Under a Philadelphia Subway Station, One Dentist is Dedicated to Helping the Homeless
Dr. Janine Burkhardt provides oral health care at an unlikely spot for a dental clinic: under Philly’s subway station.
Like many Philadelphians, Dr. Janine Burkhardt uses the city’s subway system to get to work. But her time isn’t spent commuting — it’s spent providing dental care to individuals experiencing homelessness at the Hub of Hope, a clinic located under Philadelphia’s subway station. As Dental Director at the Stephen Klein Wellness Center with Project HOME, Burkhardt works at the hub and another of the organization’s health centers with her peers to help individuals with affordable housing, career, medical and education services.
Between 4,000 and 6,000 people are homeless in Philadelphia at any given time. Those who can are coming in for counseling, laundry, even a hot cup of coffee — and that’s exactly why it works, Burkhardt says. As a preventist, she’s meeting her patients exactly where they are in order to ensure oral health is addressed as part of their overall well-being. In fact, more than 4,000 individuals facing homelessness came to the Hub of Hope in 2019 for help. Between the two health center locations, nearly 2,000 individuals received dental care.
How do you get word out about the dental services you offer at Project HOME?
On your way to our dental room at Hub of Hope you pass through a waiting room of people who are there for other services, and everyone gets to know you as the dentist. One person says, “There’s the dentist,” and that’s all the word-of-mouth marketing we need — and we can’t even meet that demand. [Last year, more than a third (36%) of Project HOME’s health center patients received dental care.]
What does that first experience look like for patients who’ve been without access to dental care?
A lot of the people we see are scared or they just don’t know what to expect. In some cases, they’ve never had access to oral health care; some had insurance for a brief period of time and then lost it or had Medicaid but couldn’t find dentists who would accept them.
When we have patients who come in with urgent needs but are too scared to get it done, we’ll just do the exam and take X-rays — whatever we have to do to get them introduced to the clinic. I ease them in, talk to them and gain their trust so the next time we can do the procedure. It’s nice because we’re not focused on how much money we can make from each visit. Instead it’s “How can we meet the needs of our patients?” Taking a patient-centered approach like this helps us take care of people who otherwise would not seek dental care, even for urgent issues. The hope is once we establish a relationship, they will continue improving their oral health moving forward.
What preventive measures have you taken to improve outcomes?
We’ve done a few quality improvement collaboratives where we’ve moved some oral health into the medical facility. They’ve started to apply fluoride varnish with our support and do brief oral health assessments, referring patients to us if they need to. That’s been so helpful since the medical departments are much bigger and dental often requires surgical procedures — we can’t meet the needs of all of our patients when surgery is required, so having that preventive oral health access in medical [appointments] is essential. And we focus especially on kids to get them that information at a young age, and for their parents to hear it so they can truly value oral health as early as possible.
What patients have stood out to you over the years at Project HOME?
One patient when I first started was so grateful that I extracted her tooth. She was in tears and said for years all she was able to get was a prescription — an antibiotic and some pain medicine. She was able to be seen by a dentist but, because she didn’t have enough money, wasn't getting the treatment she really needed. She was so relieved that the pain would be gone after so many years.
Another patient who our other dentist was treating got a full set of dentures. I think people don’t realize the connection between oral health and quality of life, especially for jobs. How hard it must be to get a job when you're missing teeth or have cavities and teeth that are decayed. Giving people their smile back can help them get the job, miss fewer work days because of dental issues, and also feel confident at work every day.