island life

Fiji offers flexible dental degree

Drs Shirley and magine carrying your box of instru- Fiji is a republic comprising 332 islands, 110 ments above your head as you wade of which contain the population of 880,000. Charles Scola ashore to a remote island village where Dental therapists in Fiji work for the Ministry describe a progressive there is no electricity or running water. of Health and are trained at the Fiji School of You are a dental therapist, there to Medicine (FSM) School of Oral Health, a multi-entry, multi-exit Iprovide dental treatment for the villagers and regional training centre catering to degree programme will be the first dental professional they have from all over the Pacific. seen for about one year. As you set up your Dental training at the FSM School of Oral run by the Fiji School clinic in a community bure (Fijian house or Health is a flexible programme that can of Medicine School hall) islanders are patiently queuing and eager be started and finished at various stages during for you to start work. a dental professional’s career. The course is of Oral Health. The therapist’s role is to diagnose, plan designed to provide dental personnel for the treatment, and do as many extractions on treatment requirements in the Pacific region adults and children as necessary. Wherever and a career pathway from dental hygienist to possible they will restore carious teeth but dental surgeon. unfortunately many will be beyond repair or Apart from Dental Therapy and Bachelor of require root canal therapy, which can only be Dental Surgery qualifications, the School done by a . Prosthetic replacement for awards a Certificate in Dental Hygiene and a extracted teeth is another service that only a Diploma of Dental Technology. Students can dentist is qualified to do. But villagers know it leave and return to their studies continuing, if could be a long time before a dentist visits they wish, until they get a Bachelor of Dental their island. Surgery (BDS) degree (Figure 1).

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Trainees adapt to local needs elsewhere who will be allowed to enter the In 1998 it was decided that a more flexible BDS programme at a level related to their career pathway for dental assistants was also previous training. needed. A certificate in dental assisting was discontinued and a one year conversion course New course sets high standards allowing them to obtain a certificate in dental Direct entry BDS students have to meet an hygiene was established – so far 48 students academic requirement of a 75% overall grade have graduated. These hygienists now provide in three out of four of their year seven subjects a flexible dental role assisting dental surgeons in English, , and Physics. as necessary and while doing their normal Lateral entry students do not have to meet hygienist duties (Figure 2). these grades, but should have demonstrated The benefits of this flexible learning adequate performance in their existing approach have meant that the courses can be positions. Hygienists and dental technicians matched to the oral health care needs of the can re-enter the academic programme to train public, the changing pattern of oral diseases, as dental therapists or dental surgeons. and the local cultural, social, demographic and Hygienists are able to re-enter the programme economic factors affecting oral health. to train as dental technicians. A clearly defined career ladder has been also have various challenges to face. established that permits trainees to continue The BDS course, which began in 1993, is studying, or step off at that level and enter in line with international dental degree the workforce, while retaining the option to programmes but is tailored to local needs. re-enter the course after gaining further With the population scattered across so many experience. islands it is vital that dentists and therapists Movement back into the mainstream or up working in remote areas are able to provide the career ladder is dependent upon necessary treatment. performance and the availability of posts. For example, there are no specialist oral When there is an increased need for dentists maxillofacial surgeons in Fiji, so dental in the region dental therapists could students must be able to reduce and wire apply for competitive entry back into the fractures of the mandible. All dental students degree programme. have a quota for the treatment of three For example, recent graduates in dental fractured mandibles and also the removal of therapy might be admitted back into the three impacted third molars, all under local fourth year of the BDS course, but earlier anaesthetic, to complete before qualifying. graduates might be allowed into the third year They have no difficulty in meeting this target depending on the modules they had covered. because the incidence of fractured mandibles The same applies to therapists trained is fairly high, especially on pay days.

Figure 1: Flow chart to show entry and exit points and awards made by the Fiji School of Medicine, School of Oral Health.

Dental Hygiene II BDS 1 Dent Tech II

Certificate in Dental Diploma in Dental BDS 2 Hygiene Technology Dent Tech II Diploma in Dental BDS 3 Therapy

BDS 4

BDS 5

Degree - Bachelor of Dental Surgery University of the South Pacific

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Figure 2: Graduates from the Fiji School of Medicine, School of Oral Health for the past 10 years. Figure in brackets denotes students graduating from lateral entry.

Fiji Graduates (new programme) Year Certificate Certificate Diploma Diploma Bachelor Dental Dental Dental Dental Dental Assisting Hygiene Therapy Technology Surgery 1993 5 –––– 1994 4 5 – – – 1995 5 5 4 (2) 2 – 1996 – – – 1 – 1997 3 – 6 – 13 (1) 1998 – 7 2 (2) – 17 (3) 48 upgrade from Cert. Dental Assisting 1999 – 15 (11) 2 2 16 (1) 2000 – 2 2 (2) – 14 (3) 2001 – 6 3 (1) 1 12 (5) 2002 – 1 5 (2) 1 (1) 15 (1) 2003 – 2 3 – 17 (1)

Dentistry on a Fiji island Britons Shirley and Charles describe their experience of practising in Namosi a remote village on the main Fiji Island of Viti Levu on a Rotary sponsored health camp.

We travelled to a village three hours’ drive diabetes and heart problems and inland up a rough track only accessible by prescribing and distributing appropriate a four wheel drive vehicle. We arrived at medication. 10am to an enthusiastic welcome from Our ‘haul’ of 74 extracted teeth was by the villagers and set up our surgery in the no means a record, and I suspect that the village hall. gentleman who walked for four hours to The population of 300 had swollen have his tooth extracted didn’t set a considerably with people from nearby record either. But the villagers were so villages. The village nurse organised local grateful that we felt we had spent a very people to assist us, and within minutes worthwhile day. there was a queue of patients waiting to see us. Further reading With just a chair and a table we were  Davies G N, Hedrick P, Luveni J, et al. only able to offer extractions or suggest Dental caries and periodontal disease referrals, but most patients were keen to in Fiji. Aust Dent J 1992; 37: 386-93. have a painful tooth or teeth extracted.  Davies G N et al. A new approach to We had a short break to eat a delicious the training and education of oral lunch of fish in Lolo (coconut milk), chick- health personnel. NZ Dent J 1993; 89: en and lamb cooked in palm leaves in 113-18. the ground (a lovo), and dalo (a local  Tuisuva J, Smyth J M, Davies G N. root crop). A sequential modular curriculum for We returned to our patients with oral health personnel. Community Dent renewed energy and managed to keep Health 1995; 12: 238-40. going until our medical colleagues insist-  Davies G N. A sequential modular ed we leave by 4pm to negotiate the curriculum for oral health personnel. Fiji: rough track before nightfall. The medics WHO Oral Health Country/Area Profile had also been busy screening for Programme 1996.

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