Rural and remote communities, whether in poor countries like Nepal or in a highly affluent and developed country such as Australia, can experience similar issues that affect health and oral health, including
- higher costs of goods and services
- low access to employment
- poorer environmental conditions
- poor and infrequent access to health care services
- a variety and turnover of short term providers
- less access to health information
- indifference from centralised governments
For Aboriginal kids across Australia, the rate of dental decay is roughly twice that of the general population. Aboriginal adults tend to suffer higher levels of gum disease, and greater loss of teeth than the general population. The gum disease and tooth loss can also be linked to higher rates of diabetes within their communities – gum disease is now acknowledged to be the sixth complication of diabetes.
The rates of dental disease tend to be higher in rural and remote places in Australia.
Many people still go to the dentist only for pain relief. One of our challenges is to provide dental services that encourage regular visits for check ups and routine care, especially for young children and their families.
In Nepal, Timor L’este and Bangladesh, there are simply not enough dentists and dental personnel for the whole population, and the poor, rural and remote communities miss out the most. Many people suffer tough episodes of acute and chronic pain, and often resort to traditional remedies to alleviate the pain.
Similar issues, so we have some similar approaches
Planners, bureaucrats, bosses, funders, others who think they know about dental care, love to rely on some pretty stock phrases such as “stakeholder consultations”, “capacity building”, “social determinants of disease…oops, health”, “common risk factor approach” (what??), “culturally appropriate”, “sustainability”, blah blah blah.
All of the above are noble intentions no doubt, and each has an underpinning truth for helping to improve health conditions, which includes oral health of course. But too often the intentions become empty phrases regurgitated constantly in reports, policies, plans (how to be strategic, and recommend the implementation of actions which will have measurable outcomes that will be delivered in a manner whereby management follows continuous quality improvement processes to monitor and evaluate the processes, measure the outcomes again, to feed into the next plan which will be strategic…..).
Improvements in the oral health of the people in poor and remote communities has been possible when the target community supports a well managed and consistent program. Important are: approaching the community with respect, providing sound clinical care that focusses on prevention, continuity and consistency of service providers, working with schools and families, improving the immediate environment where possible (ensuring people have adequate sanitation and potable drinking water, lobbying for fluoride to be introduced into the water supply), providing advice on good oral hygiene and good foods (though being mindful of the challenges of behavioural change when lives are tough), training local people in oral health and prevention.
Simple really. Stay for at least 5-10 years and you can measure consistent and ongoing improvements. If people continue to have immense social disadvantage, then the improvements might be very modest.
In Australia our programs work on these issues.
In Nepal, Timor L’este, Bangladesh, we work on these issues.