Dentistry in Nepal and Building a better Future for Children’s Teeth
An Adventure of a Different Sort
I remember the excitement on Coronation Day in 1953 when news was announced of the first two climbers who reached the summit of Everest. At 11:30 in the morning of May 29, 1953, New Zealand’s Ed Hillary and Darjeeling’s Sherpa Tenzing Norgay became the first known human beings to stand on the highest point on this Earth. Now in 2024, mountain climbing and trekking attract thousands of foreigners to Nepal every year, contributing more than 4% to the $40 billion economy. The country earned $5.8 million in permit fees – $5 million from Mount Everest alone – during last year’s March-May climbing season. Nepal issued a record 454 permits to climb Mount Everest in spring, 2023. “This is the highest number of permits the department has issued to summit Mount Everest,” quoted Bigyan Koirala from the tourism department. This year there is increased concern due to overcrowding on the approach to the summit of the mountain. So far 8 climbers have lost their lives, blamed largely on overcrowding. A permit to climb Everest costs £8,900 in addition to the visa which works out at £2,000 per group
After Everest we learned more about Nepal from Michael Palin in his BBC mini-series in 2004 in the Himalaya region. As many consider greater adventures in far away places, Mount Everest appears in fashion and the chance to “climb the tallest mountain in the world” is so tempting. Sadly, more climbers are dying on the mountain as queues form to reach the summit delaying the descent and increasing the risk of being overtaken by bad weather. Many travel agencies based far beyond Nepal make vast fortunes, little spent in Nepal. It now costs around £40,000 with a Nepalese Company expedition. Other companies outside Nepal are charging $33,000 (£26,000) and up to $200,000 (£158,000) depending on type of expedition and what is included in the price such as level of luxury expected !
But others have made a different journey. This month we spent time with a lifelong friend in Germany, a retired dentist, who has spent time in Nepal, not as a tourist, with eyes set on Everest, but as a dentist, later establishing a basic dental surgery in Sanghutar with a focus on childrens’ preventive dentistry. A huge feat of persistence, learning about the country and peoples, pleasure, liaison and fund raising. Dr John Adderson first went to Nepal, as a dentist, for a month with German Rotary Volunteer Doctors and realised how desperate dental care needs were – he spent his time pulling teeth in improvised dental spaces. Over time he directed his energy to establishing a better equipped dental clinic, especially for children and over the next six years assisted in the building, and equipping of a functioning dental clinic, assisting in training staff and supporting them, often finding equipment in Germany (retiring dentists’ equipment etc) and shipping it to Nepal. He then set about encouraging more visiting dentists by building a small guest house on the site.
What do you know about Nepal?
Nepal has 3 regions in a latitude like that of North Africa. Size of the whole country is 800 km (500 miles) west to east and 180-210 km (112 -130 miles) north to south. Height above sea level; 50m to 8849m (164 to 29,032 feet). There are 3 regions:
- Terai
- Hills
- Mountains
TERAI
- Flat land along border with India
- Dry jungle (think about The Jungle Book(1894), a collection of stories by the English author Rudyard Kipling)
- Fauna: Tiger, Elephant, Rhinoceros, Bear
- In the past called Five-Hell of Nepal (Malaria)
- Has 50% of population, 70% of agriculture of Nepal and produces 80% of agricultural products
HILL REGION -foothills
- High hills
- Steep slopes
- Deep valleys with rivers (summer monsoon); hydro-electric power possible but very difficult to establish as infrastructure poor
- Multiple landslides and earthquakes
- The Kathmandu Valley is 1400 m above sea-level. There were formerly 3 kingdoms in Nepal; Kathmandu (capital of Nepal), Patan (Lalitpur) and Bhaktapur
HIMALAYAN- mountains
- Boundary with Tibet (China)
- Highest Mountains in the world: Mount Everest (8849m, 29,032ft)
- For 50 million years the Indian Tectonic Plate is being subducted under the Asian Plate, leading to multiple earthquakes each year
Nepal’s history is the history of the Kathmandu Valleys. Here can be found the culture and art origins influenced by Tibet but mainly India. Hinduism and to a lesser extent Buddhism have influenced the culture of the Nepalis, who are 80% Hindu and 20% Buddhist followers.
Recent history: 1814-1816 the war against Britain was lost. A consequence of that was one Gurkha Regiment has served the UK since that time. The Royal Gurkha Rifles (RGR) is a rifle regiment of the British Army, forming part of the Brigade of Gurkhas. Unlike other regiments of the British Army, RGR soldiers are recruited from Nepal, which is neither a dependent territory of the UK, nor a member of the Commonwealth. The Gurkhas in general and the direct predecessors of the Royal Gurkha Rifles in particular are considered to be among the finest infantrymen in the world, as is evidenced by the high regard they are held in for both their fighting skill, and their smartness of turnout on parade. In 1846 power was taken by the Rana family which lasted 100 years. Foreigners were not allowed to enter Nepal. In 1950 the borders opened to foreigners. Disruption occurred between 1995-2005 during the Civil War with Maoists. Finally, in 2008 the King resigned and Nepal became a Republic.
It was in 1950 that the Start of Modernism came to Nepal, not long after the independence of India from UK rule. At that time:
- 97-98% Nepali illiterate
- Population 6 million
- No roads only tracks
- No schools or healthcare systems etc.
