A Global Perspective on Health Global Millennium Goals A Creative

A Global Perspective on Health Global Millennium Goals A Creative

13487 IC Digest 25/3/04 11:12 am Page 21 should be placed on oral health in the broader dimension of educational imperatives will be determined. ...

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should be placed on oral health in the broader dimension of educational imperatives will be determined.

A Global Perspective on Health Convergence towards higher standards in oral health care in an expanding European Union may be seen to be a model for promoting convergence towards higher standards in education and training in the health sciences throughout the world, but it is well recognised that the extant model has application only in the industrialised world. Unfortunately, this development is relevant to perhaps less than 5% of the global population. There is a serious lack of interest in the plight of those in countries with emerging economies. The DentEd effort has to be placed in the context of a world of devastating contrasts in access to health care, education, equity and basic human rights. The global dimension presents a far more difficult and serious challenge where the traditional doctor and dentist may be less relevant to the alleviation of needs than a broadly based health care worker, together with environmentalists, macroeconomists and agronomists. Nevertheless the leadership of international health care organisations needs to be more aware of global health issues, perhaps the greatest threat to global stability. [See Appendix Page 22]

Global Millennium Goals There is an essential role for those in the health sciences, particularly doctors and. dentists, to contribute to the effort based on humanitarian principles in addressing the Global Millennium Goals.13 Those who educate must ensure that future health care workers are also better informed. It will make a difference if world leadership in the professions addresses the human suffering and deprivation that leads to ill health and asks what our societies can and should do. This does not diminish the importance of high quality oral care for those who can afford the choice. The questions is: can we also be more realistic in recognising the needs of the others in the global community, and the relevance of individual patient care that applies to less than 5 per cent of our global community?

A Creative Future for the European Section On a positive note, it is worth remembering that the catalyst for the development of the DentEd/DentEdEvolves Projects was the visit to Moscow just over 10 years ago, co-sponsored by the European Section of the ICD and the WHO. As George Read-Ward, then Secretary-General of the European Section was the main inspiration behind the initiative, it gives me great pleasure to see that the College has made him a Master of the ICD, an honour he so rightly deserves. I believe that with vision of this kind, there will be much more for the European Section of the ICD to achieve as it plans for its future, while celebrating its 50 years in existence.

Diarmuid Shanley Dublin December 2003

Professor Diarmuid Shanley FDS (RCS Edinburgh), FFD (RCS Irel.), MSD (Indiana Univ.), MA (TCD), FTCD., Dr. Odont. (hc) Univ. Oslo, was awarded the William J. Gies International award from the International Federation of Dental Education Associations in 2001 in recognition of his work as co-ordinator of the DentEd/DentEd Evolves Thematic Network and his outstanding contribution to international dental education. Prof. Shanley is an honorary Fellow of the ICD.

Open access to all areas of the DentEd website is maintained: For further information please e-mail: [email protected]

13 Global Millennium Goals. http://www.jdcweb.org.uk/MDG-UN-FFD-files/list-of-goals.htm [26/01/04]

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APPENDIX The Enormity of the Consequences of Poverty The World Health Organisation1 explains the enormity of the consequences of poverty: • Three billion of the world’s population live in unhealthy sanitary conditions. • Of the 800 million whose levels of starvation threaten their lives in sub-Saharan Africa, 170 million are infants or pre-school children, where the AIDS epidemic has devastated an already starving and deprived population. The US University of Columbia’s Earth Institute2 maintains that • investment of available knowledge and finance in infrastructure, agronomics and health care could save 25 million who will die this year from the consequences of deprivation and poverty.

