Project yeti

Photo: Randy Larcomb

It sounds like a quest to locate the ever-elusive abominable snowman in the lofty Himalayas. In fact, Project Yeti describes the work of one Australian dentist who’s set his sights on treating some of the neediest residents in the region. By Kathy Graham

Many people when they get to retirement age want to give something back, and Dr George Manos was no exception. After 30-odd years in private practice, the Adelaide-based dentist who says jokingly that his main obsessions for most of his adult life were “sports and family … in that order” and that he didn’t “think altruistically at all”, had a change of heart. “I remember thinking, ‘dentistry has been very good to me; everything I have is thanks to dentistry’. I wanted to return the favour somehow and help those who are not so fortunate.”

Project Yeti is the fulfilment of that desire. Just north of the ancient Buddhist town of Boudhanath, in Nepal, is Kopan Hill overlooking the terraced fields of the Kathmandu Valley. The hill was once the home of the astrologer to the King of Nepal. These days it is the site of Kopan Monastery, residence to a community of monks ordained in the Tibetan Buddhist tradition. It’s also where Dr Manos returns twice a year to oversee the running of the volunteer dental clinic he and his wife Helen founded in 2012 to provide dental care to the underprivileged monks, nuns and orphans of Nepal.

Dr Manos says the seeds for Project Yeti were sown in the late 1990s when he attended a performance by the Gyuto Monks of Tibet. By then, both he and Helen were practising Tibetan Buddhists. Dr Manos was so affected by the monks’ multi-tonal chanting, he offered then and there to perform their dental work for free. He even felt compelled to purchase a 14kg portable dental unit, though he only devised a concrete plan for its use years later in 2011 when he went to Kopan to do a meditation course.

That was when Dr Manos was shown the vestiges of a medical clinic originally set up in the hippie era of the 1970s when the monastery began, now little more than an empty room with a first aid kit. Within days, Dr Manos had met with the Kopan manager and made his pitch. “I told him, ‘if you give me a room I’ll set up a clinic and bring in volunteers and it won’t cost the monastery anything.”

For the next 12 months, Dr Manos gathered up whatever basic instruments and materials he could. By the time he was ready to depart for Nepal in October 2012, his inventory included the dusted off portable unit, a portable reclinable chair and compressor he also bought, and six boxes of glass ionomer cements donated by Southern Dental Industries.

Local supplier City Dental also provided him with filling materials and a curing light, plus a generous discount on burs, instruments and other essentials.

Furnishing their bare room at Kopan took a couple of days. Dr Manos remembers, “There was only one power point and no plumbing. I set up the portable chair in the corner and found a trolley to put some of the equipment on. A young monk and nun with no dental experience were my assistants. Most of the materials were left in boxes and difficult to access. Some days the young monks poked their shaved heads in through open windows and I would make them laugh by squirting them with my water syringe.”

What nobody told the Manos’ was their opening day coincided with a religious holiday. Expecting a big turn-out, the couple felt gutted when nobody came. “We’d gone to all this trouble to set up the clinic and there were no patients.” The next day, though, they flooded in.

There are around 360 monks living at Kopan and roughly the same number of nuns living at Khachoe Ghakyil Ling Nunnery, a branch of Kopan monastery located one kilometre down the hill. They range in age from eight years to late teens, and until Dr Manos came along few had stepped into a dental clinic. Although he would eventually extend his reach beyond the monastery, in that first year Dr Manos just wanted to concentrate on treating monastics.

“You have to bear in mind that hygiene in general, even handwashing, is quite poor among young monks. So looking after their teeth is fairly low down on the priority list. If nobody makes them, they do not brush.”

“It was a little bit selective at first because if I opened the door to the village people, it would be very problematic controlling the numbers.”

In the nine weeks he was there, Dr Manos examined and treated over 200 patients, performing simple fillings, extractions, root canal therapy and many scalings.

“I made it clear early on I wasn’t in the business of replacing teeth. I was not going to do crowns, or make or repair dentures. All that was out.”

He started with the nuns first because he’d been told their need was greatest. Many had previous exposure to fluoride in their village drinking water, and one group of nuns from a particularly remote area, the Tsum Valley, had little decay. Others though, says Dr Manos “had lots of decayed teeth often with only root stumps left.”

What he didn’t anticipate was the reluctance of so many of the nuns to part with their rotten teeth. “One reason was they were very superstitious,” he says. “They thought someone would get hold of their extracted tooth and use it in black magic against them. The other reason was dentistry is quite intimate and they felt shy being with a male in such close contact.”

In these instances, Khandro, the English-speaking nun assisting him proved indispensable. “She did not tolerate fear from the nuns. She’d say, ‘open your mouth right now! The doctor has come a long way to help you so now you help him!’”

Dr Manos equally had his work cut out treating many of the monks who streamed through his clinic. “I saw lots of decay. They’d lost both their primary dentition and space, so quite a few crowding problems were created; it’s quite common to see teenagers with canines that look like vampire’s teeth. I found it difficult to decide which cases would be suitable for the first premolar extractions. So I erred on the conservative side of selecting only the most severe cases for intervention, especially as I was not in a position to follow up with orthodontic appliances.”

