Category: Blog

My name is Jennifer N. Ricaldi-Camahuali, faculty in the Department of Social Dentistry at Cayetano Heredia Peruvian University (UPCH) in Peru. I have a specialty in Pediatric Dentistry and training in Clinical Epidemiology, and five years ago I came to Seattle and received a Master of Public Health in Global Health at the University of Washington (UW).

In the last ten years as faculty in the department of Social Dentistry, I shared my experiences and knowledge gathered from training at UPCH (Peru), an internship at the Bebé-Clínica (Brazil), and a novel perspective about Global health learned at UW. My goals are to motivate, train and teach dental students about Public Health and Global Health, and bring awareness of the importance and necessity of improving oral health of the most vulnerable population.

My experience as a trainer in Colombia and coordinator in Peru of a Pan-American Health Organization project (SOFAR, Salud Oral Factores de Riesgo) increased my understanding of the necessity to integrate oral health within general health.

It was in May 2014 when I participated in the First Latin American Workshop on Clinical Research Methods in Oral Health, organized by UW in Peru, where I was motivated by Dr. Jorge Luis Castillo and Dr. Ana Lucia Seminario. Both, alumni, and faculty members from UPCH, encouraged me to achieve oral health research goals abroad. During this training experience, I had the pleasure of meeting Dr. Tim DeRouen, who was director of the Center for Global Oral Health, and he became a mentor. His vision in expanding global oral health research was inspiring. After coming to Seattle in 2016 for the 25th Summer Institute in Clinical Dental Research Methods, I was accepted into the program of Master of Public Health in Global Health at UW in 2018.

During my first year as a student in the MPH program in Global Health, I volunteered in the Timothy A. DeRouen Center for Global Oral Health, collaborating in the organization of the symposium “Inter-professional Collaboration in Healthcare: Adding the Oral Health Component to Successful Projects Worldwide,” and co-coordinating the second collection of data in the oral health project in the Peruvian Amazon- InterACTION Labs Project in Claverito (Iquitos). These opportunities further contributed to my training, learning closely from the experience of experts and peers in the oral health area.

Since my last year during the MPH program when the COVID-19 pandemic spread worldwide, my interest in health policies, implementation science, and science communication areas increased, adding some additional steps to my journey. Currently, these subjects are key factors to ensure the protection and access to health care and conditions to reduce the impact of oral diseases during and after the pandemic.

Seems like this journey has not ended but has allowed me to learn from experiences from all around the world. I have received knowledge and guidance in understanding the importance of strengthening oral health services, especially in the most vulnerable populations. I’m convinced that the improvement in communication and collaborative work will promote equal and quality oral health care worldwide.

Hi, my name is Kemporn “Pom” Kitsahawong, I am a full-time pediatric dentist and Associate Professor in the Faculty of Dentistry, Khon Kaen University. I was one of the long-term (PhD) trainees in the Fogarty International Center Training Program in Clinical, Public Health and Behavioral Oral Health Research for Thailand under the collaboration between KKU and the University of Washington (UW). Through the generous support from NIH, I received the opportunity to attend the 2010 UW Summer Institute and subsequently enrolled in several epidemiology and biostatistics courses offered at the UW School of Dentistry during my first year in PhD in Oral Science program at KKU.

I am deeply indebted to Professor Timothy A. DeRouen, Dean Waranuch Pitiphat, Dr. Ana Lucia Seminario and Dr. Christy McKinney who had tirelessly advised me to expand my perspectives and to seek opportunities to do research during my time at Seattle. These experiences increased my knowledge in research, especially in the clinical trials. In addition, my experiences in working with professionals at the IRB for human research ethics had tremendously improved the understanding of this issue among the participants and conducting good clinical research later on.

Over the past 10 years after my training with the UW team, I have been assisting Dean Pitiphat in expanding the knowledge and expertise in clinical oral health research to LMIC’s in Asia. The International Workshops on “Clinical Research Methods in Oral Health” jointly organized by University of Washington, Thammasat University and Khon Kaen University was conducted every 2 years. In the recent workshops, I served as a mentor facilitating the trainees from the leading institutes in Southeast Asia countries on developing a research proposal. This was a great opportunity to be able to share the experience with several international participants and to build partnerships that have mutual benefits in this region. Regarding research support, I have received consecutive grants from KKU Research Unit, KKU Faculty of Dentistry and the Office of National Higher Education Science Research and Innovation Policy Council (NXPO). These allow my team to carry on our research and recruit additional junior clinicians into the team.

