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First Large-scale Mobile Dental Screening Service to Enter Disability and Long-term Care Facilities Pushes On

The CASA-MODAL (Clean And Screen All Mouths Of Disability And Long-term care facilities) project was started in November 2018 with a noble mission of connecting disability and long-term care facilities to accessible dental services. However, over the past two years, the pandemic has thrown up several obstacles, resulting in various delays and postponements. We take a deeper look at how Tzu Chi’s dental team has persevered and continued to do their best within the given constraints.

Disclaimer: All activities depicted in this article were conducted in compliance with the COVID-19 rules and regulations at that given time.

The dedicated dental team working together to conduct dental screening for various beneficiaries. (Photo by Chan May Ching)

It was the end of yet another long day at the Silat Avenue branch of Lee Ah Mooi Old Age Home (LAMH). Tzu Chi dentist Dr David Lim was seen removing his personal protective equipment (PPE), and beads of perspiration all around his forehead were visible. It had been an eventful day, with he and his dental team stationed at the nursing home since morning, going from bed to bed to conduct dental screening for the home’s elderly residents.

As part of the CASA-MODAL (Clean And Screen All Mouths Of Disability And Long-term dental facilities) project, the Tzu Chi dental team has been visiting adult disability facilities and nursing homes around Singapore for the past few years in a bid to understand the overlooked oral health problems among our marginalised population. With almost all 11 adult disability facilities and over one-third of nursing homes in Singapore having never received any sustained onsite dental service provision, it is a gap that CASA-MODAL aims to fill since it was licensed by the Ministry of Health (MOH) as an offsite healthcare service offered by the Tzu Chi Free Clinic.

For this project, mobile dental clinics were usually set up in the facilities of partner institutions, including the placement of portable dental chairs and wheelchair tippers at designated areas. While dental screening was the main focus, there were also some basic treatment provided such as tooth brushing, sponge swab and topical fluoride application. In terms of manpower requirements, three to four medical personnel were usually required per patient, with the average time spent ranging from 15 to 30 minutes for each.

Dr Lim is the main lead behind CASA-MODAL, having been inspired to kick-start a nationwide dental screening outreach programme after learning about how difficult it was for the patients from a disability centre to seek dental services. Determined to help this disadvantaged group, he gathered a few of his oral health therapy students and went down to see them. That was the starting point and he has not looked back ever since.   

The dental team also helped in cleaning the dentures of the elderly residents at LAMH (Silat). (Photo by Chan May Ching)

Dr David Lim educating one of the CASA-MODAL beneficiaries from MINDS Woodlands Employment Development Centre (WEDC) about the proper way to brush her teeth. (Photo by Chan May Ching)

Challenges Galore

However, due to the pandemic, many challenges have arisen along the way. The heat, dehydration and discomfort from wearing full PPE while conducting treatment has been one of them. The team had also taken extra precautions such as taking daily Antigen Rapid Tests (ART) and self-quarantining a week prior to visits. For more than a year, the project’s progress was also stalled due to restrictions in entering the various disability facilities and nursing homes. There were also outbreaks of COVID-19 cases which led to several last-minute postponements. After a long hiatus, the project only gradually started resuming in July 2021.  

Dr Lim admitted that it has not been easy dealing with all the obstacles that have emerged over the last two years. Given that preparatory works before each visit to a facility could take anytime between two to six months, COVID-19 had further complicated the whole process.

“We stopped for a fair amount of time due to the lockdown. And when the measures started easing, our visits to the facilities had to be deferred several times,” the 36-year-old shared.

“For some of the open-air places we visited, it could get very hot and physically very tough. But depending on the situation, we will still take the best opportunity we can to go ahead.”

And Tzu Chi’s tireless efforts have not gone unnoticed by the facilities they have visited as part of CASA-MODAL. The staff from LAMH (Silat) were among those who were deeply appreciative and saw the impact that the project had on their elderly patients. Due to funding and various issues, there had not been a similar mobile dental screening programme like CASA-MODAL at LAMH previously.

Said Mr Then Kim Yuan, the nursing home administrator of LAMH (Silat): “Dental health for our seniors is very important. If they have oral health issues, it could lead to pneumonia or a loss of appetite, which would in turn cause other health problems.

“Due to the pandemic, going to the hospital or polyclinic for dental screening is actually very difficult. The task of taking care of the old folks does not only depend on us, it requires help from the community as well as teamwork from different organisations. I’m grateful to Tzu Chi for keeping us in their minds and coming over here to help.”    

