 Welcome. This is Craig Thomas, your host on Much More on Medicine, part of Think Tech Hawaii's live stream series and assisted as always by our engineers Rich and Ray. Thank you. And with me today, Tony Meranaka and Kylie Kreuzfeldt from the Aloha Medical Mission. Thank you. Thanks for coming. So the Aloha Medical Mission, in full disclosure, I've been involved since I think 1991, I've forgotten exactly. And over that time, it's evolved substantially. When I started, and it's how I started, we were doing medical missions, sort of what people think of when it's a medical mission. You get together a crew of folks, usually some interventional folks like plastic surgeons, ophthalmologists, general surgeons, ER docs, and a whole bunch of support staff. You get a whole bunch of boxes full of stuff. You sort of assault customs and wherever the country is, you end up and they shake their heads and wave you through. And you go to some place in need of service. You engage the local providers in facility and do a lot of cool stuff to be honest. And that was the core of Aloha Medical Mission. So I was founded and it's what it's done for years and what it still does. But over the years, it's also developed a couple other things. And that's really what we're going to focus on today. So one of the challenges as I see it in improving health, especially with a primarily volunteer and donation supported organization, is you have to be able to identify a need that you can obtain the resources to address both sort of skill wise, but also funding wise and match those up. And Hawaii honestly has very good healthcare coverage for almost everybody. We are I think the second best state in the nation in that following Massachusetts. So that's fabulous. Dental care, not so much. And so there's the need. And thanks to HDS and a number of other local donors, there's the resource. And I know that the dental clinic has been a major effort on both your parts. Why don't we start with you, Tony? Yeah, so first of all, thank you for having us here and this opportunity. It's great to always share. What you pointed out is very true. Dental care is a stepchild to health care. And so there is a huge need. So around 2002, we developed a clinic. And, you know, we wanted to do so much for the community. And one way to do it is to have volunteers. So we have 16 highly skilled professional volunteers that do dentistry. And people wonder, how do you do this for free? It's because, like you mentioned, the wonderful funders, the all the individual donors that come in and help us. So there's a lot involved. Not only do we do patient care for dental, we also have educational components. And one of them is called for a smile. We go into the elementary schools, the preschools as well. And we educate them how to take care of their teeth, which is really important. And then also we have a program called Welcome Smile. Okay, so that is for women who have been incarcerated or abused. And so we provide them with free restorative dental work. So it's really neat that we're able to give back that way. And I've seen some of the before and after pictures, and it's quite stunning the difference. So and what you said about good dentition being key to health is definitely true. And in fact, there's some of it is that bad dentition is associated not only with, you know, it hurts, hard to eat your food, but even things like heart disease, which is kind of surprising. But the body is a more integrated entity than most of us recognize. And as an ER doc, I am well aware how difficult it is to get somebody hooked up with dental services. So this is a real need. And we also have outreach. So one of the outreach works is where Carly comes in. Because there's a lot of work for us to do, and we can't do it just in our Kalihi community, we need to go out. So that's where Well, why don't we talk about that? So Carly, tell us a little about yourself, how it is that you happen to be here from Minnesota, a good choice, I would say, I think so. But tell us a little about yourself, kind of share your thoughts of being in Hawaii, but also what your role is here and what you're more. Okay, well, I came here through AmeriCorps. So I'm at actually the Medical Mission through AmeriCorps VISTA. And VISTA stands for Volunteers in Service to America. And then AmeriCorps is a federally funded national program. So they place VISTAs within local nonprofits all around the US. And the goal is to help build capacity of those clinics, or of those organizations, and also help them work towards breaking the cycle of poverty. So specifically with Aloha Medical Mission, it's helping patients who don't have dental insurance or are underinsured. Along with that, they may not have the funds to be able to afford dental care, but then also other social or health needs as well. And so it's kind of helping them get back years into the workforce once they get dental care as well. So my position at Aloha Medical Mission is being the evaluation process developer and then also working with community outreach. So I've worked with a lot of the clinic and patient data and coming up with data reports, seeing where our patients are coming from, the patient demographics. So it really helps see who our target population is, where the patients