Currently, I have been supervising research projects, both clinical and laboratory bases. I am mentoring master and PhD students to develop the skills required for conducting research in oral health. I have been working in collaboration with the KKU Faculty of Pharmaceutical Sciences to develop innovative treatment for pediatric patients.  As part of the KKU medical hub, I have expanded my expertise in taking care of young patients who had medically compromised conditions and also those with special needs. Our dental school plays a major role in the KKU Cleft Center, which delivers multidisciplinary treatment for individuals with oro-facial clefts and craniofacial anomalies. This center has built upon the efforts of many medical and dental specialists, including pediatric dentists who provide oral health care and interceptive orthodontic treatment as part of the holistic protocol. These has given me the experiences in participating in such a competent network.

I believe that my expertise gained during these valuable years have armed me with the necessity competency to participate and lead the projects, particularly on the aspect of clinical research and oral health in children.

Growing up as a young lad in a rural Kenyan village some decades ago, was full of fun. It was a life rich in local health traditions that each child was expected to master and apply. However, as the rest of the world opened up to me during the period I was away in high school, Kenyan and Foreign Universities, I was faced with new health issues and approaches that were more intriguing and quite different from what I had got used to. Today, I look back with nostalgia on some of the simple health tools and health education that were passed down to me by my grandparents, and which are now relevant, particularly during this Covid-19 pandemic. In those days, greater emphasis was placed on washing of hands, cleanliness of your clay- or wooden-based utensils, clean cooking and eating area. You were also encouraged to clean your hands after any handshake so that you avoid contaminating yourself and the environment where you are. These were simple instructions then, but with the current Covid-19 infection, I find myself being reminded by the health authorities to apply almost similar regimes in controlling the spread of covid-19 infection, a regime my grandparents had long mastered in their yonder years.

Nonetheless, my work as lecturer and researcher in dentistry at the University of Nairobi and my association with DeRouen Center for Global Oral Health, has given me yet another opportunity to understand better the importance of global oral health and especially as it relates to the oral health of the child. The research collaboration I have enjoyed with Dr. Ana Lucia Seminario, the Director of DeRouen Center for Global Oral Health, together with other colleagues affiliated with this Center, has further availed to me additional opportunities to this end, and even my current activities in relationship to the oral health of the vulnerable children from communities living in my own country, Kenya. I now understand their greatest oral health needs and priorities, given that many of these children come from communities that have their own peculiar challenges and health traditions.

A couple of years ago, I was shocked to learn of an existing traditional health practice in some communities in Kenya, and in other East and Central Africa nations. This practice, I learnt, goes way back to the early 20^th century when some tribes began applying it to their children as a cure for childhood diseases like fever, vomiting and diarrhea. This practice, otherwise called Infant Oral Mutilation or IOM, affects millions of children from this region. It involves the gouging of developing primary canines of a child younger than 24 months. The developing primary Canine tooth germs are considered to be ‘WORMS’ that cause childhood illnesses. The scary part of the practice is that the operators, who are usually traditional healers/herbalists, religious leaders, traditional birth attendants and even family members, use unsterile crude instruments (sharpened, stones, bicycle/umbrella spokes, nails, razor blades, wires, etc.) to gouge out these canine tooth germs. No painkillers, sedatives or anesthetics are used during the operation, thus predisposing this child to excruciating pain, besides hemorrhage, shock, septicemia, tetanus, anemia, osteomyelitis, meningitis, hepatitis B and HIV/Aids. As a result, some children have died from IOM practice, and those who have survived have ended up with unnecessary dental spaces within their jaws (see Figure 1), displaced permanent successor teeth, developmental defects of permanent and primary teeth and psychological trauma. Furthermore, with the advent of Covid-19 pandemic, the close contact made amongst those involved during the operation predisposes them to this infection, since the use of personal protective equipment does not form part of the armamentarium. The suffering these innocent children have to go through has made me to be an advocate for its eradication, making me travel to various Kenyan rural areas in an effort to help the communities understand about the dangers associated with this archaic practice to the growing child.

Unfortunately, this primitive, painful, barbaric and harmful practice called IOM has evolved into a global health concern, due to migration/translocation of some of the members from these communities to other countries where IOM does not exist. These migrants have continued to subject their new-born children to IOM in their adopted countries or trek back to their communities in Africa to have the child go through the practice before returning back. Consequently, IOM can now be found in these African migrants living in the USA, Canada, Sweden, Denmark, Germany, UK, Israel, Australia, New Zealand, etc, making IOM “a global public health and child abuse” issue and further a violation of the UN Convention on the rights of the child, that needs to be condemned by all who care and defend and protect the quality of health of the child. You could be the next advocate for its eradication, but the fact is that these helpless children require this protection now, more than ever.

