Dentistry in Cambodia

2/23/2011

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Between the years of 1974-1979 Cambodia remained under the rule of the Khmer Rouge Regime, a social group that aimed to reduce the country to an agricultural society, led by notorious dictator Pol Pot. The regime was responsible for over nearly 2 million lives in what later became known as the Cambodian Genocide. During this time, education was abolished, currency, public transportation, and postal service system. With the annihilation of nearly all institutions, medicine and dentistry were abolished. 

Following the tragedy, it was reported that only two out of the six qualified dentists were able to provide dental care. The dental school in Cambodia recommenced in 1985, and it began its journey on the road to recovery. In 1990, it was reported there were 34 qualified and trained dentists (Durward 1991). There are a large number of traditional dentists, trained by apprenticeship, that are not recognized by the school. It has been reported that there may be over 300 traditional dentists by apprenticeship practicing still today and providing care to a large number of dental care to the population (Durward 1991).   

The country conducted its first ever and most recent National Oral Health Survey in 1991. In 1991, the National Oral Health Survey reported a high mean decay, missing, total (DMT) score of 3.2 in the Phnom Penh, the capital city of Cambodia. The survey also revealed that about 6.4% of six year old children were caries free, and the World Health Organization showed 50% were caries free (and this may be true in provincial areas). 

Following this survey, the Cambodian National Plan for Oral Health Plan 1992-2000 aimed to address four areas: (1) Oral health (2) Oral health promotion and prevention (3) Care delivery system and (4) Manpower training. Moreover, the design and implementation of health preventive and promotion programs were born as an outcome of the survey results. 

Tooth brushing and nutrition programs were implemented into primary school curriculum and a fluoride rinse program was implemented. In 1991 the Oral Health Preventive School Program sought to address needs and objectives in these four areas in primary schools (Teng 2004). Today, about 95 primary schools throughout Phnom Penh participate in the Oral Health Preventive School Program (OHPSP). OHPSP has four components: (1) Daily tooth brushing (2) Weekly fluoride mouth rinsing (3) Oral health education and (4) Oral health competition. One study revealed that with good cooperation, informed knowledge, attitudes and practice about oral health and hygiene correlated with a reduction in caries prevalence among children in primary schools (Teng 2004). 

In addition, the National Plan for Oral Health recommended the training of the dental nurse to provide dental services to rural communities. It is estimated that 80% of the population live in rural areas where access and availability to dental care are barriers. In an article titled “Dental nurse training in Cambodia—a new approach” it was reported there were 12 trained dental nurses, and it was projected there be 130 trained dental nurses by mid-1997.   This would bring the dental-nurse to population ratio to 1:60,000 (Mallow 1991).  The World Dental Federation reports that low income countries like Cambodia see a dentist to population ratio of 1:119,000.   This is alarming.  The disparities in access and utilization to oral health in rural communities has become a country's call for help.  It has become an issue or need that I hope to learn more about and find out how I can help be the change. 

References
1.       Barmes, D.E. (1971) Khmer Republic-Report on Dental Health. Geneva: World Health Organization.
2.       Durward, C.S., Hobdell, M. (1991) Cambodian National Oral Health Survey 1991. In: Durward CS, Todd RV, So PK, ed. Cambodian National Oral Health Survey 1990-1991. Phnom Penh, Cambodia.
3.       Durward, C.S. and Todd, R.V. (1991): Rebuilding the ruins: dental service and manpower in Cambodia. International Dental Journal. 41, 305-308.
4.       Durward, C.S. & Todd R.V. (1993) The Cambodian National Oral Health Plan 1992-2000. International Dental Journal. 43:219-222.
5.       FDI World Dental Federation. Facts and figures. Available at: “wwww.fdiworlddental.org/resources/3_0facts.html.” Accessed 9 Feb 2011.
6.       Mallow, PK (1997) Dental nurse training in Cambodia--a new approach. International Dental Journal. 47(3), 148-56.
7.       Pack, A. (1998) Dental services and needs in developing countries. International Dental Journal. 48(1), 239-247.
8.       Shidara, E., McGlothlin, J.D., Kobayashi, S. (227) A vicious cycle in the oral health status of schoolchildren in primary school in rural Cambodia. Int J Dent Hygiene. 5:165-173.
9.    Teng, O. et al. (2004) Oral health status among 12-year old children in primary schools participating in an oral health preventive school program in Phnom Penh City, Cambodia, 2002. Southeast Asian Journal Trop Med Public Health. 35(2) 458-462.
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Cambodian History

2/5/2011

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History gives us record and events of the past.  In a poetic prose, it is the myth we make; history is story telling.  What this does is offer us a perspective on our life, the story of Us in this world.  So, it becomes important to me to hear this story so that we may not remake history. 

