Kushudebu Public Health Mission Nepal Government Reg. No.: 334/063/064
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Dental Camp at Junbesi May 2012

Dental Camp at Junbesi May 2012

By: Dr John Niven

Helen and I met Ang Tshering Sherpa in May 2011 whilst on a trip through Tibet with World Expeditions. We learnt that he was president of the board that ran the Kushudebu Public Health Mission at Junbesi in Nepal. We learnt that while clinic was able to cover most medical problems it had no dental facilities. After several conversations with Ang and many emails we decided to come to KPHMN and attempt to set up a basic dental facility.

May 15th 2012 saw us arrive in Kathmandu with many kilograms of dental equipment and supplies. We were met by Ang`s brother Ang Nigma who was our guide for our visit to Nepal. A visit to a local dental supply house to collect further supplies followed by an interview with the Nepal Medical Board to obtain my dental registration saw us ready to set out to Junbesi.

I had managed to put together a simple transportable dental surgery, consisting of a portable dental unit(from China) a suction unit I found in Kathmandu, and a suitable quantity of instruments and supplies provided by generous dentists and dental supply houses in Australia. A dental supply house in Kathmandu was the source of the balance of our supplies.

We flew to Phaplu by a small twin engine Otter, landing on a gravel runway on the side of the mountain. We were a day late due to adverse weather conditions. A four hour trek brought to us to Junbesi; fortunately we had porters to carry our baggage and dental supplies.

After setting up our rudimentary dental operating suite in a spare room at the clinic we were informed that 91 people had already registered for treatment and that there were more to come, especially as our presence had been advertised on the local radio. The original plan was stay at Junbesi for 5 days, 3 days clinic and then visits the local monasteries after which a 12 day trek had been planned; however after day one it was obvious we would have to stay longer. So plan B was formulated, stay at Junbesi for 2 weeks with the occasional day off for some local trekking and monastery visits, then return to Kathmandu for a few days.

We then set to work, we saw and treated 167 patients, which included 137 extraction cases, 53 restorative cases, and 19 miscellaneous cases. The clinic staff were most helpful. Ang Enigma and the doctor translated and explained to treatment to patients, the nursing staff were only too willing to assist in treating patients and wanted to learn all about dental treatment.

The patient mix was interesting, we saw many older patients with multiple rotten teeth, but what was encouraging was the teenagers' dental health. Most had fairly good oral hygiene and often presented with only one obvious carious lesion which could be restored. We saw many monks and nuns who came down from the monasteries. Many patients had travelled for several hours in order to see us. There was no appointment system, the patients just appeared and had to be seen. We were able to postpone treatment on the immediate local village patients to get some order into proceedings.

We managed to obtain good if basic working conditions, the doctor's couch was the right height for extraction cases, and a bed was utilised for the restorative cases. Lighting was by strong LED torches, not ideal but satisfactory. We managed without any radiography facilities. The clinic had an autoclave, and all instruments were cleaned and autoclaved between patients.

The local people were very hospitable, we received a welcoming ceremony on arrival, and even bigger one when the Wilderness School arrived. We stayed in a comfortable local guesthouse. The landlady could not do enough for us. We managed some short treks to see the local monasteries, and an overnight visit the Everest View Guesthouse (a somewhat distant view I might add) to see sunrise over the Himalayas.

We had an interesting visit to the local school. At a future visit I would like to examine all the children in order obtain a pattern of dental disease and the develop treatment and preventive dental programmes.

During our stay there was a festival at the monastery in the village, where we were treated to displays of Lamas and others dancing over two nights.

Our departure from Junbesi was dramatic. Ang Nigma had organised with the Head Monk at the Thupten Chholing Monastery for a helicopter to take us back to Kathmandu. This helicopter was bringing back the body of their recently deceased High Lama for entombment. We trekked up to the monastery at 6.00am in the morning, along with most of the village who were coming to greet the return of the High Lama's body, as well as farewelling us. All very emotional.

So we left Junbesi after a very satisfying visit. I feel we achieved everything we set out to do. We established a basic dental facility which is there for our return or another dentist. We treated many patients who had no or limited access to dental care.

We completed our trip to Nepal by sightseeing in Kathmandu and a mountain flight to see Mount Everest.

We hope to return to Junbesi in the near future as there are still many people requiring dental treatment.


Report on Dental camp held 17th-31st may 2012

A successful dental camp was held at Junbesi by Dr John Niven from Australia. A basic dental facility was established using a portable dental unit obtained by Dr Niven from China, and a portable suction unit located in Kathmandu

Dental instruments and supplies came from the following sources:-

  • Donations from
    • Henry Schein Hallas Australia
    • Trollplast Australia
    • Southern Dental Industries Australia
    • Plateau Dental Care
    • Dr Stephen Shelton
    • Dr John Niven
  • Purchased from
    • Garg Dental Pvt Ltd Kathmandu

The operating room was set up in a spare room in the medical clinic, utilising suitable examination couches and beds on which the patients lay to be treated.

Patients
Total patients examined and treated167
Extraction cases136
Restorative cases53
Miscellaneous treatments22

The dental condition of patients varied and a sort of pattern immerged:-

Very young children with multiple carious lesions and broken down teeth

Older children, teenagers and young adults with good oral hygiene and occasional large carious lesion in a molar tooth which could be restored.

Older patients with very varied problems from multiple broken down carious teeth, periodontal(gum) disease, to relatively healthy mouths .

Monks and Nuns who had a lot of untreated dental problems.

The biggest problem for most patients would be the lack of easy access to a dentist. The nearest dental clinic is Phaplu, a 3 hour trek; and it appears there is not always a dentist present in that clinic. This probably means that unless a patient is in pain they do not seek treatment and consequently early and/or preventive treatment does not occur.

The medical staff was very helpful enabling us to work efficiently. The nurses were keen to learn about dental treatment. It must be emphasised the importance of the presence of an interpreter to assist a foreign dentist. It would have been very difficult or even impossible to run the camp without the assistance of Ang Nigma and the doctor.

Recommendations for the future

Equipment

  1. Improve the lighting, simple angle poise lights attached to the overhead beams would suffice.
  2. Slight modification to a bed to improve position of the patient’s head
  3. Investigate availability and cost of portable dental x-ray machine
  4. Investigate availability and cost of an ultrasonic scaler

It is important that the dental clinic set up is kept as simple as possible. Complex equipment would be extremely difficult to service adequately given the relative isolation of Junbesi.

Treatment

There is a need for a dentist to attend the clinic at Junbesi as often as possible as there are still many patients in need of treatment Additional equipment as noted above would enable more extensive treatment to be offered.

A survey of all the school children would be useful in determining patterns of dental disease and treatment planning

Conclusion

The camp set out to establish a basic dental facility and treat as many patients as possible.

This appears to have been achieved.  It has also been possible assess future developments.

By: Dr John G Niven BDS(Lon)


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