Comprehensive dental care for a vulnerable population
In a new clinic at the School of Dental Medicine, refugees who survived torture are having all of their dental needs met by students and faculty.
As part of a School of Dental Medicine clinic tailored for survivors of torture, students work with clinician Olivia Sheridan (second from left) to deliver comprehensive care.
In a private space in Penn Dental Medicine’s Henry Schein Cares Clinic in honor of Edward & Shirley Shils, a pair of fourth-year dental students lean in toward a reclining patient, clad in jeans and white high-tops. Positioned to the side of the dental chair, a rolling monitor projects a friendly faced, live translator, ensuring the patient and practitioners understand one another clearly as they discuss the patient’s oral exam and treatment needs. The students check in periodically with Olivia Sheridan, who is overseeing the clinic, before moving on to the next stages of the appointment.
In many ways, the procedures and care are precisely the same here as they are for every patient occupying a dental chair in the School’s clinics. But the visiting patient population is different. Here, students and clinicians are dedicated to treating people who have come to the United States seeking asylum, specifically those who have survived torture in other countries. At Penn Dental Medicine, they’re receiving comprehensive care without paying out of pocket.
“This clinic epitomizes one of our goals as a school: To find the most vulnerable people in Philadelphia and to help them,” says Mark Wolff, the Morton Amsterdam Dean of Penn Dental Medicine. “And for our students, working with these patients gives them a personal satisfaction that is incredible, beyond anything that can be described.”
Many may not have had dental care before, especially preventative care. This clinic is meeting a huge need for us.
Ariel Ressler MacNeill, manager for health access and specialized support at NSC
As part of the survivors of torture clinic, the school has partnered with Nationalities Service Center (NSC), an organization that helps connect immigrants and refugees with a variety of support, including legal and medical assistance. NSC, working closely with Penn Dental Medicine, refers select clients to receive treatment at the school. In addition to survivors of torture, NSC is referring those who have undergone other types of trauma, including human trafficking, violent conflict, or persecution.
“Our clients have a lot of dental needs,” says Ariel Ressler MacNeill, manager for health access and specialized support at NSC. “Many may not have had dental care before, especially preventative care. This clinic is meeting a huge need for us.”
Building on a strength
This special outreach offering was a direct product of Wolff’s desire to augment the School’s community engagement initiatives. Since arriving at Penn last year, he has overseen expansions in the capacity at a number of the school’s community-based clinics. The program also mirrors a similar one he implemented at New York University (NYU), where he served on the faculty before coming to Penn.
At NYU, he had heard from a physician about the pressing needs for oral care by survivors of torture, and worked with others to quickly put together a program to serve them.
“These were people who had been tortured by having a bright light shined in their eye, or with sounds, with pain, some were tortured orally by inflicting damage and injury to their teeth,” he says. “It required us to do our very best as dentists at understanding and coping with the individuals’ needs.”
At Penn, he already knew the students, faculty, and staff were highly experienced at meeting these needs with sensitivity in a variety of populations, including pediatric, elderly, and disabled patients. “And we’ve been highly successful,” says Wolff. To extend that outreach, he turned to Joan Gluch, chief of the Division of Community Oral Health at Penn Dental Medicine, to identify an organization the school could partner with to reach survivors of torture. Gluch pointed him to NSC.
Assembling the team
This past spring, Wolff took that information straight to the office of Sheridan, a professor of clinical restorative dentistry.
Working with colleagues from around the school, Sheridan selected and trained 20 students to participate in the clinic.
“Olivia is truly incredible,” Wolff says. “She manages to do things for our patients that I think are very, very important and she transmits that to our students.”
Sheridan took on the project with full force. With support from Najeed Saleh, associate dean for clinical affairs, she claimed a space within the Henry Schein Clinic that is somewhat secluded, and put processes in place to ease the paperwork and check-in process for patients.
Our commitment is to treat these people and bring them back a sense of joy in life and dignity in their smiles.
Mark Wolff, the Morton Amsterdam Dean of Penn Dental Medicine
“We set up everything internally so we have our own clinic coordinator, Joanna Jimenez, who interfaces with NSC,” says Saleh. “We typically receive their medical histories in advance from the primary care providers of these patients through NSC. And because we are covering costs that aren’t otherwise handled by insurance, they can bypass the patient financial services area as well.”
Beyond coordinating those logistics, one of the most significant tasks associated with the launching of the clinic for survivors of torture involved reaching out to students to participate in it. After sharing the opportunity with fourth-year dental students, Sheridan screened applications and selected 20 to take part.
Fourth-year dental student Amy Malakoff puts her background in psychology to use in caring for the clinic’s clients, all of whom have endured trauma in some form.
“I was looking for students who had any experience working with special populations, either in dental school or before,” she says. “Students with international experience, and definitely students with very high social sensitivity and social skills, who could also work independently.”