Jeffrey Sachs3, Director of the Earth Institute4, speaking on the Global Millennium Goals, warned that these inhuman sufferings have profound implications on geopolitical stability despite the fact that we have the capability of addressing them because: • • • • • •

The affluent 1 Billion earn $25 Trillion per year Each one on average in the poorest 1 Billion earns less than $1 per day The 400 top income earners in the world earn $69 Billion between them This is more than the combined economies of Nigeria, Botswana and Gambia Households that earn above $200,000 account for $1.7 Trillion per annum A tax of 5 Cents per $10 on the world’s one billion top earners would yield $125 billion per year • This would be enough to solve the poverty of sub-Saharan Africa and alleviate the inevitability of death facing 25 million this year. The poorest countries on the other hand: • Give the rich countries $64,000,000 per day • Spend more on debt than on health and education • Over 19,000 children die every day as a result of disease DBS December 2003

1 World Health Organization: http://www.who.int/en [10/01/04] 2 The Earth Institute at the University of Colombia: http;//www.earth.columbia.edu/ [09/01/04] 3 Sachs, J. The Millennium Development Goals. Paper delivered to The Global Development Challenge, July 10th 2003 in Trinity College, Dublin. 4 The Jubilee Debt Campaign Web Group: Campaigning to Cancel the Debts of the World's Poorest Countries: http://www.jdc-web.org.uk/index.htm [03/02/04]

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Dr. Paul Becker, FICD USA Section, resident in the Ukraine since the late 1990s, writes of dental care there, and asks: Is there an Opportunity for the European Section of ICD to Become Involved in Recognizing Advancing Standards of Ukrainian Dental Care? Very often in life we see parallels in the development of society, organizations, educational institutions and even governments. Life in the former republics of the Soviet Block countries has undergone many positive changes towards democracy, protection of human rights, freedom and economic progress. While investigating the changes and developments in the dental community of Ukraine for the past 20 years, I have learned some amazing facts and stories, both of institutions and individuals. One such individual is Dr. Alexander Shimchenko.

A Compassionate Professional Alexander Shimchenko, now a Ukrainian dentist, started his carrier as a general doctor and anesthesiologist at a First Aid hospital in Odessa, Ukraine in 1976. Dr. Shimchenko received his undergraduate education at the Medical University of Moscow in 1973, at that time the most prestigious of all institutions in this part of the world. One day, a patient with no name or medical history was brought into the surgery. The patient came with liver cirrhosis, and intensive internal bleeding. He died later that day. The next day Alexander was called to appear for questioning at a meeting with high Communist Party officials, the KGB, the coroner, medical experts and hospital staff. The diagnosis and every possible cause of death were scrupulously investigated. The patient who died was a Regional Communist Party Secretary. Alexander was lucky that the expert committee agreed on the conclusions of death. Had they not, he would have been sent to prison. Alexander Shimchenko’s introduction to dentistry started when he realized that there were no adequate or safe methods of performing dentistry with general anesthesia. In contrast to what had gone on in the past, where there had only been what were called “poly clinics” controlled by the state, between the years 1983 and 1989, Dr. Shimchenko had been running a specialized clinic, or “cooperative”, where dentists could come with their patients and perform

the needed dental services with anesthesia. By degrees, patients became familiar with paying for special services. After six years, Dr. Shimchenko realized he was not satisfied with the level of dentistry being performed by many of the stomatologists who visited his office, so he decided to go back to school in 1989, receiving his diploma in oral surgery from the Odessa State Medical University in the same year. In the beginning of the 1990’s, perestroika was having an influence and Dr Shimchenko was finally allowed to privatize his practice, Pan Med, in 1995. He now had the resources to build a beautiful office with all of the latest and most up-to-date equipment. During this same period Shimchenko continued to keep busy with his inventive mind. In 1993 he patented a new method for the storage of sterilized instruments. This began a new revolution of sorts. He travelled to many exhibitions with this product, and in 1993, was discovered by the Septodont, Kulzar and Ferro Companies in Moscow. They all approached him and asked if he would represent their companies in Ukraine. So, in 1994, the first private dental office and store opened in Odessa, thus enabling other dentists to see what new western products, ideas and procedures were available. This action was further enhanced in 1995 when the “European Bank of Reconstruction and Development” opened in Odessa. This brief vision of financial opportunity came to an end when the Ukrainian government declared that there was “ no legal basis” for these loans. But it was too late: the ideas of self-realization and independence from the state controlled polyclinics had already been planted. The development and integration of private practices in the former states of the USSR, such as Georgia, Belarus, Latvia, Ukraine and Russia, have been most interesting. Today there are roughly 400 licensed private clinics in Odessa alone.1

