Students: My Indian Elective by Dr Kishan Sheth

On a rainy July afternoon my five friends Sahil, Aditi, Hemel, Sagar, Devin and I discussed the final plans for our elective to India the following day.

Each of them had vivid memories of past visits to India but this trip would be my first. I was excited and nervous at the same time.

Both my parents originate from Gujarat, Western India. I was looking forward to seeing the country first hand but knew that it would be hugely different than the privileged country where I had been raised.

The aims of our elective trip were to learn more about the departments of restorative, paediatric dentistry, orthodontics, periodontology, oral medicine, oral surgery and dental public health in D. Y. Patil Dental College, Pune. We were also keen to discover more about the oral health challenges that India has compared to the UK.

We landed in Pune on the evening of the 29th July. The streets were quiet and the poorly lit tarmac and lack of pavements on the side of the road were a surprise. I’ve been to many countries where poverty levels are high, but the real India was far from what I’d imagined. It was nothing like the images that my parents painted in my head through their childhood stories.

Our first week was spent at the D. Y. Patil Dental College, Pune. We were amazed by how little clinical experience that students seemed to have before graduation, compared with students in the UK. Final year students had not covered endodontics, crown preparations, bridge preparations or fabrication of partial dentures to the same extent as we had at KCL.

Instead they were doing extractions, restorative work and periodontology. The former areas, which are covered under the BDS UK undergraduate programmes, were seen to be ‘complex’ or at specialist levels, and therefore not covered by undergraduates. It was no wonder so many students specialised straight out of dental school!

A few students were lucky in that their tutor may have supervised them with a more complex case however it seemed that there was an unregulated and unstandardised educational system in place.

A major shock was the lack of infection control processes. Watches and hats could be worn in clinic, as could sandals, plimsolls, and skirts. Hair need not be tied back, shoes need not be fully covering the feet and barrier wrap was not a necessity.

In the UK it’s drilled into students that it is vital to barrier wrap high risk zone equipment such as the bracket table, light handles, instrument hand pieces and the head rest of the dental chair. This is to reduce the bio-load that may form on these high-risk zones surfaces.

The faculty at the dental college were very welcoming and hard working. They started at 8am in the morning and worked hard until around 5pm in the evening. Regular examinations were conducted and there were serious consequences for students who did not ‘perform’ to expectations. Regular progress information was shared between students and their parents, something that does not take place in the UK dental education.

Very few patients had even heard of a toothbrush, let alone knew how to use it effectively. Many used charcoal powder, twigs and their hands. At first this was shocking having come from an environment where OHI concentrates on flossing and interdental cleaning and it is assumed patients already brush their teeth to at least some level of efficacy. In India, the health levels and oral hygiene standard is far from this yet. Many people claimed that this is due to problems with the government not targeting national dental campaigns and lack of funding for dental services. In a country with huge levels of poverty and little government funds and resources available, it is no surprise that dental health is lower down the priority list.

What was also surprising was the fact that many people spent hours and travelled for miles and miles to get to the dental hospital, as private dental clinics charge high fee levels which most people can’t afford.

Another big difference was the actual layout of the clinical space. At Guy’s Hospital, London we have about 20 dental units each separated by a low-lying wall to ensure patient privacy. In the D. Y. Patil Dental College about 40 dental units were all closely packed with absolutely no privacy from one clinical unit to the other.

It’s clear that the priorities of the Indians and British are very different. Britain benefits from a great amount of domestic wealth creation and generation and so the average person in the UK is highly educated, with the Internet at their fingertips. Oral health can be prioritised in the UK. In contrast, the Indian population lack this level of education and priorities include keeping shelter over your head, ensuring that your family are fed and ensuring that you can afford school fees to educate your children. I do feel that there was a lack of government support for those who did wish to go out and do domestic research or charity work with locals. The Indian government could do more to prioritise the healthcare of its citizens. Simple toothbrush education in schools, public campaigns backing smoking cessation and more education around diet and exercise would be of huge benefit to the Indian population. Many may not even know that diseases such as caries or periodontal disease are preventable and reversible in their earliest stages.

