Reasons for Going on STMs

Recruitment of dental volunteers is the first thing organizations and leaders need for a successful dental STM and a discussion of the benefits of going is helpful. Dental STMs can refresh memories of why dental practitioners entered the profession – the idealism, the compassion, and the desire to help others – which may have been lost in the fog of insurance paperwork or bureaucratic indifference. Mission dentistry can challenge one’s skills and give confidence that fine dental work can be accomplished even in austere environments. The dental professional can brighten lives and teach non-dental staff about a rewarding, healing profession. Even though mission dentistry involves hard work, it can be the kind of “good stress” which lets one sleep well at night and can represent some of the most memorable aspects of a dental career.

For many people, the top reason they participate in STMs is for the life-changing experience they are hoping a trip will bring. A trip can enhance personal spiritual growth as a STM is a contemporary form of pilgrimage.^[7] A improved prayer life, a commitment to resist materialism, and a newfound orientation toward servanthood often result from an STM experience. Dental personnel become ambassadors for faith- based outreaches or humanitarian causes and contribute to the unity between nations, organizations, churches, and other people groups. Traveling to serve fulfills a purpose in life using dental skills to be significant and to make a difference. STM participants can teach and share their knowledge of dentistry, sterilization, and oral hygiene information with international medical/dental professionals and students. Indigenous partners are also often taught dental skills due to the vast dental needs globally.

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Working for Hugs in Guatemala

Travel brings adventure and wonderment. Safaris in Africa, riding camels around the pyramids in Egypt, having a lemur climb on a shoulder in Madagascar, riding an ostrich in Kenya, being presented a Siberian wolf pelt from the commander guarding the Russian-Mongolian-Chinese border, embracing the risks of caring for refugees in a volatile part of the world, or learning to brush teeth with local twigs in Senegal are a few of the highlights experienced by these authors. STMs are educational and give perspective to life. They increase appreciation for what one has and decrease dependence on material things.

Studies document that altruistic behavior decreases stress, increases immunity, relieves pain, improves emotional health, decreases anxiety, relieves depression, increases longevity, and improves social interaction (Detollenaere, 2017; Jenkinson, 2013; Wilson, 2012).^[8-10] Interestingly, these health benefits are tied to giving of oneself and the benefits are not as significant when giving money alone.

STMs are considered a charitable tax deduction either from the dentist’s business or on an “Individual Schedule A Tax Form,” for those who itemize. The Christian Dental Society offers CDS “Designated Fund Accounts” where mission dentists or team members may receive tax benefits for donations and costs of volunteer trips.

The Organizational and Leadership Basics of STMs

Dental STM prospects provide an open door to aid the developing world with a myriad of opportunities and viable groups who are requesting dentists. Hundreds of organizations are listed on the American Dental Association (ADA) website (www.adafoundation.org/ internationalvolunteer), on the CDS website (www. christiandental.org/international-missions), and numerous sites under “dental missions” with an Internet Google search. Personal contacts, churches, volunteer organizations, and dental schools all offer prospects. The ADA Foundation (www.adafoundation.org/en/adaf-international-programs) and the CDS (www.christiandental.org) are great resources for volunteer dental mission trips. The CDS has published Dental Mission Manual for Portable, Short-Term Dental Trips (2015), a comprehensive, practical guide for dental STM teams which summarizes 50 years of dental, missionary veterans’ experience, information, and advice (available on Amazon and Kindle). The ADA has an International Dental Volunteer Guide available at www.internationalvolunteer.ada.org. Dr. Francis Serio’s presentation on “International Volunteer Projects-Part 1–6” is available on YouTube and contains many of the leadership and organizational details for dental volunteerism which were presented in 2015 at the International College of Dentists (Europe). The Global Missions Health Conference (www.medicalmissions.com/ conferences/gmhc) held in Louisville, Kentucky, each November is a large meeting and an excellent place to be encouraged and to network for possible mission locations.

With so many needs and opportunities, the world can be a large and daunting – yet exciting and adventurous – place.

Leaders often say that “a giving heart finds a way to serve.” Initial questions to ponder when choosing a dental mission include the kind of mission one desires. Options include providing care in a clinic versus more austere settings; teaching dental students, dentists, or indigenous, non- medical personnel where there are no dentists; providing care to outreach ministries, disaster relief, and children ministries; and religious versus strictly a humanitarian trip. Is there a connection, desire, or calling for a particular situation? Does the sponsor appear organized with a reasonable leadership and knowledge base pertinent to a dental STM? How much time is available and does the timetable fit with the sponsoring organization’s schedule? Are family members welcomed and do they desire to participate? What are the financial considerations? What are the language considerations? What logistics are needed for the site (housing, safe food, transportation, and communication)? What are the health considerations for the team (immunizations, physical demands)? What are the needs of the site – is it a new project or one already well-established? What is the political, social, and religious stability of the site? Are there legal requirements (licenses, registrations, and permits)?

