EP31 Oral Health as a Basic Human Right with Dr. Fabiola Milord

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I AM GPH EP31 Oral Health as a Basic Human Right with Dr. Fabiola Milord

EP31 Oral Health as a Basic Human Right with Dr. Fabiola Milord

Alexandra Arriaga: Welcome to I AM GPH. My name is Alexandra Arriaga. And today we're going to talk to Dr. Fabiola Milord. Dr Milord obtained a Bachelor of Science degree from St. John's University, followed by a Doctor of Dental Surgery from New York University College of Dentistry. Through international non-profit organizations, she has taken part in more than 50 medical missions, treating impoverished men, women and children with stunning levels of decay and bone loss in countries such as Ghana, Guyana, Haiti, Jamaica, South Africa, St. Lucia, St. Vincent's, as well as the U.S. Inspired by her travels and the need to emphasize oral health as a basic human right, Dr. Milord completed a Master's degree in public health at New York University's College of Global Public Health. She currently also serves as a full-time faculty member at NYU where she has clinical education, lecturing and mentoring responsibilities. Hi, Fabiola. Welcome to I AM GPH. How are you doing today?

Fabiola Milord: Good, thank you. And thank you for having me.

Alexandra Arriaga: Of course. It's our pleasure to have you. Fabiola, you have a background in dentistry.

Fabiola Milord: Yes.

Alexandra Arriaga: Can you tell us a little bit more about that?

Fabiola Milord: Well, I graduated from the College of Dentistry a while ago in 1994. So I'm a proud two-time NYU graduate. And how I got into dentistry, I'll be very honest with you, my parents chose this career for me. And certainly back then there was nothing like Google or the internet to research careers or anything like that. But I always had interest in the sciences. And so it seemed like a good fit for me, for them to put me into. And I took to dentistry like a fish to water. I really enjoy the profession. And I've been practicing, my 25 year reunion is coming up next year. So that's my background in dentistry. I am in private practice. I teach at the College of Dentistry. And as you'll soon find out, I do medical missions all over the world. So I travel quite a bit. That degree has been a blessing for me.

Alexandra Arriaga: And if you started out with dentistry, how did you transition into the MPH? What inspired that decision?

Fabiola Milord: That's a very good question. Even I did not anticipate having a career in public health. The thing is that with all the traveling and everything that I was doing with dentistry, it seemed a little bit disjointed. And I wanted to explore more the possibilities of groups, populations. How can the system improve? What's missing in these particular health systems? Is it clinics? Is it hospitals? Is it lack of awareness? What's missing? So ironically enough, I got home one day and I found a postcard from the School of Public Health saying, "You know what? Come to our open house. There may be some ... " It was a random postcard. And direct mail still works more than email. And I found myself attending the open house for the College of Public Health. And it seemed like a very natural fit from where I was in oral health to public health and population health. It seemed like a natural fit. And I just, after the open house, I was sold. So that's how I decided to get into public health.

Alexandra Arriaga: I didn't expect that. A postcard, which is-

Fabiola Milord: A postcard.

Alexandra Arriaga: Influenced all these decisions.

Fabiola Milord: Yep.

Alexandra Arriaga: That's crazy.

Fabiola Milord: It works.

Alexandra Arriaga: Well, there you go. I'm glad it did. I think it's interesting that your background is in dentistry, because generally when we think of our healthcare, we often forget about oral health. Right?

Fabiola Milord: Sure.

Alexandra Arriaga: And how did you manage to bring that component into the public health environment, and why do you think it should be considered a human right?

Fabiola Milord: Well, unfortunately there's a lack of awareness of oral health and general health. I think oral health and dentistry is siloed into its own profession and its own area where everything is tied in together. The human body is a well-oiled machine. Everything is working together.

Alexandra Arriaga: Yes.

