Caring For Those Who Have Fallen Through the Cracks

Dr. Heidi Rabie on Serving Vulnerable Populations ( (5-minute read)
In August 1990, fourteen-year-old Heidi Rabie was on vacation in Montreal with her family when she woke early one morning to the sound of her father taking a sharp intake of breath. He had been sitting up all night watching the live news from Kuwait, where troops were amassing on the border. In the coming days, as the world watched, Saddam Hussein would lead the Iraqi invasion and occupation of Kuwait, an offensive that would unleash Operation Desert Storm and the first Gulf War.

Born in Egypt, Dr. Rabie moved to Kuwait with her family when she was just seven months old. Her father was an engineer in the oil and gas industry. Kuwait was home. It was where she had grown up, gone to school, and made friends. Now, sitting in a hotel room halfway across the world with little more than a suitcase full of clothes, everything was about to change. In the coming days, friends and family back home would pack up their cars and head across the desert to the nearest border. Property would be seized and bank accounts frozen. The Rabie family had a decision to make, and they had to make it quickly: they would not be going back to Kuwait. “Suddenly we had no home, no car, no bank accounts,” says Dr. Rabie. “The minute my father heard of the invasion he ran downstairs and paid the hotel for the next two months. He took out whatever money he could from the bank and sent us on the shopping spree of our lives before the credit cards got cancelled.”

Despite the volatility of the situation, there were some positives. Dr. Rabie’s parents had already been scouting out the possibility of a move to Canada, and Heidi’s father had been accepted in the skilled worker category and was admitted to the Ordre des Ingenieurs du Quebec. Also, as a child Dr. Rabie had attended international schools back in Kuwait and so was fluent in English and had some knowledge of French. By the time Kuwait was liberated in February 1991, the family had decided to stay in Canada long term. They settled in Montreal where Dr. Rabie attended Lemoyne d’Iberville High School, a French language school in Longueuil. Four years later, having excelled in Quebec’s Champlain College CEGEP, she transitioned directly to dental school at the Université de Montreal. In May 1998, less than eight years after the invasion of her homeland, she graduated with a DDS at the age of twenty-two.

Following graduation Dr. Rabie worked for a decade as a general practitioner in the Outaouais region. She got married, had a child, and got divorced. At 29 she was a single mom to a two-year-old while trying to carve out a career as a dentist in private practice. Then in August 2008 she saw an advertisement for work in a public health clinic in Calgary. Public health had always been something that piqued her interest, and for a single mom it made a lot of sense in that it offered stable employment with hours that were childcare friendly. She applied and got the job and moved to Alberta. And although her decision was largely driven by practical needs, it wasn’t long before Dr. Rabie realized that public health was something close to her heart. “Being able to work with vulnerable populations spoke to me on many levels,” she says. “Having experienced such upheaval when I was young gave me a glimpse of what it’s like to not be able to afford private dental care. I found working with vulnerable populations to be very rewarding. It gives instant gratification. There is so much need out there.”

Fast forward thirteen years and Dr. Rabie is now Clinical Chief of Public Health Dental Clinics in Calgary where she runs two clinics that provide care for socioeconomically marginalized populations. Homeless people. Refugees. People suffering from addiction and mental health issues. People who have fallen through the cracks and are experiencing barriers to care. In order to maximize the impact of what they do, the clinics provide a basic but essential level of care – extractions rather than root canals or crowns. In a typical year Dr. Rabie and her team will perform in the region of three thousand extractions, many of which are referrals from local emergency departments for patients who are in terrible pain. “It’s a public health approach. You can’t do ideal all the time. We would love to do more root canals and crowns but that is just not feasible. The priority is to eliminate pain and eliminate infection. Retain what functionality we can. Do you know what happens if a dental infection is left untreated? Thankfully we don’t see it much in private practice, but sadly we see it in our public health clinic.”

THE ALBERTA DENTAL FOUNDATION

Dr. Rabie also serves as a board member of the Alberta Dental Foundation, a brainchild of the Alberta Dental Association and College created to improve access to dental care for underserved and low-income Albertans. Her role includes the vetting of grant proposals, the coordination of fundraising, and collaboration with other foundations in the interest of dental health. Recent initiatives include a collaboration with the University of Alberta to purchase dental equipment for underserved areas, and the Brush Up Alberta Campaign that raised $22,000 and distributed over 38,000 oral health kits to people in need during Oral Health Month in April. Though still in its infancy, the foundation offers much promise to the province of Alberta, where it is estimated that 25% of the population do not receive dental care on a regular basis. It is an initiative that Dr. Rabie hopes will grow across Canada: “There is a lot of volunteer work being done in dentistry, but we don’t seem to have a collective front where we can gather funds and address important issues like access to care. The Alberta Dental Foundation is just the beginning. Hopefully in the future we can join other dental foundations in other provinces and form a larger foundation.”

COVID-19

As in every other sphere of the dental profession, the events of the past year have presented a unique set of challenges for public health dentistry. The impact of suspending dental care has more fallen heavily on the high-needs population than it has on the general population. While Dr. Rabie and her team were able to continue with tele consultations during lockdown, she admits that reopening was a challenging time: “At that point it was just extractions upon extractions,” she says. “We had to pick and choose who we could see. In order to reduce aerosols, we weren’t even doing fillings.”

On a positive note, Dr. Rabie believes that the pandemic has brought dentistry to the forefront of healthcare and helped to define the essential nature of it. It has also highlighted the importance of public dental health and raised many important questions, questions she hopes will lead to positive change in the future: “What exactly is essential care? And if dental treatment is essential care, then how do we manage payment for lower income populations? These are foundational questions that COVID is clarifying. In Calgary we have 250 people a year hospitalized because of dental infection. We should be able to address this.”

She makes a compelling argument. She walks the walk, as they say. And although nobody knows what policy change may come about as a result of COVID, Dr. Rabie is hopeful that things will improve for the populations she serves. And even if they don’t, you can be sure that this dentist will continue to do what she does best and do it with a smile on her face: “We will continue to focus on the people who have fallen through the cracks. Either by helping them navigate the system or by treating them directly in the clinics. To be able to take away somebody’s pain – to witness the moment when the anesthetic works, and the patient stops clutching the side of their face - it is a sight to see. It’s amazing. Almost sacred. I love being able to help.”

Gabriel Fulcher is Digital Content Editor for CDA Oasis. He is an Ottawa-based writer who specializes in medical, scientific, and health-related content. He holds a BSc in Health-related Sciences and an MFA in Creative Writing from University College Dublin, Ireland.