Dr Manos admits that working with rudimentary equipment was frequently challenging. “I had a very limited array of donated instruments, many of which were damaged. And things like extraction forceps are very hard to get hold of. That said, the coupland elevator that was donated to me and had a chipped working edge was my favourite instrument. It proved to be the ‘go to’ instrument for removing badly decayed third molars and other root remnants. I surprised myself with how many difficult extractions I successfully completed.”

Initially, without an experienced assistant, Dr Manos was only able to restore teeth with glass ionomer materials. “It was a choice of GICs or silver amalgam. The cavities were enormous, reminding me of the early years of the pre-fluoride era.”

No-one likes going to the dentist, least of all children yet even the youngest of his patients did not flinch during pulpotomies and extractions, impressing Dr Manos with their stoicism. “What really surprised me was they were prepared to lie there even though they were going to incur some pain with injections and so on. But then they’d had very tough lives. And in the monastery, they’re very strongly disciplined.”

Dr Manos has no doubt that the majority of dental problems he encounters—to this day—could be prevented with better oral hygiene, noting that the monks are far worse in this regard than the nuns who are more appearance-conscious. “You have to bear in mind that hygiene in general, even handwashing, is quite poor among young monks. So looking after their teeth is fairly low down on the priority list. If nobody makes them, they do not brush.”

It doesn’t help either that soft drinks and sweets are ubiquitous; even the onsite canteen largely sells junk food. Dr Manos confesses, “I haven’t got my head around how to change that, especially when I see the truck come in with crates of soft drink every week.”

He does what he can though, certain constraints notwithstanding. “You’ve got to understand how a monastery works before you can change anything. There’s a school within the monastery where they learn western schooling. I have to get the headmaster onside, develop rapport with him and try to get him to understand that oral hygiene is important.”

Since that first trip, Dr Manos—who now has a state-of-the-art clinic with modern marble benches, three chairs, specially designed cabinets, two autoclaves and an X-ray machine—has been back to Kopan eight times. He usually goes twice a year, before and after monsoon (March-April and September-October). In March, the annual intake of monks occurs. “So there’s 40-50 young monks who need a lot of dental treatment who have never been to a dentist. There’s a lot of issues to deal with that keep us busy at least for a week and a half.”

In fact, Dr Manos is flat out the whole time he’s at Kopan, unable even to find a spare hour to attend the many Buddhist meditation and study classes on offer. “From the very moment I arrive, my mind is focused on the clinic and making it work because as you can expect, there’s always problems.”

A major headache until recently was an unreliable electricity supply. “Every year the power outages actually increased. Sometimes we only got power for three to four hours a day. And of course, the clinic can’t run without power.” Eventually Dr Manos got a grant which enabled him to “put a diesel generator into the clinic. So now we have power all the time.”

In the beginning, Dr Manos worked solo (except for Khandro and the teenage monk Pende, who helped by cleaning instruments a few hours each day), and consequently was limited in what he could accomplish. These days he’s got more help than he needs, saying “the increase in the number of volunteers since 2015 has now escalated to the point that I cannot accept all the applicants.”

As more qualified professionals have signed up, Dr Manos says his ambitions for the clinic have expanded to the countryside. Every time he visits, he also examines and treats the 16 young residents of the nearby Nifon Orphanage. And last September, accompanied by a dentist from Adelaide and a hygienist/therapist from Maroochydore, he journeyed to a remote Tibetan settlement near Salleri—a 12-hour road journey from Kathmandu followed by a three hour (and 2,700m)—trek high in the Himalayas. Four porters lugged their dental equipment, portable chair, compressor, dental unit, instruments, autoclave and supplies.

“Our aim was to examine and treat the monks living in the monastery and the school kids who board there,” Dr Manos explains. “Word got out that we were in town and so we also had a line-up of locals, some of whom had walked a couple of days to see the dentist! We screened about 100 patients, doing fillings, extractions, scalings and sealants. For most of the patients, this was their first dental visit.”

Dr Manos hopes to return to Salleri regularly. “We’ve set up a five-year plan for it. The hope is to have a permanent base there that’s fully equipped so we don’t have to lug gear every year.”

But Dr Manos insists the Kopan clinic remains the main game. “It was always my idea to set up the Kopan monastery as the main base. And any work outside of that would have to come from that base. My reasoning has always been that you have to have an established clinic that you can rely on for any other outgoings.”

At 67, Dr Manos says his years of dentistry are fairly limited and he’s preparing for the day he’ll be less hands-on. “The idea is to try and set it all up, make it easier for other people to come without me being there.

“What I envisage is that maybe I’ll go once a year or only go for part of the time the volunteers are there, just to make sure everything is okay. And if the volunteers are doing the work efficiently, I see myself pulling back slowly, so that if anything happens to me and I can’t actually get over there, the work of Project Yeti can still continue.”

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