Mimi Baker (left) found that getting up early was worth it at RAM!

Remote Area Medical was a life-changing experience, one that I will keep a special place for in my heart. The patients were all so grateful and appreciative of everything that we did for them. They were in high spirits throughout the whole day, even though most of them had been camping outside all night just to secure a decent spot in line. This put things into perspective while working in the community setting; usually I have patients that are easily perturbed when we don’t crank out their prescriptions in under 15 minutes on a busy day.

There were so many different interactions with patients and health care providers alike that I had while I was at RAM, but most of them revolve around providing the optimum patient care. One instance was when I was at the pre-med station, where pharmacy was playing a major role in pre-medicating patients with amoxicillin and ibuprofen before dental extraction/surgery. I was making rounds with my ibuprofen when I happened upon one gentleman who had a yellowish cast to his skin and eyes. He did not seem to be responding as well as the other patients. I immediately thought that he had hepatitis, but his triage papers did not say so. I asked him if he had hepatitis, and he finally admitted that he had A and B. I alerted our residents, Rose and Bethany, and they were able to relay this information to the dentists who were responsible for pre-checking all the patients. The gentleman was then sent to the medical tent for further check-up on his condition.

Another time was when I was at the smoking cessation booth and I had lured some foot traffic our way by standing in front of our booth, holding the face mold of the chewing tobacco cancer victim. A gentleman walked right up to me and started asking me about the face mold. I showed him the progression of cancer for the victim and the toll it took on his facial features. I gave the back story to the face mold, letting him know that the victim was a world class athlete who had a bad habit of chewing snuff. I guess it hit home because he started asking me about smoking cessation, and I happily provided him with all the information that he needed. He looked me right in the eye at the very end of our conversation and said, “It won’t be easy, but I’ll try.” I thought that was awesome.

I’m not a morning person, but waking up at 4:45 every morning to be on site by 5:15 wasn’t even bothering me by the second morning we were at Wise. I was running like a well-oiled machine by 6 a.m., going around and doing everything from health testings to counseling patients when they picked up their medications.

I have already thought about coming back to RAM every year I can spare as a pharmacist when I graduate in 2016. I know that all of our patients were extremely thankful for our work, but they didn’t know that they were also rewarding me with the pleasure of working with them. I enjoyed every single moment that I helped them and I’m thankful that I got to be part of such a great team assembled by Natalie (Nguyen), Erika (Lambert) and Dr. Sisson.

Participating in RAM taught Rebecca Saunders (second from left) that there are people in need both here and abroad.

Remote Area Medical is a great thing for any pharmacy student to experience, no matter where they want to practice after pharmacy school.  To be a pharmacist, one needs to have a serving attitude and that is just what you do at RAM in Wise, Va.  You serve the people of the area and surrounding states.

I took many blood pressures and blood glucoses in triage and pre-op, but when I felt most helpful to people is when they were lost and I could point them in the right direction.  Most of them not knowing which long line to wait in next, where the pharmacy was or that there was even a pharmacy to get their prescriptions filled at.

RAM makes you feel how fortunate you are and that in the United States, not just third-world countries, there are people who need help desperately.

Margaret Robinson (front row, third from left) found joy in helping RAM patients both medically and otherwise.

Remote Area Medical was truly one of the most wonderful experiences I have had since being in pharmacy school. I thoroughly enjoyed helping each patient and assisting volunteers throughout our time at the site. I had several interactions with patients while at RAM — assisting with premed, taking prescriptions, filling out medication cards, taking A1Cs and so on.

Some of the most meaningful times for me, though, were ones where I wasn’t serving the patients as a pharmacist but rather helping them carrying their belongings to their next destination or running to find a plastic grocery bag for a woman whose bag of things was leaking. I had the opportunity to talk to one gentleman at the smoking cessation for an extended period one afternoon. He told me about his experience with trying to stop smoking and how he had cut down from 2½ packs per day to ½ a pack. He told me about his reasons for wanting to quit — so he could enjoy more time with his nieces and nephews and put the money he saved towards a house while becoming healthier. It was nice to have him open up and be so honest about something that I have not personally experienced.

