which are being posted somewhat later than I had planned for reasons I will explain in the tip jar.
We finished triage and x-rays at 10 AM. By then we had enough patients to fill the remaining treatment slots. At that point I was able to make my farewells, get in my car, and head North. As I drove back home I did a fair amount of reflection on the past few days, including absorbing many of the comments on the three previous diaries on this subject the past three days.
I will offer the results of that reflection below the fold. I do not claim this is a well-thought out reflection, rather, it is still very much a work in progress.
I invite you to read and to respond as you might deem appropriate, if at all.
The issue of dental health is not going to go away. Today I worked with another dentist in triage. He spent the last year as a fellow on the Hill, and told me of his disappointment when the idea of trying to fold dental into health care reform was dropped. This is one key point to which I feel I must keep returning.
For a variety of reasons, we are almost alone in the Western industrialized world in treating dental health separately. Part of the reason is the approach of our for-profit insurance providers. Still, Germany provides all medical insurance through private providers and does not have the problems we do.
So much of the problems of dental health are so easily preventable, with education, prophylaxis, and the like. I still believe that especially in rural areas we may need to associate dental clinics and basic vision and hearing testing with the school setting - it may be the only way for some of our rural poor to have access, particularly when they are young.
I truly hope that we as a nation will begin to reexamine how we partition health care into separate silos - body health, mental health, oral health. They are interconnected. A person under stress is likely to grind or clench teeth, which can cause serious problems. Oral health problems can cause heart disease, and can interfere with getting proper nutrition, which of course then has serious impact upon basic bodily health.
We have cultural issues and commercial issues, and on nutrition we see the result in dental clinics. Too many of those we are seeing dip tobacco, which causes major problems in oral health. Many of those who don't still smoke, which also can cause problems. There is far too much consumption of softdrinks sweetened with HFCS. People culturally expect to lose teeth, so are almost fatalistic, not doing things that are within their control, such as changing consumption patterns, learning to floss, brushing, rinsing, and all that. Perhaps the only way we can begin to address some of this is through the schools for the future generations, including banning all artificially sweetened beverages from schools - of course the beverage industry will scream.
I am ever more firmly convinced that we have ignored if not abandoned the people who live in our rural areas. Too much policy, at state levels as well as at the federal level, is made without consideration for how such policy can be implemented in rural settings. Some senators, notably Russ Feingold and Jon Tester, having been making the point about this with respect to education policy - there are no schools to transfer to, there are no charters, there are no supplemental education suppliers . . . many rural schools have trouble getting more qualified and skilled teachers, especially in math and science, but also in special ed. We claim these are national priorities, but then do little to provide resources in a fashion to enable rural schools to participate.
Similarly with medical and dental. It is hard to get newly trained people to live in the rural areas - especially if one has several hundred thousand dollars of loans to be repaid, when rural hospitals and clinics cannot pay what their competition in suburbs and some cities can offer.
I mentioned one medical student who is having his tuition paid by the local hospital in the community where he grew up in return for a commitment to come back and serve the community. We probably need to provide federal assistance for similar programs for health care providers, and for some specializations in education as well.
We will not fix the problems of rural America quickly. We will not fix the health and dental problems that exist in inner cities as well, and even in some suburbs. But that is not an excuse for giving up. Until we can properly adjust policy at the federal and state level there will continue to be a need for events like Wise. Which is why I will continue to volunteer, and to annoy people with diaries like this.
I find myself getting angry at those who block the meaningful reform of health care and health insurance because of concern their profits might diminish, or they might be answerable to government oversight. If there is one thing I have seen as undercutting the common good in this nation it has been the tendency to try to privatize what should be public services - education, trash collection, medicine, etc. People are entitled to make a decent living. There is, however, somehow something immoral and even disgusting when the profit motive is allowed to trump all else. The Citizens United decision is but one illustration of where that can lead. we have empowered corporate interests at the expense of ordinary people. We continue to give more access, more power to those who already have, and as a result see increasing concentration of wealth among those already wealthy at the expense of everyone else. That wealth leads to more political access which means even further concentration of wealth and power into the hands of the few at the expense of the rest of us. And if anyone raises a question, the response is accusations that they - we - want class warfare.
