KOHCP creates sustainable, rural oral health care systems by combining grassroots-level infrastructure development with locally-run community education.

Problem

Untreated dental caries is Nepal’s most prevalent childhood disease, exceeding both malnutrition (43%) and vitamin A deficiency (58%). Over 69% of adults over fifty suffer from dental caries—one of the most widespread, least attended, and most easily addressed health crises facing rural Nepal. It is associated with a host of health problems including chronic and systemic infection and heart disease. Existing solutions are akin to sopping up Niagra Falls with tissues. Ninety percent of dentists live inside the Kathmandu valley while 80% of Nepalis live in rural villages. Besides sparse access, there is little understanding of prevention or risks around oral disease. Recurrent dental pain and tooth loss are widely taken for granted—a crisis of both infrastructure and attitude.

Solution

Prior to 2004, severe oral disease and pain were commonplace in the village of Kaskikot. At the government health post, rusty pliers thankfully went unused. Occasionally, a privately sponsored dental camp would arrive for a few days of treatment, often handing out toothbrushes and paste…and then leave. Local shops sold a cheap, unfluoridated spice mixture as toothpaste, but many people didn’t brush their teeth at all. Oral disease was accepted as an uncomfortable reality of village life. Today, Rishi Subedi, a Kaskikot native, provides weekly dental care in Kaskikot’s center. For five years, each of Kaskikot’s twelve schools has been visited annually by a KOHCP seminar conducted by a local Team (whose members attended those same schools as children). On day one of a seminar, the Team conducts education and free screening for children and parents on school grounds, providing referrals to either the KOHCP clinic or a city partner. On day two, the clinic opens for a special day of treatment. Except for quantity of patients, this is a normal clinic day with normal routines; treatment is not provided at schools because our purpose is to establish connections with permanent health care facilities. A health care system consists of both medical infrastructure AND societal factors that enable people to use the structure effectively. Teams compare the cost of toothbrushes to the cost of sugar; time spent at a clinic to time spent ploughing. Seminars allow Team members to address myths, economic concerns, and nuanced cultural hinderances in an organic manner.

Example

A two-sided problem requires a two-sided solution. KOHCP establishes locally-based, consistently available dental treatment, while simultaneously engaging a team of teachers to provide community education. In each village, a local medical technician is trained to provide screening, filling and extraction at a weekly dental clinic, and a referral system is established with the closest city services for complex cases. Meanwhile, the technician joins a team of teachers to conduct monthly education and screening seminars in schools, where prevention is emphasized and treatment services are explained. Seminars catalyze an intensive period of learning and treatment by educating the community about newly available resources. This combination of facilities development and education empowers people to manage their own healthcare, which is the only acceptable outcome of a sincere healthcare initiative. We aim for each replication to be self-sustaining in 2-3 years.

Marketplace

KOHCP is the only integrated oral health care program in Nepal. It is in a completely different category from private dental camps or trainings which themselves are scarcely available. We actively seek out partnerships with other organizations, professional associations, universities, and the Ministry of Health at all levels including Village Health Posts and their associated community health networks; we work especially closely with a Nepali NGO derived from the World Health Org United Mission to Nepal Oral Health Program (see below). But Nepal has no other holistic, sustained oral health intervention at all--if anything, it is the apathetic legacy left by sporadic interventions and distribution programs that KOHCP must overcome. Our “competitors”are merely attitudes and old habits.