The main purpose of an oral healthcare mission is to deliver oral hygiene instruction and clinical care to areas where it is nonexistent or substandard. Reasons for a shortage of dental care can include insufficient numbers of trained clinicians, armed conflict, famine, societal practices, poverty, a natural disaster or an epidemic.
During oral healthcare missions, as in other settings, patient and dental healthcare safety are key. Furthermore, re-emerging and emerging diseases, together with the global threat of antimicrobial resistance, emphasize the need for vigilance, precautions and infection control. Recent concerns have included drug-resistant tuberculosis, dengue fever, the Ebola virus disease outbreak, and the current outbreaks of Zika virus disease (Zika). While Zika is primarily transmitted to humans by bites from an infected Aedes mosquito and typically results in a mild fever of up to several weeks duration, it can be transmitted from an infected pregnant woman to her fetus causing microencephaly. The Zika virus is also present in the semen of an infected male and can be sexually transmitted, and it is present in the blood of infected people for a period of time. Palliative care relieves the symptoms of Zika and plenty of fluids prevents dehydration, however there is no vaccine. Therefore, it is important for dental healthcare workers going on mission trips to take extra precautions if the mission site (or travel) is in an area with a Zika outbreak: clothing should cover the skin (long-sleeved tops and legs covered), and a CDC recommended EPA-registered insect repellant should be conscientiously applied during the mission trip following the directions on the labeling. In addition, clothing and gear can be treated with permethrin, and mosquito nets are recommended for sleeping. Upon returning home, to prevent transmission of the Zika virus sexually active male mission participants should only have protected sex, and all returning participants should take care to avoid mosquito bites which could transfer Zika to a previously uninfected mosquito and then to another person by this vector.
Invitation to Come
Many dental missions are repeat visits. Whether the mission is a repeat or a first time event, there are documents of agreement that must be signed by both parties. Preparation is key to a successful mission. Travel to areas of need often requires securing certain permissions, releases and privileges from government officials, which takes time and attention to detail.
Local Partners – Cultural and Language Barriers
Oral healthcare missions require flexibility – “expect the unexpected.” Since most healthcare missions involve volunteers, offers to help and cooperation are expected behaviors that make the mission more successful.
Volunteers must be responsible and respectful guests. It is extremely important to show sensitivity to local cultures including language, traditions, superstitions, beliefs about health as well as religious faith and practice. Culture is like the air we breathe: taken for granted, but impossible to live without.
Political statements are out of order. So are criticisms of local facilities, volunteer and local healthcare professionals, patients and others in the community. Prior to the mission, the group must establish a mechanism through which suggestions/offers/thoughts can be tactfully brought forward.
Offers for social or recreational invitations are a common and important part of a healthcare mission. An effort should be made to engage and graciously accept the hospitality. If a mission attendee chooses not to participate, then the mission’s volunteer coordinator should be informed.
Many healthcare missions attempt to partner a local person (or two) with each visiting volunteer. Partnering leads to increased effectiveness and efficiency, promotes sharing of ideas and thoughts and can help establish professional collegiality as well as personal friendships.
A successful healthcare mission must match projected goals and the associated needs with the resources required (human, physical and financial). It is imperative to describe the mission in detail months before leaving for it. Realistic expectations are then paired with the resources required. Local resources must be determined and a mutual understanding of the mission established. In spite of extensive front-end planning, healthcare missions demand a certain amount of flexibility.
Dental missions can challenge one’s concept of efficiency and effectiveness. Much of what some societies are accustomed to is completely different in the places missions serve. It is probably better to see fewer patients and perform fewer procedures than to overreach and be disappointed with the results. Traveling to, staying in and functioning well within a foreign country can be difficult. Louis Pasteur once said, “Chance favors the prepared mind.”