For the publics health

Ohio hygienists describe the advantages of working for the state government - as well as what they miss about private practice.

Ohio hygienists describe the advantages of working for the state government - as well as what they miss about private practice.

Cathy Seckman, RDH

The visitor who follows the smartly dressed businesswoman deep into the maze of office cubicles feels distinctly out of place. What does a hygienist know, after all, about business? About politics? About management concepts?

We`re firmly grounded in hands-on reality, we hygienists. We see our work, we smell it, we touch it, we change it. How far removed can you get from that and still be a hygienist?

Pretty far. Ask Sandy Brado of North Canton, Ohio. She looks every inch the competent businesswoman, sitting at her desk before a monitor, with annual reports and work schedules piled neatly at hand. But behind her on a corkboard is the ubiquitous "History of Dentistry" poster, the one that appears on hygienists` operatory walls all over the country, and the initials on Sandy`s business card aren`t MBA; they`re RDH.

Sandy left the hygiene chair seven years ago to work as a consultant for the Bureau of Oral Health Services, under the umbrella of the Ohio Department of Health. She`s a step removed these days from fluoride foam and ultrasonic inserts. She deals in training concepts and government budgets instead. Her day is more likely to be filled with paperwork than plaque.

"I couldn`t have imagined this back in college," Sandy admits. Although she actually majored in sociology ("There wasn`t a bachelor`s in dental hygiene, then, and you had to pick something."), Sandy never thought beyond a career as a practicing hygienist.

"I started out wanting to be a nurse; but, at the same time, I hated the sight of blood. And I knew I didn`t want my patients to die. So I went to hygiene school and loved it, even though I ended up looking at blood all day long." She earned her dental hygiene credentials and sociology degree from Ohio State University, then worked for the same dentist for seven and a half years. Out of the blue, an opportunity came to apply for a state position as an oral health consultant.

"I still enjoy hygiene," she says now. "I didn`t leave private practice because I was tired of it. But I was single at the time, and I needed to think about benefits and a pension plan. The variety in the job appealed to me, and so did the idea of traveling around the state."

Sandy also had begun to think about the health risks of hygiene - carpal tunnel syndrome, arthritis and the necessity of depending entirely on her hands. "When the call came that I had the job, I had just suffered a volleyball injury to my left thumb. It wasn`t too serious, but still, it took six weeks to heal, and there was therapy. It made me think. What if that had been my right thumb?"

She took the job. Ohio`s Bureau of Oral Health Services employs more than a dozen hygienists (and one dentist) to implement its programs, which are funded by a federal block grant for maternal and child health.

"Because of the grant," Sandy says, "our focus is on programs like WIC (Women, Infants, Children), Child Health and Head Start. The lower-income population is our target. We want to reach people who don`t know where to go for dental care. We work in maternity wards, in schools and in public health clinics. What we do is provide training for the trainers - and that includes hygienists. For instance, we might supply a slide presentation or a video for workers at a residential facility for MRDD children."

As part of a program called "Oral Care Basics for Caregivers," for example, the caregivers are taught such things as how to use mouth props, as well as how to modify toothbrush handles for patients with limited dexterity.

Hygienists at the bureau do work in the political sector as well. One of Sandy`s responsibilities in the 12 counties she covers is to consult with community leaders on public water fluoridation - providing information on startup, maintenance, reimbursement and quality control.

Sandy also speaks to hygienists` and dentists` component groups about the state`s educational programs, such as Operation TACTIC (Teens against Chewing Tobacco In the Community) and PANDA (Prevent Abuse and Neglect through Dental Awareness). She can provide modules that include handouts, videos and lesson plans. A component can then purchase the module to use and distribute in the local area.

"But we can`t force them to use it," Sandy is careful to point out. "It`s up to them to take us up on the offer."

Another of Sandy`s duties is to make "cold calls" to public health agencies that have not used their services before. "I tell them who I am, who I represent, and what we can do for them. I let them know we have an oral-health resource packet available. And you know, you get the strangest responses when you`re trying to give something away. Instead of saying, `Great, thanks!`, they say, `Who are you, and why are you doing this?`

"People are leery of dental health. We`re trying to make it seem important to them, and they`re still wondering why we`re there at all."

Presenting in-service programs for teachers also falls under Sandy`s job description. In fact, it was one of her first responsibilities. "When the bureau first started with this, 90 percent of the teachers we talked to didn`t know what sealants were."

Presenting the same information over and over was an easy way for Sandy to learn the basics of public speaking. "People always tell me I should have been a teacher anyway, because I like to do that. And the more you speak in front of people, the more comfortable you feel about it."

