Allan Formicola: Building Bridges for Community-Based Oral

Health Care in Underserved Communities

Ayos, Almyra.
Ro, Marguerite J.
Journal of Health Care for the Poor and Underserved, Volume
17, Number 1, February 2006, pp. 1-5 (Article)
Published by The Johns Hopkins University Press
DOI: 10.1353/hpu.2006.0002
For additional information about this article
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http://muse.jhu.edu/journals/hpu/summary/v017/17.1Sayos.html
1 Ayos and Ro (%2/%3!.$'2%!4)$%!3
Journal of Health Care for the Poor and Underserved 17 (2006): 1-5.
!LLAN&ORMICOLA"UILDING"RIDGESFOR
#OMMUNITY"ASED/RAL(EALTH#ARE
IN5NDERSERVED#OMMUNITIES
Almyra Ayos, AAS, BFA
Marguerite Ro, MPH, DrPH
A
s Allan Formicola recounts his career and the traiectory that led him to his
current position as Vice Dean of Columbia University`s Center for Community
Health Partnerships (CCHP), it becomes evident that he is passionate about the
health and well-being of people in medically underserved communities. He has been
a relentless champion and a visionary for improving oral health care service delivery
in Washington Heights and Harlem, two communities of color whose members
are at high risk for oral disease. Yet he sees his role as a leader and an academic
not as one man`s accomplishments but as a single, if vital, thread in the tapestry of
humanity and community we all belong to. He uses words such as creativitv and
prcblem-sclvinc to describe the tasks of his chosen vocation. The roads taken in his
illustrious career have brought him in touch with the oral health practitioner, the
legislator, the academic, the dental student, the patient, the everyman.
Dr. Allan Formicola`s groundbreaking work has been in the areas of community-
based dental services and diversifcation of the oral health workforce. The Community
DentCare Network that formalizes the academic-community partnership between
the Columbia University School of Dental and Oral Surgery and northern Manhattan
is iust one example of how he has realized his vision of oral health, moving dentistry
and dentists from standard, conventional practice to addressing oral health through
community service and community engagement (locally and nationally) to alleviate
the pandemic of health disparities in this country. His community-based efforts
have served as the foundation for the W.K. Kellogg Community Voices Oral Health
Campaign and the Robert Wood Johnson Dental Pipeline Initiative.
&ROM$REAMSOF"RIDGESTO$REAMSOF$ENTISTRY
As a college student, Dr. Formicola initially decided to study civil engineering,
aspiring to build bridges like the George Washington Bridge in upper Manhattan.
As often happens to college students, he chose to change course mid-stream. A
wise future brother-in-law suggested that civil engineering would limit his ample
!,-92! !9/3 is a Research Cccrdinatcr in the Divisicn cf Ccmmunitv Health at the Cclumbia
Universitv Schccl cf Dental and Oral Surcerv. -!2'5%2)4%2/is the Senicr Health Pclicv Analvst fcr
Ccmmunitv Vcices and is an Assistant Prcfesscr in the Divisicn cf Ccmmunitv Health at the Cclumbia
Universitv Schccl cf Dental and Oral Surcerv.
2 Community-based oral health care in underserved communities
creativity. Dentistry, however, was a great profession, something he could take
in many directions. From there, Allan Formicola`s path seems to have stretched
inevitably to where he is today, although one might say he is still fulflling a dream
of building bridges.
Upon frst attending dental school at Georgetown University, Dr. Formicola
professes that he was not at all certain he would enioy being a dentist, but did love his
courses in the School of Dentistry. It was not until his 3
rd
year, working with patients,
that he discovered his passion for dentistry, for taking a problem mouth with ear-
to-ear-caries in the pre-prevention era of dental care, and fxing it. It was an early
signal of his drive to target problems and solve them creatively. During the Vietnam
era, as a Lieutenant in the U.S. Navy based in Pensacola, Florida, he spearheaded the
development of the Navy`s frst ever Periodontal Specialist Treatment Facility.
4EACHINGASA"UILDING"LOCK
Dr. Formicola fell in love with teaching` during a supplementary, temporary iob
teaching at Georgetown University while working in private practice, a passion
that brought him to an important crossroads. In his next position as an Assistant
Professor and Clinical Investigator for the Institute of Dental Research at the
University of Alabama in Birmingham, Dr. Formicola had the chance to work in
a premier academic oral health center. From there, at the young age of 29, he was
appointed Chairman of the Department of Periodontics in the New Jersey Dental
School at the College of Medicine and Dentistry of New Jersey. As he climbed up the
ranks in leadership, from Chairman to Associate Dean and then eventually to Acting
Dean, he further realized that there was a larger role that he could play in addressing
oral health by being an administrator shaping an academic dental institution, in
addition to the important role of being an educator. More importantly, during this
time he recognized the potential to institutionalize patient centered community
based dentistry.
