 Welcome to INSIGHT, produced in partnership with Lakeland Public Television, serving North Central Minnesota. Today we are chatting with Jean Larsen, Executive Director of the Northern Dental Access Center. Jean has generously agreed to share some of her experience with us. I'd like to thank you, Jean, for joining us today. Thank you very much. So dental care in rural America is a major, major challenge. Talk about the work of your organization to ensure that people all across North Central Minnesota receive appropriate dental care. That is a very big question. And thanks for this opportunity, as I mentioned to you earlier. Way up here in the North Country, we feel pretty voiceless on this topic, and so we've done some really incredible things that I'm so proud of and I'm happy to speak about. So this is a great opportunity. And you're right, rural care for dental especially has been a challenge across the nation. This region, North and Central and Western Minnesota has been especially hit hard over the last few decades. And the concept of safety net dental clinics started emerging, say, 10, 15 years ago in the state, as a way of augmenting the private practice's struggle to serve a population that is often at high risk, often geographically isolated, and even maybe culturally different than what the mainstream delivery is accustomed to. And about 15 years ago, this lack of access started really deteriorating the health, the public health of the entire region. And a number of community leaders got together to say something needs to change. Teachers were seeing lack of productivity. It would take two days to get to a dental appointment, say, or take a whole day off to get a child 200 miles away for a dental appointment. The school, the nurses would come to this group of people talking about the situation and say, kids, the school nurses, they're dealing with tooth aches now and families that can't find appointments. And the same thing, if it's hard for a child to learn when they're not fed, it's hard for a child to learn with a tooth ache. Well, and we forget that poor dental health means constant pain. It does. It just means constant pain. As a child, you're living with constant pain. As an adult, you're living with constant pain. You can't eat. It has an effect on learning, on concentration, on quality of life, on other health. There's many misconceptions that, well, if it's just the baby teeth, then we'll get to it later. And I think a lot of people misunderstand that decay and disease in the baby teeth actually sets the foundation for the adult teeth. And so you really can set a child on a lifetime of pain if those baby teeth aren't even addressed properly. And I think we forget that there's all unemployment and it's very difficult to get a job or keep a job if you don't have front teeth or if your smile is less than desirable for a public setting. So let's talk a little bit about the different cohorts that you serve. You have different people from different cultures, from different backgrounds, from different strata in society, different wealth levels. Plus you have this huge logistical problem where people are two, three, four hours away from dental care. Could you just lay out the various cohorts of people that you serve in this area of the country? The profile, I think, is misunderstood about the kinds of people that we serve. But it certainly does run the gamut from the most extreme in need and isolated and diseased to average folks that we all know and would walk down the street and would be amazed to know that they're enrolled in Medicaid or medical assistance or Medicare. Is the tradition of different people in this area different ethnicities? Different backgrounds. Does that also have an effect in terms of your client base and how you approach and treat people? Their attitudes toward health and dentistry and receiving service. In a sense, when you're walking into a doctor's office, that can be a very intimidating experience. I think what we've been able to do is, number one, focus on cultural competence. And we're a very values-driven organization. If you look at the core values that we have, they are incredibly complex because we understand the complexity of poverty and the nuances that every single family faces and they're all unique. One of our core values is that poverty is a condition of economics, not ethnicity. So we truly don't focus on which ethnic groups we might be serving. We focus on the economic condition that anyone family might be facing. And by doing so, we've created a very welcoming environment where our staff are trained to not judge, to not expect any one individual or family to have the same values that we may have grown up with and to simply meet people where they're at and to understand what it's like to walk into a dental office. If you've not had care for 10 years and you walk into a dental office, it's likely whatever you have is painful. And that pain creates a level of anxiety that most of us can understand because we've been to the dentist before, but you multiply that generationally where only exposure you've ever had to dentistry is painful. If you grew up going to the dentist every six months, you get a checkup, you get a few sealants, and then you go back. If you have children that have not ever been to the dentist and you start at age 12 and they've been in pain all that time, it's not a pleasant experience. And I think we forget some time in