A little girl cries herself to sleep every night. She winces in pain at mealtimes. She has a developing abscess in a baby tooth, and nobody can help her. Imagine this four-year old is your child, niece, neighbor, or granddaughter. You call for an appointment, but the nearest help is 100 miles away, the earliest appointment a month hence. And, there are no paved roads. What would you do?
This is not a distant Third World dilemma; it happens far too often right here in Indian Country.
I strongly feel that an ideal solution to the shortage of dentists in Indian Country is to increase the number of American Indian dentists from federally recognized tribes. There are only 135 of us in the entire USA! The first American Indian dentist graduated from Creighton University in 1956. He is our only retired dentist, having recently retired from clinical practice.
A dental career is not even a remote consideration for most American Indian youngsters, because they have never even seen an American Indian dentist! We at the Society of American Indian Dentists have ideas on encouraging American Indian students in 6th, 7th, 8th grades and high school to consider dentistry as a career. But there are also many obstacles in our way.
I am NOT representing American Indian dentists, but in my own personal opinion, the most important obstacles are:
- Manpower. Our number in the SAID is small, and dentistry is such a demanding profession that we do not have time for the herculean efforts required. Spare time in the evenings and weekends cannot begin to address the need. We need other dental professionals to join us; the SAID has membership open to anyone.
- Resources: Most of the American Indian Dentists are younger than 40, even 30, so there aren’t any endowments to keep us going. We do not yet have personal wealth.
- Dental Education: The cost of a dental education scares many Indian youth. Rich grandparents, uncles, aunts and family who can loan them the funds are rare. They do not realize that service in the IHS or military can pay-back much of this debt.
- Communication: American Indian dentists are spread out across the entire USA, often on remote American Indian reservations and Alaskan and Hawaiian villages. Cell phones may not even work. Internet options may be limited. Communication can be difficult, slow & expensive.
- Organization: We tribal members have been unwillingly disjointed, making it even more difficult. For example, my tribe, the Prairie Band Potawatomi Nation, is a Great Lakes tribe who was forced in the 1830s to walk to Kansas. I live in Michigan, our tribe’s homeland, because my grandparents walked back. Imagine the immense difficulties I have to overcome, trying to help the PBPN set up a dental clinic, 6 states away. I haven’t even seen them face-to-face, nor have they met me!
Thankfully, some tribes have contributed generously, notably the Shokapee Mdewakanton Sioux from Minnesota. They, along with an initiative from the University of Minnesota, have identified three college students who are pursuing pre-dental studies. The Arizona School of Dentistry and Oral Health, Creighton University School of Dentistry and the University Of Oklahoma School Of Dentistry, among others, have strong outreach programs to American Indian high school and college students. Contact them and ask how the American Indian dental students are performing.
You must remember that the tribes have had huge monetary obstacles to overcome from the past. For example, my own tribe has had to build its entire infrastructure. There were no paved roads on the reservation prior to 1990. No schools. No fire station, no medical facility, let alone a dental clinic. No sewers or municipal water, no elder care. Unsafe bridges. With a profitable bingo hall, and then a casino very recently, my tribe has accomplished a lot of this in the past several years. Perhaps now that these major ventures are done, the PBPN can begin to think about a dental clinic.
Recognize that still today, American Indian tribes and their citizens do suffer from Post-Colonial Traumatic Stress Disorder, a result of more than 500 years of historical trauma. The process of grieving for lost language, tradition and religion is not over. The forced relocation of entire tribes into strange geographies less than 500 -200 years ago did lead to helplessness and total dependency. It was – and still is – so easy to give up. The forced and brutal removal of American Indian children from their homes, into “Indian schools” tore the very fabric of families apart. My own grandmother was forced into an “Indian school” and tattooed on her right forearm as a girl. They tried to beat and religicize the “Indian” out of her. She was forced to throw away her Indian clothes and shoes and adornments, could never speak the Potawatomi language, and her beautiful hair was cut short. Besides school, the children – as young as five years old!!- had to work 6 to 8 hours per day. They slept in barracks with 30 or 40 other little kids. Can you even imagine this, as you tuck your own children into their safe beds tonight?!!
In the 1950s, the US government forced the federal policy of termination onto many tribes. Essentially, the government got rid of the “Indian” problem by terminating the federal recognition of many historical tribes, expecting they would assimilate into the general society overnight. Reservations were “privatized,” thus another land grab was initiated. Even today these tribes are continuously attempting to regain their federal recognition.
