DENTIST: You feeling any pressure there?
SUSAN DENTZER, NewsHour Health Correspondent: A tent at a sweltering county fairgrounds in rural Virginia, not exactly the place you'd expect to get state-of-the-art dental care. Freddy Duty did not expect that, either, but judging from his badly decayed front teeth, he needed it.
FREDDY DUTY, Truck Driver: I'm a truck driver. I've got three kids, and I just haven't been to the dentist in like 10 years. And sitting in a truck, I don't have a lot of opportunities to brush my teeth, you know, after I eat a meal or something. And as a result of that, I've lost quite a few of my teeth, you know, to cavities.
DR. CAROL BROOKS, School of Dentistry, Virginia Commonwealth University: We're going to take good care of you, get you smiling nice again.
SUSAN DENTZER: Duty, who doesn't have health or dental insurance, originally came to this three-day health fair in Appalachia to get his teeth pulled, but dentist Carol Brooks talked him out of it.
DR. CAROL BROOKS: So we have just some teeth that we just really need to save.
SUSAN DENTZER: Brooks is clinical director of the Missions of Mercy Project at Virginia Commonwealth University's School of Dentistry.
DR. CAROL BROOKS: I said, "What are you going to do if you have these teeth taken out?" And he's like, "Nothing." And I'm like, "But then that changes your chances for a job or just your overall appearance." So many it's judged quickly by just whether or not you have front teeth or not.
These front teeth that have cavities have these big holes, but their roots are great. There's plenty of bone here.
SUSAN DENTZER: Brooks' colleague, dentist Neil Turnage, then got to work on Duty, one of roughly 3,000 patients who swarmed here to this annual event in late July. On top of dental care, they came in search of eyeglasses.
OPTOMETRIST: Is the feeling tight enough?
EYE PATIENT: Yes.
SUSAN DENTZER: Women came for mammograms, some for the first time in their lives.
DOCTOR: It's going to be tight.
SUSAN DENTZER: These and other medical services would be out of the reach of many if they weren't available here for free.
HEALTH FAIR WORKER: 740 through 750, come on through!
SUSAN DENTZER: The Wise County Health Fair has been spearheaded for the past seven years by Remote Area Medical, or RAM. That's a Tennessee-based organization that delivers free medical care worldwide, often in emergencies, such as after Hurricane Katrina.
In Virginia, the group brought in dental chairs and other supplies on its vintage World War II-era plane. More than 1,000 other volunteers joined in. British-born Stan Brock is RAM's founder.
STAN BROCK, Remote Area Medical Volunteer Corps: We started giving out numbers at 2:00 a.m. this morning. And at 5:30, which is still dark here, there were 792 people that had numbers. And so by 9:00, in fact, we had to cut off the line at 1,201. It's very sad that, of course, the state of affairs requires us to provide this kind of care in the world's richest country.
OPTOMETRIST: Can you see the lines going up and down, the lines going side to side?
SUSAN DENTZER: A visit here offers one grim window onto the state of health care in America. The patients who come here come from as far away as Ohio and Alabama. Almost all lack health insurance. Many are disabled or chronically ill, often due to very preventable diseases.
A number of people we saw at the fair were smoking. Obesity was widespread, along with the conditions it's linked to.
NURSE: What's the case with you? High blood pressure.
SUSAN DENTZER: Ida Potter came to the fair with her husband, Ken. Both have been deaf since birth, and Ken was recently laid off from his printing job of 27 years.
DR. CATHY CUSTALOW, University of Virginia Health System: We'll check your blood pressure again.
SUSAN DENTZER: Dr. Cathy Custalow treated Potter. She's one of a number of medical volunteers who came here from the University of Virginia at Charlottesville.
DR. CATHY CUSTALOW: We estimate about 80 percent have high blood pressure in this area; 50 percent have diabetes. And so she's a set-up for those types of problems. And they come with a lot of complications: heart attack, strokes, peripheral vascular disease, neurological problems, and chronic pain.
SUSAN DENTZER: Poor health is compounded by the region's deep poverty. Employment in the area's coal mines isn't what it once was. Education, especially about health matters, is low.
