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News Bulletin : ADA News Bulletin June 2011
38 JUNE 20 11 unintended consequences mentioned above. In some ways it is easier for projects to get on with their work where no local worker exists but then nothing continues when the project stops. Clearly there are unmet dental treatment needs throughout the world and if a project does nothing but clinical treatment then it can seem like the labours of Sisyphus. Therefore, it is much better to add a preventive dimension to projects. However, sustainable prevention is hard to deliver and does not give the immediate sense of achievement which accompanies a procedure which is why many dentists find it unsatisfying. Projects determine their own priorities and will look for personnel to achieve these. Dentists may not be the first choice for prevention measures. A project's philosophy may be printed in bold type but it's surprising how often it is not absorbed by successive volunteers. As in DIY, projects' handbooks should have the adage, 'when all else fails, read the instructions', written on each page. Handbooks are not infallible but they minimise intra-team tensions and differing opinions on what a particular team is trying to achieve. It is just as important to have agreement on the procedures to be undertaken as it is to agree on how much to do, for whom and within the time constraints of each day and the whole trip. It can be distressing and frustrating for new volunteers to see so much pent up need for treatment. However, work needs to proceed at a methodical and sustainable pace. The pace is even slower if one of the aims is mentoring of local dental workers. Pre-visit briefings for the whole team will reduce mixed messages but it may not be possible to bring everyone together before travelling. DONATED EQUIPMENT The ADA Special Purpose Committee for Dental Volunteers is frequently contacted with offers of old equipment which may range from entire dental chair/unit combinations to one box of out- of-date local anaesthetic. Most offers are declined due to logistical difficulties and expense, venal customs officials at receiving ports, lack of current spare parts, installation and maintenance problems, heat and humidity problems, and lack of operating manuals in English let alone translations. The golden rule for equipment is to follow the KISS principle: keep it simple and robust. Note where the fuses for electrical equipment are placed and take spare fuses of the correct amperage as power supplies can fluctuate and stop altogether. This brings us to the DIY capabilities of young urban graduates going into areas where a phone call does not bring an instant technician. Volunteer dentists should take the opportunity to learn some basic repair and maintenance skills -- before they go. Successful primary oral health care rests on the three principles of equity of access, active participation of the community in which it operates and involvement of other sectors of the local economy such as the education department or local government or private enterprise. Volunteer projects usually exist to correct equity imbalances but it takes hard work to engage communities to achieve the other two principles. The term 'stakeholder' can be overused but unless a community learns to see itself as a stakeholder and not a passive recipient, a volunteer project will have little impact in the long-term. In the competition for scarce financial resources, oral and dental health often doesn't rate a mention. Dentists on a project should advocate to all levels of politician and bureaucrat in the region that good oral health is indispensible to good general health. Good oral health for most of the community is a desirable end in itself. All sections of the community are liable to be affected by dental diseases -- this is brought home when projects set aside time for 'VIP' patients -- therefore volunteers can press the message of enlightened self-interest. Further, a recurring dental budget doesn't have to be regarded as an item only in the expenses column; better public clinics providing better services will bring in revenue and may even be a profit centre. This advocacy role was recognised as long ago as the Ottawa Charter of 1986 but it's often overlooked. In furthering the principle of equity, projects will increase access to care through the upgrade or introduction of equipment, knowledge transfer to locals and encouraging the employment of a local dental health worker. However, access to care doesn't just mean the provision of a dental unit and an air compressor. It may be that digging a well at a school will save more teeth if the school can then have fluoridated brushing sessions. Regular hand washing probably saves more lives globally than any amount of antibiotics; so sanitation and tooth brushing are complementary baseline disease prevention activities. SAFEGUARD YOUR HEALTH A cardinal rule when treating patients in any situation is to safeguard one's own health. The same rule applies in clinics as with CPR; don't put yourself in danger. Work posture is a critical feature of this. Patients come and go every few minutes but the operator has to last all day and for several days. Be seated and be comfortable. Seeing photos in dental newsletters, magazines and journals of volunteer dentists standing hunched over straight back chairs while filling or removing teeth is bemusing. How do these dentists feel after a week of work? Volunteers know to protect themselves through prophylaxis from infectious diseases such as malaria, HBV and HCV. There are some extra risks when travelling by truck or motorbike in Asia, but there are also avoidable risks like eating meat at roadside dhabas or not using bed-nets in malaria-endemic regions. MONITOR AND EVALUATE ACTIVITIES As with any enterprise in life, projects should monitor and evaluate their activities. It is said that the most detailed battle plan does not survive first contact with the enemy; flexibility is necessary. So too must projects adapt and evolve to achieve their aims. To do this some markers need to be set in advance so that progress may be measured. Doing more of the same may seem impressive but that doesn't guarantee improved outcomes. Efficiency is not the same as effectiveness and hubris is always stalked by nemesis. SUMMARY OF PRINCIPLES A summary of principles for volunteer projects: • observe and assess the status quo and if any form of service exists then find any good points and build on them • not foster a cargo-cult or dependency culture or marginalise any local worker • only introduce technology which can be maintained and systems that can be sustained • evaluate actions and outcomes and be prepared to adapt. From the foregoing it may seem that volunteering is in the too hard basket but that is definitely not the case. More and more young people are volunteering and creating their own projects. All members of the dental team -- from dental assistants to technicians to specialists, have a place in the spectrum of volunteer projects. To offer free care to those in need, in circumstances where no other treatment is likely, confers benefits at many levels. The patient, their family and community benefit, the local clinic and any workers benefit from better skills and equipment, clinics at home benefit from more enthusiastic staff on their return and, not least, the volunteer benefits from an enormous sense of fulfilment and enrichment of life. RESOURCES FOR POTENTIAL VOLUNTEERS There are many resources which are available to potential volunteers and project directors to help prepare and guide them. These include: • Handbook for Dental Volunteer Projects, http://www.ada.org.au/volunteer/volmanual.aspx • Basic Package of Oral care (BPOC), http://www.dhin.nl/bpoc.htm • Organization for Safety, Asepsis and Prevention (OSAP), http://www.osap.org Jamie Robertson Chairman SPC Dental Volunteers committee report
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