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Elective in Kathmandu

Research Elective 26th March - 18th April 2001 Working with United Mission to Nepal, Kathmandu. Jessica Poulsom, Manchester Dental School with a grant from MMA HealthServe
It is largely thanks to the Christian Dental Fellowship Annual Family Conference that my friend, Sarah-Jane, and I went to assess oral health status in Nepali leprosy sufferers compared to the unaffected Nepali population. At two consecutive conferences we met dentists who have worked aboard and also know missionaries still in the field, and who gave us some brilliant ideas for projects.

We went to stay with Robert, Ruth, Sunita, Robson and Christina Yee in Kathmandu, Nepal. They welcomed us warmly and helped us adjust to the strange new culture in which we found ourselves. Robert is a dentist working for UMN Oral Health Programme; he and his colleagues kindly arranged for us to visit three leprosy centres to carry out oral examinations then visit the UMN Headquarters to carry out the same examinations on their Nepali employees to act as our controls.

One of the highlights of our trip was working with the leprosy patients. They were so full of fun, and delighted that we had taken the trouble to visit them. We had been given 300 toothbrushes and tubes of fluoridated toothpaste that we gave to participants of our study, and these were great motivators for people to get involved! In Nepal, toothpaste and Coca-Cola are widely advertised products and apart from one toothpaste brand (Pepsodent; soon to include Close-Up) are nonfluoridated. This is due to the influence of India from where much of the toothpaste is imported. India has fluoridated water therefore does not fluoridate its toothpaste. One person we examined at the UMN HQ had fluorosis and we discovered he had been brought up in India. On the other hand, the Nepalese do not have therapeutic levels of fluoride in their water so require it in their toothpaste. Another influence on Nepalis choosing a brand of paste to use is the colour of its packet or of the actual paste - Nepalis love the colour red.

Nepal has a population of 22 million and 240 dentists. 95% of these dentists work in Kathmandu, leaving only a handful of dentists to provide care for the Nepalis living outside Kathmandu. Fluoride replaces hydroxlions in enamel, creating a structure more resistant to cariogenic attack therefore helping reduce caries experienced in teeth, thus reducing treatment need. Another problem is the widespread Nepali habit of chewing tobacco, leading to sub-mucous fibrosis and malignancy. Much of the work of the UMN Oral Health Programme is the provision of preventative advice especially within schools. UMN OHP also train dental officers (for instance in the provision of treatment Sarah-Jane and I have highlighted for leprosy patients at the three places we visited) who then are able to go outside of Kathmandu and provide accessible dental care.

Sarah-Jane and I felt extremely blessed by the Lord from start to finish. All our plans fitted together in a way that could only be from God. -We are amazed by the potential repercussions our small piece of work has. For example, treatment of leprosy patients (a group not yet included in the OHP); training of dental officers through the provision of this treatment; the use of equipment donated by family, friends and dental staff for the OHP's work which Sarah-Jane and I were able to take out with us.

For us both this was an experience of a lifetime.
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