For nursing students, hands-on education usually takes place in a hospital. But for three days in July, students from the University of Virginia had an opportunity to practice their skills in a setting normally used for music festivals and horse shows.

An estimated 2,500 people, mostly from Southwest Virginia, Tennessee and Kentucky, filled the Wise County Fairgrounds July 25-27 for the annual Remote Area Medical clinic (RAM). RAM is an organization that brings free dental, medical and vision care to underserved populations both overseas and in the U.S. Most of the visitors seen at the event are uninsured or underinsured. An ever-growing contingent of U.Va. Health System volunteers provides medical care at the Wise County clinic.

This year, 214 U.Va. volunteers, including 14 undergraduate and graduate nursing students, made the 300-mile roundtrip to Wise. Many of the nursing students attended as part of a U.Va. School of Nursing class, “Exploring Culture in Health Care through Remote Area Medicine.”

For many RAM patients, the annual clinic is their only opportunity to see a doctor or a dentist, or have their vision checked. According to Healthy Appalachia, a program in which U.Va. takes part, 19 percent of residents in the Coalfield region of Virginia had no health insurance in 2005, compared with 10 percent of all Virginia residents.

Third-year U.Va. nursing student Carolyn Lawson works with a patient at RAM’s patient education area. (UNIVERSITY OF VIRGINIA HEALTH SYSTEMS PHOTO)

Big Stone Gap residents Jonathan Hollyfield and his fiancée, Amy Van Dyke, demonstrate the difficulties that many area residents face. Hollyfield has three degrees in computer-related fields but the only job he can find, as a contractor for an electronics firm, offers no dental or vision coverage. The health insurance is limited to “only the most serious of medical,” he said. His fiancée is on Medicaid, but the dental coverage ended when she turned 21. They remain in the area because Hollyfield cares for his sick grandmother and grandfather.

Assistant Professor of Nursing Audrey Snyder, who teaches the nursing school class, said she wanted her students to gain an understanding of why patients from different backgrounds might not follow a nurse’s instructions, such as getting a prescription filled. “There are so many things that factor into why a patient doesn’t follow instructions,” she explained. “If students can grasp cultural differences in a population within the United States, then they’re more likely to interact appropriately with the wide variety of patients we see at U.Va.”

Third-year nursing student Carolyn Lawson took Snyder’s class so she could attend RAM. During the last morning of the clinic, she was assigned to work in patient education, where she spoke to patients just before they were discharged. In many cases, she also gave them smoking cessation information that she and another student had put together for a class project. She said the experience taught her better ways to communicate with patients.

“We try to break it down,” she said. “A lot of times it’s explaining the doctor’s instructions again to the patient. It’s easier to do something if you understand why you’re doing it.”