In October 2009, I travelled to Bolivia with Remote Area Medical Volunteers (Canada) (www.ramv.ca) as the lone volunteer dentist in a team comprising 2 physicians and 6 support team members. The objective of our journey was to provide medical and dental treatment to the Aymara and other indigenous peoples who live in a remote and almost inaccessible area of the Amazon. For perspective, from La Paz airport it took an 18-hour bus ride followed by a 16-hour boat journey to reach the Carmen Del Emero region, where life gets as primitive as one can imagine.
I have volunteered internationally in the past, in places where there was some dental infrastructure. This was my first trip where there were absolutely no dental tools available except for exo forceps, some intermediate restorative material (IRM) and a makeshift dental chair consisting of a wooden bench with a soccer ball for a headrest.
Here are some of my clinical observations: evidence of many do-it-yourself extractions; a high ratio of dental attrition combined with common oral lesions; almost all adults treated were partially edentulous (only 1 patient had a dental prosthesis for the missing teeth); about 70% of adults had complete or partial loss of vertical dimension and shift of midline; almost every patient had some form of periodontal disease, ranging from mild gingivitis in young children to advanced periodontal disease in adults.
There was evidence of many deep carious lesions primarily due to the presence of refined sugar in the diet. However, the farther away a person lived from the city, the lower the rate of caries.
Most of the broken teeth were damaged as a result of decay. The effect of iatrogenic dentistry was evident in many cases. Without proper training and lack of modern equipment, poorly trained local health care providers had left many root tips in place during extraction, which I had to remove both surgically and nonsurgically.
We delivered a great deal of badly needed emergency dental services to these villagers in a short time. They were extremely happy with our services and were highly cooperative. Although we feel great satisfaction in getting people out of pain, we should spend more time educating the villagers about the basics of oral and general hygiene.
As I write this letter, Haiti is in dire need of rebuilding help following a devastating earthquake. I am calling upon my dental colleagues to consider helping with the dental component of the rebuilding process. As a start, our clinic has begun raising funds toward Haiti relief. My long-term vision is to build an educational and clinical dental institution in Haiti with the help of Canadian dentists. I therefore encourage all dentists to contribute ideas for this project, so we can help put a smile on every Haitian’s face. Please send your input or suggestions to: Drmirzaei1@gmail.com.
Dr. Amir Mirzaei