrived with medical supplies. Dental chairs, sterilising machines, auto-refractors and eye charts, everything from the silver for fillings to wooden tongue depressors. Volunteers began unpacking boxes of sterile gloves, opening crates of cotton wool and paper gowns, delineating sections for eye clinics and examination rooms. Hundreds of volunteers, thousands of dollars of equipment — all of it donated.
Stan Brock is the man overseeing the operation. He founded the Remote Area Medical Volunteer Corps, a non-profit-making organisation, in 1985, but he had the idea when he lived in the Amazon in the 1950s. He has carried out medical relief missions all over the world, but increasingly his focus has been on the poorest Americans.
So who is this British man, living in the middle of the Bible Belt in Tennessee and trying to solve America’s healthcare crisis? It might be a temporary fix, but he is driven by those in desperate need, and his devotion is paying off. How did he become a hero for so many?
The Ram headquarters operates out of a 37,000-square-foot schoolhouse that Brock leases from the city of Knoxville for $1 a year. This is his home. On Friday morning, the day before this year’s event is due to start, Brock shows me round. The plaster is peeling off the walls, it is damp and cold, and many of the volunteers work in parkas. We walk through the schoolhouse as Brock, still fit and strong in his seventies, leads the way to a classroom where we’ll sit and talk. This is the only time I see him seated for the next 48 hours.
Brock was born in Lancashire in 1936 and grew up mainly in South Wales and along the south coast of England. He had been given a scholarship to the Canford school in Dorset, but dropped out at 16 to join his mother and father, a civil servant who had been posted to British Guiana on the northern coast of South America — now known as Guyana.
His life story unfolds like an action-packed western where Brock is the hero. For the next 15 years he lived as a cowboy with the Wapishana Indians on Dadanawa ranch in the Amazon. It was during this time that he was inspired to start a volunteer medical-relief corps that would bring free healthcare to people who were poor and isolated.
In the US, Brock is remembered as the star of Wild Kingdom, a popular TV series about wildlife conservation that began in the late 1960s. Off the back of this, Brock starred in a few films in the 1970s that were low on plot but packed with animals. There are fading posters on the wall from Escape from Angola and Forgotten Wilderness. On this poster, Brock is pictured in a swamp wrestling a real anaconda. Also hanging on the wall is Brock’s tae-kwon-do black belt and several framed photographs — he looks more at ease in the ones with lion cubs than in those with humans. He was often referred to as “the original crocodile hunter”.
Forty years later, his adventurous spirit is still thriving. Part James Bond, part Gandhi, he moves with purposeful velocity. He seems incapable of wasting time. And because he has, as he says, “no dependants”, he is utterly, passionately committed to Ram. He needs very little. Brock sleeps on the floor on a mat, and his main companion is a stray dog, Rambeau, who is now blind. Until six months ago, the two of them showered outside in the courtyard with a hose, but when the temperatures dipped below freezing, ice cubes came out of the nozzle, so an indoor shower has been installed. There is no hot water? “No,” he says, recoiling. “Hot water is bad for you.” Brock does not take a salary and has no income. “I am here 365 days a year, all day, every year.” All of his money has gone into the organisation. He has no car, no house, no possessions, no bank account. He was sending in tax returns with “zero” under income for so long, the IRS (Internal Revenue Service) informed him it wasn’t necessary for him to file. “This is all I do. I do not need money. I had oatmeal to eat this morning and one of the volunteers brought the oatmeal.”
He laughingly admits he has taken a vow of poverty. He does not go to restaurants because he’s not able to pay the bill, and he doesn’t miss it. He lives on a diet of rice, beans, fruit and oatmeal, and only occasionally protein, such as a can of tuna. The only beverages he drinks are water and 100% fruit juice. He has never had a fizzy drink.
Every day, sometimes waking up at 4am, he does two hours of exercise — tae kwon do, 600 sit-ups, and running, but only on a soft surface. He will ride his bicycle out to the local airport or soccer field and run around on the grass.
Personal details are hard to pin down. There is brief mention of a marriage, which, he says protectively, “didn’t work out”. He has no children, and later I discover his marriage lasted for 12 years. His family is his work — and the volunteers he surrounds himself with. Twelve years ago the operation became so large and complicated that Brock had to begin paying some of the volunteers. Jean Jolly will be 74 in August and has been with Ram for the past 15 years. Her salary is about $1,000 a month, and since she retired in 2004 from work at Talbots, a retail-clothing store, she is now the full-time volunteer co-ordinator; the engine that keeps everything running smoothly.
