Medicine: Pockets Open, Mouths Follow
In four cities in Israel, Hadassah and the Jerusalem Friendship Fund have opened prototype dental clinics with services to help needy kids smile a little brighter.
The patient’s mouth is a mess. His dentist has booked him for five appointments during which three teeth will be filled, seven will be crowned and six beyond saving will be extracted. During each appointment, the patient will be heavily sedated. Why? Because he is 6 years old. The total cost of his dental care: $1,500. a An 8-year-old patient needs more extensive treatment still. Ahead of her are root canals, fillings, crowns, extractions, fissure sealants, infected tooth-pulp removal, tooth rehabilitation and the fitting of space retainers. She will be managed under general anesthetic, bringing the cost of her treatment to almost double that of the little boy.
Dental treatment costing thousands of dollars is a burden for everyone. For low-income families in Israel, it is a luxury that is out of reach.
“Unfortunately, it’s among this population that the condition of the mouth is usually worst,” says Dr. Jonathan Mann, dean of the Hebrew University–Hadassah School of Dental Medicine in Jerusalem, founded by the Alpha Omega Fraternities. “For good oral health, you need good genetics, good oral hygiene and good diet. Genetics are the wild card, but diet and oral hygiene are determined by the individual. Caries, for example, are infectious, so if they go untreated the infection spreads to surrounding teeth. Preventing caries by regular brushing and healthy eating isn’t always grasped or emphasized on the lower rungs of the socioeconomic ladder.”
It’s against this background that a prototype dental-outreach program is now under way. “Last year, the Jerusalem Friendship Fund [Keren HaYedidut] approached Hadassah Medical Center with $2 million to be spent on an innovative health project,” says Dr. Shmuel Shapira, Hadassah Medical Organization’s deputy director general. “Dentistry rarely attracts major donations. I decided to talk to Jonathan Mann.”
With his department’s 25-year history of dental-outreach programs, Dr. Mann, who also heads the Hadassah dental school’s Community Dentistry Department, knew at once how the money should be spent: on underprivileged children. “Dental care in Israel isn’t covered by insurance,” he says. “I saw the JFF gift as an opportunity to develop a pilot dental-health program of treatment, education and maintenance to address what is a national problem.”
Dental outreach is a well-trodden path for Hadassah. Sixth-year dental students have run oral-health projects in Jerusalem since 1980. Hadassah dentists treat the teeth of victims of terror without charge and help staff the virtually free geriatric dental clinic and mobile dental units run by Yad Sarah, a volunteer humanitarian organization. The dental school developed and runs dental hygiene and dental assistantship training programs for newcomers to Israel, primarily from Ethiopia and the former Soviet Union.
For JFF, however, dental outreach is a new direction. Set up seven years ago by Rabbi Yehiel Eckstein, head of the International Fellowship of Christians and Jews, based in Chicago and Jerusalem, JFF has till now focused on immigration, absorption and welfare, for which it has raised an impressive $65 million, much of it from non-Jewish donors. But Eckstein and JFF chair Devorah Ganani liked Hadassah’s idea of providing dental care for needy kids.
“The pain these children suffer from aching teeth is the world’s pain,” says Eckstein. “We’ve connected with the best and most professional institution in the country to do something about stopping that pain.”
Naming the project Smiles With Friendship, the pieces rapidly fell into place. “We…decided to treat children whose families are on social security,” says Dr. Mann. “We selected a lower age limit of 6 years old, when permanent teeth begin coming in, to an upper one of 12, when youngsters are better able to take responsibility for their oral hygiene. [Then] we chose four different parts of the country.
“Jerusalem was a given,” he adds, “both because that’s where Hadassah and its facilities are and because the city has many underprivileged children, an estimated 20,000 of them in the age bracket.”
The township of Sderot to the south and Akko to the north (each with some 1,000 needy 6-to-12-year-olds) and Beit Shean in the Jordan Valley (with 500 potential patients) were then added. However, equipping and staffing clinics and involving the local welfare departments proved far more complex. “In Jerusalem, of course, the clinic already existed at Hadassah,” says Dr. Mann. “Akko wanted the Smiles With Friendship project to build them a clinic. Sderot, on the other hand, was equally insistent that we didn’t build them a clinic because they wouldn’t be able to maintain it when the project ended. And Beit Shean had an empty building that they wanted the project to equip and furnish.”
