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ヘルスサイエンス・ヘルスケア Volume 6，No.1（2006）

Dear Fukai-senseiThank you for your kindness to keep in touch

with me. I would like to introduce great efforts bylocal nurses, school teachers, and motorcycle dri-vers and Earthly Health Cantata (EHC), a newsmall non-profit organization, implementing anOral Health Program in a rural area of Cambodia.

Welcome to the eternal green rice fieldsPeople get up early at 5:00 in the morning with

rising sun in Cambodia. The big family eats break-fast together with smiling every morning. Aftereating breakfast, they work in the vast fields,which are eternal green rice fields. Further, theylive with cows as well as livestock animals such aspigs and chickens in their houses. Their lives arein harmony with nature. This report is a smallstory of promoting oral health program in a ruralarea of Cambodia.

The program had been implemented in Puokdistrict in Siem Reap Province which is a ruralarea in Cambodia in 2001. There are 121,317 resi-dents in the district. 25,651 schoolchildren go totheir corresponding 62 primary schools. (Puok Dis-trict Education Office Report in 2005) However,there is no dental hygienist. Also, there is no den-tist. Can you imagine that there is no dentalhygienist and dentist in your town?

Where there is no dental hygienist

Nurses, teachers and motorcycle drivers play animportant role for people in Puok District in SiemReap Province.

First, what nurses, teachers and motorcycle dri-vers need is to be motivated to work in ruralareas where work and life are difficult conditions.One Cambodian motorcycle driver along with hisJapanese friends started to introduce rural popula-tion to the basic rules of oral hygiene in 2001.They visited villages and schools in rural areasand met many people who have suffered fromtooth pain.

Second, these volunteers who work in ruralareas are encouraged to become good friends withlocals. In May 2002 the Cambodian motorcycle dri-ver asked one Cambodian nurse to prepare goodteaching materials for people. The nurses alongwith the Japanese completed a special gamenamed“Fukuwarai game”，while they becamefriends in the process. They made very big facefrom clothes, and players could move parts of facesuch as nose, eyes, lips and teeth. During thegame, the players noticed that teeth were animportant part of face. They learned naturally.Gradually, they got accustomed to brushing theirteeth while was washing their face.

Third, these nurses, teachers and motorcycledrivers are teaching their knowledge of oralhygiene in a friendly and informal way. The Cam-bodian nurse taught thirty two school teachers in

Where there is no dental hygienist

Emiko Koito Shdara（Department of International Community Health, Graduate School of Medicine, University of Tokyo＆Earthly Health Cantata）

six primary schools and around one thousandschoolchildren in two primary schools about oralhygiene in June 2002. They played“ Fukuwaraigame” and learned the causes of dental caries,gum disease, and methods of brushing. The nursesand the teachers have sustained oral health educa-tion for the schoolchildren from 2003 until now. In2005 the program was approved by the Ministryof Education and the Ministry of Health in Cambo-dia.

Fourth, these volunteers are also learning andteaching the newest information on oral hygieneand general health. In December 2005 the Cambo-dian nurse taught diagnosis of dental caries andgum disease to nine nurses in five health centersand to nine school directors in nine representativeprimary schools in the district. Furthermore, ninenurses were trained to examine schoolchildren.The purpose of this training was to find school-children who got severe dental caries with therisk to develop abscess and sepsis. When the nurs-es identify a severe case, they refer it to the healthcenter or the hospital. The nurses tried to learnand got skills to exam teeth of schoolchildren.However, they still need more practice and train-ing.

Fifth, what nurses, teachers and motorcycle dri-vers need is to be encouraged to cooperate witheach other, schoolchildren, their parents and vil-lagers. Further, they sustain the implementation topromote an oral hygiene program. The oral healthprogram has good opportunities to expand thecomprehensive health activity. Since 2005 theyhave implemented the comprehensive health activ-ity in primary schools with the Japanese friends.The comprehensive school health activity is basedon World Health Organization recommendation.(1)

The plan was that: to wash hands before eatingand after use of the toilet, to drink boiled water, toclean the classroom and a toilet. Also, another part

of the plan was to inform schoolchildren aboutdengue fever and diarrhea. They planed to intro-duce a set of hygiene rules and routines. Minimumcosts were an important aspect of the program.

Who are their Japanese friends?The Japanese people, who were interested in

voluntary activities in oral health and comprehen-sive health, came from different specialists such asdental hygienists, dentists, doctors, nurses, nutri-tion specialists, economists, and students. Theywere the Japanese friends of the Cambodian peo-ple. They put together an education plan that usedinformal methods such as songs and games. Theyalso developed informative materials. Eventhought all members could not go to Cambodia,they wanted to be involved in the project. Further,they established“Earthly Health Cantata,”mean-ing global school clinic, in 2001. Their logo was“Ifpeople in the word could live happy”．They initi-ated actions to achieve this hope. Their associationis not so big size, but they are looking forward togetting more international cooperation for the localpeople in developing countries.

Furthermore, some specialists for the publichealth, community oral health, and health scienceall over the world, also have supported our pro-gram.

They are good friends nowThey have been working together for five

years.One day, smiling.One day, quarreling.One day, crying.One day, be angry.One day, be sad.One day, be happy.

In the end, they hold their hands tight andbecome friends. They will face many problems in

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LETTER TO THE EDITOR

the future. They will, however, walk together any-time. Where there is no dental hygienist, Cambodi-an people and their friends will find solutions forthis problem and live together with partnership. Inour collaborative efforts we had the approval andthe support of the Ministry of Education and theMinistry of Health.

Reference1. World Health Organization． Health-PromotingSchool Series5．1st ed，pp1-26． Regional Officefor the Western Pacific：WHO，1996．

AcknowledgementsWe are grateful to Dr. Toshio Nakajima, Dr.

Norimasa Seo, Dr. Masatoshi Goto, Dr. Yu Sugana-mi, Dr. Hideaki Oda, Chorin temple, Chiba Prefec-ture, Yokohama and Niigata City for supportingthis program with funds. Our gratitude goes to Dr.Masanine Jimba and Dr. Seigo Kobayashi for theirinvaluable academic advice. We would like toexpress to all schoolchildren, their parents, the vil-lagers and the members of Earthly Health Cantatahaving participated in this program.

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ヘルスサイエンス・ヘルスケア Volume 6，No.1（2006）

【著者連絡先】Emiko Koito ShidaraDepartment of International Community Health, Gradu-ate School of Medicine, University of Tokyo7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, JapanE-mail：koito@med.kawasaki-m.ac.jp