A lot of the conservative outrage over welfare and other social services seems to come down to a fear of entitlement, a feeling that poor people are somehow basking in the comfortable laziness that comes with undeserved freebies. Without commenting on this attitude, or overtly pushing a message, the new documentary Remote Area Medical acts as a shudder-inducing corrective. A fly-on-the-wall look at a traveling pop-up medical clinic settling down for a 2012 weekend in an Appalachian town, the film captures a working-poor populace in a state of humbled, grateful despair, accepting essential services with a mixture of embarrassment and low-key frustration. There isn’t a lot of greed or defiance in an environment where people with no steady jobs and rotting teeth are happy just to have those teeth yanked by short-term visitors to town.
A subdued air hangs over Remote Area Medical, from the editing to the music to the quiet offscreen interview questions. Directors Jeff Reichert and Farihah Zaman seem to take their tonal inspiration from their interview subjects, who only rarely leaven their meekness with flashes of humor or anger as they start lining up 12 hours in advance in hopes of making it through the door before the clinic moves on. A title card sets the scene: “Remote Area Medical was founded in 1985 to bring free medical care to inaccessible regions of the Amazon rainforest. Today, over sixty percent of their volunteer-run pop-up clinics take place within the United States.” The clinic—a huge operation that processes 500 people on its first day, and 800 on its second—rolls into Bristol, Tennessee’s NASCAR track on planes and tractor trailers on Thursday, and is passing out access tickets by 3:30 a.m. Friday. Its volunteers—doctors, dentists, and people who just hand out food or fill out intake forms—provide services from X-rays and check-ups to teeth extraction to eye exams to denture-fitting. There’s a sense throughout the whole film that none of it is remotely close to enough, but it’s still more than the residents—many of whom haven’t seen a practitioner in a decade or more—can afford on their own.
Reichert and Zaman don’t editorialize, which keeps Remote Area Medical from being preachy, forceful, or didactic, but also leaves it feeling shapeless. The interviewees largely aren’t identified, apart from RAM founder Stan Brock, a former Wild Kingdom host and author who explains why he started the program in 1985, and how he’s watched it change. Other interviewees speak briefly and broadly about their experiences: Patients reveal how a facial cyst or a rotting tooth or worsening vision has impaired them, and why in an environment of poverty, underemployment, and jobs without health-care benefits, they can’t afford the rising cost of treatment. The volunteers talk about cases that surprised or moved them, like a 14-year-old with bad vision who didn’t know what a leaf looked like until RAM fitted him with his first glasses. It’s blunt and artless, one talking-head after another, interspersed with scenes of Tennessee nature and set to David Wingo’s plaintive score. (Wingo, a frequent partner of David Gordon Green, excels at plaintive.) But it’s evocative, and frequently horrifying.
Reichert and Zaman never follow any one interviewee for long. The line for services resembles a tailgate party with little food or drink, as carloads of families camp out in a parking lot for days, waiting for access; the directors capture some frustration over RAM’s organizational methods, and some obvious fear from people who stand to miss out if they can’t live in cars at the NASCAR track for 48 hours straight. But while the filmmakers capture a woman who openly lies to jump the line, and a man who bulls over the complainers by talking about his hopes for a life-saving treatment, there’s no follow-up to see what these people need, or whether they get it. It makes for a fractured, impressionistic story, full of widely diffused pain and need. One of the saddest moments comes when a woman talks about how she was raised to independence and self-control, so taking even this necessary form of charity will diminish her. These are often proud people, entering the clinic humiliated by the betrayal of their bodies, and leaving pathetically grateful for the weeping, swollen scar of a fresh surgery, or the raw bloody socket of a pulled tooth.
There’s no attempt to contextualize the film with statistics, about RAM, or American poverty, or the health-care system. Brock mentions that his organization has cut back services in Africa and Central America because they’ve become overwhelmed with the need in the United States. But the film isn’t an angry indictment of the system, or American politics, or the state of the health-care industry, so much as a plaintive, direct document of desperation. “I wish all the people who make decisions could come down and be at the racetrack this weekend, to see what the consequences of some of their decisions have been,” a patient says mildly at one point. Her accusation—non-specific, gentle, polite, but profoundly wounded—sums up the film as a whole.