Hi, my name is Janella Bermúdez and I’m currently a fourth-year dental student at the University of Washington. I am one of eight students selected to be in the Regional Initiatives in Dental Education (RIDE) Program, an educational track of the UW. Through community-based experiences, RIDE develops socially responsible dentists who foster a commitment to improving the oral health of vulnerable communities.

Being a RIDE student fortifies the deep importance of solidarity with the underserved. During the summer quarter of my second year, I had the opportunity to complete a clinical rotation at a community health center in a farming community. This experience increased my knowledge in caring for diverse populations and allowed me to learn about the outreach done to connect migrant farm workers to the clinic and help them become patients. I will return to this same community for the last half of my fourth year and I am excited to be a part of a team that provides dental care to communities in need.

Joining the DeRouen Center

I am honored to be an intern at the UW Timothy A. DeRouen Center for Global Oral Health. The work done by the DeRouen Center shows me what empowering communities looks like intentionally and actively. I joined the DeRouen Center because I recognize the importance of global oral health in dental school education and the importance of becoming a global citizen. I believe global oral health means being intentional about how we heal communities in need. Health is not intended to be localized; health inequities of the underserved are a similar fight across the globe. Learning from communities abroad and building international partnerships benefits our home communities as well.

During my time here at the DeRouen Center, I applied to the Northern Pacific Global Health Research Fellowship to work in Kenya and I’m excited about the opportunity to witness global oral health out in the field. As I’m graduating from dental school, my time at the DeRouen Center has helped to expand my perspectives and to seek opportunities to make an impact in global oral health.

Former Dean of Faculty of Dentistry, Thammasat University, Thailand

In 2019, I was invited to participate the International Symposium of DeRouen Center for Global Oral Health at University of Washington, under Director Dr. Ana L. Seminario. This meeting reminded me of my involvement with Oral Health at the World Health Organization (WHO) which I have served as an Expert Panelist on Oral Health for many years. The official meeting of WHO includes expert participants from many regional offices and, in many occasions, I was invited as representative of the Southeast Asia Regional Office where Thailand is an active member.

In the past decade, one of the activities of the WHO is to provide consultants to developing countries worldwide. I had the privilege to be short-term consultant for oral health in a few countries such as Dental education and dental public health in Laos PDR, and Myanmar; De-fluoridation to prevent fluorosis in Tanzania, India, and Sri Lanka; Atraumatic Restorative Treatment (ART) for appropriate dental restorations in Bhutan, Indonesia, and Syria. It was necessary to study the local health and oral health system and situation in advance, as well as seek the advice of local authorities during the visit. First-hand information about the people through direct dialogue was key input for the WHO consultants to develop a practical oral health plan with appropriate technology. My latest activities with the WHO was involvement in the Myanmar First National Oral Health Survey in 2016, followed by using collected data for planning the National Oral Health Strategy in 2018. Then in 2019, the Ministry of Health and Sport organized the WHO Regional side-meeting with the Asian Chief Dental Officers Meeting (ACDOM) in Mandalay, Myanmar.

Communication is much faster now through internet and international meetings, both face-to-face and virtual. But regional experts are still needed to share their experiences with well-known faculty members from highly developed countries. In order to achieve the Sustainable Development Goals (SGD), health and oral health goals needs to be designed to suit the local as well as global development. The balance between high-ended advanced and appropriate technology must be carefully considered for many developing countries to be economically feasible, and acceptable to achieve better oral health of the people worldwide.

I am excited to learn that the DeRouen Center for Global Oral Health at University of Washington has projects in many continents such as Thailand, Kenya, and Peru. I sincerely believe that the DeRouen Center for Global Oral Health will be the focal point to develop oral health experts for better oral health globally, under the leadership of Prof. Timothy A DeRouen as Chair of the Board of Directors and former Dean of the School of Dentistry, University of Washington.