Among those chosen was Amy Malakoff (D’20), whose background as an undergraduate psychology major sets her apart from many other dental students. “The administrators of the program said they were looking for people who demonstrate excellent interpersonal skills and resilience,” Malakoff says. “Those are areas I like to focus on growing as a clinician, treating a patient not just from a biological perspective but from a psychosocial one.”
Goldie Razban (D’20), another student selected to participate, felt similarly about her desire to hone the emotional intelligence required to serve a vulnerable population. “Since members of this population are still healing from physical and psychological wounds,” she notes, “it’s a matter of allowing yourself to step back from just doing the dentistry—the handwork of it—and taking the time to understand the patient fully and have them be comfortable in your chair before you even start treatment.”
Goldie Razban, now in her final year of dental school, had worked with refugees as part of the public health-oriented Bridging the Gaps program at Penn.
Razban had garnered previous experience with refugees and asylum seekers as part of Penn’s Bridging the Gaps program, which connects students in the health fields with underserved populations in need of health services. During her first two years in dental school, Razban had worked with organizations, including NSC, helping recent immigrants gain access to welfare services and other benefits.
“When I first heard about the clinic here, I was immediately blown away because, through my previous experiences, we were trying to include dental services for refugees,” Razban says.
A deft approach
Beginning in May, with the students on board, Sheridan organized several workshops to get everyone up to speed on some of the issues they would need to be prepared to encounter.
“We did a whole series on immigration policy in the U.S.,” says Sheridan. “We had one evening that we spent discussing some of the things that they have experienced that might be triggers in a clinical setting. We had another session on the physical manifestations of torture, and common maladies associated with both refugee camps and with torture.”
Such conditions could arise from physical torture; for example, being hit in the face or mouth, causing injuries to joints, lost teeth, or soft tissue injuries. Students were also taught about post-traumatic stress disorder, and given strategies for approaching care that could help patients avoid possible triggers.
Having similar experiences to those of her patients, fourth-year student Irada Rahman has taken away a sense of satisfaction in helping them through the difficulties of establishing a new life in the U.S.
Student Irada Rahman (D’20), an immigrant herself, was drawn by the opportunity to help people through a difficult time of their lives.
“It’s been eye-opening,” she says. “Everyone who goes through a time like this experiences it differently. We were taught to put ourselves in their shoes and learn their story as much as they want to share. I’ve been through a similar time and would have appreciated an opportunity to have access to dental care in this kind of setting, as are most of the patients we’ve seen.”
Rahman has also been grateful for the financial support of the school that has taken away any barriers to treatment. “We’re able to provide the best treatment we can give,” she says. “Knowing the position that these patients are in, that freedom makes me so happy.”
‘Great investment’
The clinic launched smoothly in July. It runs one afternoon each week, and the students, split into pairs, operate as a team, trading off practitioner and assistant duties. They’re committed to give their time to the clinic for the full year, and their involvement is all volunteer-based, over and above their other clinical and community requirements.
The students commit to working in the clinic for a full afternoon every other week, over and above their regular scholarly and clinical work.
“We keep adding to the list of things that did work and that didn’t work,” says Sheridan, who leads them in a recap discussion after each session. “We’re calling this a pilot; we want to keep learning so we can improve each week.”
When asked what drew her to the project, Sheridan doesn’t miss a beat. “Patient care,” she says.
From feedback thus far, the clinic is exceeding expectations in that regard.
“I’ve heard a lot of really positive feedback from clients and from our liaison who visits the clinic,” says MacNeill. “They’re being able to communicate well with the students who are working with them, they’re happy with the quality of care, and the fact that they don’t have to pay huge sums to get it is huge. If they show up with dental pain, they’re not just getting a prescription for pain meds, they’re actually getting the work done that they need.”
In response to clients who have asked if their children can be seen, Sheridan and the students will be providing pediatric care in the clinic as well, with backup from the school’s Division of Pediatric Dentistry.
Clients of the Nationalities Service Center, a refugee services organization that refers patients to Penn Dental, painted stones as part of a wellness exercise. “This clinic is meeting a huge need for us,” says NSC’s Ariel Ressler MacNeill.
“We’re getting a lot of support from specialty programs around the school,” she says. “They’re stepping up to give that specialized work that’s needed.”
Though the initiative is being framed as a pilot program, Wolff, Sheridan, Saleh, or NSC don’t have an end date in place.
“We look at this as a great investment,” says Wolff. “We are teaching our dental students through experiential learning. Our commitment is to treat these people and bring them back a sense of joy in life and dignity in their smiles.”
Homepage photo: Many of the clients seen in the clinic have not ever had routine dental care. The School of Dental Medicine has committed to providing them with all the care they need—even from speciality clinics—at no out-of-pocket cost.
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