Baseline qualitative study for oral health development programs in Mayan villages of Toledo, Belize

The impact of oral disease on systemic health is evident through the clinical manifestations of nutritional deficits, developmental delays and chronic pain. In rural communities where access to health care is limited, the incidence of oral disease is high, and the effects can be devastating. A 2009 PAHO report identified the Maya as the most impoverished ethnic group in Belize, and the most isolated from the Belizean health care system. In Toledo, the least developed district that hosts the largest Mayan population in the country, there is only one dentist to provide care for more than 30,000 residents. A 2010 needs assessment performed by Child Dental Relief, Inc. found dentistry as the primary health concern in several isolated Mayan villages. Because there is limited literature on oral health in Mayan populations, we conducted a qualitative study to determine barriers to oral health care access in these communities. Economy, transport, location, education and beliefs were assessed in unstructured interviews with 75 men and women across 10 Mayan villages. The assessment showed a general lack of access to oral heath care throughout Toledo. Interviews revealed lack of finance as the overwhelming barrier to oral health care access, with finance permeating other barriers. Future studies should address means of overcoming financial barriers, specifically oral health cost reduction strategies. We propose effective measures include placement of a provider in the empty dental operatory in a central village, the regular use of mobile dental units, and increased coverage of both restorative and preventive care.