Dr
Garry Workman BDS, DComH
(Otago, New Zealand)
Public Dental Service Director, New
Zealand
I have been most fortunate to have
been invited to visit Cambodia and participate in various dental programmes at the
Phnom Penh School of Dentistry and the Dental Nurse School at Kampong
Cham. In particular, I wish to thank
the Dean of the Dental Faculty, Dr Suon Phany,
and the President of the Cambodian Dental Association, Dr Someth Hong, for
their kind invitations.
I have met a number of Western dentists
during my visit as well as visiting private, traditional and N.G.O. dental
clinics. I also spent two days with a
team of medical and dental providers sponsored by the Sobhana N.G.O. to treat
villagers in the Kampot and Kep areas.
Senator Dr Khieu San, of the Legislation Commission, was a leader
of this group.
I have a background of dental public health in New Zealand where I am
clinical director for dental therapists, who provide free treatment for school
children. I also treat adults who
cannot pay for private dental care. I
have written a manual that sets out the programmes and treatments that the
therapists must carry out and have written a policy of minimum quality
standards that they must reach in all aspects of their work. Once per year each therapist has her work
performance in the dental clinic examined by me and her grade can affect her
salary. We call this an audit.
My comments show indicate that Cambodia
has a poor standard of dentistry compared to our Western standards and I offer
some suggestions that may help to improve this situation. I realise that poverty is the primary reason
for the low standard, but I am sure more can be done to improve the oral health
of all Cambodians, even within the available budget. I have found, without exception, a great willingness and
enthusiasm with all people whom I have met, to make improvements. This is very encouraging.
I am sure many of my recommendations are
attainable over a period of time and would help greatly. I wish to thank the following people who
have assisted me in writing the report:
Dr
Suon Phany Dean
Dr
Someth Hong President C.D.A.
Dr
Francois Courtel Coordinator,
A.O.I.
Dr
Callum Durward Paediatric
Dentist, New Zealand
Dr
Ralph Francis Orthodontist,
Latter-Day Saint Charities
Dr
Stefano Dallari Implant
Specialist, Italy
Dr
Hasse Lundgaard Orthodontist,
Spain
Ms
Marie Klaipo Consultant, Dental
Nurses School
Dr
San Nyiep Director, Dental Nurses School
The
Postgraduate Students Faculty of
Dentistry
There is a huge unmet
need for dental care of an acceptable standard in Cambodia. This need requires quantification, through a
survey that is representative of the whole country. In this way the actual oral health situation of the population
could be measured to international specifications and compared to other
countries.
One small survey of just one school in
Phnom Penh shows perhaps the worst oral health of young children anywhere in
the world. A personal visit to rural
areas has shown high dental needs in the adult group as well.
If a nationwide survey was to confirm
that this is indeed the situation, a very strong case could be made for more
government and international assistance to address this major health problem in
Cambodia.
At present there is a move to obtain
funding from FDI in order to undertake such a survey, probably using Cambodian
dental surveyors. It is very important
that the survey is carefully conducted to international standards so that the results
may be compared with other countries in the region.
The results of the survey will help to
identify which areas and groups in Cambodia require preventive and treatment
resources to be focused.
The number of qualified dentists is far
too low to meet the requirements of the population. Foreign aid should therefore be most effectively used in the
better training of many more dental providers, particularly dental nurses.
Traditional dentists meet some of the
need but even they do not seem to have helped the country villagers very
much. Due to the very low standard of
care given by traditional dentists they should eventually be forbidden to
practise as they are capable of doing far greater harm than good for many of
their patients. Some could perhaps be
encouraged to train properly as dentists, as some have a strong desire to
provide proper dentistry and already seek the advice of qualified
dentists. Their infection control
procedures are dangerous.
I believe most of the Cambodian dental
workforce need only be trained to do a fairly limited range of treatments but
to do these to high minimum standards.
The range would include simple fillings, simple extractions and scaling. The dental nurses are the appropriate personnel to
provide most of Cambodia’s oral health needs. There is a much lesser need for more highly trained dentists. However there is a great need for improving
the knowledge and skills of the existing dentists through continuing education
courses.
