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More than Teeth: Dentistry Services with Mark Koday

Mark Koday DDS
Dentists tend to see teeth a lot. Sometimes we have to take a different look and see the patient, and where they’re coming from. Things make a lot more sense when you do that.
More than Teeth: Dentistry Services with Mark Koday

Mark Koday, DDS, admits that the surgical mask that dentists don can serve multiple purposes -- like hiding a frown. A few years ago, when the last appointment of the day -- the child of a migrant farmworker --  arrived 15 minutes late, Dr. Koday decided to go ahead and see the patient, “but I wasn’t very happy. I had my mask on, and I’m glad that the mom couldn’t read lips,” he said.  The mother began telling a story in Spanish to the dental assistant. When Dr. Koday asked for a translation, “she said, ‘She’s thanking you. She knows she’s late—she’s thanking you for seeing her.’ I was feeling a bit small at that point,” he laughed. The patient went on to tell the dental assistant her story: While driving down the road in an un-air-conditioned car full of children in 100+ degree weather, she decided to stop for a family standing outside a car that had broken down on the side of the road, to make sure the family had water.  Then, another stop by a tree, to help her kids cool down. “With all of that, she was just 12, 13 minutes late,” Dr. Koday exclaimed. “It’s been years since that happened, but it really taught me: You can’t look at our lifestyle and make judgments on people.”  He continued, “Dentists tend to see teeth a lot.  Sometimes we have to take a different look and see the patient, and where they’re coming from. Things make a lot more sense when you do that.”

ACCIDENTAL SERVICE

Dr. Koday became a migrant clinician “more by accident than design,” he said. After graduation from his residency program in Maryland, he was reassigned from the Indian Health Service to the National Health Service Corps.   His wife, a Montana native, missed her home state. He found a National Health Service Corp position in Yakima, Washington, at a clinic focused on migrant and seasonal farmworkers. “I promised I’d get her as close to Montana as I could – and Yakima Valley Farm Workers Clinic was the closest… I just fell in love with it,” he admitted, and he is still at the same clinic, almost three decades later.

The Yakima Valley Farm Workers Clinic serves the vast population of migrant and seasonal farmworkers who toil in the fertile lands of central Washington and Oregon, which grows “just about everything but citrus,” said Dr. Koday. Workers come in after working with asparagus, hops, wine grapes, corn, chili peppers, pears, apples, and cherries.  The common complaint of the migrant clinician -- the difficulty in assuring regular care -- is equally concerning in dental care, where routine check-ups are essential to prevent infection and abscess. “The main issue is access to routine care. We see with the adults, because they’re not covered by anybody, they tend to come in only when they’re hurting, and even then, only if they’re not working,” explained Dr. Koday. “They’ll tolerate a toothache if it means losing their job. They don’t get sick leave, obviously. They can’t get or can’t afford to take time off to come into dental.”

OVER THE YEARS

In the last 30 years, his clinic has seen many changes, many for the better: “The traditional migrants have decreased in numbers over the years, because they’ve settled,” he said, noting that seasonal workers who stay year-round in the valley can easily continue care at the clinic, including receiving routine dental care: “We can catch them not just during the growing season, but year-round, so we get better access to that population.”

A different type of change, in the Migrant Education program, led to unforeseen or perhaps just inescapable consequences.  A decade or more ago, Migrant Education could bring kids to receive dental care with a parent’s consent form. Now, the parent must be present. “It certainly wasn’t to create an obstacle – it was... to get parents involved,” Dr. Koday explained, but, “if the parents are working, they need that income, and we have a harder time accessing the children because of that.”

But, with the growth of the clinic, has come the growth of services, which consequently means greater access for the migrant farmworker community, overall. Now, Yakima Valley Farm Workers Clinic houses 10 dental clinics and two residency programs throughout Eastern Washington and Oregon, and Dr. Koday serves as its Chief Dental Officer. “I miss the clinical work, but I feel I can effect change more if I do a good job as an administrator now than I did as a dentist. I can affect more people in a positive way than I did before,” he says, by “ensuring, to the best of our ability, quality of care and efficiencies.”

PROGRAMS TO BRING DENTISTS INTO THE MIGRANT HEALTH WORLD

Dr. Koday is also the director of the Northwest Dental Residency program, which he helped develop in 2006.  “It’s a one-year advanced education in general dentistry program,” where the residents work in one of the Yakima Valley Farm Worker Clinics. The program is co-sponsored by the University of Washington School of Dentistry, and currently has about six to eight residents enrolled per year.

“Not only do [the residents] get the training that they want, it also exposes them to a population that they really don’t get much exposure [to],” Dr. Koday said.  Post-residency surveys have shown that residents “find out that working in a community health clinic, and working with our patients, is actually a pretty nice experience.  Many of them go on to community health center employment, and we tend to see higher percentages of Medicaid” acceptance, in residents’ eventual private practices, compared to the general private dentist population, said Dr. Koday.

The experience also contradicts students’ expectations; they assume they’ll encounter “dimly-lit operatories with shabby equipment, on patients that don’t like dentistry,” said Dr. Koday. “They find the opposite is true. The patients are really nice people and have great needs, and are appreciative.  Most of the health centers you walk into are very modern facilities. It’s really a mind-changer.”

“What most of our students say, is that they’re told that you can’t have a practice with your income requirements if you concentrate on the poor,” Dr. Koday explained -- and he agrees.  With a private practice, the “horrible” pay from Medicaid makes serving low-income adult patients very difficult, financially.  But the community health care model allows dentists to “work in that environment, see these patients, make a nice living and enjoy what you do,” said Dr. Koday, a win-win for dentists and patients.

IMMIGRANT STORIES

Dr. Koday is not a Latino immigrant, but he feels he can in some ways connect with their reality. “All four of my grandparents were immigrants from Eastern Europe. None of them spoke English when they got here—in fact, two of them never did,” he said. “It’s a new immigrant population but it’s the same story…  Eventually, they work their way up, their kids are in college. I wish that service was there when my grandparents came to this country. These health centers, they really have a higher purpose in serving this population.”

30 CLINICIANS MAKING A DIFFERENCE is a project celebrating Migrant Clinicians Network's 30th anniversary through the life stories of 30 clinicians making a difference in migrant health. Learn more about Migrant Clinicians Network.

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