[Nasional-m] Street dentists in Pakistan ready to do their worst

[Ambon]

Street dentists in Pakistan ready to do their worst
 David Rohde
The New York Times Tuesday, August 20, 2002

LAHORE, Pakistan Mohammed Aslam uses pliers, wire cutters and a metal file
on the mouths of patients he treats in a dusty public park stinking of
urine.
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Mohammed Ishaq Khan, a fellow practitioner, believes that toothaches have
nothing to do with teeth. "If there is something wrong with someone's teeth,
I can instantly know there is something wrong with the digestive system," he
explained.
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Mohammed Jameel received his training on the street. He has never gone to
school and is illiterate. "I learned it in Karachi from a Chinese guy," he
said. "I was 10 years old when I started."
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The three men are among thousands of street dentists who provide crude
dental care to tens of thousands, possibly hundreds of thousands, of
pitiable patients a year in the avenues, parks and trains of Pakistan.
Excruciating to watch in action, they chop cavities off live teeth, insert
metal wire into the center of dead ones and use metal files to shave down
false teeth that have been inserted into patient's mouths.
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"I indulge them in conversation and when they are distracted I use this,"
Khan said, hoisting a metal probe with a razor edge. "Pain only goes away
with pain."
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The legions of street dentists here are a testament to Pakistanis' high pain
thresholds and desperate poverty. Nearly a third of Pakistan's 140 million
people live below the international poverty line, and earn less than $37 a
month. Having a false tooth inserted by a licensed dentist can cost $40.
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"I can't afford it," explained Mohammed Sajjad, a factory worker who
recently asked Jameel to repair a front tooth damaged in a fight two and a
half years ago. The pain, he explained, had started to bother him.
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As Sajjad sat on a small stool on a pedestrian footbridge over a set of
railway tracks, Jameel pried out brown chunks of dead tooth and flicked them
onto the red plastic tarp spread out under the stool. At one point, the
amateur dentist lit up a cigarette to smoke as he worked. At another point,
a locomotive passed under the bridge, belching black diesel smoke onto the
instruments and into the patient's mouth.
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The factory worker showed no sign of discomfort as Jameel filed down his
false tooth. He did not even complain when his gums started bleeding.
Throughout the ordeal, he only winced twice. Afterward, he admired his new
tooth in a small hand-held mirror and thanked his dentist. "I came here a
year ago" for work on another tooth, he said. "It's good quality."
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Pakistani health officials say they have tried to force the dentists off the
street, but the demand for their services is too great. "It happens across
the subcontinent," said Dr. M. Rashid Anjum, assistant secretary of the
Pakistan Medical and Dental Council, a regulatory group. "It's the poorest
people usually."
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Hygiene also appeared to be spotty. Jameel worked with bare hands.
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When blood from the factory worker's gums ran onto his hands, he just wiped
it off with a cloth. He and other street dentists said they constantly clean
their instruments - in a form of locally distilled moonshine.
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Novel medical theories abound. Khan, the dentist who said that toothaches
are caused by digestive problems, went on to say that brushing your teeth is
harmful because it damages your gums. The smooth-talking 54-year-old said it
is better to use your finger and an herbal medicine he sells.
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"The medicine we give has such a sweet fragrance that they can go to any
party and they won't have bad breath," he said, thrusting a pungent
concoction that smelled like nail polish and peppermint under a visitor's
nose. "You just need two drops."
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All had at least a partial set of dentists' tools and used the same type of
enamel false teeth as licensed dentists.
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Aslam, one of the dentists who worked in the park in Lahore, said outsiders
and wealthy doctors may laugh at their work - "the foreigners find it
amusing" - but they are helping impoverished people.
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Anjum, the regulatory official, agreed. He said he wished that Pakistan had
the luxury of eliminating street dentists. But for now they provide dental
care that would otherwise be unavailable.