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Something to Smile About


tow1Dr. Lashley is Professor of Community Health Nursing at Towson University. She has served as a volunteer nurse at the Helping Up Mission in Baltimore, Maryland for seven years. She was elected to the Helping Up Mission Board of Directors in August, 2007. Dr. Lashley is Board Certified in Advanced Public Health Nursing through the American Nurses’ Association. She has been a nurse for 29 years and has taught at Towson University for the past 24 years.

As a Professor of Public Health Nursing in a large, metropolitan university, I have devoted most of my professional life to teaching aspiring nurses how to care for vulnerable patients and their families outside of the traditional hospital environment.  Due to escalating health care costs, much nursing care is now provided within the home and community. Students visit patients’ homes, assessing the health needs of each member of the family, performing physical examinations, teaching patients about their medications and disease conditions, and referring them to health care resources in the community. They also conduct health education and awareness programs, educating the community about how to stay healthy, bringing this message to them where they live, work, play, and worship. 

 I had never considered working with the homeless, much less involving my nursing students, until I was sitting in church and heard a group of men speak from a local rescue mission in my community. I was moved by their compelling stories and became acutely aware of the many unmet health needs that were a part of the experience of homelessness and addiction. One day, I mustered up the courage to visit the mission. This started a process that, seven years later, has blossomed into something I could never have imagined.

Each semester, when I introduce this site to my students, their reaction is mixed. Many are wary, concerned for their safety, and wonder what it will be like to work with homeless men, many of whom have a record of incarceration and years of hard core chemical addiction.  Yet, every semester, I see the transformation in their thinking and attitude as they interact with persons one-on-one and come to know each individual as unique and of immeasurable value. 

tow4The mission provides addiction recovery and overnight shelter services to over 400 homeless men in Baltimore City.  We started by approaching homeless residents and asking if they would like to have their blood pressures checked. Then, we would invite dialogue on their past and current health status, compiling information on their major health complaints and needs. We organized health fairs and screening programs, addressing the most pressing health issues in the population including heart disease, high blood pressure, diabetes, HIV, foot care, and basic hygiene.  These programs were provided to the mission free of charge. 

Over time, it became clear that dental care was an urgent health need. Access to medical care was far better than access to dental care for this poor and uninsured population. It was not uncommon for men to come with abscessed, rotting, or crumbling teeth asking for help.

At first, I thought all I needed to do was find them a dental clinic in the community to serve them.  But it was not that easy. Most clinics that serve the poor still charge a sliding scale fee, which is often cost prohibitive for the homeless.  It did not matter if it cost $30 or $300 to get a tooth extracted when a man only had $5 in his pocket and needed 15 teeth pulled. The waiting lists for treatment were long, and transportation was an obstacle to accessing treatment.

I searched for grant funding and dental colleagues to help address this unmet need.  Seed funding from a private foundation enabled us to initiate an oral health program at the Mission.  Nursing, dental, and dental hygiene students provided on-site education on basic oral hygiene, signs and symptoms of oral cancer, and nutrition. Residents were screened for oral health problems by volunteer dental faculty and students from a neighboring university dental school. Treatment services included preventive and restorative care such as cleanings, fluoride treatments, fillings, extractions, periodontal care, crowns, root canals, and dentures. 


The program, which has been sustained by nearly a half million dollars in funding, has engaged over 500 dental, dental hygiene, and nursing students and provided preventative and restorative care to nearly 600 homeless Mission residents. I believe the program has achieved its goals to improve clients’ oral function, appearance, and self-confidence so that they may enjoy better health and improved employability and to inspire future health care professionals to work with homeless and underserved populations.

This community engagement initiative has impacted students and the men served through it.  As one man impacted by the program reflected:

“I came in as an emergency patient from the Helping Up Mission for a tooth pain. I had been taking antibiotics (3) three times this year for the problem but it kept resurfacing.  Your students explained that since the tooth was infected inside the antibiotic was only a temporary relief never fixing the problem.  Knowing that I have not been at the…Mission very long, I knew that the only thing that the school was going to do was yank the tooth out.  I was overwhelmed when your students asked me if I wanted to save the tooth.  Just hearing that somebody actually cared what I thought or wanted meant so much to me”….I then received a partial root canal and a temporary crown so that when I am able to receive [comprehensive] care the tooth can be permanently saved and repaired. The word that comes to my mind is ‘Grace”. I received something that I did not deserve.  The University and its students looked past the fact that I am a homeless man with nearly 30 years of an active addiction.  Instead they saw a human being who needed help and hope that only they could offer....”

tow3Another story illustrates the impact of this program on a client’s long term recovery.  A resident shared how men who are not willing to complete the one year recovery program choose to stay in order to receive dental care. While they are waiting to receive services, they spend more time in recovery and gradually experience the transformation that comes about from being immersed in a culture of recovery. Although initially motivated to remain in the program because of the dental care they would be eligible to receive, they end up staying, working the program, and ultimately achieving long term recovery.
The program has been successful in restoring dignity and oral health to the lives of homeless men and has inspired students in the health professions to work with underserved populations.  Of the 221 dental, nursing, and dental hygiene students surveyed to date, 99% report they would consider volunteering their professional services and 95% report they would consider working in settings that provide care to the homeless and underserved.  Here are some journal excerpts to illustrate this transformation in world view:

I used to think that homeless people were careless, were of low education and socioeconomic groups, and had no manners. That is what the media portrays the homeless to be…Anyone can become homeless at any time…addiction does not discriminate….I have learned and grown so much this past semester and am so grateful to have had the opportunity to work with these men.”
“I have not expected having such a broad and mind opening experience. This particular experience definitely had a huge impact on my life and the way I was thinking.”
“The men are neither heathens nor criminals like I expected…”

 “I have to admit that when I found out I would be assigned to the…mission, I was a little discouraged. My initial thought was:  how do I help someone who does not want to help themselves? I could not be more wrong…. I left the mission that day with a completely different perspective. These were not just men with addictions who were pulled off the streets. These men wanted a better life, to overcome their addictions, to make a difference.” 

tow2“When I heard about the program initially I was a little wary. However, since I decided to treat a HUM patient, I know my view has completely changed. These are great guys who made a mistake and are turning their lives around. It’s really exciting to be part of that process since an improved smile can really help someone’s confidence and, in turn, the way others perceive them.”

“Being at the mission has changed my whole outlook on addiction….Everyone has different life circumstances that may have contributed to addiction, and they should not be wrongfully judged as being weak, or immoral.  People with addictions deserve a chance to put their lives back on track…”
“I have learned from these men the meaning of hope, endurance, courage, strength, and love. I learned that to fall does not mean defeat.  I have learned that to hit your bottom, does not mean your end.  I have learned that a kind word and a warm heart can make the difference in someone’s day.  I learned that truly listening is often the best medicine and patience truly is a virtue. I learned that what we do not have makes us stronger if we work towards our goals with honesty and integrity…I have learned that anything is possible and with the generous help of others the “possible” is easier. I have learned that to support another human being without expecting anything in return is the greatest gift a person can give themselves.  …the power of the mission has changed me. It has moved me in ways that I don’t even think I have come to realize yet.”

Enduring social change occurs as participants embrace a new vision for the future and experience a transformation in world view. Both clients and aspiring health professionals consistently report being deeply impacted by the program. When students in the health professions begin their careers inspired to work with underserved populations, they become a powerful force for change and exert a profound impact on their professions and their communities. These are people who may one day give back by providing free dental care, volunteering in a homeless clinic, or advocating for better access to health care for the poor. In essence, they create a sustainable work force that is able to provide health care to the poor and homeless well into the future.

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