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Alaska dentist honored as Community Health Leader

Barrow, Alaska—The Robert Wood Johnson Foundation Oct. 8 honored North Slope Borough dentist Dr. Amanda Gaynor Ashley as "one of 10 extraordinary Americans" with its 2009 Community Health Leader Award.

Dr. Ashley said she "has been on cloud nine" since she learned she won the award. She was one of more than 500 national nominees this year and said she was honored to make the cut as one of the 15 finalists and then one of the 10 national winners. She is only the fourth dentist to receive the Community Health Leader award since it was established in 1993.

In 1999, Dr. Ashley, raised in upstate New York and fresh out of dental school at the University of Pennsylvania School of Dental Medicine, headed for Barrow in search of adventure and challenge.

"I thought that working in a remote area, providing access to care to Alaska Natives, flying to remote villages would be a great fit," said Dr. Ashley. "It really lured me to Alaska. I had grand ideas of all the things I would do when I got there."

But soon after arriving at Barrow's Samuel Simmonds Memorial Hospital Dental Clinic, she realized that it would take longer than the term of her one-year contract for people to be receptive to her new ideas.

"They had already had years and years of people coming in with new ideas, and then leaving," she said. "I started out just doing a lot of hands-on care—big fillings, extractions, other emergency dental care for adults. I hardly ever saw children at first. I spent two years doing mostly hands-on work and listening to the people in the community: finding out what their needs were."

Dr. Ashley's goal to switch the local dental care dynamic from emergency care, extractions and restorations to preventive oral health services began to take shape after she'd been there for two years.

She wanted to encourage local residents to explore career opportunities in dental assisting, enabling patients to visit the clinic and feel more comfortable there because they would see familiar faces. But she learned that local women had many cultural duties and responsibilities that didn't allow them to participate in a traditional year-long program at the University of Alaska in Anchorage—more than 700 miles from Barrow.

"Many women are so busy because they juggle traditional roles that take them out of the workforce at times," she said. "Many are involved in whale and caribou meat preparation during those seasons, child care and other traditional duties."

Dr. Ashley collaborated with the hospital, the Ilisagvik Tribal College and the local workforce development organization to launch a concentrated dental assisting program in Barrow. The first class began its studies in 2003.

"Our students live at the hospital during the intensive program and receive lots of mentoring," she said. "After six years, 18 dental assistants trained through the program now work for the dental clinic—some full time and some part time. Others have gone on to jobs in other health care disciplines, everything from pharmacy to medical records."

The dental assistants, she added, have flexible work schedules and generous leave times that allow them to continue to fulfill their traditional social and family obligations.

The dental assistants and the other three clinic dentists conduct weekly fluoride programs and teach toothbrushing and oral hygiene to schoolchildren in Barrow and five outlying villages.

"I am dedicated to lifelong learning," said Dr. Ashley. "I have a master's degree in education, so I am always looking for ways to use it in dentistry."

After a decade, she sees a noticeable shift from providing mostly emergency care to preventive care, and children not only come to the clinic more often—most are on a three-month recall.

"Our arms will always be wide open for emergency patients—patients who choose not to seek dental treatment until they have pain," said Dr. Ashley, "but I think we have been making progress with access to care and prevention. Our young patients love to come here now. We have cool prizes for them. You have to realize there is no toy store here. It's a big treat for them to get a toy at a dental visit. We have moms tell us their child wanted to come in more often than every three months because they could get a cool prize."

The key to her success, she added, is not trying to apply a private practice model to her clinic but implementing more public health strategies. "My feeling is that building a community-based, ongoing prevention program has helped the whole community."

Dr. Ashley met her husband Noah, a biologist, in Barrow while he was working on his Ph.D. He is currently conducting research on the Lapland Longspur, an arctic songbird. Their children, Asa, age 2 and Sabine, age 4 months, have shifted Dr. Ashley's focus to a new kind of adventure.

"When I first came to Barrow, I would fly every month to remote villages to provide care. I worked 80 hours a week. I have chased caribou off of runways, chipped a half-inch layer of ice off the inside of a Cessna windshield for the pilot to be able to see. Before I became a mom and a wife, I would think, 'This is cool, I nearly died.' Now I work 50 to 55 hours a week in Barrow, and let the other dentists do the flying."

The Community Health Leader award honors exceptional men and women from all over the country who overcome significant obstacles to tackle some of the most challenging health and health care problems facing their communities and the nation. Each recipient receives a $125,000 grant to be used in their programs.

"I will have to write a proposal to receive the grant," Dr. Ashley said. "I am not sure about the specifics yet, but it will focus on working with kids and preventive care in Barrow and the outlying villages.

"You don't move to a place like Barrow and expect to win this kind of national recognition," she added. "The award is a tremendous honor, and it is one I share with everyone at the clinic. The strong leadership at the Samuel Simmonds Memorial Hospital has been so supportive of our efforts."