Always consider the best weather or environmental conditions when scheduling the mission trip, as this maximizes effectiveness and enjoyment. The political climate may not be acceptable during elections or upheavals and national/cultural holidays are also considerations. Since the need for dentistry is so great throughout most of the world, team leaders can plan to go when the conditions are the most favorable and the safest for the team and the patients.

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6-chair dental clinic in Maasai Bush in Kenya.

Leadership and Organizational Hints

Worthwhile organizations begin with competent leaders. A team leader guides, communicate priorities, organizes, and problem solves so that the group can function well and can maintain a unity of purpose and harmony within the group. Managerial responsibilities and duties are often shared, but it is advisable that one identified person coordinates and communicates the myriad of details involved. There is often a sponsor local-national leader as well as a dental team leader and they must work together. Group dynamics must be worked out and the team needs to bond together. Since dentists are independent operators and often desire autonomy, working efficiently as a team on a mission trip requires each individual to adjust, to communicate needs and expectations, and to be especially tolerant of change. The leader tries to be a servant to all and must attempt to balance the individuals’ needs with the purposes and goals of the mission trip.

The leaders communicate the responsibilities and the duties to all team members and support the local/national leadership. This dynamic process occurs throughout the trip. The team supervisor oversees administrative details, finances, timelines, transportation, food, lodging, patient treatment, dental logistics, spiritual expectations, cross-cultural basics, and many of the concerns outlined in the CDS manual. The leader does not do all tasks but must see that it all comes together.

Leaders establish the team vision and direct by example. They take care of the team and place the need of others above their own. The person in charge ensures that organization, priority setting, communication, and proactivity minimize unpleasant surprises. “Shepherd” leaders challenge and stimulate others to grow while encouraging, supporting, and setting boundaries. They promote fun throughout and use humor to lubricate the gears of human adjustment.

A helpful leadership philosophy includes these elements: (1) Take care of the team; (2) communicate; (3) minimize surprises; (4) utilize everyone’s talents; (5) work as a team to support mission goals; (6) convert negative feedback into positive action; (7) support quality patient care; and (8) have fun.^[11]

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Teaching oral hygiene and prevention in Haiti.

Sponsoring Organizations

It is essential to honor and respect the local organization and national people. They are taking time from their responsibilities and busy schedules to host the STM team. As visitors, the team may not be aware of what the locals are going through or facing and the team must help them carry the load. The in-country sponsoring organization is critical to the success of the trip and may or may not be familiar with the special requirements in hosting a dental team. These overseas groups may have protocols and trip details worked out, but it is important that the dental team leader communicates specific dental and team needs. How to support and incorporate a dental team for maximum effectiveness is a dual responsibility of both dental and national team leaders to fulfill the goals of the organization.

The team trusts the host organization to have a focus group of patients, as the dental needs are usually overwhelming. The dental team’s capabilities must be aligned with patient numbers and expectations, and the host organization normally takes responsibility to identify those that will be treated. If patients are not seen that expected treatment, it may damage the reputation of the host organization or cause negative feelings and animosity toward the mission goals. The local sponsors are orchestrating the priorities of which dental clients are seen and the follow-up will be their task. The spiritual welfare of the patients and the outreach to the communities are primarily the responsibility of the hosts.

The number of patients to be helped depends on the hours of treatment time in the day (taking into account transportation and clinic set-up and tear-down times), the anticipated procedures performed (extractions go faster than fillings), and generally limiting treatment to a few teeth on each patient to do the greatest good for the greatest number of patients. The team usually cannot do all the dental procedures nor see all the patients. Leaders can calculate the number of patients that can reasonably be treated in a day and they can be scheduled through lists or numbered cards. Leaders must set reasonable expectations and control the gate (the access to care).

The sponsoring organization should meet the dental team at the airport and accompanies and protects the team from start to finish. The sponsors help plan the budget and advise on all details involved with transportation, food, lodging, legal requirements, immunizations, visas, and tourism. The dental team is supporting the organization and they provide patients, interpreters, introduce the team to the organization’s mission, and give general support in all areas. The leaders must plan for a balanced experience with work, rest, shopping, tourism, and, possibly, faith-based outreach. Flexibility and patience in the face of problems is an expectation and good leaders stay optimistic with an ability to flow with change. The team usually reflects the attitudes of trusted leaders.

The STM team must always remember that they are guests visiting the mission field at the invitation of the national organization. The sponsoring organization introduces the team to their mission so team members can gain a better understanding of the long-range strategy of the organization and how the team fits in. The team has not come to take over the work or to tell them how to do it; the team is there to lend a helping hand. It might be necessary to perform the task “their way” with a cooperative spirit. No job is beneath the dignity of anyone involved in the mission.

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Dental team meeting in Cambodia.

