Monday, August 24, 1998

By Rod Thompson, Star-Bulletin
Dental assistant Cassandra Ooi advises patient Lionel
Rodrigues on follow-up care after he had two teeth removed
in Catholic Charities' Mobile Care van. Such vans operate
on the neighbor islands, where large distances and low
populations may make permanent clinics impractical.

Mobile dental services
treat neighbor islanders
who have no alternatives

By Rod Thompson


WAIMEA, Hawaii -- The constant pain Lionel Rodrigues suffered for a week progressed from his jaw to the top of his head.

"My teeth was all rotten inside of the root," he said.

The 39-year-old welfare recipient with mental health problems went to the Hilo Hospital emergency room. "They looked at it and said they couldn't do anything. My Medicaid wouldn't cover it."

Finally, a state mental health worker drove Rodrigues 55 miles to Waimea last week, where Mobile Care, a dental health van operated by Hawaii Island Catholic Social Ministry in partnership with St. Francis Healthcare System, pulled two of his teeth.

Without Mobile Care? "I'd be in big trouble," Rodrigues said.

On the neighbor islands, where large distances and low populations make permanent clinics impractical, many people like Rodrigues would be in trouble without services like Mobile Care.

In west Hawaii, Mobile Care served 1,000 people last year and already has passed the 1,500 mark this year, said coordinator Kaye Lundburg. A second van for east Hawaii is funded but possibly a year away, which is why Hilo resident Rodrigues had to go to Waimea.

On Kauai, a dental van operated by Hoola Lahui Hawaii primarily for native Hawaiians has a three-month waiting list, says administrator Dave Peters.

On Maui, about 11,000 people lack dental insurance, and a survey showed about 700 people needed dental care in a single week but couldn't get it.

Catholic Charities' Office for Social Ministry plans a dental trailer for Maui but needs $178,000 to make it a reality, says Sister Roselani Enomoto.

That's in addition to $50,000 set aside by Maui County and $150,000 in equipment obtained by part-time Maui resident Dr. Jack Boarini of Illinois.

Having been involved in what he calls "welfare dentistry" with 11 clinics in Chicago for 25 years, Boarini said people with no access to dentistry include not only welfare recipients but also the elderly, homeless and working poor.

Congress ended Medicaid dental benefits about a decade ago, partly on the theory that dental problems aren't life-threatening, Boarini said.

In reality, for example, a Big Island man died in 1992 because he couldn't get dental care.

Lance Lawrence, 38, a welfare recipient whose clergyman friend Richard Brown unsuccessfully tried every dentist in the Big Island yellow pages, developed an abscess that turned into a blood infection, leading to his death before he could get treatment in Honolulu.

Lundburg called the case a failure not of dentists, but of the social "safety net" that is supposed to aid people like Lawrence.

Meanwhile, new laws push welfare recipients toward employment without recognizing dental needs.

A job applicant with missing or blackened front teeth is unemployable, Boarini said. Maui County official Mark Purcell said, "If you don't have many teeth, you don't show up very well at an interview."

Others have worked hard all their lives, have no insurance, yet are reluctant to take charity. "Lloyd, I'm very embarrassed," a retired coffee worker told Big Island Mobile Care driver Lloyd Mills, who assured her the service was meant for her.

Mobile Care's costs are about $80 per patient, says Lundburg.

That's less than what a hospital emergency room will charge the state for a Quest patient, even though the hospital may only provide antibiotics without fixing the dental problem, said Mobile Care dentist James Martin.

"(Mobile Care) makes sense from the taxpayer's view," he said.

Cassandra Ooi from Cairns, Australia -- licensed as a dentist there but serving as a dental assistant here -- says the need among poor people is about the same in Hawaii as in Australia.

The difference is, there are a lot more services in Australia, including dental care for every school child through the 10th grade, she said.

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