Studying abroad is now a given part of tertiary education worldwide. Final year dental student, Fathima Patel recounts her experiences on her Erasmus and elective programmes.
The world as we know it is changing, becoming more dynamic and globalisation now redefines what used to be relatively homogenous societies and countries, Ireland being one of them. With it, health plans are changing, focus groups are becoming more varied, research and new techniques are rapidly developing and progressing. Population statistics for diseases are slowly changing to reflect this new demography, and diseases such as sickle cell anaemia, which are associated with certain populations, are on the rise. Now with the constant stream of migration to Australia and U.K. becoming a popular trend with dental graduates, dental students require an undergraduate training that exposes them to different clinical situations which demand a broader dental foundation and education to cope with this changing climate. With this in mind, I decided to embark on the Erasmus exchange programme offered by Trinity College Dublin and the Dublin Dental University Hospital during the second semester of fourth year and the subsequent summer elective.
The Erasmus programme is part of the European Union's Lifelong Learning Programme that allows students to spend part of their academic years studying abroad. I was fortunate to attain a place in the world renowned Karolinska Institutet medical university in Stockholm, Sweden I was greeted by -9°C temperatures and knee deep snow but life carried on as normal- the first major shocking difference to Ireland. The city boasts an authentic atmosphere untouched by the modern developments of the past century but the society is as multicultural as London and this diversity exists unnoticed in this metropolitan city. I stayed in the international student dorm on the coast of Sodermalm, a beautiful island south of Gamla Stan, in the heart of the city. Shops, amenities and tourist sites were all within walking distance or if you were feeling lazy or too cold, public transport was a practical alternative.
The dental school and hospital is located on the KI campus in Huddinge, a suburb 20km south from Sodermalm but it only took 15 minutes to reach by commuter train. Registration and settling in was well organised. I was one of 13 Erasmus students in KI dental school, the others coming from Holland, Pakistan, England, Norway, Finland and France. The Erasmus coordinator Malin Ahlen briefed me on KI and student life. Lars-Erik Lindgren was in charge of our clinics for which patient arrangements were made prior to our arrival. I was registered for paedodontic and comprehensive care clinics as they could be undertaken in English and I had the opportunity to attend orthodontic and temperomandibular joint disorder clinics. The dental hospital was spacious with restorative clinics that were divided into five sections, each with 20 or so chairs. Bay A was for emergencies, bay B for dental hygienists, bay C for endodontic treatment only, bay D for basic restorative treatments and bay E for prosthodontic treatments. These clinics ran every morning and afternoon and our modules were assigned different sessions in these clinics as per our timetable. Patients were to be booked into Effica, the Swedish computer charting system that was very organised, fast and easy to follow even though it was all in Swedish. A chair request in the respective bay was also to be made in Effica according to the respective treatment the patient needed on that day. One major difference was the level of supervision available; usually about three to four supervisors specialised within that area were assigned to each bay which was very helpful, especially when complications arose in the treatments. This was good exposure to broaden the thinking of young dental minds with the variety of opinions and techniques each specialist brought with their different experiences. Dentists and supervisors were relaxed, somewhat less formal to fellow staff members, students and patients and always wanted us to do as much as we possibly could within our limited exchange time. We were all on first name terms and this equality was underpinned by everyone wearing exactly the same scrubs. Extra clinical sessions were given to us subject to clinical chairs availability and I therefore spent the bulk of my time treating patients.
The library collection is extensive with a wide range of textbooks in English and excellent access to journals online as well as hard copies. Erasmus students were exempt from Friday lectures or we would literally be lost in translation. The workload and weekly hours are much lighter than dental science in TCD (Trinity College Dublin). Life appeared easier, more relaxed and more college student orientated especially when it came to social evenings and I really appreciated this difference. I returned home to Dublin for a few weeks to finish my term at the beginning of June, spent the first week of July in Spain walking the Camino de Santiago and then it was time in mid July to experience dentistry in the developing world.
