Columns 2006

Dentists in Bush Alaska

It’s become one of those trite truisms that all we ever needed to know we learned in kindergarten.  I don’t quite agree with that since I’ve never actually seen a kindergarten kid filling out a tax form.  But I do believe that we should have learned one of our most important lessons there, and that is to play and work well with others.

In that spirit, and to help the dental society avoid anymore of those large, costly ads they are running about the proposed dental health aide program, let me make a suggestion that perhaps will help us get unstuck from everyone’s entrenched position.

For those of you who haven’t been paying attention – and really, unless you live in Bush Alaska, why would you? – the issue is a new program being proposed by Native health care corporations to train local people as dental aides, most closely analogous to the extremely successful community health aide program that has brought medical care to remote Alaska villages for over forty years.

The state and national dental society apparently feel this program offers second-class service to Native clients.  The Native health corporations feel it offers the only routine dental care most villagers will ever see since dentists do not usually set up practice in remote Alaskan villages.  The reality is that a dentist, while sorely needed in most villages, would be hard pressed to maintain a practice in that setting.  Yet the alternative of dental health aides filling in when dentists aren’t available seems distinctly unpalatable to the dental society.

And so we sit at an impasse. In our villages, people suffer daily from painful dental conditions.  The dental society claims it has hundreds of dentists waiting to go out and alleviate that pain if the Native health corporations would just get out of their way. The Native health corporation say a part time dentist in a village is just not good enough, that a full time care giver needs to be in place to continue to provide treatment for problems that arise after the dentist has left.

So here’s my suggested solution.  Work together.  I know that’s a radical concept but stay with me on this.  The dentists go out to the villages.  The health corporations work with them to get them out there and give them a chance to show that they really can provide ongoing coverage of village dental health needs. The dental society works with the dental health aides and gives them a chance to show what they can do and how effective they can be.  They work with the dental health aides, not against them.

If, in fact, the dental association is right that they have the dentists needed to meet the needs of Bush Alaska, then the dental aides will be able to focus on prevention and education and won’t have to do the procedures that seem to be tying the association’s undies into knots.  And everyone wins because the villages get great, consistent dental care, the dentists show they can bring reliable dental care to the bush, and the dental health aides get to help their villages learn how to prevent these problems before they start.

If the dental association turns out to be wrong and they can’t keep a steady stream of dentists flowing throughout bush Alaska, everyone still wins because it then becomes glaringly obvious that dental health aides are a critical component of dental health care in bush Alaska and the dental society will back off their claims that they can do it all. The dental society will hopefully then help make the dental health aide program one that is as effective and professional as the community health aide program.

Mom and our kindergarten teachers were right.  Learning to work and play well together is the best solution to most problems. People in the bush desperately need good dental care from someone, anyone, who can provide it in a consistent and ongoing manner.  Shouldn’t the money be spent achieving that goal and not running ads and paying lobbyists to influence politicians to pass laws that will only make things worse for the people in the most pain?  Just seems to make sense to me. But then, I stopped working for the bureaucracy over six years ago and so my common sense is starting to reassert itself and I realize that can be a drawback in these situations.