“From the first time I heard about RAM …” ANDREW CARMICHAEL, 8/11/10

RAM reflections


From the first time I heard about RAM last fall, I knew I wanted to take part and add my passion to its mission. There is nothing more pure to health care as a free clinic or health fair. I have spent half my life in and out of free clinics donating my time, when I could, to not only help those less fortunate than myself but to also feel more complete myself.

I feel like I learn more at the end of the day from seeing patients without the restrictions of a paycheck than I do from any other method of learning. They teach me true empathy, to keep things simple and clear, and that every little bit I can give does make a difference.

When I applied to RAM, I honestly was afraid I wouldn’t make the cut to be a part of the team. While I’ve volunteered at a hometown free clinic extensively, spent time tutoring disadvantaged kids at risk of falling behind and provided patient comfort services for hospice patients and their families, I was still worried there was a multitude of others with far superior resumes than my own. I was also competing with upperclassmen with therapeutic classwork behind them and far superior hands-on clinical experience. I also am not one of the people that stand out in my class by vying for multiple leadership positions, joining the single sex or coed fraternities/sororities, or by being extensively outgoing. What I did have to offer was passion, and I could only hope that translated across the pages of my application.

Being picked not only made me feel grateful but ecstatic. It was the chance to learn more from patients than I could learn in weeks on my own through books or classroom experience. It also made me feel good that I had an opportunity to give back to a community that truly needed more health services than they could currently afford. It gave me to chance to show that I do have some leadership and professional skills when given the opportunity to show them.

The entire summer prior to RAM, I spent time with Dr. Sisson at the Center for High Blood Pressure, feverishly trying to learn as much as I could from my professional peers of like and different disciplines and my patients at the clinic. I was determined to be as prepared as possible for the trip and to be able to offer everything I could to each patient I came in contact with at RAM. By the time the trip began, I had become comfortable and strong in several areas I had previously mentioned as potential weaknesses in my RAM application. I did not want to be relegated to the corner because a lack of expertise. Helping the patients manage their health is the crux of my professional mission, and I wanted to make sure I could realize that goal.

Once we arrived at RAM, I was at once awestruck by the enormity of it. While a good portion of this health fair was for dental care, I realized the potential for pharmacy students to become involved and intertwined with the other health professionals. I was excited to receive my schedule and to see at what stations I could be of service. When I first got my schedule, I was a little disappointed that I got so little time in triage while it was busy and was not going to be able to do rapid A1C testing. But I re-evaluated my feelings and set myself to doing the best job I could possibly do at the positions I was assigned to and to see how the weekend played out.

This weekend not only brought me close to patients, but I learned and became closer to many of my RAM members. I tend to be a loner by nature, but I got to know several people on my time much better than I ever expected to. I became impressed by their individual stories, passions  and personal drives. I came around to opening myself up to them, when I am usually quite reserved. I got to know several of the patients over the course of the weekend, too. I asked them how things were going as they progressed through multiple services over the weekend and got to know them a little as people and understand their fears, concerns and hopes for the future.

I found out over the weekend, too, that the positions were not set in stone and at one point was asked to blindly start taking A1Cs when I originally was not trained. I at once was pumped and quickly read the instruction sheet for the device and watched another student do a test before jumping in. I found this and smoking cessation to be my favorite parts of RAM, personally. When doing A1Cs it takes five minutes to perform the test, and these five minutes give me a patient’s absolute time to talk to them about their health, how things were going for them and so much more. I made sure to impart everything I could in that small span of time, to help educate my patients as much as possible before their time with me was cut to an end. When I gave them either the good or bad news, I also spent a little more time with them explaining what their numbers meant and how it would effect their life.

Smoking cessation was equally rewarding because the patients I talked with I felt really listened since I was in their own shoes a few years back myself. I understand myself just how damaging and intense an addiction can be to tackle amongst a sea of never-ending problems. I really got the chance to connect with these patients and let them know that there is help out there for them and that it is hard, but by keeping at it they can quit themselves and stay there.

Despite the lack of severe lack of sleep I experienced over the four-day period and the rough process of recovering from lack of sleep (it took me a little more than two weeks!), I am beyond grateful for the experience to go to RAM. Even if I cannot be a part of the physical team next year again, I hope that I can support the future team in any way possible. It was one of the best parts of my student career.

