UW puts safety of Alaskan Natives first

DAN G. MIDDAUGH GUEST COLUMNIST

Providing health care to Native Alaskans who choose to remain in their traditional villages is a unique challenge. In places reachable only by small plane, boat or snowmobile, it's not feasible to locate physicians or dentists year round. These small villages rely on traveling doctors, supported by local health aides, who are usually trained to provide preventive care and to respond to emergencies until a patient can reach a clinic or hospital.

It's not a perfect health care system, but it allows Native Alaskans to inhabit their historic remote homelands while receiving modern health care. A June 29 Op-Ed on this issue attacked efforts by the University of Washington, the American Dental Association and Washington State Dental Association to improve dental care ("UW says no to dental help for Native Alaskans").

Recently, the University of Washington's Medical School and Dental School were asked to train health aides to provide dental surgery for Native Alaskans. High school graduates would receive two years training in preventive care but the proposal also requested they be trained to perform dental surgeries, such as extractions, drilling and filling cavities and performing root canals.

The dean of the medical school, joined by the dean of the university's dental school, wisely declined to support training to perform these more complex surgical procedures. They have agreed to provide training in preventive care, including nutrition counseling, performing cleanings and applying fluoride applications and sealants. The university's president supports that decision.

Their reasons are straightforward, as these surgical procedures, and their possible risks, require the comprehensive training provided to dental students in a four-year doctoral degree program.

While improved dental care for remote villages in Alaska is needed, patients' safety must be assured. What, then, are the alternatives to this proposal?

Patients suffering from true emergencies are routinely transported to a clinic staffed and equipped to address their needs.

For dental surgeries, many of the tribal villages contract with traveling dentists to see patients in the villages. Most tribal corporations took this approach for many years, but some tried unsuccessfully to replace contractors with their own dentists as employees. When that approach failed, the dental health of many villagers suffered. Tribes or the Indian Health Service should re-establish contracting with dentists and dental hygienists.

The American Dental Association has recruited more than 100 volunteer dentists ready and willing to travel to remote villages to provide free care.

Long-term, the Oregon Health Sciences University School of Dentistry has proposed setting aside up to 10 dental enrollment slots annually for students contracting to practice in remote areas of Alaska. The UW could consider a similar approach while continuing to train dental health aides to perform preventive care.

And this certainly is not a solution for our state, where no one is geographically isolated. Washington's access problems are about economics, which is why the WSDA has been expanding charitable care in local public schools and clinics and why WSDA will be bringing the Legislature proposals to improve efficiency of dental practices and to expand public funding for indigent dental care.

The attacks in the June 29 Op-Ed obstruct efforts to find workable answers to this unique problem. WSDA joins those at the University of Washington and in Alaska who seek to create solutions, not needless controversy.

Dr. Dan G. Middaugh is president of the Washington State Dental Association.

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