Episode Transcript
Dr Callum Durward speaks to Rebecca Ahmadi
[00:00:01] Speaker A (BECKY): Kia Ora and welcome to The Whole Tooth Aotearoa NZ. A podcast for oral health professionals made by oral health professionals. Here we will share the kaupapa of the oral health profession in Aotearoa, where we will seek to speak the tooth, the whole tooth and nothing but the truth.
[00:00:18] Speaker B (BECKY): Kia ora, oral health professional whānau, you're in for a treat today as we speak to Doctor Callum Durwood, paediatric dental specialist. He has a rich story to tell, so sit back, relax and enjoy! Ka Kite.
The Whole Tooth Aotearoa NZ is sponsored by the Clare foundation.
The Clare foundation is a progressive philanthropic organisation that wants more for our people and our planet. They're proactively acting in ways to positively influence our environment, oral health, youth, wellbeing and women to create extraordinary change. You can find them at www.clare.nz That's Clare C l a r e.
[00:01:01] Speaker A (BECKY): Welcome Doctor Callum Durwood to The Whole Tooth Aotearoa/NZ podcast today and I'm super excited to have you here, but it's your first podcast so we welcome you with warmth and the aroha that we provide here in Aotearoa. So welcome, Callum Let's start with a bit about you, okay?
[00:01:20] Speaker C (CALLUM): Kia ora, Rebecca and hi, everybody.
I've had a career that really has been very different from most dentists. It all started, I'm a Rotorua boy and then I went to Otago to study dentistry. And after graduating I went down to Southland Hospital. I was a dental health surgeon down there for a year. And like many graduates in those days, I decided to go overseas for a while and I was heading to England to do my big O.E. and work over there for a while. But I didn't quite make it to England. I got as far as Thailand and then I happened. I had been reading before I went about the terrible refugee situation of the Cambodian refugees, the Vietnamese refugees and so on. And I knew that there were refugee camps and there were dental clinics in some of those camps. So I made some inquiries when I got to Bangkok and I actually met somebody who was able to connect me with one of the refugee camps. And I went there and worked for three months with an ngo and then I was able offered a job in another refugee camp, this time in Malaysia for Vietnamese boat people. So I worked there for three months and then I was transferred from there up to a refugee camp on the border with Cambodia and stayed altogether about three years. Then I decided to go away. I felt during that time I could see the huge needs, especially in children, and how, you know, the private practice sort of approach to addressing dental problems wasn't going to work very well.
I was also training Cambodian and Vietnamese people to be dental workers, to provide some of this treatment and so on themselves and run some programs in the camp schools. So I thought, oh, I'd really like to get more training. And so I went, applied to Melbourne University, and then I went there and I spent three years in Melbourne. I did my master's there; It was called children's and preventive dentistry. So that was a great experience and I really enjoyed it.
After that, I went back to the camps for another two years up on the border with Cambodia.
But at that point the camps started to close because the peace process had been taking place and people were getting ready to go back to Cambodia. So an NGO that I was with was asked by the Cambodian government if. If we could come over to Cambodia and start giving some assistance in the dental area, because Cambodia had been very isolated. They did have some help from the eastern block countries like the Soviet Union, Cuba, East Germany and so on, but not from the other international countries, not from the US, New Zealand, Australia and so on. So I went with this NGO over to Phnom Penh, where I worked for the national dental school at first. And we had a really interesting time for a couple of years.
We helped to set up and re equip the national dental school. (in Cambodia)
We helped set up some preventive programs in schools. We were able to set up at that time a dental nurse training program and therapist, basically, but they called them dental nurses because the first ones in that program were medical nurses. And it was an interesting program, quite unlike New Zealand's program, because at first we had a Burmese trained dental nurse who came over.
She went to the provinces from province to province with a local Cambodian dentist, and they trained nurses in a short three to six month course out in the villages how to do basic oral healthcare.
They focused on ART (atraumatic restorative technique) & prevention.
They learned how to give local anesthetic. They did extractions of primary and permanent teeth.
And then they went back to their villages and communities and were able to set up with just a simple set of basic instruments and supplies able to provide primary oral health care.