A much smaller number of dentists should
have additional training within
Cambodia in areas including children’s dentistry, minor oral surgery, simple fixed
and removable prosthodontics, endodontics, orthodontics, periodontics, public health dentistry etc. In
most of these areas a 2-3 year part-time diploma course could provide an
appropriate level of training. Assistance
by overseas experts in teaching these courses would be essential. Some areas of dentistry such as implants should be a very low priority.
A very small group of dentists who are
teachers at the Faculty, should be trained overseas in more advanced specialist
dentistry. Of particular importance is the field of oral and maxillofacial
surgery, as Cambodia has no-one fully qualified in this area to date. Normally many years of training are required
for this.
I see four levels of
dental providers.
Level
One Similar to dental nurses
trained at Kampong Cham
Level
Two Dentists
Level
Three Postgraduate Cambodian
Diploma
Level
Four Overseas Postgraduate Degree
While Cambodia has a good number of
Government employed dentists, working at the Faculty and Dental Nurses School, in hospitals, and in the Ministry of
Health, it is making poor use of their skills.
Most do not work full time and therefore have limited productivity such as fluoridation. One of the main reasons for this is that the
Government cannot afford to pay proper salaries. It is unlikely that foreign aid could be found to supplement
salaries, and so we must
accept part-time work at the present time – however measures should be put in place to
ensure that all personnel
work efficiently and productively for the few hours they are there. This situation may improve with the proposed
reforms in Government salaries. Income
generated from the clinics can also help to supplement the teachers’ salaries.
This would have great benefits in raising
the clinical dental standards closer to those required in the West and would
also enable a better undergraduate education for the dental students. Presently teachers are often absent from the
clinics.
Work has already started
to teach children and their parents the great benefits of brushing their teeth
and gums at least twice a day with a fluoride toothpaste. Some school programmes also include daily
supervised brushing and rinsing mouths with a fluoride mouth
rinsinge. AOI is doing some good work in this area.
Hopefully all children, even in remote
villages, will eventually be able to take part in these programmes and take the
practice into their homes. If all
Cambodians did this at home each day, there would be very little dental
disease.
Oral health education does not need to be
done by a dentist or dental nurse, but could be added to the curriculum and job
description of any health worker eg midwives, perinatal and child health care nurses, public health nurses, etc. In the absence of a dentist or dental nurse
these other health workers could also give dental health instructionsadvice.
The gift of a toothbrush and toothpaste
for every child, and instructions on how to use them, should be an objective of
the Ministry of Health. In the present
school programmes toothbrushes and toothpaste supplies are heavily subsidised
by manufacturers. With help from the
N.G.O.s to write good proposals even more assistance could be obtained.
In larger towns, with a public water
supply to each home, the single most effective way to reduce tooth decay for both
children and adults is by adding fluoride to the water. The cost is very low – just a few cents per
person – and tooth decay has been shown to reduce by 30% or more. The decay that does still occur is very much
less severe and more easily treated.
A working group is urgently needed in
Phnom Penh to assist in getting fluoride added to the new water plant which has
been funded by the Japanese Government.
A suitable fluoridation
unit e plant has already been offered from
Perth, Western Australia, so the costs would not be excessive.
The working group should comprise
representatives from the Faculty, CDA, OHO of MOH, and NGOs. It should seek help and advice from the
Ministry of Health, WHO,
and overseas experts who have been involved in similar schemes eg in Thailand
and Vietnam. Perhaps the Japanese
Government could be approached for funding.
At a later date, other large towns such
as Battambang and Kampong Cham should could also have fluoridation plants for their
water supply, once the
natural fluoride water levels have been checked..
There is a need for the Faculty, CDA, OHO
and other organizations in Cambodia concerned with oral health to develop the
capacity to write good funding proposals so that the implementation of the
National Oral Health Plan can be supported.
There appear to be very many verbal offers of help from visiting
dentists but often these are not followed up, and so opportunities are
lost. If each of these offers was
carefully documented and a good proposal written (in line with the National
Oral Health Plan), I would expect Cambodia would receive much more funding
than it does at present for dental
projects.