“Returning to the dorms after long hours …” DEREK MIRES, 8/9/10

RAM gang.jpgRAM reflections

Returning to the dorms after long hours on the fairgrounds, I found it hard to sleep.  It may have been the heat, but I couldn’t get my mind to rest.  My head buzzed with questions and my heart was overwhelmed with emotion.  So, like I always do, I began talking.  It turns out that my roommates Andrew, Loan, and Elle all felt the same way.

We spent that night reflecting on the day’s experiences.  Even the veteran volunteers amongst us were surprised by the health disparities within our own state of Virginia.  Patients drove for hours from all directions (some over several state lines) to wait in crowded grandstands.  These same patients were screened for various health conditions such as diabetes, cancer and hypertension.  They received limited dental and optical care, often having the majority of their teeth pulled or finding a pair of glasses with a prescription “close enough” to their own. 

We all felt privileged to serve as team members on the RAM expedition.  The professionals and community members not only volunteered their time and services to their patients but taught us, as students, how to become better clinicians. Working at the fairgrounds, we learned more in four days than some of us learned in weeks of classwork.

However, that night while we reflected, we struggled with the idea that these patients have so few opportunities to receive medical treatment.  We debated our personal responsibilities to our communities as future pharmacists.  In the end, exhaustion gave way to sleep  — far before we could solve the problems of the world.  But the uniqueness of RAM was that it gave us, as peers, the opportunity to discuss real world issues outside of the classroom, away from teachers and with fresh experiences to reinforce our convictions. 

“The Remote Area Medical service experience …” LINDSAY SAMUEL, 8/9/10

Lindsay and Erika.jpgRAM reflections


The Remote Area Medical (RAM) service experience in Wise, Va., was a defining moment in my pharmacy student career and personal life. I was exposed to many different people, professions, private and public service organizations.  Not only did I gain valuable clinical experience, but I was also able to step outside of my comfort area and touch patients in a variety of ways. 

I chose to apply for a spot on the team because I wanted to honor my family by giving back to those in need.  My parents come from a rural community where they lived below the poverty line.  Their access to health care was very limited, and some aspects of their health status now, especially dental issues, stem from their lack of health care during their childhood. 

There are so many aspects of the RAM trip that I could focus on; however, my time in triage was the most emotional part of the trip.  During the patient interview, I was able to catch a brief glimpse into the patients’ lives that we were serving.  What touched me the most were the faces of the young patients in their twenties that looked so much older and patients that looked malnourished because they could not eat a proper diet without teeth or dentures.

The trip also gave me a chance to interact with different health-care professionals and promote the pharmacy profession.  I enjoyed collaborating with the nurses at triage, counseling patients at the pharmacy and talking with patients at the grandstand about general health promotion and disease prevention.  

After talking to a pharmacy resident from the University of Virginia Health System, I opened myself up to the possibility of pursuing a hospital residency.  From this experience, I personally felt that I had a greater appreciation for the struggles that my family went through when it came to accessing health care.  I also learned the importance of being a voice and advocating for patients that fall through the gaps of the health-care system.  I feel that it is my responsibility now and even more in the future to remember the patients that I met and advocate for policies that support patients in similar situations.  

It is hard for me to put into words the many emotions that I carried away from this trip, and I have a lot of respect for the many volunteers that transformed a county fairground into a positive, patient-centered medical experience.

“When people asked me how my trip to RAM was …” AMANDA KROLL, 8/5/10

RAM reflections

When people ask me how my trip to RAM was, I find it difficult to answer with just one word or emotion.  Words like interesting, exciting, eye-opening and challenging all come to mind.  However, none of these words encompass the true description of my trip to RAM.  The interactions I had with patients and other health-care providers were experiences that I might never have had the opportunity to be a part of, if it weren’t for RAM.   

It was amazing to me how friendly and thankful all of the patients were, even after they had spent hours, or even days, waiting in the heat for their number to be called.  While talking to patients during their medication reconciliation, triage and in the pharmacy, I was able to learn so much about them, their background and their families.  Many people almost broke down into tears telling me why they haven’t been able to see their doctors and take their medications recently and how thankful they were for RAM providing them medical care. 

I usually don’t get a chance to interact with a lot of young children under a medical setting, so it was really a great learning experience to talk to parents and their kids and explain to them the importance of a healthy lifestyle.  The phrase “Don’t blow smoke, blow bubbles” was often used, while handing out soap bubbles, to emphasize to young children the importance of avoiding tobacco.