Fabiola Milord: So you have the ... Diabetes as an ... Oral health as an indicator for diabetes. Or periodontal disease and attached to smoking, oral cancer, heart disease and depression, anxiety, appearance, speaking, nutrition. It all ties in together. So if you don't have a basis, and the basis is good oral health foundation, whereby your mouth is in a condition whereby you are able to take care of your mouth, go to work, contribute to society, function in a way that keeps you healthy, how can you possibly contribute to that society? Meaning without good oral health as a foundation for general health, as it's all tied in together. You are really putting yourself in a very tenuous position with your overall health. So it is all tied in together.

Alexandra Arriaga: Absolutely. And it makes a lot of sense when you put it that way. I think like you were saying, it can be an indicator for so much more than just-

Fabiola Milord: But just, let's say cavities or pain. Yeah, that's one part of it. But even pregnancy, bacteria can cross the placenta. And yeah, sure. Bacteria can cross the placenta. That's why many obstetricians will refer to a general dentist for an examination and a cleaning. Again, basis for good general health starts with oral health. That's why it needs to be recognized. More school days, children are in a lot of pain. They miss a lot of school for it. It's completely unnecessary. And so if you have good oral health and good oral health systems, dental clinics, hygienists, everybody working together in order to provide good oral health care, that is the basis and a foundation for excellent general health.

Alexandra Arriaga: I agree. And using your expertise and all that you just described, which by the way, I think when you put in this perspective, it just provides such a broader understanding of all these underlying issues. How do you think that acknowledging these issues maybe made you start working with non-profit organizations?

Fabiola Milord: I think that's also a very good question. Again, a lot of things happen. I'll call it chance, but sometimes you have to also call it opportunity. Once you become a dentist, and I was three years after dental school when I first started working with nonprofits. My name just got out there about many groups and nonprofits were traveling to different countries, Jamaica, Ghana, South Africa, whichever. And not taking a dentist with them. Again, the lack of acknowledgement of dentistry and oral health, because they were thinking more about diabetes, the blood pressure, heart disease, cholesterol, and everything else. And when got to their destination, many of the local community inhabitants would say, "Well, where's the dentist? I have a problem here. I have a problem with this. And I have a problem with that. And you came here with all this whole team of doctors, and you did not travel with the dentist." And so that's how I was recruited. I was a young, recent graduate. I'm still young by the way.

Alexandra Arriaga: You are.

Fabiola Milord: I was a recent graduate. And the opportunity, my first non-profit was ... It was the Max Cadet Dental Foundation in Haiti. Unfortunately that clinic was destroyed during the 2010 earthquake. But that was the first one that they recruited me to work in their clinic, maybe a summer. And then from there, my name went out again to another organization, and another organization. So once you start this type of work, your name becomes connected and affiliated with this type of work. And your name just gets out there and people really come and say, "You know what? Would you mind working with our not-for-profit? Would you mind working here? Would you mind ... These are the dates we're traveling." And really it is, your reputation will literally proceed you.

Alexandra Arriaga: So you are highly requested?

Fabiola Milord: Yes. I've been very fortunate 50 medical missions later.

Alexandra Arriaga: I can see why.

Fabiola Milord: Thank you.

Alexandra Arriaga: Definitely. I'm curious, what was the most common case that you would encounter, and you would have to take care of in some of these missions?

Fabiola Milord: Early on, most of the cases where extractions. Still are, unfortunately. But as we've gotten a little bit more sophisticated, and with the travel regulations, and the weight limits of equipment, and luggage and suitcases, we were able to do prophylaxis, cleanings, minor restorative procedures, fillings. So we're able to offer a little more. However, still pain being the main driver, the number one requested service, I'm sorry to say, is still, "Pull the tooth," extractions.

Alexandra Arriaga: That's unfortunate.

Fabiola Milord: Worldwide, including here in the U.S.

Alexandra Arriaga: Wow. And thinking back about your very recent years at NYU. Now that you have all this experience and all this expertise, when you think back about the classes you took as an MPH student, which ones just stand out to you? Which ones do you think back on and you say, "Wow, this really helped me when I was in the field."

