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Tuesday
Apr292014

« Race & Dentistry: A conversation »

 

Editor’s note: This is not a compendium on race relations within the WSDA today, nor was it intended to be. Rather, we set out to ask questions that would stimulate discussion between colleagues of all races about how people of color practicing dentistry in Washington would describe the conditions they practice in today, versus what colleagues entering dentistry in the past faced. As evidenced by the number of people who declined to participate, race can still be a provocative issue — the elephant in the room, if you will —  even in Washington state, where we pride ourselves as being open and affirming to all. 

"It’s not so much that views have changed, but that laws have changed. I don’t think that people’s viewpoints have necessarily changed, except to say that a lot of the prejudiced people are dying off. There’s a shift towards a group of people who have grown up in a world where race is not an issue and who believe it is wrong to deny someone because of race. They’re reinforcing this with laws on the books that make it illegal, which helps, too. And that’s really basically it. If you’re in a major urban area, there has been a cultural shift, but when you look at a map of blue and red states, the middle of America is pretty homogenous. You have to wonder if that is by design – do they not want to be around people who don’t look like them?"
— Dr. Marshall Titus
“In this country, American means white. Everybody else has to hyphenate.” — Toni Morrison

As a society we like to think that views on race and gender are changing — and that may be, but as Dr. Titus and others we talked to for this article pointed out, it may just be that the people holding on to antiquated views are dying off, relics of a time when making judgments based on the color of someone’s skin or their sex were more the norm than not. With so many successful, intelligent people in dentistry, we wondered, was race even an issue anymore? It turns out it is, in ways both overt and subtle. Some of the dentists we talked to still feel isolated or marginalized by a dwindling white majority, others don’t, but all have felt the sting of racism in their lives, and each has been left to wonder what role race has played in the way they were treated in myriad situations — for some, it continues on today. 

For Dr. Yoshitaka Ogata, the racism was overt: imprisoned in an internment camp during WWII, Ogata and his family spent three years incarcerated simply because they were Japanese. 120,000 Japanese Americans living on the west coast were interned in ten camps established in California, Idaho, Utah, Arizona, Wyoming, Colorado, and Arkansas. During the war, Ogata and his family called Minidoka in Southern Idaho “home” as best they could, where education was often an afterthought, and families lived in tarpaper shacks with no running water or cooking facilities. Today, the Japanese Americans we spoke with seem to shrug off the notion of racism, at least of anything overt. As Yoshitaka’s son WSDA's President-elect Dr. Greg Ogata said, “Race had no bearing on my dental school experience. That’s one of the things about Seattle – I’ve never felt that any of my classmates, patients, or teachers cared. Now, maybe some patients went to somebody else because they didn’t want to come to me, but I can’t say. But the ones who walked through the door didn’t care. I don’t think it was an issue.” 

However, six decades after the elder Ogata was interned, Dr. Princy Rekhi, past president of the Seattle-King County Dental Society, bore the brunt of a similar wave of racism immediately following the 9/11 attacks. Frightened Americans lashed out against anyone who looked remotely like the terrorists they saw on television. The fear enveloped the country, as people looked for someone to blame and worried about another attack. How many of us can say we didn’t look up to the sky for months after, when we heard the sound of a passing plane? Rekhi was a junior dental student at UMKC, and with his traditional Sikh turban and beard, he made an easy target on the ground. “Overnight people treated me differently. I had been accustomed to eating out almost every meal, but even walking down the street people would call me Osama Bin Laden or a terrorist — it was insulting, and it made me sad,” he says.

Rekhi sometimes feels the lingering effects of the 9/11 tragedy, especially when the event is featured in the news. “I think anytime they show an image of one of the attackers on television there’s another emotional swell that occurs in the common population.” Still, Rekhi has been encouraged by shift in the public’s understanding of his religion and culture, saying, “Almost 11 years after 9/11, a horrific event occurred that jarred the Sikh community. A Sikh temple in Oak Creek, Wisconsin was the site of a mass shooting that left six dead and four wounded at a place of worship. This time the community response was different. While sitting at a doctor's office waiting for my appointment, I had a random older gentleman come and touch me on the shoulder and say, ‘You’re Sikh, right?’ I responded and said ‘yes’, he then looked at me and put his hand on my shoulder and said ‘I'm really sorry for the loss your community suffered last week, and wanted to offer my sincere condolences.’ This was a response that actually made me realize that there is a change that is occurring. It was really gratifying to see a few changes from 9/11/01. Namely, a random stranger recognized me for who I am, a Sikh; also, that a random stranger offered condolences to a random stranger who was far different then he.”