I was also able to learn so much from the nurses that were volunteering in the triage section.  One nurse that I worked a lot with, Vicky, was so eager to teach me and answer questions that I had, it truly made me feel special and like I was really helping all of the patients.  She showed me how to make sure I was taking someone’s pulse and respirations correctly and the most efficient way to triage patients.  She was so kind and empathetic that it was truly inspiring to me.

Growing up, I have never been exposed to a true medically underserved group of people.  Being able to provide health care to such a large group of people in a short amount of time was not only a great learning experience but also a very humbling one. Listening to the patients talk about many of the hardships they have endured throughout their lives was really upsetting.  However, they still took time out of their lives to travel (up to hundreds of miles) and sleep in their cars overnight to seek health care for themselves and their families.  They realize how important it is to take their medications and get physicals and vision screenings even if they can’t always afford it and were willing to go great lengths to seek out care.

I am so grateful for the opportunity to participate in RAM this year and only hope I can continue to participate in the upcoming years.  RAM provided me with amazing hands-on experience and allowed me to apply many of the things that I learned during my first year in pharmacy school.  Being able to get insight from patients, other pharmacy students, students in other health fields and health care professions all added to this amazing experience.

“When I first heard of RAM …” LOAN CHIN, 8/3/10

Loan.jpgRAM reflections

When I first heard of RAM, it wasn’t through the school or word of mouth. I actually read an article upon entering pharmacy school. When I finished reading about RAM’s efforts and mission statement, I was set on participating.  I have never been to RAM, and this summer was my first experience. RAM stands for Remote Area Medical, and its name in itself reflects exactly what it stands for. RAM provides free medical, dental, vision and pharmacy services in Wise, Va., one of the most inaccessible regions to receive care. So you can imagine an overwhelming number of people who drive hundreds of miles to receive medical and dental services.

The time I spent in RAM was a humbling experience and a constant reminder of the growing gap between those with health care and those who don’t have health care in the United States. Fortunately, I have experience in providing medical relief in third-world countries, but to provide medical relief hours away from my hometown is an eye-opening experience. It really brought me down a notch. It turned something that I heard and knew about into a reality.

RAM offered a myriad of experiences. I developed and enhanced my skill sets in measuring blood pressure, glucose testing, A1C testing, patient counseling and taking pulse and respiratory rates.  I developed and cultivated new relationships among my team members, other professionals and, more importantly, my patients.

On my second day, I met a family who touched me. This family had three children and a niece visiting from afar. While my partner and I were there in the grandstands, we got the opportunity to meet this family. What inspired me most were the children. They showed curiosity, knowledge, concern and insightfulness about health and especially about diabetes since it runs in their family. We spent over an hour teaching them, and it was one of the most rewarding experiences I ever had. This specific moment in my life became a powerful realization that teaching the youth and empowering them with knowledge is the key to any successful outcome, especially when they are enthusiastic about learning.

I am very lucky to be a part of RAM Pharmacy 2010 because of the organization’s efforts. I am also very fortunate that I was one of many people who helped to hold up the image of such an organization that encompasses the perfect example of interdisciplinary professionals working together to achieve optimal patient care and outcomes.


“As I reflect on my fourth year at RAM …” EVAN SISSON, 8/2/10

RAM reflections

(Note: Evan Sission is the RAM team advisor.)

As I reflect on my fourth year at RAM, I struggle to capture all that the event means to me. As an educator, the opportunity to work with students in this setting is awesome. My approach is to provide each student with resources, then allow them to dig deep into their toolbox to meet the challenges of the weekend.  The students know that I am always watching close by and that I will step in, when Sisson.jpgneeded, to lend guidance. It is extremely satisfying to hear them counsel and educate patients using many of the same words and concepts that we reviewed together.

This year I was struck by the willingness and ability of the students themselves to assume mentoring roles. Third- and fourth-year VCU students not only engaged their less experienced team members but also junior pharmacy students from Appalachian College of Pharmacy (ACP). Students from both schools recognized the value of working as a team to meet the needs of the patients they served.

Reading through the blogs, it is clear that student team members from VCU School of Pharmacy are highly motivated to provide high quality patient care to the medically underserved. The students consistently sought opportunities to meet the needs of patients and providers at the RAM event without questioning the personal return or the relationship of the tasks to their future pharmacy careers. These selfless acts were recognized by patients and RAM volunteer healthcare providers alike.