I want to write today about Cambodian history because quite frankly, to me, these stories were captured and released only by survivors and very few historians.  Everything I learned about Cambodian history came from my father and mother and personal interest from published reading materials. 

My father once told me legend has it that Cambodia was born through the union of a Chinese princess and Indian foreigner.  My parents agreed little is known about prehistoric Cambodia.  They told me Cambodia stretched over a huge area in the beginning, but slowly over time it was reduced to a small country by neighboring countries claiming occupation and territory into Cambodia. 

There were a number of kingdoms that ruled early Cambodia. One of the earliest and largest kingdoms was known as the Funan kingdom by the Chinese.  Funan was a major seaport, and it played a central role in the introduction of Indian culture into Cambodia.  The Funan kingdom worshiped Hindu and Buddhist deities.  Early Cambodia was governed by autocratic kings who practiced hierarchical caste concepts that were adopted from India. 

The Angkor Empire was considered to be one of the greatest rise and fall of an empire in mainland Southeast Asia.  The rise of the Angkor Empire was attributed to water and the development of a complex hydraulic system.  In 1066 the king ordered for the construction of the Angkor Wat Temple.  It is believed that this temple was built for the Hindu god Vishnu.  This majestic temple would serve as the temple and a mausoleum.  Furthermore, Angkor Wat would resemble a spatial universe and be a symbol for man to reach and be closer to the house of the gods.  But like other great empires, the curtains were about to close the stage; the show was about to end.  Many suggest that the decline of the Angkor Empire was the outcome of overworked irrigation systems, deforestation, and massive construction that lead to a strain on the empire and its people.  Following the fall of the Angkor Empire, Cambodia was ruled by a series of kings, and over time, Thailand and Vietnam ruled this region too.    

In 1863, France began its 90 year rule by forcing Cambodia to sign a treaty of protection or protectorate to protect Cambodia from being erased from the map.  The French maintained its interest by controlling internal affairs.  The French did little to encourage education, and by the end of World War II, after 70 years of colonial rule, there were no universities and only one high school in the country.  After years of war and rebellion, Cambodia declared its independence in 1953.  However, even following its independence Cambodia endured political turmoil. 

North Vietnam communist forces invaded Cambodia in attempts to gain more control over the land. Throughout this period, a coup called the Khmer Rouge worked alongside Vietnam to gain control over Cambodia.  In 1975, the Khmer Rouge had launched its final and successful attack on Cambodia and overthrew Prime Minister Lon Nol and the government.  This ended the civil war in Cambodia. 

On April 17, 1975, the Khmer Rouge regime, led by the infamous dictator Pol Pot, paraded into the Phnom Phen celebrating victory.  Within hours, these ringing sounds of joy would be suppressed by sounds of cries, horror, and gunshots in the streets.  The Khmer Rouge would begin its plan to restructure Cambodia into a utopian communist society.  This was the beginning of a mass genocide and human cleansing.  Almost 20 percent of the country's population lost their lives under Pol Pot.  The Killing Fields were a number of sites in Cambodia where a number of people were killed and buried by the regime.  The Khmer Rouge abolished currency, postal services, and education.  My mother recalled these events.  The elderly, sick, and rich were forced out of their homes carrying only what they could and forced into concentration camps.  My mother was a survivor of the Cambodian Genocide, but many people died of famine and disease.  In order to survive under the rule of the Khmer Rouge, her family lied on multiple accounts to avoid execution because her father had worked for the former government.  The burned family photos and documents that would lead the Khmer Rouge to uncover her father’s former association with the old government.

Finally, on January 7, 1979, Vietnam liberated Cambodia from the Khmer Rouge. Thirty years later, Cambodia is still on the road to recovery.  Today, Cambodia is considered one of the poorest countries in Asia, but people tell me there is a small gleam of hope and burning optimism wherever you go.  That makes me smile, and it gives me the strength to know we can still make a difference.  We can write a different story.

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