The infrastructure of the prisons is generally poor, though in recent years several have been refurbished with support from AusAID. Some of the prisons are overcrowded. The government allocates 1,500 riel per day (about US$0.38) for food for each prisoner. This is supposed to cover the cost of food, sanitation, cooking fuel water, electricity and administration. The water provided is often unsafe to drink and at times scarce - as little as 5 liters are allocated per person per day for both drinking and washing. The availability of toothbrushes and toothpaste is also limited.
The health situation in Cambodian prisons is very poor. Prisoners have some access to medical care, but almost no access to dental care. Many prisoners suffer from chronic medical and psychological problems, and many suffer from painful oral infections, resulting in problems with eating and sleeping. Poor nutrition, vitamin deficiencies, concurrent medical problems, poor oral hygiene and a lack of dental treatment all contribute to poor oral health. Conversely, poor oral health can directly affect the general health of the prisoners.
Four dentists involved in this project recently visited the CC2 prison near Phnom Penh and examined the mouths of 8 women, 5 adolescents, and 6 children (aged 1-6 years). Almost all of those examined required at least one extraction and several restorations; one woman required 10 extractions. Among the women, the average number of decayed teeth was 7; among the adolescents and children the average was 4 decayed teeth. However one 5 year old had 10 decayed teeth. Most said they had been suffering from toothache. Their dental needs are obviously very great, and should be addressed both through the provision of a treatment to relieve pain and infection (eg extractions), but also through the provision of dental restorations and cleaning, to prevent further deterioration in their oral health. During Phase 1 of the project, the most urgent treatment needs (mainly extraction of painful and abscessed teeth) will be addressed, along with simple cleaning.
Permission to establish a prison dental service has been discussed with the Cambodian Prisons Department who are supportive. The warden of each prison will also be approached for permission to visit.
The project will involve visits to prisons on at least one day per week to provide basic dental services to those prisoners who seek care. The dental team will take with them a set of portable dental equipment and supplies. Before treatment is provided a medical history will be obtained, followed by an oral examination and basic treatment plan. Relief of pain and infection will be the first priority. Prisoners will provide informed consent prior to treatment. When children are treated, their mothers will be in attendance. Cross-infection precautions will be strictly adhered to as the prevalence of HIV and Hep B and C is known to be high in this population. All contaminated instruments will be sterilized before being used on another patient. Staff working in the prisons and their families will also have some access to the prison dental service.
The dental team will normally comprise 5 persons – two dentists and three dental assistants. Two portable dental chairs will be set up. At each chair dental examinations, extractions and cleaning will be carried out. A few patients may require the urgent placement of simple fillings. In Phase 1, these will be provided using the Traumatic Restorative Treatment technique recommended by WHO – ie the cavity will be prepared using only hand instruments, and then filled with a white fluoride releasing dental cement. No “drills” will be used. In one day it is expected that 30-40 people will be treated.
The timetable of visits to the prisons will be finalized after discussions with the prison authorities. Initially the prisons close to Phnom Penh will be visited. Later, visits to outlying provincial prisons will be arranged with trips lasting from 2 to 5 days.
In Phase 2 of the project, which would start one year later, dental equipment and instruments will be purchased to allow more conventional restorative treatment to be carried out. By this time most of the urgent “relief of pain” treatment will have been provided in many of the prisons.
II. Activities Implemented
1. Prisoners in Prey Sar Prison Undergone Dental Examination and Treatment
A dental team of at least 8 members of Khmer Association for Development (KAD) led by Dr. Callum Durward and Mr. Meas Chandeth, KAD director have gone to Prey Sar prison providing dental services for prisoners. All team members are all volunteers from various institutions such as the Ministry of Health, Dental faculty, Cambodian Dental Association, private dental clinics, NGOs etc. providing dental treatment for prisoners every Saturday. Starting working time is from 8:00AM-4:00PM. There are 2,340 prisoners in Prey Sar prison, so dental treatment will be provided until there will be no more dental patients and then our team will move to other prisoners throughout the country. Up to September 2008, 120 prisoners and some prison wardens have received dental treatments including dental extraction, filling, minor surgery, cleaning, examination.
Miss. Ban Chenda, the former dentist assistant of Dental Faculty who volunteers to help provide dental services to prisoners said that she is very happy to work for harmony of other people. She added that she used to work at Dental Faculty as dentist assistant for 5 years. She wants to use her knowledge, skills and experiences to help other people and doesn’t want her knowledge to disappear. She said that although currently, she works as Khmer teacher for private school, she spends her time, every Saturday to work for this project.
Mr. Phan Sandeth, year-5 student of Medical Science of Dental Faculty, a volunteer said that he is very glad to work in this project because he wants to help Cambodians, take pity for Cambodians and doesn’t discriminate although they are prisoners. He added that they have dental problems as if we do and up to present time, he has helped do a lot of this kind of work, not only for KAD but also for other institutions.
Dr. John Dell, a volunteer from New Zealand said that he is very happy to help work for this project because in New Zealand, he owns dental company providing dental services for prisoners as he does in Cambodia.
Mr. Lim Sokha, dental nurse of Khmer Association for Development, also a volunteer said that he spends his time every Saturday to help treat prisoners because they had never received dental services and he even wants them to have healthy teeth.
Mr. Meas Chandeth, Director of Khmer Association for Development said that his organization has received a grant from German Embassy to Cambodia to support Dental Services Project for Prisoners in Cambodia so that they have healthy teeth. He added that good teeth bring about good general health and that this project is well underway due to good cooperation from prison authority. The prison authority has asked our organization to provide dental services until all patients are treated. Mr. Meas Chandeth appeals to all dentists throughout the country to be involved in provision of dental services for prisoners and to both national and international organizations, funders and kind people for assistance in this project.
