Providing dental care in the Appalachian Mountain region
September 25, 2018
Rotations: University of Louisville dental student Sarah Jestel examines Red Bird Dental Clinic patient Revelle Berry. Third- and fourth-year dental students from the university began clinical rotations at the clinic located more than 200 miles east of the school and in the rural region of the Appalachian Mountains.
— When Dr. William Collins was serving as Kentucky Dental Association president in 2016, his friend Dr. Lee Mayer at the University of Louisville asked him to stop by the Red Bird Dental Clinic to see if he could help.
Accessed by winding roads and tucked away in the mountains of southeastern Kentucky, the clinic offers oral health care for residents of the Appalachian Mountain counties of Clay, Bell and Leslie.
However, Dr. Collins said, the clinic had lost their lone dentist more than a year prior. And because of geographic and economic conditions, residents have limited access to oral health care. The community is more than 45 minutes by highway to any hospital or health care provider.
"[The clinic] had a waiting list over 300 people," said Dr. Collins, who now serves as the Red Bird Dental Clinic director.
Today, he credits organized dentistry and a close collaboration between the University of Louisville School of Dentistry and the Red Bird Mission in helping the clinic make slow, but positive, progress in serving the rural Appalachian communities.
In March 2017, fourth-year University of Louisville dental students began clinical site rotations at the clinic. Five months later, third-year dental students started mandatory rotations of four students per week. Since then, dental students, with volunteer staff supervision, have provided care for almost 600 patients and completed nearly 700 procedures for the clinic's patients, many of whom are uninsured or underinsured.
In addition, the clinic is expanding its outreach efforts, including providing support for residents and patients undergoing substance abuse treatment.
"The way this began was all due to organized dentistry," Dr. Collins said.
The Red Bird Clinic includes both dental and medical components. It grew out of the Red Bird Mission, Inc., which started in 1921 with a private school, and expanded to include job training, clothes closet, food pantry, adult education and senior citizen services.
"The services offered through Red Bird are so important for the people of this region," said Kentucky state Sen. Robert Stivers, R-25th. "We are pleased to have UofL reach across the state to engage with us as we strive to become a healthier community."
Collaboration: Left, Dr. Tim Daugherty, of University of Louisville School of Dentistry, speaks with Dr. William Collins, director of Red Bird Dental Clinic.
After Dr. Collins visit, he agreed to help and work on Saturdays — while having a fulltime practice in Pikeville, Kentucky, teaching at the University of Kentucky College of Dentistry and serving as KDA president.
"There was so much need," said Dr. Collins, who soon started working Thursdays and Fridays, along with Saturdays at the clinic after resigning from the University of Kentucky. "My charity turned into paid. I had no time, but people were being treated."
In October 2016, Dr. Gerry Bradley, University of Louisville dental school dean visited Red Bird and the two began work on getting dental student rotations at the clinic.
"The clinical experience at Red Bird enhances the education of our students with enriching cultural and clinical practice experiences that will make them compassionate, exceptional dental health care providers," said Dr. Bradley said in a news release.
The students learn under the supervision of Dr. Collins; two other UofL alumni, Drs. Susan King and Bob McGuinn; and Dr. Sharon Turner, former dean of the University of Kentucky dental school.
The clinic does all phases of dentistry except for orthodontics, Dr. Collins said, adding that most of their work involves restorative and oral surgery.
"The patients were so appreciative of the work we completed, especially those individuals requiring extractions," said Sarah Jestel, a fourth-year dental student who spent much of July at the Red Bird Dental Clinic for an Area Health Education Centers program requirement. "Many came in with elevated blood pressure and had been in pain a long time."
Students like Ms. Jestel travel more than 200 miles from the dental school to Red Bird Dental Clinic, staying at an apartment furnished by the clinic for the duration of their rotation.
At the clinic the students encounter varying levels of difficulty, including emergency situations and medically compromised patients, Dr. Collins said.
"They work out of their comfort zones and increase their confidence levels and speed," he added. "They also learn practice management skills."
According to Kari Collins, executive director of the Red Bird Clinic, Inc., and Red Bird Mission, Inc., generations of poverty have greatly exacerbated health conditions for patients, requiring extensive, late-stage treatment, follow-up and support.
"Our vision is one of a stronger sustainable community and UofL is an important partner in carrying out this vision," she said.
With the help of individual donors, the Good Samaritan Foundation and Delta Dental of Kentucky, the dental clinic is working to expand its reach to other nearby counties through community partnerships.
A mobile dental unit, donated by Avesis, has helped increase the clinic's ability to help residents, including a outreach to individuals undergoing substance abuse treatment. Adding oral health care helps support their efforts to achieve and maintain recovery, Dr. Collins said.
"Red Bird is also trying to find a way to get them clothes for interviews and professional support once they are released [from drug rehabilitation programs]," he said. "We are committed."