When Treasury officials managed in 1994 to extract free dental care for children from the National Health Insurance Bill, they probably felt they were saving the public coffers from a major drain. But they didn't consider the great loss to society.
It took mega-businessman Ilan Ben Dov, who recently took control of the Partner (Orange) cellphone company to explain the social and human damage caused by the inability to afford dental care, which is a NIS 5 billion business in this country, with 95 percent paid by patients.
At a seminar at the Hebrew University-Hadassah School of Dental Medicine, Ben Dov said: "When a six-year-old has a cavity, and it hurts, he cries. His parents can't afford to take him to the dentist. What will his mother do? He goes to school and suffers. He causes trouble in class, and maybe the whole school suffers.
"Everyone pays health taxes for treatment of their whole bodies, except for what goes on in their mouths. Why are eyes and skin - even psychiatry - covered but not the mouth? Weak populations have very little awareness about dental health. While middle- and upper-class parents teach their children about brushing and diet, the socioeconomically disadvantaged who can least afford it don't. They struggle every day just to survive," said Ben Dov. "Some don't even know such treatment is not in the basket of health services."
THE SUCCESSFUL BUSINESSMAN, a speaker at the seminar on "Voluntary Dental Health Projects for Special Populations" at the dental faculty on Jerusalem's Ein Kerem campus, was not merely talking. Three years ago, he established a private organization called Derech Lotus that provides free, high-quality dental care to thousands of disadvantaged children around the country (including Beduin) as well as a wide variety of other social projects.
"We just opened our 17th dental chair a few weeks ago. We hope to offer 100,000 treatments in 2010, he said, praising Ya'acov (Kobi) Weisel who runs the free clinic services for Derech Lotus.
The lotus was chosen as the name because these blossoms flourish even in swamps. Thus Ben Dov and his colleagues looked for fields neglected by the government and have kept their activities - which included teaching marginal youth to train dogs otherwise destined to be "put down" - low key. The businessman declared that there is a "window of opportunity" for the provision of free dental care for children and perhaps other needy groups because of simultaneous support by the finance minister, the deputy health minister, voluntary organizations and dental medicine academics.
DEPUTY HEALTH Minister Ya'acov Litzman recently recommended that the health services include dental treatment for children. "I'm glad to have put dental care on the public agenda. I know the problems and arguments. We are studying the matter," said Litzman at the seminar. But even if the government finds the money to provide basic coverage, he said, "Lotus will surely find ways to help those left out."
Weisel, who also addressed the seminar, said Derech Lotus has annually spent NIS 3.5 million on free pediatric dental care alone, and in 2008 provided 18,000 hours of treatment to 8,000 youngsters.
"The problem is huge. We go to the mayor of each municipality to get his cooperation, as the recipients have to be recognized by the welfare authorities as genuinely needy. But we also consult with school principals, as some families are too ashamed to go to welfare."
Derech Lotus has 30 dentists and 60 workers in 13 clinics. It finances everything, but salaries are channeled through local voluntary organizations. "We train them, buy materials and have a central computer terminal that allows us to know what all the dentists are doing at any time," added Weisel. "We don't want any child to be overtreated. The professionals have monthly targets, and we insist on quality. We make both scheduled and surprise visits to monitor them."
YEROHAM MAYOR Amram Mitzna came to speak of how families in the southern development town appreciate what the clinic established by Derech Lotus, the International Fellowship of Christians and Jews (IFCJ) and the Hadassah dental school has done. Mitzna noted that people with neglected teeth often suffer from malnutrition because they can't eat properly. "It isn't easy to find high-quality dentists to work in clinics. We have to reach people who don't necessarily know they need care or where to get it," he said.
The former Haifa mayor said children must be brought to dental clinics "before it hurts. One has to go to homes and persuade them to go, and call them the night before to remind them. We also give dental services to the elderly, with help from a variety of ministries."
The municipality owns the clinic that was built by funds from Mifal Hapayis, and the Yeroham Foundation pays for ongoing costs including equipment and hires dentists. Mitzna displayed a letter written in braille to Ben Dov and Weisel by a blind Yeroham girl who said how much the treatment changed her life.
Dental faculty dean Prof. Adam Stabholz noted that Alpha Omega, the Jewish dental fraternity that established and helps support the school, is active in social involvement. Prof. Jonathan Mann, head of the faculty's department for community dentistry and organizer of the seminar added: "There are many people who can't work because of untreated dental problems. If you cope with dental problems, you alleviate a whole range of social problems not only in children, the elderly and Holocaust survivors but also in working people."