Fabiola Milord: The policy classes definitely stand out. The ones that have been the most useful recently have been anything that has to do with the software, because you have to manage large data sets. So Atlas TI, back then they had SPSS. I don't know if you still use SPSS or SAS, or some of those.

Alexandra Arriaga: NR, and all of that.

Fabiola Milord: Biostats. You still have to be able to manage and interpret large data sets. So a lot of the biostats even though I didn't particularly enjoy that class. No offense to the public health program. Those really do come back to revisit you, whether it's qualitative with the Atlas TI, and any of the qualitative software out there for responses of what people want to say. Or just managing raw data. The SPSS, the SAS, and all that. Many of those had a lot to do with the work that I do now. So you have to know the software. And you have to have a good ... Anything that had to do with research. Again, the policy classes about global health policy, those classes you have to have to know where you're researching, and how the research goes, and if the research is valuable to what you're trying to put out there. So a lot of the research-based classes were good too. No regrets about this program at all. It was very good.

Alexandra Arriaga: That's great to hear.

Fabiola Milord: Yeah.

Alexandra Arriaga: And so even if we don't enjoy the classes, we should still-

Fabiola Milord: Yeah. Stick it out, because I promise you, you will need it. You will value it. And you will use it.

Alexandra Arriaga: That's very important. I think most of us as MPH students, we look at someone as successful as you. And we think, "What is the best advice you can give us?" All of those that are maybe still in our MPH career or about to graduate, what would you recommend?

Fabiola Milord: I would recommend two things. The first thing is, never stop learning. Because you graduate, and I graduated the public health program here in 2013. Because you graduated does not mean you cut yourself off from the program. What I enjoy seeing is getting these emails from the College of Global Public Health with all the different speakers and topics that you all are offering. It keeps me current. It keeps me in the know. Many of them unfortunately, because of my schedule I'm not able to attend. However, it keeps me in the know of what is the issue of the day, what is on the table for discussion? What is important in the moment? What is affecting population health? So never, never stop learning. Coming back and seeing if you can get some new current information. The second thing that I would also emphasize, and again, it's worked for me. Network, network, network. The network that you have here is so powerful while you're here. My story is, and how did I get a position at the College of Dentistry, is that I made an impression on one of the professors. And at the time, the dental clinic I was working in was about to close. And I really needed a job, and I was about to graduate here with the student loans, and all the other financial responsibilities that I had. The clinic was closing. And so I sent an email to many of the professors. But there was one who said, "You know what? You were an excellent student. I'm going to put you up for a recommendation for the chairman of the department at the College of the Cariology Department." And so five years later, here I am. That just worked out, and worked out well. So I can not emphasize enough about networking. Not sucking up. I'm talking about really doing your work, doing your work well, getting along with your fellow classmates and the professors. So that if you need that bridge to go back and ask for a letter of recommendation, a job interview, whichever. That will definitely be helpful. Also, the internships. I interned for that. Not only did I take her class, I was one of her interns. And it was not an easy internship. But again, the impression I made must've been effective enough. Here I am sitting in front of you today with her giving a strong letter of recommendation. So I'm very thankful to her and this program. Networking, you got to establish your networks now.

Alexandra Arriaga: And I think that's something that you have to put in the work.

Fabiola Milord: Well, yes.

Alexandra Arriaga: Obviously it's not something that ... Like you said, it's not about sucking up.

Fabiola Milord: No.

Alexandra Arriaga: It's more about really making that impression through your hard work, through your knowledge, your attitude.

Fabiola Milord: You hit the nail on the head, Alexandra. That's exactly what it's about. You have to be ... Even if you suck up, if you don't give the results that they are ... the outcomes, successful outcomes that they are expecting of you, you're not going to go far. But if your attitude, your enthusiasm toward projects, not giving up. Even though you know what? Maybe you did like me, did work a full day and then you have to do a nighttime internship. Do what you have to do. It's not permanent. Do it in a temporary fashion, so that when it does come for your time to ask for something, you won't be embarrassed to ask. And certainly that person will put you in the forefront of their mind as far as whatever recommendations they're going to make for you.

