Miles of smiles: SmileMobile provides dental services to Spokane’s Marshallese community

Instead of being excited about turning 6 on Oct. 28, Elje Mwejenwa, a child from the Marshall Islands, was in pain.

“She was crying and complaining that her teeth were really hurting pretty badly,” said her mother, Bena Maneki.

Mwejenwa was one of the only child patients dentists saw in the SmileMobile RV, a mobile dental clinic funded by Delta Dental and operated by dentist Sandi Walker, Paul Phillips and Karri Amundson.

For four days last week, they provided service outside the Spokane Tribe Casino in Airway Heights, offering dental exams, cleanings and other treatment to specifically Spokane’s Marshallese community and other communities of color.

Amundson discussed the relationship between the community organizations and SmileMobile. In her role, she is to “reach out to BIPOC communities and populations.” BIPOC stands for Black, Indigenous and people of color.

“We really do believe in equity and everybody deserves access to oral health,” she added. “So whatever those barriers are, we’re trying to work on breaking those down and connecting them directly with dentistry programs.”

The SmileMobile connected with the CHAS Health , Smile Spokane, Spokane Regional Health District and Better Health Together to encourage and improve the local Marshallese’s community dental hygiene.

From there, Marshallese community members worked to inform their neighbors and coordinate transportation to the clinic, as well as offer translation services. Amundson also pointed out that many patients were not aware that Apple Health, Washington’s Medicaid program, covers both medical and dental services . Ronako Mejbon, a Marshallese woman and health worker for CHAS, served as an interpreter between the Marshallese and the dentists.

“Interpreting is something I picked in March 2020,” Mejbon said. “I realized COVID (protocols) made it so important to get info to those who don’t speak English.”

Flyers in English and Marshallese were created to reach as many people as possible. {%%note} {/%%note} Marshallese Restoration Church and the Marshall Islands Congregational United Church of Christ also assisted the health organizations in gathering people and sharing information. Doresty Daniel works for Spokane Public Schools and used both her identities as a Marshallese woman and language specialist to help SmileMobile’s project run smoothly.

She explained that American oral health practices are not common in Marshallese communities.

“We didn’t have toothbrushes or toothpaste. We just washed our mouths and were still fresh,” said Daniel, who was born on Mili Atolla, an outer Marshallese island. “There is no dental hygiene tradition in the Marshall Islands. It’s something that we never knew that was important to our health because we never thought that was something important.”

Poor dental hygiene can be linked to heart disease, diabetes and arterial blockages, additional detrimental health issues that disproportionately impact that Marshallese community. Amundson said that many of the patients were adults suffering from longstanding health conditions, including their dental hygiene. Amundson had to be cautious about medication once Hemilen Robert, a 61-year-old patient, had four of her teeth removed. The surgery could potentially trigger complications with her high blood pressure.

“Oral health impacts your overall health, especially in the Marshallese population where they have a really high diabetes rates, so (SmileMobile) is seeing a lot of Marshallese people that have diabetes (this week),” Amundson said. “We want them to get their overall health under control because it does affect their diabetes.”

SmileMobile dentists worked in an RV outside of the casino’s restaurant, Three Peaks Kitchen + Bar. On the right side, padded dental chairs to diagnose issues were installed. Extra supplies were stored under the van. In light of COVID-19, ventilation panels filtrated the air out of the RV’s roof . The space was cramped for the three dentists, Mejbon and patients, but it was enough space to boost health in the Marshallese community.

Phillips has been a dentist focusing on equity for more than 40 years. He also has a health contract with the Colville Reservation and a tribal member was one of the first patients of the SmileMobile that morning. Phillips said he was happy to turn Spokane’s equity initiatives for the Marshallese community from “talk into action.”

“The tread hits the pavement right here because I know in Spokane, there’s a lot of networking going on,” Phillips said. “But this kind of interaction, this eye-to-eye, person-to-person? That’s what’s necessary to help others in the health care system. We have the interpreters and they’ve helped us connect with the patients. Once (interpreters) are comfortable, that feeling is interpreted to the patients. With equity issues, this (community effort) is what is necessary to connect with groups.”

He did a quick examination, realizing that she would need to use silver diamine fluoride, a teeth-decay protectant that would turn Mwejenwa’s teeth from brown to black.

“She has about three of her six molars coming in, and it’s important that they’re healthy and that we seal them,” Phillips said.

After Amundson applied the fluoride, Phillips referred Mwejenwa to a pediatric dentist who would be more appropriate to assess and improve her dental hygiene.

With SmileMobile concluding their dental care clinic on Friday, they look to return and improve their outreach to the Marshallese community. Many of the Marshallese community live close to Rogers High School. For those who may have been without transportation or carpool, the 30-minute drive to Airway Heights became an hour and 15 minute bus ride . An Uber ride would cost nearly $50 to and from the mobile clinic. Amundson said they hope to “provide services in proximity to the communities they serve.”