Several of the people at the booth were funny, and I really enjoyed educating them about smoking cessation and breast cancer awareness. I loved talking to some patients who told me as soon as they were done being cared for they were going to volunteer for the remaining time. One of the most touching experiences was a father telling me that he wanted his daughter to have braces, so that’s why he was coming to receive free care for himself.

While there were tons of positive experiences, there were also those interactions — like an 8-year-old boy telling me he’d only gotten 10 minutes of sleep the night before as they waited for the gates to open, or a woman telling me she’d lost her mother just two days before — that made me so thankful for all that I have and reminded me of how fortunate I really am. There was no hierarchy at RAM — no one was better or worse — everyone deserved the best care they could receive whether they had a million dollars or barely anything.

The interprofessional experiences were fantastic as well. I learned so much from Liz at the smoking cessation booth and from another woman who was well-educated in breast cancer awareness. Both of them showed such great joy in sharing what they knew with patients and students. They seemed to love having us there, and I was even able to get contact information for the woman who taught me about breast cancer so that we can possibly meet with her in Richmond and she can educate others.

I had a great talk with a nursing student, as we explained to each other the different types of pharmacy and nursing and the education required for each. It was so interesting because I know so many nurses but so little about the different levels of nursing. She was surprised to hear that there wasn’t necessarily a hierarchy in pharmacy like in nursing.

I would love to go back to RAM next year and then again when I’m out of school. The people we served were those who were in such great need and were so appreciative of us. While I wasn’t always doing “pharmacy” things, I had a great time helping out in any way that I could —  and sometimes those were more important ways. I felt like I was making a difference — even if it was just sharing a smile with a patient or trying to ease a concern for a minute or two.

A few of us on the team discussed one night the types of occupations patients reported on their triage sheet. There were many of the expected unemployed, disabled, or retired, but I was surprised to find there were also so many people who were employed as clerks, receptionists and even teachers and nurses who came to receive care.

I am so fortunate to be able to receive health care immediately and not worry about not being able to see a doctor if I get sick. If I have any mouth problems, I know I can call my dentist and be seen within the week. There are too many others who do not share this luxury. Many of these people work harder than I do and they deserve great care. I’d like to help give back.

At Remote Area Medical, Melinda Ellis (left) discovered that people her own age were as much in need as older people.

“The best way to find yourself is to lose yourself in the service of others.”                       — Mahatma Gandhi

As a student pharmacist who eats, sleeps and breathes every day within a mile of a major medical center, it’s hard to believe that someone in today’s society wouldn’t have access to appropriate medical care. Sadly enough, there are people all over the state for whom this is true — and especially for the people of Wise County, Va.

The days leading up to Remote Area Medical were filled with excitement, both to experience something new and to be able to work alongside my fellow classmates helping people who were less fortunate than us, but also apprehensive. I’ve learned all of this information in class, but could I apply it to real-life situations? Either way, I was headed to Wise, and I couldn’t have been more excited for what this journey had in store for me.

The first day came early — 4:30 p.m., to be exact — and people were already lined up at the gates waiting to get in. As we triaged patients, took vitals and medical histories, it dawned on me that the people we were serving weren’t just older — there were patients my age, as well. Young adults who had chronic medical conditions who weren’t getting appropriate care — people who could have further complications prevented.

It was one patient that I helped that particularly hit home with me — a teenage girl with Type 1 diabetes who had lost her mother due to complications of the same condition. As we talked, she told me about her struggles with not being able to afford insurance, insulin and sometimes — healthy food. She hadn’t slept in over 24 hours in order to keep her spot in line to be seen because she had seen her mom suffer and didn’t want to be faced with the same problems in the future.

I couldn’t help but admire her for being so proactive despite the struggles she seemed to face.

Volunteering at RAM has been one of the most rewarding things I’ve done thus far in my pharmacy career. It afforded me the opportunity to strengthen my clinical skills and knowledge, teach patients and help them understand more about their medical conditions and medications, learn about other professions, make new friends and, most importantly, provide care to patients who were overwhelmingly appreciative of what we were doing.

