Tessa Jensen, a fourth-year dental student from Adelaide, was one of the five recipients of our FutureFocus grant in 2018.
Tessa completed her voluntary placement at Manipal Teaching Hospital in Pokhara, one of Nepal’s busiest hospitals, where she spent a month learning how oral maxillofacial surgery and general medicine in Nepal differs so much from Australia. Tessa looks at the experience as a life-changing volunteering expedition and saw just how important the role of dental education is in preventing life-threatening disease.
Read a full account from Tessa about her incredible journey below.
For four weeks over the Christmas holiday period, I was lucky enough to undertake a voluntary placement in the dental department of Manipal Teaching Hospital. The trip not only allowed me to gain an insight into the barriers facing developing countries such as Nepal, but also provided me with memories and friends to last a lifetime.
In choosing to travel to Nepal, I was shocked to hear that many of the leading causes of death in the country were diseases in which dentistry can play a vital role. As we continue to discover more links between general and oral health, it seemed important to me to explore the reasons that preventable and manageable conditions such as diabetes and heart disease are uncontrolled amongst the Nepali population. In particular, I wanted to understand how dental awareness in the country was affecting these statistics. Travelling to Manipal Teaching Hospital in Pokhara provided me with a unique experience to see both sides of the story – from the dental and the medical perspective.
Manipal Teaching Hospital is the largest private hospital in the region, with five floors of dedicated in and out-patient departments, amongst which is the Dental Out-Patient-Department (OPD) and a much smaller in-patients ward. Despite employing two general dentists, an orthodontist, prosthodontist, oral maxillofacial surgeon and a hygienist, the clinic is restricted by its lack of facilities. Consequently, patients may be left waiting for hours before they can be seen. While this is not as apparent during winter months, when many patients are unable to travel to seek care, during the peak summer months, the clinic regularly sees over sixty patients per day. With just one x-ray machine between five dentists, a very limited sterilisation system and few instruments, there are often times where the staff have to sit and wait before they can see any more patients.
Despite the tough circumstances, I was surprised by the high standards of care that the dentists aim to uphold. The approach to treatment is always to provide holistic care where possible, something I had not experienced in other impoverished countries and was therefore sincerely impressed. Given the time and facility restraints on the clinic, there could easily be the mentality of solely addressing the patient’s chief concern and then sending them on their way. Instead, the preliminary examination covers not only the chief complaint, but the entire dentition and all areas requiring further investigation or treatment are noted. Only then is the patient sent for further investigations such as x-rays to aid diagnosis, and treatment commenced.
As I began to see more patients in the OPD however, I grew increasingly aware that this model of patient management falls short in patient education. The walls in the waiting area feature many posters depicting various dental diseases, but the dentists have neither the resources nor the time to talk to their patients about the importance of dental health. There is very minimal information provided about the causes of dental disease, and no guidance given for caring for ones’ teeth at home. Routine dental check-ups are not scheduled and, combined with the distance that many patients must travel to attend the clinic, almost all patients are symptomatic attenders only. Patients are always informed about which areas need to be addressed, however the lack of understanding regarding the importance of regular dental attendance and maintenance means that most patients do not return until they are in pain again.
It soon became apparent that this lack of patient education is one of the main areas, from a dental perspective, contributing to the high rates of untreated and uncontrolled disease in Nepal. In Australia, dentists will dedicate time particularly to explaining good oral hygiene to patients whose medical conditions may be compromised by poor dental health. However, in Nepal, most of the time there are very few special considerations given to treating medically compromised patients, let alone educating them.
The largest problem that these patients face, is from the medical point of view. I was lucky enough to be staying with several medical students during my time in Nepal, and consequently was given the opportunity to spend time in the emergency department and operating theatres. It was an incredibly eye-opening experience and gave me huge insight into just how insignificant the relationship between general and dental health is in Nepal.
I was shocked to learn that most patients presented so late to the ED and as a result, there was very little that could be done for them. People who had suffered a stroke would routinely present days after it had occurred, at which point it was far too late to consider thrombolysis. Similarly, there were high numbers of patients with chronic kidney disease who presented with renal failure because their condition had either gone undiagnosed, or they had not sought medical help until they were too ill to even get out of bed. Almost all of the conditions I witnessed in the emergency department and operating theatre, I was told, were far more advanced than anything you would usually see in Australia.
Apart from the difficulties facing patients to access care, one of the major contributing factors to the late presentation of patients is the lack of primary care in Nepal. There are no general practitioners or routine health checks, and minimal education. Hospital care is sought only when seriously ill, which for some patients means they will only be seen when unconscious. Consequently, underlying health issues are diagnosed late, if at all. Preventative health education, tests and management simply do not exist.
The lack of primary healthcare was also evident in the oral maxillofacial surgery (OMFS) area of the dental OPD, where I was fortunate to shadow the head of the department. Patients would present with advanced oral pathologies, along with ear, throat, nose and jaw complaints, which they would almost certainly have attended their GP for in Australia. The way in which these patients were managed, with very little consultation between the OMFS and other medical specialties, reinforced my newfound understanding of just how little impact the link between general and dental health has for the prevention and treatment of disease in Nepal.
I travelled to Nepal with the organisation Work the World and one of the first things they told me upon arranging my placement is that you are there to observe and learn, not to criticise or attempt to bring change. This really hit home when deciding how to best use my FutureFocus grant to benefit the clinic. For everything I had learnt about oral maxillofacial surgery, general medicine and how procedures and protocols in Nepal differ to Australia, it still came down to the fact that every dentist, patient and procedure was limited by their facilities. How could they possibly endeavour to grow and improve dental care to patients, if they had to work with sub-standard tools that were only available sporadically? As such, I decided to purchase $500 worth of instruments and other supplies for the clinic, supporting not only the department but also the local manufacturer.
On my last day at Manipal Teaching Hospital, I presented the clinic with the new supplies, along with donations I had collected from home. It was humbling, but also incredibly exciting to witness the joy and elation the whole department shared at receiving the gifts. In many ways, I feel extremely spoilt to have been able to work with and give back to such a deserving and supportive group of people. I took so much from this experience, not just in the way of learning, but emotionally too. I cannot thank BOQ Specialist enough for their support and of course, Manipal Teaching Hospital Dental Department for welcoming me so openly and teaching me so much.
As I enter my final year of undergraduate study, this trip was my last as a dental student. However, I cannot wait to start planning my first volunteering expedition as a fully-fledged dentist and learning all that countries like Nepal have to teach us.
This experience provided Tessa with greater insight into the impact dental care plays in Nepal, identifying that the "lack of patient education is one of the main areas, from a dental perspective, contributing to the high rates of untreated and uncontrolled disease in Nepal".
Developed exclusively for medical and dental students, each year the BOQ Specialist FutureFocus grants enable five students the opportunity to undertake an overseas placement so that their commitment to helping others can be realised. Applications for our FutureFocus Grant open in May and close in August.
You can also access funds to help undertake an overseas placement, with our Student Banking Package.
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