Zac Morse, Leenu Raju Maimanuku & Seema Lal
School of Oral Health - Fiji School of Medicine

Dental Education in Fiji

Fiji is a group of islands located in the South Pacific about two-thirds of the way from Hawaii to New Zealand. It was settled at least three and an half thousand years ago by what is thought to be a migration originating from the aboriginals of Taiwan down through New Guinea and across the Pacific.

Traditionally the Fijians lived in a feudal society where the chiefs had absolute power over their subjects and could have them killed at will.

Fiji was ceded to Great Britain in 1874 and the accompanying epidemics that followed nearly wiped out the population. Cannibalism was practiced up to the 1880’s but disappeared as Christian missionaries gained influence. From 1879 to 1916 Indians came as indentured labourers to work on the sugar plantations and today they comprise 40 per cent of a total population of nine hundred thousand. Since Fiji’s independence 35 years ago it has experienced three coups that have lead to population loss and economic difficulties. At the time of witting, a controversial law providing amnesty to those involved in the last coup is being considered and the military has openly stated that it will remove the government if it continues the introduction of the law.

Fiji is particularly well-known for its resorts where many of the worlds rich and famous go for holidays and honeymoons. To the tourist who only visits a resort Fiji may appear like heaven on earth, however the reality is that 25.5% of the local population live below the poverty line.

Figure 1. Fiji School of Medicine’s First Medical Graduates.

The Fiji School of Medicine is the primary health care educational institution in the Pacific proper and possesses the only dental school in the Region. A significant proportion of graduates have come from countries all over the Pacific, excluding some American and French territories such as Guam, Tahiti, New Caledonia etc.

 The first graduates of the school were in 1888 and were licensed as Native Practitioners that primarily administered vaccinations (Figures 1 and 2). In 1945 the 4 year dental training program commenced. In 1957 the course shortened to 3 years by exclusion of prosthetics which became an optional postgraduate course. Dental training ceased in 1985 with the government sending students overseas. Upon return the local situation was completely different to what they had learnt and most went back to the developed countries where they had trained. The current 5 year bachelors degree was introduced in 1993 with a multi entry multi exit approach. A sequence of educational modules allowed for a career path from dental technologist, dental hygienist, dental therapist and dental surgeon with a university degree. This allowed people to step off and enter the workforce and after further experience they could re-enter at the point of exit. There are currently approximately 100 dentists and 60 therapists in the country.

The program does not have a dedicated staff member versed in dental ethics and ethical and related issues are somewhat superficially covered in various courses throughout the program. Consent is covered in the first year and built up over the next four years. Consent as it pertains to orthodontics is addressed in the last two years. As part of the Community Dentistry course over the two final years, general principles, legal issues, professional ethics and epidemiological research ethics are introduced and components of ethics are integrated with other topics such as group dynamics, team strategies, leadership and planning.

Figure 2. More recent graduates

Research ethics has received attention of late where the School of Oral Health first established a Research Committee that reviews ethical aspects of any research conducted at the school in 2003.

In July of 2005 we were fortunate to have Dr Suzette Porter, Discipline leader in Community Dentistry, Ethics and Professional Development, School of Dentistry, University of Queensland deliver a one week program to all dental students.

The students were divided into 3 groups, namely 1^st year, 2^nd & 3^rd years, 4^th & 5^th years where the following topics were covered:

- Principle of bioethics
- Privacy and confidentiality
- Introduction to reflective learning
- Autonomy and consent
- Paternalistic and nonpaternalistic deception
- Professional and client relationships
- Value of Professions – Roles and responsibilities
- Ethics and the students developing a code of student ethics

A lunch time session was dedicated to the staff at the School of Oral Health on Academic Ethics.

Figure 3. Recent graduates

Dr Porter concluded her stay in Fiji by being the Key Facilitator at a one and a half day workshop at the Annual Meeting of the Fiji Dental Association. At this interactive workshop the following objectives were achieved:

a. Creating awareness and sensitising participants to take responsibility as oral health care providers
b. Encourage and advance understanding and consideration of the values, patient rights and professional duties that guides the clinical practice of dentistry and delivery of oral health care.
c. Address the ethical issues surrounding HIV/AIDS and infection control and our responsibilities as oral health care providers.

Today Fiji faces many governance and racial challenges; nevertheless the country continues to play a major role in regional affairs and is recognized as the focal point of the South Pacific.

Currently the principal author of this paper is the only member from the Pacific Region.  As IDEALS continues to grow it may wish to consider strategies to include members from countries facing ethical challenges yet it is these very countries that often have the least resources available to them to address these concerns.

Acknowledgements

We wish to kindly thank Dr Porter for her pioneering contribution to the training in dental ethics in Fiji. Her visit was made possible through the Australian and New Zealand government funding under the FADEP assistance to the Fiji School of Medicine.

References 

https://www.cia.gov/cia/publications/factbook/geos/fj.html
http://www.fijifvb.gov.fj/about/history/pre_hist.shtml
http://www.fijifvb.gov.fj/about/history/history2.shtml
J. Tuisuva: Dentistry in Fiji. Program and Abstracts 44^th Annual Meeting IADR, Australia and New Zealand Division 2004
http://www.fsm.ac.fj/new_web/about_fiji_school_of_medicine.htm

Contact Address:

Zac Morse
Associate Professor
School of Oral Health
Fiji School of Medicine
Private Mail Bag
Suva
The Republic of the Fiji Islands
Phone: +679+3311700
Fax: 3305873
Email: zacmorse@hotmail.com
http://www.fsm.ac.fj/soh.html