Fortitude and resilience in service of the population: a case study of dental professionals striving for health in Sierra Leone

Abstract

Objective Sierra Leone (SL), with a population of over 7 million people, has a critical health workforce shortage. This research explores the views of key players on population oral health needs and demands, the challenges of oral and dental care delivery, and professional careers in dentistry, in order to inform future capacity building. Materials and methods Semi-structured interviews were conducted with a purposive sample of key players in dentistry and healthcare, both in-country and externally. An interpretive phenomenological approach was used in exploring views of key-players on the oral needs and demands of population, challenges in the delivery of oral and dental care, professional careers of dental professionals in SL, and future workforce capacity building based on a topic guide drawn from the available literature. Interviews were audio-recorded, transcribed verbatim, anonymised and analysed using QSR NVivo 10 for data management and reported in accordance to the consolidated criteria for reporting qualitative research. Results Twenty-one informants, of whom 18 were male, 17 were in-country and 16 were dental professionals, participated in the research. Dental professionals reported clear consensus on a considerable level of unmet oral health needs, most notably dental caries and periodontal disease, together with life threatening oral conditions such as osteomyelitis, Ludwig’s Angina and Burkitt’s Lymphoma. Challenges associated with the delivery of dental care revolved around five themes: patients’ predisposition for traditional remedies and urgent care; practical hindrances to the delivery of care; professional isolation and weak governance; and place with pressing local crises and lack of political will. An emerging typology of dental professionals included: demonstrating loyalty to their nation and family; exhibiting resilience in challenging circumstances; embracing opportunity most notably amongst expatriates; and striving to serve the needs of the population. There was support for innovative future capacity building developments. Conclusion This paper provides important insights to the delivery of dental care in a low-income country with significant oral health needs and multiple challenges in the delivery of dental care, whilst also providing a vision for developing, building and retaining future human resources for oral health.

Embarking on a professional career: social advantage in dentistry and medicine. UK dental and medical student applications and admissions, 1996-2011

“…There is some evidence from a low-income settings that loyalty to serving the population can help with drawing dentists back to serve their home communities. (64) Who is admittedand who is under-represented?…”

Is the vitamin D status of patients with COVID-19 associated with reduced mortality?

“…Older age, obesity, chronic kidney disease, diabetes, hypertension, and cardiovascular disease are some critical risk factors that have been reported as associated with the severity of COVID-19 [42][43][44][45]. There is evidence that vitamin D deficiency can be caused by older age, obesity, and chronic kidney disease [46][47][48][49][50][51]. Type 2 diabetes, hypertension, and cardiovascular disease also are associated with vitamin D deficiency [52,53].…”

Needs-led human resource planning for Sierra Leone in support of oral health

“…PUFA (Pulp, Ulceration, Fistula, Abscess) lesions [12]. Prior to embarking on the national survey, the views of dental professionals and key individuals associated with SL were sought on the challenges and solutions for Sierra Leone, together with their rationale for working in the country and vision for the future [13].…”

“…SL has a dearth of dental professionals as only 10 dentists, supported by approximately 10 dental care professionals (dental therapists, dental assistants and oral health promoters) are available nationally; almost all of whom are based in the capital city Freetown [13]. A critical shortage of dental personnel has been evident since 1963 [14,15], with only one dentist to 200,000 people at best over that time (Table 1).…”

“…A critical shortage of dental personnel has been evident since 1963 [14,15], with only one dentist to 200,000 people at best over that time (Table 1). Our current evidence [13] suggests that some additional oral health care is delivered through personnel with no formal dental qualification i.e. non-dental personnel (NDPs) including community health officers (CHOs), community health workers (CHWs) and traditional healers as well as visiting non-governmental organizations.…”