A Cambodian dentist could be appointed to
coordinate this process, with assistance from the international NGOs. This person should ideally have good English
and be highly skilled in negotiating, writing proposals and writing evaluation
reports.
The salary of such a person would be
returned many times by the additional aid that would come from overseas. At present I am certain much aid is lost
because there is no person to write the proposals and follow up each offer.
I have already written on the types of
dental provider needed in Cambodia under the Workforce section.
Cambodia needs to continue training dental nurses and
dentists in order to improve the access of Cambodians to basic dental services,
however the number of dentists trained each year should not be increased. Instead of increasing the numbers of dentists, efforts
should be focused on upgrading the quality of training, which is presently far
below that of neighbouring Asian countries. The dental school should be seen as
the centre of excellence for the country where the highest possible standards
of dental care are taught and practised.
These very high standards are then maintained by the graduates through
their practising life. The low
standards in place in some areas of the dental school at the present time may
put patients’ health at risk through poor techniques and poor cross-infection
control procedures.
Although dental nurses only provide
simple types range of
treatment – mainly just simple fillings and extractions – these procedures
should be taught to the highest quality standards. There is evidence that this
is occurring at the Dental Nurses School.
In the long term, I feel the four levels
of dental provider would be best for the country. The first level would be taught at institutions such as the
Nurses’ School at Kampong Cham.
The Dental School would be responsible
for Levels Two and Three, and overseas institutions for Level 4.
If more qualified teachers were able tocould be employed for
longer hours (or more effectively) in the clinical situation and facilities
were upgraded, the standard of Cambodian dentistry would be greatly
improved. For most students I feel that
even simple types of treatment are difficult to carry out when there is often a
lack of slow handpieces, limited suction, no chair-side assistants, inadequate
materials, and little supervision by staff.
If teachers and students were able to
work efficiently from 8:00am to 5:00pm the length of study for each student
could probably be shortened to perhaps 4-5 years.
It would seem to be of mutual benefit to
both the Phnom Penh hospitals and the Dental School if access was available for
the Faculty oral surgeons to be appointed as visiting consultants to one or
more of the hospitals. Dental students
should also have the opportunity to observe the management of pathology and
trauma, and operating room techniques in the hospital situation. Most doctors who teach at the medical school do I think have
positions in hospitals, but not the oral surgeons eg Dr Chhin, Dr Tuy Tel and Dr Someth. Perhaps this could initially be implemented
at Calmette which could become a teaching hospital for the dental school.
This would also foster an exchange of
ideas between medical and dental specialists which would be very valuable.
There should be a policy manual for the
entire Dental School that describes every clinical and organisational procedure undertaken in
the School by every staff member and every student and assistant. Each procedure should be done to a specific
minimum standard that is written in the policy manual.
Everybody should know what the policies
are and must work to that standard. An
example of a Policy Manual for a New Zealand clinic has been left with Dr
Someth Hong. A much different policy
manual would need to be written for the Dental School. For example the policy would have sections
stating all the requirements needed to maintain a good standard in controlling
cross infection, using different equipment or materials, how to look after
equipment to ensure it does not break down, how to make the patient comfortable
and much, much more.
I have extensive experience in
establishing infection control programmes into the New Zealand School Dental
Service and I have found the programme in place at the Dental School to be
completely unacceptable by any standard.
In other countries the clinical departments would be forced to close
until standards improved. The
paedodontic and oral surgery departments have made efforts to improve
cross-infection control, but the rest areis completely
unacceptable. I know the Dean is aware
of this problem and is also anxious to improve the situation.
It is therefore very pleasing to hear of that a French infection
control advisory team about tohas recently visited the
Cambodian Dental facilities. I
sincerely hope that the Dental School is able to adopt their
recommendations. A policy manual left
with Dr Hong on our New Zealand School Dental Service has a very extensive
section on infection control and I have also left a yellow paged book on sterilisation
standards.
The only suitable dental sterilisers for
the dental school are autoclaves and these should only be operated to the
manufacturer’s instructions. Some now
require distilled water to operate properly – not tap water or deionised or ozone drinking water.