The first step in my Fogarty journey was a one-week long orientation at the NIH Headquarters in Bethesda, MD. The first two days of orientation involved going through an intensive Methodology workshop, and trainees can choose between quantitative or qualitative methodology approaches, dependent on the nature of their project. In these workshops, you get a crash course in data collection, management, and analysis that is pertinent to global health research.  Every morning of orientation, there were breakfast networking sessions with directors of different NIH centers. I was one of the two people involved in the field of dentistry, and the first dental student to have ever received the award, which gave me the opportunity to have casual conversation with the director of the National Institute of Dental and Craniofacial Research (NIDCR), Martha J. Somerman, DDS, PhD. It was a rare opportunity to have a one-on-one conversation over breakfast with the director, an opportunity I know many dental researchers will never have. Further, this Fogarty orientation period provided us with more opportunities to interact with some other greats: Anthony Fauci, the immunologist and director of the National Institute of Allergy and Infectious Disease who made significant contributions to HIV/AIDS research and advocacy and is now leading the nation in the battle against COVID-19; Francis Collins, the director of the NIH who also led the Human Genome Project; and Roger Glass, the director of the John E. Fogarty International Center.

The beauty of the Fogarty Fellowship is how dynamic the fellowship is, and how different everyone’s experience is. The nature of public health research, especially Global Health, is that there is an ebb and flow of the workload while you wait for approvals or face unique barriers in implementing your study. Fogarty fellows and scholars are diverse- but, the beauty of the Fogarty Fellowship is that it can be tailored to the stage you’re at in your education. For example, several participants are still students in professional or grad schools, while others have recently graduated from their doctoral program. I was able to join an ongoing study in Nairobi (already with IRB approval), which I feel is most appropriate for my level of research experience. However, others, usually early career researchers, are implementing their protocols with no foundation to build from.

Over the past year I have grown as a researcher, having been able to dedicate most of my time to reading scientific literature, career development, writing, and discovering new funding opportunities.  My consortium, NPGH, conducted weekly video calls that are aimed at professional development. The topics of these calls range from tips on getting through the IRB approval process, manuscript writing, fostering a positive mentorship experience, etc. We are also given the opportunity to practice presentations about our work followed by constructive feedback from our peers. Each consortium provides different experiences and learning tools for the fellows and scholars. Thanks to my mentor Dr. Kemoli, I sat in on some classes and seminars at the University of Nairobi School of Dental Sciences, and spent some time with fellow dental students to understand more of what their experience is like being a dental student in Kenya.

While living in Nairobi, I joined a local cycling group on the weekends for different bike tours around Nairobi and the surrounding areas as a way to meet friends and see the country on two wheels. Nairobi was a great city to meet new people and had so many things to do- from hiking Ngong Hills to visiting a local art gallery. I was also lucky to have the support and encouragement from my mentors to take time to travel around Kenya, East Africa, and wherever else on the continent. My mentors stressed the importance of traveling during your Fogarty year- it gives you room to grow as a global citizen, to be more immersed in local culture, and to network and make connections. I was able to travel with other Fogarty trainees this year throughout Tanzania, Kenya, South Africa, etc. and had several other trips planned in the region before the pandemic hit. While in Dar es Salaam, Tanzania I was able to visit the only other dentist in the Fogarty program, Dr. Kasusu Nyamuryekung’e at the Muhimbili University of Allied and Health Sciences School of Dentistry.

 

 

 

Justin is a third-year dental student at the University of Washington. He graduated from Brigham Young University with a degree in Physiology and Developmental Biology and is passionate about the health-care field. Justin lived in São Paulo, Brazil for two years as a volunteer through church and loves to learn about cultures and people around the world. He enjoys playing and spending time with his daughters and watching sports with his wife.

Hi, my name is Justin. I’m currently a third-year dental student at the University of Washington and have been enjoying my experience so far at the DeRouen Center for Oral Global Health.

My journey in becoming a future oral health care provider has been an interesting process to say the least. I distinctly remember the day my mom brought a library book to our home (I am not sure how old I was, but I was probably in elementary school). It was a photographic book about the careers of cardiothoracic surgeons. At that moment, I knew that I was destined to become a medical doctor.

Fast forward to my junior year of my undergraduate career. The many years of sweat and tears had paid off so far. I just needed to take the MCAT and send out my application. I happened to have the invaluable experience of working as a medical scribe at an emergency department. There, amid the chaos of first responders running through the ambulance bay and the constant beeping of monitors recording vital signs, the physicians were collected and totally in control. It seemed as if there was nothing that they couldn’t do; from trauma to infectious disease to neurological disorders, they completely embodied the concept of “jack of all trades.” Yet there was one population that always seemed to be beyond their reach: patients with dental pain, especially those lacking access to regular care. I remember these patients in excruciating pain entering the emergency department well past midnight, only to leave again after being handed a paper with a list of local dentists and a prescription for antibiotics.