Nellie Jafari (front row, yellow dress) found value in the interprofessional aspects of Remote Area Medical.

Remote Area Medical has truly been a remarkable experience. Not only did I get to learn from the pharmacy students from my school, I also got a chance to meet pharmacy students from Appalachian College of Pharmacy. It was really interesting to compare curriculum and hear their perspective on pharmacy. In addition, I got to meet medical students, dental students and nursing students. Having the opportunity to work in an interprofessional environment was a great way to foster lasting relationships that could lead to future collaboration.

Another aspect of the trip that I enjoyed was practicing my clinical skills in the areas of triage, medication reconciliation, the pre-med area and in the pharmacy. I learned so much from the nurses, residents and pharmacists. They were able to provide me valuable feedback to improve my skills. I am very grateful that they took the time to supervise the students because their input is very beneficial to us.

Not only did I learn from the health practitioners, I also learned a lot from the patients. They were so amazingly grateful for the service we were providing. Most of them had slept overnight in their cars just to receive medical care, but they did not let it show in their interaction with us. They were so positive and thankful for the advice we would give them.

Although it was rewarding helping the patients, my favorite part of the trip was simply interacting and talking with the patients. Learning about their life and their view on health care really made me understand the health disparities that pervade in the Wise community. It is evident that their daily routine is not ideal for their health. Although we cannot directly change their socioeconomic situation, I am appreciative for the opportunity to have been able to help with their health care. 

A defining moment for Sara Ayele (second from right) came when she met a father and daughter who had defied the odds to get to RAM.

“Wherever the art of medicine is loved, there is also a love of humanity.”

When I got to Remote Area Medical, I saw a sea of T-shirts with the above Hippocrates quote. Upon my arrival to RAM, I had no idea that the short four days that I would spend in Wise, Va., would rock my perspective.  Before my arrival to Wise, I hoped to gain a greater understanding of how to help patients with limited resources navigate the health system. Little did I know that I would walk away from Wise having gained much more than I would have given.

We always learn in our pharmacy classes how important it is for us as pharmacists to work in rural, underserved areas. But I never quite understood how much of an impact a pharmacist could make in a rural area until I came to Wise.

A defining moment for me at RAM was when I was in the medication reconciliation station. Here I met a father and daughter who traveled three hours to get to Wise. As I sat down in the bleachers side by side with them, slowly they unraveled their story to me. As I interviewed the daughter on what medications she took, she explained to me that her primary concern was to get her teeth examined. She knew she had at least four cavities and feared having to get extractions. She also wore glasses and needed an updated pair of lenses. Her mother was raised on a tobacco farm, causing her to have COPD from the second-hand smoke she inhaled. As a result, her mother was bed-ridden, jobless and dependent on an oxygen tank to breathe. Her father bounced from job to job, and the jobs he took didn’t include insurance benefits, leaving his family uninsured. Worst of all, her father suffered from a stroke just days before RAM and was confined to his bed for three days without being admitted to the hospital because he couldn’t afford it.

I tried to weave in some advice to the daughter and father about the hallmark signs of having a stroke and the importance of getting to the hospital as soon as possible. The only one who knew that the father had a stroke was the family dog. The father claims that the only thing that kept him alive was the constant licking from his dog as the dog tried to keep his face from going numb and drooping.  Although today, the aftermath of her father’s stroke are undeniable. When speaking to the father, I noticed he would often lose consciousness and would have difficulty coming up with words to express himself.

The father put his daughter’s health needs above his own in coming to Wise. He got a lottery number only for his daughter to be seen because he knew that he couldn’t sacrifice missing two days of work if health care providers saw both him and his daughter. For him it was a simple decision, but to me it was a selfless decision. To them their story was an ordinary one, but to me it was anything but that.

Having walked away from Wise on Sunday, I learned much more than just how to provide patient-centered care for patients with limited resources. Above all, I saw with my own eyes the best of humanity. At RAM, I saw the Hippocrates quote I read on the DO’s shirts come to life. It is the essence of what tied us all together not only as RAM volunteers but also as patients.