So that was something that was established during that time and very successful while I was there also, we undertook the first national oral health survey in Cambodia, so we actually could identify what the problems were.
And of course, because of the Khmer Rouge, there had been no dental services or no education for about four years. So this was all new. And there were a lot of unmet treatment needs, so services were gradually being established. But there were only 34 dentists left after the Khmer Rouge, so huge needs.
Then I decided to leave. And after that, those years, I decided to go to America and do a one year master of public health. So I did that at University of Chapel Hill, North Carolina. And then after that went back to Cambodia for a little while and then I applied for a job at Otago University in paediatric dentistry under Bernadette Drummond.
So I came back and worked as a lecturer, senior lecturer at Otago for about three years in Dunedin and then decided to go to Auckland and join ADHB, the Auckland District Health Board, and was working in Green Lane and Starship Hospital and Middlemoore (hospital) as a paediatric dentistry consultant.
While I had been in Otago, one of the things that I enjoyed doing was I did become the principal dental officer for a while and so got very involved in the school dental service and so on. And that was a great experience. I enjoyed that. And then when I went to Auckland, I became involved in a project in Northland and this was called the Mid north pilot and oral Health. The problems were so acute in that area and they wanted to try something a bit different that involved more of a toothbrushing program in the schools, much more focus on prevention, getting the local community involved and so on. So that pilot, I thought it was worthwhile and we did learn a lot from that and I think it helped to address some of the needs. I was working with Mary Barrel and Pamela Clark and others up there. They had a fantastic team in Northland.
And then after about ten years working for ADHB, I decided to go back to Cambodia. And so I upped sticks and went to Cambodia and stayed there for the last 16 years. And I was the dean of one dental school and then I became the dean of another dental school.
And then just in January this year, I came back for personal reasons. And now I'm working in Christchurch in a private paediatric dentistry clinic. So with a couple of other dentists and treating children mainly through the public system, children that are referred to us and enjoying it. So here I am.
[00:10:05] Speaker A (Becky): Goodness me, Doctor Callum Durward. I've just jotted down some notes of like, this is your life. And, you know, this could be ten people's professional careers all in one human being. It's absolutely incredible how this is. I could tell early on in your story that your heart was for that greater population, the global population, perhaps the refugee population. There's something in there at the start of your career because not everybody decides a career outside their culture or outside their norm is going to be for them. But, you know, what a story. Like, what a life. Have you started your memoir yet? Because I imagine that's going to be such an amazing read.
But let's start here with you and your story. I'd love to know a little bit more about how did you come to be. Did dentistry sort of just come along as you were growing up? Or was it something at university or at a high school that said, you know, teeth is for me or health is for me? So how did you get into the field of dentistry?
[00:11:11] Speaker C (Callum): Well, my father was a medical doctor and my sister became a nurse and my brother went to medical school. So health was in our family, and we all had a passion for trying to promote good health of New Zealanders.
So this seemed like a good way. I liked using my hands. I enjoyed that. I liked working with people. So I made a decision at university that would like to try that.
[00:11:50] Speaker A: I can see. I can see. Look where it's led you. Can you share a story with us, Callum of something that inspired you, you, or significantly impacted you? You did touch on how you went to, or you were over in Thailand and you first visited the refugee camps. What exactly was it there that created that drive or passion or desire for you to continue to visit these places and stay within these environments? Because I imagine it has its challenges when you're in a different countries with the language barriers or cultural barriers.
Could you share with us maybe one or two stories of that time and how you adapted and adjusted in that space?
[00:12:36] Speaker C(Callum): Well, I always felt that I was very fortunate because of the education I'd received, the training I'd received, and how, especially in Cambodia, where the whole educated population virtually was wiped out.
You know, I felt that I, along with others who were working in the camps and so on, could help to relieve some of the suffering there and also help people in the country to get back on its feet through education in particular.