After the last patient passed through the triage station on Sunday, we began to tear down tables, pack away equipment and say our goodbyes to the nurses and pharmacy volunteers. I was amazed at the number of nurses who complimented our students and implored that we return again next year. I affirmed that we would form a new team and be back for our fifth year.

As an alumnus and faculty member, I was honored to accompany such an outstanding group of VCU pharmacy students who represented the school and the profession of pharmacy so well.

“During this summer, I was part of RAM …” SHREYA PATEL, 8/2/10

RAM reflections

During this summer, I was part of the RAM team, and the experience I gained from this trip is immense. I had realized earlier that there are a lot of third-world countries that need help but had not realized that people here are in need of the same help. I thought to myself that there is no better place to start than at home, and being part of RAM helped me accomplish this goal.

In the period of the four-day trip, I have learned a lot about myself. I was very nervous going into this trip, but then I saw that the patients were grateful to any sort of help, little or big. First day, I had my shift in triage where I was assisting the nurses in taking vitals and managing the patients medications. Over the course of my first and second year of pharmacy school, I have taken plenty of blood pressures and blood glucose tests. Thus I was very comfortable; however, helping the patients figure out the names of the medications they were taking was something new. They would come in saying that it is the “water pill,” and I was able to figure out it was a diuretic and would then go from there.

During the day, I had another shift in the smoking-cessation clinic. I was not very comfortable there, as I had nothing to relate to that I could use to motivate the patients into quitting. However, partnering with a fellow volunteer made it easier for me as I watched him counsel. Moreover, in the pharmacy I was also counseling patients on their antibiotics and other meds, which made me more confident.  All these opportunities and support from friends at RAM have made me realize that I am going to be a good pharmacist if I keep up my confidence.

At this event, the volunteers from all over, including me, have contributed a lot to these particular types of people. All the patients that I had received were either disabled or unemployed, and receiving any sort of help for them was a blessing. They would wait an entire year so that they could receive treatment for any of their conditions. Therefore, giving up our luxuries for four days to help these people was a wonderful feeling.

I always would think to myself, “When I have money, I will help the poor.” But with RAM, I have realized that I can help people even without money. There are plenty of organizations that I could join that reach out to such communities, and there is no better place to start from than home.

The most important thing I have learned from this trip is that to be able to succeed in life and any goal, one needs to believe in themselves. I have always doubted my capability, but this experience has given me a lot of confidence and strength to do anything that I put my heart to. The thing that was a challenge for us as a team is that knowing that once we left, the patients are not going to have any access to health care for another year. The team thought that next year it would be a great idea to find out about free clinics in the area and provide the patients the information as they come in.

As a whole, I believe we impacted the community in some way or another. It may be through the information they gained about dental hygiene, smoking cessation, cancer, blood pressure, blood glucose or other things. With the amount of people we attended this year, I believe the trip was a success.

“When I returned from RAM …” ERIKA STIENE, 8/2/10

RAM reflections


When I returned from RAM, my friends, family and co-workers all wanted to know how it went. I was so excited leading up to RAM, I had been talking all of their ears off about this weekend of service in rural southwest Virginia. Each time someone asked, “How was your weekend?” I would have a different response. They received answers like “Amazing,” “Gratifying,” “Heart-wrenching” and “Humbling.”  There were not enough words to describe all of the emotions that ran through my mind during those three days in Wise.

Upon first glance, Remote Area Medical truly is amazing. The fairgrounds are entirely covered with buildings, tents and booths completely devoted to helping those in need. Thousands of volunteers from all backgrounds donate their time and skills to patients who normally would never have access to such services. The fact that so many people want to help blows my mind every year.

Even though the setup itself is awe-inspiring, the patients attending RAM really make the whole experience what it is.  Families camp out in their cars the night before just to get a good spot in line. Many will come all three days to ensure they can have all of their needs met. I think the best part, though, is their overall great attitude. No one is grumpy or upset about waiting. Instead, they are beyond grateful for everything the volunteers do. They wait patiently in dental and vision lines because for some of them this is their only chance for this type of care all year.