“We are the only nongovernmental charitable organisation in the United States that offers free dental, free visual, free medical, without any restrictions or questions asked,” she says proudly.
There are two separate entities. The Ram Foundation is the fundraising and administrative arm of the organisation, managing the private donations that underpin the work, with two full-time and five part-time employees. Then there is the Ram Volunteer Corps, which organises the expeditions and field operations, record-keeping and statistical information. Brock is chairman of both.
Last year, Ram was profiled on the American news programme 60 Minutes. Up until then, the annual budget had been about $250,000. And Ram had directed 94% to 96% of unrestricted funds to programme services, and spent between 4% and 6% on administration and overheads. But now, thanks to that exposure, the annual budget will be $1.9m. All donations and grants are from private donors and family foundations — no government money, no taxpayer money, no corporate funding. So what does that $1.9m cover? $595,000 of it was spent on an aeroplane, part of Ram’s mandate to take advanced surgical teams to communities that have never had a clinic before. It will fly a surgical team to Guyana a few times a year. There will also be a tractor-trailer rig outfitted as a self-contained mobile medical unit — to travel across America.
Twelve clinics are scheduled a year, but it usually ends up doing twice that. Some of those are one-day clinics offering one-day screenings, and so on. In the US it has expeditions scheduled in Kentucky, Virginia, Ohio and many more in Tennessee.
For this weekend’s event, Ram will spend between $2,500 and $3,000 on supplies and $500 on fuel (since it is so close to home). The estimate for the entire weekend is $4,000.
The reason for this low figure is that nobody gets paid. Everyone who has travelled has done so at his or her own cost. All volunteers cover their own food and lodging. There are no expenses.
By the end of the weekend there will have been 570 volunteers — including 36 dentists, 25 hygienists, 12 opticians, four optometrists, and three ophthalmologists. There will be nurse practitioners and dental students and those who have shown up to make coffee and offer administrative support. There will be people like Dr Joseph Smiddy, a pulmonologist who went to truck-driving school and got his licence as a truck driver in order to drive his 18-wheeler customised x-ray unit and mobile clinic.
There will be volunteers who have travelled at their own expense from 15 states — including Marta Flood, a nurse practitioner who drove eight hours from Cleveland, Ohio, and Moira Stangeland, a nurse from Los Angeles. When they first arrive they will be overwhelmed, unsure what to expect, and by the end they will have become friends, with plans to meet up again for a future Ram event.
There will have been 911 patients registered — some who have driven from nearby states like Georgia, Kentucky and Texas. Of those registered, 13.4% said they earned less than $5,000 a year, while 73.8% refused to answer the question about income; 88% of patients were in the 21-64 age group; 70% were Caucasian, 22% African-American, 9.4% Hispanic; 61% are unemployed and 61.5% have no health insurance. At the end of this event, 1,538 services will have been provided; many patients will receive more than one service. There will be 424 pairs of spectacles made, 26 mammograms, and 904 teeth extracted. The value of care will total $189,290.
By 9.30pm on Friday, all that can be seen is a serpentine row of headlights set against the endless blackened sky as people arrive and wait. Tickets are distributed by the Tennessee State Guard on a first-come, first-served basis. People are told they will be allowed to return tomorrow at 5am — as a safeguard to prevent carbon-monoxide poisoning from running car heaters all night. But those who have driven for hours choose to stay overnight in the car park rather than risk losing their spot. They can’t afford a motel.
Ida Stanford is on a fixed income. She is number 9. She’s worried if she’s not here when her number is called she will be passed over. She has problems with her eyesight and needs a new pair of glasses. Darrell Ledford is number 69. He is disabled — having suffered a spinal injury — and here to see if he can get 14 teeth extracted. He is in excruciating pain. His jaw is swollen to the size of a grapefruit. If Ram weren’t available he would have no choice but to do what he’s done all year: lie at home with a toothache. A small heater is on the passenger seat next to him in the truck. Will he stay out here all night? “Yes, ma’am,” he replies. “It’s rough. My teeth hurt real bad. I’d sleep out here three nights if I had to.”
Tony Blake is an Iraq and Afghanistan veteran who has walked from his house down the road to get his ticket. The Veterans Health Administration provides him with his blood-pressure medicines, but he says they don’t do a lot of dental care unless you’re about to be deployed. He was a construction surveyor in the army, but can’t find employment. He talks for a while about the veterans and how they are treated when they come back. He is angry. “I served 15 years in the military. I spent 15 years as a firefighter. Pretty much my whole life has been in service — for my country or as a civil servant. I’ve been all over the world. I free people from oppression, and I’m more oppressed in my own country than the people I free.”
