Just after sunrise on Sunday morning at the Stadium School in Northeast Baltimore, volunteers ushered cars into the parking lot next to a sign that read “clinic capacity has been reached.” Patients — some of whom slept in their vehicles all night to ensure they could be seen — were already inside talking to triage staff about the medical or dental problems that brought them in, which they hadn’t been able to address anywhere else.
A semi-truck emblazoned with the words “Remote Area Medical” sat at the back of the parking lot. The Knoxville, Tennessee-based nonprofit set up shop in Baltimore for the weekend to host a pop-up clinic event where volunteer providers delivered an array of medical and dental services free of charge.
Inside, Kisha Hargrove of East Baltimore sat in line with other patients in a hallway outside a classroom where several makeshift exam rooms were set up. Hargrove came seeking dental care for a toothache she had for a few weeks, but arrived two minutes after the clinic opened at 6 a.m. — too late to snag one of the coveted spots. She hoped to get antibiotics prescribed by one of the doctors to vanquish the infection but didn’t know what she’d do to get the tooth itself fixed.
Hargrove, 48, gets Social Security disability benefits and therefore has Medicare, which does not offer any dental or vision coverage. She said, “It’s been so long” since she saw a dentist, she can’t remember the last time.
While Maryland’s efforts to plug the holes in a fragmented health insurance system have been much more robust than other states’, large gaps remain — leaving behind people who need care badly enough to sleep in a dark parking lot just to increase their chances of getting treament.
Adults with Medicaid, for example, just got dental benefits at the start of this year, but 35,000 lost coverage this month in the post-pandemic mass renewal, and thousands more will be disenrolled over the next year. Even people with commercial insurance, whether it’s through their employers or the state health benefit exchange, often contend with large deductibles and copays that cause them to avoid health care unless it’s an emergency.
Gary Johnson, 60, of Catonsville, has insurance through his employer, but he struggles to afford the 40% copays for dental care. He came to the pop-up clinic to see a dentist but, like Hargrove, just missed the cutoff, so stuck around to get a physical exam.
Free events like the ones offered by Remote Area Medical “give people a chance to understand what their [health] status is,” said Johnson. “People are so worried about health care,” in terms of costs and time taken off work to go to the doctor, he said, that “a lot of the people here wouldn’t have gone to the doctor if it wasn’t free.”
“Many of our patients work full time, they just can’t afford their deductible,” said Mary Johnson, volunteer manager for Remote Area Medical, who is not related to Gary Johnson. “Or, they don’t have dental or vision.”
Some of the patients, though, are entirely uninsured. Many are immigrants, some undocumented, who are all but locked out of the insurance system. Remote Area Medical typically has volunteer interpreters speaking many different languages — on Sunday they offered Spanish, Mandarin, Vietnamese and Turkish.
One such patient is 39-year-old Carla Amador-Games, who emigrated from Honduras a year and a half ago and lives in eastern Baltimore County with her five children and another renter. Amador-Games works in interior demolition for an asbestos abatement company and has not sought medical care since she’s been in the country.
About three months ago, Amador-Games began to experience persistent pain around her kidneys and began taking over-the-counter painkillers to manage it. After about three weeks, the pain suddenly became so intense she couldn’t bear it. “I was screaming,” she said in Spanish, and went to the emergency room.
She was hospitalized for three days with anemia and a severe kidney infection, she said. She was discharged with instructions to follow up as soon as possible with a primary care provider, and given the phone number for Healthcare for the Homeless, a health center in Baltimore City, but couldn’t get an appointment because she has stable housing, she said.
Amador-Games is worried, she said, because she has not seen a doctor since her hospitalization, so she came to the free clinic to make sure she’s OK. Her kidneys still hurt sometimes, she said, especially when she’s on her feet working.
Many patients who come to Remote Area Medical events are in need of follow-up care, said Medical Supervisor Colleen Madigan, especially those with chronic conditions, such as diabetes or hypertension. “We can’t fix that in one visit,” she said. DentMed, the local organization collaborating with Remote Area Medical to host the event, is tasked with connecting patients to free or low-cost care in the community. Chief Executive Officer Portia Ackridge said she follows up with patients for months sometimes to make sure they can get an appointment.
Remote Area Medical typically offers free eye exams and glasses at pop-up clinics as well, but lacked enough volunteer providers to do so in the Baltimore area. Chris Cannon, media relations coordinator for the nonprofit, said they had to turn away an ophthalmologist who volunteered at the last minute because he didn’t have time to complete Maryland’s lengthy process for approving medical volunteers from out of state.
He said 11 states, including Tennessee, where the nonprofit is based, have “open” systems where the organization can verify state licensures and send them to the medical board of the destination state. This makes it much easier for them to hold pop-up events that are well-staffed and able to provide a range of care for a large volume of patients, he said.
Remote Area Medical saw 87 dental patients and provided 112 medical visits over the weekend, said Cannon. Just 10 of those dental visits were on Sunday, as the clinic had only one volunteer dentist — Dr. Michael Seitz, who hails from Cornwall, New York, and volunteers in different states about once a month alongside his wife, Young Kim, a pediatric nurse anesthetist who acts as his assistant and helps wherever else she’s needed in the clinic.
On Saturday, several fourth-year dental students from Howard University College of Dentistry provided care under supervision, Cannon said.
Seitz said “it’s fun” and gratifying to volunteer; “You get to give [patients] their smile back.” He noted the last patient he saw was covering her mouth with embarrassment over badly decayed and missing teeth. Seitz said he frequently treats patients who have not seen a dentist in years or sometimes ever, and present with multiple dental problems.
“The first goal is always to alleviate pain,” he said, as many patients are suffering from infected or abscessed teeth. He tries to take care of the patient’s second-biggest problem, too, he said, but the third-biggest “you might not get to.”
Unlike some other free dental clinics that do only fillings and extractions, Seitz and some other dental volunteers at RAM provide detailed restorative care, preserving teeth and fixing decay whenever they can.
Kim said patients sometimes get emotional when they see how much their teeth have been transformed.
“Teeth reflect the state of a person’s being,” said Kim, noting that teeth are markers of overall health, diet and social class. Bad teeth make it more difficult for people to secure employment and can affect their self-esteem.
Cannon said dental care is the most sought-after service at RAM’s clinics and accounts for 60% of the care it provides.
Jeanette Snowden, 66, a resident of Sandtown-Winchester, showed up early Sunday morning to get her teeth cleaned after being turned away from the clinic on Saturday. Snowden has dual Medicare and Medicaid benefits, but was not aware that her Medicaid covers dental care. In 2019, Maryland launched a pilot program covering $800 dollars worth of dental care annually for people with dual coverage who had previously lacked any benefits.
The complexity of the health insurance system can make it difficult for people to understand what care they have access to, Kim said, and benefits for both public and private insurance are frequently in flux.
“We’re a very rich country here,” said Kim. “Dental care should be given to everybody.”