Alexandra Arriaga: Thank you so much for that advice. I will really keep that in mind. And you had an interesting story in the sense that you started out in dental school. And then you sort of transitioned into the MPH. So what would you suggest to those people that already graduated from maybe an MPH, or are already seasoned professionals that are looking into switching their career? How would you go about that?

Fabiola Milord: The best piece of advice I would give is, follow your passion. It has to work on both sides. Meaning the dental degree is one thing, and the public health degree is the other thing. Use the knowledge that you have in each of those disciplines, so that they're all merged. And make you and what you're trying to achieve a better person, a better professional. If you are out there with an MPH, you are a seasoned professional. That means you have a knowledge base already. And now you're adding the MPH to it. That means you have even more of a knowledge base. Use that to look for the right opportunity. Again, if it were easy, everybody would do it. It's not easy. But once that opportunity, you will feel that click in you that says, "This is it. This is what I'm going to go for." Follow your passion. Know that what you have, nobody can take that away from you. The knowledge is there. The knowledge base is there from both disciplines, from one discipline. Whether it's social work in MPH, medicine in MPH, whatever it is. If it's research, it's research. Whether it's community work, whether ... Whichever it is, follow that passion. Know how to get to ... There are other people who also have the same interests as you. Again, networking within those people, they know or they may have the knowledge that you need to get to that level, to the next level. Use it. Follow your passion. The dreams are there, they're just waiting for you to reach out and touch them.

Alexandra Arriaga: You just have to work for them.

Fabiola Milord: Yes, you do. Again, it's not easy. If it were, everybody would be doing it. However, if you really persist, it'll happen.

Alexandra Arriaga: So this gives me a clear view of who you were as a student. And listening to you talk, some of our listeners may not know. But you're currently faculty, correct?

Fabiola Milord: Yes, yes. At the College of Dentistry.

Alexandra Arriaga: And we're so lucky to have you, because I'm just listening to the way that you express everything and how you just are so clear in the way you explain things.

Fabiola Milord: Thank you. I try to be.

Alexandra Arriaga: You are. We're so, so lucky to have you as a faculty here at NYU. Now that we had your perspective as a student, I'm curious to know, as a full-time faculty member, what are the most important messages that you want to convey to your students?

Fabiola Milord: I want them to be better than me. I teach them so that when they get out there, they're better than me. So that I look at them and what they're doing in awe. And hope that whatever little influence I had on them during the times that they were with me, I had a little piece of that. And that makes me feel very proud. So to my students, I tell them discipline is my number one theme. Discipline in all things. You have to be organized, you have to have your mind and your work, and everything in order so that you are setting yourself for a clear line of what you want to do, how you want to go about achieving it in the most efficient manner possible. If you can discipline yourself to do that, the shortest distance between two points is a straight line. You will achieve that straight line. Get to it, and get to it the most successfully and the most efficiently. So I tell my students at the end, I hope that I've instilled enough of a discipline and enough of a passion for what you want to do. It's not just about cutting teeth and taking people out of pain. A machine can do that. It's about really being sensitive to what the patient needs, what the community needs. It's not just going into a community and imposing. It's about, "Okay, we're here for this. But what would you like to see?" The same thing as a patient. "You're telling me this. All right. So let's come together to have some sort of mutual agreement as to what a successful treatment outcome is going to be." Again, I think when you achieve that, the students who open their mind and are willing to listen, will be the very best at what they do. And they'll be more successful than me. And that makes me very proud to know that what that student is now on the lecture circuit, and doing all kinds of things out there. And I hope I had a little influence in that. And I'm very proud of my students.

Alexandra Arriaga: I think you do influence them. I’m listening to you right now-

Fabiola Milord: I hope so.

Alexandra Arriaga: Yeah. I already ... I'm so-

Fabiola Milord: Thank you.

Alexandra Arriaga: ... motivated right now. I'm like-

Fabiola Milord: Thank you.

