Pav, Paras, Manish and Kiran share their experiences of volunteering in the Philippines to encourage other people to embark on an elective.
In the summer of 2016, the four of us took the 28-hour journey to Iloilo. This article will touch upon the vast variety of clinical practices experienced by our group from prevention in schools, curative extraction clinics and missionary work.
In the heart of Iloilo was City Health Office, which comprises of numerous healthcare sectors all of which are government funded. Iloilo is split into a number of barangays (districts), each of which had an outreach clinic to which a dentist was assigned.
I travelled for about an hour to a local village. Upon my arrival, I was led through the village to a small hut which appeared to be the village nursery. My work station consisted of a plastic table and chair – both made for children – and my dental instruments were four different types of forceps, two elevators and one dental mirror. I constantly had four local village children around me, fascinated not only by me but also by what was going on. A far cry from oral surgery at Manchester University.
My supervisor assessed the patient very briefly and then simply stated the tooth to be extracted. I was limited to one cartridge of anaesthetic per patient; not that this was a problem as I soon realised that even the youngest children in the village had a very high pain threshold. Due to the lack of dental light, my supervisor would often use her smart phone camera to shine into the patient’s mouth to assist me.
I completed twenty extractions in the hardest conditions I have ever had to do dentistry in, which involved 35 degree heat in the absence of air conditioning and the constant battle of operator – patient positioning.
This village experience is something that will always be a highlight of my dental career. An elective is so much more than gaining experience for yourself, it is a great way of using your skills to benefit poverty-stricken communities. This is definitely something I would be interested in doing again in the future (but next time I will pack a headlamp!).
I was based in City Health Office, with my supervising dentist and dental aid. My morning consisted of curative treatment, similar to my colleagues, involving mostly extractions of grossly decayed teeth. Ideally, one cartridge of anaesthetic would be used (costing the patient around £1.60), and ID blocks were rarely administered. I would do 15-20 extractions in the mornings on a variety of age groups.
In the afternoons, my team and I would commute to different schools to educate on oral health, distribute free toothbrushes and search for the ‘orally fit’ student (free of decay). The data collected helps City Health Office assist the government of Iloilo City allocate funding and decide on target age groups that need more oral health prevention.
The orally fit child would be entered into numerous prize draws and be rewarded for their great efforts. I was honoured to be asked by the head of year in one school to award one student a prize during my fieldwork. This highlighted how significant of an impact it had on other students by giving them an incentive to look after their teeth. On examination, whilst screening for decayed teeth, I would also apply fluoride varnish. On another occasion, I applied fissure sealants to six-seven year olds with only cotton wool rolls as moisture control, no dental chairs, no clinical light and a portable light cure. Although challenging at times, this was an incredible experience.
IloIlo City Community College was a small medical centre; the dental consultation room was equipped with a fully functioning electrical chair, running water and air conditioning (all somewhat of a luxury in the Philippines!). On a typical day, I would tour the school in the morning, informing the pupils to come to the medical centre if they needed any teeth out.
The students did not have to pay for the anaesthesia and all treatment was completely free. I would typically carry out five-ten extractions in the morning and after each extraction, the socket was immediately packed with amoxicillin granules and cotton wool soaked in iodine.
Antibiotics were always prescribed, usually amoxicillin, with instructions given to the pupil on how to take it. The antibiotics were used as prophylaxis due to the poor sterilisation of instruments, which can often lead to post-operative complications.
Needles were re-sheathed and dipped in a solution of alcohol and forceps were simply rinsed under the tap after each use and cleaned with a toothbrush. It was not uncommon for my supervisor to use her bare hands when examining the patients, adopting a ‘non-touch technique’.
Local anaesthetic was commissioned to ICCC dental clinic on a monthly basis by the City Heath Department. Towards the end of my time at ICCC, LA ran out, therefore my time was spent scaling the student’s teeth with a supra-gingival ultrasonic scaler. There was no aspiration tip, so every few seconds the patients would spit out the excess water into the basin.
ICCC was an up-to-date and efficient health centre to work at, with staff and pupils who were a pleasure to work with.
The journey began on local transport (Jeepney) to the clinic in the barangay Jaro, Iloilo city. The clinic consisted of one surgery that had a basic dental chair, a sink, a bench and a desk. Each patient that came into the surgery had a vague medical history taken and blood pressure measured. I would administer local anaesthetic to numerous patients consecutively within the same surgery. Whilst waiting for the anaesthesia to take effect, I would begin treatment on the previous patient.
If a tooth was tender to percussion, local anaesthetic was administered and it was immediately extracted. The use of preoperative radiographs to assist in carrying out an extraction was extremely unusual, if not non-existent. The only instruments available to use were luxators, three forceps and a chisel. Unfortunately, restorative dentistry was a rarity due to lack of resources, economic constraints and restricted access to private clinics.
I had the opportunity to take part in a medical missionary camp in San Isidro village with a charity group, Gawad Kalinga. Queues of patients of all ages had formed outside a school hall, which was our ‘surgery’ for the day. Equipped with only a plastic chair and table, an IPhone torch for visibility, local anesthesia and a few forceps, we saw around one hundred patients collectively. This day in itself was an exceptionally fulfilling and eye-opening experience.
So would we recommend an elective?
Our two weeks practicing dentistry in the Philippines was an extremely informative, enjoyable and humbling one. We would definitely recommend completing an elective as it truly pushes you out of your comfort zone and teaches you invaluable lessons about the ways in which dentistry is practiced worldwide. Not only do you enhance your clinical dexterities, work ethic and communication skills, you also make memories and friends that will last a lifetime.
Pav, Paras, Manisha and Kiran all attend the University of Manchester and are in their final year. They decided to share their experience of volunteering in the Philippines to encourage other people to embark on an elective and share their experience.