SEMIAHMOO DENTAL OUTREACH: November 20 to December 1, 2017
The Semiahmoo Dental Outreach (SDO) team completed its eighth annual dental clinic in Siquijor December 1st, 2017. Our goals were to continue to treat as many school children as possible, and to promote prevention of dental disease on the island of Siquijor, building on our previous work there. We have committed to return in November 2018.
The Team and Its Local Counterparts
The 2017 team of 28 included seven dentists (Ken Stones, Murray Bohn, Joan Eaton, Janis Boyd, Warren Ennis, and Gabor Balogh, one oral surgeon (Kulminder Bahi), and several hygienists, chairside dental assistants and additional volunteers. All personal expenses, including travel, accommodation, and meals were paid by team members themselves.
The Siquijor Rotary Club makes a huge difference in enabling us to concentrate on the clinical and prevention work. They welcomed us back this year, and helped us build on our work from 2010 to 2016. They had everything in place upon our arrival. They provided on average 20 volunteers each day, transported children to and from the clinic, arranged to have lunch provided for us each working day, and took care of any needs as they arose.
In previous years, we have taken a group of nursing students to teach prevention at the schools, and a sex education team doing presentations at the high schools and colleges. This year the Siquijor department of education has hired additional staff to take on these instruction programs themselves, following our models. We see this as a very positive step on their part!
Siquijor is an island of about 100,000 people, with a very low average income. Due to the huge sugar consumption and poor knowledge of the sugar-caries cause-effect, there is a very high caries rate on the island. Although three government-employed dentists on the island do relief of pain by extracting teeth, we observed very little restorative work. There are also two private dentists but most people cannot afford treatment.
The team arrived on site Saturday November 18th (after almost 24 hours of travel), with 19 dental bags in addition to personal luggage. This enabled us to spend much of the next day, Sunday, setting up the clinic. We assembled six units in the clinic, and an additional two units in the Siquijor dental bus. This gave us seven dentist work stations and one sealant unit. The bus was sent out to a small village in the hills, Cang Asa, where we treated over 150 students. We rotated a team of five on the bus everyday.
Over the ten days in the two locations we treated over eight hundred children from three schools, restored over 1250 teeth, and extracted many teeth that were beyond saving. We also applied fluoride varnish to every patient, and with the sealant team of Ideh and Glenda, were able to do almost 1800 sealants! The oral surgeon was also able to see many adults during our clinic, extracting almost 600 teeth.
This year we were able to utilize Silver Diamine Fluoride (SDF). This newly available product (approved for use in Canada March 2017) arrests caries with a simple one-minute application involving no local anaesthetic or caries removal! We used SDF extensively on carious deciduous teeth that we do not usually have time to treat. We believe that SDF adds tremendously to our ability to deal with the rampant caries we encounter so often in our SDO clinics. We first used SDF in Kenya at our June/2017 clinic. It has been proven effective in many countries (used for over 80 years in Japan).
We also used SDF under deep restorations enhancing the “ART” (“Atraumatic Restorative Treatment”) technique of restoring teeth. We have been doing ART restorations for many years now, enabling us to save “bombed out “teeth without requiring endodontics. We have had the opportunity to observe the success of many of these restorations in the students of the Solangon students over the years.
We owe the clinic’s extreme success to many participants, especially the team members whose dedication and enthusiasm made it happen and a cadre of dedicated local volunteers and Siquijor Rotarians. The success of the trip was bolstered by the crucial support of the ICD whose donations were used to purchase supplies and equipment. We also received some donations from individual members of the South Surrey community specifically given to support the work of the Siquijor Rotary Club in their community projects on Siquijor. The Club sponsors lunch programs for undernourished children, installs water systems for those schools with no running water, builds school washrooms, sponsors over 100 students for further education, tests the vision of elementary students on the island and supplies prescription eye glasses when needed, and carries out many other community projects.
Meetings with Local Officials
Over the years, we have made an effort to set in motion prevention measures that will be ongoing after we leave. Our influence in Solangon has led to several meetings between officials there and owner/operators of corner stores that sell large amounts of inexpensive candy and pop to the children with devastating results. At the meetings, vendors have been encouraged to look into alternative snacks that are more nutritious and less damaging. This has met with limited success. Dental education of the shop keepers is badly needed as we noticed their children were amongst the worst of the rampant caries patients we saw.
The lack of dental preventive knowledge is quite disturbing. When contrasted with the information the public receives in Canada, it seems that Filipino dental organizations do very little to increase public awareness. Medical information is distributed to the public but not, as far as we can see, dental information. Even the link between sugar and caries is not known by the majority of the people we talk to. Instead, residents of Siquijor seem to view decay as a mysterious affliction that affects just about everyone.
Improvements and Progress
Some progress is being made. Less sugary snacks are being offered by vendors now. And, in early 2015, the school superintendent banned the selling of “junk food” in all 84 school canteens. This is something we have been pushing for since 2010 and we were extremely happy to see this happen. Last year (2016) the superintendent also decreed that all schools are now “candy free zones”. This means that kids buying sweets from the local vendors cannot return to the school grounds to consume them. This has proven an effective deterrent at Solangon Elementary as the children attend school for nine hours a day (7:30 – 4:30).
As noted above, the Department of Education has now taken over our dental prevention program, insuring that this important information is part of the school curriculum. We have been running our programs for the past seven years, so we are really pleased to see the importance of this work recognized and adopted locally.
This year we again saw significant gains in the children’s dental health, but only in the schools that have a preventive program in place. About half of students in Solangon Elementary School are now caries free. In 2010 and 2011, fewer than 10 students of the 250 pupils were caries free. Solangon School is a successful working model of what can be achieved, and we need the other schools to follow suit. To this end, we met with the principals of Cang Asa and Cang Al Wang Schools to urge them to adopt a similar prevention program. We look forward to seeing more signs of healthier children next year. As the Solangon School has demonstrated, it can be done!
Siquijor is a small Province with a small bureaucracy, so the possibility of change is very real. My hope is that there will be changes made following the example of Solangon School. The principal who implemented the improvement in that school, Josephine Sevillano, has been moved to another school and is now attempting to achieve the same transformation at Tambisan School.
Awareness about sugar and dental health is also spreading on the Island. Information is gradually filtering to the population. For example, because of the meetings we had in 2015 with the governor, mayors and clinic directors, nursing bottle syndrome, a very serious problem on Siquijor, is now being addressed by the six Island health clinics.
Permanent Dental Clinic
With donations from the Semiahmoo and White Rock Peace Arch Rotary Clubs, and a private donor, Mrs. Florence Wall of White Rock, we were able to fund construction and equipment for a permanent dental clinic on the grounds of Siquijor’s largest elementary school. The clinic opened in 2015. This is apparently the only clinic in the Philippines offering free dental care to school children. It is set up for foreign volunteer dentists to work in, and there are German dentists who visit the clinic regularly. This will greatly increase the treatment available for the children of Siquijor. There are also two dental buses that were acquired in 2016. They are supposed to be used to visit the many schools on the Island, but there is only one part-time dentist employed to do this work. The buses still do not have any restorative materials on board, so, with the exception of our restorative work on the bus, this potential resource is not really making an impact. We supplied the bus for our own restorative work.
Many regularly returning team members have established relationships with children and families where we work resulting in education assistance for dozens of students. Others have donated money for some infrastructure improvements and still others are supporting a nourishment program. Thus, we are making a difference for the Siquijor residents on many fronts.
Semiahmoo Dental Outreach