Cruisin' with Dr. Begalla

by Cathy Hester Seckman, RDH

Suppose you save some money, make reservations, fly to the coast, and board a cruise ship for the vacation of your dreams. Suppose you climb into your bunk the first night, thrilled and exhausted by the day's activities. But suppose the seas are a little rough, and you fall out of bed.

Crash! A look in the mirror confirms your worst fear. Your front tooth is broken. Now what? Don't worry, this is a job for ... cruise dentist!

That's exactly what happened to a patient of Dr. Bill Begalla's of Boardman, Ohio, who works for Holland America Cruise Line as a ship's dentist. Two or three times a year, Dr. Begalla boards one of Holland America's mammoth ships and spends one or two weeks working at his profession while cruising the seven seas. He estimates he's been on 30-40 cruises to more than 25 countries. He's visited the Mediterranean, the Pacific Northwest, Europe, Scandinavia, the Iberian Peninsula, South America, the Antarctic, and the Panama Canal. He estimates he's been to the Caribbean 15 times. Sounds like a tough life, doesn't it?

Dr. Begalla, a Boardman native, is a graduate of John Carroll University and The Ohio State University School of Dentistry. He first became interested in dentistry through his mother, a nurse anesthetist. "My mom worked with a lot of the oral surgeons in the area," he recalls, "and I used to go to work with her sometimes."

His father also was an influence in his career path. "My great-grandfather, grandfather, and father all were in the service, and it seemed like the natural thing for me to do too. My father was a Marine, but he always said the Coast Guard had the best duty assignments, so I applied to the Coast Guard Dental Corps after dental school."

He was finishing a general practice residency in 1984 when he got the call. "One of the Coast Guard's dental officers was a hardship case and had to leave the service. They needed someone to take over his position in the southeast United States, providing dental treatment for small stations. I liked the idea of living in the south. It was an opportunity to travel and hone my dental skills by doing comprehensive dentistry. I did whatever they needed at small, isolated boat stations."

While in the Coast Guard, he met a nurse who worked part-time for Holland America. When she told him the cruise line also employs dentists, he was immediately intrigued. "I love to travel, and it sounded like a great deal. I asked her what the criteria were, and she said my Coast Guard background would be just fine. I applied and got my first assignment in 1987."

By that time, he had finished his Coast Guard stint and formed a partnership with Dr. Robert Bitonte in Boardman. When Dr. Bitonte passed away, Dr. Begalla continued with a solo practice and works five days a week. He also supervises a dental residency program at Northside Hospital in Youngstown, Ohio, and is active in local charity work, particularly the American Cancer Society.

Every Holland America cruise, Dr. Begalla says, includes a physician, several nurses, and a dentist. They are available for passenger emergencies, but their primary patients are officers and crew members, who spend nine to 12 months at a time on the ships. Depending on the ship, there might be 1,200 to 1,800 employees aboard.

"The officers are Dutch and British, and the crew members are Indonesian and Filipino," Dr. Begalla says. "Onboard medical and dental care is a job benefit for them. Passengers may not realize it, but every Holland America ship has a full hospital on board, complete with operating rooms, an intensive care unit, and a morgue. The dentists do routine physicals, blood pressure checks, and things like that, but they also can do emergency surgery if it's necessary. Anything elective, like a tonsillectomy, would be contracted out in a port city like Miami."

While the ship is at sea, Dr. Begalla is on-call 24 hours a day, and usually works 8 a.m. to 6 p.m. doing cleanings, restorations, extractions, and even root canal therapy.

"Anything that involves lab work, like a crown or dentures, has to be contracted out on shore, but I do everything else. I have an X-ray unit, a darkroom, an autoclave - everything you'd find in a normal dental office."

He usually works alone, but a nurse is available to help out if needed. "I remember one cruise where I was doing a full-mouth extraction for a crew member. One of the nurses was assisting, and she passed out."

Dr. Begalla may see up to a dozen passengers during a typical cruise, handling anything from a toothache to recementing a crown. When passengers have a dental emergency, they fill out a release form that states they will be responsible for any charges. An appointment then can be billed to passengers' credit cards, just like a mai tai. When passengers return home, they can submit the bill to an insurance company.

At the end of the day, Dr. Begalla puts on a dress uniform and becomes a ship's officer himself. He has specific duties to perform during emergency drills, and he occasionally escorts shore excursions. When the ship is in port, he doesn't do dentistry and is free to become a tourist. "It's a nice way," he says casually, "to see different parts of the world. My favorite place so far has been Monte Carlo, but there are still places I want to see. I want to go to Asia to see Singapore and Hong Kong. I've been asked to take a world cruise, but that's 90 days, and I couldn't leave my practice for that long. Maybe someday."

Besides taking the cruise itself, Dr. Begalla is paid a nominal daily fee and is allowed to bring his wife along with him. There's also a reduced-fare schedule for relatives. "I don't do it just for the trip and the money, though. It's very rewarding and gratifying because the crew members are so appreciative. Dentistry is expensive in their countries, and many of them are in dire need of dental care. The only care they get, sometimes, is from Holland America. They're given toothbrushes and floss, and you can really see improvement in their own care."

Dr. Begalla doesn't have the relationship with onboard patients that he has with his own patients at home, of course, but he does get to know them. "I try to follow through as much as I can. I might start out with a cleaning, then do any necessary fillings before the cruise is over. Sometimes I have to leave things for the next dentist. Many of the crew members are long-time employees, though, just like me, and they're friends. I've seen them over and over again. I've made friends with some of the passengers too, people I've kept in touch with over the years. It's been a really good experience."

Dr. Begalla works hard on the cruises, but there are compensations. After a long day of helping people improve their dental health, he can just walk out to the deck, cocktail in hand, to watch the sunset over Cabo San Lucas, or Charlotte Amalie, or Ketchikan, or Rio de Janeiro. It's a tough life!