Elective reflections
Completing a period of elective study is compulsory in order to graduate from Glasgow Dental School and a number of other dental schools in the UK. Many students choose to use this period to undertake dental volunteer work in a developing nation and it is often seen as something of a “rite of passage”.
Having recently completed just such a project – in the town of Palampur in the north eastern region of Himachal Pradesh in northern India – I have taken the opportunity to reflect on the experience for Scottish Dental magazine, in order to offer any advice for students and any other dental professionals thinking of undertaking volunteer work.
When discussing these projects with my fellow students, we had several things in common that we hoped to achieve. Perhaps the most common aim for students bound for developing nations was more time spent extracting teeth. Older generations of Glasgow Dental School graduates often wax lyrical about the number of extractions they performed as students, and the skill of the oral surgeons at Glasgow Dental Hospital is testament to their hours of practice.
However, most students in my year feel like they have nowhere near this amount of experience, making it a priority for their elective. While this is an understandable, realistic goal for most students, it is important to always keep in mind the ethical implications of extractions and consider each patient and their needs on an individual basis. It is also essential to consider the patient’s safety at all times.
Many volunteer projects operate in very remote areas and treatment is provided in ‘camps’, where volunteers set up temporary treatment areas. Time and resources are often limited and it can also be difficult to obtain a thorough medical history from patients – they may speak little or no English, be unaware of any medicalproblems and translators may not understand what you are asking.
These factors all increase the risk of complications resulting from extractions and, when operating without the safety net of the Southern General Hospital’s maxillofacial department, extractions can seem more intimidating. Therefore, it is important to always consider the necessity of the extraction, the health of the patient and discuss any concerns with fellow volunteers, supervisors and the patient.
Time pressures
This leads to another of the most common aims for volunteer work – the opportunity to work in a high-stress environment. Time constraints do not often cause a problem for students in GDH compared to daily working life in general dental practice (with the exception of Friday afternoon in the Oral Surgery treatment area), as we manage our own restorative patients and consultant clinics are well controlled.
Therefore, many other students and I found ourselves hoping for the opportunity to have more patients to treat, less time and fewer resources in order to prove to ourselves that we are ready for the challenges of working life as a dental professional. However, it is again necessary to consider the ethics and safety of every working situation, continue to strive to deliver the highest standard of care possible and not to undertake any task or treatment which you are not comfortable with.
The opportunity to travel is one of the biggest appeals to most students. Dentistry is a demanding course, and we do not get the long summer breaks afforded to most students, narrowing the scope for travel.
Therefore, the six-week elective period, followed by the five-week summer break is seen by many as the last opportunity to enjoy an extended period of travel before working commitments take priority.
Logistics
Trying to make the most of this experience can become a bit of a headache as flights, trains, visas, vaccinations and many other considerations must be arranged while simultaneously studying for final exams and juggling patients, but is undoubtedly worth the hassle, as travelling with friends and fellow students is a once-in-a-lifetime experience.
Myself and numerous other students found STA Travel extremely helpful, as its flights are comparable to any prices found online and the staff were always keen and available to offer any advice.
Humanitarian projects are not without risk to the volunteer. Knowing how to stay safe when travelling is essential and litigation is a common concern, with MDDUS offering free elective indemnity to students which is quick and easy to obtain. But the main area of concern is needle stick injuries. The threat of sharps injuries is omnipresent in the dental profession both at home and abroad – however, in developing countries, there are additional complications.
Sterilisation processes and cleanliness are often far lower than we are accustomed to. I observed numerous practices in India which would not be tolerated in the UK, particularly the reuse of instruments such as forceps, mirrors and even gloves and endodontic files on different patients without sterilisation.
Safe disposal of sharps is also of a lower standard – we resorted to using a glass water bottle for disposal of our sharps when working in camps and, as noted earlier, it is often difficult to obtain a complete medical history. Considering that India has an HIV population of approximately 1.6 million and a hepatitis B population of approximately 1.1 million, these factors added a new level of danger to sharps injuries.
However, there are a number of steps which can be taken to minimise the dangers. Post-exposure prophylaxis kits are essential, and while they are expensive (£100 per kit) they take two years to go out of date – meaning we managed to get kits at a discount from groups in the year above who took kits but did not use them. A protocol for the disposal of sharps is also essential, as it will minimise confusion and the length of time that used sharps are present in the working environment, as well as ensuring all sharps are disposed of as safely as possible.
That said, the most important factor in minimising the risk of sharps injuries – as with working at home – is personal vigilance. A keen awareness of which instruments are being used, how to use them, where they are, how to dispose of them – as well as good clinical knowledge and skills – is by far the best means to prevent sharps injuries and volunteers should not feel pressurised into undertaking any tasks or treatment which they are not comfortable with.
The link between poverty and dental disease has long been established, so it is no surprise to find that dental health is often neglected in developing nations.
During my time in India I saw poverty I had never imagined, and dental health is clearly a very low priority, with gross caries and abscesses often left untreated for long periods as patients cannot afford the basic fee of 50 rupees (around 70p) to have the tooth extracted.
I am yet to meet a fellow student who did not find providing essential treatment and the gratitude expressed the most rewarding aspect of the entire experience, and it is important to remember that helping those in need – rather than personal or professional development – should be the main reason why medical and dental professionals undertake volunteer work.
About the author
Alasdair Regan is a dental student at the University of Glasgow going into his final year. His main areas of interest are oral medicine and oral surgery, and he recently completed a three-month training programme in minor oral surgery with the oral and maxillofacial department at Forth Valley Royal Hospital.
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