KDA Today

KDA Today

For Immediate Release

Date: Jun 26th, 2009
Contact: Dr. Thomas Clark
Phone: 1-800-292-1855

Making the World a Better Place, One Village at a Time!

Louisville, KY (June 26, 2009) It is an incredibly daunting challenge to deliver quality dental care in a remote backwater part of the world utilizing “home-brew” self-fabricated equipment and donated materials and supplies, literally carried in on our backs. Oh, and not to mention, the sub-tropical temperatures and humidity levels radically alter the handling characteristics of all of our dental materials, making outcomes something less than predictable. However, a group of eight dental students and two faculty from the University of Louisville School of Dentistry recently returned from Belize, Central America, where they did just that—rendered quality dental care to some of the inhabitants of the Village of Red Bank, located in the south-central part of the country. Over a three day period, 159 patients received the spectrum of basic restorative dentistry, extractions and minor oral surgery, and some received on-sight fabricated prosthesis (flippers) to replace missing teeth. The field dental clinic is operated as a part of the International Service Learning Program, which is the premier international outreach program of the University of Louisville. This multi-disciplinary program was begun in 1996, and since 1999, has been operating in several sites in Belize. As an outgrowth of this activity, the program has won a prestigious award, and numerous publications describing the various facets of its operation have been made, and a book chapter devoted to the program, has also been published earlier this year. Other disciplines represented this year were Education, Justice Administration, Communications, and Expressive Art Therapy. 38 students and faculty participated in all in this year’s program. So, what do these other disciplines have to do with the delivery of dental care? Well, first let’s take a look at the country of Belize.

Belize is a small country about the size of the state of Connecticut located in the eastern aspect of Central America, just south of Mexico, east of Guatemala, and north of Honduras. Formerly known as British Honduras and part of the British Commonwealth, it gained its independence in 1981 and became the sovereign nation of Belize. English is the dominate spoken language, however there are around nine to ten other common languages as well. People from numerous diverse ethnicities are represented, Meztitsos, Chinese, Indian, Middle Eastern, Mayan, Vietnamese, North American, and Mennonite. Belize has the distinction of having the longest living coral reef, and the second largest barrier reef in the world. Inland, it has the largest rain forest preserve in the western hemisphere, with the largest population of jaguars (spotted leopards). Scattered throughout the countryside are numerous Mayan Temples and ruins, some of which have yet to be explored. Ranging from coastal savannah-land and marshes in the east to rugged mountains in the west, parts of the country are breathtakingly beautiful. The spectrum of citrus fruits and bananas are produced, along with sugar cane. A growing aqua-culture industry supplies shrimp and various other kinds of seafood to the world market. Several products found in our local grocery stores here in Kentucky have their origin in Belize. Recently, high-grade light sweet crude oil was discovered, however, since there are no refinery facilities in the country, it must all be exported and refined petroleum products imported back into the country. But, in spite of this, the country remains one of the poorest countries in the western hemisphere. No one really knows for sure, but it is thought that the population is somewhere around 300,000. Unlikely as it seems, there are still parts of the country where it is possible to be born, grow up, have a family, get old, and die, and as far as a paper trail is concerned, you never existed.

The government of Belize is a Parliamentary form of government, with there being a president, a prime minister, various cabinet ministers, and various elected officials. The Queen of England is the titular head of state, but she seldom visits, and for all practical purposes, the prime minister is the head of government. The national currency is the Belizean Dollar which is tied in value to the U.S. Dollar at the rate of one U.S. Dollar to every two Belizean Dollars. The government is stable and not subject to the volatility of some of the other Central and South American governments.

Our efforts in Belize are continuously evolving. We began working in the Village of Red Bank in 2006 following successful operations for several years in another village, the Village of Gales Point Manatee, which remains an active site for our program. Red Bank is a Mayan community composed of around 1,400 individuals comprising around 300 households. This community is predominately agrarian, with most of the men, and a few of the women working on surrounding banana farms and some in the citrus groves. Families raise a limited amount of corn (maize), and some rice, and beans. Native cassava is also cultivated and forms a large part of the diet. Chickens are readily available and with a small amount of beef, form the bulk of the meat in the diet. However, iguana is also consumed, known locally as “bamboo chicken”, and there is a creature regarded as a great delicacy, called a gibnut. It is something like a beaver but without the tail. Another name is “Royal Rat”. This animal looks like a giant guinea pig and weighs around 10-15 pounds. As honored guests, we have had gibnut many times when visiting Mayan homes. The village is served by an eight-grade government school which has around 350 students. Everyone in Belize is entitled to an eighth grade education, at no cost to the student other than meager supplies, however, education beyond that level is usually obtained from private high schools which are very costly by local standards, and out of reach to most individuals. An interesting relationship exists between church and state in that, a lot of the elementary and high schools are built and operated by churches, but the state pays the teachers’ salaries. There is presently one University in the country modeled much after the universities in North America. The average annual income in the village of Red Bank per family is around $600-800 Belizean dollars, and the tuition for high school, the closest of which, is located in the town of Independence some twenty miles away, and is about $1,200-1,300 Belizean. So it is easy to see why education beyond the elementary level is usually out of the question for most children. Large families are not uncommon, sometimes numbering up to eighteen children, but the usual number is five to six. The children are expected to help out on the farms and upon reaching a size big enough to help support the rest of the family, formal education usually is usually over.

