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Dental Health with John McFarland

John McFarland DDS
My idea of primary care done correctly is comprehensive care that includes medical, dental, and behavioral health.
Dental Health with John McFarland

John McFarland, DDS was a young dentist preparing to open his first private dental practice in the early 70s, when he first heard about a job at a health center, housed in an old onion warehouse in the South Platte Valley region of Colorado. He took the job at the community health center, now called Salud Family Health Centers, thinking he’d work there for a few years, grow their program, and then begin his own practice. The dental clinic in the new center was serving a large migrant farmworker community with just one chair, two dental assistants, and Dr. McFarland. “About all you could do was provide emergency and acute services,” he admitted. Forty-two years later, he’s still there, a witness to the vast changes in his community and the responses of the health center. Now, he’s the Director of Dental Services, and, under his leadership, the dental program has ballooned to 60 dental chairs, housed in nine different sites, with 15 dentists and 12 hygienists, serving 20,000 dental patients.

EARLY YEARS AND FIRST ENCOUNTERS WITH MIGRANT HEALTH

His middle class upbringing in Denver was followed by dental school at Northwestern in Chicago. After time in the military and a few years of travel, Dr. McFarland returned to Colorado. He had no experience with the migrant and seasonal farmworkers living in his home state when he took the job at Salud. Shortly after being hired, he took a trip out to the fields, along with the medical director, to better understand the day-to-day lives of the clientele of the health center. At the time, the South Platte Valley was home to a thriving sugar beet industry, and, consequently, the vast majority of the health center’s patients were migrant and seasonal farmworkers from the beet fields. He and the medical director used the standard long pick with a short handle, the beet thinner’s tool, bending over clumps of beets in the hot sun. 

“The medical director and I lasted about an hour, because it was such demanding work. It was hot and it was difficult,” Dr. McFarland explained. “Here were all these migrant and seasonal farmworkers, who were working very hard, contributing to the economy, all the things that we talk about in a cliché manner of putting food on the table, and really getting nothing from it in terms of basic services including education, health care, etc. When I saw that, I thought, ‘This isn’t right’... I was shocked.”  

Dr. McFarland calls it a sentinel moment: “Where did I miss all of this, when I grew up in my middle class world?” 

His patients and their everyday reality provided inspiration to Dr. McFarland, but he finds it difficult to single out one motivating patient story, over his long career. “There are so many stories of people in similar situations, living in horrible conditions and really just barely getting the basic necessities – including health care,” Dr. McFarland said.

PROGRAMS AND PROGRESS

In 1972, the Colorado Health Department started a new program to have dental students join the health center during the summer. Over the years, the program has grown. “Virtually every student from the University of Colorado [School of Dentistry] rotates through us. We have a lot of students -- plus we have the residency program,” both of which expose dentists early into their career to the world of health centers, helping to break stereotypes about health center facilities and their patients.

Dr. McFarland chaired MCN’s board from 1987 to 1991, and he saw the need to have a similar network for dentists and hygienists. In 1991, he founded the National Network for Oral Health Access (NNOHA), which he says he based off of MCN’s structure. He chaired NNOHA’s board until two years ago. “It’s somewhat similar to MCN. It’s a group that represents and supports oral health clinicians,” Dr. McFarland said. “In the early days, we were just in the hundreds,” of oral health clinicians focused on the underserved. Now, NNOHA counts around 3,500 dentists and 1,500 hygienists in community health centers across the nation. There are roughly 5 million community health center dental patients today.

MOVING FORWARD

Yet, those 5 million dental patients are just 22 percent of the patients visiting community health centers. “We all have to be pleased with how much health centers have grown over these last 45 years,” said Dr. McFarland, but he is frustrated that dental lags so far behind medical. Dr. McFarland’s goal has been “to ensure that oral health is a part of the health center primary care model,” he explained. “My idea of primary care done correctly is comprehensive care that includes medical, dental, and behavioral health.”

Funding has stymied expansion of services. “Medical drives the bus,” Dr. McFarland said. “Dental finds itself in the position where we have to fight and advocate to try to improve access to oral health care services.”

Yet, he continues his work, and is embarking on his final years before retirement. He finds inspiration in his fellow health center workers, who share a common mission. “We’re here because there’s something that we think is worthwhile, and that is improving the health status of a lot of people, that if we weren’t here, it wouldn’t happen,” he noted. “I am so lucky to have been involved with the wonderful people that I’ve been involved with in migrant and community health. I am proud of what we’ve achieved, but, boy, we sure have a long way to go.”

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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