1 The population of the Ukraine is 50 million approximately. The ratio of dentists per 100,000 of the population is 39.8, yet the DMF rate for12-year-olds is 4.4. This compares with, for example, a similar dentist/population ratios of 39.8 in the UK and 33.3 in Portugal, yet in these countries the DMF is 0.9 and 1.5 respectively. http://www3.who.int/whosis/health_personnel/health_pers onnel.cfm [15/01/04]

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"Perestroika" and New Ideas in Education Following “perestroika”, opportunities for dental professionals in the Ukraine to travel and to learn abroad arose. With the invasion of western technologies and ideas, the establishment of several excellent foreign exchange programmes, and the introduction of European teaching, the professional educational level has been rising all the time. Ukraine now, and many other areas of the former Soviet Union, offer wonderful opportunities for providers of good dental therapy. In spite of these positive academic improvements, there are still dentists, who having practiced for many years under the socialist system, seem to have little sense of accountability or incentive to provide high quality service. So several voids remain, for example: • in the promotion of high ethical practice and the honouring of meritorious service to the profession and humanity; • in the education of the general public regarding up to date methods of dental therapy; • in the failure to enforce the renewal of licences once they have been issued, and to insist on Continuing Professional Development.

No State Support for the Underprivileged In Ukraine, if a patient cannot afford dental work, it simply is not done. Poor people can go to a state “poly clinic” for treatment where they are asked if they can pay for the services. When the answer is no, some decay may be excavated and cement placed. The typical “prophylactic service" for a child consists of a visual examination with no radiographs. There is no cleaning or application of fluoride, and local anesthesia is not provided for either children or adults. Consequently most individuals avoid all visits to the dentist unless there are no other options. There are no programmes in dental public health.

An Opportunity to Help There are practical ways in which the ICD could help: * As one of the aims of the ICD is to foster cordial relations with dental professionals on an international level, I believe firmly that it is now time for the European Section to become acquainted with colleagues like Dr Shimchenko and many others in these Eastern European countries, in which our fine profession was held back due to economic and political reasons. * If the ICD recognized dentists in Ukraine who provide high standards of dental care, it would encourage other professionals to organize their efforts to standardize quality dental care. Above all, we could arrange meetings in venues they might be able to afford. Paul Becker January 2004

Dr Becker moved to Odessa, Ukraine with his wife Tetyana in 1994. He performs dental consultations on a voluntary basis but his primary work is with orphans and street children. He has designed and built two dental facilities both for orphans and children suffering from the effects of tuberculosis, made possible through the efforts of different world organizations including the American Foundation of the International College of Dentistry.

Vladik and Katie in a new dental surgery in the boarding school cum orphanage in Odessa, Ukraine. Built two years ago, the surgery caters for 400 orphans.

Dental Education in the Ukraine To-Day Today, if a young person wishes to become a dentist or doctor, most professional families in Ukraine send them to a medical university after the completion of normal high school at age 17. This consists of five years study plus one year of internship. • At this point the individual receives a diploma and is referred to as a dentist of the “Third Category”. • After another five years of practice along with continuing education, the individual sits for an examination and if successful is promoted to the “Second Category”. • This same procedure continues, and after a three year period, if successful, the student becomes a dentist of the “First Category". • At a later stage, usually after another three-year period, if a written paper is submitted and accepted, the candidate receives recognition as a dentist of the “Highest Category”. • There are presently 15,791 individuals holding BA’s in one of these four categories licensed to practice dentistry in Ukraine. • Whether the dentist is of the third, second, first or highest category, there is no distinction regarding which procedures may legally be performed. • Some dentists who have attained the highest degrees, limit their work to one speciality, such as orthodontics, pediatrics or oral surgery. Unfortunately at this time, the statistics relating to the distribution of dentists in these various categories are not available.

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The Coat of Arms of The Worshipful Company of Horners

Lynn Walters, FDSRCS, Master of the Worshipful Company of Horners, on guarding tradition while making an invaluable contribution to Educational and Charitable Projects.

