Inside Hygiene 32610

March 23, 2010
RDH editor Mark Hartley interviews a dental hygienist working in Liberia, and joins Dianne Glasscoe Watterson in asking if you brag about your employer's work.
Heralding good work in Liberia
Unless you’re in a painful employment situation, dentistry is hardly the equivalent of a migraine. Painful employment situations shouldn’t sound like an understatement, because it’s obvious that the economy has left an impact on the profession. Generally speaking, though, the prevalent issues for dental professionals range from scheduling woes on the Main Street level to defining the role of dental hygiene on the national level.I receive and read articles about all of those topics. But sprinkled into the mix are the articles that literally make me pause and reflect on what’s really important. Missionary dentistry captures professionals in their finest hours. The settings in the articles are usually Third World countries, but in recent years America’s Toothfairy has initiated these adventures in our own backyard. Sometimes, local newspapers run articles about these charitable expeditions; sometimes RDH publishes these articles too.But these efforts to stem dental disease on a global effort always seem largely unheralded to me.Last fall, Wisconsin hygienist Cathy Anderson met Brenda Pigeon at a CPR refresher course in Madison. After listening to Pigeon’s accounts of her life in Liberia, Cathy wrote to introduce me to her CPR partner.However, Pigeon headed back to Africa before we could set up anything here in the States. So eventually, I began an e-mail correspondence with Pigeon that, once again, opened my eyes to how fortunate most of us are to be haggling over what dental insurance does and doesn’t cover.Brenda Pigeon hails from Wisconsin, which was why she was in Madison fulfilling CE requirements. She graduated from Madison Area Technical College and worked in the area for six years before heading to Liberia, which is on the west coast of Africa, in February 2009. Her workplace is called the Trinity Dental Clinic, which was started in February 2008 by a Texas dentist, Dr. Keith Chapman, and a Canadian dental therapist, Frieda Schmidt, RDT. The two had worked on Mercy ships before focusing on a permanent location south of the Liberian capital, Monrovia. Dr. Chapman is one of five licensed dentists in the entire country (home to more than three million people; more than half are under age 18), and Pigeon is one of two dental hygienists. “It's an honor to work in a place where the skills we have are so desperately needed,” she says.Although the Liberian civil wars are becoming a distant memory, the strife had an enormous impact on the economy. The country’s unemployment rate remains one of the highest in the world, and the United Nations began lifting sanctions against Liberia three to four years ago.At this point, I’d like to let Brenda just “talk” via her e-mails, since this is the sort of thing that awes me every time I’m confronted with missionary dentistry.Regarding who works at the Trinity Dental Clinic
The only full-time [expatriate] staff members we have right now are Keith, Frieda, and myself. We also have volunteers who come for a few weeks at a time throughout the year. We have seven full-time Liberian staff members who we have trained to work with us, including a front desk person, three assistants, a sterilizer, a dental health educator, and someone who makes small removable partial dentures. On a typical day at the clinic
When we arrive in the morning, we never know what we will encounter. I personally have a hygiene schedule where patients we have seen previously for extractions, fillings, etc., are referred back to me for cleanings. For most of the people I see, it is their first time ever having a cleaning because there is so little preventive care and almost no access to dental care in general. When I see people return for cleanings, I can spend as much time with them as I need to give instructions and educate each person individually. People are typically extremely receptive to suggestions and advice and very appreciative. I have even started seeing a few people back for six-month cleanings. It's fun when people come back because the difference in their oral health the second time is usually quite a dramatic improvement. Other than doing cleanings, I do administrative tasks for the clinic such as tending to our Liberian staff members, getting supplies and medications, and making sure the clinic has what it needs to run from day to day. Quite often, we have people in life-threatening conditions come in. Keith will usually handle those cases, but occasionally it is so serious that it takes a team effort to get the patient on IV antibiotics immediately, and sometimes driving the patient to a different hospital where they can stay until the infection has gone down, or until the airway is manageable. Unfortunately, because of the lack of dental care, we see conditions on a weekly basis that dentists in the States may never see in their entire career.On keeping a mental balance in that environment
It is sometimes very difficult to work in an environment like this and to develop friendships with other workers because the lifestyle can be quite transient. Fortunately, I made some close friendships quickly, which is probably the reason I was able to continue working here. I am so thankful to now be engaged to another expat who lives here and does aid work here. The circumstances can be extremely intense sometimes, dealing with situations and circumstances we would not likely encounter at home. So it is crucial to have some sort of support network.On what the American dental community can do
The clinic is almost entirely funded by private donations from churches and individuals in the States. However we believe it's important to charge reasonable fees for services. For example, we charge $3 for an extraction. It's not enough to keep the clinic running. We rely on financial support and donations, mostly supplies and equipment, from people in the States to keep going. We desperately need dentists to come over, even if it’s just for a week or two at a time. Not only is it great to get a different perspective on dentistry and life in general, but it also relieves our full time staff, who get extremely tired and work long and intense days.To view the Web page for the Trinity Dental Clinic, click here. In addition, the expatriate staff members mentioned above have Facebook profiles.Do you brag about the doctor’s work?
Dianne Glasscoe Watterson, RDH, who is the author of the Staff Rx column in RDH magazine, wrote a feature article for the upcoming May issue that focuses on being a “blue chip” employee for a dental practice. She had a few changes to make during the editing process, fearful that hygienists “looking for reasons to hate their boss” would tune out the article prematurely. I mentioned to her that Kristine and I collaborated on the “perks” survey (Kristine’s article in this issue can be found here). One of the questions that Kristine will likely follow up on in a future issue dealt with employee payment of dental fees.It was one of those “check all that apply” questions, so the percentages below don’t add up to 100%.• 30% said, “All dental care is free for employees.” • 60% said, “Employees pay lab fees only.” • 11% said, “A percentage of the treatment fee is charged.”• 4% said, “None. Dental care for employees at this office is charged at 100% of fees.” And this last option is what I shared with Dianne. Eight percent said, “I prefer to seek dental care at another office, regardless of whether discounts or free care are offered.”So 8% don’t want treatment in their employer’s office? To me, that is a good thing, that a very low percentage of dental hygienists seek treatment elsewhere. They may have a good reason, as opposed to the bad reason of deploring their employer’s work. Maybe the hygienist’s childhood dentist is still actively practicing. Maybe the benefits for the hygienist’s spouse somehow offer a better deal for the entire family. But Dianne disagreed, saying, “The last two categories (no discounts and seeking treatment elsewhere) on your list could most likely be combined. If I worked for such a jerk that he or she did not provide my dentistry with at least a discount of some kind, I’m quite certain I’d go somewhere else to get my work done. So at a minimum, 15% do not like or have enough confidence in their employers to let them do their dentistry. I’d say the percentage is higher, maybe even 25%.”She added, “Regarding dental care for employees, this is one area where some doctors step over dollars to pick up dimes. I mean, what better advertisement could a doctor get than from staff members who have been the recipient of his or her good care?“I have several gold inlays, and I used to pull my cheek back and show patients how beautiful they are. There’s no telling how many I sold by showing off my boss’s dentistry. It wasn’t selling to me; it was showing off his great dentistry. Some dentists do not realize that what they give away with the right spirit comes back to them multiplied many times over.”So all of this begs the question: If you receive free or discounted care from your employer, do you brag about his or her dentistry?