And, while Rekhi says that it’s fairly routine for potential patients to ask if there is a dentist in the practice who doesn’t wear a turban, or ask his front desk staff if he speaks English, others engage him and ask questions about what it means to be Sikh, “I give them a breakdown of my religion, tell them where I am from, what I believe in. Some ask if I am Arab, and I explain that my family is from India. It’s different. A lot of patients will come in and assume that I’m Muslim and say, ‘Oh there’s a Muslim family that lives near to us’, and I will laugh and say, ‘We have Muslim families who live near to us too, but I’m Indian.’ I appreciate the fact that there’s some cultural awareness and that they ask questions.” 

In the 1950s Dr. Richard P. Ferguson could point to race as the reason he was repeatedly denied graduate schooling in any dental program provided by the Air Force Institute of Technology (AFIT). Finally in 1968, he applied directly to the University of Washington for the graduate orthodontic program. He was accepted; but then began the struggle to get AFIT to pay for his schooling. It took a trip to Washington, DC and an appointment with the then Surgeon General to get approval to attend the UW and to retain his commission as a Lieutenant Colonel in the Air Force. Finally AFIT agreed to pay for Dr. Ferguson’s schooling. He had been refused earlier, as no African American dentist in the United States Air Force had been given graduate schooling.

Dr. Ferguson was the first African American on active duty in the Air Force to be promoted to the rank of Colonel, retiring in 1973. He was also the first African American to graduate from the UW’s program in orthodontics. He taught part time and was a member on the University’s Dental School Admissions Committee as well as a volunteer instructor for the ethics course for nearly 20 years. Dr. Ferguson was also WSDA’s only African American president.

Growing up 
For Dr. Jessica Bremerman, race was less a factor than circumstance was. She says she always knew she was going to go into medicine, which is astonishing when you consider her childhood. Bremerman, a Yakama Indian, grew up on the Yakama reservation, shuttled from relative to relative as her parents went through a divorce. While she contends it’s common in Native American families to be raised by someone other than your biological parents, her story is a testament to her resilience. “I changed grade schools 11 times,” she says, “I lived with my aunt, my grandmother, my mother, and friends throughout that time. We were homeless for part of the time I was with my mother, so that taught me a lot.” While her parents were neither supportive nor dismissive of her studies, neither can say where her drive comes from — all Bremerman knows is that schoolwork became her sanctuary. By the time she was in high school her father was in jail and her brothers were dealing with addiction and gang issues, but Bremerman continued her path to success, saying, “I knew I wasn’t just going to graduate high school or college, I was always looking further ahead, I wondered how far I could go. I’ve always had that personality – I’m very goal-oriented, and has served me well. I’m always asking how it happened, given my upbringing. Some of it is just luck, and some of it comes from my drive.”

Rekhi often encountered racism when he was growing up in Kenmore, Wash. He explains, “I got picked on quite often in school, so I always had to have a little thicker skin to deal with it. I was fortunate because everyone in my family was well educated and intelligent — I can only imagine what it must be like to be impoverished and have the same issues I did. I may have looked different, but my parents treated me differently, too. I got a sports car when I turned 16, so while I stood out because I had a turban and beard, I also stood out because I had things. We lived in Northshore Summit, and that helped us fit into the socio-economic model — so I wasn’t an outcast. Being smart helped, too — but being on top of your class put a bulls eye on your back for other reasons.”