I couldn’t help but think about those patients long after my shifts were over. I would wonder if they ever received the treatment they desperately needed. Somehow, these patients reminded me of the people I met when I lived in São Paulo, Brazil for two years as a volunteer for my church. I remember that certain people, especially those in poorer areas, were especially susceptible to lack of access to adequate dental care. I remember that these people often had difficulty in many aspects of their life due to poor oral health, including difficulty eating and speaking, suffering through severe pain, and being self-conscious of their dentition. That’s when it struck me that oral health disparities weren’t just a problem in my home country; rather, they span across the entire globe.

I love working with the DeRouen Center for Global Oral Health and look forward to doing my part to help address these very real and concerning problems in our society and around the world.

Meet Sara Stanley

Hi, I’m Sara Stanley and I’m the new program manager for the DeRouen Center for Global Oral Health.

Why I chose public health

I chose to go into public health because it is an interesting and ever-evolving field. As the current COVID-19 pandemic shows, once basic public health breaks down, people cannot work, take care of their families, or interact with their communities in a normal way. Public health is the pulse of our society – without basic metrics of public health people are not able to pursue their daily lives.

I have worked in different aspects of public health and research over the duration of my career, including community physical activity, organ donation programs and low SES population access, behind the scenes managing grants and contracts, and now in global oral health. Every area has been interesting and full of surprises – working with new and interesting people and learning about new areas of national and global health.

Joining the DeRouen Center

I’m excited to join the DeRouen Center and be working in the oral health field. There is so much to do, as many people around the globe do not think about oral health as part of standard public health. But it is. As anyone who has ever had an urgent dental issue knows – it cannot be ignored. And the way oral health manifests in disease populations such as HIV has many parts of the world needing urgent oral health care in conjunction with their main disease treatments.

Hi, I’m Susan Lee and I’m fourth year dental student at UW.

Why I chose dentistry

My decision to pursue a career in dentistry started with a mission trip to the Hill Tribes in the mountains of Chiang Mai, Thailand. I spent a week in the Hill Tribes, making friends with children my own age. Despite the cultural and language barriers, I sensed the heartfelt appreciation of the tribespeople from their small gestures and genuine smiles – toothless smiles. Severely lacking oral healthcare amongst the tribe came as no surprise, a result of their financial inability to leave the mountains for adequate treatment and lack of preventative education. Many of the adults were missing teeth and children suffered from rampant caries at an early age. Witnessing firsthand the suffering caused by inadequate oral care, I wanted to drive change in a more enduring way, through working toward a career in dentistry.

Joining The DeRouen Center

I went back to the same Hill Tribes every year for seven years and I’ve always longed to return to the mountains in Thailand to implement oral healthcare for the tribespeople. Working with The DeRouen Center allowed me to advocate oral healthcare for not only the local communities near me in Seattle, but also globally for communities of different cultures experiencing healthcare barriers.

A Reflection from the Chair of the Board of Directors, Timothy A. DeRouen, PhD

As we celebrate the success of this first fundraising breakfast, it is perhaps timely to reflect on the progress made by the Center up to now.  When I retired a couple of years ago, I turned over a Center to Dr. Seminario that had its primary focus on South East Asia, through a Fogarty International Center training grant designed to enhance clinical research training for faculty in dental schools in Thailand.  That training grant has now run its course, and the faculty at Khon Kaen and Thammasat Universities in Thailand now have a planning grant from the Fogarty Center to apply for their own training grant and become a resource for other dental schools in South East Asia. If they are successful, it would be a desired outcome for our efforts, and we will celebrate with them.

Since Dr. Seminario has become Director, she has extended the reach of the Center to include active research collaborations in Peru and Kenya, as well as initiating research in Seattle on refugees.  This has been done in conjunction with existing research projects in Peru and Kenya by faculty in the UW Department of Global Health, and these collaborations show promise to attract significant new research funding.  At the same time, the interest in the oral health of refugees in Seattle and elsewhere in the State of Washington has drawn encouragement from administrators and politicians with responsibility for refugee health.

In moving in these new directions, the Center has attracted the interest of undergraduate students, dental students, graduate students in Public Health, as well as volunteers.  This has allowed the Center to undertake activities such as the very successful symposium a year ago and the fundraising breakfast this year.  This kind of progress has been phenomenal since there have been very limited resources to support these activities.  The fundraising breakfast will provide some resources for future activities, but the future of the Center will depend on more fundraising and success in grant applications.  Hopefully, these efforts will be successful, and the exciting potential of the Center demonstrated thus far will come true. I invite you to join me in looking for ways to help the Center find the resources to ensure its future success.