Elaine Shore, Orla Carty, Rory Boyd and I chose to do our elective in Cambodia with One2one Charitable Trust www.one2onecharitabletrust.org, a non-profit organisation from New Zealand. Started up in 2009 by Dr Callum Durward, a specialist paediatric dentist and Dean of the Dental Faculty of the Cambodia International University, the organisation aims to provide health and social care to some of the poorest and most neglected parts of a country where there is no free health care. The average five year old has 8-10 decayed teeth, and teenagers in Phnom Penh have an average of 6 decayed permanent teeth. Elaine and I arrived into temperatures in excess of 35°C and our first impression of the place was an assault on the senses. Heat, air pollution, food aromas, and loud noises greeted us and we quickly discovered that roads were the busiest and most hectic aspect of Cambodian life. Travelling in the organisation's tuk-tuk to the bus station, we passed by numerous dental surgeries where the clinics were practically on the road for everyone to view. After boarding the coach for Siem Reap, the rush and chaos of Phnom Penh was gone only to be replaced by "obstacle course" roads that were well decorated with "craters".
Bringing vital dental care to neglected communities in a country that is struggling to recover from the aftermath of the 1970's Khmer Rouge "Reign of Terror" was a challenge. The first week was spent in a prison in Siem Reap, providing emergency care to some of the 1500 inmates. Heavily decayed teeth causing chronic pain were given priority to be extracted. Carious anterior teeth were restored with composite. Endodontic treatment in anterior teeth was done blindly without any radiographs. Minimal security appeared evident as for every 100 prisoners we had around us, there were two or three guards supervising them. We were each partnered with a Cambodian dental student who acted as our translator and provided a lot of assistance especially with the difficult extractions. Our concept of healthcare which focuses on a clinical setting in a fully equipped hospital was constantly challenged and even seemed inappropriate for the host setting where the main concern was emergency care with limited resources. Diagnosis was done in three minutes without proper lighting and you always had to be on the ball working fast. The Cambodian students were without doubt very clinically experienced and we learned so many different extraction techniques from them and the supervisors as we pulled out countless teeth. Sterilisation involved scrubbing the instruments with bleach, shampoo, water and pressure cooking them. As Murphy's law has it, drama must follow and one of the dental volunteers mistakenly grazed her finger with a needle and another smeared blood under his eye after a surgical extraction. Immediately both patients were tested for HIV and Hepatitis C and both students started the HIV prophylaxis medication. Thankfully, results the next day came back clear but the episode taught us the importance of being alert in such a risky setting and that the HIV drugs have a potent negative side effect. On a more touristic side, we visited the ancient temples of Angkor Wat and were awed at the dominating presence these buildings command against the jungles and city of Siem Reap. Khmer food took some time to grow accustomed to, especially since we ate the standard dishes for breakfast, lunch and dinner.
Elaine and I travelled to Takeo and spent our second week in a primary school located deep in the farms of this one street village. With 500 children and 100 adults to treat, we all became experts at placing glass ionomer composite fissure sealants and restorations and fluoride within minutes. We learned how to extract primary teeth using an explorer and forceps only. The children had never seen a dentist before, many did not own a toothbrush or toothpaste and sometimes it was so difficult to console them as language and fear of the unknown were the greatest barriers between us. Dr Annie Chen-Green, a key volunteer overseeing the administration of this organisation, explained to us that continuity, provided that there are sufficient volunteers, both local and international, is being implemented, hoping that these forgotten communities will become more oral health conscious and a movement from "once off" fluoride varnish application and toothpaste delivery to more consistent interventions can be achieved. In this sense, they hope that sustainability from within the Cambodian society can flourish and eventually rebuild an adequate and affordable healthcare system that can support its own people using their own means. By the time our volunteer work was over, our clinical skills had developed and we had fostered both personal and professional understanding of situations very different to what we face on a daily basis and the importance of taking time out from our own comfort zones to help those at a comparable disadvantage to those in our own communities. My travels in South East Asia continued on to Malaysia, Thailand and Singapore before my journey took me home again to Dublin and my final dental year and here I am. It was a fantastic six months living, studying and sightseeing abroad. So many exciting challenges faced me and influenced me. As a dental student, I have become more clinically confident and motivated and gained international experiences. As a person I have become more independent, open minded, more culturally sensitive and tolerant and able to adapt to new circumstances better. And with this, working life after graduation doesn't seem so daunting.