Team Meetings and Team Dynamics

Group meetings and good communication are essential to not only discuss mission trip details but also to build the team, to define roles, to align expectations within the group, and to teach cross-cultural tips. It is vital that volunteers are advised on how to be responsible and respectful team members and guests of the international country. It is extremely important to show sensitivity to host cultures concerning language, traditions, superstitions, and beliefs about health, as well as religious faith and spiritual practices. Leaders should hold daily group meetings to resolve conflict and to keep everyone informed, with established mechanisms in place where suggestions, offers, and thoughts can be tactfully brought forward.

Consider the idea of giving out three “freebies” (verbally awarded) to each team member to be used for mistakes, omissions, or misguided actions. These “freebies” are extensions of grace (unmerited favor) and a gentle reminder that the team is forgiving and will tolerate individual problems or errors (for example, lateness, loss of an item, and a wrong communication). Humor and light teasing are used when awarding a “freebie,” as everyone acknowledges that it is easy for anyone to have lapses when out of normal routines and practices. Perfection is not expected.

Family members, friends, and relationships on the team can be easily thrown out of harmony in an unfamiliar, often stressful, setting. Although dentists are in their usual work mode of doing dentistry (although out of the comforts of their own office), the spouse, family member, or friend are trying to help in a situation where they often have little or no knowledge of their role on how to assist, sterilize, comfort a patient, etc. Dentists must adjust their mentality to not be driven to the efficiency and productivity levels of their home offices. It is helpful if the dentist offers information, encouragement, and reassurance to those unaccustomed to clinic work. It is important to give everyone a job on the team, so they feel useful. It is essential that everyone feels included. Sometimes people get oppositional on no other basis than the unspoken question, “Why wasn’t I included in this decision?”

Tuckman^[12] has a model of understanding team dynamics represented by the stages of “Forming-Storming-Norming- Performing-Adjourning.” With diversity among individuals and the preconceived ideas and expectations each one carries, it is important to communicate when passing through these stages. STM work is dynamic, to say the least. Maintaining group cohesion is every bit as hard as the dentistry and is just as important. Discussing these steps seeks to ensure maximum harmony and efficiency of purpose as rapidly as possible.

1. The “forming” stage is driven by a desire to be accepted and to avoid controversy and serious issues. People are on their best behavior and gather information and impressions. They learn about the opportunities of the mission, the challenges involved, agree on goals, and begin to tackle tasks. It is a comfortable stage where the leaders can be quite directive concerning the details of the trip and the motivation and purposes of the mission

2. The “storming” stage is inevitable and, although conflict may be more or less suppressed, it will be present and is necessary for growth. People deal with issues and differences and often establish a pecking order. Leaders may stress tolerance, patience, open communications, and conflict resolution, as this stage can be destructive. The goal is to help everyone feel safe in sharing input without negative judgment from others

3. In the “norming” stage, the “rules of engagement” and responsibilities for the group become established, and team members often change preconceived views. The team agrees on goals and has a mutual plan. Some do have to compromise their expectations and wishes

4. The fourth stage is “performing,” characterized by a state of interdependence and flexibility. The team knows each other well enough to work together and trusts everyone enough to allow independent activity. The high degree of comfort allows the energy of the group to be directed toward the task with maximum efficiency

5. “Adjourning” is the stage of disengagement and may bring anxiety, sadness, and self-evaluation following the STM.

Ten Commitments for STM Participants^[13]

(1) I am here to serve, not be served. (2) I know the American philosophy of dentistry/medicine does not apply here. (3) I need to do the best I can for the most people. (4) I accept that I will not have all the equipment and comforts of my office at home. (5) I do not know about this culture, so I am here to learn. (6) I am not here to change things, so I will not criticize. I recognize that short-term participants do not know the culture, costs, government regulations, and other constraints with which this ministry operates. (7) I am here to work hard and do more than my share. (8) I will encourage national and missionary staff. (9) I will happily conform to standards of conduct to protect the testimony of this organization/ministry. (10) I will love and respect the patients I treat.

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Training local-nationals to extract teeth where there are no dentists.

How to Perform Portable, Dental STMs

The detailed specifics of “How To” lead and organize a dental STM will have to follow in another article and consult the previously discussed CDS Dental Mission Manual. With modern portable dental equipment, dental treatment can be performed safely and comfortably anywhere in the world. A complete, portable clinic can be carried in four, 50-pound airline checked bags and may possibly be set up in a matter of minutes. There are 33-pound, completely self- contained dental operating units with the full capability for restorative dentistry. A 13-pound dental chair that can support a 400-pound patient and two-pound dental stools with back support are available through the CDS. Certifiable sterilization in a $45 pressure pot with a total turn-around time of only 20 min will work with electricity, gas, propane, stoves, charcoal, or over a fire. These resources are available on the CDS website.