Oral health campaign beset by teething problems
Text and photo by Yoko N. Sari
JAKARTA (JP): Yos Andesbon, a self-taught dentist, practices on the sidewalk of Jl. Gatot Subroto, a main thoroughfare in South Jakarta.
The 35-year-old Yos sees his work as a public service, providing quick, painless and inexpensive treatment, as well as dispensing drugs to patients who need them.
Judging by the flocks of customers that come for treatment, his business is booming.
Never mind the dust, the exhaust from passing cars, buses and trucks, or the lack of hygiene. Many people find his treatment effective, at least that's what the man who hails from Medan would have you believe.
"I've been doing this since 1984, and all praise to Allah, I haven't received any complaints from customers about infections or anything," Yos told The Jakarta Post as he was busy cleaning a patient's teeth.
In this year, which the World Health Organization (WHO) has declared as the Year of Oral Health, Yos's sidewalk practice can be seen as either a boost or an impediment to increasing public awareness of oral health, particularly dental health.
In Indonesia, as in most other developing countries, there remains a tremendous ignorance among the people about the importance of regular dental checkups.
Last resort
Going to a dentist is considered only as a last resort for most Indonesians. Or as WHO puts it, "pain and pay" is still the norm for most people in developing countries.
Indonesia is joining this year's WHO campaign to promote oral health, although as one health official pointed out, it is not on the government's list of health priorities.
Nor is it a priority for the bulk of the population.
"I only have my teeth examined when I feel pain and need to get fillings," said Jovita, a 26-year-old lecturer at the School of Social and Political Sciences of the University of Indonesia. "But if I can deal with the pain, why should I go see a dentist?"
Her opinion is echoed by many Indonesians, most of whom still shun doctors, opting instead for traditional treatment and traditional medicines.
Ingrained attitudes seem to be the biggest obstacle to promoting oral health. Admittedly however, Indonesia suffers from a shortage of dentists.
One official statistic shows that each qualified dentist in Indonesia serves 22,500 people. Yet another figure shows that some 1,100 dentists are currently unemployed.
The problem lies in the poor distribution of dentists, with most bunched up in major urban centers. An official recently remarked that many female dentists would rather remain unemployed than work in remote areas.
Another major obstacle to promoting oral health is money, or lack of it.
The cost of dental checkups is exorbitant for most Indonesians, and dentists have only themselves to blame.
"We cannot interfere with the way dentists set the fees at their private practices," says Zaura Anggraini, a board member of the Indonesian Dentist Association (PDGI).
She quickly adds that the cost of visiting dentists in hospitals or community health centers is quite low.
A private practice using laser beam technology charges Rp 120,000 (US$56) per quadrant for cleaning the caries, and $150 to $240 per filling depending on the extent of the damage.
Zaura says the high cost is due to the large investment dentists must make to buy equipment.
A dental equipment supplier in Central Jakarta claims that the cheapest set of dental equipment costs Rp 10 million ($4,683), while a set of laser equipment could cost upwards of Rp 100 million.
"It is up to the dentist to choose whether to purchase cheap or expensive equipment," said Soetiyono who runs a dental equipment supply shop.
"Many of them invest heavily simply to build their reputations, furnishing their practices with expensive equipment to make their patients more comfortable," Soetiyono said.
Statistics
WHO statistics suggest that dental decay and other related diseases in developing countries are not as severe as in the more advanced countries, mainly because more affluent people tend to eat more sugar and starch, which are both harmful for teeth.
The PDGI, in connection with the Year of the Oral Health, is also doing its part.
It is launching a campaign urging people to have their teeth checked more regularly, at least once a year. It is also sending teams to selected villages to offer free dental care services.
The government is also taking an active role. By next year, it plans to furnish all the community health centers across Indonesia with dental care equipment.
Most elementary schools in Indonesia already have programs to bring in dentists regularly to examine the pupils, believing that the habit of caring for one's teeth, like all other disciplines, must begin at an early age.
Unfortunately, this measure is not supported by the capability of the dental care industry, S.L. Leimena, the director general of community health, acknowledges.
It is not followed up with quality service, something which would definitely help boost the children's awareness, he reminded.
"Unfortunately the dental clinics in elementary schools do not yet supply information, such as how to keep teeth clean; most of them only conduct clinics," he says.
The lack of awareness regarding oral health coupled with the messy state of the dental care industry has left a huge gap for self-taught dentists like Yos.
He advises his clients of the need to maintain their dental health, while reminding them that they can do much of the work themselves.
"You don't have to go to dentists to have clean teeth. You can clean them yourself. It's cheaper," he said.
"Sir, you need to avoid tooth decay or you will lose all your teeth," he said while preparing to treat a customer.
For Rp 3,000 ($1.40), a client can have his teeth cleaned thoroughly and leave with a sweet taste in his mouth, apparently from the medicine Yos administered to him.
Yos said the formula contains 15 percent toothpaste and the rest Vitamin C.
"I don't feel numbness. I can still feel the sweet formula though," said one happy client as he left the open-air practice.