In 2023, a survey administered to 1,400 North Carolinians found that 68% of respondents experienced healthcare affordability burdens within the past 12 months. In their responses, North Carolina residents cited a wide range of healthcare concerns, ranging from high costs of dental and vision services to elevated prices of prescription drugs. The survey also found that, along with financial barriers to much-needed healthcare services, a lack of geographical access to healthcare services led to increased challenges in accessing treatment for North Carolinians.

Rural populations face additional barriers to accessing healthcare services. Shortages of healthcare providers and transportation barriers to the nearest clinics and hospitals are among the biggest causes of these inequities. In fact, in North Carolina, 11 rural hospitals have shut down or halted inpatient care delivery since 2005. According to N.C. Rural Center, North Carolina is home to 78 counties that fall under the definition of “rural” counties–counties that contain 250 or fewer residents. Even though rural areas are less densely populated, 40% of North Carolina residents reside in these counties. 

The Duke Health System provides a comprehensive range of healthcare services with 412 primary care physicians and advanced healthcare providers providing treatment during nearly 67,000 inpatient stays and nearly five million outpatient visits in 2023. Given the scope of Duke Health systems and existing care disparities, how can Duke bridge the healthcare access gap and deliver equitable care in rural North Carolina?

What is Duke Remote Area Medical (RAM)?

Duke Remote Area Medical (RAM) aims to address this need by connecting Duke students to local community organizations in Durham or free clinics across the Southeast on weekends. Duke RAM was created as an extension program of the national non-profit organization of the same name, providing an opportunity for Duke students to work at the intersection of public health and medicine. Duke RAM’s mission is to expand healthcare access in low-resource areas across North Carolina and nearby states, such as Virginia and Tennessee. Since its creation in 2022, the organization has evolved to provide assistance across multiple dimensions. 

Above: Duke RAM attends a pop-up clinic in Morristown, Tennessee. Image courtesy of Srishti Kumari (Trinity ’25).

“Duke RAM primarily connects other students to opportunities that help reduce health disparities, but we do this in a couple of different ways,” said Anika Vemulapalli (Trinity ’25), General Co-President of Duke RAM. “On a broad level, we plan trips to pop-up clinics in rural areas that deliver medical, vision, and dental care.”

Vemulapalli, who has been a part of RAM since her freshman year, emphasized the impact of sustainable care in the rural communities they serve. Locally, Duke RAM provides volunteers beyond weekend pop-up clinics. “In Henderson, the city 45 minutes away where we host our annual clinic, we try to do more local impact year-round rather than just coming and going out of a community,” Vemulapalli said. “This can consist of working at their homeless shelters, talking to senior centers, and engaging with community partners. We’ve also worked with the local Durham community in collaborating with organizations like Durham Rescue Mission and Root Causes.”

What are some projects Duke RAM has been working on over the past couple of years?

Currently, North Carolina does not allow providers from outside the state to volunteer. This policy has a direct impact on healthcare service delivery, especially in hard-to-reach areas. Duke RAM wants to change that: “Recently, our advocacy chairs have been doing a good job in formulating a bill amendment to change that North Carolina is a closed state,” Vemulapalli said. This policy change is crucial to expanding healthcare access for North Carolinians, removing systemic barriers that have prevented the expansion of medical care. “We are trying to change that because not only would it severely impact the number of patients we can see at our clinic, but there are also a lot of nonprofits that operate on providing free health services that can’t collaborate with neighboring states and providers,” Vemulapalli said. 

With such a wide range of avenues for increasing healthcare access, Duke RAM has not only expanded its scope of volunteering across the Southeast, but it has also increased its scope of healthcare access with student volunteers at weekend pop-up clinics. At Duke RAM’s first clinic in May of 2022, the team served a reported 150 patients and provided $150,000 worth of free care. In 2023, these numbers grew significantly; student volunteers reached 230 patients and delivered $186,000 of free care. Vemulapalli attributes this expansion of care access to clear goals and deliverables for each year since RAM’s founding in 2022. After the founders of Duke RAM, Rishi Dasgupta (Trinity ’22) and Rishabh Jain (Pratt ’22), graduated, Vemulapalli and her co-presidents hoped to expand several components of the club, including student participation.

“The first year was navigating what we can do to ensure that our students are good volunteers and that they can volunteer,” Vemulapalli said. “We really focused on expanding on volunteer efforts and going to more clinics while also implementing ethical volunteership and emphasizing the core values of volunteering as prioritizing the patient.” 

After expanding volunteering and focusing on patient-centered care, Vemulapalli aimed to expand the recruitment of healthcare providers. “The next year was great because we found a connection to a dental school, and we were able to bring so many dentists and double the amount of patient reach,” Vemulapalli said. Now, Vemulapalli hopes to focus on improving and creating more robust patient care. “This year, now we are thinking of extra details and how we can make this more robust and comfortable for patients rather than just having services available for them,” Vemulapalli explained. 

What are the next steps for Duke RAM?

With such a wide scope of care and efforts to reduce healthcare access, Duke RAM directly works with a complex set of determinants that necessitates a culturally competent model of care delivery. A diverse range of patients attends the pop-up clinics. Around 48% of patients are African American, and 20% of patients are Hispanic. RAM reports that 79% of patients did not complete a college degree, and 31% are unemployed. Given the diverse patient backgrounds and needs, a one-size-fits-all approach to patient care would exclude a wide range of patients. Through conversations with patients at these clinics, Vemulapalli and other student volunteers learn how to implement a more successful clinic.

Vemulapalli cites language as an example of a critical barrier in serving diverse patients. “There are additional considerations to think about when serving non-English-speaking patients. From my internship with RAM over the summer, I noticed how huge language barriers are around clinics. As a result, we have organized a coalition of interpreters for our clinics through collaborations with Duke graduate students and Mi Gente (Duke’s student organization focused on strengthening the Duke Latinx community), and that’s been really great.”

Above: Duke RAM outside a pop-up clinic in Lick Creek, Kentucky. Image courtesy of Srishti Kumari (Trinity ’25).

Despite obstacles in the implementation of clinics and volunteer recruitment, Vemulapalli remains optimistic and is excited about the next steps that Duke RAM can continue to take to bridge healthcare inequities in North Carolina. In particular, Vemulapalli hopes that Duke RAM can recruit students with a wide range of interests. “We need everyone,” Vemulapalli said. “We need people with a finance background to crowdfund and raise funding, we need people who know how to write grants, we need people with communication and rapport-building skills to recruit more providers. In terms of next steps, I’d like to see Duke RAM expand to new students and new populations at Duke.” 

With ongoing projects and a new year coming up, Duke RAM has a wide range of opportunities for new objectives to further develop how health inequities can be addressed on a local level. “Every year is a continuous development to get better,” Vemulapalli continued. “I’m excited to see how our next presidents will develop Duke RAM more.” 

Above: Duke RAM volunteers at the Morristown, Tennessee pop-up clinic. Image courtesy of Srishti Kumari (Trinity ’25).