Common
Health
- Commonwealth
"Thoughts After Close of Play"
Brian Mouatt CBE, President of the Commonwealth
Dental Association (2000 - 2003)
(Also printed in BDA News)
Are you sitting comfortably? Probably fairly so, the back
might ache a bit and the eyes are feeling tired but on
the whole it has been a rewarding day at the surgery. The
list went well, just one broken appointment, luckily at
coffee time and the crown preparations for Mrs Figit went
swimmingly - really something to be proud of. The staff
were smiling and on time. Yes, it was a good day.
Time perhaps for some reflection. How lucky we are to
have such a profession, giving us the satisfaction of
multiple jobs well done with the benefit of our high
technology gear. We can bask in the knowledge that our
patients seem generally grateful and if we are honest,
all in all, it's a pretty good living. Of course life
could be better. We all have our own aspirations, goals
and dreams.
Perchance to dream, ay there's the rub; suppose that
things were different, suppose we were a developing
country.
Imagine, if you will, a woman with an infant and two
small children selling fruit by the side of a dusty track.
Her husband is dead of AIDS, her children have malaria. A
farmer nearby, stares at his rotting produce, undersold
by foreign imports, masquerading as food aid. A disabled
boy says he is tired of being hungry and beaten; a group
of women wish for a place of safety away from domestic
violence and fear of conflict. Imagine then, on top of
all these woes, the impact of dental pain and disease
where there is little hope of treatment. Is it any
surprise that these people feel alienated from the
affluent west and their own politicians?
Life for a dentist in these circumstances is very
different from our own, more comfortable experience.
Where the rare dentist is to be found, he will be
overwhelmed by demand for treatment. Perhaps at six in
the morning or earlier, long queues will form, hoping for
relief. Many will have badly neglected mouths, some will
have gross pathology. There will be a few jaw fractures,
especially if it is after a weekend. Our practitioner
must be on the look-out for oral cancer (as common here
as cervical or breast cancer), and maybe one of the
children will have noma, that form of gangrenous
stomatitis which can be fatal if not caught early.
This dentist will work on these patients in the certain
knowledge that between 20% and 30% of his patients will
be HIV positive and he will often see the tell-tale
candidiasis indicating early sero-conversion to AIDS.
The clinic itself is a headache. The once smart dental
unit donated by some well-meaning aid programme, long ago
ceased to work. There are no spares or an engineer to
help. In any case, there might not be any electricity
today; there is no fuel for the generator. The supplies
of local anaesthetic and glass ionomer needed for ART are
running low. Fortunately the autoclave still works on
distilled water from the local garage. So do the forceps!
It looks like another day of pain relief by extraction.
It's a pity most of the patients can't afford to pay -
nevertheless he works on. It's his job.
If you are tempted to think this is an exaggeration,
believe me it is not. It is typical of the desperate and
deprived circumstances our colleagues suffer in the
developing countries. They are coping with conditions
like these on a daily basis. These dentists have gained
professional status and their qualifications through
years of bright achievement and sacrifice, yet this is
their reward.
It is awareness of these circumstances that motivates the
Commonwealth Dental Association (CDA) to work towards
improving the lot of our colleagues in the developing
countries. CDA works by making available educational
support and CPD programmes through the use of distance
learning wherever possible. It holds workshops and
training sessions; importantly it lobbies governments for
a fairer share of the country's health budget. Above all
it is forum for professional exchange of experience,
nurturing friendships and common interests.
If in your dreams you would like to help, why not become
a friend of CDA by joining us?
A donation of £25 (more if you can) will make you a Friend and bring you the CDA News for
three years. You will generate new contacts and new
interests. Look out for a new initiative that is being
developed jointly by the BDA and CDA to bring both sides
of the "dental deficit" together. Its coming
soon to a practice near you.
Donations can be sent to and membership of CDA
Friends arranged through the CDA Administrator by sending an E-mail to:
administrator@cdauk.com
[22/01/2009]
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Affluenza - a modern disease
Brian Mouatt CBE, President of the
Commonwealth Dental AssociationYes, I confess it - I have been
there with the best of them complaining about inadequacy
of the fee scale, the iniquitous treatment of practice
expenses and the outrageous cost of running a good
ethical practice. Dentists were complaining about these
injustices as long ago as the Tattershall Report of 1967.
Many of these expressions of dissatisfaction stem from
legitimate comparison with other comparable professions
who, it seems, earn rewards bordering on the disgustingly
affluent. It cannot just be that the grass is greener on
the other side of the professional fence - it just seems
so unfair.
It is at this point in our musings that we would do well
to pause for a moment's reflection and ask ourselves if
the comparisons we make are not a little biased or dare
we admit it, unfair in themselves. Pause for a moment to
consider that half of the world's population lives on
less than US$ 2 per day. The majority of the deprived
developing countries have much less. The scale of poverty
in these countries, especially those with large rural
populations based on subsistence farming is simply an
outrage. Because these people do not directly touch on
lives and because we have little or no knowledge of them,
their situation does not trouble us unduly, except
perhaps when a harrowing image flicks across our screens.
