Figure 1. Map modified from National Geographic

Introduction

Due to the geographical and economical condition of the country, it takes time to access much needed dental health care services in rural and small communities in Nepal.

Supported by Araniko Dental Hospital, (Bhaktapur), District Health Office, (Ramechhap) (Ministry of Health) and Swiss Agency for Development and Co-operation/Rural Health Development Project (Ramechhap), the Basic Oral Health Training of Health Workers programme, was successfully implemented in December 2007 in Ramechhap district, Nepal, in order to help provide dental health care services to needy rural children and adults.

Background

The Government of Nepal has already declared primary health care policy approach and needs adequate health care stations with skilled manpower in rural and communities. Oral health is frequently not perceived as a priority amongst the deprived communities, hence oral health related problems are increasing day by day in these communities. There are no oral health care facilities in the health posts in the rural areas and most of the people from rural communities do not receive essential dental care services. Hence there is an acute need for appropriate dental health service and made accessible and affordable in the community.

Figure 2. Instructor Dr. Kushal Bimb Demonstrating Instruments

Project Outline
Keeping this in mind, the Basic Oral Health Training of the Health Workers from the Health Post/Primary Health Care Centers in Ramechhap district was planned and implemented. Newly trained Health Workers mean increase in the dental care services manpower.

The trained Health Worker would be able to

• Diagnose common oral diseases.
• Perform simple tooth extractions.
• Minimize gums problems, performing scaling.
• Instruct the use of fluoride tooth paste.
• Spread oral health education in the communities as well as in the schools.
• Carry out ART fillings.
• Provide first aid facilities of mandible and maxillary fractures

Programme Methodology

• One week of Theoretical Classes, Demonstration Presentations
• One week of Practical Training (Dental Camp)

Training Place

• Theoretical Class: Ramechhap District Hospital, Ramechhap
• Practical (Dental Camp): Ramechhap District Hospital and Different Villages of Ramechhap District

Basic Oral Health Training Schedule

• 6th to 12th December, 2007. Theoretical Class. Ramechhap District Hospital
• 13th to 15th December, 2007. Practical (Dental Camp). Ramechhap District Hospital
• 18th to 19th December, 2007. Practical (Dental Camp). Sandedada, Hiledevi Village Development Commettee, Ramechhap, District
• 22th to 23th December, 2007. Practical (Dental Camp). Betali, Betali Village Development Commettee, Ramechhap, District

Figure 3. Assistant demonstrating Glass Ionomer cement mixing method

Training Activities

• 1st 6th December, 2007 Training Inauguration & Introduction, Theoretical Class Demonstration: Skull, Decayed tooth, Presentation: OHP, Slides. Ramechhap Hospital
• 2nd 7th December, 2007 Theoretical Class
  Demonstration: Skull, Decayed tooth
  Presentation: OHP, Slides Ramechhap Hospital
• 3rd 8th December, 2007 Theoretical Class
  Demonstration: Skull, Decayed tooth
  Presentation: OHP, Slides Ramechhap Hospital
• 4th 9th December, 2007 Theoretical Class
  Demonstration: Dental Instruments & Equipments Ramechhap Hospital
• 5th 10th December, 2007 Theoretical Class
  Demonstration: Tooth Extraction Ramechhap Hospital
• 6th 11th December, 2007 Theoretical Class
  Demonstration: Tooth Filling (ART) & Hand Scaling Ramechhap Hospital
• 7th 12th December, 2007 Course Revision
  Demonstration: Oral Health Education
  Practical: School Dental Health Program 1. Ramechhap Hospital,
  2. Bal Mandir Primary School Ramechhap
  3. Gaurishanker Secondary School, Primary Wing, Ramechhap
• 8th, 9th, 10th 13th, 14th & 15th December, 2007 Dental Camp Ramechhap Hospital
• 11th& 12th 18th& 19th December, 2007 Dental Camp Sandedanda, Hiledevi VDC, Ramechhap
• 13th& 14th 22th& 3th December, 2007 Dental Camp Betali, Betali VDC, Ramechhap

Trainee in Spoting Test

School Dental Health Programme

Dental Camp Summary

• Place Number of Patient Treatment Provided
• Ramechhap District Hospital, Ramechhap Total: 342
  Male:154
  Female: 188
  Dental Check-up: 243
  Tooth Extraction: 137
  Tooth Filling (ART): 64
  Hand Scaling: 11
• Sandedanda, Hiledevi Village Development Committee, Ramechhap Total:205
  Male: 82
  Female: 123 Dental Check-up: 205
  Tooth Extraction: 87
  Tooth Filling (ART): 37
  Hand Scaling: 5
• Betali, Betali Village Development Commettee, Ramechhapt Total: 245
  Male: 116
  Female: 129 Dental Check-up: 245
  Tooth Extraction: 98
  Tooth Filling (ART): 38
  Hand Scaling: 3
  Total Patient: 792
  Male: 352
  Female: 440 Dental Check-up: 792
  Tooth Extraction: 322
  Tooth Filling (ART): 139
  Hand Scaling: 19

Dental Camp

As part of the training, the Trainees visited Schools with the Team and participated in oral health education activities in class rooms demonstrating proper tooth brushing methods to school children. They carried out ART fillings and other activities in the Dental Camps.

Trainee performing ART

Achievements
All together in December 2007, 12 Health Care workers were trained. They were from Different health posts in Ramechhap district.

Working Places of the Trainees

• Doramba Health Post
• Tokarpur Sub-health Post
• Salu Sub-health Post
• Gunsi Health Post
• Manthali Primary Health Centre
• Gumdel Sub-health Post
• Tilpung Sub-health Post
• Rakathum Sub-health Post
• Rasnalu Sub-health Post
• Ramechhap District Hospital
• Okhreni Sub-health Post
• Sukajor Sub-health Post

Conclusion

Access to dental care and lack of trained manpower in the rural areas of Nepal has been a problem. Training Health Workers in Health posts and Sub-health posts in performing simple dental care activities would bring relief to many children and adults living in small communities and rural areas in Nepal. If the example in Ramechhap District is successful, hopefully the rest of the country could perhaps follow this programme successfully.

Dr. Kurshal Bimb & Training Co-ordinator
Mr. Raj B. Shrestha

Reference

Final Report of the Basic oral Health Training Program to the health workers of Ramechhap District, Dec 2007.

Acknowledgement

We would like to thank Mr Raj B Shreshta, Director, Araniko Dental Hospital for helping us with this presentation and providing pictures of the programme.