PIKEVILLE — Alison Sizemore drove from her home in Hazard to Pikeville on Friday night and camped out to wait for the Remote Area Medical Volunteer Corps' free clinic to open.

She and her 3-year-old son camped in a tent, and her husband slept in the truck, so they could be ready for dental checkups at 6 a.m.

They were among about 750 medical, dental and vision patients to be seen Saturday morning at the clinic held by the Knoxville-based non-profit. The clinic continues Sunday.

Sizemore said her husband was laid off from his job at Wal-Mart in January, so they lost his health care coverage, and she lost her job when Quiznos sandwich shop closed. She said she has been a full-time student at Hazard Community and Technical College and will start a nursing program in the fall.

"It's been tough for us," she said as her son played with RAM volunteers and ran up to hand her a picture he had colored. Since Pike County's first Remote Area Medical clinic was held in 2008, the size of the endeavor has more than doubled. That's partly because of an economic downturn that reached a low point in the past two years, said Pikeville dentist Dr. Bill Collins, Kentucky's RAM chapter leader.

It's also because volunteers overcame the misconceptions they had about the patients at RAM, he said. Even medical professionals didn't realize how great the need was until they saw hundreds of people camped out for a dental checkup or new eyeglasses.

"Everyone perceived this as taking money out of their pockets, and I hate to say it that way," Collins said. "But once they became involved in it, and they saw that the people we were treating were not the patients that came into your office."

The patients have RAM or nothing, he said.

Collins said his private dental business is off about 18 percent for the year, partly because of unemployment and coal mine layoffs that started last fall.

Before the clinic, he said he thought many newly unemployed workers would be showing up at RAM.

Dr. Andy Elliott, a dentist in Martin in Floyd County, said he thought the clinic had always had willing volunteers — never fewer than 60 providers in the dental clinic. But as word got out, more volunteers have showed up.

A group of University of Kentucky oral surgery residents volunteered for the first time this year, he said.

"We are busier. We've been able to expand to see more patients," Elliott said.

The clinic has added EKG and echocardiograms, dermatology, podiatry, and even autism screening information for children.

The organization also overcame a snag it ran into in 2008: Optometrists weren't allowed to volunteer outside their offices in Kentucky, so they couldn't come to RAM clinics. That rule has been changed. Also, rules about temporary licensing of volunteer doctors from out of state have been loosened, partly as a result of RAM, organizers said.

This year, a group of U.S. Public Health Department employees from Washington, D.C., volunteered at the RAM clinic as part of their readiness training program.

It helps them learn how to turn non-medical buildings, such as Pike Central High School, into clinics and shelters in case of emergency, said Cmdr. Kimberly Elenberg.

The free clinic provides high-quality care, Elliott said, but it's not solving long-term health care problems. Medicaid and public health system funding need to increase, he said, if private health care costs don't come down.

"Public health is a stop-gap, a last line of defense, and they need more funding," said Elliott, who recently finished a term as vice president of the American Dental Association.

Without RAM, no treatment

After having all his upper teeth pulled Saturday, Garth E. Robinson of Prestonsburg could only nod and write out answers to questions. He said he had been living with the pain of broken and decayed teeth for 10 or 12 years, and he and his wife don't have medical insurance.

He works for Appalachian Security as a night watchman at a coal mine, and she works for a local attorney. They have two children.

"It takes all we can do just to get by," he wrote.

He said he was a miner until he was dragged under a belt line and injured his back about 10 years ago. He said he has constant back pain, in addition to his dental problems.

He's due for an MRI Tuesday and will be back at the RAM clinic on Sunday to have his lower teeth pulled, but he might have to miss work.

"Puts me in a bind," he said. But if he didn't have the RAM clinic, he said, he'd go without any treatment.

Many people in his position would have tried to be declared disabled and collect a check. Robinson, his numb mouth full of gauze, grimaced and shook his head at the thought. He said he feels lucky to have a job and wants to keep working, even though it's a struggle.

"I just do the best I can for my kids," he wrote.

Teen volunteers pitch in

A group of teenagers from Long Island, N.Y., who formed a charity fund-raising group to aid enslaved children in Africa, recently has adopted RAM as one of its domestic causes.

Several girls from the group, One is Greater Than None, had their first field trip and first trip to Kentucky this weekend. Before their trip, they said the only thing they knew about the state was that Johnny Depp is a native.

But they're committed to RAM and know a lot about its cause.

Health care is a crisis in many parts of the country, not just Kentucky, they said.

"I know people who have lost their jobs and can't pay their insurance," said Anjelica Mantikas, 17. "I didn't realize how big of a situation it was until we found RAM."

As the girls shadowed dental students, they also helped patients who couldn't read and write fill out paperwork, played with children in a waiting room and handed out fliers with information for follow-up care.

"I'm absolutely in love with this charity even more," said Ariel Stern, 17. The girls make bracelets to sell online, and in April, they held a walk-a-thon fund-raiser for RAM at their high school.

"We came into this knowing how many people there would be," said Sam Malis, 17, who was dressed in a mask and gown to observe University of Louisville dental students perform tooth extractions. "But this experience is just so overwhelming."

'People who are in pain'

Ron Fields visited a RAM clinic in Harrogate, Tenn., last month for some fillings, but he couldn't have his broken tooth extracted then, so he came to Pikeville.

Fields said he lost his computer help-desk job two years ago when it was outsourced overseas from Cincinnati. He moved with his parents, brother and nephew to Morristown, Tenn., when his father retired from AK Steel.

Fields hasn't worked since and hasn't been able to collect unemployment from either Ohio or Tennessee. His parents' pension and Social Security support the family, and he gets a little income from selling collectibles on eBay.

They hunt and fish on their land near Douglas Lake.

"We take care of each other, and God will take care of us," Fields said. But he hopes to find a job in the fall. The market might be looking up, he said.

"I don't think enough people realize how big a need the United States" has, said U of L dental student Paul Maizan.

He said he was in the military for 10 years. "I saw a lot of need, a lot of global health care need. It's not only in different countries," he said.

Maizan is one of six to start the first student chapter of RAM in the country this year. After visiting Pike-ville's first clinic three years ago, the students decided to attend as many as possible. Around 150 volunteers from U of L's dentistry school volunteered, as did a group from the University of Kentucky's oral surgery department.

"You see fog coming down from the mountain, you see this long line of people waiting, camping out overnight, you see this, just, anticipation of people who are in pain," Maizan said. "People who are there are just appreciative of being seen. It's pretty moving."

The student group has connected with volunteers from other schools at RAM events and has encouraged them to start student chapters. "A lot of people have been sheltered in their life," said U of L dental student Caroline Curtis.

"I have a very strong feeling about community service. I saw myself going to Africa, South America to do patient care," said Curtis, who was a dental assistant in Alaska before starting at the U of L program. "When I went to Pikeville last year, I was amazed at what I could do right here. I can make a big difference here."