And so that's why I've always been passionate about education, because I have been so happy to see those students, even the refugee dental workers who didn't have formal education but were trained in basic dentistry, many of them, some of them went overseas and were resettled, but many of them went back to Cambodia. And I followed their lives, and they have made successes of their lives. They, as part of their working in the dental clinic in the camps, they learned some English, and that was a huge help, especially when the United nations came to Cambodia and they all needed translators. Many of them got jobs, good jobs as translators, and then some of them stayed in dentistry and had been able to work providing dental services, which has been good. Some of them were quite successful, others have gone on, got more education. So that's been very good to see, very satisfying. And then at the university where I was working, many of those students that I worked with graduated, and now they're the leaders in Cambodia in dentistry. Some of them have gone into the public health side, contributed a lot, working at the Ministry of Health in hospitals and so on. Others have set up dental practices and good dental practices and are doing great work.
Others, many of them have come back as teachers at the university to train the next generation. That all has been hugely satisfying because it just spreads from something small into something much bigger. And oral health in that way can be improved throughout the country.
[00:15:12] Speaker A (BECKY): That's what an amazing legacy that you've offered to all those people that you've walked alongside and how humble you are in the sharing of that story, because I imagine there, I can't imagine hundreds, hundreds, thousands of people who have been impacted by your walk across your dental profession.
Yeah, it's amazing that you still say you follow their journey, you follow their lives, and it's not just about that small time you were with them for education, it's about their future and how they're then impacting not only their lives, but the people around them. It's quite incredible. I still think you should write a book.
Right. So the next part I'd love to expand on is Cambodia, that time that you were in a position of authority and decision making as a dean and your role there, what are some of those challenges that you faced and how did you overcome them in that role?
[00:16:10] Speaker C(CALLUM): Well, I think initially Cambodia developed the new profession quite slowly. They started, as I said, with only 34 dentists left in the whole country, and then they had to develop everything from there. So there were no specialists at first.
So when in the dental schools, we didn't have a lot of highly qualified people, but we found scholarships, tried to help them find scholarships overseas so we could send some graduates overseas, get more training, come back. And now many of them have come back.
They are now the lecturers, the clinical tutors, the future leaders, they, and doing a fantastic job. So I think that has been a challenge not having. And even now there's no specialists in some areas of dentistry, for example, for example, oral pathology, there are none in the whole country. There's two paediatric dentists in the whole country. There's two periodontists in the whole country, and this is about 17 million people.
So in fact, the dentists there need to be quite highly skilled because they don't have, especially in the provinces, there are almost no specialists out in the provinces, so they need to be able to handle quite a lot of situations and provide good quality care.
So that's been challenging but slowly improving over the years. Another big challenge at the dental schools is the funding, of course, and dentistry to study. Dentistry is so expensive because of all the equipment you need, the materials. And the students are mostly not rich. They're from middle to lower socioeconomic families and parents struggle to find the money to pay for the fees for their children. So our fees were. The universities I worked were private, although I started working at the public university a long time ago.
The fees are about $2000 to $3,000 a year, which for Cambodians is an awful lot of money. But in New Zealand it's probably like 50,000 to pay for a dental school education or something like that. So with only that small amount of income, it's been challenging to set up and run the dental school, especially the clinical part.
But we have been successful.
We had clinics that have very low fees, like $5 for an extraction, $10 for a root canal treatment, this sort of thing. Keep the fees very low so that the public, who can't afford to go to a good private clinics, they can come to our school and get good quality care at a low cost. So that's been challenging.
Another thing that we've done over the last 15 years or so is try to have more international links with other dental schools in the region, attend meetings and conferences with other schools. That's led to scholarships, it's led to opportunities for overseas lecturers coming and, you know, teaching our students and so on, giving courses for the dentist.
So a lot has been gained from that, from those collaborations.
[00:20:10] Speaker A (BECKY): Another great sort of examples there of that sustain. I've written down some words like, it's such a sustainable practice there, you're up-skilling or empowering others to go forward and then support them. Just even the five dollar extraction, you know, it's not just about the money worth it. You're seeing the value in that experience. And I think that also, as you were saying, that all I could think about was the distribution of wealth is just. There's such an injustice there. When you think that the cost of being able to gain an education or a skill in Cambodia is comparison to America or New Zealand.
