Reflection at the halfway point

I am currently on a ferry halfway between Juneau and Sitka so I figured that it was an appropriate time to reflect on the halfway point of my summer project experience. So far, so good. I have been having such an enriching experience – not just through the stated goals of my summer project, but also through the social and cultural experience of Alaska. I have hiked 2,500 feet in elevation change to an alpine ridge where I saw bald eagles and blooming Shooting Stars. I have wandered 2.9 out of 3 miles to John Muir Cabin before turning around and sprinting back to the trailhead, terrified of brown bears every step of the way. I have seen traditional Tlingit dances and parades. I have seen “big” cities and small villages. Each experience has taught me something about the state of Alaska.

Alaska is such a unique and interesting place. The land mass of the state would cover 20% of the lower 48, however, the population of the state is so small. Every city in Alaska is like a small bubble – a tiny populated, developed area surrounded by thousands of square miles of vast forest. Even in cities like Juneau and Anchorage there is nothing beyond the city limits.

The people in Alaska all have interesting stories. There are the traditional people, the Tlingit, who spend their lives attempting to balance the Eagle and the Raven and continue storied family legacies that preserve their ancient culture and tradition. There are also many who have come to Alaska to find out something about themselves or to escape the fast pace of a big city. Either way, everyone that you meet offers a unique monologue on life and what it has brought them.

In regards to my summer project, I have learned some pretty incredible things. When I spoke to people before May 16th I told them, “Why Alaska? I’m going to Alaska because dentistry is done differently there and should offer me a unique perspective on the profession.” Differently? Until recently I’m not sure I even know what that meant, however, some recent experiences have helped to clarify.

Maybe it was the woman I spoke to who walked 60 miles through dense, bear-filled forest with her 75 year old mother and 8 year old son just to catch a ferry to come to Juneau to schedule a dental appointment. The woman was the only one of the three that came to Juneau for some dental work. The other two? They wanted to see what Wal-Mart and Costco were.

It could have been my experience in Hoonah, AK where SEARHC dentists visit the clinic once every two months. I did some math after my trip to Hoonah. There are ten appointment slots for four consecutive days for a total of 40 appointments. There are 800 dental patients in the village. If a dentist visits once every two months, that averages out to 20 dental appointments every month. By this math, it would take the dentists 40 months to see each patient once! 40 months. That’s enough time for a cavity to turn into a root canal and a root canal to turn into a nasty oral infection.

Or maybe it was just in Juneau, where I have continually spoken with patients who have simply told me they forgot their dental appointments or just didn’t feel like coming in that day. These people are offered an incredible service by the Indian Health Services – a service that provides them free dental and medical care for as long as they need it – yet they have found a way to abuse the system while others clamor for an opportunity to schedule a routine hygiene appointment because they feel the dentists are too young or the residents are simply there to experiment.

Different isn’t in the way a dentist preps a crown or crafts together a bridge – it’s in the people that make up the patient base. It’s in the mindset of patients who still don’t understand the basics of brushing and flossing. And it’s in the devotion of public health dentists who pass up a chance to join country clubs and drive BMWs to extract rotten teeth and fill cavities from the mouths of skeptical Native Alaskans. If nothing else the trip has offered a great opportunity for me to re-evaluate (not saying I’m quite ready to sacrifice the country club just yet!) the importance of dentistry and its impact on a population. Beyond that, I’ve been offered a chance to do more than just think – I’ve been offered a chance to make a real difference.

My telephone survey has helped identify whether or not patients are overcome with dental anxiety and fear and given the SEARHC dental staff a litany of reasons why their patients aren’t coming to their appointments 25% of the time. In addition, it has also helped to fix a broken scheduling system by identifying some disconnects in patient contact information. Hopefully, dentists will be given more access to Eaglesoft which will help provide the front desk with a more reliable way to confirm appointments and reach patients. There’s only so much you can learn over a telephone, though.

The waiting room survey has been equally effective. It has helped to identify that SEARHC’s approach to dental education information in the past wasn’t quite as strong as it could have been. It’s helped prove that, yes, these patients do generally care for their well-being and oral health – we just aren’t reaching them in the right way. Hopefully once the dust settles and the data is analyzed Dr. Hort and I will come up with something powerful and meaningful that will reach a new generation of patients and help break down the walls of skepticism and prejudice.

Even more than just the general knowledge of the state or the chance to make a difference, the trip has extended an opportunity to start over after two tough years - both personally and academically. I have always loved video games because you can always stop and hit the reset button. You get an endless amount of chances to do whatever it is you want – you simply cannot fail. In life, you can’t hit the reset button after getting a poor grade on a test you know you should have spent more time studying for or after reacting poorly to bad news. But for the first time in two years I feel lucky. At times over the past two years I have felt like I have been stuck in quicksand. Not only was I stuck but, the harder I tried to escape, the farther I got pulled down into a mess of personal and public anguish. This trip has taught me to appreciate the little things again and to create a stronger balance between working and playing. Not everyone gets a chance to live a video game life but, right now, I’m getting a chance to hit the reset button.

I’m not sure what the next four weeks will bring but I am excited for the possibilities. As my friendships with my co-workers continue to develop and I delve deeper into my patient interviews and surveys I’m hoping that I can leave a lasting mark on those around me and impact them as greatly as they’ve impacted me.

I’m off the to the back of the boat because for some reason I am really enjoying the cold, whipping wind and the spruce trees that line the sides of the ferry.