Bringing Greater Awareness of Oral Health to the Global Health Community and Vice-Versa

My name is Brittany Seymour and I am an instructor at that Harvard School of Dental Medicine. I’m also an associate for curriculum development at the Harvard Global Health Institute.

I’m working to bring greater awareness of global health to the oral health community and greater awareness of oral health to the global health community.

I do a lot of curriculum development for both global health programs and oral health programs so that we can marry these two fields. I’m a faculty member right now at the Harvard School of Dental Medicine. I teach our dental students about global health – what it is, and what the role is that dentists need to be playing in global health. I also write curricula for the college here, as well as general competency recommendations for what non-dentists should know about oral health.

My other major project is with the Clinton Health Access Initiative in Rwanda. The Ministry of Health of Rwanda has decided to do a major health reform by way of health education. They are going to scale up the quantity and quality of health care workers across their nation as a means to improve the health of Rwanda. Oral health was not part of the original plan, but our oral health team went in, did our spiel, and now it is. We are currently building the first dental school in Rwanda, which will open in August of 2013. I’m assisting with writing the curriculum for the new dental school. We’re hoping to do a lot of integrated training of nurses, physicians, and dentists on some of the horizontal factors for health and then start phasing in more vertical, technical, skill training that is specific to dentistry.

I had a great pediatric dentist — I’m sure that had something to do with it (laughs). Well, I always wanted to do medicine. I really loved science, and career coaches throughout middle and high school always told me, “Oh you like science. You’re good at it. Consider medicine.” So I got to college and did what a lot of college students do. I became pre-med because half of students do. Then I realized that half of students are pre-med. I didn’t want to do something that everyone else was doing. So I actively started thinking about dentistry. The pre-requisites were exactly the same. Dentistry just has a slightly different career path and is lot less popular. So I started exploring and got an internship in college at the Department of Public Health’s oral health division for Colorado, which definitely is where my love of public health started.

The most common thing to do after dental school is to go into a practice and work there. Private practice was never my first love, but as a dentist I wasn’t really sure what else there was to do, which is something I’m working on for my own students. I was very passionate about disparities and needs, but I just didn’t have the training to understand it. I started volunteering with migrant populations, and realized that certain populations had much more substantial needs than the inner city populations that I would work with in inner city Denver. That led me to start doing volunteering outside of the U.S. in communities with no dentists or fluoride.

I really started to see that my one or two week a year volunteer missions were never going to even touch the amount of need that was out there. So over the process of four years, I decided I wanted a career change. I trained a dentist for a year to take over and buy my practice from me, and I moved to Boston. I got a Masters in Public Health with a concentration in Global Health from the Harvard School of Public Health, and then somehow managed to convince the School of Dental Medicine to keep me on as faculty (said jokingly). So that is the very quick version, but it took me about four years to transition from a once-a-year volunteer mission trip to a full-fledged career in global health.

Treating patients was a privilege, and an amazing opportunity for me, but the more that I started to see the disparities in health across the world, the more I realized I wanted to effect change on a more macro level. I could only reach so many people in my lifetime by providing individual care. There is way too much need, and I’m way too passionate about this, so I decided I had to go out and build an army.

As I transitioned out of clinical care and private practice, I decided to look at how to marry the fields of global health and oral health. I went back and studied global health, and I specifically chose a program that didn’t have many dentists in it, because I wanted to see what global health was, who the players were, and where I could fit in. I asked, how can I inject what I know and find a role for myself and my profession in global health?

I think my approach is productive. I could have launched a campaign, fundraised, advocated, or lobbied for oral health programs, but that approach essentially makes it a competition. I mean, we’re competing against the big players like HIV/AIDS. I can’t ever say cavities should be prioritized over HIV/AIDS or over diabetes. Joining forces and figuring out what my role can be in the ongoing global health effort, I feel like will lead to success for everybody. It will kind of eliminate that competition for resources, because honestly we’re never going to win if we take that approach. And health shouldn’t be about winning.

One day a week I oversee students who are treating patients as a clinical preceptor. One day I teach a didactic course in global health to dental students or advanced graduates. Two days a week I am at the Harvard Global Health Institute working on curriculum development and initiatives for global health to strength global health curriculum for the College and University at large. And then one day a week is an administrative day for me. I’m on a student advisory committee for students doing global health projects for the School of Medicine and I also do office hours with my students. So my days vary, but I read a lot of current literature, and write up a lot about what we’re doing, what we need to do, like reports for internal use or publication in journals to spread our message.

I really love my job so that’s a big question. I guess I love how creative I get to be on a daily basis. Not only is that something that I get to do, but that is a requirement of my work. I have to be creative as far as what kind of innovations we are going to develop to tackle these huge problems. I get to be creative in how I develop curricula and teach students to be innovative. I get to be creative in research problems. What problems do we want to learn about? How do we design a study to test those problems? So I really love the creativity that goes into something like this.

As far as the downside, right now, it’s a challenge because there are not a lot of mentors for me in global oral health. I’m finding strong mentors in dentistry and strong mentors in global health, but there are very few, if any here, who are strong in both. So I try to find a balance of mentors, draw from their strengths, and kind of create my own individual pathway.

I love travel, which works out because a lot of that is for my job. I also love outdoor activities, particularly winter sports like skiing if there is snow, or running and hiking if it is summer. I love reading and I love going out to a really good meal and sharing a bottle of wine with friends.

– The End of Poverty: End of Possibilities for Our Time, Jeffry Sachs
– Development As Freedom, Amartya Sen
– Behind the Beautiful Forevers: Life, Death, and Hope in a Mumbai Undercity, Katherine Boo

My advice to students is don’t feel like it is a dead end if there isn’t a set or well-defined opportunity waiting for you in your area of interest. Be willing to put yourself out there and develop that opportunity yourself. First of all, that is a great quality in a leader and something that is really looked on favorably. So don’t be afraid to forge your own way, find something that is related, but maybe not exactly what you want to do, and then create what you want to do yourself.

So what I do is a diagonal approach to global oral health (Julio Frenk’s term). Essentially what it means is a combination of horizontal and vertical programs. Vertical means specifically targeted programs, like fluoride prevention, and horizontal means pooling resources, building a team, and looking at common underlying risk factors that many of us care about. In an ideal world, if we put all our resources into horizontal approaches, we would eliminate all risk factors and wouldn’t need vertical programs. But that is an ideal world. For a long, long time we’re still going to have disease and need, so we’ve got to do both, and that’s where I come in.

People have said what we’re doing is pioneering. And I guess so, but that seems like such a big word. It’s really hard for me to be like, “I’m pioneering,” because that just feels like a big responsibility. I think the marrying of global health and oral health is catching on more rapidly in the dental community than in the global health community, but that’s okay. As more and more of our profession is aware and making these efforts, we can continue to penetrate global health better.

I tell students who want to get into global oral health that right now what’s needed is leadership and innovation because it’s a blank slate. Everything is needed, all the way from individual patient care, to pharmaceutical research, to training of dentists, to training of non-dentists. You’ve got to be ready to be a leader, and you’ve got to be innovative and come up with some ideas to start carrying forward.