A little girl cries herself to sleep every night. She winces in pain at meal times because she has a developing abscess in one of her baby teeth, and nobody can help her. Imagine this 4-year-old is your child, niece, neighbor, or granddaughter. You call for an ap-pointment, but the nearest help is 100 miles away by dirt roads, and the earliest appointment is available in about one month. What would you do? This is not a distant Third World dilemma; it happens far too often right here in the
United States—in American Indian country.
I strongly feel that an ideal solution to the shortage of dentists in Indian Country is to in-crease the number of American Indian dentists from federally recognized tribes. There are only 135 of us in the entire United States! The first American Indian dentist who graduated from Creighton University in 1956 recently retired from clinical practice and is the only retired American Indian dentist. A dental career is not even a remote consideration for most American Indian young people. This is due in part to the fact that most have never even seen an American Indian dentist!
The members in the Society of American Indian Dentists (SAID) have ideas on encouraging American Indian students in sixth grade through high school to consider dentistry as a career. However, there are many obstacles in our way. In my personal opinion, the most significant obstacles are manpower, financial resources, dental education, communication deficiencies, and organization. Let’s look at each of these briefly.
Manpower: The number of members in SAID is small, and dentistry is such a demanding profession that the members alone do not have time available for the herculean efforts required. Spare time in the evenings and weekends cannot begin to address the large demands and needs at hand. We really need the help of other dental professionals and would like everyone to know that SAID membership is open to all dentists, including non-American Indian doctors.
Financial Resources: Since most of the American Indian dentists are younger than 40 years of age, there are not any endowments available to keep us going. We do not yet have enough personal wealth to fund all the needed support.
Dental Education: The cost of a dental education is growing every year, and it frightens many Indian youth. Grandparents, uncles, aunts, and other family members who have the financial ability to loan them the funds are rare. In addition, many are not aware that service in the Indian Health Service (IHS) or military can pay back much of this debt.
Communication Deficiencies: American Indian dentists are spread out across the entire country, often on remote American Indian reservations or Alaskan and Hawaiian villages. Communication can be difficult, slow, and expensive. Means of communication that many US citizens may take for granted at this point in our history are often partially or even completely unavailable. For example, Internet options are still often limited and even cell phones may not work in some areas.
Organization: We tribal members have been forcibly moved against our will and unwillingly disbanded. This has resulted in disjointed and long-distance relationships that are difficult to maintain. For example, my tribe, the Prairie Band Potawatomi Nation (PBPN), is a Great Lakes tribe that was forced in the 1830s to walk to Kansas. I live in Michigan, our tribe’s homeland, because my grandparents managed to break away and walk back. Imagine the immense difficulties that I have had to face while trying to help the PBPN set up a dental clinic, 6 states away.
REACHING OUT TO YOUNG STUDENTS
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 3 college students who are pursuing predental 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. (If you are interested, please take some time to contact them and ask how the Amer-ican Indian dental students are performing.)
You must remember that the tribes have had huge monetary obstacles (unrelated to dentistry) to overcome from the past. For example, my own tribe has had to build its entire infrastructure. There were no paved roads, and bridges were unsafe on the reservation prior to 1990. There were no schools, no fire station, no medical facility, no sewers or municipal water, no elder care—let alone a single dental clinic. With a profitable bingo hall and a casino opened very recently, my tribe has accomplished a lot of this in the past 8 years. Perhaps now that these major projects are done, the PBPN can begin to think about and plan for a dental clinic.
IS EVERYONE AWARE? A BRIEF HISTORY
Recognize that still today, American Indian tribes and their members do suffer from postcolonial traumatic stress disorder, a result of more than 500 years of historical trauma. The process of grieving for lost language, tradition, and religion is still not over. The forced relocation of entire tribes into strange geographies 200 to 500 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 unwillingly tattooed on her right forearm as a girl. They tried to both beat and religiously remove the “Indian” out of her. She was forced to throw away her Indian clothes, shoes, and adornments, and her beautiful hair was cut short. She was forbidden to speak the Potawatomi language. Besides school, the children—as young as 5 years old—had to work 6 to 8 hours per day. They slept in barracks with 30 or 40 other children. Could you even imagine this as you tuck your own children into their 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,” and as a result, another land grab was initiated. Even today, these tribes are continuously attempting to regain their federal recognition. So, 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 will be edentulous by middle age? Depression leads to inaction and acceptance. Shouldn’t all of us in the dental profession speak out and take action since edentulism is unacceptable for any American?
