WFO fellow leads award-winning Wentworth Foundation to provide orthodontic treatment to impoverished population in Kwa Zulu Natal in South Africa
In 1987, Dr. Sikki Singh, a WFO fellow, returned to his home province of Kwa Zulu Natal (KZN) in South Africa after completing the graduate orthodontic program at the University of the Western Cape in Cape Town, South Africa. As he established his private orthodontic practice in Durban, South Africa, he immediately saw the tremendous need for orthodontic and cleft lip and palate treatment among the impoverished residents of the province. Compelled to act, he started a community-based orthodontic clinic at the Wentworth Hospital Dental Clinic, located south of Durban, in 1990.
“Although there are many hospitals and clinics spread around the province, there is no tertiary level of dental care,” said Dr. Singh, who notes that Kwa Zulu Natal has the largest and most impoverished population in South Africa. “This means that indigent patients with severe dental and facial problems, such as malocclusions, cleft lip and palate, craniofacial anomalies and jaw injuries, have no recourse for treatment or rehabilitation. Moreover, there is no full-fledged dental faculty in KZN to alleviate the problem. … I could not turn a blind eye to their plight.”
When Dr. Singh started the clinic, he treated approximately 20 patients a month and worked with the resident dentists and dental assistants. Word about the clinic quickly spread. It began to draw patients not only from Kwa Zulu Natal but also from Eastern Cape, a neighboring province. The plastic surgery department and the craniofacial clinic affiliated with the medical school at the University of Kwa Zulu Natal also began referring all of the cleft lip and palate patients to the orthodontic clinic for orthodontic treatment. Outlying hospitals, clinics and private practitioners also referred their patients to the clinic.
Twenty-three years later, the clinic is now known as the Wentworth Foundation, and the volunteer doctors and staff treat approximately 200 patients a month. More than 18 volunteers work in the clinic every month, including two orthodontists, five dentists, three dental hygienists, one dental therapist, five dental assistants and one dental technician. A maxillofacial surgeon and a plastic surgeon are also part of the volunteer group and assist with the management of the foundation, which was registered as a non-governmental organization in 2007 and as a public benefit organization in 2011.
In recent years, the Wentworth Foundation has received awards for its work. In 2012, the foundation received the International Award from the World Cleft Lip and Palate Foundation. The award recognizes the Wentworth Foundation as the best community and volunteer-based project for cleft-afflicted individuals in Africa. Here, Dr. Sikki Singh (fourth from the left), founder of the Wentworth Foundation, accepts the award from the World Cleft Lip and Palate Foundation representatives. The Wentworth Foundation has also received awards from the Health Professions Council of South Africa, the Rotary Club of Durban and the Kwa Zulu Natal branch of the South African Dental Association.
The Wentworth Foundation is the only community-based dental/orthodontic organization in Africa that will treat patients, who cannot afford care, from birth to adulthood. “We treat a cleft patient at birth for the feeding plate, at 7 years for slow expansion, at 10 years for orthodontics and bone grafts, at 18 years for orthognathic surgery, and at 20 years for nose revision,” Dr. Singh said. “It is also a unique public/private sector initiative. Under difficult circumstances, the foundation has managed to document some of the patients from birth to adulthood. Recently, with more sponsorship, we are documenting most of our cleft cases.”
To qualify for treatment, patients have to provide documentary proof that they cannot afford private treatment. All patients are placed on a waiting list. A number of patients are selected for treatment each month.
Through the years, however, the Wentworth Foundation has faced numerous challenges as the patient load has grown. The volunteers have had to deal with the issues of expenses, space and working conditions.
Whenever possible, patients pay for the material costs associated with the laboratory work. However, as most patients cannot afford to pay, the foundation will cover these costs. In addition, orthodontic companies have donated materials. To raise additional capital, the foundation has held fundraising drives within the dental community and in the private sector. The volunteer doctors, staff members and the laboratory technician also provide their services free of charge.
The lack of proper treatment facilities is another hurdle for the foundation. “Initially, when the public-sector clinic started 20 years ago, we treated patients for orthodontic problems only, and we used only removable appliances,” Dr. Singh said. “With the referrals of cleft lip and palate and orthognathic patients to the clinic, we had to progress to full fixed orthodontic treatment and everything that went with it. The problem was the lack of facilities at the dental clinic. With only two dental chairs and no X-ray facility, it became impossible to work.”
To address the issue, the foundation has split the patient base into two groups. Those patients requiring orthodontics only are treated with removable and fixed appliances at the public-sector clinic. The volunteers attempt to take as many pretreatment records as possible. Patients who require surgical intervention are treated in private practices. Dr. Singh, who devotes one day a week to the foundation, is currently treating approximately 60 of these patients in his office. “Full pretreatment and posttreatment records are done for these patients,” he said.
To further the foundation’s endeavor, Dr. Singh and the other volunteers reached out to the province’s dental community about four years ago. All dental practitioners in the province received a pledge form that asked them to pledge free services for patients in their area; these services include prosthodontics, periodontics and maxillofacial surgery.
“It is amazing how many private practitioners volunteered. We had 80 pledge forms returned to us from all parts of KZN, and a number of the foundation patients have already been treated for free by these private practitioners in their offices,” Dr. Singh said. “Dental practitioners volunteered to do fillings, extractions, scaling, etc., and specialists volunteered to do the advanced work.
“South Africa is a country of very rich and very poor ― first world and third world. Working in the foundation’s clinics always brought me back to reality. The reality is that +/- 70 percent of the people in South Africa are poor. The greatest pleasure for me and my team is trying to help the disadvantaged in whatever way we can to bring a smile to their faces.”