There just seems such an unfairness there when, when there's such a great need for 17 million people.
So in our last section there, I'd love to talk to you a bit about your observations of a paediatric dental specialist, but, I mean, we could also go into, because, you know, your public health expertise and knowledge as well, are there any current trends or developments that you might, that you have been quite excited about or you've discovered over the last few years, or is dentistry staying quite static with its approach to improving oral health?
[00:21:37] Speaker C (Callum): Well, if I use Cambodia as the example, they have now set up some fantastic programs. I mean, the government virtually puts almost nothing into oral health. That in itself is starting to change. Just last year, a national oral health action plan was made after a long consultation program with stakeholders from all levels in line with the WHO International Global Action Plan.
So dentistry is starting to get on the map instead of just being completely ignored and having no funding. So that's been really great to see.
But some of the programs that we've had in Cambodia in the last ten years, one of them, and Doctor Bethy Turton, who's been on this podcast, has talked about, probably one of them, is called Cambodia Smile. And this is involving midwives and nurses in rural areas who see mothers and young children and at the vaccination visits, provide oral health education and apply fluoride varnish. And we, through that program, we've seen a 40% reduction in caries in those children. So integrating with general health has started to happen a bit, and we hope that that will expand.
We've got a fantastic Cambodian team, or ‘steepo’, that is working on this and moving out and expanding this. The other program that I think has been particularly good in Cambodia is called Healthy Kids Cambodia, and it involves a range of NGO's in cooperation with the Ministry of Health, Ministry of Education and Universities.
And this program is for preschool children and school children, and it has several levels, but one of the important parts of it is the use of silver diamine fluoride. And Bethy would have spoken about this as well. She's one of the architects of the healthy kids program.
So at the very basic level, the team, and it can be dental nurses, as they're called in Cambodia, as well as some dentists, dental students will go into the school, set up toothbrushing programs, and almost every child will have silver diamine fluoride applied to their teeth.
The decay levels are horrendous. About dmft of nine at age five.
So the SDF applied to their teeth. Arrests 80%, 70 or 80% of that carries with two applications, and then the focus can be more on the permanent teeth Fisher sealing with GIC is what is the next level, as well as art restorations. So for these basic dental care, teams can go into the schools, they don't need electricity, they don't need equipment, they don't need local anaesthetic even. And they can provide a lot of the treatment needed to help stabilise and treat the caries in the primary and permanent dentition.
And that's been extremely successful at very low cost because, you know, finding funds for dental programs very difficult, and the government hasn't got much money for that. There is a level three, which is more treatment, but only in those schools where they can find funding for that. So just the basic care and especially the silver Damian fluoride is a fantastic approach. And in New Zealand, coming up very soon, I know that SDF is going to be approved for use. And I think this is going to be a huge game changer in New Zealand.
In fact, today after this, I'm going to a meeting for some discussion about what's coming. So I'm very confident this is going to make a big difference here as well.
[00:26:02] Speaker A: Oh, that's great news. I think it was about four or five years ago, four years ago in the Waikato, we all sat around talking about how amazing SDF would be as part of our toolkit and the community oral health service.
Yeah, it certainly would be at an advantage for these kids who are not quite getting seen on a recall that they need. And as you're talking about those strategies and programs in Cambodia, the thought come to mind.
What can we in oral health learn about the Cambodia setting for us to progress and move forward to improve our health for our tamariki? Because, you know, I think we're at a state where we could have this conversation about, you know, if we're in desperate need of SDF, we're probably in desperate need of a few other things. What can we learn from Cambodia?
[00:27:00] Speaker C (CALLUM): Well, I think we can learn that at relatively low cost. A program like this, if it's extended out to all children who need it and not all need it, but those who need it, it's going to make a huge difference, and especially for the very, for the preschoolers who we know are difficult to treat, who we know and in the past have often needed general anaesthetic or sedation for those children in particular, I think it'll be a game changer. And I, in Cambodia, it's shown it. I mean, the situation here is quite different from Cambodia, of course.