No, what we want is an end to the class warfare in which most of us are disarmed and those already in the upper economic strata or who can affiliate with them use every weapon and method, legal or not, moral or not, to keep the rest of us from rising us and insisting that a democracy cannot survive with such increasing concentrations of wealth and power.
Unions used to provide something of a counter balance. So did high incremental tax rates above a certain level, and inheritance taxes to prevent the increasing concentration of wealth and thus power into the hands of the few. Somehow we need to teach our children and our adults the history that so often gets suppressed.
We do not need any more glorification of the Rich and Famous. We certainly do not need to let the very wealthy dictate educational policy for the rest of us, and thereby create an educational system that limits the possibility of meaningful change in our society.
I find myself becoming increasingly radicalized as I look back at the past 3-4 decades, and maybe even a bit further back. I see people suffering. I see hope disappearing. I see the opportunity of meaningful change on behalf of the great numbers of our own people becoming less and less possible.
I already saw that happening in schools. I fight against it as best I can from within my classroom and in the activities I do on educational policy.
I certainly see it in politics, and find myself conflicted - I have access to try to influence policy at least on education, but if I push too hard, if I also take on as I think I must health care and political reform, will I then lose the access that I have on education.
Then I realize - to even think that way is to disarm myself. That is what those who do not want push back want us to do, to so value our access that we sacrifice our integrity.
I know enough about the political processes to understand the pressures that some in or seeking office encounter. They have taken on the burden of seeking public office, and some of it goes with the territory as that territory is now defined.
But it does not have to be so defined.
We need our Prophet Nathan, who could call King David to account for Bathsheba - you are that man. We need our iurodivny - the Russian tradition of the Holy Fool like Basil, who could speak bluntly to the Tsar known as Ivan the Terrible.
We need many voices, each speaking with passion, so that we do not become dependent upon the voice of one who can be assassinated, or arrested, or coopted.
I volunteer at Wise because health care is a moral issue.
I volunteer at Wise, and write about it, because I have some hope, however vague, that I can help people understand that Wise and health care are not the problems, but rather symptoms of a very deep moral illness in our society.
While i volunteer in dental triage, my only purpose is to help the dentists triage as many as possible, so as many as possible can obtain some relief. Those patients are my only priority then, while I am there.
When I write, my purpose must be something beyond that, or else we will never get past the need for more and more clinics like Wise.
My thoughts are incomplete. I cannot present a coherent simple message, one that fits on a bumper sticker. But hell, in order to have a bumper on which to place that sticker you need to be able to afford a car, and too many of those we saw cannot even afford a ten-year-old heap.
Some of those we had triaged yesterday did not return today for treatment. They could not stay another night in the cars, or they had children for whom they had to care, or they needed to get back to be on time for work tomorrow - remember, some traveled great distances. We had diagnosed their problems, were prepared to offer treatment, but time and distance interfered. Which angers and saddens me. To raise hope and then dash it - and yet, we could not ask the dentists to work beyond the 10-11 hours some of them were already working. Some were so exhausted last night they did not even bother with dinner, but just collapsed into sleep in their hotel rooms. Some with whom I ate were by the end of dinner nodding off at the table, the exhaustion taking its toll.
Our exhaustion matters less than the frustration at not being able to do more, at the recognition that no matter how much we do it is not enough,that we are treating symptoms of society not addressing the underlying conditions.
We do what we can. We must. There are persons for whom what we do makes a difference. These are the starfish we can save.
It is not enough. We must be honest and address the underlying moral illness of our society that allows such suffering to continue year after year, decade after decade.
We pulled some teeth. We fixed others. Some got a good cleaning. We know we did good, we provided a meaningful service.
That's at Wise. As it will be in Grundy in October, and elsewhere throughout the year.
I am not at Wise. I sit in my home less than 10 miles from the Capitol in which policy is made, from the White House in which it is proposed and from which directions are given to carry out policy.
I think I see, how ever much still through a glass darkly, and feel that I must speak out.
So I have written another diary. This diary does not extract one rotten tooth. But perhaps it shines light on a far greater decay, the moral decay of America that allows such suffering to continue for year after year after year.
Somehow I do not feel at Peace at the end of this reflection. I wonder why?