January 24, 2019

Compassion Is Part of Treatment

Dr. Ihab Mansoure. Photo courtesy of Yad Sarah

For most of us, dental work is not at the top of our wish list. But for patients treated by Dr. Ihab Mansoure through Yad Sarah, a visit from the dentist could just be their greatest wish.

Mansoure, 56, who specializes in geriatric dentistry, attends patients throughout the southern region of Israel, from Be’er Sheva to Ofakim, Ashdod to Arad. But she doesn’t have an office — she brings the office to her patients.

A Christian-Israeli Arab from the old city of Akko, Mansoure performs critical dental work on the homebound on behalf of Israel’s well-known health and humans services organization. With her massive army-grade gray suitcase, her Romanian driver, British dispatcher and Russian dental hygienist, she shleps around the largest region of Israel with her mobile dental clinic. She has extensive equipment, from X-rays to drills, and can perform a vast array of procedures in-home, except for oral surgery. A dental MacGyver, she never says no to a patient in need, even if she has to rig a supportive procedure-ready chair out of a broom and a couch cushion.

She estimates about 99 percent of her patients are elderly, an often forgotten or neglected demographic. With an otherworldly empathy, Mansoure doesn’t treat only her patients’ mouths, she treats their overall condition.

She recounted some of the challenges she has experienced firsthand in watching her parents age. “I remember the first time I had to put my father’s socks on, he cried,” she said. “He didn’t say anything. He just cried.”

She intimately understands that her patients are struggling to accept their limited independence and myriad of health issues. She knows that this respectful understanding is the key to her success. As she says, “It starts from the mental state. If the head and heart don’t accept you, they won’t accept your help and treatment.”

“I always said, if every person gives a little, everything would be totally different.”— Ihab Mansoure

So how does a Christian-Arab female dentist from Akko who studied in Romania end up working for Israel’s premier health and welfare nonprofit in Be’er Sheva? She listened to the radio and to her heart. Fresh out of dental school, Mansoure was driving from Akko to Jerusalem when she heard the ad that would change her life. Yad Sarah, well known for its rehabilitation services, was opening a new dental services initiative and looking for volunteers. She called immediately, and for more than 20 years has been an integral part of the Yad Sarah dental program.

Mansoure started with Yad Sarah as a volunteer. One day a week, she would close her dental clinic in Rahad, a Bedouin town near Be’er Sheva with a population of 70,000, and jump in her Yad Sarah mobile clinic and serve patients throughout the south. After 10 years as a volunteer, she joined the organization full time. Today, she spends three days a week based in Be’er Sheva traveling around the south, two days at the Yad Sarah dental clinic in Jerusalem and her weekends at home in Akko.

Compassion, healing and volunteerism are obvious to her, an innate and significant component of her being. Mansoure repeats her life’s mantra: “I always said, if every person gives a little, everything would be totally different.” Yad Sarah is the last stop for those navigating services in Israel’s health care sector. Mansoure knows these are the people she is meant to serve: “I grew up in a house that emphasized the interplay of whomever haves versus whomever needs.”

As Mansoure recounts story after story of the special patients she has met along the way, one can start to feel a bit of what it must be like to be visited by this angel of healing. The respect she has for each individual, the empathy for each situation, and the care and compassion to solve someone’s problems is something that can’t be taught in dental school. Beyond the white lab coat and dental drill is a sensitive woman who looks you in the eye and listens to your soul. Mansoure is the rare dentist who patients look forward to seeing again and again.

Dating 101 – A Poem

He asked me out for a drink.

I agreed to meet after work.

He arrived on time.

I was five minutes late.

He was dressed nice.

I was having a good hair day.

He was the age he said he was.

I was hopeful.

He was the height he said he was.

I was still shorter in my heels.

He had a job.

I was impressed by his manners.

He had hair.

I thought the grey was sexy.

He was missing a bunch of teeth.

I prayed he was a hockey player.

He had never played hockey.

I couldn’t bring myself to ask about it.

He never mentioned it.

I stayed for 46 minutes.

He asked me out for a second date.

I went home to impale myself.

He will find a nice girl with missing teeth.

I will never understand how dating works.

Three front teeth people!

I am jaded, but  keeping the faith.

