If Stan Brock, creator of Remote Area Medical, can deliver health care to the furthest corners of the developing world (and large swaths of the U.S.) why can’t Congress? How America’s healthcare mess is preventing the poor countries from getting healthcare.
When Stan Brock was sixteen years old, he was living with the Wapishana Indians on the Brazilian border of what was then British Guiana. The job of the Wapishanas was to drive thousands of wild cattle through a narrow path in the rain forest onto a steam ship, where they were sailed down the Berbice river to market. After hunting with the Indians for a few months, Brock was given his own horse—a wild Spanish bronco that had already killed two of its owners. “We tied him to a tree, put a blindfold and saddle on him, and I climbed on board and cut him loose,” Brock says of the fateful day. “He went bucking across the savanna totally out of control and we had a head-on collision with a corral.” Brock was badly injured. As he lay on the dusty ground, groaning and desperately in need of medical care, a Wapishana explained that the nearest doctor was twenty-six days away on foot. Brock had an epiphany.
Fast-forward half a century. Stan Brock is now seventy-three years old. He has no money and no possessions and subsists mainly on the oatmeal and fruit given to him by friends. He often sleeps on the floor. For years, he showered under an icy stream spewed out of an old garden hose. By American standards—where most people’s idea of the dream life is a big house with an expensive car in the driveway and a fat bank account—Brock might be considered a failure. But take another look. Brock, born in Britain in the nineteen thirties, lived through World War II and saw firsthand how a democratic government can deliver healthcare to all of its citizens during wartime. He spent fifteen years living in the Amazon with those Wapishanas and became “super fit” by doing so. A lifelong nature lover and fitness fanatic, Brock held a stint co-hosting the television show Wild Kingdom in the nineteen seventies. But all this was just prelude to his life’s chief accomplishment—founding the Remote Area Medical (RAM) program in 1985, for which that horse accident in the Amazon provided the initial germ of an idea.
The initial goal of RAM—a mobile group of volunteer doctors, nurses, veterinarians, optometrists, and dentists—was to provide free health care to the poor in developing countries, such as the upper Amazon where Brock spent his formative years. But in the early nineteen nineties, Brock saw that there was a critical need for his services right here in America. In 1992, Brock set up camp in Tennessee and launched the American operation of RAM. There have been three hundred and eighty American clinics so far, with calls for them in every state. “It’s impossible to keep up with them,” Brock says. At his clinics, which have been featured on 60 Minutes, it’s common to find patients who drove hundreds of miles to get there, and many who camp out overnight, sometimes in rain or snow. Wendell Potter, the former Cigna executive, cited his visit to a RAM expedition in Wise County, Virginia, as what caused him to resign from the health insurance industry and become an advocate for healthcare reform.
What does the need for Brock’s RAM program in the United States say about our healthcare system? While some claim that Brock’s patients are simply lazy, choosing not to buy insurance and milking the free care, Brock’s informal surveys have revealed something different. At a recent event in Kentucky, Brock discovered that about half of the seven hundred patients possessed medical insurance—but the co-pays were so high or coverage so inadequate that they still couldn’t afford to go to their local doctor or dentist. Brock’s frustration with healthcare in the United States surfaces most starkly when comparing the U.S. with the birth of universal care in Britain sixty years ago: “Here in the world’s richest country, which is not involved in World War II, with a similar population of people without access to care, what are you going to do for them?” But even beyond the debate over reform, one can learn something from Brock.
In a country where hoards of its citizens still buy more luxuries than they can afford, eat foods that make them sick, get too little exercise, and cling to the “greed is good” mentality, Brock owns nothing, buys nothing, eats sparingly, does six hundred crunches every morning, and spends every day of his life helping others. And he is happy. I spoke with Brock on a Thursday as he was gearing up for another RAM expedition, number 590 worldwide—this one in Grundy, Virginia.
—Jake Whitney for Guernica
Guernica: We’ll get into the nuts and bolts of delivering free health care to Americans. But first, let’s talk about your early days. How did you end up living with an Amazonian Indian tribe?
