Opening wide in paradise lost Decay: The rotting teeth of Marshall Islanders symbolize how America's sugary diet has undermined a once-healthy population. Staving off dental disaster is an overworked team of three dentists.

Sun Journal

October 28, 1997|By Frank D. Roylance | Frank D. Roylance,SUN STAFF

MAJURO, Republic of the Marshall Islands -- Dr. Jack Shannon, the last U.S. Public Health Service dentist in the Marshall Islands, would like to be brightening smiles all over the land.

Instead, the wiry, crew-cut former missionary, who heads the only dental practice in this former U.S. Trust Territory, spends most of his time in a cramped hospital clinic here pulling rotten teeth.

"I've seen 6-year-olds with 18 decayed teeth," he says. "The most [teeth] they can have is 24."

An increasingly Western diet heavy with highly refined food and sugar arrived with the Americans after World War II, and now it is turning Marshallese teeth to mush.

And it is likely to get worse. Now that the Marshalls are politically independent, Washington is cutting back. Shannon's job will vanish as soon as he gives it up.

At the same time, the Marshallese government's falling revenues are pinching staff and supplies at Shannon's clinic, which provides the only dental care available in this far-flung Pacific nation of 60,000 people.

"In all developing economies, dental care seems to be the last health area to be addressed," says Shannon. "If you don't have money to put food on the table, dental care just takes a back seat."

So, Shannon, 56, and two expatriate Burmese dentists, aided by two Marshallese dental nurses trained in Fiji, do the best they can.

Their clinic occupies one end of a wing at Majuro Hospital -- a white, one-story prefabricated building moldering in the tropical heat and humidity. There are five dental chairs, four of which work. The space is air-conditioned when the system is functioning. Most months, Shannon says, the clinic sees about 900 patients; in July it set a record of 1,044 patients.

Shannon and his staff do their own paperwork, and make both full and partial denture plates -- 25 sets in July alone. "We can't come anywhere near making all the dentures we need, given all the teeth we pull," he says.

Dental health education is almost nonexistent here, and people generally do not take care of their teeth. More than half the 1,044 people seen in July had teeth pulled, a statistic that would astound the average family dentist in the states.

"On Monday, I was alone here," he says. "I treated 45 patients. I started at 9 o'clock and I had four appointment patients for fillings, and the rest were all walk-in emergencies. I put in nine XTC fillings and pulled 46 teeth."

"The average family practice in the states hardly pulls any teeth," Shannon says. "If they did, and they had a little problem, they'd get sued. So, they send them to an oral surgeon."

"It's frustrating," he admits. "But at least we're relieving pain."

Shannon manages the volume only because he rarely stops to X-ray first: "Ninety-five percent of the time you never run into a complication. If you do, and the tooth is not coming out, you take an X-ray of the root and find the problem."

As busy as they are, Shannon's staff would be overwhelmed if the Marshallese did come in for regular preventive care. "We would probably have to double the size of the clinic, and add three or four more dentists," he says, "which isn't going to happen, I'm afraid."

With so many patients, Shannon is well-known on the streets of Majuro. He drives a tiny white Suzuki pickup, and his off-hours dress runs to khaki shorts, sandals and T-shirts. He speaks quietly and modestly, his eyes wrinkling with wry humor from behind trifocal lenses.

He grew up in the old Belgian Congo, (later Zaire and now the Democratic Republic of Congo) where his parents were missionaries. He received his dental training at the University of Illinois, and later joined the Public Health Service to expand his training so that he could return to Africa as a dental missionary.

"I guess it's part of being of service to mankind," he says of his missionary instincts. "It's a vehicle for spreading the Gospel."

He returned to Africa in 1972, working in an urban dental clinic in Kananga, Zaire. But he fell ill, and eventually had to return with his wife and three children to the states. He later served with the Public Health Service in Memphis, Tenn.; Norfolk, Va.; and at Indian Health Service clinics in Oklahoma and New Mexico before deciding in 1991 to fill a slot in the Marshall Islands.

"I jumped on it," he said. "I've always loved the ocean, and I like warm climates, and I'd always wanted to have a sailboat."

He got the first two, and spends his free time fishing and scuba diving. The Public Health Service pays him $100,000 a year -- modest by standards in the states. His Burmese colleagues are paid $29,000 each by the Marshallese government.

But Shannon's dream of packing a sailboat with portable dental gear and sailing to treat patients on remote Pacific islands died when the sailboat he bought was damaged en route to Majuro and could not be fixed.

So, he labors on at Majuro Hospital. Divorced, he is alone now except when his children come to visit. Two daughters stayed for a year and taught in local schools.

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