Increasing the Quality of Care for the Coquille Indian Tribe and Across Indian Country
While working as a dentist in Bethel, Alaska in 1999, Dr. Mary Willard felt like she was “just putting out fires.” The lack of available dentists, in combination with patients’ fears of dental procedures, meant that Mary and others were seeing patients too late to avoid pulling teeth. It was during this time that she learned about Dental Health Aide Therapists (DHATs).
A DHAT is a dental practitioner trained to provide more services than a dental hygienist, but less than a dentist. Under the supervision of a dentist, a DHAT can provide cleanings, fillings, and other services, freeing up the dentist to tend to patients who need a higher level of care. Because DHATs don’t require as much training as dentists, incorporating their services is a cost-effective solution for rural areas to expand services and reach more people in need.
Mary quickly realized that employing dental therapists was a safe, effective, and culturally appropriate solution to better serve her patients and others like them. Over the next several years, she was involved in the training and supervision of DHATs in Alaska, introducing over 70 new DHATs into practice. Fast forward to 2021, and Mary is bringing her expertise, and dental therapists, to Oregon.
In 2021, the Coquille Indian Tribe opened the Ko-Kwel Wellness Center in Coos Bay, Oregon, with Mary as the Dental Director, and Jason Mecum, a Coquille Tribal member and one of Mary’s students, as the clinic’s first Dental Health Aid Therapist.
Having their own dental clinic has been a desire of the Coquille Indian Tribe for many years. Previously, Tribal members would have to travel to receive care, which created barriers to accessing the dental services they needed. As Jason explained, “The Tribe wanted someone from the Tribal community to go learn the art of dentistry, so they could have someone from the community come back and facilitate care for Tribal members. I’m really happy to come home. A lot of people have been waiting for this for a long time. A lot of Tribal members are really excited for the clinic to open up, so they can come here and get the care they want and deserve.”
Having someone from the Coquille community serve as their first DHAT was important to Mary as well. “There’s a level of trust that someone from the community can bring that I can’t,” she said. “When I worked in Bethel, I had an assistant who was a member of the Tribe. The kids asked her if I was any good – if I was going to be there when they came back. I want to provide culturally appropriate care and work to do that, but I’m not Native. Jason can provide that.”
Getting dental care will only be one facet of the Ko-Kwel Wellness Center’s holistic approach to healthcare: the same building will also hold primary care, a pharmacy, behavioral health support, and community services. The building is arranged in a circle, and departments will cooperate and share health records to make it easy for community members to visit multiple departments in one trip.
“We’ve done a disservice by fragmenting dentistry from the rest of the body. It’s all part of one body,” Mary said. “When the Tribe built the Wellness Center, they focused on treating the whole body. We have to see the patients for their mouth too. Oral health is just as important as physical health and behavioral health. We are called providers, but a better way to see us is as partners in health. We’re going to be honored that they chose to come here.”
While the clinic just recently opened in 2022, Jason Mecum has a clear vision of what success looks like for his community. “I’d like to see every chair filled with patients getting cleanings — no fillings or procedures. I want to see healthy, happy people here.”
To learn more about the role of DHATs contact, Dr. Miranda Davis, Native Dental Therapy Initiative Project Director at NPAIHB at mdavis@npaihb.org with any questions. Already a Dental Health Aide Therapist, Behavioral Health Aide, or Community Health Aide? Consider joining the Community Health Aid Program ECHO Learning Collaborative, a group a dedicated practitioners working together to bridge the gap between traditional practices and modern standards of care to ensure that everyone across Indian Country gets the high-quality care they deserve.