This shows 3 horn-bugles & 3 leather bottles on the silver shield, and links the old with the new by a representation of the polyethylene ring in the circlet above the shield and the benzene ring around the narwhale horn of the silver ram

The City Livery Companies Of London There is no such thing as a free lunch – or dinner! At the ICD gala dinner in Dublin last June, I found myself seated next to Cecil Linehan who asked me what interests I had outside dentistry. I replied to the effect that I was currently Master of the Worshipful Company of Horners. Then came the inevitable response, “What on earth do they do?” After a brief explanation, Cecil then declared her true colours, admitting she was the Editor of the European Section of the ICD, and asked would I write something for her on the subject. My resolve not to accept any more unpaid work being weakened by wine and good company, I agreed to do so.

11th Century Origins For an understanding of the origins of the London City Livery Companies one must look back to the end of the Anglo Saxon period in the 11th century. At that time, the geography of the City was clearly defined by the remains of the old Roman walls, soon to be restored by the Normans, and many of the crafts working within formed themselves into Guilds (from the Saxon word for payment) or friendly societies, for the protection and promotion of their trades.

Lord Mayors of London After the Norman Conquest, King William I, recognizing the strength and influence of these City Guilds, made no attempt to take the city by force. Instead, he agreed terms with them, entered the City in peace, and was crowned in Westminster Abbey on Christmas Day 1066. The terms agreed gave the citizens of London a succession of Royal Charters, which laid the foundations for the government of the City, with first the Sheriffs and then the Mayoralty. Thereafter, the citizens of London have

had the right to elect their Mayor rather than have one imposed by the Monarch, and have done so each year since 1192. Most people have heard of Dick Whittington (and his cat) who was one of the most famous Lord Mayors of London, as distinct from Ken Livingstone who is the Mayor of Greater London, a political appointment and a different thing altogether. The Lord Mayor of London is head of the Corporation of London, the local authority for the Square Mile as the City of London is otherwise known. Within the City, only the Sovereign takes precedence over the Lord Mayor.

An Established Order of Precedence The Guilds grew in strength and wealth. Members took to wearing distinctive costumes or Liveries, many of which are worn to this day during special ceremonies. In the early years, the rivalry between companies was intense. The great Companies armed their retainers to the teeth, and pitched battles were fought on the streets of London as they jostled for position and prestige. Matters were not settled until 1515, when the order of precedence was settled by King Henry VIII, not by the age of a Company, but by the power and influence it could bring to bear at the time. There are 103 Livery companies today, with a membership ranging from as low as 80 members in some, to 450 in the largest. The Horners Company at present has 270 members. 1 The most senior are the Mercers, Grocers, Drapers, Fishmongers and Goldsmiths, and the most recent are the Information Technologists, World Traders, Water Conservators and Firemen. The Merchant Taylors and 1 Should anyone wish to learn more, most companies have their own web site which can be found via any search engine. The Horners is www.horners.org.uk

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Skinners agreed to disagree over who should be number 6 and who should be number 7 by alternating seniority each year. Hence the saying, “ All at sixes and sevens”.

Royal Charters Royal Charters, issued under the Great Seal of England, grant specific privileges to individuals or groups of people. Before about 1750, without a Royal Charter, merchants and craftsmen were largely unable to obtain corporate status, were not permitted to enter into legal agreements, or go to law. Once granted, a Royal Charter remains in force indefinitely, or until the recipient ceases to exist.

Officers of the Livery Companies Many companies become Livery Companies by the grant of Royal Charters, and are titled “The Worshipful Company of……”. The most important person in a Livery Company is the Master who usually serves for one year. Before he becomes Master, he will have served on the Court of Assistants, a Livery Company’s governing body, and progressed therefrom by way of being Renter Warden and Upper Warden. The Clerk carries out the administrative work of the Company, and the Beadle assists the Master and Wardens on ceremonial occasions. Between 30 and 40 Company Halls exist today. Many are grand, being beautifully fitted out and reeking of history. Their use is not exclusive to the Livery Companies as they can be hired out for corporate and private functions.

