High charges of dentists open door to wandering untrained dental therapists in Syria’s Homs
Homs – Orwah al-Mundhir
Under the winter sunlight of December, Abdullah sits on his small wooden chair, opening his mouth to allow Hayel, a wandering untrained man who practices the profession of dressing and installing artificial teeth, to check his molar teeth.
Hayel examines Abdulla’s mouth and counts five fully-worn molar teeth. He returns to his chair and begins rolling a cigarette with Arabic tobacco, saying to the sixty-something-year-old man Abdullah, “I will prepare five artificial molars for you at the cost of 120,000 Syrian pounds (SYP = 41.667 USD). In return, I want you to market my services to your neighbors and relatives after we finish the installation operation and you try them.”
Hayel descends from one of the gypsies or Dom “nawar” clans that lived in the al-Waer neighborhood groves in Homs province. He works in carving wooden-handled knives and cleaning copper pots, as well as dressing and installing artificial teeth, a profession that has increased lately in the light of high prices.
The nawar community in Syria are groups of gypsy people, of whom the greatest part are located in the desert of Homs and Hama. They live in nomadic communities, whose lives are highly unstable, and most of them live in makeshift tents on the outskirts of cities.
High cost pushes patients away from visiting dentists
Abdullah told Enab Baladi that he does not want to fix his teeth by the nawar, but he has no other choice. He added that he first headed to a dentist; however, the latter told him that the treatment of his five molars would cost him more than 350,000 (SYP =121.528 USD) for the used materials other than the doctor’s fee; thus, Abdullah asked Hayel to treat his dental problem.
Syrian dentists do not adhere to the wages set for them by the Ministry of Health, as the prices of materials used in their work are subject to the US dollar exchange rate and almost are entirely imported. Besides, the wage rates bulletins are not periodically updated, as the publication of the latest bulletin was in 2018.
Dentist Rahaf Habboush says that it is impossible to set fixed prices when installing dental bridges and teeth and molar implants, for the prices of the materials used are unstable and are of different types and values. Thus, the dentist will agree on the treatment fees with the patient before starting work.
Dentists in Homs province charge patients high prices compared to the average income. The procedure of drilling and filling a molar tooth costs on average about 25,000 (SYP = 8.681USD), while the installation of a dental bridge costs more than 120,000 (SYP =41.667 USD). Dr. Habboush also attributed the high charges to the expensive cost of equipping the dental clinics and the huge expenses that dentists bear during their study years. She said the average price of a dentist chair alone is more than five million (SYP = 17,361USD).
After 2007 and as living conditions improved in Syria, patients stopped relying on the nawar to treat their teeth, and instead, they resorted to dentists’ clinics. Since then, the work of wandering nawar dental fixers became limited to older people; however, the deterioration of living conditions restored the profession of dental dressing and installation, according to Hayel.
Improper sterilization of no medical or scientific basis
Hayel confirmed to Enab Baladi that he uses the same materials used in dental prosthesis laboratories that dentists deal with. He added that his work is no different from that of the dentist except in place and scientific degree. He attributed his low prices to the few numbers of people working in making the artificial tooth.
Before starting his work, Hayel washed his hands thoroughly and wore a medical mask after Abdullah asked him to do so. He then started sterilizing his tools in front of the patient to reassure him.
Dr. Habboush expressed her resentment at the fact that some people are still resorting to the nawar to fix their teeth. She said that the nawar do not comply with medical standards and health conditions during their work and that they put the patient at risk of gum inflammation (gingivitis) when they cut it with unsterilized instruments or poorly sterilized ones, especially with the spread of the novel coronavirus (COVID-19) pandemic.
The young dentist added that the nawar usually install dental crowns and artificial molars and manufacture full dentures. They cannot perform tooth drilling or filling procedures because they require expensive medical equipment.
The nawar clans experienced repeated displacement due to the seven-year military operations in the governorate and its countryside. They are known for isolating themselves from the Syrian society. The nawar speak Arabic besides their mother tongue, the Domari language (an Indic language variation). Some nawar groups claim to descend from ancient Arab tribes, such as Bani al-Murrah and Bani-Tamim.
The nawar clans have worked in various professions, according to the 2006 book “The Nawar Clans of the Levant,” by Damascus University anthropology professor Ali al-Jablawi.
These clans include the Qurbat who are famous for making sieves (a device for separating wanted elements from unwanted materials), al-Tabalah, al-Riyass, al-Tanjarliyeh, al-Sa’adeen, the monkeys and bears tamers, the acrobats, the blacksmiths, al-Sabbagh, the nawar who install gold and silver artificial teeth, the copper cleaners, the Hajiyat women who entertain at parties, the fortune tellers, the al-Sha’ar, and the al-Qawasid.
The nawar clans are concentrated in Homs in the al-Waer neighborhood and the eastern countryside, near the Lebanese-Syrian borders, from which they were displaced after the Lebanese Hezbollah took control of the area. Some of the nawar people returned to the al-Waer area, but in the eastern countryside, the existence of the Islamic State (IS) cells and mines prevented their return.
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