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Do Good: Dentistry Goes Mobile by Pauline Rick, Colin Hohnstein, Amy Dodge and Kimberlee Winterton, Casey Morgan

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Mercy Ships: Bringing First-World Care to the Developing World
by Pauline Rick

When the Africa Mercy docks for a 10-month stay in a developing country, it brings a modern facility with five operating rooms, 82 patient beds and the capacity to perform approximately 7,000 surgical procedures annually—all free for patients.

“Having the infrastructure of a first world hospital sitting there in port allows us to do a lot more than we’d be able to if we were attempting to provide care by shipping equipment in and setting up on the ground,” explains Tom Velnosky, senior bio-medical systems engineer. “We’re able to carefully control the environment for patients, and also give our volunteers a comfortable setup so they can hit the ground running with treatment.”

Among those volunteers are many dental professionals. The Africa Mercy hosts up to 1,200 medical volunteers over the course of its stay in a country, most of who serve in periods of two weeks to a month. The off-ship dental clinic is equipped with eight dental chairs, allowing its volunteer dental professionals to treat patients who have no other access to quality dental care.

“Imagine a toothache that has lasted years,” says Mark Bullock, DDS, lead dentist for Mercy Ships. “Many of our patients have no concept of western levels of dental care, and frequently, care in our clinic is a huge blessing simply because we have and use adequate anesthesia.”

As a veteran of the war in Afghanistan, Bullock is experienced in delivering care in the poorest places in the world, where he aims to “combat despair with service and compassion.” He explains that the ship’s setup allows the organization to serve patients faster and better than a land-based system. “Our ship-based platform allows for an unprecedented consistency in the quality of care we are able to deliver,” he says. “We are not as susceptible to the rapid deterioration of our facilities and programs that is inherent in developing nations’ health systems. Also, unlike land-based models of aid, we can operate at a much higher operational tempo because our infrastructure is generally reliable.”

The infrastructure of the dental clinic has been revamped in recent years to a setup that can now accommodate four dentists with two chairs each, four dental assistants and a hygienist. As part of this renovation, A-dec donated chairs, delivery systems and handpieces.

“It is only through the generous support of partners like A-dec that we have been able to develop such an effective program,” says Bullock. “Having quality and complementary delivery units, dental chairs and handpieces is truly essential to making our clinic work.”

Although dental services are only a small part of the care that the Africa Mercy provides, Velnosky explains that they are an important way to touch lives. “The dental needs we treat are typically very immediate and have a simple solution,” he says. “We can quickly solve problems with decaying teeth and issues that would otherwise become painful and problematic in the long term.”

“Generally, there is authentic gratitude and relief from patients,” says Bullock. “I believe our patients are able to feel our compassion and understanding of their pain and fears and I hope we are able to bring some small level of comfort to their lives.”

In his ongoing work for Mercy Ships, Bullock hopes to create a model that could be adopted by a country as a comprehensive dental health system. “Currently, our urban clinic is an exceptional model for the delivery of care to the underserved in an urban setting,” he explains. “In the future, I would like to expand our program to include rural interior mobile clinics. I hope to raise awareness that difficult-to-reach populations are often the most desperate for services, and the use of small mobile clinics is the optimal way to provide those services to populations that are too small and too remote to sustain a full sized clinic.”

Mercy Ships has treated roughly 120,000 dental patients, completing more than 300,000 dental procedures.

Bullock states that the most fulfilling part of his job is “being able to deliver high levels of care to people that have little access to dental care of any kind, because it provides vision to people of how dental care can positively impact a community.” He adds, “I cannot describe the satisfaction of being able to heal the poorest of the poor at the highest of standards. God has blessed me with a very unique skill set that can improve people’s lives and I feel duty bound to use these skills to the best of my abilities.”

In summing up the importance of the organization and its mission, Bullock states, “Mercy Ships serves as a reminder to the developed world that there are still people in the world untouched by modern medicine. Equally important, it shows that we are not helpless in the fight against human suffering, but through cooperation, our technologies can be used to make the world a better place.”

Nomads in Paraguay by Colin Hohnstein

In October 2011, Dr. Edgardo Gonzalez, a dentist of 37 years who was an Outpost Ambassador for Smiles for Everyone Foundation, received an email from the CEO of Smiles for Everyone Foundation asking if he would like to be a part of a dental outreach mission. He quickly said yes, and one month later he, four dental colleagues and an operations team landed in Asunción, the capitol of Paraguay.

Before arriving, the team had a small window to gather all of the necessary equipment, materials and supplies for a portable, foreign dental mission. “In retrospect, this was a huge undertaking,” Gonzalez said, “starting with nothing and then having everything come together within a 30-day window.”


Once in Asunción, the group of volunteers, called SEAL Team 1 (Service Expedition Accelerating Leaders), met up with a local support team that would facilitate the mission, bringing with them five portable dental chairs, a NOMAD portable X-ray, and 10-foot lockers of dental materials and supplies.

Judah Mooney was the leader of the local support team. Mooney helped establish a charitable organization to support nutrition centers in Paraguay and has been involved in feeding Paraguayans in need. As it turned out, Mooney was a native of Laredo, the Texas town where Gonzalez was born and raised. “Talk about a ‘small world,’” Gonzalez said.