Ferguson grew up in Ohio in a town of 80,000, in largely mixed race neighborhoods where he recounts, “We had some of the same racial problems that all towns had at that time. My teachers were all white, both women and men, and while I was in high school I was probably the only African American in the class.” The youngest of nine, Ferguson planned on going to college from an early age, and grew up in a family that valued education, “In grade school my brother was three years ahead of me,” he recalls, “And when we got home at night he would teach me what he had learned that day - math and algebra.” His parents instilled confidence in their children, taught them to earn their own money, and emphasized that they were as good as anyone else, encouragement that proved valuable. It was a time when racism — especially that directed at African Americans — was part of everyday life, and Ferguson recalls incidents of racism as early as junior high, and says, ”Little things happened over and over, and the only boundary I could see was race. But it taught me to step back and observe the person or the situation to make a determination if it was isolated only to African Americans, or just the way that person treated everyone.” 

One incident fundamentally changed the way Ferguson reacted when he suspected racial inequity was at play. It was his first year at Ohio State, and he wrote a piece for his English Composition class about prejudice, specifically about sending servicemen from the south to the north, and vice versa. No mention was made of race, because Ferguson realized the problem was one affecting both blacks and whites equally. He received a D on the paper, even though no corrections were made. “It bothered me for two years,” he says, “So I went to my counselor to complain – I felt that the lowest I should have gotten was a B. My counselor told me that he was a new teacher, and if that had come to light he would have been in trouble, so I let it go. I have always said that if I had known then what I know now, I wouldn’t have stopped until I saw the president of the University, because that was incorrect. I learned from it, though — from then on, I documented everything.”

Role Models
Everyone we talked to had role models – from parents, to educators and dentists — lots of dentists. We wondered, were they of the same race? For Yoshitaka Ogata it was — his childhood dentist, Dr. Fukuda. The elder Ogata was able to pay that forward when he became the role model for Greg later in life, who says, “My dad was a huge role model in my life, I’ve always wanted to emulate him. My other role models were dad’s friends from his peer group in the ortho study club. They were great guys doing interesting work, but they were also happy and had fun. Dad enjoyed his work tremendously, but still had time to coach little league. I knew that when I was raising my kids I wanted to do the same things.” 

Bremerman, it seems, found mentors in every aspect of her life — her coaches, employers, and her high school counselor. And while none of them were Native American, later in life she found role models within the Native American community — Dr. Rex Quaempts, and the dental assistants she worked with at IHS, who remembered her as a child. All, she says helped support her and get her to where she is today. 

We profiled Dr. Tyrone Rodriguez in the WSDA News recently — the current president of the Hispanic Dental Association is active in all levels of organized dentistry – component, state and national — and he shows no signs of tiring. When asked about his mentors, he ticked off a litany of people who helped him along the way — his most influential chairside role model was African American; his greatest diagnostician, pathology and radiographic influence was Jewish; the doctors who illuminated the value of evidenced based practices and risk assessment were American; his biggest influence in dental philanthropy and missions was British; and the best instructor in dealing with children was a six year old Hispanic boy who had taken a cattle truck, a bus, and had walked all night to have Rodriguez pull his tooth in the Nicaraguan jungle. As he says, “A mosaic of people and families have helped shaped my perspective as a practitioner, and I am truly grateful and blessed to have met and worked with them all.”

University life
University life can be difficult for anyone, and we wanted to know if the respondents felt any additional pressures or issues because they were minorities. Dr. Woody Crow attended UCLA, where he got along well with faculty, patients and fellow students. Crow, who recently retired after 30 years of service with the IHS (including serving as the group's regional director), is an enrolled member Seneca-Cayuga Tribe of Oklahoma. At UCLA he was the only Native American there, except for a Philippine woman who claimed to be American Indian because she thought it would help her get into dental school. “But it was always like that for me anyway,” Crow relates, “Between me, my brother and perhaps one or two other guys, I was always the only American Indian in school anyways. I grew up in suburban Los Angeles, not a reservation, so I was used to it.”

