7
Volume3 Issue2
|
CDA
at
W
ork
I
arrived inEdmonton30years agoas a land-
ed immigrant tobeginmy life inCanada.
Themorningaftermyarrival, I continuedon
toYellowknife, Northwest Territories (NWT),
where Iwould live for thenext 3years. Iwas
a recent dental school graduate, drawn to the
ideaof anadventure in theCanadianNorth. At
the time theNWThadapopulationof about
50,000andoccupiedanarea larger than India. It
was—and still is—avast and sparselypopulated
place.
Iwasheaded toanassociateshipat the
YellowknifeDental Clinic, affectionately
knownas YKDental. Theclinicheldcontracts
for providingdental care tonumerous small
indigenous communities throughout the
southern regionof theMackenzieValley.
Thedozensof communities throughout
theNWT range fromvery small, isolated
hamletswithbasic facilities to larger towns
withmodernclinics anddental facilities. The
scopeof dental carewewereable toprovide
includeddiagnosticandpreventative
services, simpleandcomplicated tooth
removal, direct restorative treatments,
selectedendodontics and removable
prosthodontics. Highdisease rateswere
common toall thecommunities I visited.
Often the treatment needs exceeded
what couldbedeliveredwithin the
communityorwithin theavailable time.
Althoughmanydentists volunteer to
provide itinerant dental care invarious areas
of theworld,most practitioners in
Canadamaynot be familiar
with thechallengesof
practising inour ownnorthern setting. Hereare
just someof thechallenges I facedback then:
•
Providingdental carewithmobiledental
equipment in remotecommunities
presented some special challenges;
rarelydidwefind that theair line from
thecompressor—if indeed therewas a
compressor—couldbeconnected toour
equipment. I travelledwithanextensive
set of tools and spareparts andbecame
comfortableadaptingand repairingour
equipment. Onlya fewhealthcentreshad
dental chairs andeven fewer hadX-rayunits.
PortableX-rayequipment isparticularly
awkward touseand inCanadahand-held
X-rayequipmentwasnot available (and
remainsunavailable to thisdaydespite its
widespreadacceptance inother countries).
Thehealthcentresusuallydidnot have
adequateprovisions for infectionprevention
andcontrol andwehad to travelwithour
own sterilizers.
•
Referral pathwayswerevirtuallynon-existent
for patientswith treatment needsbeyond
the scopeofwhat amobile servicecould
reasonablyachieve. Anefficient system
shouldusea teamapproach toprovide
comprehensiveoral healthcareandhave
well-established referral pathways for
conditions suchas as earlychildhoodcaries
(ECC),multi-quadrant toothextractionor
moreextensive restorativeneeds. Getting
patients the treatment they required
wasmademoredifficult by the lackof
administrative support, difficulties involved
inobtainingmedical histories and language
barriers.
From thePresident
ALookBack
DentalCare inNorthernCanada:
AlastairNicoll, bdsh
ons
