When’s the last time you had your teeth looked at?
Your answer likely depends on how many hurdles are between you and your dental care. And according to an oral health equity report recently published by the nonprofit Voices for Vermont’s Children, people without legal immigration status face particularly big barriers.
That’s because unless you are pregnant or under the age of 19, there is no public or private health insurance available. And if you are among the 1,000 or so Latino immigrant farmworkers employed by Vermont’s dairy industry, you also likely work long hours, don’t have reliable transportation, and don’t speak proficient English.
But there are local efforts to overcome these challenges.
Like at the Middlebury Dental Group, where, on a Monday morning around Christmastime, Navidad Latina Radio played over the speakers.
In one of the treatment rooms, a group of people gathered around the patient chair.
Among them was Shaguftha Pabani, a University of New England dental student, who was finishing the last day of her externship. Nearby were dental assistant Max Hopper and volunteer Spanish interpreter Susan Stone.
Also there: Maria Fernanda Canales, who goes by Fernanda. She’s the dental coordinator between this office and Open Door Clinic, the free health clinic for uninsured adults in Addison County.
At the center of everyone sat a local farmworker, 34-year-old Luis. He was there for his third or fourth appointment at the clinic, getting some fillings done.
With some translation help from Fernanda, I asked Luis how long it had been since he’d gone to the dentist, before coming to the clinic. (We'll paraphrase what Luis said in English, and will also include his direct quote in Spanish.)
He told me that it had been awhile.
"Oooh!" he sighed. "Mucho tiempo."
Then he said he started having tooth pain, and didn’t know where to go for help, when his coworkers told him about Open Door Clinic.
"Empecé con un dolor de muela, y no sabía ni a dónde ir, y mis compañeros me dijeron que en la clínica Open Door, me podían a atender sin motivo alguno," he said.
And that’s how he ended up in the dental chair at the Middlebury Dental Group.
While Luis got his final two fillings done, I wandered down to the office.
Over a loud computer server that sounded a little bit like a dental drill, Dr. Peter Hopper — one of the Middlebury Dental Group co-owners — explained how they’ve prioritized serving farmworkers for years.
"It's always been our feeling that because these migrant farmworkers are the lifeblood of the dairy industry here in Addison County, this was one way we could give back to that important industry within the community," he said.
Peter said that at first, the dental practice set aside two special days each year for farmworkers. They got maybe a dozen patients each time.
Then Middlebury Dental Group co-owner Dr. Adam Fasoli began coordinating with Open Door Clinic, which led to more farmworkers accessing care.
"There was so much need, and, you know, the back list just — yeah, got huge very quickly," Adam said.
A solution to this problem? Hosting a dental student extern from the University of New England and a resident from the University of Vermont. Adam oversees both.
"That's really given us a lot more ability to see more people," he said. "It's like a teaching hospital almost at this point, which is really cool."
Adam noted that Middlebury Dental Group’s successful business is what allows them to provide this care, free of charge. That, and the resources provided by Open Door Clinic.
The clinic organizes the volunteer Spanish interpreters, and it also funds some supplies, a dental assistant, a hygienist and Fernanda Canales, the dental coordinator. She has relationships with immigrant farmworkers and their bosses, so they can get time off for a dentist’s appointment.
Fernanda said another important part of the job is reassuring immigrant farmworkers that they can feel comfortable here. She said new patients are sometimes reluctant to come into the waiting room.
"And we invite them in, and we welcome them in, and the front desk welcomes them in, and we have an interpreter usually waiting for them," Fernanda said.
She added that these choices are based on her own experience of immigrating to the U.S. from Argentina several decades ago.
"As an immigrant myself, having come here, I feel like it's so important to be seen, and to be seen as part of the community," she said.
These days, Fernanda said Middlebury Dental Group can now see about 20 extra patients from the farmworker community each week.
For the needs the Middlebury Dental Group can’t get to — like a recent case in which a worker got kicked by a cow after business hours — Fernanda said she's building relationships with more dentists to connect people with care.
But she can only do so much for farmworkers who live outside of Addison County.
"We have to say, 'I'm sorry, you know, we have to, we serve this county, and we will help you get connected,'" Fernanda said. "But then, you know, they tell us up there that there's no place that will necessarily be able to see them in the way we see them, right?"
She said she hopes more dental offices in more counties will follow this model.
Because it’s working for people like Luis, the farmworker who was getting some new fillings on the day of my visit.
He told me he was grateful for the clinic, where he and his coworkers have come and gotten their teeth fixed, and have been treated very well.
"Sinceramente gracias a esta clínica, pues muchos compañeros han venido aquí y han compuestos sus dientes, lo han atendido muy bien gracias a Dios," he said.
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