Practice Dentistry at the Top of the World

Richard Gawel

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Dentists who want adventure while doing good deeds should consider volunteering 2 weeks of their time with Around Good People, which conducts dental outreach missions to remote villages in the mountains of Nepal. In addition to providing care for those who greatly need it, participants are immersed in an exotic culture with opportunities for once in a lifetime recreation, too.

“This is humanity at its best. The whole job is international volunteers coming into the community, ethnic villages that never open up to other people. But since our social workers have worked with them, they have a rapport with these volunteers,” said Rijul Bhaskar Gurung, the country director for Around Good People. “This is getting to know each other. It’s a global village, so it’s giving back to the community.”

Dentists on these excursions perform cleaning, scaling, sealant applications, restorations, and even extractions. More complicated procedures such as root canals are referred to nearby dentistry schools and facilities, which then provide that care for free. Procedures typically are performed in a nearby school or other community center that the volunteers convert into temporary, working dental facilities.

Participants also teach villagers about oral hygiene. Nepal has one of the lowest per capita rates of dentists in the world, with only 319 in its population of 29.5 million, so these villagers need to manage their own oral care. Volunteers train a pair of educated and married women in each village so they can continue care once the volunteers leave.

“Ours is grassroots activism in the sense that we continue with this community long after the international volunteers leave the outreach,” said Gurung. “Our work is a little different from institutional work because we want the program to be owned by the community.”

The first 3 or 4 days of the trip are used to travel to whichever village will be benefitting from the outreach. Eight days of dentistry then follow, as volunteers cycle between roles each day in a rotation that facilitates learning and promotes enthusiasm. At the end of the day, participants spend time with the villagers, eating with them, getting to know them, and taking part in their customs and traditions.

“And since most of our volunteers are young people, and Nepal is a huge, popular holiday destination, we dovetail a holiday experience during the last 3 days because they work so hard,” said Gurung. “We try to incentivize them by giving them a cultural experience. We call it cultural immersion.”

Activities during downtime and those last couple of days in Nepal may include hiking, biking, rafting and canoeing, bungee jumping, safaris, paragliding and ultra-light flights, zip-lining, and even plane tours around Mount Everest and its surrounding peaks. And that’s in addition to the constant cultural exposure, which includes living among the villagers in hardy conditions.

“We have tented accommodations,” Gurung said. Or, volunteers might stay in the house that belongs to the village chieftain, though that can’t be guaranteed due to the earthquake that struck eastern Nepal in April 2015. But facilities are always safe, comfortable, and sanitary. “We have a commode and running water,” Gurung said, “and then a hot shower after a hard day’s work.”

The equipment is portable by necessity, and it is typically left behind so the villagers can manage their own care after the outreach is over and the volunteers have left the village. Around Good People pays for its equipment, supplies, and logistics through the fees volunteers pay to participate, though many dentists who take part also donate supplies to support future outreach excursions.

“Every last cent is spent on outreach,” Gurung said. “No administrative costs, no gimmicks. Everything is transparent. After every outreach, we provide the accounts, where the money goes, how the money was spent. That’s why lots of volunteers who have volunteered with us bring back a team. That’s how we are scaling it up now.”

The need for dentistry is growing in Nepal, too. The tourism boom over the past couple of decades has brought more westerners into its cities and its remote regions, along with more processed food.

“Working with the high mountain people, 20, 30 years back, they didn’t have these dental problems. They didn’t have these dental issues because in their food, there was no sugar,” Gurung said. “And now the young men go out to the nearest town or the cities to work, and when they come back they bring loads of candies, and that is how sugar is introduced to small children. That’s the problem.”

Lack of controlled water fluoridation and overall poverty that prevents families from travelling to existing dental facilities and paying for treatment exacerbate this poor oral health. According to Around Good People, 11% of children in rural Nepal who are 6 years old have a decayed, missing, or filled tooth, with 61% of those surveyed saying that they have never brushed their teeth.

As a result, Around Good People has a significant impact in areas where dentists simply aren’t available. Between November 2014 and January 2015, 215 professionals and students performed 14,387 procedures in 4,338 hours on 9,651 patients. They also provided oral health education to 4,533 Nepali students from 37 schools. One outreach has been completed so far in 2016, with 2 now underway and 11 more planned.

Each outreach involves a minimum of eight volunteer dentists and dental students with 4 in-country dental volunteers for a total of 12. Despite the rugged terrain, there are no physical requirements except general good health. Participants are expected to abide by ADA guidelines for ethical practice.

All dental professionals are eligible, along with dental students and students in dental nursing, dental hygiene, and dental therapy programs with a minimum of 2 years of study in a related field. These students are paired with the dentists on the team, who provide supervision. Around Good People also is looking for volunteers who can assist with oral hygiene instruction, equipment sterilization, and clerical assistance.

“We do take in nonclinical volunteers as well. They don’t have to be associated in any way to dentistry,” said Gurung. “We need clinic managers, assistant clinic managers, and the people who mind the timing of the different clinical bases. This is a very structured and planned outreach, so we need people for that all the time.”

Many of Around Good People’s volunteers have come from Australia and New Zealand. But the organization is now looking to the United States for participants. In fact, Gurung traveled from Nepal to ADA 2015 in Washington, DC, last November to promote the group and recruit new volunteers. Since its inception, he said, its volunteers have had positive and rewarding experiences.

“They feel it’s reconnecting to dentistry. They feel real proud to be reconnected to their profession,” Gurung said. “It is touching these human lives, touching this culture. It is trying to redefine yourself and your profession. It’s rediscovering yourself. And they are very happy.”

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