The concept of service learning has its roots in the notion that each of us, as educated individuals, has an obligation to our fellow man to give something back to those less fortunate. But in so doing, a rich and rewarding cultural exchange can take place, especially in the context of a foreign venue. Our approach has been to first visit a community and then to sit down with the leadership, and establish a dialog of common human interests. What we offer most is intellectual capital, to help the local folks solve problems that they perceive as significant. From our perspective, often times we see what we think are significant issues that need attention. However, if the villagers that we seek to serve, don’t see those issues as a problem, then all of our elegantly contrived “solutions” are for naught, and a total waste of time. Therefore, we work together with the village leadership to target those areas that we can help with. Obviously, in the places where we work, health issues are very prominent, but we have been surprised at some of the other issues that are local concerns, as well.

This year, each of the participant disciplines had an area of concern, as had been determined in prior discussions with community leaders. The Education faculty and students worked with the local school teachers and students spending time helping with a variety of educational topics. One of the neatest projects was to teach the local kids how to survey and then draw accurate maps of the village. A lot of educational territory was covered with that. The Expressive Art faculty and students assisted with that project, and also spent a great deal of time during the screening process for our dental clinic, in having the child-patients make drawings to illustrate their personal concerns about their own dental health. I must admit, that never having seen this sort of thing in action, I wondered what would come of it. But, it is truly amazing what came out in the children’s drawings that really made our task of treating them much easier. This turned out to be an incredible tool for communication. Building on data collected last year in Red Bank, the Justice Administration and Communication faculty and students contrived a survey to develop a demographic image of the community and its concerns. This was done on the basis of visiting in the homes of families in the village and conducting the interviews in person. Some areas of concern emerged that we, and the community leadership were not aware of and we expect to address those areas as we can, in the future. Each of our disciplines contributed students to this process. We supplied dental students to help with the education, communication, and justice administration projects. The other disciplines supplied their students to help us in the dental clinic operation, where they assisted in helping to in-process patients, served as dental assistants, helping to disinfect instruments, and for those so inclined, to do simple extractions. An interesting outgrowth of this activity was that at least two of the non-dental students plan to apply to dental school in the future. English was not widely spoken by most of the adults in the village, but we were able to enlist some of the older children to translate for us, and they obviously felt and were very important to us.

We set up our clinic in a small wooden building that was owned by one of the churches in the village. We had an area where patients could be screened and triaged. Our treatment area consisted of four folding chairs that were light weight camping lounge chairs that have proven to be very durable. Our operator stools were also light weight folding camp stools. Our dental units were designed to drive a high speed and a low speed hand piece, along with a three-way air/water syringe. I have been serving as a mentor to senior and graduate-level engineering students for the past four years, in the Capstone Project of the J.B. Speed School of Engineering at the University of Louisville. Participation in this project has yielded several prototypes of lightweight dental units that we have been able to test under actual field conditions. Three years running, we have been able to have engineering students accompany us to Belize where they have not only assisted us with dental equipment issues but also in developing sustainable potable water systems for the project sites. In addition, work on the portable dental units resulted in one of our engineering students obtaining a patent on a unit of his design. Such an addition to his resume is invaluable for career advancement. Suction was provided by the hospital-type high vacuum Gomco suction units. These units have proven to be bullet-proof and absolutely reliable. Operative illumination is of the high-intensity LED head lamp variety, and we use photo-cure restorative materials as much as possible. All of our surgical and operative instrumentation has either been donated or borrowed, and of course, all of our anesthetics and dental material supplies are donated, as well. Other equipment, such as lab equipment, has been scrounged and modified to suit the ambient conditions in the country. In the past, we have been able to take various medications into the country, but with increasingly stringent TSA restrictions, this is getting harder to do. It is because of these restrictions, and the conditions under which we operate, that we have had to be creative and innovative, with equipment design and fabrication. Our students have all had a part in this and it has given them opportunities to think outside of the box in addressing the “real-world” situations that we are confronted with. The cost for each of our students is not inconsequential. This year, the cost averaged $2,800 per student. The Louisville Dental Society established a scholarship to fund one student each year for the program, and the Dean of the U of L School of Dentistry has also supplied varying levels of funding for the program. Private donations frequently help out, as well, but the majority of the funding for each student is the student’s responsibility. Given the present economy this is no mean feat. Educational opportunities abound away from the highly structured school environment, and after this life-changing experience they arrive home with a gleam in their eyes that they never had before.

The question is always asked, “Why do you go to all of the trouble and expense to take students down to Belize, when there is so much poverty and crying need right here at home”? The short answer is that, unlike our system here at home, the country of Belize is not a welfare state. In our country, there really is no good reason for anyone to do without medical or dental care. Many state and federal programs exist to underwrite care for all children and most adults if they would actively seek it out. However, in Belize, as well as some other emerging economies in the world, this is not the case. The places where we go and treat patients have no safety net, and people do die of dental infections and their complications. If they didn’t receive the care from us, there is no one else to provide it, and they are left to fend for themselves. In this place, we really do make a difference. The government of Belize does the best it can, but unfortunately, it doesn’t have it to do with.

But the purpose of this program is not just to take care of needy patients. It exists to provide a framework for the student to gain a truly international, multi-cultural experience and education. As an accredited course, it becomes a year-round pursuit, with preparation in learning all about the country, its geography, its history, and its people. Moreover, it facilitates the development of an interdisciplinary approach to solving common human problems. The supposition is that at some point during their lives, every one of our students will find themselves in the position of being a thought leader in their respective communities. They may be among the best educated individuals available in those communities. With the world growing ever smaller, it will be incumbent upon them to have a global perspective underwritten with international experience and a sense and respect of multi-cultural diversity. If we, as educators, are successful in planting these seeds in each of our students, then we have done our jobs, and have succeeded in “making the world a better place, one village at a time.”

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