the dominant culture that even getting in the door is incredibly difficult. And then you add to that the geographic isolation or the complexities that come with living when survivability on a day-to-day basis is difficult to manage. And we often judge that difficulty those families have as, I can't believe you're late, with, oh my gosh, we should celebrate the resiliency of a family that must... After a two and a half hour ride just to get there. Just to get there and maybe not their car. You know, they had to borrow somebody's car or they had to ride along to somebody. Our transportation research, for example, many people in the dominant culture will say the biggest problem in rural Minnesota is transportation. Our experience is that it isn't. The biggest problem is in healthcare we're not flexible enough to acknowledge the transportation issue. And so we learned a long time ago that it isn't that people don't have vehicles. It's that they don't have access to the cost of fuel, perhaps. Or they know somebody's coming to Bemidji. But they can't say exactly when they're going to get there because we might stop here and we might stop there and I can't, there are the ones going, I can't control when they leave home. And so we have the flexible scheduling that allows us to welcome them 10 minutes late, 20 minutes late this afternoon, and it's a welcome. It's no judgment, it's a celebration of their ability to get in that door because for many that's harder than many things that they go through. And also if your life is not regimented by 15 minute time segments, but instead your life is regulated by the weather or conditions or other factors, then this whole idea that we've always lived according to our watches is completely ridiculous. That's for most of human existence we haven't lived in that way. It's very much a reflection of this achievement-based dominant culture. Or industrial. Yeah, most of us have really grown up in that, what's next? What's next? I have to, or being able to please people because I don't want people to think I'm late. And then you add to that this sort of regional Scandinavian paranoia that people aren't going to like us. So we'd rather be 15 minutes early than two minutes late. When a family is food insecure, safety insecure, transportation insecure, perhaps economically or employment insecure, it's pretty arrogant to assume that they're going to make sure they're five minutes early to their dental appointment so that we can relax and know that that slot is filled. And when, in a dominant culture, we tend to say that's a failure. I'm asked all the time, what's your patient failure rate? Our patients don't fail. If we fail to deliver dental care, we have failed. We're the stewards of the public trust. The, as a non-profit, we have the luxury of resources that are dedicated to deliver dental care. If we fail to deliver that dental care, the patients didn't fail, we fail. So we have to really change what we do. And what's great about Northern Dental is the ability to turn everything on its side and really look at the patient's needs and adapting what we do, how we feel, all of our definitions we change. And really pushing the status quo as hard as we can to say it's, we have to focus on the complexity of what the patients are facing. And in fact, celebrate their resiliency. Studies show that people in poverty spend more than 30% of their time just maneuvering through the social safety net system. And we assume, or we expect at the policy level, that a safety net process is adequate to bring a family above just subsistence. Which is not the definition of safety net. Safety net is, let's make sure they don't die. Talk about the team that is assembled to deliver these services, both on the professional side as well as the volunteer side. So the dentists are fully paid dentists. The nuance is, as any rural area who has recruitment problems with professionals, they're not our staff. We recruit dentists, we pay them a daily rate, and they come from all over the state. And they drive here for a day a week, two days a week, a week a month. Hey, I heard Bemidji's nice in the summer, how about I come up for the summer? And we cobble together this amazing schedule. We have four or five dentists on site every day. But it never might be the same group, and they come from all over the state. And it's nice, we have four generations. We have those right out of dental school, they come here to sort of hone their skills and work side by side with some real veterans. They're mid-career, and they can make a little extra money a day a week here and there to help their own practice be sustainable. They just sold their practice but aren't quite ready to quit. Or they've been retired for 20 years and they just can't let it go. Where we are, you can just come and do dentistry. We will handle the rest, you don't need to worry about the business aspects, the claims, the scheduling, the personnel problems, the equipment. You don't have to, you have nothing, we do all of that. And so the rest of our team are staff members. And those are that core, we train extensively. I'm very much a Richard Branson fan. The employees are your customer number one. Because once you have a great set of employees, they will make the patients the best, they make the best customer service. Jean Larsen, thank you so much for sharing the work of the Northern Dental Access Center. And thank you so much for your insights.