Dr. Jay Grossman: He gives homeless something to smile about

In 1991, Dr. Jay Grossman was waiting at a stoplight in West Los Angeles when he spotted a bedraggled homeless veteran who was missing his front teeth. The dentist was a bit hesitant as he reached into his wallet to give the man a handout; he worried that the veteran might spend the money on drugs or alcohol instead of food or shelter. “But then I thought, ‘Where is the tzedakah in that?’ ”
Grossman, 51, said in his Brentwood office recently. “So instead of a dollar, I gave him my business card. I said, ‘Let me see what I can do about getting you out of pain and replacing those missing teeth so you can function by eating and look good for a job interview. That’ll give you more benefit than my giving you a buck.”
Grossman continued giving his business card to other homeless people, and, in 1992, he enlisted the Western Los Angeles Dental Society to participate in his new program, Homeless Not Toothless, which would offer free dental care to the needy in the hope that the service might help patients land work and re-enter society. “It’s tough to get a job if you’re in pain or missing your front teeth,” Grossman said.
Over the past 24 years, Homeless Not Toothless has treated tens of thousands of patients, with $2 million in work provided by Grossman alone. Today, more than 100 dentists volunteer to serve individuals screened and recommended by the nonprofit Venice Family Clinic, at sober living facilities and elsewhere. To qualify, patients must be sober and actively looking for work.
Grossman — a graduate of New York University’s dental school — said the primary inspiration for his charitable work comes from the dentist who worked on his teeth at low cost during his low-income childhood in New York. “Dr. Mike was a Jewish dentist working in a Puerto Rican neighborhood,” said Grossman, who served as president of his Young Judea region in high school and attended his freshman year of college at Hebrew University. “He always said he believed that everybody deserves dental care whether they can afford it or not.”
Grossman’s pro bono patients have included an elderly ex-convict who had no teeth and had had to survive on a liquid diet for 40 years; a 5-year-old whose teeth were so blackened by decay that he had been ridiculed at school; and a 50-year-old, John, who had spiraled into homelessness as a result of a methamphetamine addiction, losing his construction business and his family in the process. Grossman not only cured John’s severe tooth pain by extracting his teeth and providing him with a full set of dentures, he also allowed John to live in his Malibu Hills home for two years while John worked in construction. When the dentist learned that John hadn’t seen his 17-year-old son for 15 years, he surprised John by arranging to fly the teenager to Los Angeles; then Grossman invited the youth to stay at his home for an entire summer.
In 2013, Homeless Not Toothless began working with foster-care children after actress Sharon Stone asked Grossman to provide services through her Planet Hope charity and Los Angeles County; last year, Homeless Not Toothless dentists saw 13,000 foster kids ages 5 to 18 “whose teeth were often filled with rot and decay due to neglect,” Grossman said.
His goal, he says, is to expand Homeless Not Toothless nationwide: “This is my tikkun olam.” 

Dental care for all

Navah Paskowitz knows that her 4-year-old son, Edwin, is long overdue for a dental checkup, but she’s terrified to take him for one.

About eight months ago, the Sherman Oaks resident and her husband took Edwin, who was diagnosed with autism, to his first visit with a dentist. As soon as they walked in the door, the boy started screaming. 

“There was normal play going on in the waiting room, and just from the sounds of being inside a closed environment with children, he basically flipped out,” recalled Paskowitz, a member of Temple Beth Hillel in Valley Village. “We were completely mortified. We didn’t know what to do. … It was such a traumatic experience that we literally aborted mission, and we left.”

Her experience is not uncommon among parents of children with autism. Because these children often have difficulty processing sensory information, the bright lights and unfamiliar sounds and activity in a dentist’s office can send them into a panic. 

For many parents, the only way to get their child’s teeth checked is to physically hold them down in the dentist’s chair or have them put under general anesthesia. Others may forgo dental visits altogether, putting their child’s health at risk.

To help address the problem, researchers at the University of Southern California (USC) and Children’s Hospital Los Angeles (CHLA) are conducting a pilot study in collaboration with Beit Issie Shapiro, which describes itself as Israel’s leading organization for people with disabilities. The research, funded by a $531,000 grant from the National Institutes of Health, is examining whether a type of multisensory therapy brought to Israel by Beit Issie Shapiro to treat children with developmental disorders and special needs can be effectively used to make dental visits less stressful for autistic children. 

The therapy, known as Snoezelen, involves creating an environment that is both calming and stimulating to the senses. It includes the use of soft lighting, gentle music, enticing smells, cozy fabrics and visual displays such as moving pictures on the ceiling and transparent tubes filled with bubbles that children can touch. In the dentist’s chair, the child is wrapped in a weighted butterfly vest designed to duplicate the feel of being hugged by someone. 

The researchers are working with 40 children — half diagnosed with autism and half not diagnosed with the developmental disorder — to assess their behavioral response to the therapy during dental cleanings. Sharon Cermak, the study’s principle investigator and a professor of occupational science at USC, said her team expects to complete the cleanings by June and then begin analyzing the results. Depending on the findings, the research could eventually lead to changes in how dental care is provided to autistic children, and possibly other children as well, Cermak indicated.

