By Becky Smith, CRDH, EdD, FAHDA
2023-2024 ADHA President
November 20, 2023

As we celebrate Native American Heritage Month, I reflect on a decade of my life that I spent working with and for a Native American tribe as their dental hygienist. (No, I didn’t brush alligator teeth!)

 

Growing up in what is now southwestern Miami-Dade County, I would occasionally see Miccosukee tribal members at my junior high. Their last names intrigued me: Osceola, Cypress, Billie…they were not everyday names from a telephone book (Am I dating myself or what?). The Miccosukee Indian Reservation was located in the Everglades, approximately 40 miles west of my home, and I would see them at the grocery store my family frequented as it was their closest grocery store, too.

My First Job Was on a Reservation

Fast forward to the 1990s: I had just graduated dental hygiene school, was newly licensed, and looking for a job to put my new skills to use. In the Miami Herald I found one hygiene job posted: the Miccosukee Tribe was seeking a dental hygienist. I recalled how the tribal members I had seen interested me and I was immediately intrigued. In all my years in Miami, I had driven past the tribe’s tourist center on fishing trips to Everglades City with my dad, but I’d never stopped to visit. This was my opportunity to learn more about the true natives of this land – an immersion opportunity – so I applied.

After several interviews the job was mine. I was ecstatic! One of the requirements had been at least one year of experience but I figured I must have interviewed well because they hired me fresh out of school. I couldn’t believe it! I had only applied to one job and I nailed it! The official job title was “Public Health Dental Hygienist” but I later came to realize the more accurate title would have been “Becky of All Trades.”

At first, the tribal members were suspicious of me since I am NOT Native American, and I asked a LOT of questions about their culture and beliefs. While tribal members were initially hesitant to pay me a visit, we soon built mutual trust as they understood the intent of my questions was to help me provide better care.

A Rich Culture, Native to the Southeast

The culture of the Miccosukee Tribe is rich with legends and beliefs passed down for hundreds of years. They were originally part of the Creek Nation north of Florida but migrated to Florida in the early 1700s. Most of the Miccosukee were captured and removed westward in the 1800s during the Indian Wars but a few hundred went south and hid in the Everglades. Today’s tribe is thriving at over 600 and are direct descendants of those who avoided capture.¹

While they do have their own language “Mikasuki”, there was no written language until the early 1970s when tribal members created the Miccosukee alphabet and put words to paper. I learned several phrases that helped me when I saw tribal members who only spoke Mikasuki:

Chehentaamo!        Hello!

Shenobisha!       Thank you!

Chenoote nowaachimo?    Does your tooth hurt?

Cheloo kenaa!         Hurry up!  (This one helped with the kids!)

Autonomy Comes With Many Hats

Tribal lands are under the jurisdiction and control of the federal government, not the state, so the rules were different. I didn’t know until I started that I was going to be working independently, making most of the daily decisions on my own. A dentist was available by phone for consultation but came in person only one day a month. Yet, the tribe’s contract with the Indian Health Service stated that all Health Department employees would abide by the laws and rules of Florida. So, I contacted the Florida Board of Dentistry for guidance, but was told I could do what I wanted because I was on federal land. Not so helpful!

The dentist would visit monthly, review my charts and then administer treatment based strictly on exams of the patients I had seen the previous month. You would think it impossible for him to see a month’s worth of my patients in a single day, but my time all month hadn’t been focused solely on practicing clinical hygiene. I wore MANY hats because…public health.

 

In the 10 years that I worked on the reservation, I became the tribal Health Department’s Safety Officer. This included incident reporting and several policies and procedures manuals, including Hazard Communication, Bloodborne Pathogens, Exposure Control Plan, Fire Safety Plan, Hurricane Plan, the dental clinic’s infection control policies and procedures and more. I provided training and enforcement to Health Department staff specific to those policies and procedures, provided oral health education at the Tribe’s school (K-12), Head Start Program, and Daycare Program. I ordered the clinic’s supplies and equipment, learned how to be a dental assistant, completed, filed and collected insurance claims, provided and coordinated dental health promotion/disease prevention (HP/DP) activities for the tribal community and completed home visits for those members who were homebound, and so much more filled my days outside of clinical hygiene.

Is it any wonder that the dentist was able to see “all” the patients I saw in a month in one day? Eventually, I was able to convince the Tribe’s Chairman to hire a dentist for one day a week, and eventually two days a week. We evolved our clinic from providing only preventive care, to a fully operational dental clinic, providing our patients all kinds of dental care from fluoride treatments and prophies, to root canals and veneers.

The Miccosukee Tribe was the first Tribe to become a 638 Authority program. 638 Authority is a legal tool for Tribal self-determination and control of eligible federal programs.² This meant that although the Tribe had a contract with the Indian Health Service (IHS) which prescribed where the Health Department monies would be distributed, the Tribe now had complete control of HOW they wanted it distributed. The IHS officers provided guidance and site visits, but no IHS officers were placed at the Tribe as healthcare providers. The Tribe could oversee and have final say in everything.

Lifelong Memories and Friends

I loved working at the Miccosukee Tribe. Some days were filled with back-to-back patient visits, while other days were spent attending the Head Start program or high school graduation. The benefits of working at the Tribe were generous: paid CE and travel; health & dental insurance, paid vacation and sick time, 401k matching …just about everything you could want in a benefits package. Every day had new excitement, new learning, a new patient to meet, a new challenge to overcome.

I made many lifelong friends among my coworkers. My youngest sister married a tribal member and they share three daughters. I had the pleasure of watching my niece Heide graduate 12^th grade from the Miccosukee Indian School this past May and I reconnected with people I hadn’t seen in over 20 years.

I am grateful for my experiences working for and with this Native American tribe and proud of our accomplishments improving their oral health, overall health and access to care over those ten years. Sharing their lives and their culture enriched my life in many ways and expanded my understanding of different cultures and beliefs, helping me grow as a person in the process.

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References:

1. History of the Miccosukee Tribe. https://miccosukee.com/miccosukee-tribe-history/ Accessed on 11/16/2023
2. Public Law 93-638 Indian Self-Determination and Education Assistance Act, As Amended. Department of the Interior, Bureau of Indian Affairs. Department of Health and Human Services, Indian Health Service. https://www.bia.gov/sites/default/files/dup/assets/bia/ots/ots/pdf/Public_Law93-638.pdf Accessed 11/15/23