Tony is going to walk home and return at 5am. He needs some fillings done and his teeth cleaned. When asked what he would do if he didn’t have Ram, he shrugs. “I’d suffer.”
At 11pm, the volunteers are still inside and focused on being ready for the morning. Brock stands over a rubbish bin peeling an orange — this and a banana will be his dinner before he goes back outside to see how it’s going and make sure nobody has passed out in their car. He will spend the night in a camper van in the car park — the van has been lent to him for the next two days by Laurie and John Osborn. They’ve been involved with Ram since 1992, and John, a dentist, is now the dental director.
When Laurie shows Brock how the thermostat works and asks how he likes it, he looks baffled. “Whatever’s normal,” he says. There is a double bed, but he chooses to sleep on the floor. He’ll be up at 4am so that the gates open promptly at 6.
The sun has only been up for a few hours and already hundreds of people have been treated. Everyone here has a sad story. When I meet Brandi Devine, 33, she is in tears. Her husband, Shane, helps walk her over to the stairwell so she can rest. She has just had five teeth pulled and she is dazed from the pain. Shane says she has lived in agony for months. They are from a small rural town 40 miles away called Tellico Plains. They arrived at 7.30pm on Friday and slept in the car. They look worn out.
Being unable to help ease his wife’s pain has taken its toll. “I felt like half a person,” Shane says, stroking her hair.
Neither of them has health insurance.
Five years ago, his wife developed an infection that caused the enamel in her mouth to deteriorate badly. They have been married for nine years and have a three-year-old. He had been working as many shifts as possible at the foundry but is now unemployed. He is relieved his wife can eat something now besides soup. “This has saved our marriage,” he says.
Dr Joseph Gambacorta is a dentist who has driven 300 miles from Buffalo, New York, with his 13-year-old son, Patrick. He has been pulling teeth nonstop for four hours. “The American system is not working,” he says. “There are a lot of people who are working middle class and can’t afford the co-pay or the deductible.”
To understand what he’s referring to, it’s important to grasp some basic facts about American healthcare. In 2008, there were approximately 48m Americans with no health insurance whatsoever and 25m-30m more who were under-insured, according to the National Coalition on Health Care in Washington, DC.
Health coverage in the United States is a complex labyrinth that is dizzyingly brutal to navigate. If a patient in the US seeks medical care from a physician, there is usually a co-insurance requirement. This is a percentage that they must pay for the medical care, and this percentage is determined by their employer’s health plan. The co-pay is a specific amount the patient has to pay for prescriptions. However, neither coverage nor benefits kick in before the deductible has been met. This is what the patient must pay from their own pocket at the beginning of every year, and varies based on different employer benefit plans. For instance, if the deductible is $400, and you see a physician who costs $100, you will need to pay that amount in full. Then there is the premium.
The premium arises when a health-insurance plan charges the employer for providing coverage, and most employers require their employees to share in the cost of that premium. The average amount is about 30%. This gets deducted from their pay cheque.
Under the 1986 Consolidated Omnibus Budget Reconciliation Act, when someone loses their job they are allowed to purchase coverage from their former employer, and so can continue on that company’s insurance plan — but they have to pay it in full. They can do this for up to 18 months. After that, it’s discontinued and the only option is for them to try to insure themselves privately or to seek government assistance.
Millions of Americans who are working still cannot afford the cost of healthcare. They are considered “working poor” because they are earning a modest income and unable to qualify for Medicaid or Medicare, the public-assistance programmes for those whose income and resources are insufficient to pay. Medicare is the nation’s largest health-insurance programme, providing coverage for about 39m Americans who are aged 65 or older or who have a disability. Medicaid provides medical assistance to approximately 36m low-income Americans and is funded by the federal government and the state governments.
TennCare is the Medicaid programme in Tennessee that provides healthcare for children from low-income families, pregnant women and those who are disabled. The eligibility explanations on the website are a jumble of obfuscation — sections for Medically Needy versus Poverty Level Income Standard versus Supplemental Security Income. It is an incredibly convoluted and confusing process just to figure out how to get help when it is needed. And most people who are truly in need do not have the acuity or the time to make sense of it.
Though Brock has adapted to living with the suffering of others, the rawness of it still hits him when he has to turn people away.
