Charities and Volunteerism Transcend Barriers—and Borders—to Increase Access to Dental Care Worldwide and at Home
Brittney F. Jerred; Allison M. DiMatteo
While the barriers to receiving dental care include language, distance, insurance, education, and affordability, there are a number of volunteer and charitable efforts that are penetrating them—both at home and abroad. Organizations such as the National Dental Association (NDA), the International/American Associations for Dental Research (IADR/AADR), the World Health Organization (WHO), and the American Dental Association (ADA), among others, serve as umbrella organizations for the outreach projects that reach patients one oral examination at a time. Without these efforts, many people throughout the world—as well as here in the United States—would go without dental care of any kind.
ETHIOPIAN OUTREACH
An important international meeting will take place in September in Ethiopia largely because one US dentist decided to start with what he could do. Brian Swann, DDS, co-chair of NDA’s International Committee and a practicing dentist in San Jose, CA, will make his second trek to Ethiopia this year when he attends the IADR conference. Together, he and the IADR, the Ethiopian Dental Association, and the ADA are making strides toward global oral health by creating dental schools in a country that has only 48 dentists to serve 75 million people.
Before he went to Ethiopia, he asked himself: “How does one person make a dent?” Then, he answered his own question: “With what I can do.” Since he committed to doing just that, donations and generosity have overwhelmed him.
First, New York University (NYU) College of Dentistry, the largest dental school in the United States, agreed to donate state-of-the-art chairs that were being replaced in a multi-phased project. Then, CSX, a railroad company, agreed to pack and ship the chairs for free. The US-based organization Ethiopian Aide for Orphans Foundation helped coordinate the effort using their government contacts and, when the Clinton Foundation learned of Swann’s efforts, it too committed to send medical, dental, and educational supplies to Ethiopia.
“This was a true example of a team effort from people who did not know each other, but agreed upon a common goal—to get supplies to the people in need,” Swann says. “Sometimes, whether you believe in the divine or not, once you get started doing what you can, other people get involved and you’re not alone.”
But it’s in helping those people who are directly in need that lives become changed forever, Swann explains. Those who participate in charitable endeavors become affected and inspired.
“What we’re really looking for are both new and experienced dentists—people who have the talent and knowledge. You find there are people who need you and it’s just reciprocated,” Swann believes. “It’s about human nature, helping people, and how it comes back to you 10-fold.”
Swann and the NDA are returning to Ethiopia this year with the IADR and bringing with them people to visit hospitals and orphans. Since the effort began, the Ethiopian Dental Association has begun working with the International and American dental associations.
Collectively, those involved are working hard to generate the kind of enthusiasm necessary to continue delivering quality dental care to those who need it. NYU will donate enough chairs this year to help three other schools in African countries—including Uganda, Tanzania, and Kenya—obtain more chairs and restock old ones.
And the effort is growing. In April, the ADA published an article1 about Swann’s outreach efforts. The article tells about the efforts Swann has coordinated and provides Swann’s e-mail and phone number. Since then, Swann says, a number of dental students and young doctors have contacted him to ask how they can get involved.
“And I think that’s great because when young doctors get involved, it’s something they will always do,” Swann notes. What’s more, this type of involvement in fostering access to dental care has other far-reaching implications that transcend cultural, racial, and ethnic differences, he says.
PROMOTING EDUCATION & ORAL HEALTHCARE SUSTAINABILITY
Helen Cherrett, director of the ADA’s Center for International Development and Affairs (ADA-CIDA), is familiar with Swann’s efforts, noting that what he and others are doing in Ethiopia is similar to what her department does. Both focus on teaching and training the local people while always being sensitive to sustainability, ownership, and appropriate technology. The ADA operates on the old adage, “Give a man a fish, he’ll eat for a day; teach a man to fish, he’ll eat for life.”
The ADA-CIDA partners with public health officials, universities, and national dental associations in the international community. The ADA does not just go anywhere it wants to; they need to be invited and partner with a local agency or organization.
“We go where we’ve been requested to go,” notes Cherrett. She finds that many developing countries want the same thing that we want for our children. They want orthodontists and preventative education and care for their communities. The ADA-CIDA has partnered with a non-government organization called Health Volunteers Overseas (HVO) and is currently working in Cambodia, Vietnam, China, Moldova, Nicaragua, China, and St. Lucia. Over the past 15 years, the ADA-CIDA has worked in such countries as Brazil, Zimbabwe, Haiti, Jamaica, and Guyana, to name just a few. Sometimes, however, as with Zimbabwe, the program has been cancelled because the political climate became too hostile for ADA volunteers.
“The ideal situation is when you educate and empower a community to the extent that they no longer need you as they can now take ownership of their dental services,” Cherrett explains. The ADA-HVO programs need volunteers as well. After September 11, their volunteer base dwindled, but now it’s being built up again, Cherrett says, as people feel more secure to travel.
