91PORN

This June, Luke Seiler, DS4, won first place for his poster, entitled “Upstream Preventative Interprofessional Team Approach for an Ethiopian Outreach”, at the virtual 2020 Humanitarian Health Conference, an Institute for International Medicine event. The poster highlighted clinic protocol and baseline data collected during a dental and medical outreach trip to Ethiopia in June of 2019. The Ethiopian Outreach Last summer, Luke Seiler, DS4, Keith Usry, DS4, Claudia Samaniego, DS4, Michelle Zhou, DS3, and Moshtagh Farokhi, DDS, MPH, a clinical associate professor in the department of comprehensive dentistry, traveled to Aleta Wondo, Ethiopia along with medical students and faculty from the Long School of Medicine. Since 2007, 91PORN’s (UTHSA) Long School of Medicine has nurtured a longitudinal relationship with Common River, a U.S. based non-governmental organization (NGO), in Aleta Wondo. Last June, the dental team joined the Long School of Medicine on an Ethiopian outreach. Jordan Barton-Garcia, MS4, Duff Dean, MS4, Max Feng, MS4, Kirsten McLane, MS3, Autumn Chidester, MS3, Amanda Groover, MS3, Delaney Rawson, MS4, and Cameron Holmes, MS4, formed the medical student team who was accompanied by medical and public health faculty members Ruth Berggren, MD, MACP, Tyler Curiel, MD, MPH, and Jason Rosenfeld, DrPH, MPH. Cameron’s father, Joseph Holmes, DDS ’86, and uncle, Joshua Austin DDS ‘06, are both graduates of the UTHSA School of Dentistry. Preparation for the journey consisted of global oral health training, the content of which was originally developed by Taylor Reece, DDS ’19, during an American Dental Education Academic Career Fellowship program overseen by Dr. Farokhi. Other preparations included introduction to Ethiopian culture, interprofessional team building and a lunch and learn with a local Ethiopian business student from St. Mary’s University. The preparations also included numerous vaccinations and fundraising. Funding for the outreach came from the team’s crowd sourcing account, the UTHSA’s Office of Student Life and Center for Medical Humanities and Ethics, the International College of Dentists, medical student fundraising, the School of Dentistry’s Hispanic Center of Excellence, and a combined DSI and DS2 class party. The Journey Aleta Wondo is nestled in the Great Rift Valley, about 300 kilometers south of Addis. Rich with resources, the community is located in the heart of the Sidama coffee growing region. Upon settling into their guest huts at Common River, the interprofessional teams organized and assessed the oral health of the Aleta Wondo community, which included the 239 students of the Common River’s primary school, staff workers, and members of a women’s literacy group. The teams completed joint home visits observing typical living conditions, daily nutrition, water access, and at-home hygiene sanitation. Dental assessments began with oral and nutritional health information and oral hygiene instructions provided to community members with the assistance of the appropriate Sidamo and Amharic translators. As the interprofessional teams conducted oral health examinations and oral cancer screenings, the team members learned of the practice of chewing “chat” or “kath”. Khat is a native, flowering plant which, when chewed, stimulates the body much like amphetamines by causing hyperactivity, loss of appetite, and euphoria. Long-term practice of chewing khat is associated with bleeding gums and periodontal pocketing. This most often leads to tooth sensitivity or loss. Under the supervision of Dr. Farokhi, the dental team treated patients with a silver diamine fluoride to prevent cavities and relieve tooth sensitivity, and also applied a fluoride varnish as needed to prevent tooth decay. The dental team was able to train two members of the River Common community in the application of the fluoride varnish so as to maintain its effectiveness. The UTHSA teams were able to donate enough supplies to sustain the community for both the 6 month and one year follow up applications. The community’s English teacher was provided with oral health promotion materials and demonstration models in order to continue the educational effort. The community traditionally uses what is referred to as the natural Ethiopian toothbrush or “mefakia”, a utensil made from fibrous twigs, roots and the stems of plants. Even then, not all community members practice the use of it, therefore all patients received a toothbrush, toothpaste, and a supply of dental floss. Outcomes and post journey The outcome of the outreach revealed that the Common River community of Aleta Wondo are at high risk for periodontal disease and cavities. The level of risk is associated with a dietary practice of frequent consumption of sugar cane and coffee for hydration. The teams’ opportunity to board within the community during their stay allowed them to observe the social determinants of health, such as limited access to both general medical and oral health care, low fluoride use, and poor oral hygiene practices. In addition, a diet rich in simple carbohydrates points to the cause of high caries scores. Of those examined, 74.9% of patients presented with either active or early-stage tooth decay while 96.6% presented with signs of periodontal disease. Almost half of those examined, 49.6% of patients, reported pain as the chief complaint. The teams made a conscious effort to train and empower key staff with oral health education. The River Common community showed their appreciation by hosting a celebratory bonfire and a local prayer ceremony wishing the teams a safe journey back home. “I’m so proud of our dental students,” says Dr. Farokhi. “So proud of how hard they worked, how they engaged with the CR community and the impact they made.” Dental students reported on their experience post journey. Comments included phrases such as, “community and cultural immersion experience”, “ability to engage in all aspects of public health and education”, and “I have learned that it’s okay to show compassion in more ways that just words; how to show your patient that you care with just body language and how important preventive dentistry is.” The outreach would not have been possible without the financial, technical and administrative support of Dean Peter M. Loomer and Dr. Adriana Segura from School of Dentistry’s Office of the Dean, Dr. Ruth Berggren from the Center for Medical Humanities and Ethics, and Dr. Juanita Pineda from the Hispanic Center of Excellence. Just as important, the medical student team leaders, Ms. Jordan Barton and Mr. Duff Dean, Dr. Jason Rosenfeld, from the Long School of Medicine for his leadership and enormous global health wisdom, Ms. Donna Sillan, for being a gracious host as the co-founder of Common River, and Dr. Farokhi, for visualizing, creating and supporting this program based on the needs of the community and the Common River founders’ development mission. A recording of Luke’s virtual poster presentation can be viewed on the 2020 Humanitarian Health Conference webpage.