Likewise, growing up in Spokane there weren’t many other Asians, or other minorities for that matter, recounts Dr. Eugene Sakai. As he tells it, it wasn’t a problem. “I was always one of the few minorities,” he explains, “So basically I always had the mindset that anything was possible.” When he went to dental school it was the same. He explains, “Maybe there were issues because of my race, but I wasn’t sensitive to them because of where I grew up. I didn’t have time to worry about it. If I wanted something I had to go after it and get it.” Sakai was one of three Asians in his class at OHSU — the last year, he says, that the school observed de facto quotas on minorities. “Of course, they didn’t call it a quota, but there were no women or non-whites other than the three in each class. After my year they had two women, and now that number as grown to almost 50 percent.”

Calling the former dearth of women in dentistry shocking, Sakai is pleased with the explosion of women in the dental workforce, saying, “Women needed to get in the field because otherwise that might have wasted all that intellectual talent – they have changed the dynamic of how we practice by job sharing and working less hours in order to raise a family. There’s nothing wrong with that at all, it’s just different than many of us are used to. The real issue is that you cannot waste intellectual talent – you want the smartest, most capable people in every field.” 

Rodriguez was the first child on either family’s side to attend college, his family expected him to work hard, be honest, and make a difference in the world — and his achievements to date fit squarely within those expectations. Dentistry is his third career, following stints in molecular physiology /biophysics and teaching. Rodriguez also encountered racial quotas in university, but they worked to his advantage, not against it. Still, he felt that he had to overcompensate to justify his seat in the program, saying, “I took every chance to exceed my requirements and clinical experiences to prove others wrong about diversity quotas. The power of involvement and performance helped me to transcend stereotypes.” 

In his freshman year, Rodriguez became president of Hispanic Student Dental Association and began a newspaper called La Sonrisa. He found community outreach opportunities for dental and dental hygiene students, and served as both photographer and reporter, documenting the work of the students in the community. Rodriguez was so committed to the fledgling paper that he paid for the first three issues using his personal credit card, and made sure that every student had a copy in their mailbox. The cost to produce the paper was eventually underwritten by a dental product manufacturer in exchange for ad space, student participation began to expand, and Rodriguez was able to secure 501(c)(3) status for the chapter. The following year, his school enrolled 11 Hispanic students, which demonstrated how action could impact academic culture. Still, Rodriguez fielded criticism from those who didn’t understand why he wasn’t more involved with ASDA, who thought he was only looking for opportunities to help Hispanics, and who felt he should focus more on dental school and not the community. Rodriguez says, “Truth be told, I wanted to get the most out of my dental education and felt I needed to work with familiar territory. These were my people, my culture and my heritage. If not me then who? It wasn’t easy, and leadership can be lonely with doubters and roadblocks all along the way.”

Drs. Titus and Ferguson attended predominantly Black dental schools for different reasons. Ferguson was initially intent on attending Ohio State, but ran afoul of racial quotas — they had a system that allowed for only one African American dental student every other year, with one African American student accepted into their medical program on opposite years. Ferguson applied to dental school in a year when they were only reviewing for the single opening in the medical program. Because of that, he made his way to Meharry Medical College School of Dentistry, a then Black school in Nashville. When asked how the experience was going to an all-Black dental school, Ferguson replied “I didn’t think one way or the other, I thought that I got as good or better of an education than had I gone anywhere else, and having seen some of the other schools, our facility was much better than some of the others.” Finances and the opportunity to learn alongside other Black students were the primary reasons Titus chose Howard University. He says, “The interesting thing about Howard that a lot of people don’t know is that we had people of color from all over the place. In my class of 90 people, 45 were women, and out of the other 45, only 20 were from the US – all the rest were from places like West Indies, Africa and all the other places of color around the world.” Howard is a community-service oriented school, where they instilled an understanding of the underserved and their needs, and made sure students were trained to provide whatever needs were required, rather than focusing on training specialists. Going to a predominantly Black school had many benefits for students like Titus, who says, “I am aware that I didn’t have to worry about race factors playing into things. I know that for other African American students at schools other than Howard and Meharry, it was definitely a factor in their education – they had to make sure they weren’t being singled out because of the color of their skin.” 