The hot air oven sterilizer has a sterilisation cycle of 2 hours which is not being followed, and
is difficult to
adhere to when instruments are needed within
minutes. Poor cross infection control
procedures put patients and dental students at risk of contracting HIV and hepatitis.
The entire practice of each dentist,
student and assistant needs to be thoroughly taught and monitored to ensure
cross infection is controlled. One
problem is that the dental assistants do not really work at all as chair-side
assistants, which makes cross-infection control by the
students more difficult.
A staff member at the School should be made responsible for
infection control and must ensure all staff and students do exactly as required
at all times.
Suggestions to enlarge the sterilising
rooms follow in later pages.
At this moment, for the safety of all staff and
patients, a good infection control programme, properly monitored at all times
to ensure all observe the procedures, is the absolute number one priority.
The School has a large amount of
equipment but unfortunately most much of it is not working. Also many items have gone missing such as
slow handpiece motors (couplings).
It is impossible for students to get an
adequate clinical education in these circumstances.
The equipment in the school would
probably have a value of at least $500,000 if it was working.
Surely it makes sense to employ an expert
dental equipment repair person (people) to repair and maintain the equipment
which is so valuable. The cost of such
a person would be little compared to the value of the functioning
equipment. The repair person should be
skilled in electronics, plumbing and as a general ‘handy man’. They would also need to be skilled in
understanding exactly what is written in the repair and maintenance
manuals that come with each item of equipment.
I suggest that:
1.
a repair
person is employed to care for all equipment.
2.
there is an
inventory done listing all the equipment and instruments owned by the School
(the list should include the serial number, where present, of each item).
3.
all items
of equipment should be engraved with an indestructible mark that identifies it
as belonging to the School (this should discourage theft of items currently
being stolen).
4.
a
reasonable supply of tools and spare parts should be provided to enable the
person to do their job properly.
5.
The repair
person may require some additional training to provide them with the necessary
skills. This could be done by sending
them overseas or by bringing someone here to provide hands-on teaching.
If each student was given (or was able to
buy) two sets of high and low speed handpieces, as well as clear written
instructions in a manual on how to care and maintain these, this could solve
the present problem of lack of handpieces. Once again
a proposal could be written and funding sought to provide the handpieces.
In addition, the school should ensure
that it has a good range of instrument sets for use by the students. It is impossible for any student to do good
work, even to reach a low standard, with the equipment and instruments
currently provided. Weekly inventories
should be made of the instruments and lost and broken instruments replaced.
I feel that a very big problem for both
staff and students is in understanding exactly what is meant when reading
instructions in a foreign language.
This is particularly true in reading operating instructions and in
maintenance for equipment and how and when to use materials. Even the post-graduate paedodontic students
who have good English still cannot clearly read instructions for using donated
materials.
A Cambodian person within the School who
is very gifted in English (and perhaps French) could be appointed to ensure all
staff and students understand exactly what was meant in the foreign
language instructions.
I think many mistakes now occur due to
this lack of understanding and translating important instructions into Khmer
would be very useful. I suggest a
translator, from within the existing staff, be appointed.
These are very time consuming positions
and while a little time in teaching for the position holder is to be encouraged
I do not consider that the Vice Dean should also have the very large burden of
being Head of Department as well. A job description for each of
the staff would be very helpful, and I strongly advise that an executive manager
position be formed.
Every Dental School in the world probably
employs an executive department to manage the day-to-day activities of the
School. The executive manager would be
highly skilled with a graduate degree in business management, and work very
closely with Dean and Vice Deans. This
person could do a lot of the work that is presently the responsibilityof the
Dean. An important function would be to
find extra money to allow the School to function better. In each area where money is required the
executive manager could write proposals to funding agencies such as Ministry of
Health and N.G.O.s. Every verbal offer
of help would be quickly followed up by a written request for financial
assistance with good reasons why the money should be allocated. The executive manager would link closely to
the Ministry, Cambodian Dental Association and N.G.O.s. Many of the functions of the Dental School
would be organised by the manager such as equipment, supplies and employing a
repair person, finding a translator, and building modifications. A secretary could also help the manager to
do all this. If a funding coordinator
were appointed outside the Dental School the executive manager would work very
closely with that person.
