Humde, Manang District, Nepal

nepalclinic2.jpgPerched at 3000m, in the shadow of the Annapurna mountain range, the Humde Dental Clinic provides much needed dental care to the entire Manang District of Nepal, from Chame to Kangsar.  Originally funded by Rotary and the Manang Youth Society, it is located on the grounds of the local Tibetan school. Prior to the clinic's opening, residents had to walk six days to the nearest road before boarding a crowded bus to the dentist another three hours away.

 

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The region experiences two types of dental problems that are generally stratified by age. Periodontitis (gum disease) is the greatest problem for the adults in the area. Their diet is primarily rice and grains, so they do not develop many cavities. However, without regular cleaning by a dentist, they accumulate heavy tartar build-up and consequently suffer from gum disease. It is common to see young adults in their 20s or 30s with no cavities, but several mobile teeth with associated gum infections. Children, however, suffer from decay due to the introduction of sugar from the advent of tourism in the area. Unfortunately, the majority of cases involving all patients in the area are due to pain. Traditionally, preventative dentistry has not been a part of their way of life. So long as there is no pain, residents typically do not seek treatment.  Unfortunately, premature tooth loss often results when pain, rather than prevention, finally motivates a patient's visit to the dental clinic. 

 

karma%20face.jpgDental care is improving with the introduction of the resident Oral Health Worker, Karma Buti.  A local graduate of the high school in Manang, Karma has been working at the Humde Dental Clinic since it opened in 2004. In addition to the instruction and guidance Karma has received from various visiting dentists, she has further enhanced her skills with training in Kathmandu during the winter. She is adept at performing simple dental extractions, thereby providing immense relief to numerous patients.  She also has basic knowledge and skill at providing deep cleaning (scaling), and placing simple fillings.

 

humde%20kids%20sized.jpgWisdomtooth's ongoing work at the Humde Dental Clinic remains focused on two substantial goals: to expand the present proactive prevention program, and to improve Karma's clinical skills.  The clinic's proximity to a Tibetan school has facilitated excellent oral hygiene, instruction, and care in the local student population.  We would like to expand this level of prevention to all area schools. In addition, Karma would like more mentoring in providing fillings. While she has training in Atraumatic Restorative Treatment (ART), Karma still feels hesitant placing fillings confidently. Additionally, the clinic has a dental unit (drills, generator, and compressor) to prepare teeth for definitive (amalgam and composite) fillings. With the addition of a 220V amalgamator or curing light, she could be trained to place more definitive restorations. In short, additional hands-on instruction from visiting dental professionals would support the clinic and Karma in providing essential services to the local people.

 

As you see, there has been great progress, investment, and hard work to improve the oral health of the people in the region. However, there is still significant opportunity to develop new programs and clinical skills. We invite you to come share your expertise with the hearty people of this high Himalayan region.  Your effort and skill are essential to building an on-going sustainable program to improve the dental health throughout the Manang region.

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Posted on Thursday, April 17, 2008 at 06:41PM by Registered Commenterwisdomtooth | Comments Off

Leh, Ladakh, India

leh%20sized.bmpIsolated in the Indus River Valley, high on the Tibetan plateau, Leh serves as the capital of Ladakh, India. Originally from Mongolia, Ladakhis settled the valley over a thousand years ago, farming barley in the marginally fertile soil.  Here lies the Lamdon School. Founded in 1973 by the locally created and administered Lamdon Social Welfare Society, the school has grown from its original 27 students and one teacher to a local enrollment of 1200 with an additional 800 students in 10 remote sites. The school consistently produces highly educated students, many of which are full time boarders, coming from poor families on full scholarships, and places a strong emphasis on maintaining local Ladakhi and Buddhist culture.

 

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However, dental prevention has not traditionally been a way of life here. There has always been a struggle with periodontitis, but now, with the availability of refined sugar and carbohydrates, there is an increase in tooth decay.  A study done in 2008 under the guidance of Eugenio Baltran of the CDC showed that 80% of the students with primary (baby) teeth suffer from tooth decay. Many of the students suffer from infections of the tooth pulp and dental abscesses which are extremely painful. Fortunately, this figure drops to 45%, and impacts only a few teeth as the students acquire and maintain their adult dentition. However, calculus (tartar) build up, which is a major causative agent in periodontal disease, becomes a significant issue. Over 90% of the students 12 years and older have calculus deposits to some degree that if not removed lead to weakening of the supporting
bone and eventual tooth loss. Some of the older students (17 and 18 years old) are already showing signs of this, and developing Periodontitis.

 

The realization that something could be done to halt the problem spurred the school’s administration to take action to improve the oral health of the students. Several steps have already been implemented to improve the oral health situation. The principle, Mr. Eshey Tundup, has banned the sale of sweet tea and candy at the school. Bill Kite, and American resident of New Zealand, and long time humanitarian in the Himalayan region is facilitating and coordinating the efforts of foreign volunteers. In 2007 every student and staff received a tooth brush, paste, and floss in addition to proper oral hygiene instruction administered by a group of 85 students from Singapore (UWSEA and Tanglin Trust School), under the guidance of Dr. Kelvin Chye.

 

clinic%20plan%20sized.bmpA plan to construct a larger clinic on Lamdon's Leh campus is being considered.  Matthew Frantz, an architecture student at the University of New Mexico rendered the plans (at left) for the structure.  It would be a combined medical/dental facility built if and when Lamdon receives a full time dental therapist.  Dr. Hemalatha Nathan of Nanyang Polytechnic interviewed candidates in 2008 for a slot in their three year dental therapy program. However, none were chosen.  To meet the current need for dental care, the Singapore Dental Society sent a dental team of 15 dentists, lead by Dr. Myra Elliot, for five days in July of 2008 to provide direct care. They returned again in 2009 to provide care to the people of Nubra Valley (north of Leh).  Vivian Levy, a dentist from New Zealand also brought a team to provide direct dental care.  These efforts are all critical to address the immediate suffering, and are greatly appreciated. However, they are short term interventions, and do not deliver continuous, sustainable, long term oral health care.   

 

cavity%20kid%20sized.bmpIn the early summer of 2008 Wisdomtooth trained the school nurse, Yangchen Dolma how to provide basic dental care. A long time presence at the school, she has earned the students’ trust and respect, and has proven her commitment to the health of the children. After six weeks of intensive training, she acquired the skills and clinical judgment required to adequately diagnose: decay, calculus, pulpitis, and dental abscesses. She gained proficiency at placing fillings with hand instruments in baby teeth, removing calculus, and extracting painful and abscessed teeth. In 2009 our volunteer returned for five weeks to provide training in how to place permanent silver fillings.  The training was extremely successful.  Yangchen is now placing occlusal amalgams in adult teeth with skill similar to that of any recent dental school graduate.  She also continues to emphasize personal oral hygiene and tooth friendly nutrition education.



Wisdomtooth is currently seeking more dental professionals to continue training Yangchen at Lamdon School.  She is the only ongoing dental presence for Lamdon’s 2000 students for the foreseeable future, and will then continue working with any dental therapist who comes to Lamdon. This is a great opportunity to be on the cutting edge of international dental aid while empowering the Ladakhis themselves to meet their dental treatment needs. Please join us in one of the most breathtaking Himalayan settings as an honored guest in this unique community. Room and board will be provided, as will the potential for treks in the area.

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Posted on Thursday, April 17, 2008 at 06:39PM by Registered Commenterwisdomtooth | Comments Off