I learned that patient names are very important. In a country as vast as India, the surname is an indication of the religious and geographical background that the patient may have. I learned that Jain populations often present underweight and with vitamin C deficiency leading to ascorbic gingivitis. Gutka populations are more likely to have cancerous lesions due to the abrasive nature of Gutka chewing. Gutka is a preparation of crushed areca nut and tobacco, which is regularly used by members of the Indian population. Persistent chewing of Gutka can lead to sub-mucosal fibrosis, buccal mucosa blanching, intolerance of hot and spicy foods and restricted mouth opening.

It was clear that India had a tradition in which guests should always feel welcome and be honoured by special events and occasions. We were welcomed by a welcoming ceremony in which all of the faculty were present to welcome and brief us. On the evening of Thursday 3rd August, we were invited to a talent evening, where we were entertained by a variety of students and staff who danced, played instruments or sung for us.

The D. Y. Patil Dental College demonstrated such a high regard and passion for the performing arts. It was indeed a pleasure seeing their performing students and the talent level was exceptional.

We were surprised to be called on at the end to do a guest performance but being a dancer in your spare time has its advantages! We got a chance to show how we do Bollywood and Bhangra in Britain! It turns out those late night KCL Charity Diwali Show rehearsals paid off!

The week flew by and before we knew it, the elective period had finished. We’d like to thank all the students and staff at the D. Y. Patil Dental College, Pune, for the beautiful memories. It was clear that they spent a lot of time organising a very interesting and stimulating programme for us and the student and staff body made us feel truly at home.

With the elective having come to an end we took a six-hour cab journey towards Mumbai for the start of the next adventure. I’m not a major fan of long distance travel and fell asleep for most of the journey! My friends on the other hand had a great time, mainly capturing funny videos of me sleeping.

Our group had a great first day exploring the city centre of Pune, Maharashtra! It was such a vibrant area, with a very thin line separating wealth and poverty. We were touched this evening by the kindness and generosity of the locals who welcomed us with open arms.

We also explored Shaniwar Wada Palace and I experienced my first ever auto rickshaw ride. I was indeed hanging on for my life. It brought back memories of Thorpe Park rollercoasters. The roads are filled with moments that make your heart skip a beat!

Another major highlight of the trip was when we visited the Taj Mahal. It was not just another piece of architecture but the proud passion of emperor Shah Jahan’s love wrought in stone. I was grateful to have finally seen and stood before the iconic castle in the air. It truly is a wonder of the world for very good reason!

After our time at the Taj Mahal we had an amazing time in Agra learning about the Mughal dynasty. Then we reached Rajasthan, ‘land of Kings’, to witness the palaces, strongholds and fortresses, which rank amongst the most impressive in the world.

On the final two days we were very fortunate to have seen and stood before the Golden Temple in Amritsar. From the moment we washed out feet, saw the lights reflecting off the water and heard the chants and prayers of the visitors we felt very much at peace. The temple feeds a vegetarian meal to around 100,000 people a day, regardless of race, religion or class. Imagine a world where everyone opened up their hearts to each other, just like the gates of the Golden Temple.

I definitely ended my time in India on a high. On the very last day, I witnessed the iconic flag lowering ceremony at the India–Pakistan international border near Wagah that reflects the cutthroat rivalry but ends with a handshake between the Indian Border Security Force and the Pakistan Rangers.

At the end of a long three weeks of learning about dentistry and exploring the country, I was starting to get tired and admit I was a little home sick. Thank you to Sagar for approaching D.Y. Patil Dental College and getting the ball rolling with the organisation process. The trip and country opened my eyes to just how much we have and take for granted in the Western World.

From a dental perspective, I appreciated what a privileged situation we have in the UK and other developed nations. Information about healthcare is freely available to all and our standard of living is so much greater than those of other countries.

I hope to be able to visit India and other less developed nations again and support the oral health education programmes that are currently taking place. India opened up my eyes to a whole different side of dentistry, and a whole different side to the world.

Dr Kishan Sheth recently graduated from KCL as a runner up for the prestigious Jose Souyave Prize and will embark on his vocational training in Sussex. He has become the most recent and youngest Honorary Editor of DentaltownUK.