Ayesha Khan is a final year student at Leeds University and she hopes to qualify in 2014. This article focuses on her invaluable experiences gained from carrying out a dental volunteering placement in Cambodia.
Along with three other dental students from Leeds, Ayesha embarked on this journey in June 2013. The students chose to focus their two week placement in Cambodia, as the levels of dental decay are amongst the highest globally; the average five year old having 8-10 decayed teeth, and teenagers having an average of 6 decayed permanent teeth. Furthermore, due to recent history of internal conflicts and struggle to recover from the aftermath of the 1970's Khmer Rouge 'Reign of Terror', Cambodia suffers an acute shortage of healthcare professionals, and significant scarcity of dental care.
After much debate, enthusiasm and keen anticipation, our chosen country for the dental elective was Cambodia, hosted by the one2one charitable trust, a non-profitable organisation founded in New Zealand.
Upon arrival in Phnom Penh on 9th June, we were pleasantly greeted by a temperature of 35°C, bustling streets, lively Khmer traditional music, lingering food aromas and thankfully a member of the one2one group! Our visions of an air conditioned taxi were immediately dashed as we squeezed into the organisation's tuk-tuk, and luckily managed to make it to 'Grace' House, the one2one accommodation, without losing our luggage! I was pleasantly surprised at the cleanliness and size of the accommodation, and the warm, friendly reception received by the houseguests made us feel extremely welcome.
Clinical Experience
We were awakened at the crack of dawn by street sellers, birds chirping, racing motorbikes and excitement, and soon travelled in a minibus to our mobile placement. Our first week was spent in Takeo, a rural village on the outskirts of Phnom Penh, which had extreme poverty and consisted mainly of farmland. On the first morning, we were initially surprised at how basic and run down the primary school was, particularly that we would be using gym bench presses and classroom desks as an improvisation for dental chairs. There were no dental lights, however we had brought head torches which proved to be useful. The instrumentation and equipment was extremely basic, there were no radiology facilities. There was a portable generator but we soon realised we didn't have much more than a probe, forceps, excavator, wards carver and local anaesthetic. I was surprised at how obedient and well-disciplined the children were. None of the children I treated in Cambodia were tearful, which differs greatly to England. We had nurses and some teachers to assist with interpretation; however it was difficult to offer reassurance to the children due to the language barrier. Majority of the children did not own a toothbrush or use toothpaste, so it was extremely satisfying to be able to offer each child the supplies we had managed to collect as donations. It was important to teach the children how to brush correctly, so another dental student and I took it upon ourselves to visit each classroom alongside an interpreter, in order to offer physical, visual and verbal oral hygiene instruction. This was in the hope that these less privileged communities could become more oral health conscious and a movement from merely fluoride varnish application and extractions, could extend to more consistent and long term interventions.
Most of the children were extremely anxious due to fear of the unknown, and naturally overwhelmed by the instruments and foreign faces; this made it paramount that each child had a positive experience so as to avoid a spread of communal fear. I felt that my non-verbal communication was vastly improving, and found body language alone was in invaluable tool in offering reassurance and overcoming the language barrier. It was enjoyable to learn key Khmer dental terms and to obtain a response from the patients who were extremely supportive of our efforts. Having spent a week at the school, we had managed to treat our target number of patients, and headed back in high spirits to Phnom Penh, excited as to what the following week would offer.
Seal Cambodia Project
I felt extremely privileged to be a part of the 'Seal Cambodia' initiative which is an exciting three year project which aims to seal the first permanent molars of 60,000 Cambodian children within three years. This project currently has made a huge difference to the dental health of these children, most of whom presently require extraction of their first permanent molars on completion of primary school. We took part in the 'Seal Cambodia' project at a local school in Phnom Penh, prior to treating the children, we were given training on how the programme works and strict protocols for GIC placement were given. Particular attention with regards to moisture control was required, as we were only provided with cotton wool isolation. As the protocol and guidelines explained; we were required to use a specific hand technique to provide a clear visual field, cotton wool isolation, accurate quantities of GIC sealant and thumb placement of Vaseline over the fissure to allow setting and provide a moisture barrier. By the end of the day, we had done approximately 100 fissure sealants each, and had mastered the fissure sealant technique! It was most surprising to see during break times, the children would sprint to an endless row of sweet stalls, and indulge in various low cost, highly cariogenic sweets, which undoubtedly contributed to the high levels of tooth decay. Following this observation, I took it upon myself to suggest to the teachers and lead of the 'Seal Cambodia' initiative, to investigate the possibility of a replacement with healthier food stalls, and nutritious snacks, and it was agreed that this issue would be discussed and addressed as a priority.
Sweet stalls within a local Cambodian school, which encouraged children to frequently snack within school breaks
International University Clinic
Our following placement was at the International University of Cambodia, where we were given the opportunity to work alongside Cambodian dental students, where the clinical setting appeared extremely modern in comparison to the mobile clinics. It felt almost luxurious to have a three in one hand piece, functioning light, adjustable chairs and nurses! A radiology unit was available, however there were no film holders or protective lead shield; a current issue being addressed by the University due to radiation protection litigation. The Cambodian dental students were extremely dedicated and encouraging and I was able to gain invaluable extraction and elevation techniques after extracting countless numbers of teeth! We mainly treated adults whilst at the University, and I also carried out some restorative and endodontic procedures. I was surprised when made aware that the sterilisation process involved cleaning the instruments with bleach, alcohol, shampoo and water prior to placement in a pressure cooker! However I realised that even without a fully equipped hospital; good treatment plans, accurate diagnoses and efficient use of limited resources was enough to provide good quality care to patients in desperate need of dental care.
Reflection
Overall, I feel that volunteering has been an invaluable and life-changing experience to my personal and professional development as a dental student. Following this journey, I feel my clinical skills have vastly developed alongside my confidence and technique when performing both paediatric and adult extractions. I feel I have furthered my tenacity and ability to deal with challenging and unfamiliar situations in clinical practice. Despite the high temperatures, unfamiliar surroundings and lack of comfort zones, I feel the discomfort was a small price to pay in comparison to providing dental care to the Cambodian residents, who have been deprived of access to dental services. It was extremely interesting to hear personal accounts of the devastating years of political and military strife suffered in Cambodia and gain an insight into local traditions, new cultures and values. On personal level, embarking on this dental volunteering placement has allowed me to become more culturally and socially sensitive, independent and tolerant. It has undoubtedly been an invaluable experience which has allowed me to further both my clinical knowledge as a dental student, and life experiences as an individual.
Ayesha Khan
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