Slice of life: Open hearts, open mouths

Open hearts, open mouths

Bronwyn Chester | At 6 pm, the entrance of Le Bon Dieu Dans La Rue is full. But it's not because of the snowstorm blowing outside.

Dr. Tony Iannella working on a Dans La Rue patient PHOTO: Owen Egan

This is the Wednesday dental clinic, held once every three months at this east end centre for street kids. A motley crew of volunteer dentists, students, dental hygienists, EMTs (emergency medical technicians), clerks, technicians and general organizers of people and supplies transforms the entire cafeteria into a free treatment centre, one of three in McGill's Dental Outreach Program.

The scene is right out of a movie set; the stack of pizza boxes, electrical cords everywhere, bright lights shining, generators humming periodically and the props -- five mobile dentistry units -- are being set up.

The scene in the waiting area, however, is something else. One by one, the young people come to the registration desk where student volunteers from Western Laval High School pull old patient records and make new ones. They're the same age as many of the patients, but dressed differently.

Metal abounds in and on the Dans La Rue kids, especially the guys. It's studded into their clothing, pierced into their lips, noses, eyebrows and tongues. Some are flamboyantly dressed in squeegee, neo-hippy or metallic style. A few, dressed conventionally, don't match the image of street kids at all.

"We've got 24 kids already registered and 25 is the maximum," says Sabrina Parisien, the Dans La Rue employee whose job tonight is to make sure everyone knows what's happening and when. "Let's see how many fuses we can blow today," she says with a wry smile.

So far, the patients are patient. It's the high school volunteers who are a little stressed; there's an inordinate number of first-time patients tonight, meaning a lot of paperwork.

Randi Waks, too, is being run off her feet. She's the program's dental assistant and takes care of getting food sponsors and setting up the supplies, including preparing all the sterile instrument kits for the dentists, but she's usually assisted by the student dentists, who haven't shown up. The autoclave, or sterilizer, set up in the kitchen works non-stop.

Professor Paul Allison, director of the Faculty of Dentistry's division of dental public health, is ushering the first patients to the EMTs, volunteers from the City of Côte St. Luc, who take the medical history.

The medical history is important with any patient, notes oral surgeon Dr. Julia Pompura, but especially so in a narcotics-using population. The combination of lydocaine -- a common dental anaesthetic that is in the same family as cocaine -- and a narcotic like heroine or cocaine can cause heart failure or sudden death, she says.

Other than the relatively high incidence of drug use, little differentiates these patients from the average office patient. The "universal precautions" used to protect the dentist and patient from any infection passed through the blood, such as HIV, are the same here as in any dental office.

As for the piercing, it's not unique to Dans La Rue. "I see all sorts of piercing in my office," notes Pompura, one of the eight volunteer dentists who are also faculty instructors. The dentists here aren't bothered by any of the rings piercing various parts of the kids' faces. The so-called barbell that runs vertically through some tongues, however, is another matter. "We tell every patient wearing one that they chip their teeth and wear down the enamel."

Asked why he wears such a device, François, one of the patients smiles coyly, "C'est pour ma blonde."

At 6:40 pm, the director gives the go-ahead. The dental stations are operational and the first patient heads toward dentistry professor Michael Wiseman, founder, three years ago, of the Outreach Program and its ongoing director.

A big, cuddly bear of a man, his bootlaces untied, he couldn't look less intimidating to a nervous kid. In order to minimize the stress, "you tell, show, then do," he explains, adding that the open concept of the room is to reassure the patients.

"It's open in order to reinforce the positive experiences. It's reassuring to see your friend being worked on."

At Sun Youth, another of the Outreach Program's sites, there are partitions put up in the bingo hall, explains Wiseman, while at Jewish Family Services, the social workers' offices are converted into dental suites. The arrangement gives privacy to these patients, who are generally new Canadians who don't have the salaries or the dental insurance to pay for dental care.