- Today, every child must attend school and Higher Education in Kathmandu is possible
Problems today:
- Overpopulation of 30 million
- Food shortages
- Unstable government (>40parties)
- Corruption
- High unemployment and 6 million Nepalis work abroad
- Clean drinking water, Public Health Service, Roads, Electricity Supply Waste Disposal etc still not available in many areas
- Nepal has no direct access to a harbour so imports expensive
- No natural resources to sell on overseas markets, except perhaps climbing Everest and other wider tourism !
Occupations and Work:
- Most are poor farmers and live hand to mouth
- Hardly any industry. Most self-employed with small shops
- Skilled workers, for example electricians and plumbers and qualified employees are scarce
With that background, what exactly did John get involved with as a member of the German Rotary Club in Miltenberg?
As with world-wide Rotarians Miltenberg, a town on the River Main, contributes to efforts at home and abroad to enhance services for different needs in communities and the medical and dental grants for Nepal come into that category. John first went with Rotary as a dentist to Ghana in 2012, and continued the outreach work with the dental work in Nepal. In Nepal the Rotary Club of Kavre-Banepa was closely involved.
His first experience in Nepal was in 2013 in Manthali in a medical camp, where dental and medical rooms were set up to provide basic care for the population, under the auspices of the Tamakoshi Service Society and Tamakoshi Cooperative Hospital (TCH) with Dr Suman Karmacherya, the hospital director. The project ran the Dental Office from 2013-2018. Manthali is a municipality and the headquarter of Ramechhap district. It is 130km (81miles, over 3 hours by car) immediately east of Kathmandu. The district has the highest population of endangered native groups, ‘Kusunda,’ and has the lowest population growth rate in Nepal. In the earthquake of 2015, the Ramechhap district sustained extensive property damage. It was listed in the 12th position of the most affected districts. Manthali Municipality area also suffered extensive damage.
Improvised dental chair, washing facilities and sterilising equipment in outreach dental clinic in Manthali 2013
In the following years John assisted in the improvement of the kitchen and canteen at the hospital and provided a nameboard for the hospital; he also refurbished the intensive care room. Not forgetting recreation, he even introduced a badminton court
Map of Nepal
The April 2015 Nepal earthquake killed 8,962 people in Nepal and injured 21,952 more. On May 12 a magnitude-7.3 aftershock struck some 76 km (47 miles) east-northeast of Kathmandu. Sanghutar and Manthali were badly hit and John was able to purchase with emergency funding, and fill with emergency supplies, plastic buckets for distribution in the locality where many homes were destroyed in after-shocks. He also provided mosquito nets for mothers in tents.
Sanghutar is a village development committee, and the home village of Dr Suman Karmacherya, hospital director of TCH, in the same Ramechhap District in the Janakpur Zone of north-eastern Nepal. It has a small market called Sanghutar Bazaar, situated in the bank of the Likhu River and bordering Okhaldhunga District. The bazaar is flat land near to the bridge (Sanghu in Nepali); hence its name is Sanghutar. It is a main commercial centre of many neighbouring villages of Ramechhap and Okhaldhunga District with a secondary school called Himaganga.
The Dental Clinic was planned in the grounds of the school in Sanghutar as an outstation of the Tamakoshi Cooperative Hospital in Manthali, 34 km east, with the support of The Hospital Director, with John Adderson and the Miltenberg Rotary Club financing the project. The school has more than 600 students, none having access to dental treatment, during their years at school. As the clinic stands in the grounds of the school, dental education and treatment can be carried out without great interruption to school organisation and students are encouraged to take part in this dental health programme.
Dentistry in Nepal is usually focused overwhelmingly on pain relief achieved simply by extracting decayed teeth. In Manthali 80% of adult patients have teeth extracted due to pain and infection. Today, modern dentistry aims to prevent caries, halting tooth decay and consequently loss to teeth. Prevention through dental hygiene—cleaning-teeth morning and evening and fissure sealing (fissure sealing is the most important treatment to eliminate caries), is a well-known tactic in developed countries like Scotland, and the clinic will encourage school children to use dental hygiene in their own lives, and to have a dental check-up once a year.
The first meeting for planning was held in March 2018, a site was chosen and in 2020 the treatment room opened. Since then, various additions have been completed, and equipment purchased or donated. John has received donations from dentists around Miltenberg and further afield. Dental staff have been recruited and accommodation, in a Guest House provided for them and visiting dentists. The whole project was handed over to the school and the local Rotary Club in Kavre-Banepa, in March 2023, both of which have been involved in the projects and will manage them in the future.
Pictures below of a team from the Dental Department of the Dhilikhel University organised by Professor Dashrath Kafle (seen here organising teeth cleaning routine with pupils of the school).
The Dental Bungalow is to the right of the tall yellow school building, and Guest House in the trees.
MARCH 2023 THE HANDOVER CELEBRATIONS!
Thanks were expressed to John on this official Opening Day of the Dental Clinic by TCH, with the Director Dr Suman Karmacherya, and representatives of Nepal Rotary Club of Kavre-Banepa. The children were assembled and presentations made.
Job Done!
In a world with opportunities for distant travel, and overseas working holidays, to assist local populations achieve basic healthcare, education and/or training has almost fallen out of favour. All credit to John Adderson, who has achieved his aim, and continues to travel to Nepal to assist the project. There are concerns about longer term funding but John remains optimistic it will be found. The UK government used to sponsor such strategic projects. What a pity many have been lost!
Thanks to John Adderson for his photos from this whole period.
Sally Campbell
May 2024