“You try not to become immune. I review e-mails that come in by the hundreds.” He reads them all? “Oh yes,” he replies. “You can’t exit out and move on.” His current mission is to raise awareness about a key issue: that qualified, licensed medical professionals should be permitted to cross state lines to practise and provide free healthcare to indigent people. But owing to licensing laws, they are not, and that, he says, is the greatest impediment. The only place in the United States this can happen is in Tennessee, and this is because Brock had the laws changed. Most of the doctors who will show up over the weekend will be from out of state.
In April 2008, during the heart of the election campaign, Brock was asked to speak at a congressional hearing on healthcare in Washington, DC. He gave his views and asked: why can’t doctors cross state lines? He was given five minutes to say his piece and then was asked questions. And since then, what has transpired? Nothing. “It was a big disappointment,” he says.
It hasn’t stopped him. Brock seems most at ease when he is in motion. He is a qualified airline transport pilot — and often pilots a vintage second-world-war Douglas C-47 plane built in 1943 and flown in the Normandy invasion by the US Ninth Air Force. It is used for the transport of medical equipment and volunteers from the Knoxville base to various Ram clinic sites in the US. During Hurricane Katrina it evacuated refugees out of Baton Rouge.
There are a total of five aircraft in the donated fleet. Aside from the C-47, there is a Twin Beech classic from the 1950s; a King Air turboprop plane that was bought after a donation from Rena and Sami Shulsky of New York; a Cessna 206 bush plane that is based in Guyana flying a free air ambulance mission every 1.9 days throughout the year; and a Cessna 150 basic trainer.
We are inside the Jacobs building, with the event under way. As we talk, Brock squats, feet flat on the floor: “Sitting down isn’t good for you.”
Reluctantly he talks about some of his own bouts of illness. While in Brazil in the early 1960s he developed a severe form of malaria — plasmodium falsiparum — and spent three weeks drenched in sweat and delirious. He had no medication. When asked what happened, he responds stoically: “I got over it.” Amused by the line of questioning, he tells me about the time he had leishmaniasis, a flesh-eating parasite transmitted by the bite of a sandfly. He had it in the late 1950s when there was no cure, and he says with a smile: “It was inconvenient.”
How did Brock end up in Tennessee? In the 1980s he was asked to help design the Central Florida Zoo. His television show, Wild Kingdom, was off the network and he had never been interested in pursuing a more active Hollywood career. One zoo led to another, and he ended up in Knoxville and fell in love with the area.
Teresa Gardner is a nurse practitioner and excecutive director of The Health Wagon, a mobile unit she drove up from Clinchco, Virginia, about four hours away. She is able to do smear tests and breast examinations, will screen-test for cervical cancer and will call the patients when the results come in and help refer them for follow-up care. Inside the tiny waiting area, Lottie Crudup-Richardson wears a hat covered with round and shiny Barack Obama buttons. She is 52-year-old, and anxiously waiting her turn. Tresa Osborn is 46. Her last breast examination was two years ago, and she too is nervous. She has two part-time jobs, but has no insurance. She makes too much for TennCare. “You’re punished if you work,” she says quietly. She was told 15 years ago that she should have a hysterectomy, but as she has no insurance, she hasn’t been able to have the procedure.
A few feet away outside, Robert Macelyea is trembling from the cold. He has been outside since 4.30am. It is nearly 3pm. He is number 477. He works in Wal-Mart and can’t afford to pay extra for his insurance. It’s about $200 a month. He has three children under the age of four, and he is here to have his teeth and vision checked. He lives in the next county. “Number 475!” is called. He leans on the gate and waits it out.
Glimpses of Brock reveal him overseeing, answering questions, making decisions, observing. Things are running without incident.
Brock would like to organise Ram UK and is currently exploring various options, but there are problems. Not least those to do with licensing laws, which can make it difficult for Canadian and American medical and dental professionals to practise in the UK. He says that possibly, if there were enough practitioners giving their support, then they might be able to do it. He hopes to get past the bureaucracy.
Today’s expedition is winding down, but tomorrow it will begin again. Hundreds more will be seen, disease will be detected, pain extinguished, lives saved.
Right now, Lottie is worried. Her voice is soft and shaky as we sit in the trailer of Dr Smiddy’s truck. She has just had her chest x-ray done.
She is a smoker who has been rolling her own unfiltered cigarettes for years. In The Health Wagon she was told she has a rapid heart rate, which is what led her here. “Maybe it’s nerves?” she asks, with apprehensive hope. We wait to find out.
Dr Smiddy takes her x-ray and reads the result. It is good news. There is nothing cancerous, no sign of emphysema or chronic obstructive pulmonary disease.
“Thank you, Jesus.” She exhales when he delivers the outcome.
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