Stan Brock: When I was a youngster, my father had an assignment for the British government in what was then the only British colony on the continent of South America—British Guiana. One summer holiday, I sailed to British Guiana, and on the journey I heard about this vast area of wild country on the northern border of Brazil inhabited by various Native American tribes and thousands of longhorn cattle and wild horses. A few days after arriving in British Guiana, I headed for the Brazil border. That turned out to be the end of my school days. From then on, I spent every day of my life in the saddle. I’d wake up well before daybreak and look for my hat, gun, and lasso. We would ride this huge range—it was about 3,500 square miles. It was a one-month journey to get the longhorns to the marketplace. So I became a cowboy in a place where all the cowboys were Indians. The Indians were the Wapishanas.
Guernica: And you came up with the idea of RAM while you were with the Wapishanas?
Stan Brock: Several months ago, I was in Tuscon, Arizona, and had the pleasure of having breakfast with the sixth man to walk on the moon, astronaut Ed Mitchell. He asked me the same question, and I told him the story of the wild horse and the twenty-six days on foot to the nearest doctor. He said, “Gosh, I was on the moon and I was only three days from the nearest doctor.” So I said, “Well, Ed, for the people who live in [that part of the Amazon] and indeed for the thousands of people we see at the RAMs here in the United States, they might as well be on the moon for the access that they have to healthcare.” So we started the American operations [of RAM] in 1992, and we’ve been doing them consistently ever since. Of course, this healthcare crisis is something that’s been with us forever. Theodore Roosevelt tried to solve it at the turn of the century, and Harry Truman and numerous others, but now it is front-page news.
Guernica: Did you learn anything about human health from living with the Indians?
Stan Brock: It was nothing for us to walk thirty miles in a day and do it at the trot. When we were going up and down that trail, you didn’t take horses because there was nothing for them to eat, so it was all on foot. So everybody was incredibly fit and wiry. But what I’m seeing now are Indians who are putting on weight and eating junk foods. They are coming to see us at our clinics showing signs of high-blood sugar and diabetes. Tribal groups in places like the former British Guiana territory are getting more involved in so-called western influences and are starting to develop western diseases—especially among the more affluent. When they start eating that nasty stuff off the shelves that line stores and getting further away from their traditional foods…
Guernica: So you’re saying that the more affluent Wapishanas are buying a lot of processed Western foods that are making them sick?
For the thousands of people we see at the RAMs here in the United States, they might as well be on the moon for the access that they have to healthcare.
Stan Brock: Yeah. The pursuit of gold and diamonds is causing a lot of the problems. It used to be a three-day ride to Boa Vista. But now there is a road [through that area], and it’s got very good access to Brazil, so now Boa Vista is a metropolis [a little bigger than] Knoxville, Tennessee. What caused that was gold and diamonds. The Indians find jobs in some of these mining camps and make a little bit of money, then buy a bicycle and go back to their village and erect a store. They buy trade goods, which includes some of this darn trash food that lasts forever, and they sell it—and of course eat it themselves. That food is causing health problems. Compare that to what happened with the Native Americans in this country. In the eighteen sixties when the American government started moving the Indians off of their tribal lands, the government provided them with flour and lard. So fried bread, which eventually became the mainstay of the Native Americans in this country, is causing obesity and diabetes and heart disease. One in six Native Americans in this country has diabetes. I’m afraid that we may see similar problems among the South American tribal groups as they become more involved with western nutritional habits.
Guernica: How did the traditional diet of the Wapishanas compare with the western diet?
Stan Brock: The staple food of the Amazonian Indian tribes is cassava root. They also plant pineapples and bananas, and eat meat and fish. But keep in mind that when you shoot a wild deer with a bow and arrow, that’s a pretty lean piece of meat. It’s not something that’s grown on a feedlot and pumped up with chemicals and grains to make it marbled with fat. Wild range meat or cattle that’s raised strictly on grass—and grass that’s not nourished by chemical fertilizers—is going to be a lot better for you than something off the feedlot. So wild game, lean meat, and fish and all the other things in their traditional foods makes for a healthy diet. And then there is their great physical efforts. In the United States, on the other hand, people keep getting heavier. One of the reasons for these huge crowds at our clinics is that people in this country have not been looking after themselves in terms of diet and exercise.
Guernica: It’s pretty widely accepted that poor diet and lack of exercise are contributing to the healthcare crisis in this country. But what can we do about it in this age of powerful food lobbies and ubiquitous advertising?
