In Shakhzada Baina Zarova’s telling, relocating to the U.S. from Kyrgyzstan has been “a dream.” Since settling in metro Atlanta in 2015, Baina Zarova had her three children: ages 2, 4, and 6. Her husband supports the family by working as a forklift operator.
“I love America,” Baina Zarova says.
But life in the refugee haven of Clarkston has come with a painful inconvenience. In the seven years she has lived here, Baina Zarova has been unable to see a dentist. The only plan the family can afford on the federal health insurance marketplace doesn’t cover dental care.
The result is near constant toothache, which Baina Zarova tries to manage – and prevent from getting worse – by taking over-the-counter painkillers, increasing her calcium intake, and avoiding food that is either too hot or too cold. She can only tolerate ice cream, she says, if it’s been out of the freezer long enough to have nearly melted. According to Baina Zarova, dental problems impact the day-to-day of most of her acquaintances.
“Here in Clarkston, every refugee needs help with dentist. Absolutely.”
Refugee advocates say that some of the factors blocking refugees’ access to dental care are similar to those that nonimmigrant low-income communities face, such as cost barriers or the difficulty of finding a dental practice that accepts Medicaid. But there are additional challenges. Language access and transportation issues complicate the picture for refugees and other vulnerable immigrants. Advocates say bad teeth take an underdiscussed toll on refugees’ quality of life, exposing newcomers to physical pain and even social stigma, of the kind that can restrict access to certain jobs and even delay the process of integration.
It’s a problem that will likely get worse before it gets better, given the recent influx of refugee arrivals and lack of comprehensive solutions on the horizon.
Credit: HYOSUB SHIN / AJC
Credit: HYOSUB SHIN / AJC
“It’s a huge issue,” said Dr. Hogai Nassery, a family medicine practitioner.
Last fall, alongside fellow members of the local Afghan immigrant community, Dr. Nassery co-founded the Afghan American Alliance of Georgia (AAAGA), a nonprofit that helps evacuees from Taliban-controlled Afghanistan start new lives in the Atlanta metro area.
Dr. Nassery says her team of volunteers are scrambling to find solutions for many families in need of “significant” dental care, raising money to cover the cost of procedures and contacting dental practices to see if they would be amenable to seeing refugees pro-bono.
“We’ve all reached out to our own dentists to see if they can help out,” she said.
“It’s not like they’re going to get the teeth repaired. They just need to be pulled because we can’t afford the cost of a crown and all this stuff.”
Upon settling in Georgia, refugees are given Medicaid coverage through the state’s Refugee Health Program. But that coverage lapses after eight months, and it can be difficult for newcomers to find providers that will take their insurance and arrange transportation to make it to an eventual appointment.
That’s the situation that that Ahmad Farid Frotan, 28, and Rahima Rahimi, 27, find themselves in. The couple, parents to a one-year-old, fled Afghanistan and were resettled in Clarkston last November.
Frotan says he has tried to make appointments at different dental offices but “they said we don’t cover, you should pay money … it’s very difficult for us. We don’t have enough money right now.”
Frotan makes $14 an hour working at an AC repair business. He says his wife would like to fix the teeth she has left. She had several pulled already back in Afghanistan because she couldn’t access routine dental care there either.
“My wife sometimes she has shame. Not smiling, not laughing because of her teeth. ‘My mouth is empty how I can smile? How I can laugh?’ It’s very big problem for us.”
On a Friday late last month, Frotan, Rahimi, and their daughter Sosan had walked to Ethne Health, a nonprofit clinic in Clarkston, for a medical checkup.
Credit: HYOSUB SHIN / AJC
Credit: HYOSUB SHIN / AJC
Because of the influx of Afghan evacuees like them, the clinic is now seeing over 850 patients per month. Though Ethne doesn’t provide dental services – aside from fluoride varnish treatments to help prevent tooth decay – complaints over oral health are common.
“As a medical provider, on a good week, I can see maybe 10 or 12 people that come in and say I have teeth pain, or they have an abscess or inflamed gums,” said Dr. Esther Kim, chief operations director and co-founder of Ethne Health. “A lot of people think oral health, having good teeth is just a privilege. It’s actually not. It’s so crucial to your health … There’s a lot at stake.”
For patients who are insured, Ethne staff has identified three dental practitioners in the Clarkston area that accept Medicaid. From January to June, Ethne sent out 83 referrals to those dentists. But whether refugee patients get the most out of those dental appointments isn’t guaranteed.
87% of referred patients have no English-speaking ability, and dental offices are generally unable to provide interpretation services. Transportation is also an issue.
“Many of our patients, even if they have Medicaid that covers for dentistry, they may not be able to go [to appointments]. And so, they’re not going and they’re rotting away their teeth,” Dr. Kim said.
At a gathering of refugee advocates and service providers held in Clarkston in May, Dr. Kim said her “biggest wish” would be for Ethne to open its own, nonprofit dental clinic within walking distance of refugee populations.
Experts say several such initiatives would be needed to meaningfully address dental health disparities.
“The scale of the need is so immense that, you know, one mobile unit, even one clinic, Ethne opening one clinic, it’s not even going to touch the immense need,” said Mary Helen O’Connor, deputy director of the Prevention Research Center at Georgia State University, which is currently conducting a study to better understand the dental needs of refugees and immigrants.
“It’s a very difficult problem.”
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