Amritasmitham

The Amritasmitham tribal outreach program under the Department of Prosthodontics and the Department of Public Health Dentistry of Amrita School of Dentistry has been running for nine years in the tribal belts of Kerala since 2008. It thrives on the sense of social responsibility and accountability of the medical profession and thereby offers a replicable model to make available rehabilitative services to the unreachable populations.

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About

Indigenous populations across the globe continue to remain one of the poorest and marginalised group. Studies have shown that the health indicators of this population are poor and warrant attention. Compounding this problem is the severe dearth of doctors serving the tribal belts. With such a significant poverty gap, it may be stated that the tribals face the brunt of the 3As – availability, accessibility and affordability.

The tribal communities of Kerala are geographically isolated and extremely deprived. Several infectious and chronic diseases are known to exist including respiratory infection, diarrheal disorders, skin infections, malnutrition, anaemia and degenerative disorders like diabetes. Oral diseases are no different and have been found to be highly prevalent. Coping with the burden of more life threatening diseases, oral health is seen as less of a priority. As a result dental disease and the lack of awareness about oral health, the result is extraction of teeth and thereafter a compromised life due to edentulism.

Among the tribals, edentulism is accepted as a way of life and a part of the natural process of ageing. Difficulties associated with mastication of food, clarity of speech or aesthetics are often buried under the load of such beliefs.

Mission & Vision

The mission of this program is to reach the unreached populations of Kerala, who often are geographically isolated and economically poorly equipped to seek treatment for dental ailments. The program also aims to provide healthcare professionals with an opportunity to have an experience of the health disparity faced by the tribals. It is a first-hand and very rewarding experience of volunteering in suboptimal conditions. Doctors who experience this meaningful way of making a difference in so many people's lives are eager to keep giving. The program envisions to be able to provide the highest possible level of care (within the limitations of the program) to all tribals who seek it. This is an attempt at achieving holistic care for all those who deserve it.

Process of the Camp

A location is identified based on the treatment needs of the population and the practicality of conducting a denture camp at the location. The camp site is assessed for its nearness to the colonies and presence of basic minimum facilities for the conduct of the program.
A meeting is held with the local bodies in the area which includes representatives and officials from the government.
A screening is carried out at a minimum of four locations and possible cases are identified and registered to the program.
An estimate of possible expenditure towards the camp is presented and funds are provided by the Amrita Institute of Medical Sciences.
Initial diagnostic procedures are carried out.
Following this, treatment plans for individual patients are charted out and initial lab works are completed in the institution.
An exhaustive list of all supplies (in terms of manpower, equipment and materials) is created.
A call for interested doctors within the institution is put out. It is clearly informed that the camp is a service with no remuneration and sub optimal working conditions. Only volunteers are involved.
The participating doctors are oriented towards the camp.
Teams composed of doctors and technicians are created and patients are assigned.
Following this the teams work round the clock for three continuous days at the camp site. These sites most often have issues of proper lighting and adequate space. Working conditions are suboptimal.
All the lab work is carried out at the field with the help of skilled technicians.
On the third day of the camp dentures are delivered to patients totally free of cost.
Reviews are carried out for the delivered dentures at the interval of 15 days and then again at one month interval.

Need of the Program

The burden of oral diseases is very high in the region.
Studies have shown that the prevalence of edentulism is as high as 40.2% in females and 59.8% in males.
Oftentimes, the desire for dentures for the purpose of better mastication or speech does exist, however, the poor social determinants of health push such aspirations to the bottom of the health ladder.
Hence, in a community where availability, affordability and accessibility to such services is nearly nil; this program has a major role to play in improving the quality of lives of such populations.

Achievements

The very existence of this program in the region for nine years reflects its need among this population.
Over nine years the program has been able to draw volunteer doctors to work in such settings.
While there are constant efforts from the government to attract doctors to work in these areas, camps of this nature definitely do contribute in alleviating a fraction of the health issues faced by the people in this region.
We also believe that instead of imposing, the voluntary nature of services provided by the doctors has ensured that the quality of the program is not compromised.

Future Road Map

The main aspiration for this program is to ensure its self-sustainability. We propose for public private partnership, ensuring autonomy to the program, which aims to create a model which may be replicated in unreachable locations or in geographically reachable yet physically challenged geriatric population. This integration will allow care to reach greater number of needy patients. As dentistry takes strides forward in technological advancement there is a need to extend a helping hand to those who are deprived of basic dental care. In the spirit of human care a true dentist must be able to work anywhere for anybody to the best of his ability.

Over the last nine years a total of 537 dentures have been delivered (including RPDs and CDs). The various sites have been Attapady and Puthukode in Palakkad, Thattekadu and Idamalayar in Ernakulam, Athirapally in Thrissur and Kalpetta in Wayanad district. In 2012, the camp planned in Athirapally had to be cancelled after initial two screening camps. In 2009, as many as 126 denture were provided to the patients. Since 2013, the camp has been held in Kalpetta in association with the Amritakripa charitable hospital located in Kalpetta.