I learned each patient had a story. As health care providers, it is our responsibility to hear their stories. For us, as pharmacists, that translates into providing care to make sure that our patients are around to live quality, healthy lives. We are all a part of the same tribe of humanity because their stories are our stories and our stories are their stories.

Erika Lambert, 2013 RAM co-leader, found out just how much can be accomplished in a short span of time.

This was not my first rodeo.  Last summer, I became acquainted with the organized chaos that is Remote Area Medical.  I knew what it felt like to wake up at 4:30 a.m. to see your first patient by 5:15.  I knew it was going to be hot, and I knew there was a high chance that I’d become hoarse.  But I also knew how much joy it brought me to see a patient smile despite their circumstances, and that is what brought me back.

Because I was already familiar with the organization and flow of RAM, I was able to focus more on individual patients than focusing on serving as many patients as possible this year.  Where I spent a majority of Friday clinic was at the A1C station with other student pharmacists and pharmacy preceptors.  The A1C station gave me time to actually have meaningful conversations with patients about their knowledge of diabetes and its implications on their health.

Two of my most memorable patients were women who had never been diagnosed with diabetes, but their blood glucoses were slightly elevated and they had strong family histories of the disease.  Both women knew what living with diabetes looked like, and both knew of its devastating effects if it was not taken seriously.   We spent the five minutes it took for the test to run to talk about their loved ones and their fear of the disease.  Coming from areas where unhealthy eating and little-to-no exercise were quite common, I was not surprised that neither were doing much to prevent diabetes even though they knew they were at risk.

Both women were visibly nervous as to what the number would implicate and knew that their lives could potentially be changed in five minutes.  The anxiety of the unknown created the opportunity to talk aloud about how they could be taking better care of themselves.  We discussed ways that they could incorporate more exercise into their daily life and how to make health choices even if their budget was limited.  I could tell that what they thought was completely impossible, like getting more exercise, maybe was not that far out of reach.

When the timer finally reached zero, I was even nervous because I would be the one to talk to them about seeing a physician for the official diagnoses of diabetes, something that they both clearly dreaded.  Fortunately, both women had readings under 6.0 percent, and their relief was palpable.  While they felt as if they were “off the hook,” I made sure to remind them that this does not mean that one day the numbers may not read differently.

While I am not typically a proponent of fear tactics, I believe that those long five minutes made these women seriously consider their personal risk of diabetes.  I can only hope that by facilitating the conversation, they remember what we talked about and actively work towards a healthier lifestyle.  While these were two positive outcomes of RAM, there were a handful of other patients who did not get “off the hook.”  However, it would only be at RAM that they would have access to all of the necessary resources to guide them through the process of understanding and living with diabetes right within their reach without any boundaries of insurance or finances.

While it may be hot and tiring, knowing that I may have made just a small impact on a patient’s life through just five minutes of conversation is what will bring me back again next year.

Allison Smith (center) enjoyed the opportunity to promote the profession of pharmacy as well as to provide patient care.

Remote Area Medical at Wise, Va., is an amazing place where pharmacy students and other professionals not only get to help patients but also get to interact with each other.  Interprofessional education is extremely important, and in my opinion there is no better place than in an environment where everyone has the patient’s care as their number one goal.  This year at RAM, I not only was able to help hundreds of people get the health care that they truly needed but I was also able to provide insight to the abilities and skills that pharmacists possess, while learning from other professions as well.

On the second morning, I was assigned to triage, where all the patients must be seen to have their blood pressure, blood glucose and pulse measured, as well as a medical and medicine history recorded, prior to seeing the dentists or doctors.  I saw a nurse sitting alone at one the tables, so I walked over, introduced myself and asked if I could help out.  She was hesitant but polite and told me I could.  We had a couple minutes to talk prior to seeing patients, and she told me I could write the histories down while she did the rest.