Stan Brock: When I was in England, I went to school six days a week from 8 a.m. until 6 p.m., and it was absolutely mandatory that every day we participate in some kind of athletic endeavor. I cannot remember any child in school who was obese. What this country needs is mandatory education in nutrition and exercise. And get rid of all [the junk food] that’s advertised and sold in coin machines on the schoolyards. We hold a lot of our [RAM] clinics in schools, and everywhere you turn, there’s a machine that dispenses some darn thing that’s not good for you. So ultimately all those bad habits that kids are picking up from the advertising on television and in the schoolyard—and the access to [junk food]—is ruining their health. By the time they get into their mid-twenties, if they’re not among the privileged people who can afford the healthcare system, then they just won’t be going to the doctor—and then the problems begin. The seeds are sown in childhood years—that’s when you need to develop good nutritional habits and get enough exercise. My organization is committed to helping people get access to care, but they could have avoided these long lines and grueling waits for our services if they’d set out on the right paths when they were in childhood.
Guernica: Who’s to blame for that?
Stan Brock: Well, you can’t blame the kid. I’m not a person advocating more government after a life of freedom out there in the jungle. But somebody has got to steer the education process in the right direction and put the emphasis where it needs to be—on health and education.
Guernica: Who do you think that someone should be?
Stan Brock: Well, it has to be the school boards—and the state and the government. I’m not an expert on all of this stuff. But I do have considerable knowledge about the effects because I’ve lived with people whose whole culture required them to be super fit. That was the way it was. You were either super fit or you were dead.
Guernica: You started RAM in 1985, initially to service Third-World countries. How did you go about launching such a massive undertaking?
Stan Brock: I knew it had to be a charitable, all-volunteer organization. The people who work for me don’t get paid, and I don’t either. The early days were one pickup truck and one dental chair in the back with a couple of us on board, just going where we were invited. We gradually acquired more equipment and volunteers and grew from there. Now we’re now up to number 590 of these special operations worldwide.
I’d tell the naysayers to come to one of these clinics. There will be people lined up when I get there waiting for the doors to open up at 6 A.M., just like they were in Los Angeles by the thousands.
Guernica: Is it difficult to get volunteers?
Stan Brock: We’ve had about 45,000 volunteers over the years, but it’s always been difficult getting them. In the United States, a [healthcare practitioner] who is licensed in one state is not allowed to cross state lines to provide free care in another state—except here in Tennessee. This is an extreme impediment every time we leave Tennessee. And we really saw this in August when we were in Los Angeles. In eight days, we only saw 6,344 patients. That sounds like a lot, but it really wasn’t, because we had the capability to see probably 15,000 patients—and they were there, and I had to turn them away. Candis Cohen, spokesperson for the California Board of Medicine, was quoted in the L.A. Times saying something like: “We don’t want doctors here from places like Texas and Alaska or somewhere; we have very high standards.” That is the attitude that prevents us from seeing more patients. I appeared before the House Ways & Means Subcommittee on Healthcare on April 15th last year on this subject, but I haven’t heard anything about it since.
Guernica: What are the reasons given that they won’t allow this to happen—is it always the standards issue that is cited?
Stan Brock: It’s always the standards issue that’s cited, yeah. I remember down in Louisiana where we’d been several times after Katrina, the Louisiana Board of Optometry blocked us from bringing any optometrists in from outside the state because they said we were taking business away from them. So that’s certainly an element of it. But it’s also about territory and protectionism and control. I’d tell the naysayers on this subject to come to one of these clinics—come to Grundy, Virginia, this weekend. There will be people lined up when I get there tomorrow waiting for the doors to open up at 6 A.M., just like they were in Los Angeles by the thousands.
Guernica: How early do people begin camping out?
Stan Brock: Last week, the first people in line had come four hundred miles from Indiana, and they had arrived the day before. So there will be people who arrive twenty-four hours early. The bulk of them usually come any time after eight or nine o’clock the night before—come rain, snow, or shine. We don’t ask any questions. You show up and we give you a number, because unfortunately we can’t see everybody.
Guernica: What are the demographics of the patients who show up? Is it mostly Caucasians, minorities, men, women, uninsured, underinsured?
Stan Brock: The demographic of the patients usually mirrors the population of wherever the clinic is. Tomorrow we’ll be in Grundy, Virginia, and it will be almost 100 percent Caucasian. If we go to Memphis or New Orleans, then it’s going to be the reverse. In Los Angeles, there were huge numbers of African-Americans and Hispanic-Americans, and probably some of whom weren’t supposed to be there in the first place. But we don’t embarrass these people. I’m not going to turn away a family of five that’s been out there all night with three little kids hugging hand-me-down tattered teddy bears. I’m not going to ask them, “Are you supposed to be in this country?”