The Worshipful Company of Horners - 13th Century Beginnings The first written evidence that my own Company, the Horners for short, existed in the City of London is an entry in the City records dated 8 September 1284. In 1476, the Leather Bottle Makers amalgamated with the Horners which accounts for the three leather bottles on the Horners Coat of Arms as well as three horn bugles. In 1638, King Charles I granted the Horners a Royal Charter, which is the authority by which the Company operates to this day. 1,000 years ago, horn was a natural material which had many uses, eg. drinking vessels, handles for knives, daggers and swords, hair combs etc, not to mention “knocks” for the ends of long bows to stop them splitting under the tremendous pressure of the “draw”. There

is therefore a natural link between the Horners and the Bowyers. Indeed, I was a guest of the Master Bowyer in October 2003, at a dinner to celebrate the battle of Agincourt in 1415, which was a decisive victory for the English longbowmen under King Henry V over French forces vastly superior in number. Given the virtual demise (but not quite) of the horn industry in England, the Horners felt the need to reinvent themselves if they were to be taken seriously in modern times. In 1943 therefore, the Company decided that as the products of the Plastics Industry had largely replaced horn, the Company should become associated with this, its modern counterpart. Today, the Company maintains and combines its ancient links to the City of London, together with the plastics and polymer industries, while seeking to support the traditional horners' craft. Another natural link therefore is between the Horners and the Spectacle Makers given the old horn rim glasses now superceded by plastic.

The Commitment Education Projects

to

Charitable

and

Some people see the London City Livery Companies simply as luncheon and dining clubs for the well heeled. While a considerable amount of wining and dining goes on, by far the most important functions of the Livery Companies, in addition to supporting the Lord Mayor and the Corporation of London, are in the realms of charity and education. Over £38 million pounds was raised for charity in 2002, and the amount increases year on year. Several of the wealthier Companies endow and support schools, the Merchant Taylors, Skinners and Haberdashers to name but a few. The Horners uses its Charity Funds with an emphasis on the support of educational initiatives related to plastics and polymers, their application, and scientific principles. The Company organizes Polymer Study Tours, courses designed to assist science and technology teachers. It is also a major sponsor of a joint Company initiative with the Salters’ Company in the form of an ‘A’ Level Physics Course, a modern approach to the teaching of Physics developed by York University. I see the London City Livery Companies as independent guardians of many trades, past and present, who also do much that is helpful to others in present times. Mr Lynn Walters FDSRCS December 2003

Lynn Walters qualified from Guy’s Hospital in 1961 and was in general practice for 17 years, thereafter in partnership with his wife Roslyn. In 1977 he was appointed a full-time dento-legal adviser at the Medical Protection Society from which he retired in 1997. To date he runs his own part-time Consultancy. His wife Roslyn is an FICD, and was inducted in Bergen in 1998. Page 26

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In Memorian Liet Rushkamp Netherlands

Louis J Baume Switzerland

On the 12th of May 2003, Liet Ruskamp, the beloved wife of Henk Ruskamp, passed away after a brief, but sad period of serious illness. Many ICD Fellows, and certainly not only the Benelux Fellows, will have known her well, because ever since Henk’s Induction into the College, they together attended nearly all the annual meetings. Besides her interest in the ICD, Liet was a strong support for Henk in his professional life in general. As a couple, by sharing their common interest in mankind and community, they made numerous friends and were highly appreciated for their fine mental spirit and social activities.

The distinguished Swiss dentist, Master of the ICD, and former President of the European Section of the International College of Dentists, Professor Louis J Baume, passed away in May 2003. He was born in 1913 and received his doctorate from the dental school in Bern in 1939. He went on to become a research associate at the Hooper Foundation for Medical Research in San Francisco and at the Institute of Experimental Biology at Berkeley 1948 to 1954. He returned to Switzerland to become Professor at the Medical Faculty of the University of Geneva in 1955 where he retired in 1983. He was a dental expert with the World Health Organization from 1963 onwards.

