In November 2013, less than a week before the NYU College of Dentistry outreach team was scheduled to depart for Nepal, they learned that their tourist visas were not going to be sufficient for providing dental services in a public school. Obtaining the new volunteer visas that were required could take five to six months.
Rachel Hill, director of global outreach and international initiatives, thought fast, adapting the program so that the Srongtsen Bhrikuti Boarding High School in Kathmandu, which was expecting a dental outreach visit, would not be disappointed. For months prior to the outreach program, she had worked with Kantipur Dental College, a local teaching hospital and research center, to register NYU dental faculty with the Nepali Medical Council, which would allow them to perform dental care under the supervision of local dentists. The last-minute changes meant that the NYU Dentistry team would need to work within the clinics of the dental college instead of at the school as originally intended, and they would need to transport any children who needed dental care from the school to the dental college for their treatment.
"Any new outreach location is challenging for us," says Ms. Hill, "and Nepal was a perfect example."
With a somewhat smaller team, 21 outreach volunteers from the NYU Dentistry-Henry Schein Cares Global Student Outreach Program embarked for Nepal on November 7. Their relief at finally arriving was tempered by new challenges.
"We knew that the country’s upcoming elections could present some unexpected events, but on the weekend we arrived, we learned that a 10-day general strike—the exact duration of our visit—would begin on Monday. As a result, there were huge disruptions in business and transportation," says Ms. Hill. The team also had to take safety precautions, avoiding large demonstrations and protests.
It was a lesson in patience, but one that paid off, because the NYU Dentistry team encountered one of the highest levels of tooth decay they had ever seen. They began by conducting dental examinations at the boarding school, located in a neighborhood called Boudha. The school serves about 750 students, about half of whom are children of Tibetan refugees living in exile.
About 40 percent are boarders and the others come from the poor local and mountainous areas of Nepal. Children — whose tuition is sponsored by international organizations — learn Tibetan, Nepali, and English.
The team examined 211 children at the school but had to limit follow-up care to those with the most pressing needs — pain, active infections, abscesses, and other emergencies. Children who needed treatment were taken by a tourist bus to Kantipur Dental College, about 40 minutes away. In most cases, the children’s parents were able to accompany them on the bus and sit with them through their dental treatment, and when they could not, a nurse from the school acted as a surrogate. For some parents, it was a first connection to this source of treatment — albeit one that very few of them would be able to afford in the future.
"We found that treatment needs were incredibly great," says Dr. Stuart M. Hirsch, vice dean for international initiatives, development, and student affairs. "There were children as young as five with a mouthful of disease. We could not complete care on all the children only because there were so many emergencies. So it wasn’t a typical outreach activity."
Samira Ehteshami, a fourth-year dental student, had previously participated in three non-clinical outreach visits to Grenada, where she says prevalence rates of caries climb to 83 percent. "They were just as high and in many cases even higher in Nepal," she says. "Many kids had completely decayed teeth on every surface."
Dr. Hirsch attributes the level of dental distress to a combination of diet — including increasing consumption of sugary drinks and snacks — lack of education about dental health, and lack of access to care. Being in pain, he says, is a normal situation for many people, and going to a doctor often is not an option. Although there are about a dozen dental schools in Nepal, many are private businesses that rely on clinic fees and tuition, making them unable to provide affordable care for the poorest people.
At the boarding school, two NYU Dentistry faculty members, Professors Jill Fernandez (pediatric dentistry) and Annette Huynh (dental hygiene), provided extensive oral-health prevention and nutrition education, reaching all of the children in the school and encouraging them to stay away from candy and to maintain daily oral healthcare habits. Now students will be brushing their teeth once a day in school, and all of the teachers are trained in applying fluoride varnish, which will take place every three months.
Dr. Ehteshami adds that the school nurse is a strong advocate who will sustain the project, and dormitory monitors will reinforce these activities with the boarders. The leadership of the NYU Dentistry outreach team also talked with the school principal about reconsidering the current selections in the school’s snack shop.
"Given the limitations, we were able to accomplish a lot for many kids, really emphasizing the importance of prevention and education," Ms. Ehteshami says.
Funded by the Tibet Fund in New York and the Snow Lion Foundation in Nepal, the Kathmandu project was initiated by a faculty member at NYU Dentistry, Dr. William Bongiorno, who first connected the Tibet Fund and NYU Dentistry in 2011. On a 2012 site visit to Nepal, the Tibet Fund and Snow Lion Foundation hosted NYU Dentistry’s global outreach planning team and introduced them to the Srongtsen Bhrikuti boarding school, whose principal, Venerable Jampa Phuntsok, has been extremely enthusiastic and welcoming. The Sherpa family, relatives of current fourth-year dental student Jenny Sherpa, also helped the team with advance planning and logistics in the country.
Despite hindrances and challenges, the program offered NYU Dentistry the opportunity to fulfill its three-part outreach mission of conducting service, training, and research. In addition, it met the criteria for sustainability in terms of both local-partner involvement and funding.
"This program did a lot of good," says Dr. Ehteshami, whose passion for public health and pediatrics led her to NYU Dentistry, in large part because of the extensive dental outreach program. "It also gave me a unique opportunity to perform a high volume of dental care with one-on-one guidance from faculty and residents."
Dr. Ehteshami recalls that one of her nicest memories of working in Nepal, besides the incredible cultural experience, was when one of the parents on the bus ride home, on the last day, said in broken English, 'I’m going to remember you every time I look at my son’s mouth.' All of us realized that with a limited amount of resources, we were able to use our skills to really help kids."
Dr. Hirsch adds that, while the dearth of dental care in Nepal and elsewhere in the developing world is difficult to comprehend, it is important for students to face the disparities and to think more broadly about their careers as dentists. "This is an important part of our effort at the College of Dentistry," says Dr. Hirsch. "Being a dentist is not just about sitting patients in a chair for 35 hours a week. It is broader. The dentists we’re training are very different from the dentists of the past. That is what is so exciting to us."
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