Laura Daly is a final year dental student studying at Peninsula Dental School. She has written this article to give other dental students considering volunteering an insight into what it can be like working in a less developed country, and how valuable the experience can be.
My first experience of working alone as a dentist, without help, was on my elective this summer. This article summarises the experience and my reactions to the limited facilities; and explains why, in my opinion, an elective is one of the most valuable experiences a dental student can gain before qualifying.
Don't Panic! The immortal words of Douglas Adams flash neon in my mind as I face a rather daunting task: caries removal and composite placement without supervision, water spray, suction, moisture control, appropriate hand instruments, or even a working dental chair. Although the private clinic in Tanzania in which I was working has very little in the way of equipment, the care they provide is still patient-centred and of a much higher standard than you might expect on first walking into the run-down little clinic, and I was determined to live up to their expectations.
With both the qualified dentists and nurse occupied in the next room dealing with rusty forceps, thick bone, and an anxious patient, I was left to work things out for myself. My patient speaks very little English, and I very little Swahili, but we manage. We stumble our way through options and consent before beginning treatment: caries removal and composite restoration of an UR6. No problem. Simple procedure. Local anaesthetic in, and let us begin.
Knowing there is no suction, I start with the closest thing to an excavator I can find. Sadly, that pesky caries has done what all caries love to do, and has begun burrowing its way along the CEJ. Smiling and reassuring the patient in my broken Swahili, I find a bur and check the handpiece. No water spray. The tooth is vital and already causing some intermittent pain; using my Sherlockian powers of deduction, I decide burning an already compromised tooth with a hot bur may exacerbate the problem somewhat.
My eyes drift over the equipment as sounds of discomfort and terror emanate from the room next door. No help from there. I smile reassuringly at my patient and pick up the 3-in-1. With much gesturing and a few mutually understood words, the patient gets the gist of what I need him to do. It's not the perfect solution, It's not even a good solution, but at least it gets the job done. I drill and spray water from the 3-in-1 on to the bur and tooth at the same time, stopping every few seconds for a spit-break.
I thank whichever deity happened to be paying attention, that the caries had not gone far and that I was using composite. After a few minutes the decay was gone and it was time to restore the tooth. "Hard part over?" my subconscious asks. Not quite yet.
I'll spare you the details, but rinsing off etchant without suction is quite difficult and potentially messy if you don't keep an eye on how full your patient's mouth is getting. We got through prime and bond without much incident; the light-cure startling both me and the patient somewhat due to its vocal impression of a hairdryer. Then came the composite. No suction and only small pieces of gauze available as moisture control.
I isolate the tooth as well as I can and reach for my flat plastic. Only there is no flat plastic. Or any other instrument of use. I have an amalgam plugger, a ball-ended burnisher, the excavator from earlier, and a plethora of different hand scalers. Fine! My subconscious eye twitches as it watches me use my fingers to apply the composite and shape the restoration. I grab the light-cure, this time prepared for its hairdryer impression, and set the restoration. I check the occlusion and my heart sinks. It's too high. I grab the excavator, and pray.
As the instrument carves away the excess composite, my subconscious passes out with relief. It turns out that 30 seconds curing isn't quite long enough. It takes me almost three minutes to cure the restoration with the hairdryer, and only when the patient bites down and gives me a smile and thumbs up do I relax.
When I first decided to volunteer, my main goal had been to gain more experience with extractions and oral surgery. Although I managed this, it was not the most valuable lesson I learnt. The scenario above was the first of many “ taking me out of my comfort zone and learning to adapt. In dental school we are given the best equipment to use and excellent facilities in which to work; our nurses are our fellow dental students, giving us a safety net of knowledge. This was the first time I was truly by myself, and I loved it. Yes, it was scary; yes, I wanted someone to assure me I was doing the right thing; but it forced me to use my own knowledge and skills, and most importantly, to trust myself.
Working on clinic as a dental student, it is very easy to lose all self-confidence and mistrust your own judgement. You have supervisors telling you different things (10 different dentists, 10 different treatment plans); your are surrounded by all those self-assured dental students who always seem to ace exams and exude confidence in their abilities; it seems like everyone else knows ten times more than you do, and it gets disheartening.
Being thrown into the deep end without a life-jacket forces you to sink or swim. That is the most valuable experience I got from my dental volunteering experience, and it is the reason I would urge dental students in their penultimate year to take the plunge and volunteer abroad. You will learn to trust yourself, and that will be invaluable in the career ahead of you.
So to all dental students, I say: Bon Voyage. You'll never complain about a blunt luxator again.
Laura Daly
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