Gonzalez and his colleagues were the first Smiles SEAL team to provide outreach dentistry at an international outpost, and as such, the team faced many obstacles. He remembers that the rural area where the team was practicing had limited electricity, which was an issue because the handpieces they brought for the mission were electric. But this challenge was not too much for SEAL Team 1 to overcome. They continued to provide surgical services until they were able to purchase air-driven handpieces and rent portable air compressors. As Gonzalez puts it, “All went well.”

SEAL Team 1 completed five days of clinical treatment, treating patients at various orphanages (hogares) and nutrition centers (comedors). Since he had not worked on children for many years, Dr. Gonzalez at first felt out of his comfort zone, but he adjusted to the situation quickly. “It did not take long for me to get into the groove,” he says. “The children were very cooperative, with the older kids providing guidance and comfort to the younger children.”

Steve Bilt, the CEO of Smiles for Everyone, the principal sponsor of Smiles for Everyone and the company that organized the trip, assisted the doctors during the Paraguay mission. He had never been so close to dentistry in action, and he was impressed. “Toward the end of our mission,” Gonzalez recalled, “he told us, the doctors, that we did not realize how talented and gifted we were to be able to heal people.”

Despite the obstacles, all patients, most of them children, received the necessary dental treatment that they would not have received otherwise. “Patients in pain came to us with nothing more than an outreached hand asking for help,” said Gonzalez. Working on people in need in another country only made the experience more rewarding. “The fact that we did not expect anything in return other than ‘gracias’ made the ‘light in our hearts’ shine even brighter—that light of compassion for someone in need.”

Overall, SEAL Team 1’s mission to Asunción was a success and an inspiration, and the team was brought closer as a result. “Working as a team with four other dentists and a large support group made the mission a wonderful journey of camaraderie and partnership,” said Gonzalez.

In 2013, two years after SEAL Team 1’s outreach mission, Gonzalez returned to Paraguay with his colleague, Dr. Thomas Emeterio of Los Angeles, on an ambassador mission. The two of them met with executives of various foundations that provide medical and dental care in Paraguay and provided three days of clinical treatment in a rural area and an impoverished neighborhood of Asunción.

“The goal now is to establish some continuity of care as the legacy of the original dental mission,” Gonzalez says. “Smiles for Everyone Foundation has partnered with a couple of doctors in Paraguay who supported SEAL Team 1, and they continue to provide some dental outreach, but not on a regular basis.”

On their trip, Gonzalez and Emeterio were invited to a local dental school to talk to the senior dental students about their work. The presentation garnered many commitments of voluntary service to Smile for Everyone Foundation’s continuing dental outreach mission in Paraguay.

Because of their work, Gonzalez and the rest of SEAL Team 1 have come back with an increased sense of friendship with each other, new friends in the people of Paraguay, and a renewed appreciation for the importance and necessity of the dental profession.

“I look in the mirror and I just see me,” Gonzalez said, “yet I am part of a much larger world.”

Anatomy of a NOMAD by Amy Dodge and Kimberlee Winterton

With more than 14,000 NOMADs in clinics and educational institutions worldwide, this handheld intra-oral X-ray has become a mainstream in modern dentistry. But the genesis of the NOMAD handheld X-ray all started with humanitarian work, and that continues to serve as the heartbeat of the NOMAD. Almost a decade ago, Dr. Clark Turner wanted to invent an intra-oral X-ray that was completely portable and self-sufficient so humanitarian groups could bring restorative dental care anywhere in the world. He succeeded just in time. The first NOMADs relieved suffering communities during the aftermaths of the Indonesian tsunami of 2004, providing victim identification.

The reason NOMAD is able to be so, well... nomadic is because it is battery operated, with about 400 exposures per battery. Plus it only weighs 5.5 lbs. NOMAD is a go-anywhere device that doesn’t need anything but itself, a sensor and a laptop (or film). It’s flexible enough to travel up the Amazon River to remote villages, or handle the workload of three operatories back home.

And NOMAD is designed to keep the operator safely chairside with the patient at all times. A proprietary blend of rare earth materials, formulated by Aribex (the manufacturer), completely shields the X-ray tube inside the outer plastic casing. More than thirty independent studies prove the NOMAD’s safety in comparison with conventional X-rays. Those studies also show almost non-existent levels of radiation to the operator—as safe as, if not safer than, any wall mount or other handheld device. That’s because a round backscatter shield, on the front of the NOMAD, consists of lead-embedded acrylic that captures radiation that may bounce off the patient during an exposure.

Because NOMAD has portability and safety built-in, NOMAD offers humanitarian volunteers—or anyone—the fastest workflow to help the most people who so desperately seek care.

Operators can remove an archaic, complex X-ray machine that requires a constant power supply from the equation. And no longer do operators need to rush back and forth from a room to push buttons to take X-rays. Simply take the NOMAD out of the box, slip on the handset battery and start helping patients.

