Dentistry in the Navajo Nation: Q&A with Dr. Crystal Willie Sekaquaptewa

by Allee Mead

As the managing dentist of Monument Valley Dental Clinic and assistant dental director for the company, Dr. Crystal Willie Sekaquaptewa is the first Native American to work as a dentist in the Utah Navajo Health System. Becoming a dentist to serve elders like her grandmother, she now inspires the youth in her community to pursue a career in dentistry. In this Spotlight interview, she discusses the disparities and strengths in her service area as well as her advice for others considering a career in rural America.

Tell me about your path to dentistry.

I feel that when I give someone dentures, it's like I'm giving them to my own grandmother. I'm fulfilling something I never had the opportunity to do.

I'm Native American, from the Navajo tribe, and my family originates from New Mexico. I got into dentistry because within my own family I saw a need. My grandmother was truly my inspiration. My grandma didn't have teeth, and I never understood as a little girl why. I saw her struggle to eat and I saw how her malnutrition affected her muscles and bones. With a lot of my patients, we do dentures, and those days are the best. I could never put into words how it feels to deliver a denture and to be able to instantly change someone's life. I feel that when I give someone dentures, it's like I'm giving them to my own grandmother. I'm fulfilling something I never had the opportunity to do.

What role does patient education have in your practice?

Patient education plays a big role, because frequently you assume people know the basics. For me, in my practice, I strive to educate as much as possible, because if patients know the why, then it'll help them to make better decisions about their health.

It's your mouth; it's such an intimate space, and the things we do are so small and tedious. If patients really understand the reasoning behind why a tooth would need this as opposed to that, then hopefully the next time around, we can change — if not for themselves, then for future generations. It's amazing how frequently patients comment, "Wow, nobody told me that!"

If you tell patients, "You should be doing this, or you should be doing that," it could negatively affect their confidence. If you sit down with that patient and show them a model or a picture, and you explain why, they're more responsive to it. Instead of using big words like periodontal disease, you can explain, "This is how it affects your bones." When you do that, the communication is improved but, more importantly, they also get more comfortable with you.

The majority of my patient population is Navajo. The Navajo language is the predominant language, so it's important to have someone there to interpret and to make sure that our patients are getting a full understanding of what we're trying to communicate.

What challenges are there that go along with practicing in a remote environment? How do you deal with those challenges?

When patients come, some have driven hours just to see you. You have patients who have come from near and far, who need help, so you do your best to help everyone.

I remember in dental school, my professors would say, 'Oh, you'll probably see this once every five years.' It's amazing how, in some of these rural communities, you see things like that more frequently, just because you have a broader service area.

You may be the only location that provides certain services. As a provider, you have to be prepared to do everything. I remember in dental school, my professors would say, "Oh, you'll probably see this once every five years." It's amazing how, in some of these rural communities, you see things like that more frequently, just because you have a broader service area.

We make dentures and crowns, and we place implants. The labs we use are all in the city (at least 5 hours away), so we have a longer wait time as far as shipping and getting materials to us. It can sometimes be frustrating, but we're prepared and we prepare our patients for that wait time. We are fortunate to have amazing and understanding patients, staff, and doctors who work together.

I would say another challenge would be consistency with doctors — not with my facility, specifically, but I know it's a struggle for surrounding facilities. Doctors do some time and then they leave. For patients it's a huge disadvantage, because they get to know and trust a provider, but then they leave. For any rural community, that's probably one of the hardest things for the patients to deal with in maintaining healthcare.

You talked about edentulism (toothlessness) in some of your patients. What factors do you see as the root cause of that and other oral health disparities in your community?

I would have to say patients not understanding the connection of oral health to overall health, and that goes back to patient education. Not realizing, "How does my mouth affect me when I'm pregnant? How does tobacco affect my mouth?" I think a big factor is knowing that healthcare is a full circle and all providers strive for a common goal.

What strengths do you see in your service area?

I'm very fortunate to work on the Navajo reservation but also to live here and immerse myself in a different community other than my own. In my area, specifically, the people are maintaining some of the traditional aspects of the culture. It's such a beautiful culture, and to see the culture preserved and passed down for generations, it is so special. I would say another strength is just the hope and the desire to get more Native Americans into higher education and getting them into the education or healthcare professions, so they themselves can make a difference in their own community.

Being in a small community, you get to see how they rely on each other and build each other up.…They want to improve and hope to see their youth succeed. Being able to witness their success is one of the perks of working in a smaller community.

Being in a small community, you get to see how they rely on each other and build each other up. Whether it's from the clinic setting, from education, to just the little grocery store down the road, this community helps one another. They want to improve and hope to see their youth succeed. Being able to witness their success is one of the perks of working in a smaller community.

Why are cultural competency and representation important for health, especially tribal health?

With a lot of Native American tribes and the culture in general, it's a lifestyle. It is important for providers to know what their patients' home conditions are and what their barriers to health are in general. These things play a major role not only in gaining trust but ultimately understanding patients better. I am Navajo, and I'm fortunate to work amongst my people. When my patients find out that I am Navajo, some of them immediately trust me, which I am very thankful for. Trust is the most important thing you need with your patients, and so I'm very fortunate to be able to immediately have that with some of mine.

What success stories can you share?

I have a lot of little girls who come into the clinic, and I try to be an example to these younger kids. When little girls tell me, "I'm going to be a dentist too," and they come and ask questions, it feels good to know, "Hey, if I can do it, these little ones can do it too." I try to be as encouraging as possible.

A lot of patients do come in with toothaches. The best part about my job is being able to get them out of pain. I went into dentistry because if there's a problem, there's always a solution. It brings me peace to know that if someone comes in, I have the ability to help them or direct them to someone who can.

Is there any work going on in inspiring the next generation of healthcare professionals in your community?

The Utah Navajo Health System works with different schools and colleges in allowing med students, physician assistant students, dental students, and even just college students the opportunities to experience and shadow the healthcare profession. I love that these students get to see what a rural clinic is like and that they get to learn about more rural opportunities. Even if they don't stay with us, they are aware that they could go to another reservation or another place in the country to serve a community like ours.

It is so important in working in a rural location that you immerse yourself into that community and involve yourself in the things that are important to them. My husband is a teacher, so by default I was going to basketball games and football games. Just for the kids to say, "Hey, there's my dentist," to see you out there, it further builds that trust, but it also lets them know that you care.

Every Wednesday morning is flea market day, so a lot of the patients cancel appointments or head that way to go shop or get some food. It's amazing how there are those events that mean so much to a rural community, and I don't think people tell you that. There's no handbook of what to do. If somebody was considering working in a rural community, they need to know the importance of those little events and understand how they factor into providing excellent care.

I love dentistry — I love the interaction that I get to have with my patients. But, more importantly, I enjoy seeing the difference that we're able to make in the community, to see the community thrive not only with myself but with other providers who are there to help and service them.

Opinions expressed are those of the interviewee and do not necessarily reflect the views of the Rural Health Information Hub.