Janet Reaves was a tireless advocate for North Carolinians, working statewide to improve the health of those with chronic disease. Janet excelled at creating partnerships and helped champion innovative quality improvement initiatives that put North Carolina at the forefront in of chronic disease management.
In her memory, and to highlight the connection between oral and systemic health, the North Carolina Oral Health Collaborative sponsored the first Janet Reaves Community Achievement Award this year.
The award was initially supposed to be presented during lunch at the North Carolina Community Health Center Association’s Clinical Conference on Quality and Chronic Disease in April, but the conference was cancelled due to COVID-19.
Instead, we met virtually with this year’s awardee, Dr. Rob Doherty, chief dental officer at Greene County Health Care Inc., to discuss his lifetime of service and what the award means to him.
Dr. Doherty is an innovator in the field of community-based dentistry. Throughout his career, he has worked hard to increase access to quality oral health care for underserved communities. From spearheading new approaches to school-based dentistry to pushing the envelope to offer more services from a public health setting, Dr. Doherty has shown that hard work, dedication, and collaboration can achieve incredible results.
Watch the full interview with Dr. Doherty or use the table of contents below to skip to specific topics of interest to you.
Table of Contents
0:15 – About the Janet Reaves Community Achivement Award
Remote graduation has been a melancholy reality for the class of 2020. It’s nearly impossible to replace the feeling of joining your classmates to celebrate years of hard work and dedication. And, for many, graduation will be the last time that they see one another.
We spoke with recent graduates of the East Carolina University School of Dental Medicine and the University of North Carolina Adams School of Dentistry to learn what finishing school and graduating remotely was like for them.
Both UNC and ECU’s dental schools released students a day early for spring break, which quickly extended into an indefinite cancellation of classes and clinical work.
“I was on a rotation at one of our community service learning centers in Sylva, North Carolina,” said ECU graduate Dr. Jiwon Lim. “That week of spring break felt normal, then they started telling us every two weeks that we were out of clinic for another two weeks. It stretched into April and that’s when I realized that this is pretty serious.”
At UNC, students similarly eased into the realization that they might miss the entirety of their final semester of school.
“We got the Friday before spring break off and were under the impression that maybe we’d get an extra week and then we would be back,” said UNC graduate Dr. Brittany Klein. “Then it became increasingly apparent that we wouldn’t be going back at all.”
Educators at all levels, from daycare to doctoral programs, scrambled to develop remote course plans as schools cancelled in-person classes. For dental schools, especially when it came to students in their final semesters, there was no replacing the value of in-person learning.
“We were at a time in our education where everything was done in person, and there is simply no substitute for that. You can’t do it virtually,” said ECU graduate Dr. Dakota Peachee.
Lim explained that ECU eases into the clinical setting. In the second half of the second year, students begin performing basic procedures, like cleanings and treatment planning. Then, in the third year, students are in the clinical setting for three days a week. In the fourth year, students spend five days a week in clinical settings, with little to no traditional lecture-style coursework.
The timeline for UNC dental students is very similar.
“A lot of our work in the fourth year is finishing up those complex cases for people who have been with you for years,” said UNC graduate Dr. Anne Dorsey. “So, you’ve gotten them through the control phase, taking care of their cavities and oral hygiene. And you’ve gotten them to a place where you are actually replacing teeth so they can feel comfortable with their smile.”
For the students we spoke to, missing the final months of patient treatment was the hardest part of finishing school remotely.
“We have been with many of our patients for a long time, working through complex treatment plans that we should have wrapped up this semester,” said Klein. “Not getting to finish their treatment or say goodbye — and on top of that, not being able to provide a firm timeline on when their care will be complete — has been really tough.”
Dorsey said that the students are doing their best to keep in contact with patients to help them from a distance, but she is worried that delays in treatment plans will mean many will have to start over.
“A lot of my patients were coming in once a month, and some were even coming in once a week or every other week if I could get them in,” said Dorsey. “So those will probably have to start from the beginning, going back through having their teeth cleaned, repairing new cavities, and starting a new treatment plan. It will be pretty devastating.”