Some of the charitable projects encourage local and foreign dentists to volunteer, while others are paid subsidies; some charge reduced fees, while others take nothing; some dentists are paid with fees for service (as in Derech Lotus), while others get a set amount per head; some treat patients voluntarily in their private clinics, while others go to special ones (like Jerusalem's Dental Volunteers for Israel (DVI); some, like the Israel Dental Association (IDA) treat only Holocaust survivors and others only the elderly. Mann noted that as health funds increasingly offer supplementary health insurance but 20% or so can't afford it (or don't want it), the social gaps have grown tremendously.
IDA chairman Dr. Yitzhak Chen said the government "has never invested in dentistry. It's all private or supplementary health insurance in the heath funds. If it is added to the basket of health services, I don't know who will provide the service. The health funds won't be able to afford NIS 200 million worth of free dental care. In some localities, health fund dental clinics are better than private ones, and in others, private clinics are better."
Although the IDA tried to run a major volunteer dentist project, it failed, and it has limited itself to making crowns, implants and dentures for 500 Holocaust survivors, with help from Israel Defense Forces' dental labs that donate their time.
IFCJ director Dvora Ganani, whose organization's president is Rabbi Yechiel Eckstein, said it has provided NIS 250 million to the needy around the country over the past nine years, with almost NIS 18 million spent on dental care in cooperation with Hadassah dentists.
A veteran organization that offers dental care to the needy is Meshulash, established in 1976. Its representative, Malka Brick, explained that it has no staff dentists but sends needy patients to private clinics where 150 dentists work voluntarily. "Patients sit in the waiting room like any paying patient, and nobody knows they don't pay." Any recipient who is physically, socially or mentally able to work but doesn't cannot be included unless they get a job. Some of the free patients have monthly incomes of less than NIS 1,000, Brick said. Meshulash charges a relatively small amount for major work such as crowns, but Holocaust survivors and others who cannot pay get it free.
DVI, LOCATED in Jerusalem's Mekor Haim neighborhood, was founded in 1980 by the late Trudi Berger, a Holocaust survivor married to a Jerusalem Municipality official. Today, the free clinic is run by pediatric dentist Dr. Motti Moskovich and is devoted to underprivileged children referred by the welfare authorities; 1,200 are seen each month. Some youngsters don't even know what to do with a toothbrush.
"There are many who come to us completely neglected. They can't eat or sleep properly due to tooth loss and pain. They can't pay attention in school because they suffer from chronic infections that could easily have been relieved by simple treatment," said Moskovich. "We offer comprehensive oral healthcare, all free, provided by 140 volunteer dentists, most of them from abroad who stay in a DVI apartment for a month." These professionals are the only foreigners approved by the Health Ministry for treating Israeli patients without having to obtain a temporary license; the clinic is recognized as a teaching clinic for pediatric dentistry.
THE PEF-ISRAEL Endowment Fund has run the Casper-Plitnic Health and Community Service Center in Jerusalem's Bokharian Quarter with two dental clinics for 25 years. The services were established by the late former chief rabbi of South Africa, Rabbi Moshe Dov Casper, who was moved by the needs of residents in the neighborhood. The Jerusalem quarter was "matched" with Johanesburg for Project Renewal in the 1970s. Dental care for children is now offered not only there, said representative Moshe Kahan, but also in Beersheba, Bat Yam and Haifa (to be joined by Kiryat Yam next year).
Finally, Yad Sarah - with its more than 100 medical-equipment lending branches around the country - has operated a dental clinic for the elderly at its Jerusalem headquarters for 15 years. Now headed by Dr. Sarit Palmon, the four-chair clinic depends solely on volunteers and has become expert in geriatric patients who take many medications for chronic diseases, and many come in wheelchairs. It even has facilities for making panoramic X-rays. Last year, almost 1,000 patients received 7,000 treatments from 45 volunteer dentists, each of whom commits himself to working there for three years. In some cases, a mobile clinic visits the homes of people who are homebound.
Mann concluded the seminar by noting that such a variety of charitable groups quietly help people who can't afford dental care that he himself was unaware of some of them. One of the aims of the seminar, he said, "was to find them, eliminate duplication, trade tips and bring them together to establish a national roof organization."