Ecuador Dental Missionary Trip, Quito

Francine Fletcher and Surrinder Poonian write about their ten day trip to Quito in Ecuador providing dental aid for the Dental Community Fellowship during March 2012.

Six months into our dental foundation training we were given the opportunity by a fellow Sheffield Graduate to travel to Ecuador with the intention to provide dental aid to their underserved population by the Dental Community Fellowship. This was an opportunity that we could not pass up; the chance to work in remote conditions as part of a large team and have time off work, rude not to. The trip was organised by an American non-profit missionary group called the Dental Community Fellowship and had been running since 2002. Dental Community Fellowship is based in South Carolina and was established by Dr William Sasser aperiodontologist, who organises monthly missionary trips all around the world providing dental aid. These span from Hati, Venzula, Thialand, Ulkraine, Africa, China and India. Then the reality hit, we're actually going, we being four English dentists (3 recent Sheffield graduates and Dr Nigel Mallon a practitioner and  Foundation Dentist  trainer from Sheffield) along with 70 Americans, made up of qualified specialist dentist volunteers and dental students from the Medical University of South Carolina. However as the time got closer the feelings of excitement became mixed with feelings of apprehension... What if I snap and can't extract that upper 7? What if I miss caries? What if I expose or tell a student to do something wrong? We've only done six months of dental foundation training.

A massive bonus of going with an established group to the Dental Community Fellowship clinic was that everything was planned and prepared down to the last detail. We woke every morning at 7am, travelled an hour in two chauffer driven coaches to a church hall where we provided dental treatment from 9 am to 5pm Monday to Friday. The dental volunteers worked with portable equipment, the automatic dental chairs were replaced by camping chairs, the dental lights replaced by head torches and there was definitely no HTM 01-05 procedures followed using only cold sterilisation methods, when all working it appeared to be a scene from 'carry on camping'. It became apparent very quickly that dental charity work in deprived areas is all about compromise. Advertising had been given out at a local level and every morning hundreds of people flocked to the community hall; adults, teenagers, children and the elderly the majority of whom needed multiple complex dental treatments. The dental needs of the serving population were high, the first session on triage highlighted this, patients who needed multiple extractions and restorative work could only be seen for part of their treatment, on reflection this is a down fall of the Dental Community Fellowship organisation.

The dental volunteers found the language barrier was an issue, there was no way our GCSE German or French would help us in this environment. The translators were invaluable; working in this environment highlighted to us just how important communication skills are when treating patients. Again this is another reason to go with established organisations that have links to good translators. But the quality of the translators varied, some were fantastic and really knew the message you were trying to convey, however it was a bit worrying when you speak to some translators and they'd sum up your 30 second conversation in a maximum of three words! As a result this underlined the trust that patient's put in us as dental clinicians and brought home the importance of always acting in the patient's best interests putting their needs before your own. As you can imagine informed consent was not a hot topic for charity dental work, neither was record keeping. This did make the working environment a lot more productive but again it felt strange to not actively discuss all the available alternatives and record the batch numbers of the local given.

Another important part to Dental Community Fellowship's  trip was oral health education. As part of the trip we were given times off clinic to visit local schools to provide oral health education and topical fluoride with brushes. Every dental volunteer visited two schools within the area and it compounded what was seen on the clinics, a lot of the children had anterior caries and needed a more regular and complete source of dental treatment. A total of 74 dental healthcare professionals went on our trip; established specialists in orthodontics, periodontics, restorative, paediatric and general dentistry, hygienists, newly qualified graduates and the predominating group members were dental students. Every person who went on this trip had the same mind set of doing the best you can in the limited environment you found yourself in, team work was the vital ingredient to this trip. In a five day period we saw and treated 2695 patients, and did 2329 dental procedures dispensing 7000 toothbrushes.

To try to summarise and reflect on this trip is very difficult, it did not meet any of our expectations, it exceeded them. The trip was organised to such a high standard with all dental professionals pulling together to meet a common goal that we never had to worry about anything clinical or organisational. However it very quickly became apparent that dentistry in areas like this is a compromise, no endodontics were done, cross infection control was very basic. We came for a week and we only scratched the surface of the dental needs within that one area. Although we feel proud of what we achieved you can't help but feel sad that nothing is being done for these people on a permanent basis and this is something that is apparent worldwide in other countries.

All the dental professionals appreciate how lucky they are to have been given the opportunity to help the Dental Community Fellowship to do dentistry and provide treatments for those in need. The ability and feeling of giving back to those less fortunate beats the feeling of seeing that perfect obturation radiograph for all four canals in an upper first molar. This trip was filled with lots of emotions and the meeting of new people is an experience that all dental professionals should experience, would we go again? Definitely without a doubt!