Camped out in below-freezing temperatures, Jo sits shivering in her tent. She’s been waiting outside for 36 hours. The 60-year-old grandmother is legally blind and relies on a wheelchair to get around due to metal bone replacements across huge swathes of her body.

“Without this woman I would’ve died,” Jo says, pointing at Judy, 49, both warming their hands on polystyrene cups of coffee. “She left to go get me blankets and stuff, bring back this coffee machine. She gave up her place in line to go do that. I would’ve frozen to death otherwise – I’m serious I’d be dead.”

These women are among hundreds of people waiting to receive free medical care in the tiny Tennessee town of Gray. The much needed dental, optical and medical treatment is provided by non-profit organisation Remote Area Medical (RAM), regardless of where you’re from or whether you have insurance. It’s as if a natural disaster or a war is on, but this is just a normal Saturday in America.

The Independent spent a night and a day with the patients and doctors at this country fairground turned emergency pop-up hospital to find out why one of the richest countries in the world needs it in 2018.

****

A member of the Tennessee State Guard – who patrol the event – walks up and down the rows of parked cars at 3am. 

Banging on the frosted hoods, he calls out “Tickets!” People wake up and open their windows to get the slip of paper they’ve been waiting hours for. Some use it as a chance to get up and stretch their legs, before retreating back into the comparable warmth of their cars. 

“Looks like we’ve got a latecomer,” a State Guard officer says behind me. A car has arrived hours before the event is due to begin, but still they’re too late. They are turned away.

Jo, Judy and a group of others have made a makeshift camp area, with tents, folded chairs and snacks. One man wouldn’t talk to me, but silently gave me a cup of watery coffee. On the side he had written: “In Jesus we have redemption through his blood, even the forgiveness of sins. Colossians 9:14.”

“I work nights you see so I don’t mind staying up and out like this,” 49-year-old Judy tells me. “I’ve never been to one of these clinics before – my husband has – but I think it’s just amazing. People coming together like this. When I went back and brought the blankets for her [Jo] I brought this coffee machine as well. Then these guys were like ‘Hey we’ve got some coffee too let’s all share together’.” Judy is at the clinic to get dentures, as is her husband, who has early onset dementia and is waiting in the car. 

Having moved from Missouri to Tennessee many years ago, 60-year-old unemployed Jo is now guardian for her two grandsons. “My daughter had a drug problem, she got in trouble, and she ended up going into prison – she’s been out a year now and clean sober – but it took her 18 years of her son’s 18 years.” 

Richard, a state guard volunteer who is a high school history teacher by day, eventually pulls out a megaphone and tells people to start lining up. From babies to the elderly, hundreds huddle together forming a queue along the track.  

At the front of the line near a barbed wire-topped fence is a man requiring a ventilator to breathe, next to him is a one-legged man on crutches, then a father carrying a toddler dressed as spider man. They stand in silence with their heads down, not making eye contact with anyone.

“I’ve been to lots of these events before,” a chirpy man named Gary says as he walks up and down the queue. “I’m here to try and found out whether I’ve got lung cancer, get the tests for that, everyone in my family has died of lung cancer ... and I’ve got a lot of the same symptoms as my dad so I want to check it out. And if they can’t do that I’ll hopefully get a couple of teeth pulled.”

The primary treatment given at RAM clinics is dental care. With only basic coverage on most insurance types, teeth treatments are unimaginably expensive for most of the people here. 

Robert, a man in his late forties hanging around with Gary, says: “I’m here to get my teeth fixed ‘cos there’s no way in hell I could afford it otherwise. I’ve got four kids to support and I’m doing everything I can to take care of them.”

Jo, who has been camping at the fairground since Thursday afternoon, says: “Last year my daughter had 23 teeth pulled out of her mouth, and my other daughter had 19 taken out. Without RAM I’d be dead, and they probably would be too.”

Despite the desperate situation these people find themselves in, the gratitude they have for RAM is clear.

“It just shows the kindness of humanity,” Robert says. “This is what makes America great, not all this divisive stuff. This is what makes America great.” 

British philanthropist, actor and presenter Stan Brock founded Remote Area Medical in 1985. Initially it focused on providing healthcare to developing countries, such as Guyana, Haiti, Mexico, Guatemala. Soon after launching, RAM had requests from the US, so they launched their first clinic there in Sneedville, Tennessee in 1992. 

“The only hospital in the area had closed, and their only dentist in the whole county retired,” Robert Lambert, a representative from RAM tells me. “They had no medical care, no dental care, so the mayor of the town called Stan Brock and said ‘we need your help.’”