To foster a greater understanding of what’s involved with volunteering on an international level, in 2004 Cherrett and her staff published the third and expanded edition of “International Volunteer Guide,” which outlines what dentists might expect to encounter overseas, as well as in cross-cultural communication.2 The practical advice addresses how to meet the oral health needs of people in developing countries while working in clinical- and teaching-based programs and also explains how to get started in international volunteer dentistry. The topics addressed range from selecting a site and program to bringing equipment and supplies, and tips on how to prepare for the trip as well as safety and infection control.2
The ADA Foundation accepts monetary donations as well, but Cherrett reminds contributors to designate donations to the International Development Fund; all donated monies go toward actual programs and not administrative expenses, she says.
ORAL HEALTH WORLDWIDE
The World Health Organization (WHO) maintains a Bank of Ideas on its Web site.3 The listing details projects in 34 countries that range from providing clinics to fluoridation services and establishing dental schools to installing oral health preventative programs. The ADA supports the WHO Oral Health Program and its efforts to treat people around the globe and works in part with them to accomplish that mission.
One WHO program is The Eric Dental Clinic in Mutomo, Kenya, which is staffed by a program called The Doctor Bank. Each year, 150 doctors, specialists, and dentists are sent from a pool of 500 volunteers to take turns staffing dental clinics in the area, as well as contributing to the education and training of local medical workers. These doctors and dentists typically work for 6 weeks or more, after which a new team takes over; their work is on a voluntary basis, with their only subsidies being for travel, lodging, and equipment.4
Children are a priority at The Eric Dental Clinic. During a 6-week period in June 2004, for example, 466 children were screened and 461 adults and 240 children treated; 132 fillings and 422 extractions were performed.4 Not surprisingly, the fact that the main form of treatment performed at the dental clinic is extractions reflects dental care trends in many developing countries. Patients often are poor and unable to afford treatments that could ultimately save tooth structure, and many have a long way to travel just to reach the clinic. However, recent trends suggest that patients are beginning to recognize oral health and visit the clinic for routine examinations, even when no pain exists.4
The WHO recognizes that its major challenges in the future will be to translate knowledge and experiences about disease prevention into action programs. Social, economic, and cultural factors—as well as changing population demographics—impact the delivery of oral health services in impoverished countries and communities and how people care for themselves.5
CHARITY BEGINS AT HOME
As concerned as dentists are about poverty-stricken communities abroad, they realize their neighbors in the United States often experience similar levels of poverty and deterrents to accessing quality dental care. To this end, endeavors to bring dental care to those who need it include mobile van projects and clinics, as well as donating time in triage in both private practice and organized settings.
Kids in Need of Dentistry (KIND) is just one example of an agency that understands this need. The agency was formed in 1912 by a group of dentists who set out to provide oral health care to the children of railroad workers and miners. Today it operates three different clinics throughout the Denver, Colorado area and one in Colorado Springs, Colorado.
KIND serviced 5,500 clients in 2005, according to executive director Mary Allman-Koernig. The agency operates on an approximately $1.5 million budget—$500,000 of which is in-kind services, she explains. The rest of the necessary funds are raised through different grants and donations.
KIND employs one paid dentist and paid assistants, but it relies heavily on volunteers; it coordinates 50 other dentists who volunteer in the Colorado community. One staff operates the three clinics in Denver, so at least one of the three clinics is open daily, Allman-Koernig notes, using paid staff and volunteers. The Colorado Springs clinic is completely staffed by volunteers and is open anywhere from 5 to 7 days a month. Approx-imately 3,000 patient visits were achieved in the clinics in 2005.
Another project that KIND operates is called Chopper Toppers, a traveling outreach clinic that visits elementary schools throughout Denver. Two hygienists visited 50 schools in 2005 and placed sealants on emerging molars in 1,545 second-grade kids. The agency targets low-income schools.
KIND also puts braces on about 75 kids each year and performs the follow-up orthodontic care as well. It’s about a 2-year process for most patients. One orthodontist volunteers once a month and sees about 30 patients on that day, Allman-Koernig explains. Families must meet income eligibility requirements, and parents are asked to pay a $20 co-pay, plus 10% of the total cost of services.
“One of the things we want to ensure is that we’re providing quality care,” says Allman-Koernig. “So a lot of money comes in but a lot of money goes out, too.” KIND accepts Medicaid reimbursements, whereas many dentists do not.
The next project for KIND is an educational outreach component, which would focus on caries prevention. Allman-Koernig says she’d like to do more with sealants and fluoride varnishes, and the organizations wants to reach kids before they turn 3 to teach them about taking care of their teeth.
“We’re trying to get to children as soon as we can, before their mouths are filled with cavities,” Allman-Koernig explains.
