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zoom RSS 消防車で無料歯科クリニック/米国歯科医療事情

<<   作成日時 : 2009/03/28 01:19   >>

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 長年、1974年製のAmerican LaFranceはニュージャージー州ニュートンのNo2 ポンプ車であった。新しい50万ドルの消防車に交換されるまで 25,000マイル走行し、5,000ドルでオンライン売り出しに出された。
 今や「歯科救急車」として、Dr. Robert Grunsteinの移動歯科診療所となっており、パターソンなど北ジャージーの約60の学校を訪問している。医療とは言えないかも知れないが、貧困層の子どもにとって見れば歯科医にかかる唯一の方法である。35才のDr. Grunstein は火曜日の朝に100人の子ども達を診察した。水タンクとホースがあった所を5万ドルで改造した診察室で、2時間半かけて、一度も歯科医に診てもらったことのない多くの移民の子ども達の検診をした。子ども達は歯科医は嫌いだが消防車は好きだ。
 Dr. Grunstein は2001年に歯科医学校を卒業し、パターソンのクリニックで働きはじめた時に子どもの治療をするかどうかを聞かれた。ニュージャージーのメディケイドはニューヨークの1/3程度の支払しかなく誰も扱いたくない仕事だった。州の約700人しかいない歯科医はメディケイドを扱うが小児の治療を行うものはその一部にしかすぎない。大変で低収入、悪くなる一方の仕事である。しかし、彼はパターソンで治療を始めた。
 Dr. Grunstein は4年間で25,000人の子供の検診をした。彼の医院は18,000人の子供を治療する9人の歯科医院に成長した。
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Free Dentistry via Fire Truck? It’s a Thought
http://www.nytimes.com/2009/03/19/nyregion/19towns.html
By PETER APPLEBOME
Published: March 18, 2009

画像Timothy Ivy for The New York Times
Dr. Robert Grunstein examines children's teeth next to the Dale Avenue School in Paterson, N.J. The dentist visits schools in a converted fire truck with an exam table.

Since Dr. Robert Grunstein began his pro bono dental examinations, he has screened 25,000 children.

At 9:23 a.m. on Tuesday, a shiny red fire truck pulled up to the Dale Avenue School, a drab tan-brick building by the railroad tracks at the edge of Paterson’s faded downtown.

Behind the wheel was a short man with a neatly trimmed beard wearing a white lab coat, blue medical scrubs and a blue yarmulke. Hanging from each side of the truck like a pike pole was an eight-foot toothbrush, also blue. Painted on the truck was a picture of a firefighter brandishing an oversize toothbrush, running toward a smiling tooth. The words read: “Smile Central Dental. Dental Rescue Unit.”

For many years this was Pumper Truck No. 2, in Newton, N.J., a 1974 American LaFrance. It logged 25,000 miles until it was replaced by a newfangled $500,000 fire truck and put up for sale online to any collector or eccentric who might pay $5,000.

Now, it is Dr. Robert Grunstein’s mobile dentist’s office. The truck visits about 60 schools in Paterson, Passaic, Clifton and other North Jersey towns, an ad hoc entrepreneurial and public-service venture in a world where we are much better at fighting fires than addressing the basic health needs of poor and minority kids.

Is this any way to run a health care system? Maybe not, but if the guy in the fire truck is the only way to get poor kids to a dentist, it beats the alternative.

Which is why Dr. Grunstein, 35, spent Tuesday morning cheerfully shuttling 100 children in and out of the back of the truck, where the water tank and hose bed were once housed. At a cost of $50,000, the interior had been rebuilt with a red-and-yellow examination table and a bright tooth-centric mural.

Dr. Grunstein graded each of the children, who were in kindergarten or pre-K: 1 (no cavities), 2 (up to six cavities) or 3 (more than six). As he called out letters to identify the afflicted teeth, their teachers filled out forms for the kids to bring to their parents.

Sometimes the news was good.

“O.K., my dear, let’s see what we’ve got here. Ahhh. Very good. No cavities.”

Sometimes it’s fair.

“K, L, E, F, G, I. She’s going to lose this one today. Still a 2.”

Sometimes it’s horrendous, with dark, stumpy little teeth and gum infections or mouths in which the bad teeth outnumber the good. Tuesday’s record was 14 bad teeth out of 20.

For two and a half hours, they kept coming: Kashon and Yarumi, Noyeli, Rocio, Kyara and Andres, originally from Puerto Rico, Ecuador and Peru, Pakistan, Bangladesh and Turkey, all wide-eyed about their amazing voyage. Most had never seen a dentist.

DR. GRUNSTEIN graduated from dental school at Temple University in 2001 planning to go into general dentistry. When he began working at a clinic in Paterson, he was asked if he would treat children, a job no one wanted because it meant dealing with the Medicaid bureaucracy and New Jersey’s Medicaid reimbursement was pitifully low, often a third of New York’s. Only about 700 dentists in the state handled Medicaid cases, and only a fraction of them did pediatric cases. Hard work, aggravation, low pay ― what a deal.

But Dr. Grunstein felt he had found a calling. Someone had to see the kids of Paterson. Why not him? He decided to start his own pediatric dental practice and came up with the idea of the fire truck as a way to screen children pro bono, so their parents could learn about the children’s dental health, and so he could get his name out in a big way.

“When I was at Temple there was a pediatric dentist named David Bresler, who had a ‘cavity-buster mobile,’ like the Cadillac hearse from ‘Ghostbusters,’ with a big giant tooth on top and a toothbrush on the side,” he said. “I’ve always been a car and truck guy, and I figured, why not a fire truck? Dentists have a bad rep with kids, but firefighters are universally loved. I get to be the guy with the fire truck, not the guy with the needle and drill.”

In four years, Dr. Grunstein has screened 25,000 children. His practice has grown to nine dentists serving 18,000 kids.

Is this an upbeat tale about how America works ― the guy in the yarmulke screening the black, brown, Hispanic and Muslim kids, free? Or a cautionary one about our ridiculous broken health system, in which it takes a guy with a fire truck to make sure little kids see a dentist? Choose your lesson.

“Come in. Slowly. Slowly. This is not an invasion.”

“Good. Nice. No cavities. Wow. Three in a row.”

“No, we can’t go for a ride. Show me those teeth. Oh. Beautiful.”

E-mail: peappl@nytimes.com

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