Around 90 per cent of their clinics now run in the US, with Tennessee being the state using the services most.

“If you talked to Mr Brock", Mr Lambert says, "He would’ve said ‘close your eyes, and point to the map of the US. And no matter where you point, the need would be the same.’”

Around 740,000 adults and children have received treatment from RAM, delivering $120m (£92m) of free healthcare services. Stan Brock died in August this year, but his presence is still very much felt among the queueing patients. 

Gary, who is here to check whether he has lung cancer, says through coughs: “I met Stan Brock at one of the other clinics I went to. We spoke for a good 45 minutes. He was a really good man.”

Groups start walking to the main building where the medical services are being temporarily housed, those unable to walk ferried in buses driven by Baptist Church volunteers. 

Arriving at the warehouse is truly overwhelming. Once your eyes adjust to the bright lights and sudden warmth, you are greeted by almost as many volunteers as there are patients. What was once a large outhouse building hosting country fairs, is now a rudimentary hospital running like clockwork. An army of administrators take patient details while clinic nurses triage into priority groups before people are sent into the curtained off treatment zone. 

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Other buildings give mental health support, first aid training, diet and nutrition education; the offerings are many, but perhaps most remarkable is the pop-up opticians at the top of the hill.

I follow an elderly woman – who did not wish to make a comment or be named – through the process. An optician tests her eyes, before a volunteer shows her a table of glasses frames. Preening in a hand mirror, the woman grins when she puts on a particularly large, red framed pair. 

“These are the ones!” She says with a smile. 

The frames are then taken to a van where glass is cut to her specification on site. The whole process takes about an hour. When she is handed the glasses, her eyes fill with tears. “God bless you,” she says to no-one in particular, before hurrying away. 

Despite joy being brought to the 777 people in Gray this weekend, and hundreds more at two other clinics happening simultaneously in Virginia and California, the harsh reality of why this is happening is inescapable.

Poverty and a clearly broken healthcare system means clinics like this have to exist in one of the wealthiest nations in the world. 

“I can’t afford a dentist. Even if I had a job it wouldn’t cover it,” Paul, 40 from Gray tells me. “A lot of people in Tennessee don’t have dental insurance and lot of people can’t afford it ... I think Trump should be doing something about this, definitely doing something about teeth care. We need it.”

Carl DeMatteo is an infectious disease specialist doctor and medical lead for this particular clinic. “I saw a woman today who had been a diabetic for 13 years and never been treated and that’s just wrong. The interesting thing is if you ask people ‘do you have health insurance?’ many of them say ‘yes, I have medicare, but I don’t have supplemental, or the drug part’, which is like not having any insurance at all.

“People who don’t get regular healthcare end up in the emergency room ... I have not been enamoured with what’s happened over the last two years with politics and healthcare. We’re losing control.”

On the same weekend as this RAM clinic, Donald Trump is in Chattanooga, Tennessee holding a rally. The president has consistently attacked Obamacare throughout his presidency, ending its coverage for some of the poorest in America. Mr Trump's administration has pushed new rules that allow states to waive some Obamacare protections and promote health coverage that would in fact charge people with long-term conditions more money. 

I ask William, 23, from Tennessee, about the American healthcare system while he waits to have a molar pulled: “Without this a lot of people would be in trouble. There’s clearly a problem with the way our healthcare works. When you look around and see all these people here that need help and can’t get it from the government, then it looks bad as a people.”

Although a variety of political views amongst patients, a dissatisfaction with Obamacare is clear.

Mr Lambert from RAM says: “A lot of people thought with Obamacare that everything was going to be free and great, but unfortunately it didn’t take into account dental care, or vision care, which are not accounted for under the affordable healthcare act ... RAM has been through Democrat and Republican governments, and the need for our services has remained pretty consistent.”

Following the midterm elections the Democrats have regained control of the House, but this might not mean any change for people like those here in Gray. Additional costs are pricing people out of receiving treatment, with the poorest in America forced to suffer in silence.

Later in the day, the sun now up, volunteers laughing and joking outside and treated patients starting to pack up and leave, I catch up with Jo. “I’m tired. I just want to go home and crawl into bed and not get out until next Tuesday. When I leave here [pointing at the dental area] I have to go pick up my glasses, and then I’m going to hit the hearing clinic.

“I’m very grateful this exists. If it wasn’t for them I’d be toothless or dead. I had broken teeth off poking into my gums, they got it all out, they got all the infection out. I don’t care what the weather, I come once a year just to make sure my teeth stay. Healthcare in America sucks. The politicians need to start listening to the people, what they need, what’s really going on. People truly need something better and it just sucks."

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