Here we have the wonderful system where oral health therapists are in schools and there's a publicly funded service for all children that doesn't exist in Cambodia, but so we have that big advantage and it's a matter of implementing a new approach, reconsidering what we've done in the past, because I think that has to change so that we have this extra tool in our toolkit that will make a big difference. I think the Cambodia also has started to reach out in the development of the National Oral Health Activity or Action Plan.
There was a lot of consultation with the community, with different stakeholders, with families, with decision makers, dentists, other oral health providers. There was a lot of consultation and that's starting to build a network and Bethy helped to set up this network and it's been something that's been very successful and led to changes. So networking, and I think what you're doing with this podcast is an example. Networking can be very helpful in informing the public and stakeholders, in getting support, in advocate, advocacy and bringing about change.
So I hope that that is something we can learn a little bit from Cambodia about.
[00:29:25] Speaker A: Oh, definitely. I've always. I do enjoy the idea of just having your little toolbox and then going to a space where, you know, going to the people and then saying, right, what can we do in this space? What do these people need or want? And, you know, how can we join arms with our other health providers and actually have meaningful and functional relationships with other providers of primary healthcare in our communities? Because I do see that there is a breakdown and, well, there's a breakdown. There's just everyone's very busy in their own little patch and we would benefit from having that, not only networking, but actual functional relationships for all those who visit and care for our tamariki in the educational institutions.
[00:30:15] Speaker C: We don't see see a lot of inter professional activities, which would also be good because we stick to our own schools. And that interprofessional learning, I think would be very helpful as well.
[00:30:33] Speaker A: I do see the interprofessional connections between AUT and their Bachelor of Health Sciences in oral health and the Bachelor of Oral Health in Otago. I see those teams have been working together of recent times for the betterment of the undergrads and future graduates.
And I think that's not only beneficial, but an advancement to previous maybe relationships or understandings of how we could actually all grow within our fields. So, you know, but also inter professionally, we need to sort out.
I think this is nothing, no reflection on you Callum, but as a paediatric dental specialist, I see that there could be great benefits for oral health therapists and dental therapists to have greater interactions with paediatric dental specialists. Given that we treat similar cohorts and how we could benefit from a relationship, even if it's knowledge sharing or skill sharing. I can only see growth in that space.
So we're coming to the final part of our conversation and I wonder that how do you see the field evolving in the next five to ten years? Seems very short given that in public health, not only just industry, things take a little while to progress in life. I don't know, the next ten to 1510 to 20 years, what do you see oral health changing or progressing or regressing in not only New Zealand, perhaps globally?
[00:32:04] Speaker C: Well, in New Zealand I must say that coming back after being away for 16 years, I have been a little bit surprised and disappointed at the poor oral health of many of the children that I'm seeing. I mean that is a great concern. And it just brings back to me the importance of prevention and having access to those preventive services right from a very young age and being able to reach families even in age one, age two, in that time when interventions can be put in place to help prevent what's going to happen later.
I was going to mention about one other good thing to learn from Cambodia. At the university where I was, we had a great community outreach program for our students. Our dental students would go out and take part in the healthy kids Cambodia projects and schools. They would go out on a weekly basis and provide some of this very simple care in schools. They would also go out. We had students going into the prisons every week to provide care for prisoners and students had some time to reflect on these activities, learn about how to run a program like that, see the needs out in the community, learn how they can be addressed in low cost ways. And this sort of thing for New Zealand oral health students also, I think would be quite valuable if they can get to do that sort of thing.
[00:33:49] Speaker A (Becky): And there's that building relationships again, isn't it? To be able to move into those populations, whether it be youth in justice systems or children in kangaroos or wherever the cohorts are. We've got to go. I think we need to move away from clinical space in some respect, but build relationship with community in order to make that shift for improving oral health. Get to know what's going on around your town.
[00:34:21] Speaker C (Callum): As I was saying, I think prevention is so important and I don't know what others think, whether are we still focusing a lot on that or have we moved away from that because there is so much pressure to complete, you know, treatment needs and the treatment needs are so great.
I think that has to be looked at and see what we can do to, to really bolster the preventive side.