exactly are coming from. We've seen a lot of patients actually come from the west side or even all the way from North Shore, from Bahia. So they really are traveling far to come to our clinic, which is showing there is a dental need all around the, all around Oahu and then also all around the state as well. And then with outreach, we connect with a lot of the federally qualified health centers. So they're a little different from Aloha Medical Mission. They are federally funded and they aren't completely free. They offer sliding scale fees. So that'll be based off of a family's income and household size. So we work alongside them to let them know that we exist. We're there to help and build the capacity for accessible and affordable dental care within the community and connecting patients who need that care to our services and also the services at the community health centers as well. That's excellent. I know you've also been involved in establishing connections with the various emergency departments because I'm not a dentist. You do not want me working on your teeth. So if you come in with an acute problem and abscess or that needs to be drained or, you know, a toothache that needs pain management, sure, that I'm useful for, but then we need to get you to a dentist. And that's, I know you've been engaged with that and we were just talking before the show about how we might booster that with the UR nurses or actually usually social workers so that, you know, get some case management involved and expedite that further. Definitely. We see there's a lot of patients, like you mentioned, going into the emergency rooms, say if they don't have dental insurance or say they just can't even get into a dental office to be seen and it may be an emergency, they're in pain. Like we mentioned before, patients who may not have dental insurance may just neglect dental care as it's not a priority to some some people. So they may wait until they're in pain to actually seek care. That may leave them going to the emergency rooms without immediate care. So what we want to do at Aloha Medical Mission is to help be part of the discharge process of patients going into the emergency rooms. And this will help reduce returning patients going into the emergency rooms. Since legally you can't turn away a patient who goes into the emergency room, but also you, if they're going in for a dental problem, you can't really, I mean, they can receive pain medication, but they're eventually going to have to see a dentist as well. So we want to connect them to services for the care. We're not likely to provide definitive care. So we're happy to see whoever comes, but we really like to solve their problem. So this is a vehicle to do that. What is the average weight after someone reaches out to you for services? I think our weight list right now, it ranges an average of four to six weeks. However, we do prioritize emergency appointments. They do allow walk-ins at AMM. So walk in if you are in pain, we'll try to like fit you in that day. It's not always guaranteed, but they do prioritize emergency patients that are in pain. But a lot of the federally qualified health centers also have almost longer weight lists. So we are helping to build that capacity to hopefully reduce the weight lists all over. Nice. And Tony, you had mentioned earlier that I think you said you had 16 providers. Is that currently the case? Right, 16 volunteer dentists. And so we are growing. Our average was about 200 patients a month. Just last month we saw 290. Congratulations. So with that means we need more funding for the supplies. So there's a lot involved when we grow. So that's part of the plan. So yeah, so let's talk a little bit about what your current pain points are, but also where you both short-term and maybe longer-term hope to get. Well, you know, the first thing we need to get more volunteer dentists in. You know, we're looking for very passionate, most of the dentists are passionate, but also maybe near retirement. And then we also need volunteers to help with the dental assisting. And that all goes back to funding because we need to have a part-time staff to be there that is going to be held accountable to come to work every day. Right. You can't run off a whole operation on volunteers. You wish that was possible. We supplement with volunteers. Yes. And you also have an employee dentist. Is that currently the case? I know it's been true in the past. Yes. So he is actually the dental director. Right. So he and I strategize every morning. We sit down and we, you know, have our coffee and we decide, you know, or we talk, discuss what needs to be done within the clinic, also without reach. So there's a lot of planning with this dental, with this professional dentist that we, that he's compensated part-time. Excellent. And so your job has been to, among other things, evaluate the data. What struck you most about the operation once you started looking into it? I think just seeing how big of a need it is for dental care, that it isn't seen as a priority. So there are still a lot of people trying to access dental care and how expensive it is to if you don't have insurance, or if you're underinsured. And then also the gap. So say you have public insurance, like Medicaid, Medicare, there's still