WISE, Va. - The sick and the disabled pour out of these mountains every summer for their one shot at free health care, but this year was supposed to hold hope for a better solution.
President Donald Trump won the White House in part on a promise to fix the nation's costly and inefficient health-care system. Instead, Republicans in Congress are paralyzed and threatening to dismantle the imperfect framework of Obamacare.
No relief is in sight for someone like Larry McKnight, who sat in a horse stall at the Wise County Fairgrounds having his shoulder examined. He was among more than a thousand ailing people attending the area's 18th annual Remote Area Medical clinic, where physicians and dentists dispense free care to those who otherwise have none.
"I really think that they don't have any clue what's going on," McKnight said, referring to political leaders in Washington. "You watch the news and it's two sides pitted against each other, which in turn just makes them pitted against us, the normal person."
About 1,100 such people descended on the fairgrounds Friday, with more expected Saturday and Sunday. Medical personnel from across the state were there with makeshift examination rooms in tents and sheds. Sheets hung from clothespins for privacy; giant fans pulled hot air through buildings intended for livestock shows.
These events are staged nationwide, but the Wise clinic is among the biggest, drawing people from all over Appalachia and casting Washington's sterile political debates into the starkest human terms.
A third of the patients who registered Friday were unemployed. Those who couldn't afford a room slept in their cars or camped in the fields around the fairgrounds. They lined up in the dead of night to get a spot inside the event.
It is the place of last resort for people who can't afford insurance even under Obamacare, or who don't qualify for Medicaid in a state where the legislature has resisted expansion.
At 37, with a long graying ponytail, McKnight had never been sick until about eight months ago. So he hadn't worried too much about not being able to afford insurance on his roughly $18,000 a year in pay as an auto mechanic. But now he was getting a referral to the University of Virginia hospital to check for the source of his pain, which he had vowed to withstand without resorting to opioid medication.
"The normal person doesn't care about a lot of the things that they care about [in Washington]. Most people want to work, they want insurance and they want to be able to take care of their family without assistance," he said.
The only way to do that, he said, is to have everybody - healthy and sick - paying into a centralized health insurance plan. "I really think the only thing that would truly help this country is if it were single-payer," McKnight said.
Around here, that's not politics, it's just life. Many of these people voted for Trump - not only for his vow to fix health care, but also for his promise to bring back the coal industry. They're still waiting for results, with varying degrees of patience.
Patricia McConnell was having trouble speaking around the bloody gauze in her mouth. She had just had four teeth pulled. The unemployed former McDonald's manager had driven eight hours from her home in Glen Burnie, Maryland, to attend the clinic.
"My teeth were hurting," she said. McConnell, 63 and disabled, said she had health insurance through Medicaid, but no dental coverage.
So this was her dental plan: save for six months to afford a motel room and gas, and wait in line in the morning heat to see a volunteer dentist.
McConnell has been watching the health care debate in Washington and wondering if it will ever amount to anything that actually helps people like her. "I don't know what they're trying to do," she said, struggling to get the words out around the gauze.
She voted for Trump, she said, and still feels that he's working hard to help. But his anger and his tweets seem to aggravate Congress, and no one is working together, she said.
They need to set all that aside and work to pass health care for everyone, she said. "Let's get this done."
Others had a hard time mustering the faith that anyone cared.
"They're trying to kill us poor people, is what they're trying to do," said Robert Horne, 55, a disabled former construction worker seeking dental care. Horne said he voted for Hillary Clinton last fall because of her pledge to maintain the Affordable Care Act.
That didn't work out, either.
Virginia Gov. Terry McAuliffe (D), who flew out to the clinic Friday morning, had invited Senate Majority Leader Mitch McConnell to join him - but said that the Republican leader "politely" declined. McAuliffe, who visits the clinic every year, spent nearly two hours touring it - twice as long as scheduled - and took every opportunity to proclaim that he's been trying for three years to get the state legislature to agree to expand Medicaid under Obamacare.
The Republican-controlled General Assembly has resisted, unlike the legislatures in nearby states, which McAuliffe kept reminding the patients and doctors who crowded around him on the hot fairgrounds.
"All of our neighbors in Kentucky and West Virginia and Maryland - they did it!" he said to a Christian counseling group that had set up shop under an awning. But in Virginia, he said, legislators turned down millions in federal dollars that would be available under Medicaid expansion.
"We need it," called out Tonya Hall, operations director for a hospice care facility. "Let 'em come and visit some in southwest Virginia. Let 'em see the poverty. Let 'em see how we live. Let 'em come."
"This isn't about politics," McAuliffe said.
"Right!" Hall agreed. "It's about people."
"It's about people's lives," McAuliffe said, to a round of "amens" from the group.
Hall, 42, said she had voted for Trump, but that she was disappointed that he hadn't been able to do anything to improve the health care system. If Obamacare can't be fixed, she said, "then I say we scrap it and start over. You can see the need," she added, gesturing at the masses of people waiting for their turn with a medical professional.
Beyond her, a long line stretched into the triage tent, where people were sorted, their vital signs measured. Allen Sexton, 37, was there to have all his teeth removed, years after a car accident had left them a scrambled mess.
In a metal shed nearby, vision specialists sat in darkness, performing eye exams in pools of light. One man said his glasses had broken a year ago and he couldn't see at a distance or up close, but he'd been driving anyway.
There was another tent for orthopedic care. Another for basic checkups. Each one was full, with more people waiting outside on metal folding chairs or standing in lines.
Politicians prowled the fairgrounds. Several area legislators attended while Attorney General Mark Herring (D), running for re-election, walked with McAuliffe and Sen. Tim Kaine (D) helped register patients.
Stan Brock, the English philanthropist who founded the RAM clinic program more than 30 years ago, said there was one more visitor he'd like to see at the clinic.
"It's absolutely imperative that the president of the United States come and visit one of these events," he said. "I believe if he did he would take some immediate action."