Off-Island orthodontics take a high toll

Getting braces on Haida Gwaii is a bit like sailing round-trip between Skidegate and Japan to buy a new car.

Getting braces on Haida Gwaii is a bit like sailing round-trip between Skidegate and Japan to buy a new car.

Just ask local parent  Shelley Sansome.

Sansome’s youngest son needs braces, which means about two years of monthly ferry trips to the orthodontist in Prince Rupert — more than enough ‘sea miles’ to visit Osaka, Japan.

After doing the same for her older son and daughter, Sansome already has a good idea what all those ferry tickets, hotel bills, and orthodontic fees will cost.

“I told him if he doesn’t get braces, I’ll buy him a car,” she said.

“It’s the same price.”

For Sansome and dozens of other families on Haida Gwaii, orthodontic care is no joke.

Even when a family is covered for travel and orthodontic care, and many are not, the current ferry schedule means missing three days of work or school for each visit.

For decades, Haida Gwaii patients used to take a Monday “turn-around” sailing to Prince Rupert, arriving at 5:30 p.m. and heading home again at 11 p.m.

Often, parents would team up to look after each other’s kids.

When they arrived, Dr. Jeffrey Corbett, like the Prince Rupert orthodontist before him, used to keep his office open late so he could see most of the Haida Gwaii patients in one go.

But in April 2014, BC Ferries cuts spelled the end of Monday turn-arounds.

Sansome, whose daughter has braces now, explained how it works today.

“She has to miss one Tuesday, Wednesday and Thursday of school once a month just to have her braces tightened,” she said, which also means two nights in a hotel or hostel.

“And that’s for a 10-minute appointment.”

Dr. Asef Karim is a Vancouver-area orthodontist who is working with the UBC to develop an orthodontic program for remote communities.

In December, Dr. Karim published a report based on the first-ever survey of orthodontic need among school children on Haida Gwaii.

The survey looked at children because when people get orthodontic care in childhood, they are far less likely to need surgery as adults.

Out of the 215 elementary and high school students who took part, 94 needed some kind of orthodontic treatment — more than double the Canadian average. About a third of those students had complex cases that required extra attention.

Reviewing the survey results, Dr. Karim could find no significant trends based on ethnicity, gender, or where students lived.

“Looking at all the factors, it would probably just be from being remote and isolated,” he said.

In his report, Dr. Karim outlined two possible answers to Haida Gwaii’s lack of orthodontic care: a fly-in private practice, or a regular rotation of UBC orthodontic students at the islands’ existing dental clinics.

“The most ideal thing would be if someone actually stayed there locally,” said Dr. Karim, noting that it would give the orthodontist a better chance to know his or her patients, and integrate into the community.

While there are some hurdles when it comes to staff schedules and funding, Dr. Karim said graduate students  would provide the same quality of care.

“A lot of people think of school treatment as inferior or something, but it’s actually the other way around,” he said.

“Nothing can be missed if it’s supervised to the 10th degree.”

Asked about the survey results, Dr. Corbett said he isn’t surprised by the need for care.

Getting to his Prince Rupert office from Haida Gwaii has become a lot harder since the ferry change, but it’s always been a challenge, he said, as it is for patients from other north coast communities such as Hartley Bay and Lax Kw’alaams.

Dr. Corbett agreed that having a fly-in service on Haida Gwaii would be ideal, if challenging.

“If you ask the average orthodontist, who is working in an office with all the bells and whistles at their fingertips, they’d probably say no, you can’t do it,” he said.

“But when it comes to the logistics of equipment, supplies and staff, I’d say it’s very possible.”

Besides his clinic in Prince Rupert and another in Alberta, Dr. Corbett offers basic services for McBride, a village of about 600 people.

With two suitcases of equipment and space at a local dental office, Dr. Corbett can handle most routine appointments so his McBride patients only need to make the long drive to his Alberta clinic a few times over the course of their treatment.

As for having a rotation of graduate students on Haida Gwaii, Dr. Corbett questioned the idea.

“It would be important to have a supervisor or orthodontic instructor who would be there consistently,” he said.

“Then the obvious question is why not have them do the work?”

Dr. Corbett said he has considered a fly-in service to Haida Gwaii himself, but he is already stretched for time and UBC has said for years it might start a students’ rotation.

However it gets resolved, Dr. Corbett said it’s concerning how many children on Haida Gwaii are going without orthodontic care.

“I’ve served in Prince Rupert for coming on 18 years, and it’s a patient population I know well and enjoy working with,” he said.

“In an ideal world, every kid who wanted braces would be able to get them.”