Every one of them has some kind of sad story about why they’re there. If they’re willing to endure the kind of stress and discomfort of waiting ten, twelve, fifteen hours to get the service, then you know they really need it.
Guernica: Do you know if there are a lot of underinsured who show up, as well as the uninsured?
Stan Brock: Last weekend, about half of them were insured and half weren’t. But those who were insured had very bad insurance with high co-pays and no dental or vision coverage. So you had hundreds of people sitting there with a toothache and their insurance didn’t cover it. Some of the work that we do would normally cost thousands of dollars. It’s very common for someone to come in and say “I’ve been to a dentist and he looked in my mouth and told me it would be $5,000.” And then they’ll come to our clinic and we’ll do the whole thing for them free. That’s why they come four hundred miles.
Guernica: Are there any patients who stand out in your mind as having a particularly sad story?
Stan Brock: You’ve got to understand how common this has become. Every one of them has some kind of sad story about why they’re there. If they’re willing to endure the kind of stress and discomfort of waiting ten, twelve, fifteen hours to get the service, then you know they really need it. But I remember one case several years ago. One of our nurse volunteers came up to me said, “there’s a woman in the eye exam line whose contractions are three minutes apart.” In other words, she was about to drop a baby. So I told the nurse to get her to the hospital. The nurse said, “she says she’s not leaving without her glasses.” So I asked where the woman was in the lineup and it turned out she was number ninety-two. So I asked the other ninety-one people if we could take her ahead of them. They all said yes. But we couldn’t get through the entire exam before a physician said that she had to leave immediately otherwise she was going to have the baby right there. So we get her outside, get her in the van, and I’m holding up traffic on the street. There’s another lady standing next to the van who had already got a pair of glasses. This was when those little round frames were popular. So the pregnant lady wound down the window and stuck her arm out and yelled “I want a pair of frames just like hers!” We’d done enough of the eye exam so we were able to make her a pair of glasses and deliver them to the hospital. She had the baby at the hospital about the same time she got the glasses. That story has an amusing side to it, but the sad part is that the most important thing in that woman’s life that day was getting a free pair of glasses, not having a baby.
Guernica: You’ve said that there are no politics involved in RAM, but do you personally have a stance on the ideas being kicked around right now for universal healthcare?
Stan Brock: The answer to that lies in my personal experience. Back in 1944 at the height of World War II, there were 49.7 million people living in Britain, of which I was one. There was a big shortage of healthcare due to the war. So the bipartisan government in Britain at that time—led by Winston Churchill and made up of people from the Conservative Party and the Liberal Party—assigned the minister of health to fix the problem. Universal healthcare in Britain—the National Health Service—was born. Fast forward sixty years and here in the world’s richest country, which is not involved in World War II, with a similar population of people without access to care, well, what are you going to do for them? Are you going to be able to get a consortium of bi-partisan support from the left, the right, the center, the north, and the south—torn in each direction by business interests, whether it’s the insurance companies or the pharmaceutical industry or the coal mining industry? Are you going to be able to get some agreement in this country to pass laws that are going to be to everybody’s satisfaction? I hope so. I certainly applaud the considerable level of thought that’s going into this process by the government and hope that something will come out of it.
Guernica: Do you think a single-payer solution like that which Britain offers is the best way to go?
Stan Brock: No system is perfect. I’m getting questions now from people in Britain suggesting that we bring the RAM operation there because there is an acute shortage of dentists. Students are not going to dental school in the numbers that they used to. I had a call from a large Welsh newspaper and the writer said, “Oh, they’d be queued up around the block for a mile if you brought free dentists over here.” I got similar calls from Lancashire and Scotland. So that system isn’t perfect either. But it’s better than no system.
Guernica: Is it true that you don’t take a salary and don’t have any possessions?
Stan Brock: Absolutely not. I wouldn’t take a salary if offered.
Are you going to be able to get a consortium of bi-partisan support from the left, the right, the center, the north, and the south—torn in each direction by business interests?
Guernica: How do you eat?
Stan Brock: In the first place, I eat very little. That’s not exactly true. I eat very large amounts of very little. I eat very large amounts of oatmeal, and all the fruit I can get my hands on. I have lots of friends, and they make sure that the oatmeal is on the stove, so to speak. And for that I’m very grateful. Because I don’t have any assets or bank accounts or money or any of that.