DOCTOR: Do you follow a heart-healthy diet?
PATIENT: I just eat.
SUSAN DENTZER: There aren't many medical specialists here, either, says nurse practitioner Teresa Gardner. She heads St. Mary's Health Wagon, a local nonprofit that joins with RAM to sponsor the Wise County Health Fair.
TERESA GARDNER, St. Mary's Health Wagon: We don't have a specialist in our county here like an endocrinologist, and we're able to probably bring three or four to this event. So the specialties that patients would not ever have, you know, would not have access or have to travel, you know, two to three hours to get access, you know, for this type of care.
SUSAN DENTZER: The lack of local medical specialists has been a longstanding problem for patients like Stacy Bond. At 39, he's a disabled former truck driver. He's had severe psoriasis, a skin disease, since age 18.
DOCTOR: Yes, you're covered.
SUSAN DENTZER: There are no licensed dermatologists in the area, so UVA brought along equipment from its regional telemedicine system. Through that, Bond was able to consult with the chief of dermatology at UVA, Dr. Kenneth Greer.
DR. KENNETH GREER, University of Virginia: Did you stop the pill a while and go back on it?
STACY BOND, Patient: I'd wait six weeks, and then do blood work and then start again.
SUSAN DENTZER: Greer helped clear up a medication problem for Bond, all from his office more than 200 miles away.
NURSE: No, I mean, that's fine. What I will do is relay that information to his nurse practitioner.
SUSAN DENTZER: Some, like Nancy Chisenhall, got bad news at the fair.
NANCY CHISENHALL, Patient: I'm so glad that I came. And, you know, and maybe, you know, in a little bit, maybe all will be OK.
SUSAN DENTZER: At 64, she had never had a mammogram. She came to be seen about a large lump on her left breast. UVA gynecologist Denise Young said she was worried the lump was cancerous. She immediately referred Chisenhall to a nearby facility for diagnostic tests.
DR. DENISE YOUNG, University of Virginia Health System: We can get her seen by the appropriate people so that we can get this taken care of and she won't have to worry about it anymore.
SUSAN DENTZER: But there was also good news at the fair for people like Ronald Johnson.
DR. ROSS ISAACS, University of Virginia: So your weight is down to 180.
SUSAN DENTZER: Johnson came back to see UVA's Dr. Ross Isaacs who'd first examined him at this fair several years ago. At the time, Johnson, now 55, weighed more than 300 pounds.
RONALD JOHNSON, Patient: Dr. Ross gave me a checkup and told me that I'd become a diabetic. I could lose kidneys, liver failure. And he gave me pretty good advice. He told me to start walking, get me a dog, start walking, which I did. And I lost quite a bit of weight in the first year. And now I'm pretty well back to the weight I need to be.
SUSAN DENTZER: His diabetes symptoms are also now gone. Johnson struck a Charles Atlas pose for us to demonstrate the overall results.
Another success story was waiting for us back at the dental tent, where roughly 3,500 teeth were pulled over the three days of the fair. Freddy Duty was nearing the end of a four-hour stint in the chair. Dr. Turnage handed him a mirror so he could see his perfectly reconstructed new front teeth.
FREDDY DUTY: I think it looks great, a lot better than having them all pulled.
SUSAN DENTZER: Satisfied VCU dentist Carol Brooks told us cases like Duty's were her psychic payoff.
DR. CAROL BROOKS: It's a chance to make a huge difference in these people's lives, especially when they're people that don't feel like anybody takes care of them.
SUSAN DENTZER: UVA physician Mo Nadkarni expressed another widely shared view, too.
DR. MOHAN NADKARNI, University of Virginia Health System: The fact that we have to be here at all is a real indictment of the health care system. Instead of giving comprehensive care, we're really putting a band-aid on the problem. And although I'm happy to be out here, I really wish that we wouldn't have to come at all.
DOCTOR: Chew these one, once a day, doesn't matter when.
SUSAN DENTZER: All the same, Nadkarni and his colleagues know full well they'll be back again next year.
DOCTOR: You have any questions, honey?
DOCTOR: All righty. You take care.
PATIENT: Thank you very much.