|In it for the long-haul|
|Thursday, 01 July 2010|
Dr Ian Wilson introduces the charity working in Tanzania to develop far-reaching solutions to dental care
When I graduated from the University of Edinburgh I wouldn’t say that I particularly stood out from my classmates, but I knew I wanted to do something pretty extraordinary within my career and profession.
After working for five years as a dental associate at a few NHS practices, I travelled to Africa and that was the turning point. My eyes were opened to the impact my dental skills could have in the developing world. Initially, I volunteered with a Christian mission organisation called Mercy Ships, which takes crews of volunteers to different ports to provide expertise in various fields, including medicine, sanitation, agriculture – and dentistry. It was a great opportunity which showed me what impact I could make personally into the lives of people in the developing world and got the ball rolling.
"So often our volunteering strategy can revolve around purely a curative approach and we miss the opportunity to train and empower communities for their long-term futures"
Over the next 10 years, I volunteered for dentistry projects across Africa, including Nigeria, Togo, Ghana, the Cote D’Ivoire and Kenya, but on my return to the UK I was left with a niggling question mark about the long-term impact of my work.
My photographs looked good, I was coming back with great stories, I’d taken a load of teeth out and done some fillings, but what was going on after I’d left? Invariably I’d always feel there was a vacuum, but I wasn’t sure how to do anything about that. And this struck a chord with me about the role of volunteers overseas and regulations that should be in place, but frequently aren’t.
My colleague, the former Dean of Dar es Salaam Dental Faculty, Professor Emil Kikwilu said, ‘We have a professional, moral and ethical responsibility to do something when millions of our people in Tanzania are left without the most basic of primary oral healthcare; simple and appropriate pain relief.’
We regularly see in the media the massive need and inequity of the simplest dental pain relief and primary oral healthcare in developing nations; pictures and stories of vast numbers waiting for dental services coupled with those of volunteers from Western dental professions expressing compassion by being part of the solution.
Despite research showing that more than 70% of the world’s population have little or no access to oral healthcare, which is recognised as a basic human right, very little political activity or financial aid is generated to address this problem. Is it right that this leaves many to resort to DIY extractions with horrific pain and injury?
It has been said that true compassion is more than flinging a coin to a beggar. An edifice which produces beggars needs restructuring. Today, four billion people live without access to the simplest of care. Many suffer pain not just for a few weeks but for years, with no help in communities of thousands where ratios can exist of 1 dentist to 350,000 people.
The fairly large number of dentists who volunteer their skills to work in these places is one valuable way to address the problem. Their motivations to volunteer may vary but in most cases are rooted in the recognition of need and the desire to help. They seek guidance from Non-Governmental Organisations (NGOs) whose raison d’être is to send volunteers or initiate their own projects. Unfortunately, many volunteers lack firsthand experi ence in the field and therefore are ill-prepared to make a realistic assessment of their own abilities, motives and limitations. Consequently, volunteers can fail to address the real needs of their host communities or even delivering dentistry inappropriately when they work as they have always been trained to do.
A survey of more than 200 NGOs active in international oral health revealed some concerns: lack of proper project planning, poor integration of projects into existing healthcare systems, no criteria for volunteer selection, lack of guidance and policies to manage volunteers, weak links with other NGOs and only little interest with following sound dental public health approaches.
While the impact on the volunteer is important and undeniable – as is the immediate benefit to the patients who received care – there is growing discussion regarding the long-term benefits to the local community of efforts that focus only on the immediate provision of care. It is also noted that in the UK, volunteers still go without:
• The proper registration with national government.
• Relevant overseas indemnity.
• Without appropriate strategies in place and sometimes without any accountability framework.
This often results in more harm than good, coupled with disillusionment and disempowerment of the local dental rural health worker. We would all agree with the principle of ‘give a person a fish and you feed them for a day, but teach them how to fish and you feed for a lifetime.’ Similarly, we can offer our curative expertise with admirable motives and even though many may receive care; the community will remain unchanged. Surely we can adopt the principle that to train an individual and put the resources in their hands to provide emergency oral care then you equip a community to care for themselves.
So often our volunteering strategy can revolve around purely a curative approach and we miss out on the opportunity to train and empower communities for their long-term futures.
As we volunteer and give our time, energy and resources to those in often desperate need of our care and compassion, let us pursue those strategies that teach, train and empower.
Dr Ian Wilson, Founder and Clinical Director, Bridge2aid
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