Volunteering for the Long-Term Good
Kevin S. Hardwick, DDS, MPH
There is a long and rich tradition of charitable service and volunteerism in dentistry. This service can range from free or discounted treatment for underprivileged patients in one’s practice, to donating half a day per month in the local county health clinic, to trips to developing countries to provide care to people who otherwise have no access to quality care. Dentists and other oral healthcare providers, especially those in industrialized free-market societies, have benefited from high-income jobs and often feel the desire to give back something to society. Many dentists also have the flexibility to schedule time for volunteer activities. When this motivation and ability is coupled with a sense of adventure and a desire to travel and see the world, dentists often seek international volunteer opportunities. Although international volunteerism dropped significantly after the terrorist attacks of September 11, 2001, the last few years have seen a return to pre-9/11 levels. In the United States, higher practice incomes may also play a contributing role in the increase in volunteerism.
Whatever the motivation, the first international volunteer experience usually is eye-opening and life changing to some extent. My first position as a newly licensed dentist was as an international volunteer, spending a year working in a Jamaican clinic sponsored by a private school and an international charitable foundation. I began my year as a comfortable Texas suburbanite and ended it as a global citizen. While not all volunteers will respond to the same degree, there is no doubt that volunteering and working in a different culture tends to take one’s eyes off of oneself and expand one’s perspective. Whether they last a week, a year, or a lifetime, these opportunities allow the volunteer to provide care to a population that truly needs that care and may not receive it otherwise. Any person who goes to help and gives his or her best work for any amount of time is doing a great service, and the gratitude of the patients and the sense of accomplishment is more than sufficient compensation.
While the impact on the volunteer is important and undeniable—as is the immediate benefit to the patients who receive care—there is a growing discussion regarding the real long-term benefit to the local community of efforts that focus only on the immediate provision of care. In Jamaica, I extracted more than 3,400 teeth over the course of that 1 year, and I had a sense of satisfaction at the end of every day that has not truly been matched since that time. However, when I left, the community was no better off and was still dependent on the next foreign volunteer to staff that clinic. In recognition of this fact, public health planners and policymakers are increasingly looking toward models of volunteerism that are designed to help develop and strengthen the local healthcare system. For a deeper discussion of this longer-term approach, readers are directed to a fascinating article written by Drs. Murray and Gerri Dickson, published in the Journal of the Canadian Dental Association,1 and later republished in Developing Dentistry. Other articles on this subject can be found by referencing that article’s bibliography.
Governmental efforts have long focused on developing local infrastructure in many areas. The United States Agency for International Development has worked in development for many years. While working with the World Health Organization, I became familiar with work by the Danish International Development Agency (DANIDA), which involved long-term development activities in oral health in Africa. However, most nongovernmental dental volunteer organizations continue to operate under the short-term clinical service model.
Fortunately, some organizations have begun moving toward identifying more opportunities for volunteers to participate in long-term development. One United States-based volunteer organization taking the lead in this direction is Health Volunteers Overseas (HVO), a private nonprofit organization committed to improving healthcare in developing countries through training and education. By emphasizing teaching rather than service, HVO aims to create a local cadre of trained health workers who can teach others. Rather than encouraging dependence, this approach hopes to build an ongoing capacity that will provide long-term benefit to the local population.
The American Dental Association (ADA), recognizing the value in this approach, has partnered with HVO to develop international dental volunteer opportunities in which ADA members can participate in infrastructure building activities. ADA/HVO dental projects are located in various spots around the globe and include general practice, specialty practice, and public health training initiatives. Collaborators include ministries of health, dental schools, and local dental associations. More information regarding HVO dental opportunities can be found on the ADA’s Web site: www.ada.org/ada/international/volunteer/overseas.asp.
Unfortunately, this new model tends to scare away some potential volunteers. As a member of the ADA/HVO Steering Committee communicating with interested dentists, I have witnessed excitement about volunteering turn to insecurity about the ability to teach. Dentists seem to be most comfortable performing procedures. Much of this has to do with the technique-driven and independent nature of dentistry and dental education in our country, as well as the lack of training in public health principles and education communication—other than the education of patients. These new models need to incorporate a combination of communication training and support (and some hand-holding), along with providing the opportunity for the oral healthcare worker to perform some clinical care as part of the trip. In many of the ADA/HVO projects, volunteers provide clinical care, but always in the context of working with local dentists or dental students. More emphasis is placed on allowing the volunteer to share his or her expertise with local care providers. This emphasis follows the familiar adage of “giving a fish” versus “teaching to fish.” The volunteer in this new model gets the satisfaction not only of giving back and helping those less fortunate, but also of sharing knowledge and helping out fellow healthcare workers who can continue that work on a long-term basis. This satisfaction is evidenced by the fact that HVO volunteers, although somewhat nervous on a first trip, tend to become repeat volunteers.
Research and evaluation of most volunteer efforts has been, at best, an afterthought. It is probably safe to say that most foundations or religious organizations concentrate more on doing good than in assessing the good that is being done. Epidemiologic and health-systems researchers should find ways to incorporate measurement of the impact of volunteer oral healthcare workers, and volunteer organizations should develop tools to assess both short- and long-term outcomes.
In no way am I trying to discount the many organizations and volunteers providing short-term clinical care. There are tremendous needs, and local communities are grateful for any assistance that can be provided. But immediate clinical care should always be provided as part of a larger plan to improve both the health status and the overall healthcare environment in a local community, and volunteers should be looking for ways to share their knowledge, expertise, and technology with colleagues who can continue working to improve oral health long after the volunteer has returned home.
The opinions expressed in this column are those of the author and do not necessarily represent the views of the American Dental Association or the National Institute of Dental and Craniofacial Research.
1. Dickson M, Dickson GG. Volunteering: beyond an act of charity. J Can Dent Assoc. 2005;71(11)865-869. http://www.cda-adc.ca/jcda/vol-71/issue-11/865.pdf. Accessed November 5, 2008.
About the Author
Kevin S. Hardwick, DDS, MPH
Chair, Committee on International Programs and Development
American Dental Association
Chief Research Training and Career Development Branch
National Institute of Dental and Craniofacial Research
National Institutes of Health
Volunteer Information from the ADA
The ADA has an informative and resource-rich Web site on international volunteerism, including a directory of many different volunteer opportunities, both service and education-based. Also included is a guide to international volunteerism, which covers most of the important issues to consider before volunteering.