This Woman Is Providing Dental Care In Nepal And Changing Lives

Who knew that going to the dentist saved lives?

In 2007, Laura Spero, a Bethesda, Maryland native, helped found Eva Nepal, an organization dedicated to improving oral healthcare in the rural mountainside village of Kaskikot. [Disclosure: I was a graduate school classmate of Spero's.] In Nepal, 58 percent of children and 69 percent of adults suffer from bacterial tooth decay. The lack of basic dental has also been linked to Nepal's high rate of heart disease and diabetes.

Far from being a "voluntourist," Spero is fluent in Nepali and has spent a portion of each year since 2002 in Kaskikot with a local family that has embraced her as one of their own. Spero even calls Radhika Subedi, the matriarch, "Aama," (mother) and thinks of Subedi's grown daughters as sisters.

Spero, 35, spoke with A Plus from Nepal about Eva Nepal's work to improve oral healthcare in rural villages and the ongoing earthquake relief efforts throughout the country.

Oral healthcare is not necessarily a sexy aid relief project. What motivated you to start a nonprofit that focused on it exclusively?

Photo credit: John Healy
Photo credit: John Healy

When I started working on dental care, the intention was not to start a nonprofit that would grow and go to all of these places — it was troubleshooting locally in my area. People would come to me with all kinds of things and dental care was something that I would confront very frequently. People would be asking me for help and while I can give somebody a band-aid, there wasn't very much I could do about their severe tooth pain. It started just because I wanted to be able to tell people where to go. When I started to look into it, there was no easy place for people to go.

How many people and towns does EVA Nepal currently serve?

Our active working areas cover just over 50,000 people. Then we have another handed over clinic that covers an area of about 12,000 people.

What are some of the local beliefs about dental care that you've had to confront and educate people about?

It's very commonly believed that dental treatments--like having a tooth pulled--can lead to blindness or deafness or even mental disability. We've even had employees whose job was to do community education who we first had to convince that there was no risk of blindness with dental care. It's a very, very commonly held belief in rural areas.

And then there's the belief that your teeth are going to fall out when you get old. Or the belief that it's common to cycle through severe mouth pain.

In the West, most people don't necessarily make a connection between dental care and overall medical care. But there is a connection between oral healthcare and diabetes and even heart disease. Can you talk a little bit about those links?

It's something that we [the West] don't think about very often because we have basic dental. We also have basic overall healthcare. The dental conditions that people walk around with commonly in Nepal would be totally unacceptable in the West. If you met somebody with that many missing teeth or with that much rot or blackness in their mouth, you would just think, "What could this person possibly be suffering in life that they're living with that?" And here, it's extremely common.

It's very connected to basic overall health and immunity. If you have a lot of infection and bacteria in your mouth, it just increases your overall susceptibility to all kinds of illnesses, especially with children.

There's a very well documented connection between heart health and mouth health. That's connected with things like blood pressure and diabetes. And then certain kinds of tooth infections can go into the brain and be deadly or go towards the heart and cause very serious problems.

Can you talk a little bit about EVA Nepal's oral healthcare educational curriculum?

Photo credit: John Healy
Photo credit: John Healy

We're very focused on sticking with the practicalities that will make it possible for people to make simple behavior changes that make sense to them within the context of the needs in their life as subsistence farmers in rural Nepal. Prevention of any kind is just not a very emphasized thing here. People tend to deal with problems when they are confronted with them.

Our adult curriculum is very focused on talking about how much things cost. For example, we will compare the cost of a toothbrush, which is about 25 cents, to the cost of a kilogram of sugar, which about 80 cents. Families will often go through 10 kg of sugar in a month. We put it in those terms to really try to drive home a discussion about whether or not people are too poor to afford a toothbrush.

With children, we have a different approach, which is just to habituate them to brushing their teeth, to just make it a part of their world. The core of that is the school brushing program. We just have them brushing their teeth every day at school, knowing that once they get used to that they're going to demand it in their households and push for it to make sure they can get it at home.

A lot of the discussion around this earthquake has centered on the ways in which the rich countries responded to the Haitian earthquake and how bad that response was. What, in your opinion, is the right way to help vs. the wrong way?

The first thing I would say about that is that I think there's a tendency for that discussion of what's the right way to do it to almost reflexively become an either/or. Big Aid is bad, communities are good. Communities can't be trusted, you need the big guns. In reality, when you confront a catastrophe of this scale in this kind of environment, you need all hands on deck. Each sector has different strengths and weaknesses and the danger is in thinking that anybody has all of the solutions.

The big international organizations were absolutely essential in the immediate recovery and rescue. The amount of manpower, technology, field medical aid, disaster experience--that's gets brought in by the Red Cross, UNICEF etc. Local people won't have helicopters.

A lot of the ratio starts to shift as you go forward. It's very hard to do Big Aid here in an effective way because the country is so varied in terms of its landscape, in terms of its social makeup. People live in very kind of self-sufficient communities. Governance is fairly weak here so one community to the next is different. I know that from doing, weirdly enough, dental care. It's hard to come up with large-scale approaches that are not going to end up wasting a lot of funds.

One of the things you've written about on your site is how Eva Nepal is trying to find a problem that's unreachable by “Big Aid.” Have you settled on anything?

One of the places we're finding we can fill in is in areas where there's a low percentage of damage so nobody is really paying attention there but the people who are suffering are still without a house. Because we're able to work at a more nuanced level, we figured out right away our first project was to go and use that technique of bringing in tin to help people build. We found they really didn't need the tin even though we did an assessment there first and they all said they needed tin. What they really need is manpower. They need help taking apart these half broken buildings, they need some moral support, they need people to spend a day with them and help them repurpose what's already here and then maybe some tin at the end.

Though you’re engaged with earthquake relief, you're also still trying to expand your oral healthcare program. How hard is it to stay on task and think long term when there's a crisis at hand?

(Photo credit: John Healy)
(Photo credit: John Healy)

It's hard because we're so community based. We work through schools. Right now, half the time the school's kids are showing up and half the time they're not showing up. Everyone, nationwide, is quite shaken up. We had a bunch of programs that were scheduled this month and the teachers were like, "We don't want to do the program because kids are not coming." And then we have schools that collapsed. It's hard to continue with the things that you were doing before when there's a national state of emergency and also, a national psychological state of emergency. Even though in Pokhara where we are and in these surrounding areas, the actual physical damage is much more limited, I think people feel like life is not normal and so things like attending school are just much more flexible than they were before.

All of that said, I think it's really important that both in Nepal and outside of Nepal that we recognize that those groups that have been working for a long time on the basic infrastructure and healthcare and quality of education in Nepal don't all shift completely to crisis relief.

For me, working in oral healthcare, I had a week or two weeks where I thought, 'Does this even matter anymore?' I think it took that amount of time to say, 'No, groups like mine need to recommit to the importance of the expertise that we've developed, which is not just about solving an immediate problem of putting food into people's mouths but actually looking at the long term health of this country and safety of its people.'

This interview has been condensed and edited.

Cover Image: John Healy