The moment of truth comes when, through travel and
contact, we come face to face with real deprivation - few
of us are prepared for the shock; few of us can fail to
be moved. This is brought home with personal impact when
one meets and works with our professional colleagues.
These dentists are the lucky ones, bright, enthusiastic,
intelligent. Supremely, they are survivors who have
endured years of hardship to achieve their goals. The
rewards are substantial by local standards yet compared
with our own - pitiful. The Chief Dental Officer of one
Central African state, with a PhD and Fellowship from UK
institutions, earns £ 600 per annum and is at the top of
his tree. Should we not count our blessings? A rhetorical
question I hope you agree, but could we do something
positive ourselves to relieve that slightly uncomfortable
feeling brought on by our affluenza? The answer of course
is yes, and furthermore it is simple. The Commonwealth
Dental Association is there to help, an effective and
painless cure for affluenza! If you would like to know
more do please read on.
The CDA
The CDA works, with very modest means, towards improving
oral health in the 56 Commonwealth countries most of
which are active members. In an organisation such as
this, which represents a third of this earth's
population, there are diverse and differing priorities.
The common themes which bind us together are language,
law and education. The philosophy of lending the helping
hand to those in need is the bedrock of our actions.
There is no doubt that many of our colleagues in the
developing countries live and work in the most deprived
and difficult circumstances. Often they are situated in
remote locations with poor communications and invariably
experience difficulty with funding problems. Often the
basics of clean water and an electricity supply are
absent. Despite these circumstances there is among our
colleagues in the field a remarkable dedication to
dentistry and an impressive thirst for knowledge and
professional development. This is where the CDA comes in.
Educational Initiatives
The advent of worldwide communication systems through the
developments in Information Technology is now a practical
and realistic pathway for educational communication in
the Commonwealth. The possibility that the best teaching
material and high-grade information systems can be down
loaded to a desktop in remote locations has enormous
possibilities. Even where Internet access is difficult
the amount and quality of material that can be delivered
through CD ROMs is nothing short of impressive.
Computers Delivered
The CDA has moved to develop this potential in three ways.
* Through the generosity of Unilever it has a programme
of shipping computers and their associated software to
centres which can be accessed by dental teams in
developing countries. The first group of these modern
machines has been delivered to Zambia, Nigeria, Botswana,
India and the West Indies.
* Continuing professional development programmes are
available on CD ROM and from the Internet at no cost to
the participants.
* CDA has published a Directory of Distance Learning
Material.
We are seeking further support for this innovative and
highly practical programme and are always on the look out
for ideas for developing this initiative.
Assisting on the Ground
CDA has always been from its inception an active
participant in international dentistry, reminding the
affluent and sophisticated countries and their
practitioners that there is another less rosy picture
which our profession endures. CDA has close links with
the World Health Organisation and Federation Dentaire
International. CDA President, Brian Mouatt is co-chairman
of the FDI Developing Countries Fund, a new and long
awaited initiative with worldwide support. CDA advises on
the development of oral health policy and the development
of appropriate technology. In Harare in September at the
African meeting of the International Association for
Dental Research there is a CDA workshop on Atraumatic
Restorative Technique ART. This follows amongst others
which have been on HIV & AIDS and the oral
manifestations of this scourge. Cross infection control
issues are of course linked importantly with this subject.
Raising the Profile of Oral Health
Many of us will recognise the difficulties of persuading
politicians and governments of the rightful place of oral
health in the health priority scramble. Issues of the
contribution that dentistry makes to the quality of life
are all too often pushed to one side by medical problems.
While this is understandable to some extent when
resources are limited, it often results in dentistry
disappearing altogether. This can happen even in the
industrialised countries; in the developing world it is a
daunting task to keep oral health in the picture. For
this reason CDA takes a robust and high profile political
stance whenever possible. We support and lobby the
Commonwealth Health Ministers at the World Health
Assembly and individually, whenever an opportunity arises.
We assist in the development of oral health strategies
and policy documents when the Chief Dental Officers need
help; we engage the medical profession in a dialogue
fostering partnership for dentistry in Primary Care
development.
The Real Priorities
The picture in developing countries is unlike our own. In
Africa, south of the Sahara, HIV & AIDS is a
staggering threat to every country, community and family.
Early diagnosis and good cross infection control are
nowhere more important. Trauma from conflict, road
accidents and domestic violence are seen on a much
greater scale. Oral cancer is a common threat and pain
relief from the ravages of caries presents problems of
access and provision that makes our own situation seem
more than generous. These are the issues CDA has
constantly in its sights.
We Need Your Help
In these days of multiple calls on all of our resources
it is difficult to decide on how best to help. The CDA is
one way to do something in a small way to help the
developing world and especially our deprived colleagues.
It does seem to be a practical way of giving something
back in return for all the professional privilege we
enjoy. A donation of £ 25 will make you a member of CDA
as a "friend" and in return CDA News will be
yours for three years to keep you in the picture as we
fight together for a better world. Please think about it.
Donations can be sent to and membership of CDA
Friends arranged through the CDA Administrator by sending an E-mail to:
administrator@cdauk.com
[22/01/2009]
Article published in The Dentist October 2000
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