COORDINATING RESOURCES
Without question, realizing quality dental care for those who are elderly, poor, disabled, and/or medically compromised requires a coordination of resources. To this end, the National Foundation of Dentistry for the Handicapped (NFDH) is a national charitable organization solely dedicated to meeting the needs of people with physical, medical, and mental disabilities, including coordination of services between volunteer dentists and laboratories.6
To do this, NFDH and its affiliates operate Donated Dental Services (DDS)—which provides services in 36 states—as well as Dental HouseCalls, a portable service which visits nursing homes in Colorado, New Jersey, and Illinois. According to the NFDH, more than 70,000 disabled and elderly people across the country have received more than $100 million worth of free, comprehensive, donated dental treatment through DDS since 1985.
In 2005, DDS helped about 6,000 people with the help of 12,000 dentists and 3,200 laboratories across the country, comments Fred Leviton, vice president and chief operating officer of NFDH.
“We’re more than a clearinghouse for dentists. We do what is necessary to help dentists provide the care,” Leviton explains. “We kind of do everything for the dentist. There is little paperwork involved and no administrative costs. It’s pretty easy in that respect for the dentist. Patients are usually very reliable and extremely appreciative.”
NFDH accepts patients from across the nation. Patients pass through an eligibility and screening process before they are accepted into the program. DDS links patients with volunteer dentists, usually nearby. Once a dentist and a patient have been matched, they meet for a consultation. If the dentist agrees to perform a service for the patient, he or she then treats the DDS patient in his or her own office, where they can work more efficiently using their own equipment and supplies.7
DDS serves patients across the country who are unable to afford necessary dental care because of limited income and/or permanent disability, chronic illness, or advanced age. NFDH and DDS are funded through a variety of sources, including the ADA and the ADA Foundation, Colgate-Palmolive, state health departments, disability service agencies, Delta Dental, United Way, and different charitable foundations. The need for dental volunteers is great, and the waiting lists are long for people with disabilities, Leviton says.
“Volunteering is easy and we have thousands of patients needing our help,” Leviton emphasizes. “Dentists can make such a difference in the lives of so many vulnerable people by volunteering.”
CONCLUSION
Providing quality dental care to underserved populations on a national and international level is a challenge facing everyone in the dental profession, and one that won’t be overcome by any single initiative. Fortunately, a variety of opportunities exist for those who are willing and able to contribute their time and talents, if not also their financial support, to help bring dentistry to those who need it most—the poor, the elderly, the disabled, the children—both in our own backyard as well as abroad.
REFERENCES
1. American Dental Association. “Dentists Reach Out to Ethiopia.” Available at: www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=1865. Accessed May 7, 2006.
2. American Dental Association. “International Dental Volunteer Organizations: A Guide to Service and a Directory of Programs.” Chicago, Ill; Available at: www.ada.org/ada/international/volunteer/volunteer_guide.pdf. Accessed May 7, 2006.
3. World Health Organization. Oral Health Projects and Reports: Bank of Ideas. Available at: www.whocollab.od.mah.se/expl/bankideas.html. Accessed May 5, 2006.
4. World Health Organization. The Eric Dental Clinic, Mutomo, Kenya (2004). Available at: www.whocollab.od.mah.se/afro/kenya/data/kenyalakarbank.html. Accessed May 5, 2006.
5. World Health Organization. Strategies and Approaches in Oral Disease Prevention and Health Promotion. Available at: www.who.int/oral_health/strategies/cont/en/index.html. Accessed May 5, 2006.
6. National Foundation of Dentistry for the Handicapped. DDS: Find Local Services. Available at: www.nfdh.org/DDS.html. Accessed May 6, 2006.
7. Donated Dental Services. Available at: www.wda.org/public/community/donated_services.htm. Accessed May 6, 2006.
Volunteer OpportunitiesAs highlighted in the April issue of Inside Dentistry, government agencies, professional associations, nonprofit organizations, and dental professionals are working collaboratively and independently to help serve the oral health care needs of those less fortunate. If you’re ready to do what you can, however you can—or you’d like to expand your current charitable contributions and volunteer efforts—consider contacting any of the programs listed below, each of which would welcome increased and active participation by dental professionals.
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| Figure 1 Tourists view a waterfall in the diverse land of Ethiopia. Dr. Brian Swann, pictured facing the camera, center, visited landmarks throughout the country during his trip last year when he set out to help the country establish a dental school. He plans to return in September to continue the work he and others have begun. | Figure 2 Dentists from all over the world met last year in Ethiopia to bring supplies and provide training to future dentists in Ethiopia. Many will return this fall for an international conference that aims to improve dental care within the international community. From left, seated, are Dr. Andra Woodard, Martin Woodward, Dr. Phyllis Ishida, Dr. Martin Strassmer, Ann Haspels, Dr. Charles Haspels, Dr. Norma Cordice, Jr., Dr. Robin Daniel, Deionne Traver and Beverly Clark. Standing, from left, are Jamaal Sheats, Dr. Brian Swann, Euyeal Yoseph Zeleke, president of the Ethiopian Orphans of AIDS Foundation. |