The bureau sent Sandy to a public speaking class. State government is a firm believer in continuing education for its employees, so Sandy has collected a wall full of diplomas from such seminars as adult learning theory, conducting surveys, introduction to public health, consulting skills, ethics of health professionals, infectious waste and managed-care systems.

With her previous job experience, all that training, and the resources of the state government behind her, Sandy is well-prepared to serve her 12 counties as a public health hygienist. She typically spends two or three days on the road each week, and is in her Akron office on a very flexible time schedule.

On one recent work day, she left home at 6 a.m. to make a two-hour drive to Martin`s Ferry in southeast Ohio, where she met with elementary teachers to monitor a fluoride rinse program. By 10 a.m., she was presenting an early intervention program to caregivers at a facility in Belmont County.

After lunch, she moved on to the Belmont County Department of Human Services, where she spoke to the staff of a Health Check program about baby bottle decay. Then she drove north again, arriving at the North Canton Library at 4 p.m. Because the library is closer to her home than the office is, she sometimes uses it at the end of the day to do paperwork. Two hours later, field reports completed, she headed for home, arriving at 6:10.

It`s very different from a typical hygienist`s day. Sandy agrees, "That`s one thing I miss. We work with people on a continuing basis, but we don`t see our contacts regularly. I might not see certain people I work with for a year or two.

"I still miss that personal contact. Just the other day, I ran into a former patient at the mall. I miss seeing that regular improvement, and being right in their faces to remind them. They knew me, and they expected me to be there for them."

To stay in touch with her original profession, Sandy kept a part-time hygiene job until a year ago, and she still substitutes for other hygienists whenever possible. "I subbed two days in `97. I was a little nervous about it, but it comes right back. You don`t lose it."

Patient contact aside, Sandy is glad to be away from some of the particular stresses of a dental office. "I don`t miss cancellations or standing around waiting for the dentist. I don`t miss worrying about my hands and neck and back, and wondering how long I can keep it up."

Still, the public health field has its own complications. "They say that with a government job, there`s always a pendulum swinging. Sometimes it swings in your direction, and sometimes it doesn`t. It all depends on who`s in power, what the focus of the government is, etc."

The Bureau of Oral Health Services depends on grant money for its existence, and grant money doesn`t come with a guarantee. The bureau has been downsized since Sandy began working there, but has remained stable. Like other states, Ohio has long been committed to improving public health.

The bureau`s parent organization, the Ohio Department of Health, originated in 1886 during a tuberculosis epidemic, and grew slowly over the years to include many aspects of public health. The first division of dental hygiene was in existence as early as 1946 and, after several reorganizations has evolved into the present Bureau of Oral Health Services. The bureau not only works in the local community, but nationally, as well. Bureau Chief Mark Siegal, DDS, MPH, works with representatives of other states on the federal level to shape dental-health objectives for the entire country in the coming years.

Becky Kading, RDH, the bureau`s field operations administrator in Columbus, is very proud of Ohio`s ongoing commitment to dental health. "Not all states have a dental health program," she said, "and of the ones that do, their staffs are generally much smaller. We aren`t the largest, but we`re holding up well, with good leadership and individuals who are innovative with our programs."

Kading sees the bureau as a dental practice in a broader sense of the word. When she left private practice for government work in 1979, she said, "I looked at it as having a larger clientele, not so much one-on-one. We serve the entire state, instead of individual patients. It gives us the opportunity to present the same principles of oral health on a much larger scale. That challenges us to stay abreast."

She cites the OPTIONS (Ohio Partnership To Improve Oral health through access to Needed Services) program, which links dentists with people who "fall between the cracks" where dental care is concerned. "Our programs not only prevent disease, but allow us to be forerunners in activities to assure access to quality dental health care."

Another focus of the bureau is school-sealant programs. In the federal government`s Year 2010 objectives, Siegal hopes to include a goal of 50 percent sealant placement for Ohio`s schoolchildren. To accomplish that particular objective, the bureau will be relying on Sandy and its other oral- health consultants to get the word out to local hygienists and teachers.

Public health organizations may not be something the ordinary hygienist thinks about often, but they work alongside us every day. They care for the patients we never see; patients who have no access to private dentistry, but who, nevertheless, are in need of quality care. If it weren`t for public health, and its dedicated employees like Sandy, where would those people be?

Cathy Seckman, RDH, is based in Calcutta, Ohio. She recently returned to working as a dental hygienist after working several years as a newspaper journalist.

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