volunteer dentistry in the downtown eastside - UBC Dentistry

09 OFF THE CAMPUSVOLUNTEER DENTISTRYIN THE DOWNTOWN EASTSIDEBY TERRY WINTONYK“Many people coming to this clinic in theDowntown Eastside do not have faith inhealth care providers. I remember onepatient whose interaction with studentshelped him gain trust. There’s no judgmentaround; students left their worries at thedoor—I think this empowered him.”PHOTO BY MARINA DODIS23 UBC DENTISTRY IMPRESSIONS

09From left to right: Emery Bland,Cheryle Colombe, Janice Duong,Scott Martyna and Peter Park.There is an empty shopping cart parkedoutside a storefront dental clinic on HastingsStreet a few blocks east of Main Street.This is the Downtown Eastside (DTES),where open drug use and a gritty sex tradebutt against fledgling urban renewal andhistoric Chinatown. At worst, it is a vortexof Vancouver’s most marginalized peoplesubsisting in hotels and rooming housesor on the streets. Many residents are theworking poor, barely able to raise their headsto notice the pressures of gentrification. Mosthave difficulty accessing medical services,including dentistry.The storefront dental clinic, operated by theVancouver Native Health Society (VNHS),provides DTES residents with emergency andpreventive dental treatments—free of charge.During the spring 2009 academic year, UBCDentistry launched its Community VolunteerClinical Program and operated clinics here onthree Saturday mornings. Many students roseto the challenge and volunteered.It’s the Weekend—Riseand Shine!So why would students who are in the thickof studying—and particularly those inupper-level years who are also performingdemanding clinic work on campus—volunteertheir skills on a Saturday morning?Then third-year dental student Emery Blandexplains that volunteering provides a neededservice to the community and is a chance forstudents to give back with the skills they havelearned. He also found it rewarding becauseof the practical skills he was able to use. “It’san invaluable perspective while the booksand studying are on hold,” he says. He alsofound this unconventional setting to be lessintimidating: “I can’t explain why, but I wasless constrained than in the educational setting,like the clinic on campus.”Janice Duong, then a third-year student, offersher reason: “I volunteered because I wanted tosee a more unconventional setting. I wanted toexperience the unexpected. It was a glimpse ofthe real world, and I dived in with no fear.”Dr. Bruce Ward, a volunteer communitydentist, has overseen the dental clinic atthe VNHS since 2005. He sees third- andfourth-year dentistry students grow throughthe experience of being treated as colleagues,operating more freely and calling their ownshots. First- and second-year students areenriched by being paired with the seniorstudents in a clinical setting, making dentistry‘real.’ Ward finds watching the process ofthe dental student–patient relationshipparticularly rewarding. As students loosenup, they rise to the challenge of providingtreatment and looking past the patients’personal circumstances.Cheryle Colombe, then a second-year student,managed patients in the waiting room.She explains that it is a very cooperativeenvironment, with a lot of respect given topatients. “Many people coming to this clinicin the Downtown Eastside do not have faithin health care providers. I remember onepatient whose interaction with students helpedhim gain trust. There’s no judgment around;students left their worries at the door—I thinkthis empowered him.” Then first-year studentScott Martyna remembers a patient who washesitant to get into the chair: “He needed atooth extracted and knew there would beblood—and it was neat to see his transitionfrom apprehension to calmness because of theway he was spoken to.”People who come to the dental clinic in theDowntown Eastside are usually in intense pain.Bland recalls one patient who was “crackedout”and embarrassed by her condition. “Forme, it was a revelation that some peoplemay have no control in their lives, and theexperience helped me see every patient interms of the care he or she needs.”Bland also recalls hearing a community dentistwho volunteers at the clinic say that peoplewant to contribute, to pay something even ifit is only a dollar—then the patient feels likehe or she deserved treatment. Despite theirdifferences from the patients normally seen atthe UBC clinic, DTES residents do understandthe student experience. As Martyna notes:“People—the clients—were patient, receptiveand trying to participate in the learning. Infact, I heard one say it was ‘really fun.’”Peter Park, a second-year student last springwho organized many of the clinics, believesthat pairing first- and second-year studentswho have little-to-no clinical experience withthird- and fourth-year students who have isa fantastic mentorship model. “This is activeinvolvement, not simply shadowing, andis particularly transformative for first-yearstudents who may experience what it feelslike to be a ‘doctor’ for the first time,” he says.Martyna confirms this active involvement:“To see the third- and fourth-year studentsworking on patients was a flash forward towhat I’ll be doing; it was fast-paced, learningby doing.” The clinic experience was also goodpractice for developing his interpersonal skills,which, he says, are important and have a hugeoutcome on treatment.Park, who has been to all the volunteer clinicsthis year, knows that first- and second-yearstudents contributed more than they thought.He explains: “They used their learning quickly,to perform medical interviews with patientsand to support the upper-year studentswho were working on patients by handlingand experiencing instruments. There is anenhanced self-perception, even throughpreparation work like performing a medicalinterview, because they can understand theimplications of each question when workingdirectly with a patient.”For Duong, the experience brought the patientrather than the procedures into the foreground.“My confidence improved because I did thingsI’ve never done before [in third-year] likeperforming a diversity of treatments, but not ina totally structured way like in the school clinic.Seeing results in a patient right away confirmedthe learning—the technicalities.”PHOTOS BY BRUCE McCAUGHEYUBC DENTISTRY IMPRESSIONS 24

