Jessica Scott studied at The University of Bristol and graduated in July 2014. Jessica is starting her dental foundation training in September, at a practice in Amesbury. Jessica wrote this article to share some of her experiences of volunteering abroad, whilst volunteering in Cambodia and to highlight some of the difficulties she encountered.
This article shares some of my reflections about my time volunteering at a children's hospital in Siem Reap, Cambodia last summer (2013). It highlights some of the difficulties I encountered with communication and differences in behaviour management (namely the use of physical restraint on children), and how I overcame these obstacles.
I hope to encourage other readers to volunteer abroad, in impoverished and resource poor settings, as it is such a brilliant eye opener and a great opportunity to help less fortunate communities.
Dental Volunteering Abroad
The opportunity to volunteer abroad was what I looked forward to most at university. I wanted to experience dentistry in a foreign country and learn different approaches to dental care provided in an impoverished, resource poor setting. Primarily I wanted to help other people but I didn't expect to benefit so much from the experience as well!
Last summer, I spent three weeks volunteering at a children's hospital in Siem Reap, Cambodia. I carried out a range of dental treatments including extractions, fillings, pulpotomies and check-ups. I also attended outreach clinics at schools in rural Cambodia, where it was difficult for children to access dental care. Here, extractions were the sole treatment, for children in pain.
This was honestly the best experience of my life so far and allowed me to develop my clinical and communication skills in ways very different to the UK. It was a steep learning curve, delivering dental care in an unfamiliar country and learning how to work as a team with the local hospital staff, and there were many times where frustration kicked in due to the language barrier. However I would highly recommend volunteering abroad, to enhance your perception of health care worldwide and to experience that feeling of immense satisfaction that comes with helping people from a less privileged area.
From the early stages of planning, it was evident that communication difficulties would arise. Although the hospital staff spoke English, they often misunderstood some of my queries. During my placement the supervisor spoke to the patient in Khmer to determine their primary complaint and most appropriate treatment. However, I often found it difficult to confirm the diagnosis as the supervisor would sometimes not fully understand me and just answer "yes" to all my questions. In these situations I had to rely on their judgement as to what the diagnosis and appropriate treatment was; which occasionally conflicted with my views. I sometimes felt like I was working 'blind', not knowing why I was doing the procedure, which was irritating particularly from a learning perspective. To improve teamwork and avoid confusion in the future, I think it is important to establish exactly how translation will take place. For example it might have been beneficial to ask questions before the supervisor spoke to the patient, allowing more accurate translation.
I did however embrace the opportunity to practise communicating with patients in an unfamiliar language, using verbal and non-verbal techniques. At first I relied on my body language and tone of voice, for example pointing to the ceiling to get a child to look up, or speaking softly to calm a child down. However learning some useful Khmer phrases allowed me to ask questions and give instructions directly to the patient, rather than through the translator. This was a particularly satisfying learning outcome that I achieved and it sped up appointments.
Nevertheless, I felt frustrated when frantic children did not listen or pay attention to me. I occasionally felt like giving up and getting the child to come back another time, as my attempts to calm them down and find out the problem were useless. After this happened a few times, I paused to reassess the situation and imagine being in the child's position. This helped me become more patient with everyone, including the assistant who was able to gather information from the child whilst calming them down. On reflection, I might have been too selfish and hasty; I needed to accept that I could not manage the child on my own, but had to rely on the assistant to communicate in a language that the child understood. I therefore learned to respect each team member and their individual assets. This experience highlighted how crucial verbal language is in the management of children, and I realised I take it for granted in the UK. As a result, I will endeavour to communicate with my patients in a way they can understand, to provide efficient whole patient care.
Throughout my placement, I learned different approaches to dealing with uncooperative children. Many patients cried, screamed and were restless throughout their appointment. As a result, physical restraint was used, to prevent incidents such as needle stick injuries (general anaesthetic was not an option for dental patients). When I first witnessed this I was shocked, as this method of behaviour management is not used in the UK (Scottish Intercollegiate Guideline Network, 2004). This presented a problem for me, as I was not familiar or comfortable with treating patients under these circumstances. My instinct was to calm them down before attempting any treatment. However, due to the high number of patients arriving each day and the need to undertake treatment as quickly as possible, there was little time to acclimatise the child to the dental environment. Consequently, my personal values were challenged as I believe every effort should be made to help patients feel at ease before attempting treatment. I was also pressured by the supervisor to do the treatment as quickly as possible, so all the children could be seen. Having to work within a tight time schedule helped me speed up my clinical work, but also made me realise that the reason I was there was not to produce perfect dentistry, but to help as many children as possible get out of pain and treat their illnesses. Thus put the patients' interests first.
Whilst treating a screaming restrained child, I felt overwhelmed with sadness and guilt as I could foresee the negative impact the experience would have on them. This consolidated my learning and experiences at dental school: if a child has a distressing time at the dentist, they are likely to develop anxiety (Fayle and Tahmassebi, 2003) and may not return for follow up appointments. Therefore this experience reinforced the importance of effective behaviour management in children. As a result, I will strive to acclimatise my patients before attempting treatment, as I have encountered the traumatic experiences some go through.outreach_2_xla
Nevertheless, as time progressed I learned to deal with the screaming children and use of restraint, by adapting my way of thinking. I started to focus on the need for treatment to be completed quickly rather than quietly; thus taking into account the priorities of the clinic. I learned to remain calm and confident in stressful situations and developed my skills in a pressured environment, which will prove useful when working in general practice.
I believe my volunteering experience has changed my perspective on paediatric dental care. I have learned to be more patient with fearful children, and respect and work efficiently with colleagues despite communication limitations. I very much look forward to volunteering abroad again in the future.
Top tips for dental volunteering abroad
• Plan well. Keep regular contact with the charity and find out if there's anything in particular you need to bring. Contact companies for donations of dental materials and equipment, many are very willing to help out. Request extra luggage allowance from your airline, for all those tubes of toothpaste that have been donated!
• Keep yourself safe. Visit the travel clinic at your GP. Make sure you have the necessary vaccinations, malaria tablets, HIV PEP (post exposure prophylaxis) etc
• Immerse yourself in the culture and make an effort to learn some of the local language. A few simple phrases can go a long way!
• Take the opportunity to learn the values and beliefs of the culture, get involved with the local community, visit other charities and make connections
• Don't be afraid to get stuck in! Your help will be much appreciated, speed up clinics, and give the local dentists a rest from all the extractions!