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Dentist opens clinic in Nepali village, putting 'toothache god' out of business

THE BALTIMORE SUN

A photograph of a dental clinic in Namche Bazaar, Nepal, that appeared in yesterday's Maryland section was incorrectly credited. The photographer was Larry Canner.

A seasoned traveler with a taste for the exotic, Brian Hollander went to Nepal 13 years ago with one goal in mind: to see the world's highest mountain. Hike its trails. Gaze at its majesty.

Roll the tape forward: In March, he's dedicating one of the world's highest dental clinics, a two-story stone building that sits 11,500 feet high in a Himalayan village on the trekking path to Mount Everest. Sherpa men and women, members of the local ethnic group, are smiling broadly as he displays the latest in portable, air-powered drills.

Traditionally, their answer to tooth pain had been a crude extraction or a visit to the 'toothache god,' a tree trunk known to deliver pain relief to people who nailed a few coins into its bark.

So much happened to bring him to the dedication.

Dr. Hollander's first excursion to Nepal took a fateful turn when he was hanging out in a Peace Corps office in Katmandu, Nepal's capital. A volunteer showed up in need of a root canal. Usually, Westerners in Nepal fly to Bangkok, Thailand, for serious dental work. But Dr. Hollander, a dentist schooled in Oregon, said there was no need for that. He'd take care of it.

U.S. diplomats stationed in Katmandu saw a good thing in Dr. Hollander. They set up a dental clinic near the embassy and installed him as its sole practitioner.

He stayed for 10 years, filling and crowning the teeth of foreign service workers and other non-natives living in Katmandu. There, he also met his wife, Judy, a former volunteer in a Cambodian refugee camp. They hadtwo children.

One day, a Sherpa woman and her little boy from a village high in the Himalayas showed up with two mouthfuls of cavities. "The boy was 7. He had numerous decayed teeth. His mother had seven decayed teeth. It got me to thinking," Dr. Hollander, 41, said the other day in his Baltimore town house.

Hollander knew more than a little about oral hygiene in poor countries, having worked once for a volunteer program called Dental Health International in Cameroon, West Africa. So he and a friend traveled to the boy's village, Namche Bazaar, and surveyed the oral health ofthe local children.

They visited two schools, shone flashlights in the youngstersmouths and just looked around. "You could just see holes," he said. In one school, 76 percent of the youngsters had cavities. In another, 56 percent did.

The reason was clear: Candy from the West.

The growth in tourism that followed the first ascent of Mount Everest in 1953 spawned an economic boomlet in that village of 1,000 people, the last outpost along the trekking route to great peak.

Each year, 10,000 trekkers pass through the town. Sherpa men got into the business of hauling provisions by back and by yak, up and down the Himalayan slopes. Sherpa women ran lodges where the travelers could sleep, and stores that catered to the Western appetites and sweet tooths of trekkers weary of bland trail cuisine.

"The little shops sold everything for the trekkers," he said. Besides batteries and gloves, entrepreneurs sold "cokes, candy bars and hard candy -- the things that taste real good when

you've walked a long way."

Not surprisingly, the Sherpas adopted the Western taste for sugar, an exotic diversion from a diet that traditionally revolved around potatoes and tea. Tooth decay wasn't far behind. It didn't help that toothpaste was virtually unknown; and the usual concept of oral hygiene was to rub one's teeth with charcoal.

"When your tooth gets loose, someone in the village will take it out. Or it will fall out from gum disease," Dr. Hollander said. "With children, you see grossly decayed teeth. Sometimes when they smile, it looks OK, but when they open their mouths, their back molars are decayed down to the gum."

It came as no surprise to Dr. Hollander that when he looked inside the mouths of youngsters in Phortse, a village two miles off the trekking routes, he saw a different picture. In this town where Western tastes had yet to make an impact, only 17 percent of the children needed dental work.

Tooth decay, he figured, was a modern problem brought by Western culture, and he envisioned a Western solution: a dental clinic in Namche Bazaar.

Two fortuitous events occurred to help make his vision a reality.

A Peace Corps volunteer built a hydroelectric plant in 1986, harnessing a spring that runs through the village. His purpose was to generate enough electricity to light electric stoves, but the plant also supplied enough juice to power electric drills, compressors and other modern dental equipment.

Around the same time, another Oregon dentist, Dr. Toni Eigner, enlisted Dr. Hollander's help in setting up a dental clinic for the residents of Katmandu, a city of 500,000 people. He learned much from the experience, like getting major manufacturers to donate dental equipment.

For the next two years, he laid the groundwork for the clinic iNamche Bazaar.

He hired a Nepali architect, who drew up the plans for a clinithat would cost about $20,000 to build. Richard Blum, a wealthy businessman who is married to former San Francisco Mayor Dianne Feinstein, agreed to match every dollar he couldraise. An Englishwoman who lives part time in Nepal, Diana Penny Sherpa, raised $12,000 from her biennial Everest Marathon, run by people whose idea of a good workout is to race 26 miles from the Everest base camp to Namche Bazaar.

And Dr. Hollander sponsored a trip to Nepal, charging Westerners $3,000 a piece for a trek across Himalayan trails and an excursion to a lush rain forest in the southern lowlands.

Early this year, a Nepali contractor finished the clinic after four months of work. The clinic is built of stone hauled up from a river and lumber cut from a forest 3,000 feet below. Dr. Hollander outfitted the place with dental equipment either donated by or purchased from U.S. manufacturers.

First, he stored the equipment in his parents' garage in Portland, Ore. A Thai airline gave him a discount to fly an X-ray machine, autoclave, chairs, compressor and the familiar dentist's delivery unit -- drill and all -- from Seattle to Katmandu. From there, he chartered a twin-engine plane that deposited it in Lukla, a village 9,000 feet high in the Himalayan foothills. Six porters and five yaks carried the equipment to the village, taking two days to ascend the 2,500 feet.

The clinic, as he put it, was his answer to a problem wrought by Westerners, but he wanted Nepalis to deliver the care. In a country that has one dentist for every 600,000 people, it was doubtful that a full-fledged dentist would set up a practice in so remote a place.

So he looked for a low-tech solution. He found found the answer in Saskatchewan, home of a school that trains people to deliver ** basic dental care -- fillings and cleanings, mainly -- to the native people of Canada's northern territories.

Two and a half years ago, a young woman who had never before left Nepal began her studies there. She is Nawang Doka Sherpa, 23, the older sister of the little boy who once opened Mr. Hollander's eyes to Nepal's problem with tooth decay. She graduated from the school this month and plans to begin treating the mountain clinic's first patients later this year.

Meanwhile, a "For Sale" sign hangs on the Hollander house. The family settled here about a year ago so his wife could study international health at the Johns Hopkins School of Hygiene and Public Health. They are moving back to Oregon, where Dr. Hollander will practice dentistry for a year.

Then, the family plans to pull up stakes once again and return to Nepal. There he intends to practice again at the embassy clinic and to get to work on other public health projects. Like introducing fluoridated salt to the Nepali diet.

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