There may be 43 million Americans without health care insurance. The number of Americans who lack insurance that covers dental is at least twice, if not three times, that number. Working in dental triage here at the event at Grundy reminds me forcefully of what I learned when I volunteered in Wise - we have a critical crisis in dental health in this country which may well dwarf the seriousness of the issues we normally include under the umbrella of our health crisis.
So before I do anything else, let me do this: let me urge you, if you feel moved to make a contribution, to direct it to Missions of Mercy, which is the umbrella organization that provides free dental care and skilled dentists at many of these events. Please note, I greatly admire the work of Stan Brock and Remote Area Medical, but they get the lion's share of the news coverage, and thus of the contributions, even though at Grundy - as was the case at Wise - more people will be treated for dental than for regular health and vision combined.
Please keep reading. There is a lot I would like to share, starting with, but not limited, to dental health issues.
Let me stipulate that having 43 or 48 or even on 30 million Americans with no health insurance of any kind should be a major concern.
Many health insurance policies do not cover dental services. And that is only part of the health crisis in dental care. Yes, should one need an extraction, a root canal, or even merely a couple of fillings, it can quickly get very expensive. And without financial help minor problems go untreated and become major ones - an unfilled cavity or a broken tooth becomes infected, or the gum becomes an abcess . . .
Dental health start with prohpylaxis - with proper care of the teeth and gums, which were it a more common part of every day life, the trauma of multiple extractions, or the cost of root canals and other procedures could well be avoided.
And even people who get basic dental checkups covered often do not have coverage for periodontal treatment, and yet if the gums are not healthy the bone underneath will be vulnerable, and that can cost teeth that could otherwise be saved.
The bacteria that play such a role in periodontal disease can quickly spread throughout the body, and if untreated contribute to major heart issues, among other health concerns.
We will NOT have a complete health care system if we treat dental issues as an afterthought.
I am here in Grundy, in Buchanan County, the poorest county in Virginia, as I noted in my diary last night. With its population of just under 27,000, it has four dentists, three of whom are working past retirement age.
I have found (albeit without a link) some data on the count of dentists in the US, from the Bureau of Labor Statistics, for 2006-7:
Dentists, general 128,000
Oral and maxillofacial surgeons 6,000
Dentists, all other specialists 5,000
Given that the population of the US was around 300,000,000, that would be a national ration of about 2,000/dentist, not the almost 7,000/dentist in Buchanan County, a ratio not uncommon in rural areas.
This highlights another critical issue - rural health in general. That is one reason that Missions of Mercy and Remote Area Medical are often in rural settings, or if in a city like Roanoke, one close to a substantial area of rural population.
That does not mean that dental issues are addressed in inner cities: the problems are just as severe. It is a function of income and of education: the lower either is (and they often run in tandem) the worse the health issues, with dental often being the most untreated health issues in people with a panoply of need.
I am struggling with how, other than my personal volunteering, I can help to alleviate the suffering that comes from this crisis. Certainly I write in the hope making people more aware, of engendering a response that perhaps will be heard in Congress and elsewhere.
Today we had at least three camera crews. One was from NBC Channel 4 in Washington DC. When they found out I lived in Arlington, they very much wanted to film me. I found at one point I had to bite my tongue, because when the reporter asked me why I would give up a Saturday and travel so far, this is what I thought, but did not say on camera:
I am processing paper and assisting with directing patients where they are to go. That enables the dentists with whom I work in triage to see more patients. Thus in one weekend I am accomplishing more improve health in the country than Congress has done in the last decade.
I thought it. I did not say it. In part because of conversations I have had with Stan Brock, knowing that he is trying to make a difference.
One issue is states which will not allow out of state medical and dental personnel to volunteer, despite Federal law which seems to imply that they can at most require pre-registration. Early this morning I had an epiphany on how this could be changed - conditions of aid. Let me explain.
I grew up in NY at a time when we - and in DC and I think Louisiana - you could drink anything at age 18, and in much of the Midwest those between 18-21 could drinkg 3.2 beer. And some states had no speed limits, or limits much higher than the 55 MPH the federal government decided to impose. The Feds had the big stick of federal highway funds, which at the time piad 90% of the cost of approved new roads as part of the interstate system. The Feds required raising drinking ages and lowering speed limits as a condition of receiving those funds.
The Constitution has a full faith and credit clause, one which recognizes the legal acts of other states. This applies to marriages, divorces, adoptions, and the like - and is one reason some conservative legal scholars think the Defense of Marriage Act is patently unconstitutional, as one might surmise from the Court's decision and reasoning in Loving v Virginia, which overturned the Commonwealth's refusal to recognize interracial marriages performed in other states, and also effectively ended such anti-miscegination laws. I would think one could make a good case for placing as a condition of receiving federal funds for state administered health programs (Medicaid and SChip) Congress could require that states allow medical and dental personnel - MDs, Dentists, Nurses, PHysician's assistants, etc. - who are fully licensed in other states to offer professional services for free at health clinics like those run by RAM, MOM, the doctor in Houston, and others. I intend to explore this issue with certain Members and Senators, especially those who are themselves health care professionals by background.