Looking forward, the dental graduates see both good and bad for the future of the dental profession. The pandemic has not impacted job prospects for dentists, and if anything, opportunities may be around every corner in the post-pandemic world.
Dorsey said that in one of her remote lectures, her professor brought in a few experts to talk about dentistry and COVID-19. One of the experts said that as many as one in five dental offices might not reopen, largely due to older dentists retiring rather than attempting to weather the pandemic and post-pandemic landscape. (In a follow-up, we learned that the expert referenced data for Minnesota, New York, New Jersey, and the UK, but the professor felt comfortable saying that many offices in NC will not re-open as a result of the pandemic.)
Peachee said that he expects the post-pandemic dental profession will change in many ways, especially when it comes to the awareness of patient, provider, and office hygiene. He also expressed concern for the patient load building up while offices are closed.
“I do expect that, during this time while restrictions are in place, there’s a demand that’s silently growing,” said Peachee. “Once some of these restrictions are lifted, or once it grows too big, I think the demand is going to be out there and dentists are going to be more busy than they’ve ever been.”
In a follow-up article later this summer, we will explore how these two potential trends—dental provider retirement and a potential dental patient backlog—will impact oral health outcomes, especially for the underserved.
Where are these students headed now?
Dr. Brittany Klein is starting an oral medicine residency at Brigham and Women’s Hospital in Boston.
“Going from hunkering down in an apartment to taking the public transit to a hospital every day is a bit nerve-wracking, but I’m excited to get back to work, and I’m excited to be helpful,” said Klein. “There hasn’t been much that any of us students could do to directly help with the pandemic, so I’m looking forward to seeing patients again and helping where I can.”
Dr. Jiwon Lim is starting a one-year dental residency in Ann Arbor this summer.
“I think we’re going to push back the start date for orientation, and they have cancelled a lot of the meetings,” said Lim. “But as far as the start dates for the actual residency, nothing has changed for me.”
Dr. Dakota Peachee is joining Smith Family and Cosmetic Dentistry in Sneads Ferry, North Carolina.
“Before COVID was really on everyone’s radar, I had already locked down a deal and signed a contract,” said Peachee. “I can’t wait to get that underway.”
Dr. Anne Dorsey is sticking around for a radiology residency at UNC.
“There will be very little change for me, so I feel very lucky,” said Dorsey. “Radiology is not an in-person specialty—you don’t have to see a patient to do an exam on a radiograph or an image.That’s one of the only dental specialties that can say that.”
2020 marks the fifth anniversary of Oral Health Day. Our annual advocacy event, which usually takes place in person at the North Carolina General Assembly, went digital this year due to the COVID-19 pandemic. We are pleased to say that our first online Oral Health Day was a success! Despite struggles with technology—and even a few “zoom bombers” in the beginning—we had a great turnout, and our panel of speakers were engaging and informative.
Darlene Leysath, executive director of the Cornerstone CDC, a community-based organization in Warsaw, North Carolina, kicked off the event with a passionate speech about the importance of access to quality oral health care.
"I found a path for me instructing Marines in preventive care" – Rep. John Autry on providing #dental care in the #Navy#ohday2020
State Representative John Autry of Mecklenburg County joined to discuss his career providing oral health care in the U.S. Navy, the disparities in oral health he witnessed among incoming servicemen and women, and how oral health impacts his constituents.
"Our hygienists are well prepared, well trained, and frustrated." – Dr. Shaun Matthews #ohday2020#access#equity
Dr. Shaun Matthews, the UNC Adams School of Dentistry’s director of teledentistry, joined us for his last talk before leaving the state to take on a new role. Dr. Matthews discussed some of the intricacies of teledentistry before showing a video of a live teledentistry consultation. He ended his portion of the event with a call to action for advocacy to push for better oral health policy.
ECU has an impressive network of community service learning centers across the state, where North Carolinians can receive affordable oral health care. Thank you for speaking at #OHDay2020 Dr. Flores! pic.twitter.com/d7GyEFzx2s
Dr. Andres Flores, East Carolina University’s division director of oral and maxillofacial pathology, spoke about ECU’s extensive network of Community Service Learning Centers and how they are using teledentistry to increase access to patient care.