[00:34:54] Speaker A: I wonder that from my observations or experiences in the last few years, the consistent evolution of, I guess, right on the grassroots level of leadership, changing from district health board to Te Whata Ora and Health New Zealand, a lot of change. And some of the decision makers perhaps did not see the value of prevention and saw that there was a money value or a dollar value on restorations, and that was that the treatment needs were the higher level. So things like education, prevention, fluoride programs, toothbrushing in schools, they all sort of just dropped by the wayside as clinicians just got deeper and deeper into their cavities as such.
So I wonder that, yeah, there needs to be a bit of a stop and reset. Lift your eyes up and see, actually prevention is going to be the answer to the problems that we're sitting within, I think, in Aotearoa. And I appreciate that, you know, that while you're preaching to the choir, to me, preaching to the converters, you know, but probably my audience as well. But it's great to hear this collective voice saying the same things, that prevention is going to make that difference for people to experience.
[00:36:14] Speaker C (Callum): And then also the upstream interventions, you know, at the higher level, the policies that will reduce sugar consumption, taxes on sugar, for example, in some countries of the world, have been, had positive results. Water fluoridation, of course, I'm a proponent of that.
[00:36:46] Speaker A: Yeah.
[00:36:46] Speaker C: That are going to help, definitely.
[00:36:49] Speaker A (Becky): Well, we're fighting a bit of a problem with the lunchbox situations, I have to say. I'm a lunchbox observer. As I walk around schools, down in the schools, my children go to food. The food has changed. That children are eating like what I ate of many 40 years ago in my lunchbox certainly wasn't anything in a packet.
You know, all the kids food now is in packets, unless I force my children to eat chopped up apples, grapes and carrots, which they squawk about because their friends have got oreo packets and dehydrated seaweed and all those kind of things in packets. And I wonder that these habits, these nutritional habits are going to even have a more detrimental outcome to oral health and overall health as they eat more processed foods.
[00:37:35] Speaker C: Absolutely.
[00:37:36] Speaker A: Yeah. It's a battle. It's a battle to even get my kids to eat things that are actually growing in the ground and off an animal. But anyway, I digress. But Callum, thank you very much for spending time with us today on The Whole Tooth Ao/NZ you have an incredible story and I'm sure we've only just got the tip of the iceberg of it. And, you know, I haven't even got into your time at Southland Hospital, that's where I was born, that’s my tūrangawaewae . And, you know, what was that like many years ago down old Southland hospital. I would love to talk to you again sometime, Callum. Maybe in another six months where you've had a bit more time to sit in Christchurch and see what's going on. Even the advent of SDF would lovely. We could have a celebration online.
[00:38:22] Speaker C: It's likely to be registered in the next couple of months.
[00:38:26] Speaker A: Wonderful. And then there will have to be a rollout. Right. Or some education around it.
[00:38:30] Speaker C: I think there's a huge amount to be done.
[00:38:32] Speaker A: Yeah.
[00:38:33] Speaker C: I suppose what the next steps are, all the guidelines have to be put in place and then all the training has to be done. And how is that going to affect what we have normally been doing? It's going to change what we normally have been doing such a lot.
[00:38:48] Speaker A (Becky): That's right, yeah. And I'm sure we can't. Yeah. It is very, very exciting because it means we have to then relook at the prevention that is being provided and what the process would be after Silver diamine fluoride is released within to the clinical setting. So hopefully that gets conversations flowing and a real focus back into prevention in the provision of oral healthcare. Thank you so much for speaking with us today. It was an absolute privilege and pleasure.
[00:39:16] Speaker C: My pleasure.
[00:39:18] Speaker B: The Whole Tooth, Aotearoa/ NZ is sponsored by the Clare foundation.
The Clare foundation is a progressive philanthropic organisation that wants more for our people and our planet. They're proactively acting in ways to positively influence our environment, oral health, youth, wellbeing and women to create extraordinary change. You can find them at www.clare.nz That's CLARE, C l A R E.
Go well, Oral health professional friends and whānau from us at Rebecca Ahmadi and Associates at the Whole Tooth Aotearoa NZ.