Each situation had to be addressed individually. Sderot proved simplest: an existing four-chair dental clinic and its staff were upgraded and co-opted into the project. Akko eventually checked its eagerness for a new building, deciding that funds would be better spent on treating additional children, and an existing two-chair clinic was rented.
Beit Shean offered an unfurnished, unequipped work space. “If you equip it, you’ve got a clinic!” Mayor Jacky Levy (son of former Deputy Prime Minister David Levy) told Dr. Mann.
Two dental chairs, a sterilization unit, an X-ray unit and a range of instruments and equipment later, Dr. Mann returned to the mayor. “We’ve given you a clinic,” he said. “Now help us find a dentist, an assistant and a hygienist.” Levy’s solution for a dentist was unexpected: Dr. Yassir Kish, a talented, personable and well-liked Druze from the Golan Heights, who had trained in Damascus and easily passed Israel’s Health Ministry National Boards in Jerusalem.
In Jerusalem, where it was simply a matter of opening Hadassah’s existing clinic to new patients, the project ran into a problem of principle. Jerusalem is the only place in Israel that already has free clinics for needy children (one supported by the Israel Endowment Fund and one by Dental Volunteers for Israel), and the city initially opposed limiting Hadassah services to welfare patients.
“We eventually agreed on the welfare qualification,” says Dr. Mann.
While the clinics were being set up, equipped and staffed, the social services in the four selected towns were brought on board.
“The sole condition for acceptance at any of the four clinics is a written referral from the local Department of Social Welfare,” says Dr. Mann. “That referral is the equivalent of an open check. It entitles young patients to any therapy they need, from simple fillings and cleaning teeth to root canal treatments, complex restorations and even functional orthodontic procedures.”
It also ensures that youngsters learn the basics of good nutrition and preventive dental care. After a session with the dental hygienist, every patient leaves the clinic with a cheerfully illustrated book about two toothbrushes, written by Hadassah hygienist Iris Zadik.
Sderot, the first clinic to open its doors, started taking patients last June. In its initial three months, it treated over a hundred youngsters. Among them, brother and sister Ron and Gal. “They’re really good here. They don’t hurt at all,” is Ron’s assessment. Gal confirms: “He’s right. They are really gentle.”
“We try to make coming here fun for the kids,” says Sderot dentist Dr. Alon Seidman. “We give nicknames for all our equipment. The suction, for example, is ‘the vacuum cleaner.'”
“I love working with children,” says Sderot dental assistant Ella Jarzki. “I am so glad there’s this free treatment for them.”
The Jerusalem clinic opened in August, followed by the Akko facility, with Beit Shean accepting its first patients last month.
“Finding, setting up and staffing the clinics was a major undertaking,” says Dr. Mann, whose involvement in the project is entirely on a volunteer basis. “That stage is virtually over. As far as possible, the clinics function independently… Our role now is control of quality and spending.”
Pediatric dentists appointed by Dr. Mann make regular visits to the clinics where they randomly check the quality of dentistry performed and the billing accuracy.
Nonetheless, certain decisions must be referred to Dr. Mann. His authorization is needed, for example, for sedation and anesthetics. He approves orthodontic treatment and treatment of any child outside the chosen age group. “I don’t want the role of employer in the clinics,” he says. “But some decisions involve a lot of money and can’t be made at clinic level.”
With an annual budget of $1 million and the average cost of treatment per child running to $500, the project expects to treat about 2,000 children a year. The need for free dental care has been amply demonstrated by the numbers of patients, and the JFF and Hadassah are now considering spending another $1 million to open clinics in additional areas.
“The project is just beginning, but already an infinite number of decayed and neglected teeth have been saved and serious dental problems have been avoided and dozens of children are better able to maintain their own dental health,” says Dr. Mann. “This is the kind of outreach dentistry that every community dentist dreams of being in a position to give.”