I think my favorite part, though, is the stories patients will tell you. Even after spending hours in line just to get to triage, they will open up for 20 minutes or more about anything and everything. You hear about a recent wedding, a new tattoo or sometimes a tragic accident.  Hearing their stories always makes me take a step back and really appreciate what I have been given. These patients help me to enjoy more of the little things in life. Many of these people have next to nothing but cherish every ounce of what they do have.  If one gets nothing else from RAM, you leave with a greater appreciation for your own life and an even stronger drive to enrich the lives of those in need.

“Afterward, I realized it was one of those ‘defining moments’ …” CHRISTINE NGUYEN, 8/2/10

RAM reflections

Afterward, I realized that it was one of those “defining moments” you always hear about but rarely ever experience yourself.  I am so truly blessed to have had the opportunity to take part in such an amazing experience as RAM (Remote Area Medical) this summer in Wise, Va.  Not only was it massive and provided medical Christine.jpgcare to so many people who cannot otherwise afford it, but it was also directly related to medicine, health and pharmacy.

I had many favorite parts about RAM, but one of them was being able to know patients on a personal level, to be able to follow them from 6 a.m. to when they left for home, anywhere between that same evening and the next couple of days.  I would see a patient in triage one morning as I took her vitals and recorded her medical history, then again later in the pharmacy as I counseled her on how to take her medications.  Patients with mouths full of bloody gauze would attentively listen to me and nod so enthusiastically, despite their pain.

It takes a strong person to tear away from the hardships of daily life, to stand in ridiculously long lines, yet still manage to look after his/her own health.  I encountered an elderly patient who had almost all of the medical problems on our list.  She had body pains, hearing problems, difficulty with vision, arthritis and osteoporosis, among other problems.  As I recorded her history and measured her blood pressure, I listened to her story.  She seemed so defeated and must have seen so much in her life.  She told me that her son had died two weeks ago in an RV accident.  I looked at her in empathy.  This is strength.  After everything she had seen in life, she still managed to bring herself out to the chaos of RAM, to at least look after her health.

I learned that no matter how busy or stressed I think I am, I have never had it as hard as they have.  If they can get through life and embrace it, so can I.  I learned that this particular community of people are underserved but not undeserving.  I learned that, behind the tattered black tank top, worn boots, goatee and muscular arms riddled with tattoos  was a regular man who cared about himself so much that he went to RAM to improve his health.  I honestly do not know, if I were in his same situation, that I would find that kind of strength.  But I am inspired and made stronger by witnessing it.

In the two-and-a-half days at RAM, we saw almost 1,400 patients.  Volunteers did anything from providing food  to checking vision to performing surgeries.  We filled 2,000 prescriptions. VCU pharmacy students in particular worked in triage, on smoking-cessation education, in the pharmacy, on medication reconciliation, on educational health games and anywhere else we were needed.  I saw patients who came from the same city, as well as those who came from Florida.  The services we provided, as a unit, was so valuable that if it were possible to estimate total value of care for the entire event, it would be over $1 million! 

Although we were able to help so many patients, these same patients helped us in ways they cannot imagine.  Just by being there, by looking after their own heath, they gave us hope, hope that maybe someday every single person will have the access to care that they deserve.  I know that I will do this kind of service for the rest of my life.  When there is a need (and there is always a need), I will dedicate my time and services to helping others.  This is something one must learn from experiencing it, not from reading a textbook or watching a PowerPoint presentation.  To be at RAM was to do what all of us as future health professionals should.

“This year, RAM was absolutely an amazing experience.” HODA ROSTAMI, 8/2/10

RAM reflections

This year, RAM was absolutely an amazing experience. SOP members worked hard together to help patients, and patients were very grateful for us to be there. 

On the last day, a guy came up to me and asked me if I knew of any hotlines that helped pay  for medications and I gave him St. Mary’s health wagon information. He gave me a hug and told me how much he appreciated us being there. In triage, while I was doing A1Cs, a middle-aged woman brought her mother in and said her mom used to be on insulin and she just can’t pay for the medication anymore. Her mother has to choose between her medication and her house mortgage, and when she found out we had insulin, she started crying and told me how much that’s going to help her family.

I had such a great time working with other SOP students and talking to the patients that I didn’t realize how hot (100 degrees) it was, and I was just motivated to help as many people as I could. Other health-care professionals and volunteers were also very motivated, and I had a great time working with them and I was able to learn from the nurses that I worked with.

Most of the patients had a good attitude despite the fact that they had been waiting outside either all night or most of the night with few hours of sleep; they were just happy to be there.