With elderly beneficiaries of CASA-MODAL generally divided into two groups, namely the mobile and the bedridden, the project was seen to be of greater importance to the latter group. Given that it is easier for them to develop oral-related problems and potentially cause respiratory diseases through the infection of the lower respiratory tract, it showed that oral care is just as crucial as the prevention of common sickness and bedsores among the group of bedridden elderly.

Mr Then Kim Yuan (left), nursing home administrator of LAMH (Silat), has been greatly supportive of CASA-MODAL as it has helped fill a gap in the area of mobile dental screening services. (Screenshot by Pan Zaixiang)

Going Beyond

Beyond the dental screening provided for the seniors, the Tzu Chi dental team has also tried to impart relevant skills to the healthcare staff of the various facilities. LAMH (Silat) healthcare assistant Ms Nang Nu Nu Aung is one of those who had the chance to observe and learn as the CASA-MODAL team went on their rounds in the nursing home. Given that she previously did not possess comprehensive knowledge about the proper way of providing dental cleaning for the residents, the opportunity was very much welcomed by her.

She said: “I feel glad about the Tzu Chi dental team coming over as we get to observe how cleaning is done. We just try to learn and apply in the future.”

Ms Nang also went on to share about how much the patients enjoyed the presence of the CASA-MODAL team beyond just dental services.      

“Tzu Chi is here not only to help with dental screening but they also try to chat with the patients. It is good for their minds and we had a patient who was so happy about someone coming in to check his teeth that he kept asking when his turn was,” she added.   

Providing more than just routine dental screening was a deliberate move by the CASA-MODAL team as they hoped that the project could serve as a befriending tool as well.

Dr Lim explained: “I don’t want it to be a touch-and-go service where you don’t really connect with the patients. I think it is nice to chat more and find out about their lives. It is still fate that brought us together and there are times when we in turn are able to obtain some wisdom from them. They might say something meaningful and at that point in your life, it could make a difference.”   

Personnel from the CASA-MODAL team removing their PPE after a long day. (Photo by Chan May Ching)

Volunteering Opportunities

Other than serving patients and educating staff, CASA-MODAL has also provided a platform for volunteering opportunities. While the dental team involved in the project usually comprises Dr Lim, Tzu Chi oral health therapists and dental assistants, there would also be other volunteers who joined in from time to time. The background of the volunteers would vary, ranging from professional dentists to inexperienced dental students. For prospective dental student Mr Marcus Low, being part of the project at LAMH (Silat) has been tough yet rewarding.

Said the 20-year-old: “It has been an eye-opening experience as the background of patients that we see here is very different from the ones at conventional clinics or hospitals. While it is usually the patients coming to us because they want to solve a problem, it is more challenging here as we are the ones going to them. Thus, they might not be as willing in allowing us to find a solution for their problems.

“Overall, it is quite meaningful for me. While my personal impact in this project might not be that big now, what is more important is to educate the nurses so that they can continue to provide better oral care for the residents.”  

As of end March 2022, Casa-Modal has reached out to 12 facilities and more than 810 beneficiaries. With many more still to come, the project is slowly but surely picking up momentum after all the pandemic delays. Dr Lim hopes to eventually increase the scale of the project to allow more to benefit. His wish is also to ensure that there is some form of follow-up dental treatment after the initial screening conducted by Casa-Modal.

“At the moment, it’s just me running (the project), so I hope to find another dentist who can run a separate Casa-Modal project parallel to me. Through this, we will be able to do the screening at twice the speed and hopefully cover more nursing homes and disability facilities,” he explained.

“We will also go back to check if the dental referrals happen for the patients we have screened. That means if we screen 100 patients, we will return three months later to see how many of them have actually received dental treatment. If they have not, we will try to find out the reason and decide how we should manage it.”

The pandemic has derailed multiple plans and brought about great inconvenience to many. The Casa-Modal project has undoubtedly been one that had seen its progress hit a stumbling block during the height of the pandemic. However, with Dr Lim and his team’s resolve to help the vulnerable, the thought of giving up has never once crossed their minds.

“Dental problems are always existent and could pose a risk at any single moment. Someone in the nursing home today could be suffering from dental disease that could cost them their lives,” Dr Lim added. “If you have that in mind, you won’t really want to stop.”

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