Who Knows What?

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At What Point Did You Get Involved?

Reflections from Valerie Davidson – senior director of intergovernmental and legal affairs, Alaska Native Tribal Health Consortium, Anchorage, Alaska

When I was a young girl growing up in a small Yup’ik Eskimo village in southwest Alaska, children enjoyed a strong sense of community thanks to special promises made on our behalf by every parent to every other parent in the community:

As your children walk outside your door,
I promise to look after them,
to make sure they are safe,
they have what they need.
I promise to carry them in my heart.
I trust that you too will look after mine.

In this way, our children will know they are loved.
They will know they are important.
They will know their place in our world.
They will know they too are responsible for younger children.
They will know we are all connected.

What affects one child affects every child.
What affects one family affects every family.
What affects one community affects every community.

Although we have cultural and language differences, Alaska Native and American Indian families want what every family in America wants: We all want our children to be healthy, happy and to live in safe communities. Families and communities may need to do things differently to accomplish that same goal, and specific goals may be different from one community to another. They are all important.

In Alaska, we have been working to restore the smiles of Alaska Native children by improving access to oral health care in new ways. Our Dental Health Aide Therapy (DHAT) Program is modeled after a program in New Zealand and authorized in more than 50 countries. DHATs provide basic oral health care procedures, including fillings under the general supervision of a dentist.

For me this work is deeply personal. As a child I remember when the dentist came to our village once a year. As we waited in line to be seen, we could hear the screams behind the door as teeth were pulled from children ahead of us. The door would open and we’d see our crying brother, sister, cousin or friend holding a bloody gauze bandage to their mouth. We always asked how many teeth were pulled.

For the youngest kids, this was especially traumatic because they had not experienced it before. They did not know that this was considered “normal.” Every year, one of the little ones would stand in line, terrified, and either wet themselves from fear or run out the clinic door. Our community health aide would wait five minutes to give the child time to calm down and then bring the child back. The “runner” would move to the front of the line.

For our children, going to see the dentist was truly traumatic. I have a cousin who still cannot be seen by a dentist unless she is under full anesthesia. Imagine how frightening it is for her to seek oral health care for her children.

This is why I got involved in this work. Our children deserve better. They need to know that “normal” is being cavity-free and that oral health care can be a positive experience, not a terrifying one. Our young children also deserve to have positive relationships with people in our community who look like them and who they look up to.

When we began to develop our DHAT program, we were told there was too much opposition. We were told that we were out-resourced and we were politically out numbered. We were told it was simply going to be too hard.

While we knew that was probably all true, we also knew that some of our children were graduating from high school with full sets of dentures. Many other children covered their mouths when they smiled and laughed because they had “ugly teeth” and/or missing teeth. These things happen when you only have access to oral health care once every year or two, if you are lucky.

We had tried other strategies to entice dentists to live in our frontier communities. Volunteer dentists, student loan repayments, incentive payments and other strategies simply weren’t working. We knew that we needed to find our local solution to our local problem.

Ultimately, we were not willing to accept the poor oral health status for our children any longer. As things got harder, I remembered the advice of my late grandmother, Taurluq Annie David. “Lead with love. You will not stand alone if you lead with love.”

My grandmother was a wise woman. We did not stand alone. Through the generous support from our partners in Alaska Tribal Health System, Yuut Elitnaurviat, University of Washington, W.K. Kellogg Foundation, Rasmuson Foundation, Bethel Community Services Foundation and others, we are now educating Dental Health Aide Therapists in Alaska. The program is rigorous; after all, they are caring for our children. We are proud of the fact that the DHAT recertification standards are more stringent than standards for dentists.

Today, more than 25 certified Dental Health Aide Therapists practice in rural Alaska. Our children receive oral health care from people who look like them, who speak our languages and understand our cultural norms. Beyond the dental chair, our DHATs connect with our children through schools, basketball games and throughout the community. Our children look up to our DHATs. They are people that we know and trust.

Because of these close relationships, we are already changing the smiles of Alaska Native children. We are beginning to see cavity free kids. We are raising the oral health IQ of our children, our families and our communities. What began as our local solution to our local problem is being looked at by other states as people realize that this model can work anywhere.

We have learned a number of valuable lessons that are equally applicable to almost any effort that strives to improve the lives of children, families and communities. But the most important may be this: that people will do the most amazing things when given the right reasons. And children are always the right reasons.

The result of our efforts will be to ensure that our children grow up healthy and strong and equipped to make their own promise to the children of the future. Just as I made that promise to my daughters.