"UILDINGTHE&OUNDATIONFOR#OMMUNITYBASED/RAL(EALTH#ARE
In the 70s, Columbia University`s School of Dental and Oral Surgery (SDOS), a
traditional school with 60 students and a fairly homogenous and inward looking
faculty, was striving to change. With a vision of a modern, leading dental school as the
ultimate goal, Dr. Formicola spent his frst 10 (out of 23) years as Dean building the
school`s infrastructure, by fnding and establishing resources, building the strength
of the faculty, modernizing the school, bringing in computers, and raising money, all
dedicated to strengthening and transforming the School, turning it into the leading
academic dental institution that it is today.
While restructuring SDOS, Dr. Formicola came to another turning point. He
received letters from principals of local schools in the underserved neighborhood
of Washington Heights, about children who could not get dental treatment.
Coincidently, fndings of a maior prevention center survey were released showing
that the number one problem in attaining health care was getting access to oral health
care. Here was an academic dental institution, pulsing indifferently in the heart of
3 Ayos and Ro
an underserved neighborhood, where children could not get basic oral care. This
had to be remedied.
Dr. Formicola credits two additional sources of motivation during this period
of transformation. One was his solid relationship with Dr. James McIntosh, head
of dentistry at Harlem Hospital. Together they developed an affliation between
SDOS and Harlem Hospital that expanded the mission of the Harlem Hospital
Dental Service from a mainly emergency/oral surgery service to a comprehensive
dental care service and advanced training site. At Harlem Hospital, residents in
dentistry gained education in the dental specialties at SDOS. As a result, 23 African
American specialists have completed the postdoctoral training in pediatric dentistry,
orthodontics, periodontics, prosthodontics, and endodontics. Dr. Formicola`s vision
of community-based dentistry was becoming reality, with the pieces coming together
to fght rampant oral health problems that resulted in part from poor access to dental
information and services.
Another source of inspiration was the monograph by Ernest L. Boyer, Schclarship
Reccnsidered. Pricrities cf the Prcfesscriate
1
(originally published in 1991) which
challenged the roles of teaching and learning in scholarly environments, and how well
scholarly practices are put into use outside of those environments. At this iuncture in
Dr. Formicola`s career, it all came together and made sense: here was a dental school,
children and families, and an underserved community. Bridges needed building.
Dr. Formicola took a sabbatical during which he conceptualized the Community
DentCare model. He decided he had to lay out a plan for the entire community.
He organized two planning groups comprising different community members,
many involved in school-based clinics and health centers, and used their guidance
to map out the community needs. He took this map to Albany, to the State Health
Department. He recalls struggling there, as Albany was not receptive to his ideas;
in fact, a maior disagreement ensued with one of the state offcials. However, with
persistence, Dr. Formicola saw success when the Kellogg Foundation awarded the
school $1.1 million that would allow him to realize his vision of community-based
dentistry for underserved communities. With clarity of vision and armed with an
already strong and receptive faculty, Dr. Formicola gained support to expand the
school mission in community service.
!,EGACYOF#OMMUNITY%NGAGEMENT
The Community DentCare Network is now a far-reaching community-based
network of care, which has dramatically improved access to oral health care in the
underserved communities of Northern Manhattan (Harlem, Washington Heights,
and Inwood). Community DentCare was and is grounded in the academic-
community partnerships that Dr. Formicola and SDOS faculty initiated with
community groups and churches in these neighborhoods. With Kellogg funding
to provide fnancial support, Community DentCare was established as a network
of school-based prevention programs, neighborhood-based primary |dental] care
practices, and advanced dental professional training sites.
The accomplishments of Community DentCare provided the impetus for the
focus on oral health in the W.K. Kellogg Community Voices (CV) Initiative. As
4 Community-based oral health care in underserved communities
part of CV, the academic-community partnerships that Dr. Formicola had initiated
through Community DentCare were expanded upon and formalized through
the development of the Northern Manhattan Community Voices Collaborative
(NMCVC). This includes a partnership with Alianza Dominicana, the nation`s leading
comprehensive Dominican human service and community development agency,
based in Washington Heights and led by Moises Perez. Through the partnerships
already forged with Alianza Dominicana and Harlem Hospital, the NMCVC is
working to improve access to physical, mental, and dental care for the underserved
in northern Manhattan. The NMCVC is working with its partners to extend access to
primary medical and oral health care and to assure that northern Manhattan residents
make use of existing health care resources. The NMCVC builds upon community
assets, such as working with community health outreach workers to educate residents
about preventive health care. Dr. Formicola leads NMCVC in his role as Vice Dean
of the new Center for Community Health Partnerships in the Faculty of Health
Sciences of Columbia University, where his work is a direct extension of his mission
to improve the overall health of underserved communities.