09 8:00 a.m. Saturday MorningThe clinic at the VNHS has three operatories,a radiology room and a disinfecting station;it is equipped like any regular dental office. Atypical volunteer clinic day begins at 8:00 a.m.with a brief organizational meeting with Dr.Ward. Appointments are not taken because theyare seldom kept; instead, patients walk in andare interviewed. Radiographs are taken; thenstudents and volunteer dentists discuss treatmentplans. Supplies and instruments are gathered,and the dental work is performed. Operatoriesare assiduously sanitized and instrumentsreturned for sterilization. The cycle repeats as asteady flow of patients ensures that everyone iskept on their feet the whole clinic long.Barnes, who was taking radiographs andperforming examinations, says: “It was likehaving an urgent care rotation for everypatient, the whole day.” Martyna had jumpedright in, knowing he could start “FIFEing”—that is, asking patients about their feelings,ideas, functions and expectations. He notesthat the DENT 410 course provided theknowledge and specifics to alleviate any fearof possible health pathogens.At the end of the morning, the volunteerteam comes together and debriefs about theexperience. “It was like being on a rowing team;it denied the ego,” says Park. “We never felt inthe dark, because the community dentists whovolunteered understand students and providea super supportive environment. They reallycare about the patients too.” Reflecting on theday, Colombe said the best feeling came fromteamwork, which made everything run smoothly.A Desire to ServeThere has been an overwhelming response ofstudents to volunteer. Sadly, student demandexceeds placements. Park is hopeful thatvolunteer clinics can occur more regularly, evenonce a month: “I think the enthusiasm andall the ingredients are there.” He is optimisticabout the program’s long-term goal of seeingstudents run the Community Volunteer ClinicProgram—the whole process, includingadministration. “Once the process and planningmatures, the various student roles will be clearerand far easier for newer students to assume.Student ownership will ensure the experiencewon’t be taken for granted.” Park points out thatthere is a bigger picture: student-run volunteerdental clinics give students valuable experiencein running a business.The program provides an in-the-trenchestouchstone experience—and it helps awakenstudents’ awareness of the kind of impacts theycan have through serving in their community.For Martyna, the volunteering experience willhelp him get through dental school; it remindshim he is in the right profession and that thereis light at the end of the tunnel. Volunteeringalso confirmed, for Duong, the reasons shechose a dental career: “I’m motivated by helpingothers—it feels good to help them out of pain.”Bland shares a similar sentiment: his mostrewarding moment was helping patients believethey can take care of their mouths. Both Duongand Bland see volunteering in their futures.In fact, Bland is doing volunteer dentistry inBrazil this summer. And Duong sees fittingvolunteer work into private practice with thesame passionate motivation she has for makingtime to teach piano while in dental school.Colombe, too, thinks the positive experiencegained as a student can create a persistinginterest in volunteering after graduation. Shealso sees the program generating awarenessabout volunteering among dentists in thecommunity—especially alumni.Meanwhile, a patient with one eye on hershopping cart parked outside the window isrelieved of severe pain and recovering in theclinic waiting area after a tooth extraction. Shesums up her experience with students in theprogram with this avowal: “If I ever win thelottery, I’ll give this place a million dollars.People here are so kind and professional.”PHOTOS BY TERRY WINTONYKCommunity Volunteer ClinicalProgram—A Pilot ProjectThe goal of the Community Volunteer ClinicalProgram is to engage volunteer dentists,including alumni, and all years of students(both DMD and dental hygiene degreestudents) in up to six weekend (Saturday)clinics at multiple locations annually.The program’s mission is to improve andsustain the oral health of people in needwithin the community; to promote healtheducation and social betterment, and provideassistance through treatment, training andeducation; and to enhance students’ awarenessand role as global citizens with sustainableopportunities to serve.The program is led by UBC Dentistry clinicalassistant professor Dr. Larry Rossoff and takesits mandate from Dentistry’s strategic plan toprovide students with diverse experience andto engage community. The clinics are patientfocused, which means that students will gainvaluable insight on how to treat people andhow experience in the community is uniqueand different from work in the clinic oncampus. Though extracurricular, the volunteeropportunities are designed to complementthe Professionalism and Community Service(PACS) curriculum.The program currently operates its communityvolunteer dental clinics at two locations in theMetro Vancouver area. Since January 2009, thefollowing community volunteer clinics havebeen held:Downtown Eastside Clinics(Vancouver Native Health Society)January 31, 2009March 28, 2009June 20, 2009Douglas College Clinics(in partnership with the British ColumbiaDental Association and Douglas College)April 25, 2009Next scheduled: fall 200925UBC DENTISTRY IMPRESSIONS