Maybe the best way to honour and remember Liet is to quote the memorable words spoken by Dr Joe Lemasney on the occasion of the Dublin ICD meeting in June 2003, when he said: “Liet Ruskamp played such an active role in the Annual Meetings of the European Section, both by supporting Henk in his duties, and also, in her own right, she was always gracious and kind, helpful to the new Fellows and Partners, thereby influencing many people in a positive way with regard to their first impressions of this ‘new club’ that they were joining”. The College has lost a remarkable ICD-partnermember and our thoughts are with Henk and his son Hielke. Frans H.M.Kroon Regent for Benelux February 2004

Between 1979 to 1981, he was FDI President and received the Miller Prize in 1991. A Master also of the American College of Dentists, in 1971 Dr. Baume received the Elmer S. Best Award Memorial Award, named in memory of the founder of the Pierre Fauchard Academy, and awarded only to members of the dental profession from outside the United States who have made distinguished contributions of international significance to dentistry. He also received Honours and Awards from several other Academic Bodies and Organisations including the Academy of Dentistry, Dentist of the Year, 1980; the Laureat du Prix, Pulp Biology Research Award of the International Association for Dental Research in 1989; and Doctor (hc), Universite D'Aix-Marseille, 1978. Dr. Baume was an outstanding member of our profession. His passing diminishes us all. Nicole Vallotton Regent for Switzerland July 2003

****************************************** Silence

****************************************** Silenzi

My eyes burn Boundless gnawing pangs consume my soul Serous oils from twisted pines trickle on my hands Yawns my-your sun and the heart drips poisoned by bitter oleanders The antique neon has gone out.

Bruciano i miei occhi Sconfinati tarli rodono la mia anima Oli cerosi da pini contorti colano sulle mie mani Sbadiglia il mio-tuo sole e gocciola il cuore avvelenato da amari oleandri Si è spento il neon antico

From a selection of poems published by Dr. ssa Ilaria PIAZZA ROXAS of Italy, FICD Dublin, 2003

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ICD European Section Regents 2004 AUSTRIA Peter Kotschy Lindengasse 41/15, A-1071 Wien, Austria Tel: +43 1 523 7198 Fax: +43 1 523 1798 [email protected] BENELUX (Belgium, Holland & Luxembourg) Frans Kroon ieplenlaan 9, 2061 GG Bloemendaal, The Netherlands Tel: +31 20 5666054 Fax: +31 20 5669032 [email protected] ENGLAND, SCOTLAND & WALES Phillip Dowell Old Westlands Moushill Lane MILFORD Surrey GU8 5BH, UK Tel/Fax: +44 1483 423736 (H) Tel: +44 1428 684284 (O) [email protected] FRANCE Jean-Daniel Aye 24 Ave de Villiers Paris 75017, France Tel: +33 142 27 5230 Fax: +33 118 194 280 [email protected] GERMANY Heinz E. Lassig Theatinerstrasse 40, 80333 Munchen, Germany Tel: +49 89226309 Fax: +49 8929160843 GREECE & CYPRUS Aris-Petros Tripodakis 92 Vas. Sophia Ave 115 28 Athens, Greece Tel: +30 210 7752 770 Fax: +30 210 7473 370 [email protected] IRELAND Frank Shields 'Altmore' Oaks Road DUNGANNON, Co.Tyrone Northern Ireland BT70 1HW Tel: +44 28 8772 2228 [email protected]

ISRAEL & MALTA Sheldon Dov Sydney 13, Motskin Street Ranaana 43313 Israel Tel : +972-771-3654 Fax: +972-9-771-3088 [email protected] ITALY Giorgio Blasi Piazza Marconi 5/1 17100 Savona, Italy Tel: +39 019 833 5392 Fax: +39 019 833 5393 [email protected] PORTUGAL Antonio Tavares Campo Grande 35 1* D 1700 - 087 Lisboa, Portugal Tel: +351 96 622 1999 Fax: +351 21 793 9906 [email protected] SCANDINAVIA (Denmark, Finland, Norway, & Sweden) Anders Ericson Wagnshuset, Hufvudsta Gard, SE-171 73 Solna, SWEDEN Tel: +46 8 730 22 20 Fax: +46 8 514 918 50 [email protected] SPAIN Jaime Gil Albia Dental Institute Edificio Albia 1-12 Bilbao 48001, Spain Tel: +34 94 423 1600 Fax: +34 94 423 6813 [email protected] SWITZERLAND Philip Hediger Georgette 8 1003, Lausanne, Switzerland Tel: +41 21 323 9815 Fax: +41 21 311 7041 [email protected]

European Section Website: http//www.icd-europe.com Page 28 Page 28