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Dental Volunters in Nepal by Laurie Mathews

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The clouds parted to show the gleaming gold spire of the Boudha stupa as we circled to land in Kathmandu, Nepal. This is my first trip to the valley in 2011, and I am arriving to lead two, weeklong dental camps to provide care for children. Driving from the airport, the swirl of pedestrians in bright colored saris, the din of motorcycles carrying whole families, and the intensity of light and color bring back memories of this incredible place.

Since 2001, Global Dental Relief/Expeditions (GDR) has brought teams of volunteer dentists, hygienists, dental assistants and non-dental volunteers to Nepal. Volunteers provide firsttime dental care and oral health education to children in local schools, orphanages and remote village locations. As co-director of this Denver-based charity, my work is highly varied – including recruiting volunteers, organizing camp supplies and equipment and, finally, hosting groups for weeklong dental camps. Global Dental Relief began its work in Nepal but over the past 10 years has expanded to reach kids in northern India, Vietnam and the Mayan highlands of Guatemala.

Getting Started
Advance work for a dental camp is always chock-full of tasks. Each GDR camp is led by two trip leaders, usually volunteers who return year after year to host projects. Today I meet up with Geoff Hoffman, a recently retired dentist from Denver, Colorado. Geoff and his wife Maryanne have volunteered on countless trips with GDR, and he recently joined our trip leader staff. Together, Geoff and I have a full day ahead that starts with meeting the principal at the clinic location to coordinate schedules and duties.

GDR works at the Shree Mangal Dvip school in Boudha, Kathmandu, where we spend the first day transforming a large set of classrooms into a fully functioning six-chair dental clinic. Excitement mounts as word spreads that the dental clinic is back. Students gather at the door to discuss the proceedings – some enthusiastically call out Namaste, the local greeting, while others hang back shyly awaiting notice. The cooks with strong backs arrive to unload our 9x5 storage closet which is full to the brim with all the makings of a dental clinic – chairs, compressors, dental units, instruments and supplies.

Within the hour, the bones of the clinic emerge. Portable dental chairs are set in place to define operatory locations. Bookshelves are loaded with gauze, gloves and all the varied supplies that must be on hand. Senior students at the school, wellversed in the clinic protocol, sterilize the instruments and set up tables loaded with restorative and extraction instruments. The hum of activity rises as we proceed to final touches, setting up cavitrons at each hygiene station, laying out supply tables and finding just the right spot for the jointly shared amalgamator. After five hours of intense activity, the clinic seems ready for action. The students, Geoff and I kick back to share some time catching up after six months apart.

Day two is always a favorite day as volunteers begin to arrive full of enthusiasm and a bit bleary from too many times zones crossed. Each dental camp hosts four dentists, two to three hygienists and up to eight non-dental volunteers. This group, along with the two trip leaders, will meld over the coming week to form a cohesive dental machine serving between 800 and 1,000 children with first-time or follow-up dental care. During evening hours and days off the group enjoys high-spirited time seeing local sights and spending social time together.

Our new arrivals include four dentists and three hygienists from Massachusetts, California, New York, Colorado and Canada. Seven non-dental folks round out the group, including two spouses, with backgrounds in computer science and real estate, a journalist, a CEO of a large office supply firm and two retirees. Close to half the group are repeat volunteers either returning to Nepal or veterans of GDR projects in other countries.

Group activities start the next day with a tour to see highlights of the Kathmandu valley before the hard work of the clinic begins. Today, we visit the sacred river temples of Pashupati, the historic city square of nearby Patan and the bustling trekking center full of mountain-bound travelers in Thamel. After lunch, the group gathers at the clinic as Geoff and I brief participants about a typical clinic day and acquaint dentists and hygienists with their equipment and supplies. We also lead a quick course in dental clinics and charting for the nondental volunteers to learn their duties in supporting the clinic.

The Clinic Begins
On day four the clinic begins in earnest. Each day the clinic treats children from a local school or charity home – up to 180 kids a day will pass through the clinic. The public health model GDR has adapted involves seeing all the children in a school – giving each child an exam, a cleaning when possible and then completing the restorative and extractive work needed. Completing this work might take up to three visits, so children are carefully charted to ensure they return. Each child also receives a fluoride varnish treatment, a toothbrush and small group instruction on brushing and general oral health education.

Most importantly, we see these same groups of children every two years. This approach pays off – after 10 years of work in Nepal, the children we have seen for six to eight years in a row arrive with well-brushed teeth and significantly reduced treatment needs. Overall, the numbers of extractions are dramatically reduced and restorations are much smaller in size and number. The health of the group seems markedly improved, as patients are relieved of the chronic pain and infection often present in untreated populations of kids.

We love these returning kids who excitedly call out “two times a day,” and “two minutes,” and other correct answers during the tooth brushing sessions. Their bright and healthy smiles light up the whole day. For each clinic, about half the children are returning to receive long-term care and half are new children just joining the project.