I also think that we need to begin educating people - and that includes policy makers - that separating dental from other forms of health is counter productive to all health - that includes what we normally think of as medical health, but also includes mental health.
I am still in Grundy. I do not know many we processed trough triage today. We had one xray machine fail, which caused a bit of a backup. I saw dentists who worked for more than 10 hours today, sometimes changing from fillings to triage to give their backs a break - as a few people found out that I have strong fingers and know something about how to relieve muscle strain I found I had a new service I could offer :-)
As dentist moved from place to place, or came and went, I became the one constant in triage, so that I became a clearing point for communication - with other parts of the dental operation, with the people from RAM who were doing the preliminary screening. I had to periodically remind people that I was not DR. Ken. I was pleased to be able to help those entitled to the title work more efficiently and effectively. And perhaps given my pre-teaching background as a systems analyst I found ways of making what those of us who were not dentists were doing more efficient.
We had a number of dental students. It was good for them to do what I had done at Wise, to talk with the patients while they were waiting for dentists to screen them, to serve as scribes, to work closely with the dentists. I have a sense that for many of them they had an experience similar to mine at Wise - it is lifechanging, and I fully expect many to continue to volunteer, both while they continue their studies, and after they are licensed.
It was nice to feel as if I were contributing to making a difference. A few times patients hugged me, which was something I was not expecting. They wanted to thank someone for making a difference for them, and perhaps at that point I was the one most accessible - I accepted on behalf of everyone volunteering.
I think back to what I was tempted to say to the reporter. It may seem harsh, but it also seems very real when I consider some of the nonsense I have heard from members and senators of both parties during the recent debates.
Remote Area Medical Missions - Stan Brock founded the organization because of his experience of living in the remote Amazon, where at times one was more than 20 days walk from the nearest trained medical care. He has been told by astronauts who went to the moon that they were never more than a few days away.
RAM does more work in the US than it does in remote regions of poor nations. That is worse than embarrassing. It is humiliating.
Think of Howard Dean's litany on health care: even Costa Rica...
I sit in my room at the Appalachian Inn as I write this. The local Lions Club has fed us. The County Board has paid for my room. I am listening to Bach as I write this, draining several bottles of Moosehead Lager, as I recover from a very long day: I got to our site at the school and 5:30, we began treating and triaging at around 6, and I finally finished shortly after 5:30 this evening. During that entire time I think I was off my feet for perhaps 35-40 minutes.
I am tired, I wish I could give myself a back rub I ache so much. And yet my work was far less strenuous and stressful that some of the dentists and hygienists who also worked long hours, albeit sometimes they were seated. Some are still relatively young. I am 63. Some of the dentist volunteering are older than me.
I want to scream, I want to cry, I want to collapse. But tomorrow morning i will be back at the school at 5:30 AM. We will triage perhaps an additional 50-100 people, then my work will be done, and before the event is over I will get in my car and drive home, at least 6.5 hours on the road, perhaps more. The following day I will be back with my students. The work I do there is very important, and very satisfying.
But the importance and satisfaction seem to pale in comparison to what I have experienced, first at Wise and now in Grundy. And I will probably take some time to tell them that, and why. Somehow I think many will understand that in saying so I mean them no disrespect.
I should not have to be here, but here I must be. Next year, while many who read this will be in Las Vegas for Netroots Nation, I will be back in Wise. Between now and July I will probably do one or two more of these events, always in dental triage, where I now know I can make a difference that is immediate, and I can remember something else: why elections matter. With a Democratic President and a Democratic Congress there is some hope that we can begin to address the unmet obligation we have to our fellow human beings, that we respect them enough to work to make the events at Wise and Grundy and elsewhere unnecessary.
Until that happens, so long as I am physically able, I will continue to volunteer, and to annoy you by writing about it.
People in bad health, including dental health, do not work effectively. Children with rotting teeth do not learn. People who suffer unnecessarily learn that they do not matter to us. And by our allowing this to continue we judge ourselves and our society, and by our continued inaction condemn ourselves as willing to be inhumane and unfeeling.
I cannot accept that judgment. I will strive against it.
And so I am here. And so I write this. And so I ask - even beg - that each time I do write about things like this, you help to make the words visible. Not for me, or rather, not for my ego. But for me and for you and for all of us, that we feel and act upon our common humanity.
And most of all, for the good people who come to us in desperate need, sleeping in their cars, or outside on the ground, in the hope that we will be able to help them.
The NBC reporter and his cameraman arrive around midnight last night, only to discover that their hotel shut its office at 10 PM. I asked them what they did, and they told me they slept in their car. I then told them that many of the people being treated slept in the cars, that at Wise some did so for several days. Perhaps that might help them understand the seriousness of what they were seeing and encoungering.
For these good people, who are in need, who ask us to respect their humanity, a humanity that should be something we share with them