From 2019-2020, @KintegraHealth saw over 4,900 children via their two mobile units and portable dental equipment. Care outside the traditional dental home expands #access and #equity! #ohday2020
Dr. William Donigan joined to share his perspective as the dental director for Kintegra Health, a Federally Qualified Health Center in Western North Carolina.
Talking #Covid19, Dr. Donigan expresses worry that children will be unable to see a dentist for upwards of a year, which poses serious challenges to maintaining oral health. Preventive care via #teledentistry is one solution #ohday2020pic.twitter.com/eO0wtUJmbR
After Dr. Donigan, The North Carolina Dental Society Executive Director Dr. Alec Parker, State Representative David Lewis, and North Carolina State Board of Dental Examiners (NCSBDE) CEO Bobby White all spoke about the future of oral health from their unique perspectives.
Representative Lewis spoke about the role policymakers can play in advancing equity in oral health care. He spoke about the stigma that can come with poor oral health and the duty that elected officials have to promote policies that can help their constituents access optimal oral health care.
Rural communities in #NC systemically lack access to oral health care. With teledentistry, dentists can interact with patients remotely to expand #access#ohday2020
Dr. Parker spoke about dental community buy-in for teledentistry. He spoke about the history of telehealth, the beginnings of teledentistry technology, and how far the technology has come.
Mr. White discussed the role that the NCSBDE plays in the dental rule-making process. He spoke to the important role that advocacy organizations serve, because policy change through the legislative process is necessary to allow important rule changes to move forward.
Part 1 of #OHDay2020 was a success! Next up, we are thrilled to announce that part 2 will consist of community-based tours with elected officials of Federally Qualified Health Centers across NC #access#community#healthcare
At the end of Oral Health Day, NCOHC Director Dr. Zachary Brian discussed some of the details for Oral Health Day Part 2. Since we weren’t able to engage in advocacy at the North Carolina General Assembly this year, we have worked with Federally Qualified Health Centers across the state to organize tours for members of the community and elected officials later this fall.
As we get closer to the fall, we will announce additional details so you can join us at a community tour near you! To stay in the loop, sign up for our newsletter here.
“If I start at the beginning, I have to say that I was extremely overwhelmed with everything that was going on,” said Dr. Amanda Stroud, the dental director for AppHealthCare. “But if you’re in a pandemic situation, ‘No, I can’t do it,’ is not an option. Either I know how to do it already, I can figure it out, or you’re going to have to train me. Those are the three options.”
When North Carolina began to shut down due to the COVID-19 pandemic, Dr. Stroud and her team had just started the spring session of their school-based oral health care program. Every year, AppHealthCare spends four months in schools—two in the fall and two in the spring—visiting every school in Ashe, Alleghany, and Watauga Counties.
“When we started to hear rumblings about schools closing, we had a paperwork day to figure out what we could do from the office instead,” said Dr. Stroud. “Then, I got a call from our health director, Jennifer Greene, asking me to join the COVID-19 team meeting.”
Dr. Stroud then joined the army of public health professionals across the country doing their best to prepare their communities and health care systems to withstand the COVID-19 pandemic.
Even with non-urgent dental work postponed, AppHealthCare has been able to keep its entire dental workforce employed, reassigning dentists, hygienists, and office staff to help triage patients, call in prescriptions, and reach out directly to at-risk communities.
“I think a lot of people launched into this not really knowing how to face a pandemic,” said Dr. Stroud. “We just had to realize that we do have some of the tools and we need to be resourceful to figure out the rest.”
For Dr. Stroud, a typical day for the first few weeks of COVID-19 was dominated by phone conferences and planning.
“When this thing first broke out, we had conferences with all three counties every day. That’s calls with incident management teams, community partners, all these groups,” said Dr. Stroud. “We’re looking at Armageddon-type things—I hate to say it that way—but it’s setting up plans for a temporary morgue, looking at what happens if the food chain supplying the hospital and prison goes away. What’s our backup plan, and what’s the backup to the backup plan?”
