A visit to the dentist is one of the best ways to prevent tooth decay, and can forestall other serious health problems down the line. But for many South Coast residents, dental care is not easily accessible.

No dental office exists anywhere near Pescadero, and many low-income residents lack both transportation to a dentist and the means to pay.

In April, however, the dentist came to them.

Puente teamed up with Sonrisas Community Dental Center of Half Moon Bay to conduct free dental screenings for 25 farm and nursery workers in Pescadero.

Lisa Handa brings dentistry to farms and nurseries

The screenings took place in the field – literally. One of the screenings occurred in a Brussels sprouts field where workers took a work break and sat on a folding chair while a dental hygienist peered into their mouths, snapped digital photos, and asked them some questions about their history of dental work.

The field screenings were just the first step in the pilot program, which aims to bring affordable dental care to as many people as possible on the South Coast. Sonrisas made follow-up appointments for the adults to come in for dental work, and as of May 23 out of 25 had already visited Sonrisas for their follow-ups. In six months, once they complete their treatment plan, Sonrisas will send a hygienist back down the coast for a regular check-up and cleaning. The clinic has a portable dental chair specially outfitted for the job.

The Pescadero patients only pay one-third of what dental work normally costs, says Dirk Alvarado, Executive Director of Sonrisas. If a typical cleaning and x-ray costs $160, they pay $53.

“This gives them the chance to have positive oral health. Farm workers don’t have to use all their wages. And farmers are happy because they don’t lose productivity: they’re going to be able to walk in from the field and get their cleaning, and walk out again in an hour,” says Alvarado.

Sonrisas is a nonprofit, like Puente. It was founded in 2001 to give low-income coastal San Mateo County residents access to affordable, professional dental care. The two organizations have collaborated on grant proposals in the past, and Puente has helped Sonrisas conduct dental free screenings for preschool-aged children in Pescadero. A quarter of California children between the ages of two and eleven have never been to a dentist. And many adults have no dental insurance, including many Pescadero farm workers. But avoiding the dentist can have serious effects on overall health. If you can’t chew certain foods, it can lead to malnutrition and other problems in the long run.

“A lot of times, folks are waiting for years for treatment and finally by the time they show up, they’ve been in such pain – it’s affected their work life, their home life. And we end up extracting teeth,” says Alvarado.

Roughly half the adults enrolled in the pilot program had never been to a dentist in their lives, according to Puente Community Outreach Coordinator Ben Ranz. It became clear that some people would need extensive dental work, or even need to have their teeth extracted, while others just had cavities to fill.

Ranz says he didn’t know how popular the screenings would be until word started spreading that a dentist was visiting farm workers. “I’m still getting calls from people who are hearing we’re involved in dentistry work and wanting to be enrolled in the program,” he says.

Puente is working to expand its dental outreach beyond preschoolers and field workers. Partnering with groups like Sonrisas, Ravenswood  Family Health Center, and San Mateo County Dental Services will be key, says Puente Executive Director Kerry Lobel.

“When people think about medical care, they only think about the medical part. They don’t think about the dental part. We’re trying really hard to bring that aspect of medical care to our community as well.”

It was a nightmare come to life. One day a few years ago, La Honda resident Wayne Petersen got sick. His muscles were weak and he felt tired all the time. Sometimes he couldn’t speak or swallow his food. His gait was unsteady and at one point, he fell out of his car because he couldn’t stand.

Terrifying as his symptoms were, Petersen didn’t have a health care plan to deal with them. He had been denied medical insurance due to pre-existing conditions.

By the time he came to Puente for help, Petersen had already spent his entire life savings on private doctor visits. He was broke, and in spite of their efforts, none of the experts he’d consulted could figure out what was wrong with him.

That changed almost as soon as Petersen met with Safety Net Manager Lorena Vargas de Mendez, who discovered he qualified for San Mateo County’s Medicaid Coverage Expansion Program. Within a month Puente helped Petersen access the San Mateo County Health System. He got a primary care physician, who referred him to a series of specialists. He underwent echocardiograms, breathing analysis, liver monitoring, blood cell counts – “everything you can imagine,” he says.