The first day of clinic is full of excitement, a bit of chaos and a lot of hard work as volunteers settle into their roles. For the dentists, it means adapting their skills to match field conditions and equipment. GDR provides portable dental units, which run off a large air compressor, along with sturdy portable dental chairs and doctor’s stools. Hygienists each have the same set up along with a cavitron.

Each dental professional is assisted by either a volunteer or a senior student at the school. These students are a highlight of the clinic – they speak excellent English, have a magic touch in calming a child, and are well-versed in many basic dental assisting skills. Getting assigned to the dental camp is highly sought after and only the top students achieve this coveted job. Students provide a window for volunteers into this different culture, making many new and lasting friendships.

Non-dental volunteers are the real heroes of the clinic as they learn completely new tasks that keep the clinic efficient and functioning. Typically, one volunteer manages the long lines of kids, making sure they have their dental charts, receive toothbrushes and education, and remain happy and involved until their name is called. Other volunteers escort children to dental chairs, manage clinic records, work chairside as assistants or help with instrument sterilization. Together, we try to make each child feel special. Volunteers work hard to ensure children get the care and comfort they need throughout the clinic experience.

As trip leaders, Geoff and I work hard to get the clinic underway. My job is to ensure we have a supply of kids to treat. I also work with the non-dental volunteers to ease them into their jobs. Geoff focuses on the dentists and hygienists, consulting on treatment planning and directing patient flow. Together we cope with machine malfunctions and all the unexpected demands of the day. All the while, we wait for that magic moment in each clinic when everything suddenly settles, when the volunteers are confident and hard at work. This magic moment typically comes around noon the first day. With luck, this is the way the clinic proceeds over the six days to follow.

As this clinic settles into a routine, smiles appear and grow on volunteers’ faces as they master the details of their task and relax into the rhythm of the clinic. Now our focus can transfer to the best part of the clinic experience – the children we treat. We love these kids who smile bravely as they wait for their turn in the dental chair. Some children are so excited that they walk the entire distance to the dental chair with their mouths wide open – a sight we never tire of watching!

Clinic days are full of these unforgettable moments. Volunteers point and nod to share the look of a small girl with huge eyes solemnly greeting her first dentist. We enjoy the kids in line, especially those watching so closely that they know the route through all the stations without being told. Each of us is touched by the trust of a small child who grabs your hand tightly during dental care, or who peers intently for several minutes to select just the right sticker as she leaves the clinic. During breaks we watch a child leave the clinic, mouth wide open, gesturing and pointing to his teeth as he avidly shares the clinic experience with friends and those still in line.

Clinic days are rich and rewarding, but also demanding. By the end of day three the group is grateful for a day off to tour the World Heritage site in Bhaktapur, a photogenic and interesting Newari village. Back in the clinic for days four and five, time seems to fly and each moment becomes more special. Days are long but finite – work starts around 8:30 and goes until 4 or 5 or when the line of children finally wanes and disappears.

The sixth and last day of the clinic is devoted to finishing treatment on children requiring multiple days of care. Volunteers enjoy greeting the returning children, some of whom point to the specific dental chair they prefer so they can see their same dentist again. Group pictures and pictures with new friends are a big part of the day.

That evening is capped with a special dinner shared by volunteers and the senior students who worked so hard in the clinic. At dinner, one dentist reads a spontaneous poem that relates something about each person in the clinic – to misty eyes and big smiles. Clinic stats are announced – in six days the group completed 1,248 patient visits, mostly children with a sprinkling of teachers as well. Donated care includes 753 restorations, 99 primary extractions, 43 adult extractions, 233 cleanings and 600 fluoride treatments. Total care is calculated to be $207,420 in U.S. equivalents. These remarkable numbers are celebrated to long applause. The night ends with heartfelt goodbyes, e-mail address exchanges and a sense of teamwork.

The next morning the group disperses with many leaving at dawn to catch a flight to Lukla to begin a five-day trek on the Everest trail topping off at 14,000 feet. The remainder head to the airport and home, except for a few volunteers who plan to stay for our second camp just days away. It is a bittersweet time filled with knowledge of a job well done and hope that new friends will remain so for years to come.

About GDR
Global Dental Relief is a Denver-based charity dedicated to providing dental care to children in need. Treatment and care is provided by volunteer dentists, hygienists, dental assistants and non-dental volunteers. Logistics for volunteers are coordinated by Global Dental Expeditions dedicated to humanitarian journies to serve children in need. At present, GDR/E works in Nepal, northern India, Vietnam and Guatemala.

Volunteers are needed to join 10 to 12 clinics a year. Clinics are typically six days, followed by optional sightseeing adventures. In total, trips generally last between 10 and 21 days. Trip descriptions, daily itineraries and costs can be found on the Web site www.globaldentalrelief.org. To contact GDR/E directly, call 800-543-1171 or 303-858-8857 or e-mail Kim Troggio at kimt@globaldentalrelief.org.

Author's Bio
Laurie Mathews is a founder and co-director of Global Dental Relief/Expeditions, which started in 2001. From 1991 to 2001 she served as the director of Colorado State Parks. Prior to that she worked for the Department of Natural Resources and the U.S. Senate in energy and environmental policy. She is based in Denver, Colorado.
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