NOMAD has allowed humanitarian missions and dental offices reach a better level of dental care than they ever could before. Its lightweight, fully-shielded body and its absolute portability has introduced a new age to the evolution of intra-oral X-ray, where any patient anywhere in the world can receive much needed X-ray diagnoses and restorative care.


Behind the Scenes: Iowa Mission of Mercy by Casey Morgan

Martin Andrews is patiently waiting in line to have his teeth yanked. He’s, of course, nervous as hell. “Oh yeah, I am absolutely terrified. Not a big fan of having teeth pulled,” he says. Although terrified, Andrews isn’t alone. He’s flanked by his mother, sister and girlfriend. They’re all waiting to receive oral care. So are hundreds of others. There’s a huge line of folks, in fact. It wraps around the Varied Industries Building, a massive warehouse-style pavilion on the Iowa State Fairgrounds. And it’s only 6:15 a.m. A few, toward the front of the line, have been waiting for days.

And for good reason. Andrews, his family, and the rest are all here for free dental care as part of the sixth-annual Iowa Mission of Mercy. “To get this work done at no cost...” Andrews says. “I really appreciate it.”

In 2008, the Iowa Dental Association founded the Iowa Mission of Mercy: A two-day free dental clinic for any child or adult who needs dental care, regardless of income or previous dental history. Modeled after the Virginia Mission of Mercy—the first free dental clinic of its kind—the Iowa Mission of Mercy has provided more than $5.5 million in free dental care to more than 8,500 patients. On this chilly weekend, some 1,600 volunteers provide more than $1 million in free care to 1,465 patients.

It’s a tall order, logistically. Patients begin to line up outside the venue on Thursday evening, where they sip hot coffee from the Salvation Army mobile canteen to stay warm through the night. Some nod off in their canvas chairs, others remain awake, sensitive to the ambient noise. “People were snoring, and the Kaibo doors were slamming shut all night long,” Brigetta McElvogue says. “We had to stay up, we didn’t have much of a choice.” By 7 a.m. volunteers open the doors and begin processing the hundreds of waiting patients.

Kathy Salisbury, program manager for the Iowa Dental Foundation, coordinates the Iowa Mission of Mercy, and notes that the need for dental care is a statewide problem. The Iowa Mission of Mercy moves from city to city each year to reach the maximum amount of patients in need. It’s been held in Waterloo, Sioux City, Davenport, Cedar Rapids, Newton and Des Moines

During the event, Salisbury arrives each morning at 4:30, perusing the patient lines, introducing herself. “They’ve been out there all night, so it’s nice for them to see someone from the organization. They feel like the wait is almost over,” she says. She gets a rough count of how many are waiting in line so volunteers know what to expect. She spends the rest of her day putting out fires, managing and making sure everything is running smoothly and efficiently. But Salisbury began work on the 2013 Iowa Mission of Mercy well before 4:30 a.m. She started coordinating the event in earnest last fall.

First, Salisbury creates a fundraising plan. “It costs about $350,000 in cash to do the Iowa Mission of Mercy. So that’s my job early in the year. I write grants and try to get sponsorships in addition to the fundraising,” she says. Forging partnerships is also top of mind, necessary to get the job done. Partnering with the Salvation Army and Delta Dental Iowa helped make the philanthropic endeavor possible. “One company provides all of our dental supplies, so I don’t have to go out and beg for that stuff,” she says. “They take care of that whole piece of the puzzle.”

Finally Salisbury focuses on volunteer recruitment. She coordinates two spring and fall meetings in different districts to reach as many dentists as possible. She also utilizes social media and email blasts to spread the word about volunteering opportunities.

Dr. Carol Cleaver is the operative lead for the Iowa Mission of Mercy, and her job is to answer questions for volunteers— from lay individuals to doctors. “It’s not uncommon for me to have five people standing around me asking me questions. I answer questions all day long,” she says. Cleaver has volunteered since the first Mission of Mercy in 2008.

Cleaver reflects on the impact of the mission, saying, “It’s just so rewarding. Just to be able to help people, and they’re so appreciative of what we do. A couple of years ago in Cedar Rapids, we got done on Friday night at around 8 o’clock and we walked by the line and people were holding up signs that read, ‘Thank you for your hard work.’ It was just so heart-warming. It really made all the hours and hard work worthwhile.” She continued, “I know it sounds cliché, but it gives you such a warm feeling that you can help people smile.”

After sleepless hours in line, a hefty treatment plan and a lengthy exit interview, McElvogue greets her husband with a toothy smile, her cheeks packed with gauze. “I got a tooth pulled, honey,” she says. The Iowa Mission of Mercy was McElvogue’s only option for necessary dental care. “We don’t have any dental insurance, so if it weren’t for this, we would have just went without forever. Because we just couldn’t afford anything,” she says. “Our bills are at the max right now for what we bring in, because my husband just recently retired. So we’re just getting by.”

From her office a week after the 2013 Iowa Mission of Mercy, Salisbury is assembling care packages for next year’s mission. “Oh, I’m just counting toothbrushes. It’s taxing work after the Iowa Mission of Mercy,” she says.

“I think 2013 was the best Mission of Mercy that we’ve had. Des Moines was a great help to us.” The 2014 Iowa Mission of Mercy will be held in Waterloo in September.

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