Once more, the cost of the executive
manager’s salary would be many times covered by the additional funding the
manager would be able to attract.
Ideally Heads of Department would all have post graduate overseas
training (or at
least a Cambodian postgraduate diploma) and keep fully
aware of dental advances throughout the world.
This is usually done by allocating each Head a small amount of money to
attend overseas seminars in the region.
These days a great deal of dental learning can also be done by using the
computer internet but great care must be taken in only learning from approved
sites. Most good International Journals
are now on the Internet and this would be an excellent source of learning. Perhaps the library could get involved in an
Internet Learning Project? This would
benefit all staff and students. Unfortunately
few of the Cambodian
dental staff seem to
use the limited resources that are already available in the library.
I have found that many of the dentists in
Cambodia do not continue to attend post graduate learning seminars of any
kind. In most countries it is now a
requirement that a dentist must continue to show evidence of learning the newer
techniques and advances in order to get annual registration to practise. If they do not do this they are not allowed
to practise as a dentist.
Some techniques that I have observed in
the Faculty are no longer used overseas and, at no extra cost, better techniques
could be able to be taught if the teacher was aware of them. This would obviously be of benefit to the
students and their future patients.
I was
however pleased to learn there is a two-yearly CDA conference which many of the
dentists attend. Some also attend
regional meetings such as the ones in Vietnam and the recent FDI conference in
Malaysia. These are valuable opportunities
to learn, although proficiency in English is a requirement. There are also quite a few visiting dentists who offer to give lectures in Cambodia,
however these are often
not well arranged or attended. This discourages the visitors from
providing further assistance.
I have noticed that the dental assistants
who have been employed for some time could be more helpful to the
students. Overseas an assistant will
work with a dentist or student as a team and will do four-handed
dentistry. I have noticed that the
assistants have a very poor knowledge of infection control. Even the cleaners who clean the clinics need
to have a good knowledge of how to clean clinic surfaces.
It is very important to give assistants
very thorough training in all aspects of their work especially in controlling
cross infection. They should have a
person to supervise them and to ensure that they work strictly to written
policies. A good well-trained and
experienced assistant can be very helpful to a student.
In New
Zealand we have a system of rewarding assistants who work very well with a
little extra salary. They are
thoroughly checked by their supervisor over the year and assessed on their work
performance just like students. They
can also study to pass an examination on the written policies that they must
work to. Perhaps a proposal could be written to fund some training of
dental assistants.
As well as each student, every other
person employed at the Dental School, from the Dean down should undergo an
annual performance review.
Each person would have their work over the
previous year assessed by a Manager who is familiar with the work they do. For teachers this may be Head of
Department. For Head of Department, the
Dean. For the Dean, perhaps the Dean of the
Medical SchoolRector
of the University of Health Sciences or someone from an overseas Dental
School.
Each person should each year have key
objectives to complete specific tasks within their area of work and to have a
plan to increase their level of knowledge and skills. Every person should therefore have a plan to improve the quality
and productivity of their work each year to enable this to happen.
I do not believe that the cost of tuition
should be paid by the students as only the very wealthy could then study, and
these would mostly be from Phnom Penh.
Cambodia needs dentists who are genuinely interested in treating the
poor, especially in provincial areas.
Most wealthy people prefer to live in Phnom Penh, so poorer students
from provincial areas should be encouraged.
By making the Dental School autonomous
the opportunity is there to make some of the necessary improvements. An executive department with excellent financial skills would be
even more important. The money to
operate the School would need to come from the MOH and/or MOE, as well as
income from the clinics. It is unlikely
that IOs or NGOs would be willing to contribute on an ongoing basis, although
perhaps Japan (JICA) could one day be persuaded to upgrade the facilities as
they have done in several other countries.
be long term overseas sourced probably from a very large organisation
such as W.H.O. or a sympathetic foreign government. Structures would need to be
in place to ensure all money was put to good use and not taken by corrupt
officials. Funding needs to be sustainable.
Expertise is needed for formulate a
realistic budget for the dental school.
Proposals could be written for funding different projects, in line with
an overall strategic plan for the Faculty. These proposals could then be presented to possible funders.