“Our hope is that the sensory-adapted environment will make it easier for children with autism to get their teeth cleaned,” Cermak said. “Our larger hope is that we will then be able to involve more dental clinics and use this as a model to revolutionize pediatric dentistry.”

Beit Issie Shapiro has used Snoezelen therapy in nondental settings for years in Israel as a way to treat children and adults with a variety of problems, including developmental disabilities, cancer, Alzheimer’s disease and post-traumatic stress disorder. There are now hundreds of Snoezelen therapy centers in the country. 

Michele Shapiro, the occupational therapist with Beit Issie Shapiro who brought the therapy to Israel and expanded its use there, began applying it to dental care several years ago, but her research did not include autistic children. The study at USC aims to bridge that gap. 

Shapiro and the head of Beit Issie Shapiro’s sensory dental clinic, Dr. Anat Baniel, will travel to Los Angeles in May to assist with the study. The organization’s executive director, Jean Judes, said she is thrilled about the research happening in California. She said such studies are critical to achieving more widespread acceptance of new therapy ideas that improve the lives of people with special needs. 

“Beit Issie Shapiro is very innovative in its approach. That’s really the core of us as an organization,” she said. “We feel proud that such a wonderful university decided they wanted to replicate this with our consultation. … This could have global implications.” 

Dental care is not the only area of collaboration between Beit Issie Shapiro and southern California institutions. The nonprofit is involved in three other research initiatives at at CHLA concerning children with chronic illnesses and special needs, and the development of a movement program at the John Tracy Clinic, an L.A. nonprofit serving young children with hearing loss.

Ernest Katz, director of behavioral sciences at Children’s Hospital and professor of clinical pediatrics and psychology at USC, is involved in one of the research projects that is using methods developed by Beit Issie Shapiro to provide better care for children under age 5 who suffer from cancer and blood diseases. Katz said the kinds of therapies provided to children with disabilities can also be used to help chronically ill children. 

“This local collaboration that we have with Beit Issie Shapiro [is] to the benefit not only of the children of Israel, but to the benefit of the children of Los Angeles and the Southern California community,” he said.  

Experts from Los Angeles, including Katz, have traveled to Israel to learn about Beit Issie Shapiro’s practices and facilities, and to share expertise. Last December, 10 such experts joined officials from Beit Issie Shapiro in Jerusalem to present research findings at the third International Conference on Pediatric Chronic Diseases, Disability and Human Development. 

He said he has also been inspired by visits to Beit Issie Shapiro to look for ways of bringing different kinds of services at CHLA together — such as hydrotherapy, physical therapy, physiological support and nutrition planning — so children and families can get the help they need in one place.

The Israeli organization also has hosted groups of visitors with disabilities from Los Angeles, including a mission last summer sponsored by The Jewish Federation of Greater Los Angeles. The Federation also helps support the nonprofit’s efforts in a joint project with Israel Elwyn to help people with disabilities in Israel advocate for themselves. 

“We look at ourselves as an organization for social change and betterment of society and not just providing services to people with disabilities,” concluded Benjy Maor, Beit Issie Shapiro’s director of international resource development. 

Partners in dentistry

For years, partnerships between the United States and Israel have revolved around the military and economics. Now, dentistry can be added to that list.

Beverly Hills dentist David Frey has helped raise thousands of dollars for the Jerusalem Dental Center for Children, a nonprofit that provides high-quality dental and preventative care at subsidized rates to families in Jerusalem and throughout Israel.

“There wasn’t a place that was providing quality dentistry for low-income patients” before the founding of the Jerusalem center, explained Frey, who said he has collected nearly $10,000 for the clinic.

After completing dental school in San Francisco, Frey traveled to Israel in 1990 and worked at the clinic when he was 24 years old. He grew to admire Dr. Isaac Perle, founder of the Jerusalem Dental Center, and fell in love with Israel.

“I delved into the Israeli culture,” Frey said.

Afterward, Frey started his private practice Beverly Hills, leaving Israel — and the center — behind, until he received a recent phone call from Perle. The clinic was in need of funding, Perle told Frey. It had been 20 years since the two had spoken, but Frey said he was happy to help.

On Dec. 6, Frey organized a benefit in Beverly Hills that raised thousands of dollars to support Perle’s efforts. Perle attended the event, which drew approximately 100 people, including Frey’s patients, friends and colleagues. The fundraiser also marked the opening of Frey’s new Beverly Hills dental suite, where the benefit was held.

Frey is continuing to accept donations on behalf of Perle’s center at jerusalemdental.org/Donate.html.