It is easy to see why dentistry is often not the top priority of tribes. Can you understand why so many American Indians have just accepted that they’ll be edentulous by middle age? Depression leads to inaction and acceptance. Shouldn’t we in the dental profession shout that this edentulism is unacceptable for any American?
Yet, I must say, that I personally am disappointed that the tribes I contacted did not all respond with a resounding “YES! Of course! We’ll help the Society of American Indian Dentists in its goals.”
One tribe that has done a wonderful job with its own dental clinic is the Pascua-Yaqui Pueblo just south of Tucson. This is not an Indian Health Service clinic – it was built, staffed and funded entirely by the tribe. A private dentist hired directly by the tribe provides dental services.
The Indian Health Service is part of the United States federal government, and one of it many obligations is to provide dental care. Currently there are many vacant dental positions in the HIS; historically, these dentists were male Caucasians.
As a board member of the Society of American Indian dentists, I have approached all the dental schools in the USA, numerous dental organizations including the American Dental Association and its state affiliates, many dental corporations and some tribes, looking for support and help. We are applying for grants to open a Society of American Indian Dentists central office, but we are not making much progress. We need a website, we need an outreach program, we need an office and staff, and we need to meet face to face more than once a year, students need to meet us. We need media help, conference help. How about pre-dental student development?
I have requested corporate sponsorships from the presidents of the corporations, only to be turned down flat. Then, I read about these same corporations supporting every other dental group – Hispanic, Jewish, Black and women. I have contacted many dental corporations, businesses, labs, manufacturers, institutions, continuing education programs and organizations, and more often than not, have not even received a reply. I do correspond through the US Postal Service, using official Society of American Indian letterhead, I email, I phone. I am dog-tired of it all.
Thankfully, we have had help from many dental corporations; most notably, Sullivan-Schein has been most generous and encouraging for many years. Voco, Zimmer, Proctor & Gamble, Adec, Midmark, Brushtime Products, Whitepigeon Enterprises, Colgate Palmolive and others have given in the past. Institutions such as the Association of American Indian Physicians, the National Dental Association, the Hispanic Dental Association and the American Dental Association support us and lend a helping hand. These Dental Schools have continued to help the SAID: University of Minnesota, Howard University, University of Michigan, University of Nebraska, University of Mississippi, Tufts University, Creighton and the University of Detroit.
Often, I see concern in the dental magazines and journals about the dental health therapists being used in Alaska Indian villages. Exactly what are the tribal chairs or chiefs supposed to do when repeatedly confronted with crying children in dental pain? The establishment has failed them dentally. Because we walk in both worlds, American Indian dentists have not taken a position concerning the dental health therapists in Alaska. How real is the dental establishment’s worry about dental health therapists? When we are constantly told “NO,” when asking for help in Indian Country, it gets pretty discouraging. I am beginning to believe that no one even cares; dental health therapists are just an interesting topic for arguing. For example, in The Journal of the Michigan Dental Association Journal, December, 2007, Representatives Dave Camp and Ron Kind expressed such concern about “little or no access to important dental care services” for American Indians. Yet, when I wrote, phoned and emailed them both, I did not receive one acknowledgement that they received my communications, let alone read any of my concerns and suggestions.
My own opinion is that the dental health therapists slope is very slippery. Why should there be two standards of care in the USA? The states and federal government have determined that in order to protect the public, all irreversible dental procedures shall be accomplished by a licensed dentist, and this has served the general public well for 100+ years. I sincerely believe that the USA has the most excellent dentists in the world. Should not the American Indian have access to that excellent care? But, put yourself in the position of a tribal chief, and imagine a precious child’s big, brown eyes filled with tears from dental pain, looking directly at you for help, the child’s mother and father begging. Would a kind dental health therapists be better than nothing?
I do not believe the American Indian dental dilemma is a hopeless situation, but it requires all of us involved in the dental profession to step up. There are plenty of smart and capable American Indian students who could become marvelous dentists, if they could be guided in that direction. Can you offer any help to the Society of American Indian dentists?
Jessica A. Rickert, DDS, is the first female American Indian Dentist, a member of the Prairie Band Potawatomi Nation. She can be reached at www.whtpgn.com.
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