The Dean has discussed with me the
development of a high grade oral surgery clinic incorporating a separate
gowning and hand-washing area and separate pre-medication or sedation room for
patients. This is excellent and would
be most useful to show students how such a unit can operate. It is very important to show all Cambodian
dentists and students “state of the art” conditions. As well as surgery, top class infection control could be
demonstrated. The intra oral television
camera (which the dental school already has) and screen for students would be
useful in this room.
Dr Stefano Dallari, an implant specialist
from Italy, who represents the charity C.O.I. of Turin, Italy, would like to
help the School. He has offered to
obtain surgical equipment from Italian manufacturers. He would also like to
lecture Cambodian dentists on the principles of implantology. I recommend that
a request be written to Dr Dallari for his organisation to equip the new clinic
for oral surgery. Items might include a
dental unit, good suction unit, surgical handpieces and other surgical
instruments, a good operating light, a large autoclave, storage cabinets,
surgical supplies such as sutures, spare parts for the equipment, a composite
curing light, general handpieces, air motors, etc. However, I would definitely not recommend that implants are taught
in Cambodia at the present time.
Dr Ralph Francis, who is resident in
Phnom Penh, has offered to help the school through his organisation. He has suggested that his charity may be
able to equip a high class demonstrating clinic for general dentistry. This could operate in a similar way to the
oral surgery clinic mentioned above and could include a similar list of
equipment but with an emphasis on general dentistry. Once more, a television and intra oral camera would be very
useful for teaching purposes.
Alternatively, the School might consider
offering an alternate proposal to fund the services of a repair person or
supply badly needed equipment such as air motors and handpieces or autoclaves,
etc.
It is very important that somebody should
very quickly formulate a proposal with Dr Francis.
There is need for a larger, better
equipped area, next to the outside waiting room, where patients are assessed or
triaged when they first come to the School.
The assessment area is very good practice for students who can determine
the diagnosis and priority
for the patient’s treatment and then refer them to the appropriate
department. Pre-medication and sedated
patients also need a quiet room where they can wait prior to or after
treatment.
If the reception desk was re-sited in the
outside waiting room more space would be available to extend the assessment
clinic and also create a small pre-medication room. There would still be sufficient space in the waiting room.
These are of the highest priority and
need very urgent attention. Each
sterilisation room should be much larger to allow proper infection control practices
to take place, or there should be one large sterilisation room. There should be an area for all used
contaminated instruments and a separate clean area for sterilised
instruments. Between each area the
scrubbing wash basins and autoclaves are placed. It would be excellent to have one very large capacity autoclave or
two smaller ones.
For the Restorative Clinic the space could be expanded by taking
out the wall to the minor surgery C room and using the space of the two rooms
for sterilisation and storage of instruments.
Minor surgery C room could take over the x-ray room when they move out.
The area where students take up sterile
trays and return dirty trays needs to be made bigger with a separate area to
return the dirty trays and another to pick up clean trays.
For the Oral Surgery Clinic the present room could be enlarged by
incorporating the room next to it on the right hand side which at present only
contains broken equipment. A similar
design to the restorative sterilising room discussed above would be used. Students should not enter the oral surgery
sterilising room but should get instruments and return dirty contaminated
instruments through a separate area.
Ideally all oral surgery instruments should be individually placed in
bags, but drying cycles would then also be necessary on the autoclaves used.
Other departments also require better
autoclaves and all departments need far better hand washing facilities and
techniques.
These alterations are really of highest
priority and I would like the French Infection Control Team to see this
report. Perhaps there is a charity
N.G.O. based in France that could give funding for a complete upgrade. If not, the other N.G.O.s mentioned
previously could be given proposals to fund a complete upgrade of all infection
control processes. There is a need to
consider this report and that of the infection control team and then to write
new procedures for all staff, including assistants, in a policy manual and to
also list all costs for new equipment and building operations to use for all
funding proposals. These reports,
stating the urgency of the situation, should be included in the funding
requests.
I have left a yellow paged book with Dr
Someth that shows sterilisation standards for Australia and New Zealand. These are actually too high to achieve in
Cambodia but give an idea of what is expected in Western countries now.
