Abstract
The purpose of this project was to compare the dental practices that are carried out in Taiwan, Cambodia, and Australia. My major focus as I carried out this project was based on; the level of infection, the type of control and treatment provided, and the quantity of workload per dentist. To be able to collect all the data required, I had to travel to Cambodia, Taiwan and Australia. This was necessary in order to collect primary data from my target population.
Most developing countries’ governments have challenges meeting the health needs of the common citizens, especially the majority of the common population which makes up most of the population. In this research work, we examine the state of dental health in Taiwan, Cambodia, and Australia and compare the state of dental health in these countries.
I used several methods of collecting data. They included; note-taking, observing their dental clinics, interviewing local dental officers, video recording, inspecting their medical records and using questionnaire forms that were filled by the dental officers. Through these methods, I was able to collect and store sufficient data for analysis and sequentially make relevant assumptions on my research findings. I was able to collect appropriate data that can be used to make relevant comparisons.
On completion of my research work, I was able to conclude that, both Cambodia and Taiwan compromise their level of infection control. However, there were various factors that dictated their decision. For example, lack of dental medical supplies and extremely high numbers of patients as compared to the number of medical staff. Apart from that, there were major differences in the type of dental treatment methods used in these countries.
In Taiwan and Australia, they practiced preventative and conservative dentistry. However, Cambodia clinics mainly provided services such as extractions and simple fillings. I noted that, dental staff worked for long hours in Taiwan and Cambodia and saw more patients per day than in Australia.
Description of Elective Project Placement
I spent my first elective placement in Cambodia under the supervision of Dr Li. During the first one week we practiced in the local dental clinic, when we could get some free time we would go to nearby schools to promote oral health among students. At this time I noticed the lack of equipments, dental resources and oral health education to Cambodian children. Most of the children have caries in their front tooth and practice very poor oral hygiene. I offered a helping hand to Dr Li as she performed dental treatment on many of these children.
While Dr Li performed treatment such as extraction of carious deciduous tooth, fillings of first permanent molars, scaling and cleaning of teeth, I assumed the role of dental assistant. I would perform duties such as; suctioning of saliva and water, handling of medical material and explaining tooth brushing instructions to students. I discovered that, there were only a few dentists in the province, and very scarce clean fluoridated water and dental resources. All these factors contributed to very poor oral hygienic conditions of Cambodian children.
There was an argent need for the oral health condition of Cambodian children to be improved by the government. The government can also fund to train more dentists, purchase dental equipment and resources. In case there are insufficient funds to support the project, the government can call on the international community for support. This can be achieved by making donations and sending volunteers to the local non-profit organizations in Cambodia.
In December 2011, I spent another six weeks in the Taiwan National University Hospital in Taipei. In the first four weeks I was in the oral surgery department in the dental faculty. During these four weeks, I enjoyed a great time building relationships with the dental staff in the hospital and observing their dental practices. At the same time, I had an opportunity to witness their surgical procedures in their operating theatres. For instance, I had a rare opportunity to observe the removal of oral cancer and neck lymph node clearance in some patients.
The dental staff worked long hours each day however, they demonstrated great surgical skills and excellent communication skills to patients. Among the different procedures that I encountered include; wisdom tooth extractions, implants, squamous cell carcinoma diagnosis and resection, cryotherapy, incision biopsies and impacted supernumerary tooth removal. Furthermore, I spent another two weeks as a volunteer in hospital wards.
Under the guidance of the head nurse, I helped the hospital staffs with surveys, data entry, and filing power point presentations. Overall, I gained valuable experience in my placement at this hospital and noticed various variations in the way they practice dentistry from Australia, Cambodia to Taiwan. More importantly, I have been able to established strong relationships with my supervisors and colleagues.