Because he had been born in Japan, Yoshitaka Ogata was denied entrance to the UWSoD (and others) but that changed with the passage of the McCarran-Walter Act which abolished racial restrictions in United States immigration and naturalization statutes going back to the Naturalization Act of 1790. The Act was life changing for Ogata, who says, “I was on one side one day, and on the other side the next, and it sure made a lot of difference in my life. It felt like a ton of bricks was taken off my back. One day I was getting letters that said we will only take our own, as soon as I became a citizen I was considered for the following year’s class.” 
Ogata initially planned to attend Washington University in St. Louis; but as they were driving cross-country, he and his wife, Mabel, stopped to visit friends attending University of Missouri Kansas City. While there, Ogata met with the Dean, who asked him if he would consider UMKC instead. Ogata explains, “Dean Reinhart liked Asian students because they did so well in school, and that’s why he accepted so many of them.” With Mabel’s blessing, UMKC became their new home. They lived in a housing project because it was all he could afford, and Ogata was in a small study group with other dentists, all Caucasian. There were only four Asian dentists in his class of 100, and all were from Hawaii. “Everything about the experience was positive for me,” says Ogata, “We worked together as a group, and I never felt that my race was a factor at all.” Mabel concurs, saying “Yosh graduated at the top of his class, and quite a few of his classmates credit him with helping them get through dental school.”

Competition 
Reports have shown that minority students of the same race can feel in competition with each other, and we wondered if any of the respondents felt that way. Most didn’t, instead seeing fellow students of the same race as allies. Bremerman, for instance, said, “I actually felt that the other two American Indians were an asset to me because they knew what it was like to grow up on a reservation. I often joke with my husband when I commute to my job at Indian Health Services that I’m going into a different world because it is.” The three were able to confide in one another in a way that no one else could understand. Still, at times Bremerman felt isolated, saying she felt different than other students because she lacked some of the commonality many shared — a parent who had a practice, a well off family. Being different made her want to do more. Additionally, she says “ I think that my background got in the way at times – I had to miss some of my finals because I had to go back to Yakima to attend my brother’s court date. I had another source of stress while I was at dental school that nobody quite understood.” Rodriguez had this to say, “Fortunately, I felt that many of the leaders that I met in dentistry that were Hispanic were pediatric dentists. Do I see them as competition…not in my wildest dreams — they are my mentors, colleagues and friends.”

By the time Dr. Greg Ogata was in dental school, the issue his father had faced was essentially reversed: there were too many Asians in competition for spots. “When I was in school they found many classes were becoming predominantly Asian, as they did at UC Berkeley. Those with the best scores and grades should have been enrolled, instead, they had to dial back the numbers to create equity for non-Asians, which left only the “super Asians” in classrooms and no space for other, high-achieving Asians.” Ogata continues, “You hoped to excel in other ways – in the interview, your letters. We didn’t talk about it as a group, but we knew that we were in competition with other smart Asians. Once we were in the program, the playing field was leveled. We would often joke that even the last person in class became a doctor.”

Continuing issues
We wondered what the doctors thought the most pressing issues facing minorities are today, and we got an earful. Dr. Greg Ogata thought it was financing, regardless of a dental student’s race. Dr. Sakai is concerned about insurance companies dominating the industry, just as they do in medicine and pharmacy, gradually driving us more to the corporate form of practice. And, he’s concerned about the credibility of the training foreign doctors receive, saying, “We’re unfamiliar with their schools, the methods of teaching and the quality of the education they have received. It is like all prejudices – anytime someone does things differently than you or has different references, there is the tendency to wonder about their abilities. I have concerns about their morals and ethics with all young dentists – there is a heightened emphasis on making money as opposed to doing the right thing.” 

Dr. Ferguson, retired since 2001, still keeps his fingers on the pulse of what’s happening in Washington and the country. He says that young African Americans have a harder time getting jobs, and may not get the grades they deserve because of prejudice. “I don’t know that I would say it is routine, but I think that it happens.” He continues, “It’s unfair, but I have tried to get this across to faculty at the UW that there may be a pattern, and it is worth looking into. I think that some African Americans won’t apply to the UWSoD because they feel they can’t get in, and I think the UW has an obligation to try to balance out the admissions. We’re a top school, and while I understand that grades are important, I think we should do more to make sure there is a better racial balance in the dental school.” 

