WISE — Tammy Duncan sported a toothless grin as she slid out of the dental chair minutes after an oral surgeon cut away portions of her jaw.

Numbing agents mitigated what could have been an immensely painful experience, but finally receiving direly needed dental care — in her case, surgery to accommodate the fitting of dentures — was the true source of her bliss.

She wrapped Dr. Gregory Zoghby in a tight hug and then did the same to his assistant.

“Praise the Lord, I’m going to get my teeth!”

By the end of the day, Duncan, 52, would have a new, full set of pearly whites, and her boyfriend — elsewhere being fitted for glasses — would see her clearly for the first time in a long while.

This was the scene on Friday from the Remote Area Medical clinic, an annual event that provides free medical, dental and vision services to some of the poorest residents in Southwest Virginia.

As the health care debate rages in the nation’s capital, patients and providers at the RAM clinic are anxious for change. Most of them have a resounding demand for politicians in Washington, D.C.: Fix the nation’s health care system.

Located near the Virginia-Kentucky border, the clinic at the Wise County Fairgrounds attracts residents from a wide area. The clinic, the largest of the year, has 1,400 volunteers who serve thousands of people in one weekend.

At 5 a.m. Friday — the first day of the clinic — RAM founder and British philanthropist Stan Brock stood at the entrance of the clinic as volunteers prepared to let people through the gate.

Hundreds arrived at the fairgrounds in the dead of the night to secure a decent spot in line. They slept in their cars or pitched tents as they waited for the clinic gates to open. Before the sun crested the surrounding mountains, volunteers had given out all of the numbers for the day .

“How many people are here for the dentist?” Brock said. “How many people are here to see the eye doctor?”

In the sea of people tightly clustered around the entryway, many raised their hands in response to both questions.

For a lot of folks, the clinic is a one-stop shop — their only shot at receiving health care for the year.

“Mr. Trump really needed to be here,” Brock said. “There’s been absolutely no change in the number of people that come to these events since the day I started it in the United States.”

Brock founded RAM in 1985, and this weekend’s clinic marked the 869th such event. Although the majority of the free clinics are conducted in the U.S., Brock originally formulated the idea as a way to serve people in developing nations.

“Ninety-odd percent of what we do is here in the U.S. — because of this,” Brock said, gesturing to the clinic behind him. “Let’s fix it, and then we can start concentrating on these other places that we were formed to help.”

Tonia Large, 61, and her granddaughter Isabella Mullins, 12, held coveted tickets Nos. 1 and 2 for Friday morning .

Like 60 percent of the patients at the RAM clinic, Large and Mullins sought dental care. People in Southwest Virginia depend on RAM, Large said.

Large, who doesn’t have health insurance, criticized the Affordable Care Act as unaffordable.

“I do know that with health care, unless people come up with something with premiums that people can afford, people are still going to be doing without,” she said. “It’s bad everywhere, but here with coal gone, very few jobs in this area, there’s nothing really here. You don’t have many opportunities to get a good job so you can afford to pay high premiums.”

Like many of the residents in far Southwest Virginia, Large voted for President Donald Trump in November because he promised changes to the country’s costly health care system.

She’s still waiting for him to deliver.

Meanwhile, Republicans in Congress are trying to repeal the Affordable Care Act by whatever means necessary.

While the Affordable Care Act needs to be reformed, repealing the signature legislation of former President Barack Obama’s administration should not be an option, said Teresa Gardner Tyson, the executive director of The Health Wagon, who helped start the RAM clinic in Wise County 18 years ago.

The Health Wagon is a Southwest Virginia mobile health provider and nonprofit organization. Some 98 percent of its patients are uninsured, and many show up with life-threatening conditions because they have put off health care, she said.

“To be honest, I would be ashamed to be a politician in Washington right now,” she said. “To take insurance away from one person is really unconscionable.”

In an attempt to show the need for more accessible health care in Virginia, Gov. Terry McAuliffe, a Democrat, invited U.S. Senate Majority Leader Mitch McConnell to visit the RAM clinic with him Friday. McConnell represents Kentucky and has been leading Republican efforts to repeal the Affordable Care Act. He declined McAuliffe’s invitation.

McAuliffe, who has visited the clinic each year of his governorship, toured the facilities Friday with a large entourage that included Virginia Attorney General Mark Herring and Secretary of Health and Human Resources Bill Hazel. Behind the scenes, several state Republican and Democratic lawmakers volunteered at various stations throughout the clinic.

McAuliffe’s slow-moving group weaved through dental chairs and ophthalmic testing devices as the governor paused to shake hands, have his blood pressure tested and pose for a flurry of photos with attendees.

As the entourage passed by, Beth McLoughlin, a member of the Norton Lions Club, shouted, “We do what Congress doesn’t do.” The RAM clinic volunteer in her ninth year elaborated that she meant RAM serves people. Congress doesn’t.

During his tour, McAuliffe reiterated his call for Virginia to expand Medicaid under the Affordable Care Act, which would provide coverage for 400,000 more Virginians. State Republicans have consistently blocked his efforts to do so.

“Those 31 states who expanded, their health care is in much better shape,” he said. “But the lack of a legislature to give us the authority to go expand Medicaid has really impacted Virginia.”

Although states must provide dental and vision care for children covered by Medicaid, some states do not extend coverage of those services — the same services many seek at the RAM clinic — to adults.

Republicans want everyone to have the ability to obtain affordable health care, Republican Party of Virginia Chairman John Whitbeck said in a statement.

“Democrats want to throw more money at a system that just isn’t working — a system that ‘Obamacare’ is making worse,” he said. “Democrats want people to have health insurance. We want people to have health care.”

As Republicans have failed to overhaul the Affordable Care Act, the health care law appears as though it will remain on the books, making it imperative to expand Medicaid during the next General Assembly session, McAuliffe said. The end of McAuliffe’s four-year term will coincide with the start of the 2018 General Assembly session.

McAuliffe’s visit left a bad taste in the mouth of Salem dentist Steve Alouf. A founder of Benchmark Dentures, Alouf spent the weekend fitting patients with dentures, but said the politicization of the clinic takes away from everything positive the volunteers work toward all weekend.

“People help people,” he said. “Politics don’t help people.”

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