Keeping in line his complementary mission to expand the role of dental
professionals, Dr. Formicola co-directs (with Dr. Howard Bailit) the Robert Wood
Johnson Foundation proiect entitled Pipeline, Prcfessicn o Practice. Ccmmunitv-
Based Dental Educaticn to assist dental schools in establishing and improving
oral health care programs for underserved populations (by adding such necessary
components as cultural competency to all curriculums) and to enhance their efforts
to enroll underrepresented minority and low-income students. Along with Dr. Bailit,
Dr. Formicola continues this focus in the Macy Foundation Study on New Models
in Dental Education.
The communities in which Dr. Formicola works acknowledge and affrm his
contributions. For example, he received the Harlem Hospital Dental Service`s Award
for Contributions to Minority Education and the Harlem Hospital`s Second Century
Award. On a national level, his peers have also honored him, most recently with the
American Dental Association`s Presidential Citation for signifcant contributions to
the oral health of the public and to the profession of Dentistry.
3OLIDIFYINGTHE,EGACY
Dr. Formicola continues his life work with no sign of weakening vision. He sees
some accomplishments as potentially fragile, with work still needed to make sure
they are solidly institutionalized. Through his efforts and those of his collaborators,
partners, and supporters, programs such as Community DentCare are still strong,
continue to be well-run by the dental school, and continue to grow in the community.
His continuing mission is to see these programs frmly supported and established
within institutional settings, so that when he has stopped working in his capacity
as academic/community leader, whoever follows can continue to build upon a solid
foundation.
This mission also applies to his role as a leader in the academic setting. Dr.
Formicola wants to see the University have a concentrated effort on health disparities
throughout its many schools. Many people work on a facet of disparities (in urban
5 Ayos and Ro
planning, the School of Public Health, and others) but there isn`t yet a group that
focuses solely on health disparities, examining all their many angles. He also hopes
to see this institutionalized and to see someone come in and take his place and
continue the work.
On the national level, Dr. Formicola`s work to institutionalize the Dental Pipeline
program is well on its way. The Pipeline proiect has brought cultural competency
into the mainstream and made it a permanent part of dental school curriculums.
The improvement of enrollment of underrepresented minority students is on the
map largely due to the work at the Pipeline proiect, and so the dental profession
in general has taken a huge step in expanding its service mission into underserved
communities. Dr. Formicola would still like to see the senior year in dental school
modifed to include signifcant time devoted to service in the community, working
with the underserved. The more education and experience students receive working
with underserved populations, the more likely they are to treat underserved patients
in their practices. In short, he would like to see the dental profession devote its
knowledge and resources to those who need the care and services, not simply to
those who can afford the care.
!6IEWOFA"RIDGE
When asked what he would say to a potential future dental professional, Dr. Formicola
recalls a statement from a radio address by one of his Columbia predecessors, Dean
Alfred Owre, who said there isn`t another profession where you could use your
creativity as much as you can in dentistry. Dr. Formicola has demonstrated that to
be true. There isn`t only one way to practice dentistry. A dentist may work in private
practice, be a scientist, engage in public heath research and interventions, and more,
depending on the individual dentist`s creativity. For his part, Dr. Formicola credits
his wife with being an incredible partner,` who has helped him think through tough
problems and whose support enabled him to be as creative as possible.
In reference to the tough days, when it seems problems are more rampant than
viable solutions, he points to a small, much-read and ragged copy of Rudyard
Kipling`s poem If, which is what he says keeps him sane and motivates him during
diffcult times. He keeps the booklet prominently displayed on his windowsill in the
foreground of a remarkable view of the George Washington Bridge, spanning the
mighty Hudson River, connecting Manhattan and the Bronx to New Jersey and the
vast country beyond. He says this view inspires him, reminding him we really are
insignifcant as individuals, and how we all are connected somehow to the world
and one another. Just as the bridge ioins one city to another, Dr. Formicola`s vision
binds his past to his present, and connects his personal dreams to those of a united
and healthy community.
.OTE
1. Boyer EL. Scholarship Reconsidered: Priorities of the Professoriate. Paperback edition.
San Francisco: Jossey-Bass, 1997.