I started my career as a dentist in Barrow, Alaska in 1999. I was recruited by the Indian Health Service to help provide dental care in the remote Inupiaq community clustered on a tundra bluff alongside the Arctic Ocean. Although some people refer to themselves as Eskimo, their preferred term is Inupiaq. Barrow is located 723 miles north of Anchorage. It is an isolated community of about 5,000 people accessible only by plane. There is only one stoplight and only one paved road – the airport runway. Two months of darkness descend on Barrow starting at the end of November. The sun doesn’t get above the horizon until late January and during this time severe storms can push the temperatures below minus 60 degrees Fahrenheit for days.
I had originally signed on for a one-year contract for the adventure and excitement of practicing in such a remote outpost. I thought I would be able to fix all the cavities, make a lot of people smile, and then move on. I was excited about playing hockey under the Northern Lights, pulling around a Perry sledge while cross-country skiing to work, and flying south to climb Mount McKinley. I had no idea at the time that my 11-year experience north of the Arctic Circle was about to begin.
The Inupiaq culture is very unique and elder-focused. Elders are considered teachers and provide guidance and support for people in the community. Prior to moving to Barrow, I had always lived in communities where children were the focus. It’s different in Barrow. Elders are senior citizens, and they are the most respected members of the community. Many elders still went whaling, hunting and camping, and held positions of importance in the community. The community as a whole valued the knowledge and the connection with the past that the elders brought to the table.
This high level of elder-respect even influenced my decision-making process at the Dental Clinic. When I saw the extent of dental disease in kids, I immediately wanted to start a children’s dental initiative with a sealant clinic, after-school appointment times, and fluoride rinses at the schools. That was met with resistance from the community, and it was difficult for me to get funding for that project.
It took me a couple years to realize that until I provided what the elders wanted and needed, we would never be able to gain their support to expand dental services to children. Therefore, I hired a Prosthodontist (complex dental work specialist) and lab technician and ran Denture clinics for the elders twice a year. After a few Denture clinics, I was able to secure support from key leaders in town for a children’s dental health initiative. The process was an eye-opening experience for me. It made me realize that I was just a short-term visitor in a community that was over a thousand years old. In order to gain support for projects I thought important, I needed to spend time, essentially years, listening to what people wanted, and I needed to prioritize what was important to them.
When I first started in Barrow, I did not have any cultural-sensitivity training. I was thrown right into a village trip. My dental assistant and I loaded up a Cessna 207 with dental gear and supplies and flew out to the village of Nuiqsut, along the Coleville River in Northern Alaska, and in the middle of a large expanse of actively drilled natural gas fields. I had grown up in New York where you pretty much look everyone in the eye when you are talking and most of the time you get a definitive “Yeah” or “Nah” kind of answer to your questions.
Nuiqsut was different. I soon realized that it was actually pretty insulting to look directly into the eyes of someone older than you. I also had a lot of my questions answered indecisively with responses like “Always sometimes” and “Sometimes never.” My dental assistant was also from the “lower 48,” and he was culturally just as lost as I was. Thankfully, a very kind woman in the village came to our rescue and helped bridge the cultural gap so that we could help people with their dental care. I learned that raising the eyebrows was a way to answer “Yes,” and furrowing the eyebrows gave the answer of “No.” She informed us that when people said “Achoo,” they were not sneezing; they were saying they did not know the answer. She advised us that we had come to the village during a period of active hunting and that we should consider the subsistence-hunting calendar when planning our next dental visit so that more people would be able to receive our dental services without impacting their ability to feed their family.
After that first village visit, I gained a whole new appreciation for how people perceive and access healthcare. It is not enough to have modern equipment and planes that can take healthcare professionals into remote areas that are traditionally underserved. The healthcare providers must also listen to their patients and learn about their culture in order to deliver excellent care. By listening to each other carefully, the doctor and patient and family can develop a plan towards better health. And that’s a great outcome in any area of the country!
-by Dr. Mandy Ashley
About Our Dentists: Dr. Mandy Ashley and Dr. Madison Galloway are Board Certified Pediatric Dentists proud to serve the communities of Bowling Green, Hopkinsville, and Glasgow! We look forward to sharing our vision of excellent comprehensive dental care that is fun for children and people with special healthcare needs with your family.
SKY Pediatric Dentistry has been providing dental care to children and adults with special needs since 2013. As board-certified specialists in dentistry for children, our team strives to make going to the dentist as fun as possible while maintaining high-quality treatment and preventative measures. We tailor treatment plans to each child and offer a wide range of treatment options, including sedation, in-office general anesthesia, and also hospital-based dentistry. With over 25 YEARS of doctor experience, SKY Pediatric Dentistry is a great choice for children’s dental care in Bowling Green, Hopkinsville, and Glasgow!