Now that those plans are in place, Dr. Stroud is working to reach out to vulnerable communities, making sure they have the resources and knowledge to stay as safe as possible.
Christmas tree farming is an important industry in Ashe, Alleghany, and Watauga Counties, with workers coming from across the U.S. and outside of the country for the growing season. It became essential that Dr. Stroud and her fellow health care workers assist growers and farmworkers in taking steps to reduce the risk of catching or spreading COVID-19.
“Fortunately, we have been able to get out a lot of information to the people coming in,” said Dr. Stroud. “We have been working with the North Carolina State University agriculture folks to get out resources in English and Spanish with handwashing information, making sure they’re staying six feet apart, and making sure they know what the signs and symptoms are.”
Migrant communities, who systemically lack access to health care resources, are at an especially high risk of both contracting COVID-19 and not being able to seek health care when they need it.
“We’re really trying to alleviate the fear that many have of seeking medical care,” said Dr. Stroud. “A lot of migrant workers are worried that they’ll be targeted. Trying to overcome that has been another thing we’re working on, just trying to ensure the migrant population that we are really here to help.”
Dr. Stroud said that farm owners have been receptive to working with the public health departments to improve farmworker safety.
“I think most of them realize how detrimental this could be, to their own health, the health of their families, and the health of their business and the people working for them,” said Dr. Stroud.
Sandra Rodriguez, the assistant director of Student Action with Farmworkers, said that farm owners do have a lot of stake in helping worker communities stay healthy and safe. But at the end of the day, putting safe practices in place is incredibly difficult, if not impossible.
“It’s just a very difficult growing season for the people in the field,” said Rodriguez.
In a normal season, migrant farmworkers face many barriers to accessing health care. In Rodriguez’s view, COVID-19 has compounded those barriers and shed light on other dangerous conditions that workers often face.
“These houses that migrant workers live in are usually in poor condition. They often consist of a large room with many beds, a small space to eat, and a small number of bathrooms,” said Rodriguez. “How do you actually quarantine in that kind of situation?”
Rodriguez said that while new housing obviously can’t go up overnight, it is time to start the process of addressing the migrant farmworker housing crisis.
“With the current living situation, the concern is that if just one worker gets the virus, it will spread very quickly to everyone else,” said Rodriguez.
“I don’t think we can eliminate interaction, but we have been working with the growers to keep groups together,” said Dr. Stroud. “So that’s keeping farmworker Pod A from Home A together, working together in the field and not interacting with farmworker Pod B, from Home B, trying to mitigate the spread that way.”
“I’m a dental provider. I have something to offer, but this whole thing has been a huge learning experience, too. Not just learning what the other departments do in their daily lives but learning how to drop everything and turn on a dime and say, ‘hey, I can help you with this,’” Dr. Stroud said.
Beyond extra human capacity for preparation and outreach, Dr. Stroud’s dental office has also been able to provide a lot of relief, especially in the very beginning of the pandemic response.
“Since we transitioned to telemedicine and closed our school program, we were able to shift supplies and be a backup source of PPE (personal protective equipment) for the other departments and agencies throughout the area,” said Dr. Stroud.
For Dr. Stroud, the bonds created between the different agencies who have come together to face the COVID-19 pandemic is one silver lining.
“It’s really important, especially for small counties, to realize that we can group together and lean on each other even more than we have in the past,” said Dr. Stroud. “I include dental under the umbrella of medical providers. I think we were already moving toward more integration, but I hope that with this we realize that there is even less of a separation than before.”
Beyond the strain of re-working an entire medical system to meet the immediate challenge, the well-being of those providing care is also an important topic of concern. Faced with more exposure to COVID-19, many health care providers are finding themselves forced to isolate from loved ones because they are at greater risk of exposure to the virus.
“I miss seeing my family,” said Dr. Stroud. “My parents live just 35 minutes from here, and I haven’t seen them in a few months now. We also had a death in the family. My husband’s grandmother passed away during all this on the opposite side of the state, and I didn’t go to the funeral.”
From us at NCOHC, thank you to all of those like Dr. Amanda Stroud and Sandra Rodriguez who are working hard to meet vulnerable communities’ needs during this time.
