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VA reaches out: 'Stand Down' serves homeless vets

Dublin, Calif.—For the past 15 years, Dr. John Jow and a small group of residents and volunteers have provided dental care for homeless veterans at the East Bay Stand Down.

But this year's event was different.

"I always wanted to be able to do more," said the prosthodontist with a 27-year career in the U.S. Department of Veterans Affairs. "I wanted to expand on- and off-site dental care at these events. We try to do as much as we can for the veterans but in the past, we've only been able to do screenings."

What he needed were improved facilities and manpower, and he got them by tapping into the state and local dental societies. By all accounts, the Aug. 12-15 Stand Down at Camp Parks Military Reserve Training Center was a smashing success for Dr. Jow and his team of volunteers and contributors. They screened 118 patients, provided 64 with treatment (20 on-site; 47 off-site) and provided more than $50,000 worth of dental care.

"We couldn’t have done this without The Dentists Insurance Co. or the dental society volunteers," said Dr. Jow. "Everyone should be proud of this effort."

Dental care at Stand Down doubled as Dr. Jow's personal leadership project for the ADA Institute for Diversity in Leadership, which provides a yearlong educational experience for dentists who are members of racial, ethnic and/or gender groups that have traditionally been underrepresented in leadership roles. Class members selected a project that gave the Veterans hands-on experience in identifying and taking action on a civic or professional issue of personal importance.

"I wanted to grow the dental component of Stand Down to make it more of a collaborative project with support from state and local dental societies," said Dr. Jow.

"Stand Down" is a military term for removing combat troops from the field and allowing them to rest and recuperate in a safe place. In civilian life, Stand Downs are collaborative events coordinated by local VAs and government/community agencies that serve the homeless. The events give the VA an opportunity to reach out to homeless veterans for assistance with clothing, legal issues, social work, medical and dental problems and other issues.

According to the VA, about one third of the adult homeless population has served in the Armed Services. As many as 250,000 veterans (male and female) are living on the streets or in shelters, and perhaps twice that many experience homelessness at some point during the course of a year.

TDIC, a California Dental Association subsidiary, came through by offering use of its mobile dental center, an air-conditioned self-contained vehicle that houses dental chairs and equipment. The mobile unit is primarily for property losses, said John Carothers, TDIC vice president of claims.

"When it's not being used, we try to utilize it for access programs," said Mr. Carothers. "Before this, Dr. Jow used a tent and flashlight at Stand Down. This unit has two chairs and lab and X-ray facilities. He was able to see more patients and provide necessary treatment right there."

For manpower, Dr. Jow approached local dental societies. One, the Southern Alameda County Dental Society, quickly amassed 27 volunteers.

"It wasn't just the dentists who signed up to help out," said Dr. Jow. "We got members of the Alliance of the SACDS and relatives and friends, too."

More volunteers meant more dental treatment performed in the TDIC mobile unit and off-site in private dental offices. Other volunteers maintained registration, crowd control, shuttled patients to off-site dental offices, and even delivered instruments to dental offices for sterilization.

"We started out focusing on dental emergencies and getting people out of pain," said Dr. Jow, adding they cut off dental registration when the list reached 220. "Most of the veterans are thankful just to have abscessed teeth removed, which may have been hurting them for years. The majority of procedures performed included extractions, fillings and denture adjustment."

The Department of Veterans Affairs helps the homeless veterans through grant programs and pilot homeless programs. Through Stand Down, the VA and sponsoring agencies strive to give veterans the tools they need to get off the streets.

"The purpose is that it cuts through a lot of red tape that you have to deal with," Edgar Sweeting, a Bay-area homeless veteran told the VA. "I would definitely choose Stand Down over any of the bureaucracies. I can't wait to get on the bus. It's a good feeling."

Dr. Anthony Alvarez of the Southern Alameda County Dental Society was a volunteer who treated Stand Down patients in his office. It ended up being a family affair. His wife, Terry, president of the Alliance of the SACDS, volunteered, too—along with her sister, a friend and the couple's daughter, a Navy veteran.

"Our alliance was instrumental in helping this run smoothly," said Dr. Alvarez, who also sterilized instruments for Stand Down and toured the dental operatory site for pre-event credentialing.

"The rate for follow-up care with homeless veterans is pretty poor—50 percent at best—so you do what you can the first day. But the ones that follow through, it's a very heartwarming experience," said Dr. Alvarez.

Many SACDS members signed up to see patients, he added, but the on-site dental clinic ended up "having to call many other area dentists at the last minute to see patients. They were not denied by anyone."

The East Bay Stand Down was so successful that Dr. Jow and the TDIC mobile unit moved on to Dixon, Calif., Oct. 13-15 for the North Bay Stand Down. There they treated 45 patients.

Dr. Jow credits the ADA Institute for Diversity in Leadership with providing the leadership training and resources to expand an already successful access program.

Institute faculty from the Kellogg School of Management at Northwestern University and the ADA facilitated the links with state and local societies, and the leadership training helped class members improve strategic management skills, develop project plans and deliver effective presentations.

"The Institute was the impetus for me to expand the amount of dental care we provide at Stand Down," said Dr. Jow. "It's such a rewarding job and I've always wanted to do more."

Working for the VA is an enriching experience, he said, with the added benefit of being able to pass on his experience through teaching six residents a year.

"I spent four years as a resident in veterans hospitals and saw a lot of Vietnam veterans coming back with severe injuries. I found that I really enjoyed the challenge of treating patients with complicated dental and medical problems," said Dr. Jow, a 1976 graduate of the University of California-Los Angeles School of Dentistry who emigrated to California from China at age 9.

"On a daily basis, we see patients with severe periodontal disease, trauma, war injuries, radiation oncology patients and patients with hepatitis B and C, liver transplants," he said. "This is one place where every patient is a challenge."