so, there's still such a gap between where they cover and where, if you're able to afford services without insurance. So there is, it's not as accessible, I think as what I had imagined before. But then also just seeing how much growth has been in the clinic. I think when I'd been looking at data in 2014, there was maybe about a 450 patient scene. And now in 2017, this past year, it's almost doubled to a little of about 800 patients seen. But then some patients come in multiple times. So there's more patient visits. And then also seeing how far patients are coming from. As I had mentioned before, they're coming from all over the island. And then also some patients coming from some of the neighbor islands as well. So it's a big service. No, it is. And you're demonstrating that you found a need you can address. Now we have to make sure we have the resource to do it, which is Tony's challenge. After the break, we're going to talk about an ongoing project, eight hours in time zone as a third of the world away. We'll be talking about the project in Bangladesh. This is Think Tech Hawaii, raising public awareness. Freedom. Is it a feeling? Is it a place? Is it an idea? At Dive Heart, we believe freedom is all of these and more regardless of your ability. Dive Heart wants to help you escape the bonds of this world and defy gravity. Since 2001, Dive Heart has helped children, adults, and veterans of all abilities go where they have never gone before. Dive Heart has helped them transition to their new normal, search diveheart.org and share our mission with others. And in the process, help people of all abilities imagine the possibilities in their lives. Science. Dig into the meat of science. Dig into the joy and delight of science. We'll discover why science is indeed fun, why science is interesting, why people should care about science and care about the research that's being done out there. It's all great. It's all entertaining. It's all educational. So I hope to join me for likable science. Welcome back. This is Craig Thomas, your host on Much More on Medicine with Tony Murnaka and Carly Kreuzfeldt as 2Ks. You know, these Minnesota names are challenging for us. And before the break, we are talking about the Aloha Medical Missions Dental Clinic here on Oahu, which is one of its two year-round operations. And the other one is in Bangladesh. And interestingly, that project, which was started 20 years ago, is the other, it seems a little surprising so far away, year-round project for Aloha Medical Missions. And it's called Aloha Social Services Bangladesh. And the sort of backstory is that a couple years before Aloha Social Services Bangladesh started, we went over on a couple missions and the need was impressive. And it seemed terrible to leave after a week or so. And I got to thinking, and it was pretty clear that there were tremendous medical needs, but the needs really weren't primarily medical. They were food, clothing, clean water, ability to get paid for some kind of work, and a roof over your head. Bangladesh is a fascinating country. It's about the size of Wisconsin. During the rainy monsoon season, it's up to 70% underwater, so that's impressive. And by the way, it has something around 160 million people. Wisconsin has 5.5 million. So gives you an idea. It's a fascinating place. It's mostly rural. Dhaka is a big city and incredibly crowded, but most of the rest of the country is rural. But that didn't mean it's empty. There are people working the land everywhere and living everywhere. And going there is wonderful because people are people the world over. And it reminds you of sort of what's important in life and what isn't. I don't think the overall level of happiness is different between Wahoo and Bangladesh as you would think. And we have wonderful friends there. In any event, since we decided that nutrition, clothing, education, ability to get some skills was easily the big driver of health, we gave some thought to how we might do that. And so what we did was we set up a local clinic focused on women and children and on nutrition, but also set up a school. And the reason for the school was to fold. Kids needed to go to school. But it's also an excuse to give them a uniform that's clothes and lunch. That's food. And over the years, the NGO that we formed over there has grown substantially. And now it has nine international partners. Aloha Medical Missions is one. Most of the rest are in Germany and the rest of Europe to some degree. It also has three local Bangladesh partners. Lions, for example, is now going to fund 600 and Rockier Lens surgeries this coming year. And it has two governmental sponsors in Bangladesh. So it's gotten a lot bigger. And it has many branches. It's got the schools, 600 plus students. These kids all get health care too. It's got a scholarship program for about 50 or 60 kids after they graduate. It has a hospital, which it does in terms of outpatient visits, something like 3,500 or so. But it also does six or 700 surgical procedures. The nice thing about being there all the time is appendicitis can't wait till the mission crew comes. And if you need a caesarean section, you kind of need it now. And so we have a physician who works there all the time. She's a combination of a clinic doctor and a hospitalist