Director and Chairman Department of Oral and Maxillofacial Surgery



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TORU NAGAO

Director and Chairman

Department of Oral and Maxillofacial Surgery

Okazaki City Hospital, Aichi Prefecture, Japan

3-1, Goshoai, Koryuji-cho, Okazaki, 444-8553 Japan

Telephone: +81-564-66-7232

Facsimile: +81-564-25-2913

E-mail: tnagao@topaz.ocn.ne.jp


Dr. Toru Nagao, DDS, PhD, DMSc, is a Director, JICA Medical Expert, and Chairman of the Department of Oral and Maxillofacial Surgery, Okazaki City Hospital, Aichi, Japan and Associate Professor in the Department of Oral and Maxillofacial Surgery, Aichi-Gakuin University School of Dentistry, Japan. He obtained a PhD at Aichi-Gakuin School of Dentistry in 1990. Since 1999 he has been Senior Research Fellow in the Oral Medicine & Experimental Oral Pathology, WHO Collaborating Centre for Oral Cancer and Precancer, Guy’s, King’s & St. Thomas’ Dental Institute, London, UK. Dr. Nagao has publications on the subjects of oral cancer screening, serum antioxidant micronutrients levels in oral precancerous lesions and other epidemiological studies on oral and maxillofacial diseases. He is currently the Research Fellow of the Department of Hygiene, Fujita Health University School of Medicine, Japan and obtained a DMSc in Preventive Medicine in 2006 by his recent work based on a community–based annual oral cancer screening programme.

Dr. Nagao has been contributed to the development of oral cancer control as well as dental education in developing countries. He has been engaged in an overseas surgical mission treating cleft lip and palate patients organized by a Japanese NPO since 1990 in Cambodia and Nepal. From 2001 to 2003, he worked in Sri Lanka as a Chief Advisor to the Dental Education Project in the Faculty of Dental Sciences, University of Peradeniya, which was implemented by Japanese Overseas Development Assistance through Japan International Cooperation Agency. During his assignment he has been active in lectures throughout the world on topics of oral cancer prevention. He organized an oral cancer seminar for regional countries such as Bangladesh, Nepal, Myanmar, Cambodia, Philippines and Madagascar, where oral cancer was the public health problem. Once a year since 2003 he works for the Third Country Training Programme in Sri Lanka as a monitoring and evaluation specialist.



Group Training Programme in Oral Health Sciences for

Asian and African Countries
Associate Professor NAGAO Toru *1, Prof. WIJEYEWEERA L Rufel2

*1Okazaki City Hospital, Japan



2Faculty of Dental Sciences, University of Peradeniya, Sri Lanka2

Background

Currently, 50 countries in the world are recognized as Least among Less Developed Countries (LLDCs) by the United Nations Development Program Committee in 2005 on the basis of per capita GNI (below $750 as of 2003), human resources development (average life expectancy, etc.), and vulnerability of economic structure (share of manufacturing in GDP, etc.). Among those 10 developing countries out of Asia (23 countries) and 34 out of African continent (54 countries) were defined as LLDCs, almost 88% in the world, and many are heavily indebted poor countries.

Most of the LLDCs have no dental schools such as Bhutan, Maldives and East Timor in Asia and many of African countries. Those countries have been dependent to neighboring countries for undergraduate dental education as well as medical education by their national expenses. On the other hand there are some countries having national dental schools but defined as LLDCs such as Bangladesh, Nepal, Laos, Myanmar, Cambodia, Tanzania and Uganda which have a lack of enough budget and human resources for dental education due to the low priority in health sectors. It is widely acknowledged that support for efforts toward the resolution of the problems of Asian and Africa calls for a concerned international effort, particularly in human health. In those circumstances, opportunity of post graduate training programme for oral health sciences would be helpful for oral health personnel who are expected to learn basic dental sciences and stay in their own lands as oral health professionals to support their community people who are suffering from serious oral diseases.

JICA Dental Education Project (1998-2003)

Japanese Government carries out a variety of development projects to support the nation building of developing countries. Under the theme of Dental Education and Oral Health Promotion the Faculty of Dental Sciences (FDS), University of Peradeniya, Sri Lanka received an outright grant from Japanese Government, as the only grant aid programme of this nature in their entire service. Construction of physical facility and installation of various modern teaching, research and clinical equipment which came under the initial phase of the cooperation was successfully completed in 1998. As the second phase of bilateral cooperation, a technical cooperation project was initiated by Japan International Cooperation Agency (JICA) and exchange of knowledge and transfer of technology between Japanese professionals and the Sri Lankan counterparts were carried out effectively from 1998 to 2003. As Chief Advisor, I was assigned to this project during the period of 2001 to 2003. With the technical cooperation for the consecutive 5 years, FDS has achieved a high standard in dental education as well as in delivery of oral health care.



