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Experience the Extraordinary – IHS Externships
Adventures – both at work and at play – are just one facet of an IHS externship. From the deserts of the American southwest to the windswept tundra of Alaska, IHS dental externs are gaining invaluable hands-on clinical experience, learning about traditional American Indian and Alaska Native cultures, working with underserved populations, and sampling an adventurous lifestyle, all at the same time. Most importantly, students are working in what is often their first exposure to a public health dentistry environment – different from private practice, but filled with rewards and both personal and professional satisfaction.
The staff of Impressions talked with three IHS dental externs about their recent experiences. Timothy Oh from the Arizona School of Dentistry and Oral Health spent five weeks in Bethel, Alaska, honing his dental skills with the Yup'ik Tribe and providing care in a remote native village. Kelly Richardson, who plans to follow a public health career path after graduation from the Virginia School of Dentistry, worked for three weeks at the busy Hopi Health Center’s dental clinic in Pollaca, Arizona, where she also experienced rock climbing for the first time. And in Browning, Montana, on the Blackfeet reservation, Lydia Winters gained experience with medical consultations and performed procedures she had only limited experience with in school.
We also talked with CAPT Jose Rodriguez, Dental Chief at the Pine Ridge Dental Clinic in South Dakota, which has hosted many dental externship students over the years. CAPT Rodriguez talks about public health dentistry and how an IHS externship can benefit dental students in so many ways.
Fourth-year dental student Timothy Oh had vacationed in Alaska and enjoyed the majestic mountains and forests of the national parks so much that he wanted to return to the state. Feeling adventurous, he jumped at the chance to participate in the IHS Extern Program when he learned he could take an assignment in Bethel, AK, about 340 miles west of Anchorage.
In Bethel and the surrounding region, Timothy found the real Alaska, the one you rarely see on tourist calendars and postcards – and it’s exactly what he was looking for. Wanting to make a difference in people’s lives and help those in great need, he knew he’d come to the right place. The main dental clinic of the Yukon Kuskokwim Health Corporation serves not only Bethel, but nearly 50 isolated villages throughout an area the size of the state of Oregon. The village residents, he said, are typically visited by traveling dentists flying in from Bethel in bush planes only once a year. As part of his externship, Timothy would be one of those dentists.
Adventures – both at work and at play – are just one facet of an IHS externship. Dental students have the opportunity to gain invaluable hands-on clinical experience, learn about traditional American Indian and Alaska Native cultures, work with underserved populations, and sample an adventurous lifestyle, all at the same time. Most importantly, students work in what is often their first exposure to a public health dentistry environment. It is quite different from private practice, but filled with rewards and both personal and professional satisfaction.
CAPT Jose Rodriguez is the Dental Chief at Pine Ridge Dental Clinic in South Dakota, which has hosted many dental externship students over the years. He explained that in public health dentistry, delivery of care is different and dentists often make different choices than they would in private practice.
“We try to help patients in a more preventive way. Here at Pine Ridge, students deal with primary and emergent care for patients of all ages, as opposed to the higher levels of care they focus on in school,” he said. “We’re dealing with big oral health issues: rampant caries, periodontal disease, multiple extractions, plus the high incidence of diabetes and hypertension that come into play. Students have to make treatment decisions on the spot, but we can do medical consultations right away, and deliver care sooner rather than later, because we’re in a hospital environment. Students don’t get hospital interaction in dental school. This is hands-on real -world dentistry.”
Three IHS externs told us about their experiences in the program. Timothy Oh, from the Arizona School of Dentistry and Oral Health, said he got plenty of real-world dentistry in Alaska. He experienced “a little bit of everything” during his externship, including flying in a bush plane to treat patients in remote villages. Timothy worked with patients of all ages from the Yup’ik Alaska Native Tribe, among others. Noting that there was a high rate of caries in the population, he said a lot of his work was restoring severely broken-down teeth and performing extractions.
“We did more amalgam restorations than I would do in school,” he said. “Also more complicated extractions, primarily because the patient had no access to a dentist for a long time. The teeth were broken off, there just wasn’t anything left.”
Timothy enjoyed learning about the native cultures. The dental assistants, he said, are all native and help to translate when elderly Tribe members who don’t speak English come in for treatment. He discovered that the cross-cultural dental experience can pose some challenges.
“The people there have different priorities dictated by their way of life,” he explained. “They still spend the summer fishing, hunting and gathering berries to eat the rest of the year, the way they’ve always lived. Faced with a choice between a dental appointment and going fishing, they’ll skip the appointment because fishing is more important. So when we did get patients in the clinic, we tried to do as much as we could while we had them. It’s just a different focus on what’s important and what’s not important, along with a slower pace of life.”
At the Hopi Health Center, Pollaca, Arizona, fourth year dental student Kelly Richardson from the Virginia School of Dentistry spent three weeks in a busy clinic doing far more procedures than she had done in school, including surgical extractions.
“I did procedures at Hopi that would have been referred to an oral surgeon at school, so it was a really valuable experience that way. In one case, the patient was so happy that we were able to surgically extract her partially impacted third molar during her appointment.”
Kelly has chosen to take a public health career path after graduation. She wants to work in the southwestern US, so the IHS externship fit right in with her plans. The location also fit in with her lifestyle – as an outdoor person, she found plenty to do, including rock climbing for the first time. But most importantly, she feels she has gained more professional confidence from the experience.
“I got a lot of practice doing dentistry and was able to learn about different techniques from dentists who’ve been out there practicing for a while,” she said. “There are different ways of doing things, and it’s good to learn new techniques.”
For Lydia Winters, a fourth-year dental student at the University of Louisville School of Dentistry, the IHS externship at a 13-chair clinic on the Blackfeet reservation in Browning, Montana was a preview of her planned career with IHS and the Commissioned Corps [link]. Lydia believes everyone deserves good dental care, and she’s willing to go to underserved areas to provide that good care. The clinic was walk-in only and the lobby was filled each morning with people waiting to be seen by the dentists.
“I did a lot of amalgam and composite restorations, mainly amalgam, and a lot of extractions,” she said. “I also had the chance to do molar endo, something I had limited experience with in school. The clinic is located in the Blackfeet Community Hospital, and it’s great because you have physicians and pharmacists right on hand. Doing medical consultations in private practice, it takes a long time to get the paperwork back from a physician, but in this setting, I can get it back while the patient is still in the chair.”
Lydia especially liked the remoteness of the site. The community is small, with one grocery store and a few restaurants, but no chain restaurants, and no Walmart. It’s a little isolated, but “when you’re surrounded by such natural beauty, I think you can be very happy there,” she said. As an outdoors person, Lydia found many things to do, and a lot of free time to do them. She spent time hiking in Glacier National Park and photographing wildlife such as moose, mountain goats and big-horned sheep.
Said Lydia: “Dentists work from 8:00 a.m. to 4:30 p.m. Monday through Friday, so there’s plenty of free time to spend with your family and enjoy activities after hours. Private practice hours can be very long, and you have to worry about the business side. At IHS, you go in, do the work you’ve learned to do and enjoy doing, then at the end of the day you go home, without having to worry about the endless business side of the practice.”
All the externs agree that any student considering an IHS externship should go for it. CAPT Rodriguez advises students to keep an open mind in both a clinical and cultural sense.
“The experience can change you. You’ll see things you’ve probably not heard of or seen before,” he said. “Give an externship a try. It’s like doing a residency but without a narrow focus. We give you a wide range of dental experience that will be beneficial to you when you graduate.”