Guernica: Would you describe yourself as a happy man?
Stan Brock: Oh, yeah. And busy. Glad to be busy. But I wish we were busy doing this where we set out to—places like the Brazil border. We’ve not cut back on any of [the Brazilian-area] operations, but I’ve had to cut back going to other places. Unfortunately, they’ve had to take a backseat to the needs here in the United States. Because we’ve got requests everywhere in this country—in all fifty states—it’s impossible to keep up with them.
Guernica: The American dream is tied to buying things. Everywhere you look in the U.S. there are advertisements telling us that the path to happiness is through consumerism. Do you think people can learn something about the meaning of happiness from what you’re doing?
Stan Brock: I’m a huge advocate of volunteerism. Not just because it’s needed, though of course it is, but it gives the individual a sense of pride. And so it should. I’ve seen many thousands of cases where a patient gets out of the dental chair or comes out with a new pair of glasses and puts their arms around the volunteer and hugs him—it’s very gratifying. That’s what keeps the volunteers going. And of course, every one of the people who come to our clinics—the have-nots—they have either given up or hope that one day they will have part of the American dream. So we provide a helping hand for them along the way. We don’t do any press, but when we did 60 Minutes last year, it precipitated a huge amount of mail—over 20,000 letters—and we get the odd comment here and there criticizing the patients that show up as lazy or something like that. I can’t think of any criticisms about the RAMs themselves, but a small fraction about the patients. But I can’t think of anybody from the press who’s come to one of these clinics who’s ever been critical, because [at the RAM clinics] it just looks like Guatemala. Just ask Wendell Potter.
Guernica: There is a certain ideal in American politics, espoused by some on the right in particular, of an “ownership society”—the idea that the more Americans who own houses and other things, the stronger society becomes. But what you’re doing seems to fly in the face of that—I mean, you don’t have a single possession and, as you stated, your efforts are almost universally lauded. Is a life like yours one you could see more people leading—doing more volunteer work and not relying so much on possessions and material items?
Stan Brock: That, I think, would be a pipe dream. I can’t see that happening. I mean, we could solve a lot of problems if we went back to the horse-and-buggy days, couldn’t we. Whether it’s the environment—global warming—or whatever. But no, that’s just not on the horizon. Neither is it on the horizon for the Wapishanas. They’ve built a new bridge across the Rio Tacutu so now more Brazilians will be coming across the border giving them more access to HIV/AIDS, and all of these diseases that will be increasing. These are changes that you just cannot reverse.
Guernica: Does doing what you are doing get easier or more difficult the longer you do it?
Stan Brock: Well, we’ve got this thing wired now to the point that after doing 590 of these, the mechanics of doing them is now easy for us. It’s expensive, of course. We rely on those ten-dollar and fifteen-dollar contributions from the general public. I wish we had corporate support. We have only had one or two isolated cases of corporate support. We need an oil company in the worst way because the most expensive part of our operation is fuel—moving all this equipment from point A to point B.
Guernica: Would you accept corporate support if it was offered?
Stan Brock: Yes. The only support we wouldn’t accept would be government support because it would be taxpayer money. All I want from the government is to change the rules to let doctors cross state lines to provide free care and to protect against frivolous lawsuits.
Guernica: Would you accept corporate support if it required that you had to advertise all over the place?
Stan Brock: Well, if they want to hang out a banner and say this clinic here in Grundy, Virginia, this week is sponsored by, say, Exxon, I wouldn’t have a problem with that. There is a cost to these things. It’s free care, but it comes out of somebody’s pocket.
Guernica: So whoever can help you help people, you’ll take it.
Stan Brock: Yeah. Like I said, we’re just not interested in any funding from the government.
Guernica: If you got funding from the government, then you’d probably get criticized—RAM would be called government-run healthcare.
Stan Brock: [Laughter]
Guernica: Do you have any plans beyond RAM?
Stan Brock: None at all. I just hope that the situation will change here in the United States so that we can return to our roots and get back to places like Haiti and other overseas territories for which care for the masses is non-existent. But I think it’s going to be some years before that will happen. There seems to be indications that whatever plan the healthcare debate results in, it will be a few years before it can be implemented. So I guess we’re going to doing this for sometime to come.
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