Finally, Petersen was diagnosed with Myasthenia Gravis, an autoimmune disease that presents only about 30,000 cases a year in the U.S. The neuromuscular disorder has already meant the end of Petersen’s career.  It has made simple things, like a trip to the grocery store, too strenuous to undertake. Eventually it will claim his respiratory system.

“I was used to making good money. Now it’s just surviving day-to-day,” says Petersen.

Today Petersen is managing his disease with Puente’s help. San Mateo County Public Health Nurse Karen Hackett, who is stationed with Puente, pays him regular visits and oversees his regimen of medications, doctor’s visits and physical therapy.

Vargas de Mendez also helped Petersen, who relies on a skimpy Social Security income, cut down on his electricity bill and weatherize his home with a PG&E discount.

“We can’t stop the progress of his disease, but at least he has a better life,” says Vargas de Mendez. “Just the fact that we are here in this isolated area really expedites the process of qualifying for health care. It could make the difference between living and dying.”

Of his experience with Puente, Petersen says: “Lorena helped me with a lot of stuff – got me in touch with everyone I needed, then saw me through everything.”

Puente launches health care survey

For years, Puente’s programs have made the connection between having health coverage and leading a healthy life.

“Puente really does save lives. It isn’t just a band-aid approach,” says Kerry Lobel, Executive Director of Puente. Petersen’s story is a testament to Puente’s wraparound approach to getting participants the care they need.

No one could have prevented Petersen’s disease. But changes to U.S. health care landscape will give future patients recourse to affordable healthcare before they go bankrupt.

Puente has launched an unprecedented, sweeping South Coast community health care survey to gather information on people’s current health care access; inform them about Puente’s own health care services; and help them meet the requirements contained in the Affordable Care Act.

Nicolás Romero talks with Ben Ranz about the South Coast health survey

Puente staff and volunteers will visit every home in Pescadero, Loma Mar, La Honda and San Gregorio. In so doing, they will also be able to gather more demographic details than any U.S. Census.

“People who didn’t have insurance before are now going to be required to get it. And we will be on the forefront of connecting people to these new services,” promises Puente Community Outreach Coordinator Ben Ranz, who is directing the survey. Ranz has gone door-to-door in Pescadero, explaining that the mandatory enrollment period is from October 1, 2013 to March 31, 2014 – and if people don’t sign up, they’ll be fined

“That’s a new concept for folks on the South Coast,” explains Ranz.

Getting folks signed up for medical insurance is one thing. Getting them to go to the doctor is another.

With no doctor on the South Coast, and the nearest medical office 18 miles away, it’s very difficult for locals to seek regular check-ups. Often they wait so long that an emergency develops for a disease, or a chronic condition worsens. Some illnesses can be prevented or symptoms lessened with early intervention.

“Most people say ‘no’ when we ask them if they’ve seen a doctor in the last 12 months.  It seems that people only go to the doctor when they’re sick,” says Ranz.

Distance will no longer be an obstacle to medical care starting next year. A mobile health clinic, staffed by bilingual doctors and nurses, will be housed on the South Coast.

The mobile clinic, a co-initiative of Puente and San Mateo County Health System, will serve roughly 3,000 adults in Pescadero, La Honda, Loma Mar and San Gregorio who have literally been without access to primary care since 2009.

Puente’s survey crew: Barbara Guzman, Mariela Lopez, Alicia Vega and Ben Ranz

Ranz and his team are keen to ensure a strong demand, so one of their survey questions touches on the most convenient days of the week to visit the health van if it were available.

The survey, which Ranz developed with Puente youth workers, Mariela Lopez and Barbara Guzman, along the guidance and support of the Stanford Office of Community Health, will go a long way toward helping Puente understand which medical programs people qualify for. That data, in turn, will help Puente ensure that no one who needs a doctor gets left behind.

For more information about Puente’s community health survey or to contribute, please contact Community Outreach Coordinator Ben Ranz at (650) 879-1691 ext. 143 or branz@mypuente.org. To learn about enrolling in California Covered , contact Safety Net Services Manager Lorena Vargas at (650) 879-1691 ext. 116 or branz@mypuente.org.