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Opinions of Thursday, 29 October 2015

Columnist: Shaibu Issifu

Dental surgery assistants- the untapped HR of Ghana Health Service

It is undeniable fact that majority of Ghanaians knowingly or unknowingly have oral health, taking into consideration the fact that about 90% of the world's population suffer from either dental caries or periodontal disease (the two most common dental disease). This data clearly shows the herculean task ahead of oral health practitioners and particularly the very few dentists. This equally shows that extraordinary measures have to be taken to confront this issue head-on if we really want to tackle this looming canker.

The dentist to patient ratio in Ghana has been pegged around abysmally 1: 80,000 compared to India who has a dentist to patient ratio of 1: 2000 which is 40 times better than that of our beloved country, Ghana, all these go to buttress the point that our dentists are overstretching themselves in the delivery of their essential services to the good people of our country.

It is clear that no one would like to envy dentist knowing very well the stress they go through. The multimillion unanswered question is what are we doing as a country to mitigate the suffering of our noble dentist in the course of their work?

THE ROLE OF REGISTERED DENTAL SURGERY ASSISTANTS (RDSAs)
Whilst finding a permanent solution to this challenges by way of enhanced working condition and recruitment and training of more dentists among a host of action RDSAs can be used effectively to the ultimate benefit of the dentist and by extension the general citizenry.

After three years vigorous drilling in dental related courses such as;
1. Introduction to oral health practice 1
2. Biomaterial science
3. Oral anatomy and biology 1 and 2
4. Oral health clinical practice 2
5. Endodontics
6. Periodontics
7. Prosthodontics
8. Orthodontic
9. Oral radiology
10. Oral surgery
11. Oral pathology and medicine
12. Community and preventive dentistry.
13. Basic pharmacology.

These courses are read in addition to a host of other courses such as basic nursing, medical microbiology, parasitology, biochemistry 1 and 2, Anatomy and physiology 1 and 2, basic nutrition, computing, communication and study skills 1 and 2, health system research, principles of disease control, health system management, health promotion, behavioral science, environmental health, epidemiology and statistics etc.

My question is why can't these valuable human resource be empowered to;
1. Undertake just initial assessment or examination of the oral cavity just to help the dentist in the clinical set up? No fatal harm can be caused to the patient if the findings are wrong, after all it's an initial assessment and appropriate training would be given.

2. Why can't these fine brains be officially allowed to do scaling and polishing (S and P)? Scaling and polishing consumes much time, so why would dentist's little time be exhausted on S and P to the detriment of other patients when RDSAs can effectively do it without any difficulty or problem? After all it is an open secret that RDSAs do most of the S and P country wide, so why are RDSAs not officially recognized as such?

3. Why can't RDSAs be made to take history of patients as it's done by their counterpart nurses in the general medical side? This helps quickens the work of the dentist in the midst of this unfavorable dentist to patient ratio.

4. Why can't RDSAs be empowered to take impression? This is non invasive procedure which RDSAs can do with unparalleled excellence on behalf of their dentist.

5. Why can't RDSAs give injection just as their counterpart nurses do at the general medical side? What would happen if RDSAs are empowered to least apply topical anaesthesia? I think it would rather help the course of dentist due to their over stretched nature of work.

There are a lot of things that RDSAs can do for and on behalf of dentist that poses no remarkable risk to the patients but rather enhance the work of dentist. What we should know is that no one was born with the technical skills he/she has but rather acquired through training so if registered nurse can be trained in dentistry for 8months and empowered to do a lot including simple extraction, restoration among a host of others and even further emboldened to man dental clinic without dentist, then what prevent RDSAs who have a whooping three year training in dentistry to do certain basic things as mentioned above to help their dentist and for that matter the patients at large, we should not also lose sight of the fact that most of these RDSAs are equally serving officers who have nursing background, such as Community Health Nurses and Enrolled Nurses and therefore have a remarkable skills when it comes to working on patients in a clinical set up.

It has to be made clear that these professionals (RDSAs) have equal qualifications like any other diploma trainees in the health sector, Direct Medical Assistants(DMA) receives the same 3year training like the RDSAs but lack the clinical experience most of the RDSAs have (serving officers) but are well empowered to head health centers and work with little or no supervision to the benefit of medical doctors (general practitioners), this clearly shows that the potentials of RDSAs are under tapped or untapped at all to the detriment of the innocent patients.

RESPONSIBILITIES OF RDSAs

RDSAs have myriad of responsibilities that they perform but an expanded duties as aforementioned when added would help the dentist and the country to get the optimum best from RDSAs, the traditional responsibilities includes but not limited to;

1. Receiving, registering and seating patients
2. Taking of vital signs (TPR, BP)
3. Charting
4. Taking, developing, labeling and mounting X rays
5. Placing and removing dental rubber dam
6. Assisting the dentist during procedures (chair side assistants)
7. Ensuring cleanliness of dental surgery and equipments
8. Instruments processing
9. Casting impressions and trimming models
10. Labeling and packing specimens for onward transfer to laboratory.
11. Applying topical fluoride
12. Placing pits and fissure sealants
13. Emergency care (CPR)
14. Conducting oral health education in clinic and community
15. Conducting basic screening and referring when necessary
16. Performing secretarial duties and managing patient record
17. Undertaking initial control of post extraction bleeding and giving post operative instructions.
18. Overseeing inventory control and ordering dental supply etc

SUGGESTIONS
It is my humble suggestion is that a trained mind is a horrible thing to loose, RDSAs who are trained with taxpayers money should be made to bring out their optimum best for the benefit of the taxpayer, RDSAs should be empowered to;

1. Take patients history
2. Do initial assessment or examination of patients
3. Take impression
4. Do scaling and polishing
5. Application of at least topical anaesthesia
6. Writing of progress note
7. Temporal restoration of cavities in the enamel only if possible.

These in my candid opinion would go a long way to assist the dentist in the performance of their work in the face of this daunting and frustrating dentist to patient ratio.

God bless Chief Dental Officer, God bless dentists, God bless RDSAs, God bless College of Health, God bless our motherland Ghana

Shaibu Issifu
(General Secretary, Oral Health Students Association of Ghana)