Dental teaching in all countries now
involve very great use of computers and the future training programmes in the
Dental School must increasingly make use of this technology. The School should be making plans on how
best to use this technology in the future.
I understand that Thailand is more
advanced in training dentists and other dental providers. They have very good experience of similar
difficulties to Cambodia. It would be
excellent if the Cambodian Dental School was to form very close links to the schools in Thailand as I am
sure that they could offer a great deal of advice and assistance.
If consultants from the Thai Dental
School were invited to come and report on the Cambodian Dental School I am sure
much would be achieved to improve the current situation, and develop long term
plans for a most rewarding future in dental education.
If the government cannot adequately fund
the Dental School, it is wise to consider partially privatising its
operation. The key factor would then be
to find the finance.
Ø A Nationwide Oral Health
Survey to International Specifications should be conducted as soon as possible.
Ø A much greater number of
dental providers need to be educated, particularly those to do very simple
basic dentistry (ie
dental nurses).
Ø The quality of the theoretical
and practical education at the dental school needs to be improved.
Ø Dentists should have a
requirement to undertake continuing education to improve their knowledge and
skills.
Ø Salaries for dentists
need to be increased equivalent
to the earnings possible in the private sector. Longer hours need to be worked. The staff need to work more
effectively during their time at the dental school.
Ø Further expansion of
oral health promotion in all Cambodian Schools is encouraged.
Ø Water fluoridation, in
particular for Phnom Penh, is urgently needed and would have an extremely large
beneficial effect on the oral health of all its citizens, for little cost.
Ø A working group to get
water fluoridation commenced should be established with members from the CDA, Faculty and OHO.
Ø A person or persons
should be appointed to help coordinate and write funding proposals for the
various dental programmes. This could be part of the responsibilities
of the OHO.
Ø There should be long
term planning for the development of 4 levels of dentist in Cambodia ie dental nurse, dentist,
Cambodian diploma and overseas masters/diploma.
Ø Teachers should keep
up-to-date with new dental technology and materials and be more available to
students in the clinical situation, by working longer days and/or more effectively.
Ø Links between the Dental
School and Private Public Hospitals carrying out oral surgery should be stronger
at post graduate oral surgery level.
Ø A complete policy manual
describing all the procedures undertaken in the Dental School and the standards
to be maintained should be written and followed by all staff. This is a very high priority.
Ø The first priority must
be to upgrade all processes involving control of cross infection by all
staff.
Ø A person should be
appointed to ensure the last recommendation is carried out. Any available funding for the Dental School
should first be spent on the infection control upgrade.
Ø A repair person should
be appointed to care for all equipment at the School. Training such a person may be required. An inventory of all items
of equipment belonging to the School should be made.
Ø A plan for the dental
school needs to be made to ensure that there are sufficient equipment,
instruments and materials for students to use.
Ø The appointment of an
expert translator of foreign languages would help staff and students learn exactly
how equipment and materials should be used and cared for. This could
be a responsibility of the English teaching department.
Ø The Dean and Vice Deans should have quite
small teaching responsibilities. Job descriptions should be written for all staff.
Ø The appointment of a
graduate executive manager skilled in business administration and raising money
is recommended for the further development of the Dental School.
Ø Heads of Departments
should preferably have overseas post graduate experience (or at least a
Cambodian postgraduate diploma) and be fully knowledgeable in modern dental
practice in their field.
Ø Other dental staff
should also have good recent knowledge of modern dentistry through continuing
education courses and through attending Cambodian and regional conferences.
Ø Supporting staff need
very good training and must keep their work practices to a very high
standard. They should have a senior
staff member to manage them.
Ø Consideration should be
given to a training programme for Dental Assistants.
Ø Development of special Clinics to
demonstrate high quality oral surgery and general dentistry are to be
encouraged.
Ø While the Radiography
Department is excellent, more help is needed for all others, especially periodonticsendodontics.
Ø Some structural changes
to the building would improve services for outpatient assessment and
sterilisation of instruments.
Ø Long term planning for
future use of computers is essential.
Ø