Alexandra Arriaga: ... Yes. I'm like, "I'm going to change the world." That's great.

Fabiola Milord: Change it for the better.

Alexandra Arriaga: Of course. Now from a personal perspective.

Fabiola Milord: Sure.

Alexandra Arriaga: What motivates you to do this work, to put in the hours, do the research? Where does that motivation come from for you?

Fabiola Milord: A lot of it is curiosity. As far as the public health arena or the community arena, or the research arena. A lot of it is curiosity. You'll never know where an idea will come from or what will spark an idea. I'll give you an interesting little story. Now I'm working on a faculty advice mentoring project. What's the best advice faculty would give new graduates? And again, it was a qualitative project. So you say, "What motivates me?" And how would I come about with such an idea? There seems to be a lack of ... I think some of it may be social media whereby there seems to be a lack of, I find, engagement in new graduates. A lot of it is because they have to work to pay their student loans. So they're just focused on other things. So I go to not so new graduates and ask them, "What's the advice you would give new graduates?" And we're working on that project now. And that was a little bit of a challenge with the whole IRB approval. Even though I was working with faculty and everything, you still have to go through that whole process.

Alexandra Arriaga: Of course.

Fabiola Milord: So the idea came from a baby shower. 

Alexandra Arriaga: Oh!

Fabiola Milord: Yeah. Whereby I guess, the hostess went to a party store. And she gave out cards to all the guests and said, "What's the advice you would give a new mom or the new parents?" And I said, "You know what? I could turn that into a project too."

Alexandra Arriaga: Yeah.

Fabiola Milord: So what motivates me, you just never know. You can ... Where anything will come from to say, "That seems to be an idea that I can explore." Or, "This seems to be an idea that can take flight. Let's try this out." Some of it is not so good, and it's dead on arrival. Which is fine too. You really have to open your mind up to all kinds of things and then see which one really will take flight, and see which research projects or which ideas stimulate people. The one with the faculty advice, the faculty is very happy to talk about, "Oh, this is what I would tell them. If I knew then what I know now, this is what I would tell them." So what motivates me, I'll tell you, I just enjoy what I do. The students, knowing that I'm going to work with the students, my fellow faculty members, they motivate me as well. The community motivates me. When I was with the local Community Outreach Project, which up until recently I was. When I was working with senior citizens, children, they motivate you too. Their ideas are like, "Yeah. You say this. But I'm 92 years old. And I'm telling you, you don't know yet. This is what's going on." So all of it is motivational. Life and just observing what's around you is motivational. So just get up, get out there, and see what comes at you during the day. Again, you just never know where your next idea or your next motivation is going to come from.

Alexandra Arriaga: I'm going to dare to say that I think your motivation also just comes from within, because I can tell how passionate you are about everything you're describing.

Fabiola Milord: I really try to be. It keeps me going.

Alexandra Arriaga: Of course. No, and it's, believe me, it's something that you can sense. Just hearing you talk about it, it's obvious that-

Fabiola Milord: Thank you.

Alexandra Arriaga: ... you do have a passion for this.

Fabiola Milord: Thank you very much. Thank you.

Alexandra Arriaga: Of course. Well, I think this is the best advice that we have received. And I really appreciate you taking the time.

Fabiola Milord: My pleasure. This was fun, Alexandra. Thank you. And thank you for putting me at ease. I think you're a very good interviewer. And I think-

Alexandra Arriaga: Thank you.

Fabiola Milord: ... that you'll have a very successful career in public health, or whatever you choose to be. I think you'll have a very successful career in that. I wish you well, Alexandra.

Alexandra Arriaga: Thank you so much. And I really hope that we'll be seeing more of you. I know that you're just getting started. And thank you again so much for joining us today. Please come back anytime you want.

Fabiola Milord: Thank you, Alexandra. Have a nice rest of the career in global public health.

Alexandra Arriaga: Thank you so much.

Fabiola Milord: Take care.