I agreed but explained that I would be happy to switch off since I had taken many blood pressures and blood glucoses before. Once we started helping patients, she slowly let me try to take the measurements and soon I could tell she was comfortable with my abilities.  She admitted to me that she preferred to collect the histories, and we quickly fell into a groove where I did blood pressure, glucose and pulse and she recorded the medical history.  We worked really well together, and she was able to see the benefit of having a pharmacy student around when there were questions about the patient’s medication history.  By lunchtime, we were enjoying working each other so much we even took our break together to have lunch.  She is very active with all the RAM projects and had fascinating stories to share.  I really appreciated my time working with her and learning from her.

Later in the day, while I was helping other pharmacy students take hemoglobin A1Cs of patients with high glucose readings, Dr. Sisson asked us to explain/show a pre-med student from U.Va. how to complete the test.  I walked her through the process and explained the basics behind an A1C reading.  I then had her watch me as I performed the test and counseled the next patient.  In the afternoon, when A1C slowed down, I had the pleasure of sitting down one-on-one and talking with her about her plans and pharmacy.  We talked about her interests and her plan to go to medical school.

Then she started asking about pharmacy.  I explained how pharmacy school was set up and what the curriculum consists of, as well as the many career options available for pharmacists.  Like me, when I started pharmacy school, she had no idea of all the skills and career paths that pharmacists have available to them.  She was particularly interested in the acute care rotation I was in.  She found it really neat that pharmacists and doctors rounded together in hospitals; but stated that after thinking about it, it absolutely made sense.  I really enjoyed our discussion and the chance to promote pharmacy as a profession.

For Southwest Virginia native Keshia Ward, returning to Wise County for her second RAM event was an eye-opening experience.

This year was the second year I attended Remote Area Medical.  It was nice to be coming back to the place of my roots [Wise, Va.] and offer assistance, but I am now feeling that each visit to my stomping ground only creates more grief.  Now before anyone reading this thinks the worst of me, allow me to elaborate.

Last year was very much perhaps a typical expectation of RAM.  However, despite being vaccinated, I somehow came away with pertussis [whooping cough].  So yes, the ongoing joke was that I went home and caught pertussis.  (Side note:  I have lived in many countries and even survived West Africa for seven months without catching any major illness).

What was more upsetting at that time was, like many patients at RAM, I did not have health insurance.  I was on my stepfather’s insurance, and when he was forced to turn in his resignation, my health insurance ended as well.  I was forced to pay out-of-pocket for many doctor visits.  After about a month, I finally ended up in the ER with an official diagnosis of pertussis.  Thankfully, I went to a small ER where I knew one of the doctors.   He helped to sign me up for financial assistance through that hospital.

My four-hour hospital visit had a price tag of $15,000.  After months of turmoil, my bill was finally dropped to under $200 (only because I had someone on the inside fighting to help me).  This visit really put into perspective how each and every one of those patients at RAM must feel.  No one should be forced to go without care simply because it is expensive.  I do know health care in the U.S. is more of a privilege than a right, but I somehow wish that could be changed.  I think many of those patients at RAM, if not all, would whole-heartedly agree with me.

This year I went back to Wise once again to see how I could help.  Thankfully, I did not come home sick, but I was able to stay the entire time and perhaps hear more stories than I should.  Once others knew that I, too, was from the area, I began to hear stories of what has changed over the past few years. The level of truthfulness was much more open than I expected.  One gentleman told me it was because, “You know what this is like.  If I tell other people this … well, they will just judge us … .”  This is truly where my heart began to break.  The recent loss of numerous jobs has left so many people uninsured.  They have no health care to offer their families, and the number of “bored” individuals with no jobs has caused the use of street drugs to be at an all-time high.

When I attended high school, it was not uncommon to know of individuals that used illegal drugs; however, to have many people tell me that teens and adults are using them simply because they are bored really got to me.  It was at this moment that I really realized how hopeless things feel for these patients.

I met patients who drove from hours away and graciously thanked us for volunteering.  I met patients who lived “right down the road” from my family, and perhaps we are even related.  As the weekend progressed, I met more and more people who each had a different story.  What I began to realize is the common theme — uninsured, no jobs, no desire to go to school “because there are no jobs when we get out”, no hope in the future.  I asked so many people why they did not just move away.