Analysis and Evaluation of Learning Agreement
Initially before I started my elective placement, I hoped I could experience overseas dental practice by travelling and being involved in their dental care. I set out the goal of broadening my knowledge with a wide range of experiences in different countries and to compare the differences in practices amongst Taiwan, Cambodia and Australia. I wanted to focus specially on variances in the level of infection control, type of treatment provided, dentists’ workload and fatigue, and levels of dental training in each country.
Infection Control
During my placements in both Taiwan and Cambodia, I spent a significant amount of time observing the level of infection control in these countries. I noticed that while both Cambodian clinics and the Taiwan National hospital attempted to achieve high levels of infection control, there were significant flaws in the protection of both dentists and patients in both countries. In the Cambodian clinics I visited, both dentists and patients used basic protective equipment such as goggles; masks, gloves, and gowns during treatment.
Furthermore, they sterilize all their equipment and do their best in wiping down working area after each patient has been attended to. However, there were still areas of concern in the effectiveness of infection control in the clinics. For instance, due to the lack of resources, the sterilizing machine was never checked for its effectiveness.
As a result, it was not clear whether equipment were sterilized properly or not. Also due to the inadequate level of dental supplies, dentists rarely change their masks in Cambodian clinics. This may lead to major cross contamination across patients. Similarly, there were serious concerns in the level of infection control in the Taiwan National Hospital. I noticed that the dental staff was routinely under a very high workload.
They often had very short breaks and looked after more than thirty patients a day. In order to work faster and be more efficient, they significantly compromised their standard of infection control. For example, dental staffs often failed to use gloves during routine examinations to save time but used gloves while doing other procedures.
Perhaps this was because they believed the risk of disease transmission was low under routine examinations. In addition, staffs rarely changed masks and did not offer patients eye protections during procedures. Another important aspect is that, wiping of working area is almost non-existent in the dental hospital.
These practices raised my concerns and I believed staff has become accustomed to these habits in order to save time and to see more patients. Each day there was a long list of patients booked in for every staff. Consequently, they had to work faster at the expense of proper infection control to treat every patient in the same day.
All dental staff aware of infection control protocol yet they failed to practice safely. At times staff ignored infection control procedures only for their own convenience. For instance, a dental staff ignored to wear eye protection, while performing neck lymph node clearance during an operation for an oral cancer patient and risk transferring body fluid into his eye. At other times, they fail to report and perform blood tests after being pricked with a needle. It is obvious that significant retraining is required in order improve their awareness in infection control.
Main Treatments Provided and Workload of Dental Staff
In Cambodia, there is a tremendous lack of dental material, equipment, and staff, which limits the type of treatment accessible to patients. On the other hand, patients are often faced with a significant level of pain and grossly carious teeth. In most cases, the priority is to relieve pain with limited resources. As a result, most treatments offered are either simple tooth extractions or filling. This is relatively simple and achievable given the limited time allocated to each patient.
Ironically, staff in the Taiwan National Hospital has resources and training to support a wide variety of treatment options that are similar to Australia. During my short stay, I observed a few implant cases, endodontic, restorative, wisdom tooth extractions and oral cancer cases. I will point out that there is a relatively high incidence of oral cancer and oral submucous fibrosis cases in Taiwan due to betel nut chewing. In addition to that, prophylactic removal of wisdom tooth without any associated symptoms or pathologies is a common practice in Taiwan.
The Taiwanese government supports National Health Insurance cover for many health care treatments for citizens. Some of them include numerous dental treatments such as restorative, endodontic, and wisdom tooth extractions. This has made preventative and restorative dental treatments much more accessible and increases the number of prophylactic wisdom tooth extractions. Dental staffs were trained in professional dental schools for six years after high school entry.
Each day, staffs are usually overbooked with an overwhelming number of patients that result to very late working hours and short breaks. As a result of a very high level of workload the breaks given to them is rendered insignificant. What is required is for the government to look for ways to hire more doctors and improve on disease control measures. This may reduce the level of work load. At the moment the situation is very unpleasant as the doctors keep on treating more than they can handle.