Third-Country Training Programme (TCTP) (2003-2007)

Third-country Training Programme, referred to the acceptance of trainees by developing countries under financial and technical assistance from JICA, has been carried out at Peredeniya University from 2003 to 2007 in oral health sciences to share the knowledge and expertise acquired through JICA Dental Education Project. This 4 to 5-weeks group training programme is designed for those who have no access to any postgraduate training courses in Asian and African countries. This arrangement was thought to provide the advantage of training in neighboring countries with similar social and cultural environments

A preliminary survey for the training programme was conducted in 2002 to identify training needs, assess the situation of dentistry in terms of education and practice and inform training opportunities available to neighbouring countries. Both Japanese and Sri Lankan experts visited dental universities in responded countries; Bangladesh, Myanmar, Cambodia and Nepal. Questionnaires related to the above issues were sent to African (Kenya, Tanzania and Uganda) and other Asian countries (Laos, Maldives, Bhutan, Vietnam and Pakistan).

Reviewing the observations made by the project, the following deficiencies were identified.



  1. Lack of manpower to attend dental problems of the population; most doctors like to practice in urban area.

  2. Lack of facilities with

      1. Little auxiliary staff such as dental nurses, minor staff and technicians

      2. Many dental chairs were out of order.

      3. Poor sterility of the operation theatres and in treating patients

      4. Limited specialty of dentistry

      5. Lack of diagnostic oral pathology services

      6. Minimal facilities for services and maintenance of equipment

  3. The priority given by the Ministry of Health to dental sector was minimal with no proper allocation of budget and effort in identifying many difficulties experienced by dentists.

  4. The field of basic sciences was always neglected in most universities in both facilities and human resources.

The survey concluded that although all these countries supported by Overseas Development Assistance (ODA) from foreign governments or international NGOs’, there still critical situation existed in terms of facilities, equipment for teaching particularly in human resource development in basic sciences. From the results of this survey mission, the project regarded the training programme as an appropriate means for supporting the neighboring countries and also feasible for the future sustainability in management of the Dental Hospital and FDS. Based on the needs assessment and fact findings, FDS and JICA prepared and implemented it as follows:

Aim: To impart knowledge and skills in various fields of clinical dentistry and related basic sciences.

Training methodology:

The course was conducted in the form of lectures, clinical demonstrations, chair-side clinical discussions, hands-on sessions at FDS & in study tours.



Training courses offered in the TCTP:

  • Introduction to fixed appliance

  • Restorative management in periodontics

  • Diagnosis and management of periodontal disease

  • Introduction to basic endodontics

  • Diagnostic oral and maxillofacial pathology

  • Basic microsurgery techniques

  • Minor oral surgery/ surgical removal of impacted teeth

  • Surgical treatment of oral cancer/excision of tumor and reconstruction with random and pedicle flaps

  • Effective teaching in dental sciences

  • Microbiology of oral diseases

Outcome and discussion

As of 4 years period from 2003 to 2006, 45 trainees participated from 12 countries. At the end of the programme, most participants acquired adequate knowledge and skills in relevant disciplines to internationally accepted levels in order to establish/develop oral health care systems for the community that they served. Although time was limited for sufficient coverage of the course content, most participants were satisfied with the course topics, depth of the content, logical order, lectures, practice in the clinics and discussions. On the whole, the TCTP was well evaluated in terms of its validity, efficacy and impact to the oral health promotion of participants’ countries. Continuous monitoring of all the participants by the trainers should be practiced whether they return to their position and disseminate their knowledge and skills acquired from the course.



Conclusion

So far, the TCTP is the only group-training programme held in developing countries to cover the comprehensive oral health sciences supported by international organizations. In 2003, having and sharing experience working together for the last 5 years in the dental education project both JICA and FDS felt that the time had come to extend their services to neighboring countries. State of the art facilities and equipment and trained staff available at FDS were good assets to carry out such a service. Dissemination of knowledge and technology through training programme could be an ideal way to assist these countries in order to uplift their oral health services. The training programme matched with the Sri Lankan national policy for the expansion of the higher education services to foreign students with the support of the Ministry of Tertiary Education and Training. Therefore FDS in collaboration with JICA decided to organize the TCTP. In addition, it could motivate FDS to sustain themselves as the Centre of Excellence for oral health sciences in this region.



2007 is the final year of this training programme, however, newly designed training course targeted for Africa should be expected in order to cope with many conflicts related to health care and to support the human resource development in the region.

References

  1. Japan’s Medium-Term Policy on Official Development Assistance (ODA), Chapter 3, Part III. ODA DISBURSEMENTS IN FISCAL YEAR, 2002.

  2. Report on Preliminary Survey for the 3rd Country Training Programme and Seminar on Oral Cancer Control, JICA Dental Education Project, 2002.

  3. Third Country Training Programme, General Information Handbook, The Faculty of Dental Sciences, University of Peradeniya, Sri Lanka, 2006.


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