This article was produced and provided by the W.K. Kellogg Foundation.
To get to Pine Ridge Indian Reservation, you leave Rapid City, South Dakota, and drive south for 80 miles. There you go through the Badlands, the moonscape topography that is now part of our reservation lands, the land of the Lakota people.
Imagine yourself with me on this drive in July 2010. My tribal home- land is barren for mile after mile—and remote—yet we experience the beauty and the silence of that place. It brings harmony and balance.
My Ancestral Lands
I am Lakota, I am a registered dental hygienist, and I am part of a study team documenting oral health con- ditions on Pine Ridge Reservation. Our lands, largely overlooked by mainstream society, are an immense area of South Dakota. We are pre- paring to travel through the vast- ness of my childhood and ancestral homeland. There I will find that in- adequate dental services, flawed systems delivering dental care, and punishing poverty all contribute to the reservation’s crisis in oral health.
The Way Things Are
On Pine Ridge Indian Reservation—an area as large as the state of Connecticut—there are three Indian Health Service dental clinics. These three clinics share two dental hygienists among them for the approximately 40,000 reservation residents. Compare that to a typical private dental practice clinic, where usually there is one dental hygienist for 2,000 people.
On my reservation, there is an in- adequate number of all oral health care providers—dentists, registered hygienists, and dental therapists— and their low numbers are an old, enduring problem. Preventive dental hygiene services for children and adults are almost never available. Dental rehabilitative procedures, such as crowns, root canals, bridges, and dentures, are common elsewhere but rare here.
Again and again on this journey I will hear the voices of people I meet saying, “I need services, but I don’t have any money,” “I can’t get an appointment,” and “I can’t make it to the clinic.”
Assessing Oral Health
We set up our portable dental chairs—patio lounge chairs from Walmart—in living rooms, front yards, backyards, community centers, and clinics. In one location, on the edge of the Badlands, our lawn chair is under a makeshift can- opy of tattered tarps where a woman sells beadwork to the tourists who pass through that part of the reservation. We find rocks to hold down our materials, and while the hot, dusty winds of the Badlands whip and swirl in front of us, we screen the woman and her grandchildren.
Thoughts After the Journey
In the Lakota language, our children are called wakanyeja, meaning sacred children. On this journey I am seeing wakanyeja with decaying teeth or dis- eased gums and, sometimes, ones who appear hungry. Ending their hunger, I am sure, is more important to them than their oral health. I understand; I experienced hunger as a child.
One day, after I get back in my car, I begin to weep for the wakanyeja, for my people, the Lakota. We have the same faces, they and I, and they, too, appear to be weeping. They seem voiceless, but I hear them. Through their tears they are saying, “I have these problems. Somebody hear my voice.”
At the conclusion of the study, I drive to an old cemetery where many of my family members are buried. As I read the old names on the grave markers—Sharpfish, Crow, New Holy, Mountain Sheep—I wonder about the people buried beneath my feet. I know how some died, others not. Yet I believe it true that the ancestors were healthy and lived in a man- ner that was honorable and sacred. But now my Lakota people have serious oral health issues, as well as diabetes and end-stage renal failure. Amid the existing disparities and social injustices that surround these health issues, I worry whether we Lakota will ever see health and wellness.
Moving Into Oral Health
I believe that the paltry resources allocated year after year to the Indian Health Service are shameful. This must be remedied, and remedied quickly.
But I also believe that money alone is not the answer. We must create education opportunities that train and nurture many more tribal members to deliver oral health care services to the people of their home communities. Growing our own health professionals must be a mandate. I believe that the growing existence in the United States of mid-level dental providers is a positive development and will help the residents of Indian Country. Traditionally in the United States, oral health has never had the equivalent of a nurse practitioner or a physician assistant—but that is starting to change.
The past has drawn divides among the various dental professional organiza- tions. Today we can no longer remain divided. Finding solutions to shortages of adequate oral health care that harm populations means that we need to collaborate. My specific call is that we explore creative solutions to put oral health services within the reach of the Lakota people.
Maxine Brings Him Back-Janis is on the faculty of the dental hygiene department of Northern Arizona University, in Flagstaff, Arizona, and is in a doctoral program in higher education. Before becoming a registered dental hygienist, she spent 24 years as a dental assistant with the Indian Health Service. The dental checkup study in the essay was funded by the W.K. Kellogg Foundation. The study results, “An Assessment of Oral Health on the Pine Ridge Indian Reservation,” were presented to tribal leaders on the reservation in spring 2011. Adapted with permission from Health Affairs. Copyrighted and published by Project HOPE/Health Affairs as Brings Him Back-Janis, Maxine. A Dental Hygienist Who’s A Lakota Sioux Calls For New Mid-Level Dental Providers. Health Aff (Millwood). 2011; 30(10): 2013-2016. The published article is archived and available online at HealthAffairs.org.