RESPONSE TO CALLS FOR ACTION
I must say that I am personally disappointed that the tribes I contacted did not all respond with a resounding “Yes! Of course we’ll help the SAID in its goals.” However, one tribe that has done an exemplary job with its own dental clinic is the Pascua-Yaqui Pueblo, just south of Tucson. This is not an IHS clinic; it was built, staffed, and funded entirely by the tribe. A private dentist hired directly by the tribe provides dental services. The IHS is part of the US federal government, and one of its many obligations is to provide dental care. Currently, there are many vacant dental positions in the IHS; historically, these dentists were white males.
As a board member of the SAID, I have approached all the dental schools in the United States, numerous dental organizations including the ADA and its state affiliates, many dental corporations, and some tribes looking for support and help. We are applying for grants to open an SAID central office, but we are not making much progress yet. We still need a Web site, an outreach program, an office and staff, and we need to meet face to face more than once a year. Students also need to meet with us. We need media help, conference help, and a coordinated predental student development plan.
I have requested corporate sponsorships from the presidents of the corporations, only to be turned down flat in many cases. Then, I read about these same corporations supporting just about every other dental group—Hispanic, Jewish, African American, women, etc. I have contacted many dental corporations, businesses, laboratories, manufacturers, institutions, continuing education programs, and organizations via mailings using official SAID letterhead, e-mails, and the phone. Unfortunately, more often than not, I have not even received the courtesy of a reply.
Thankfully, we have had help from many dental corporations such as Voco, Zimmer, Proctor & Gamble, A-dec, Midmark, Brushtime Products, Colgate Palmolive, Whitepigeon Enterprises and others who have given in the past. Most notably, Henry Schein has been very generous and encouraging for many years. Institutions such as the Association of American Indian Physicians, the National Dental Association, the Hispanic Dental Association, and the ADA 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 University, and the University of Detroit.
DENTAL HEALTH THERAPISTS: ACCESS TO CARE
Often, I see concerns voiced in the dental magazines and journals about the dental health therapists (DHTs) who are being utilized in Alaska Indian villages. There is more than one side to this issue. Think about it—exactly what are the tribal chiefs supposed to do when repeatedly confronted with crying children in dental pain? Because we walk in “both worlds,” American Indian dentists have not taken a position concerning the DHTs in Alaska. How real is the dental establishment’s worry about DHTs? When we are constantly told no! when asking for help in Indian country, it gets pretty discouraging. Does anyone really care, or is the topic of DHTs just an interesting topic for the sake of an argument? For example, in the Journal of the Michigan Dental Association published in December 2007, Rep-resentatives 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, I did not receive any acknowledgement that they received my communications or even read any of my concerns and suggestions.
My own opinion is that the DHT slope is a very slippery one. Why should there be 2 standards of care in the United States? The state and federal governments have determined that, in order to protect the public, all irreversible dental procedures shall be completed by a licensed dentist, and this has served the general public well for more than 100 years. I sincerely believe that the United States has some of the best dentists in the world. Why shouldn’t the American Indi-ans have better access to that excellent care? So, put yourself in the position of a tribal chief and imagine a precious child’s eyes filled with tears from dental pain, looking directly at you for help while the child’s mother and father are pleading for help.
Would a kind DHT be better than having no treatment at all?
A RENEWED CALL TO ACTION
I do not believe the American Indian dental dilemma is a hopeless situation. It simply requires all of us involved in the dental profession to step up and help. There are plenty of smart and capable American Indian students who could become marvelous dentists if they were guided in the right direction. In the words of the well-known American Indian Chief Sitting Bull (circa 1870): “Let us put our minds and hearts together and see what kind of life we can build for our children.”
Perhaps you or your organization would be willing to offer assistance to SAID to help support predental students?
Dr. Rickert, the first female American Indian dentist, is a member of the Prairie Band Potawatomi Nation. She can be reached at whtpgn.com or at (231) 276-9644.