Nepal is currently facing an oral healthcare crisis. Fifty-eight percent of children and 69 percent of adults in the country suffer from bacterial tooth decay. This can lead to infections, gum disease, and chronic pain as well as heart disease and diabetes. A national Oral Health Care Plan was drafted in 2004, but is being implemented at a glacial speed. And thousands of Nepalis in rural villages have no access to basic care such as fillings or even fluorinated toothpaste and water. Meanwhile, intense superstition surrounds dental care, including the belief that tooth extraction can cause blindness. In Kathmandu, people nail coins to a tooth god shrine to heal their mouth pain.
Enter Laura Spero, who first came to Nepal a decade ago to teach English at a school in the village of Kaskikot. Set at the base of the Annapurna range, the rural village—and those surrounding it—is a community of subsistence farmers. Most people live in mud houses, trek nearly an hour during the harvest to plant their fields with wheat and rice, and get their daily milk from buffalo. They have sporadic electricity and no plumbing.
In a village like Kaskikot, the government health post treats basic illnesses, but does not provide oral health care. Laura remembers a woman coming to her complaining of awful mouth pain. The woman had a severe infection, but when Spero went to the local health outpost to investigate, all she found in the way of dental care was a rusty pair of pliers. At the time—she was just 23—she believed that oral health would be a relatively simple problem to address.
Ten years later, she has brought oral health care education and treatment to 36,000 Nepalis in five villages. But the process has been a struggle—one that has fundamentally reshaped Spero's life and the lives of the Nepalis she has worked with for so long. She has learned the perils of "voluntourism," dealt with local opposition and political instability, and invested thousands of dollars and years of her life in a program far from her own home. Now, she is both expanding her program and implementing a handover to local governments, which ideally, should absorb the program into its own health offices. Of course, this brings a new host of challenges.
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