Strive-the Student View
July, 2006 edition

Transcultural Health Care: Migrant Worker Program in Ensenada, Mexico

 
By Wende Intoschi, RDA, RDHDental Hygiene and Nursing Student Partnership

As every dental hygienist knows, finishing the first year of hygiene school is an accomplishment on its own, but at Santa Rosa Junior College in Santa Rosa, Calif., we have a summer work volunteer program in Mexico that elevates the sense of achievement even higher.

The transcultural health care class takes place over two weeks in June. Since 1995, Santa Rosa nursing students have gone to Ensenada, Mexico, to help the orphaned children and migrant camp workers there by providing medical care. Santa Rosa's dental hygiene program later began collaborating with the medical team to provide oral health care to this population too. In 2005, I had the opportunity to participate in the fifth group that included hygiene students.

This volunteer dental program was started by Ezbon Jen, PhD, the dean of health sciences. His hard work with the local Rotary led to their donation of two complete mobile dental units to our school. In addition, dental manufacturers provided special discounts to us. Today, we have four units in total, with state-of-the-art chemclaves, ultrasonics and a new mobile digital X-ray unit.

A local pedodontist volunteers his time to work with us and perform dental services including extractions, fillings, and pulpotomies. As a student, I was eager for the opportunity to use the skills I had developed during my first year of clinic to clean a patient's teeth without an instructor having to evaluate the paperwork.

Our Travels to Mexico

Our director hauled all the equipment in a trailer behind his vehicle. I drove one of three rented vans carrying five fellow students across the border into Ensenada. The couple of hours we spent traveling together were great because we were no longer in school and didn't need to worry about the next test, but were just able to be ourselves and get to know each other outside the classroom. We sang songs, told our life stories and learned things about each other that we wouldn't have known otherwise. We stayed at a clean, comfortable local hotel along with the 12 other students from our class of 24 who took on this challenge. Although all the costs were reasonable, not every student could afford the trip and accommodations. Until last year, no more than five dental hygiene students at a time had participated, so our group was the first to equal the nursing students, who bring about a dozen volunteers each year.

Each Day Was a New Experience

Bright and early the next day, we learned how the program would work, and that we would travel together to different pre-arranged locations. There were so many dental hygiene students that some of us were assigned to go to the local hospitals with the nursing student volunteers and observe surgeries and births. Each day, we got our assignments and headed out by car. Once we arrived at our designated location, we set up canopies to block the sun and placed our dental chairs underneath. I could not believe that most of the people gathered to watch us had never seen a dentist before, nor could I imagine what they were thinking.

We provided care to these hard-working, pleasant people who had no money to spend on dental treatment. I was surprised how much was communicated through looks, nods and the mutual attempt to understand each other's native tongue. Almost all the patients gave us hugs after their treatment, and even when a person was finished being treated, they would stay with us to watch us treat their friends.

We educated them about their oral health and provided oral care products and information to continue a regimen at home. Throughout the two weeks, I worked 11 days with patients ranging from 2 years old to an elderly woman of 97 who had three teeth left and one of them extremely mobile. She had come from a gypsy camp miles away because she had heard that we were helping people at the migrant camp worker area.

The worker areas were actually built from old horse stalls and boxlike plywood rooms. The workers slept in the dirt, washed their clothes in filthy water and were happy people. The smiles and the laughter from the children and the thank-yous we received from the adults made my heart drop each time.

The Patients' Oral Health Status

The oral conditions I saw were surprising. In the orphanages, children's teeth were mostly cavity-free and had slight-to-moderate plaque accumulation. However, the adult migrant workers had heavy calculus on their teeth, and the children had a high incidence of dental caries. I am sorry to say and have my instructors read this in this article, but to remove calculus deposit from the teeth of a 35-year-old man who had never been to the dentist, I set aside what I have learned about ergonomics and stood up and used my two hands. The tenacious black calculus that circled most teeth was amazing; we had never seen anything like it in first year clinic, where we had easy cases with plaque and some granular calculus present. This experience provided a whole new world, and I loved it! I could see the pieces of calculus coming off, and explaining to these people that their teeth were actually a very nice light color was satisfaction in itself. I had to assure one woman that I was not breaking her teeth, but removing the millimeter-thick bridge of calculus on her lower anteriors. I understood that this woman was scared, but knowing I could help and that she trusted me was worth the 10 hours I spent in practice that day.

When we learned about the camp's tiny commissary that sold only soda, candy, chips, cookies, we realized why there was a high incidence of caries in these children. We dispensed fluoride trays and rinses immediately and emphasized that brushing after eating any of these foods would help.

Improving Clinical Skills in the Real World

This trip was one of the most valuable experiences of my dental hygiene education. I observed things and treated people with conditions that the United States rarely sees in a local dental office because people who cannot afford care come in only when the pain is intolerable. My clinical skills were challenged, and they improved as a result. And learning to adapt my use of instruments will help me practice more effectively once I enter the workforce.

I think that every student should become involved in this type of program and actually understand and feel that dental hygiene is about caring and treating the entire person's oral and systemic health-that it's not about removing calculus from the teeth only. I still carry the satisfaction of helping people and will continue to volunteer in programs like this in different countries and in the United States. Here's to graduating and continuing to help patients smile and understand people do care!

Wende Intoschi, RDA, RDH has been involved in oral health care since 1987. A registered dental assistant since 1988, she graduated from the dental hygiene program at Santa Rose Junior College on May 27, 2006. She plans to work in clinical practice two days a week and aspires to teach dental hygiene as well. In 2007, she will travel to Kenya to participate in a volunteer program similar to the one described in this article.