and assists on surgeries. And then we contract with local specialists to do, for example, caesarean sections or orthopedics or what is required. And it's been big. You know, it's really interesting. Is it really like $30,000 to operate the entire hospital a year? So you're asking an interesting question being an executive director. She knows how this goes. So Aloha Medical Mission is primarily a medical related organization, whereas Aloha Social Services Bangladesh has a broader scope. So Aloha Medical Mission funds the medical piece of Aloha Social Services Bangladesh. And yes, that's what it costs. It's astonishing, honestly. It required some capital infusion to build the hospital, which is a three story structure. It's substantial and it works. But the salaries there are low. Overall, there are about 250 employees, most of them not in the hospital. The health outreach workers, the teachers, the community outreach microcredit workers, those people are all in that 250. But it's become a pretty big operation. And without Aloha Medical Mission, it wouldn't be happening. Not without you. It wouldn't be happening. Well, what the honest truth is, it's without the people working over there, they're astonishing. And I'm amazed every year I go back, they do something different and more. So that's true. Aloha is everyone that's helping. Yeah. And speaking of Aloha, one of the great things that happens is they teach English classes in these schools. So you go in and let's say class four. So class four is about nine years old. They're cutest pie. And they're speaking English. And so they welcome you with Aloha. Oh, yeah, it's really cute. So it's a wonderful thing. The other big piece is the microcredit program, because if you have housing, if you have food, and a way to maintain those things, you're in good shape. And if you don't, you're in trouble. So access to credit is difficult in Bangladesh unless you're wealthy. And there are wealthy people in Bangladesh, just not very many of them. So poor people can't get loans. And so there's a microcredit program. It currently has 11,000 individuals enrolled in it. This is about 40 villages worth. And they're on the order of, I think it's 400 different groups. These 11,000 are collected into and right now I think they're on the order of 8,500 outstanding loans. And these loans come with a community worker who develops a business plan, develops a strategy where you are now. Usually this is done with little drawings on paper because people don't read or write. Excuse me. And then where do you want to be in five years? And how are you going to get there? And it's combined with a savings program. Honestly, it's impressive. So the Aloha Medical Mission support of the medical side allows the other donors to support the other aspects. Nice partnership. It is. So they're working on a 10-year plan. They're a couple years into it. They're mostly ahead of target. They are expanding their housing. They built some housing. There's 124 units. And they're working on 50 more. So all that's great. And we'll look forward to seeing, excuse me a second. I'm sorry. I picked up a virus in Bangladesh. They're working on sort of ongoing plan. Let's talk a little bit about locally what kind of plans we're talking about. Right. So locally, as I mentioned before, we want to grow. And we're looking into a capital campaign to move. And it's not a simple process. We want to make sure that we're not misspending the donor dollar. So we actually found a really nice location, which is still in the Kalihi area. And it's with the Aloha United Way. So another wonderful partner. So this year, we're going to be not only moving into a new facility, building a new facility, but also fundraising at the same time. So it's very exciting for us. A little scary, however, is something we need to do because although our lease is going to end, our services is not going to end. So it's very important for us to continue doing what we're doing. Excuse me. And I do think it's an overdue move. The current facility is challenging. And I think you've done a nice job there, but having a new, better space. Yes. Yeah. It's an older house. And we're so fortunate that we're there. However, it needs a lot of TLC. And so it's just time to move. It's just something we need to do soon. What's the timeline for this? We have three different funders that provided us an award of $315,000 for our capital improvement. They want us or the location wants us to be there, like in August of this year. So it's quite aggressive. Well, that's exciting. Lots of work. You know, I'll be fascinated to see how it goes. And I'm thrilled that it's moving forward. I've long thought that you're filling a vital need, connecting a resource to a need. And I, excuse me, I kind of thought the clinic was opening back. So yeah, so yeah, it's exciting. Yeah, it is a great opportunity for us to have everything fresh in you. So we are looking for much more donors. We do have a constituent list of about 3,000, but we need more supporters. Absolutely. Always a challenge of providing free education or health care. Well, thank you very much for joining us today. It was great having you. And I love the Law and Medical Mission. Yeah, thank you very much. And thanks for joining us also. Take care.