De: Enfoque en la atencion de salud – Paso a Paso 42

Cómo ayudar a las personas a tomar las decisiones adecuadas respecto a sus necesidades de salud

por Neil McDonald.

DENTAL significa ‘de los dientes’
ORAL significa ‘de la boca’

Nepal es uno de los diez países más pobres del mundo, con sólo US $6 por persona del presupuesto gubernamental anual para mantener la atención de salud. El tratamiento de enfermedades contagiosas del pecho y de los intestinos se traga todo este dinero. ¿Quién se preocupa de los dientes?

Nuestros estudios muestran que la urbanización acelerada que tiene lugar en la mayoría de los países en vías de desarrollo produce más caries porque los alimentos con más azúcar, como los bizcochos y las bebidas gaseosas son tan fáciles de conseguir.

En los países industrializados el enfoque tradicional es de ‘ir al dentista’ cuando las cosas se ven mal. En Nepal 100 dentistas sirven a 24 millones de personas. ¿Qué posibilidad hay de encontrar allí atención dental cuando se tiene un serio dolor de muelas? Los que viven en Kathmandu, la capital, tienen suerte ya que 92 de los dentistas trabajan allí, sirviendo a un millón de habitantes. Eso deja sólo ocho dentistas para atender a los 23 millones restantes…

El Programa de Salud Oral de la United Mission to Nepal (UMN) ha desarrollado un enfoque único para enfrentar las necesidades de salud oral de Nepal desarrollando una influencia ‘contra la corriente’, ‘en medio de la corriente’ y ‘dejándose llevar por la corriente’:

Contra la corriente (Investigación, establecimiento de una red y publicaciones para estimular cambios de políticas)

Se ha publicado ampliamente la información pertinente para informar al gobierno, a los profesionales dentales y al público de la situación actual.

En medio de la corriente (Atención preventiva de salud dental)

Los centros de salud rurales del estado son sitios ideales para proveer atención de salud dental apropiada a nivel de aldea. Los paramédicos gubernamentales que atienden estos centros han recibido ahora capacitación adicional en prevención de enfermedades y alivio básico de dolores. Se incluyen visitas a las escuelas y se anima a los niños a examinarse la boca entre ellos. Los capacitadores visitan a los aprendices regularmente y les dan cursos de repaso en el lugar de trabajo.

Se produce material escrito con ilustraciones en el idioma nepalés. Estas tarjetas y estos afiches se dirigen a los maestros, padres y otros adultos que trabajan en clases informales de educación quienes usarán la información para enseñar a los niños. Los temas principales que hemos cubierto son:

Corriente abajo (Atención curativa)

A medida que los esfuerzos ‘contra la corriente’ y ‘en medio de la corriente’ empiezan a tener su efecto, el trabajo ‘corriente abajo’ debería idealmente transformarse en una red de seguridad y no en el enfoque principal. En la práctica, ésta es una estrategia a largo plazo con el objetivo de ayudar a la gente a que se responsabilice por la condición de su salud oral. Nuestro énfasis está fuertemente inclinado hacia la prevención de las enfermedades dentales.

Neil McDonald ha sido Director del Programa de Salud Oral de la United Mission to Nepal durante tres años. Este programa es apoyado por Tearfund. Neil también ha trabajado durante varios años como dentista en Kenya y el Reino Unido. Su dirección es: c/o UMN, PO Box 126, Kathmandu, Nepal.  Fax: + 977 1 225559 E-mail: P@umn.mos.com.np

Tek and Leena's stories

Feathers or forceps?

 

Tek Chhetri is a young man of 23 from Western Nepal. He supports himself by his work as a teacher in a primary school, two hours walk from his village near Tansen. His elderly parents depend upon his support, so his salary of $45 per month does not go far. Tek would like to marry a local girl but cannot afford to do so. He’s trying to improve his situation by studying for a degree at the local college before going to work each day. The financial and work demands placed on him result in frequent ill-health.

A painful molar tooth had troubled him for many weeks. One morning he awoke to find his face swollen to the point where his right eye was closed and his mouth could barely open. In pain, he sought advice from the local faith healer who advised him to bring him twelve plump chickens. Tek borrowed the equivalent of half his monthly wage at high interest from a moneylender and bought the chickens. After the birds had been sacrificed, the faith healer placed a paperclip in Tek’s earlobe and told him that all would be well.

The following day Tek was in a dreadful state. He had a raging fever and could hardly walk. Someone in the village suggested he visit the government health-post an hour away in the next valley. News had come that there was a paramedic there who had received basic dental training through the UMN Oral Health Programme. A friend helped Tek to get there and he was seen by the health worker who promptly removed the decayed tooth, free of charge. When he went back for a check-up a week later, Tek was a very happy man. ‘Next time you get a problem, bring your chickens to me!’ said the paramedic.

Timely advice

Leena Khadka is an attractive 19 year-old girl. Her mother died when she was 10 years old and her father left home. Leena was brought up by other family members but to comfort herself began chewing pan (areca nut) which is a stimulant. After several years she began experiencing pain when opening her mouth. She also found that her mouth would not open as wide as before. She couldn’t eat her favourite spicy foods and kept away from her friends because she couldn’t smile without pain.

Leena thought she had mouth cancer and was so afraid that she didn’t seek help until she was 17 years old. Her local healthpost paramedic had recently been trained by the UMN Oral Health Programme in the diagnosis and management of common mouth problems. He noticed small growths in Leena’s cheeks which were the result of chewing pan. He advised Leena to stop her chewing habit – which she did with great difficulty. He also told her that cancer of the mouth could develop from her present problem but, by stopping now, the risk would be much less.

Leena wanted further help and the paramedic referred her to a UMN hospital where a dentist gave her counselling and mouth exercises. This helped to increase her mouth opening to an acceptable degree and improved her self-confidence. As a sign of this she even entered the Miss Nepal contest this year!

Confidence through appropriate training

Durga Adhikari has worked in a rural health-post for three years. His two years of paramedic training have equipped him to cope with most of the basic health needs presenting each day, with the exception of dental care. This used to worry him every time someone arrived in pain. He had no idea where to inject a local anaesthetic. His kit contained an old, rusty pair of dental extraction forceps which only fitted on lower back teeth. There was nowhere else to send people for care.

Durga received one month of intensive dental training from the UMN Oral Health Programme and is now able to treat simple cases confidently with his new kit. He refers complicated cases to a (distant) hospital. He had previously found it very stressful when trying to help people in pain. He had little idea of what had caused their disease and therefore found it difficult to offer advice. These frustrations had combined to make him feel disillusioned in his work through lack of support and opportunity for further education. He felt abandoned in his rural situation.

People like Durga (pictured below) are the foundation of healthcare in Nepal. UMN recognises this and targets them for training and support. Villagers who receive care are delighted to have help locally instead of many kilometres away. This is practical Christian witness – hope for the hopeless and healing for the sick.

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