Growing up in rural Alaska, Angelica Afcan has seen firsthand the problems that poor dental care can create. As one of five students who graduated Friday from the Alaska Native Tribal Health Consortium's Dental Health Aide Therapists program, Afcan, 24, hopes to soon return to her hometown of Emmonak in Southwest Alaska to provide much-needed dental care in the community.
Afcan has witnessed dental health issues in friends and family, first in the town of Nunam Iqua, where she lived as a child, and then in Emmonak, where she moved for middle school. As children, her niece and nephew were both missing their front four teeth – a common sight in many villages, she said -- and she remembers how in kindergarten some of her peers had crowns. "I remember wanting a crown," she laughed.
Some of her friends had crooked teeth, and she noticed how they had trained themselves to smile with their mouths closed. Her mother, who is diabetic and missing many teeth, struggles to eat healthful foods, Afcan said.
Afcan decided during her senior year of high school at Mt. Edgecumbe in Sitka that she wanted to be a dentist.
But "that would mean I wouldn't be able to work at home," she said, as dentists working with tribal clinics are only stationed in the regional hubs, such as Bethel. Opening a private practice in a small village would be financially impossible. Thus, becoming a dental health aid therapist would let her practice what she wanted, where she wanted.
Program celebrates 10 years
The 2014 class of dental health aide therapists that graduated Friday marked the 10th anniversary of the program seeking to bring dental care to Alaska's rural areas, where for decades access has been limited and in some cases virtually nonexistent, and where dental health problems are far above national averages.
On Thursday, the 2014 class gave final presentations at the ANTHC building in midtown Anchorage in front of their mentors and former students of the program. They spoke about enamel care, traditional medicines and treating cavities in children. During their presentations, the room would sometimes break out into further discussions about dental practices, with audience members sharing their own experiences.
The 5 graduating student have now spent a year in Anchorage and another year in Bethel completing their education. They'll now complete 500 hours of practice alongside dentists in various rural hubs. After that, they'll be sent out to smaller communities, where they will join 27 other practicing dental health aide therapists. Those dental health aides provide care to 81 rural communities, bringing access to 40,000 rural Alaskans, according to Andy Teuber, chairman and president of ANTHC.
The program is administered by ANTHC and each student is sponsored by a tribal organization. All costs are paid for by ANTHC and the sponsoring tribe. The program began following a 1999 study conducted by the Southeast Alaska Regional Health Consortium that found that Alaska Native children experienced cavity rates at 2.5 times the national rate, and that many people in rural areas lacked access to dental care, according to Teuber.
Those problems still exist today -- even in 2010 and 2011, 4 out of 5 Alaska Native children in third grade had had a cavity, according to ANTHC data, compared to about half of white children in Alaska who had had a cavity by that time.
The Dental Health Aide Therapist program's first class graduated in 2004 after spending two years at a longstanding educational program in New Zealand. Now, Alaska has its own program. Nearly 80 percent of the graduating students return to their home communities to practice, Teuber wrote.
Go brush your ivory
Afcan hopes to be one of the students who returns home. In rural Alaska, "a lot of people have dental problems but can't get to a dentist," she said Thursday.
She said that as a child, visits to the dentist were rare, and always with different dentists, who would travel to the village periodically. She was lucky in that her family was aware of the need for dental health. Her father's saying was "Go brush your ivory," Afcan said.
Her presentation Thursday focused on cultural medicinal remedies and how medical providers need to be aware that some Alaska Native people use traditional medicine such as willow bark and wormwood to treat maladies. Medical providers need to be careful to prescribe medicines that don't interact with such traditional remedies.
Going through the program has also "instilled something in me to learn more about my culture in general," Afcan said. She's begun learning Yup'ik and hopes to be fluent one day. She's also started a Facebook page with folks in rural communities to share the knowledge that has been passed down the generations and is disappearing as elders pass away.
In rural Alaska, challenges in providing care are often related to lifestyle, Afcan said. "The hardest part is going to be what's in the store and how much it costs," she said. Soda and candy are in steady supply. ANTHC data from 2011 shows that Alaska Native high school students drank significantly more soda than their white counterparts.
Aurora Johnson, who graduated from the program eight years ago, agreed that the biggest issue is helping a family change their eating habits, which are often passed down from parent to child.
Johnson, 42, remembers that as a child growing up in Norvik, a dentist came through the village once a year. Johnson now works with the Norton Sound Health Corp. and travels to the villages of Shishmaref and Koyukuk on a regular basis. When she first began practicing, she treated numerous toothaches. Now those have decreased, as has the need for tooth extractions. She has also gained the trust of children she has treated regularly over the years.
She believes the program is paramount to the health of rural Alaskans. "If we're not out in the village providing care, what are they going to do?" she said.