Now, you must understand moving away is a hard thing to do in this area.  When I moved away, well, it was hard for my family and still is.  It is hard for people to feel like they are seeking better things, when they often feel they abandoned those they cared about.  Anyway, when I asked the question about moving away, many patients responded, “For what?  We would not be able to get a job anywhere else.  This [coal mining and farming] is all we know how to do.  We don’t have an education to fall back on … and if we do, it’s not enough.”

In short, the fact that people feel hopeless and abandoned really got to me.  I heard many slanders of those in office and the government because they do feel forgotten.  I heard personal stories of growing and selling illicit drugs, and I heard of many corruption issues that have happened as well.  I would never break the trust patients gave me, a health care provider, but I have to say I was in shock.  How can so many people within a radius that stretches hours and hours be completely without assistance?  I know poverty is everywhere, but at least many places (like Richmond) have some free clinics and things to help.  Wise does have the Health Wagon, but there really needs to be more free clinics set up in Southwest Virginia.

I would encourage anyone who has a desire to serve or help others to go to RAM.  You will meet some of the most appreciative people while you are there.  These patients wait for hours upon end because they need the help.  It truly does make a difference.  I stayed in the area the day after RAM wrapped up.  To those who do not know and volunteered, I must say the news stations were blowing up with the amount of “good deeds” that were performed and the number of patients served.  Those few thousand were enough to make the long days worth the work.

In addition to learning a great deal from her interprofessional experience, Kelley Miller (right) had the opportunity to spend quality time with fellow RAM participants.

This year was my first experience at Remote Area Medical in Wise, Va.  After arriving home from the long, hot weekend, I have had time to reflect on my time in Wise and all of the wonderful interactions with patients and practitioners.

The one theme that keeps running through my mind as I think about this weekend is teamwork.  I had the pleasure of working with a plethora of health care professionals, including nurses, dentists, doctors and even pharmacists and students from other pharmacy schools.  We each set out to provide the best care possible for each and every patient that crossed onto the Virginia-Kentucky Fairgrounds.  It was amazing to me how each individual health care worker came to the grounds with their own experiences, but very quickly they came together to work as a team.

My first experience during RAM was with a nurse.  She was very hesitant to work with me; understandably so, since she had no experience working with student or licensed pharmacists.  However, she graciously allowed me the opportunity to serve as scribe while she performed the vital signs.  During the time between patients, we were able to talk about the training that pharmacists receive while pursuing their Pharm.D.  She seemed quite impressed when I was able to help with the medication history and help the patients interpret their blood sugar and pressure.  I was very impressed with her ability to speak to patients and elicit their stories.  We were both able to work together and learn from each other.

By the end of my three-hour shift we had become very comfortable with each other.  When my shift was up, she worked with Marybeth, who also shared her experience as a student pharmacist.  I believe the nurse became confident with student pharmacists’ abilities, so much so that on the second day she requested a student pharmacist as her triage partner.  This experience emphasized the importance of working with health care providers to share experiences and educate one another on professional backgrounds and training.

On the second day, I had the privilege to shadow a dental procedure.  This was a complete eye-opening experience for me.   I watched as a woman had every tooth in her entire mouth extracted.  The dentist and dental student told me about the epinephrine and lidocaine used throughout the procedure.  They also stated that many patients in the area have full mouth extractions to receive dentures and cure the constant pain from infections and decaying teeth.

I was naïve to the problems that can develop from poor oral hygiene.  The dentists helped to educate me on the infections and heart complications that can arise from tooth decay.  I was able to listen in on the education about how to properly brush and floss teeth.  To my surprise, I was actually doing it incorrectly!  It was truly amazing to me the number of people served by the dental staff and students. I was able to extend my knowledge about the dental profession and greater appreciate their role in patient care.

The weekend for me was about learning from each experience.  Each individual came to the grounds with their own practice, but left with one amazing experience in common.  It was clear to me that the volunteers were all working together as a team to provide the best care for each patient.

Participating in RAM was one of the best experiences of my pharmacy career.  I was able to interact with so many special patients and volunteers.  Each of their stories will forever be in my heart.  I look forward to participating in future RAM events.