Wiseman came up with the idea of taking the dentists to the people three years ago after a failed attempt at holding a free clinic at St. Mary's Hospital. "That clinic was badly located in terms of the population in need, and people are put off by hospitals. We needed to go into the community."

What motivates Wiseman to donate his time as both a dentist and a searcher for funds and free dental supplies for the cause of the poor? The desire to give back.

"I have three kids, we're all in good health. And I'm comfortable enough to spend the time giving back," says Wiseman, who also voluntarily runs programs in schools in Point St. Charles and St. Henri where he and his students work with the local community health department putting "sealants" on the teeth of these cavity-vulnerable children.

"These areas have a 70 per cent cavity rate in children as compared to a 10 to 30 per cent rate on the West Island," says the dentist, who has a practice on the West Island.

Wiseman's dedication seems to motivate others to work with him. Professor Philippe Mojon, for instance, a native of France and a relative newcomer to the faculty, responded to Wiseman's request for volunteer dentists because "Michael has a certain charisma and you want to help him."

Besides, he continues, having spent a good part of his evening filling the large cavity of a frightened young woman, "it's satisfying just to put people out of pain."

Dr. Tony Iannella, one of the first dentists to join Wiseman, finds it "rewarding to talk to the kids and get their feedback. We worried they wouldn't be receptive but the numbers have tripled."

He also believes it's important for him to have contact with the people of Dans La Rue. "If dentists stepped out of their offices and came to a place like this, they'd see what reality is all about."

"Je déteste les dentistes," says one patient. "Sauf moi," gibes Wiseman, while Dr. Edward Slapcoff, a veteran oral surgeon, fills in the work to be done in the patient's chart.

"This isn't a good place for extractions," Slapcoff notes, "because if something simple becomes difficult, you're in trouble." Those in need of X-rays and more complicated procedures are referred to the faculty's McCall (undergraduate) Clinic at the Montreal General Hospital.

Filling in dental charts might seem demeaning to someone of Slapcoff's stature but he's clearly enjoying it. "I think the young people here deserve more attention than they get."

What's remarkable in this odd assembly of volunteers is how everyone will talk to you of the teamwork. Dean of Dentistry James Lund, for instance, has done his time as a pizza-cutter and note-taker.

"It's a group effort," says Allison. "No one is here for the fame and glory. I tell our dentists, if you don't want to help out, give us money."

And the money has been forthcoming. Last year, Debbie Larocque, the development officer for the faculty, organized a fundraising dinner at the Ritz that yielded $65,000.

Given all the volunteer labour and donations of supplies and equipment, the Outreach Program's budget is modest. But Wiseman and the faculty have ambitions beyond the clinics; they're fundraising to buy and equip a Winnebago, much like the famous one driven by Pops, Father Emmett Johns, the founder of Dans La Rue.

While Pops brings warmth, company, food and information to the street kids he encounters, the dental vehicle would be "a Westmount dental office on wheels," says Wiseman. "Complete with two X-ray machines. We'd see the kids after they've had their hot chocolate and hotdog."

Winning the Canadian Dental Association's Oral Health Promotion Award last year won't hurt in the fundraising drive. "It was the first time the award was given to an organization trying to alleviate the inequality of care while promoting good care," says Wiseman.

Ultimately, Wiseman and his colleagues know that having volunteer dentists providing free services to those who fall through the cracks is not really the solution to the government's failure to consider dental health a part of general health.

In Quebec, for instance, 50 per cent of the population does not see a dentist. The faculty, once it has ironed out the wrinkles, wants to present its unique experiment in providing inexpensive and accessible dental care as a pilot project to the government.

Quebec City has good reason to be interested, for it is not only the impecunious, but also the immobile -- such as the disabled and elderly -- who don't make it to the dentist. And the latter group is on the increase.

Back at Dans La Rue, the gang packs up. It's 10 pm and the last patient is putting his coat on, heading toward some east-of-downtown sleeping destination. The volunteers leave to find their cars, then head north or west, back to their warm homes.