Nepal is a country of extremes, from the soaring heights of the Himalayas, the cold desert of Mustang, to the never sleeping, hustle bustle of Kathmandu. Nepal, like its neighbours in Asia, is blessed with a young population (median age 23) but it is one of the poorest countries in Asia.
For many Nepalese people, a visit to the dentist means a long and arduous trip when they are in extreme pain. Thousands of Nepalis in rural villages have no access to basic dental care, such as fillings or even fluoridated toothpaste and water.
This 75yr old gentleman carried his wife on his back, walking a couple of hours, as her legs are burned, to attend our outreach Dental clinic in Kobang.
Intense superstition surrounds dental care, including the belief that tooth extraction can cause blindness. In Kathmandu, people nail coins to a tooth God shrine to heal mouth pain.
Unlike the UK, simple dental disease in Nepal can have a potentially life-threatening impact. This problem is exacerbated by a lack of dentists in Nepal, especially in the rural areas. At present, there are ~1,803 dentists serving a population of 27 million, with 33% practising within the Kathmandu valley.
I joined a team of dentists, from the charity, Smiles Across Nepal (a UK based dental charity promoting oral health across rural Himalayas through outreach community projects and knowledge transfer) and Dullikhel Hospital (an independent, NGO institution, known for its community dental services and outreach programmes) to provide dental care, in the rugged area of Mustang.
The Smiles Across Nepal Team
Mustang is one of the remotest areas in Nepal and is second in terms of sparsity of population. The word Mustang is derived from the Tibetan word, meaning, ‘Plain of Aspiration’. We travelled to Jomsom, a town located at an altitude of 3000m, in the Mustang District. The soaring Himalayan peaks of Dhaulagiri and Nilgiri form the backdrop.
Our bumpy, precarious, teeth clenching 20-hour journey, took us through the Kali Gandaki Gorge, which is the World’s deepest canyon, separating Dhaulagiri and Annapurna, Himalayan mountain ranges.
Our precarious journey, we arrived in Jomsom, at 11pm at night in the dark, one car having dodgy headlights and the other a flat tyre!
Working in make shift clinics, established in monasteries, schools and villages, with no electricity, we used basic tools to provide urgent and routine dental care as well as providing oral hygiene education.
Our basic clinic in Kobang, with no electricity or light.
We also donated equipment to arm the local clinicians.
On our last day, we gave a lecture on oral health and donated a healthy lunch to all the inhabitants of MAITI Nepal – a NPO rehabilitation home, based in Kathmandu for the victims of sex trafficking.
In total, we screened and treated around 1000 patients. The children were very responsive to the oral health education.
Tooth decay is 90% preventable by reducing sugar intake, regular brushing, frequent exposure to fluoride and routine visits to the dentist.
Poor oral health and obesity go hand in hand leading to diabetes and heart disease.
It is a global problem.
The fight against sugar is interlinked with many diseases. It’s a shame that access to dental professionals appears to be the biggest hindrance to improving oral health in Nepal.
Dental clinic set up at the local Buddhist Monastery in Jomsom. 30 trainee monks were screened and we carried out an oral health class for them.
More ideas and work are needed in this area.
Jomsom camp at Jomsom school.
Over 500 patients were seen and even more teeth extracted! Lots of fillings done and we delivered oral health classes for the whole school.
Wifi and 4G are widely available even in the remote mountainous areas, I feel Nepal can embrace the digital age and leverage ideas developed in the UK to drive oral health education on a national scale; education is key to improving oral health for the next generation.
My trip to Nepal has given me a new awareness and appreciation for the plight of the dentists working there. I have written this article mainly as a call for action to rally more dental professionals to visit Nepal and to put pressure on the Nepalese Government and NGO organisations to invest in Oral Health Education and outreach centres for Nepal.