Bremerman disagrees, saying, “In my graduating class at least 30 percent were women and there were quite a few minorities. My class was diverse in every way – age, sex, ethnicity and educational background. I think the UW does a great job of inclusion”

Titus, however, agrees with Ferguson’s assessment of the UW, and finds it troubling. “UW doesn’t do enough to reach out to African American students. If not for Dr. Speed McIntyre, I fear there wouldn’t be any African American students at the UW — and that’s a red flag, as far as I am concerned. I was on the admissions committee for a short time, and there was always talk about whether or not African Americans weren’t far above and beyond the basic requirements to enter dental school. I think the biggest issue facing minorities today is getting more of them on admissions committees so that more of them are getting into dental schools – because you can go through periods of time where they have no advocates in the university system. I realize that dental school is pretty expensive, so there are a lot of qualified kids out there who may not want to put themselves into the position of having that kind of debt for dentistry, but that is a universal problem.”

For Bremerman, the issues she's most concerned about are those in her back yard. “Oral health continues to be a huge issue in the Native American community,” says Bremerman. “It is not taken seriously enough. I see massive decay all day long. Kids coming in with abscesses and complex medical issues, from broken homes, where oral health simply isn’t a priority, unfortunately. I don’t know how to change that – and I grew up in that environment. When my patients come in, I always tell them that I’m going to get as much done as I can in an hour, because chances are I’ll never see them again. I don’t know how to make oral health a priority in the reservation. We have five dentists and one hygienist covering a population of 14,000 people. There isn’t enough money to provide oral health care to the population – and every year that I have been here, we’ve experienced budget cuts. Some of the internal guilt that I have about leaving is that my position will be open for six months to a year because they can’t pay their dentists enough, and the government isn’t a well-oiled machine.” Bremerman says the application process is so grueling that many applicants drop out before they complete the process, noting that it took a year to find a replacement dentist after one left. And, while tribes with a casino can have better healthcare, it isn’t always the case — according to Bremerman, Neah Bay has done an amazing job. She says, “They still have oral health issues, but they have great, passionate leaders who really care. Others haven’t done such a good job of it. At my clinic, the physicians and pharmacists are excellent and have benefitted from a culture that appreciates medicine and has made it a priority, but they haven’t done the same with dentistry.” 

Rekhi, a successful dentist with three practices, says professionally his toughest challenge is attracting and keeping patients, and adds, “From a collegiate standpoint, I believe that one of our biggest challenges is gaining acceptance from our older, established colleagues, who perhaps have never grown up around or have practiced in environments with minorities. Among other things, I really think the organization needs to focus on what it publishes in the WSDA News. I think some of those articles really turn people off and make people not want to be part of the organization. The older generation is retiring, and those who remain may still have difficulties in relating, but there is still a pack mentality at times. It’s a slow process – you invite people to sit at the table, but then you do something as an organization that makes people not want to be engaged.” At the component level, Rekhi says he and his non-white colleagues can still feel left out — “I think changing that has to start with a grassroots effort by the older membership to welcome and invite new people into the organization. We see a lot of diversity at the new dentists meetings, then when you go to the society meetings those people will go once or twice and never go back because no one talks to them. There’s no welcome, or acceptance. People will say hi and then turn around and continue talking among their clique of five or six people. In all fairness, I know that for many people the meetings are the only chance they have to see their friends, but if you look at it from a professional setting, maybe the organization would benefit from holding socials where the older docs could have that time to share personally, but they could be counted on to be more inclusive in the professional setting. That's how we handle the new dentist meetings we have at SKCDS — executive council members focus on meeting as many new dentists as possible.”

In conclusion
We hope this piece will further stimulate discussion among colleagues, help to create change where possible, and alert dentists in the community to the travails and thoughts of minority dentists. If you would like to be a part of a broader, ongoing conversation about race, or would like to be interviewed for an upcoming article about gender in the community, please email Rob Bahnsen, Art Director./Managing Editor at rob@wsda.org.

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