When a petite Thai-American dentist in suburban Maryland learned that 90 percent of the children in her ancestral country lacked dental care, she traveled to remote jungle regions to fill cavities, pull teeth and treat abscesses.
Smiles on Wings, the non-profit dental care group she founded 10 years ago, now recruits volunteers to fly halfway around the globe at their own expense and then go with her by bus, truck, jeep, boat and on foot into remote villages near the Burma border.
They've treated 2,000 patients who otherwise had no chance to get dental treatment.
Volunteer Peter Kovach, a former State Department official, joined the team in January and raced down the rough waters of the Salween River towards a village full of children in need of dental care.
"The rural school at Huay Sing was the site of the next Smiles on Wings clinic," said Kovach.
"At a boarding school for poor rural kids, Thai Government Health Department officials pre-screened and aided the American, Thai-American, Thai and Irish volunteers traveling with us. They did fillings, scaling, extractions and sealing on a sea of ... unusually brave and grateful kids."
The volunteers who are not dentists teach children to brush their teeth; or they haul boxes of supplies from trucks into makeshift clinics.
Dr. Usa Bunnag came to the United States from Thailand at age eight, got her dental degree at Howard University in Washington, D.C. and soon began to donate her services to monks at a Thai Buddhist temple in the Maryland suburbs.
One of the monks told her about the need for dental treatment in Thailand and "he talked about starting a non-profit -- he connected me to the secretary of the Princess Mother Mobile Medical Foundation" said Dr. Bunnag in an interview.
The late Princess Mother, whose son King Bhumibol Adulyadej is the world's longest serving monarch, had long fought to introduce modern medicine to Thailand. She gave birth in Cambridge, Mass, to the future king while her husband was studying at Harvard Medical School.
Dr. Bunnag, speaking in her dental office in Bethesda, MD just outside of Washington, D.C., told foundation officials that she would bring "health care from America -- volunteers and supplies." The foundation said the American team could work with the local hospital mobile team in Maesariang Hospital in the Northwest of Thailand. That is an undeveloped region bordering Burma (also called Myanmar) with many minority hill tribe villages largely cut off from the mainstream of the prosperous parts of the Thai economy.
For 10 years, Dr. Bunnag has led volunteers to remote villages mainly of the Karen ethnic group -- living along the Thai side of the Salween River, which divides Thailand from Burma.
Even though Thailand has made great progress economically and in development since the 1960s, few Thai dentists chose to practice in remote regions.
If their spouse has a job or is studying, and their children go to a good school in Bangkok or another big city, it is a great sacrifice to move into the hinterland. This is a problem in America as well where young doctors needing to repay student loans and raise their families are reluctant to work in rural communities.
The Karen village where the Smiles team set up its mobile clinic is three hours drive away from Chiang Mai, the biggest city in the Northwest, over dangerous and scary roads.
I recall vividly taking a trip in the 30 region years ago to report on declining opium production. When the red clay laterite road was soaked by rain, our pick-up truck began coasting sidewise down the road and ended in a ditch.
At a fundraising gala recently held at Montgomery College in Maryland for Smiles, photos showed the team's jeeps and trucks, equipped with chains to get through the mud, fighting their way through a jungle landscape.
Mostly it is children who come to the dentist -- and mostly it is for cavities or extractions. Root canals, bridges, implants and caps are all too difficult to provide in the temporary, sparse jungle clinics set up by the team.
Thailand does provide free dental care to its citizens but only at government hospitals in cities.
"One woman told me that to take her child to a dentist she would have to walk two days carrying the child and then wait to be seen as many as two more days," said Dr. Bunnag. "And she would have to have money to pay for room and food in the city."
She estimates that 90 percent of Thai people -- who live in the poor northern hinterland, the sun baked plains of the Issan region in the Northeast, and other rural areas -- lack access to a dentist.
"I am the only dentist who serves Maesaeriang," said Dr. Bunnag.
Because there is "a lack of oral hygiene," she said, part of her volunteer team is directed to teaching the children and their parents how to use a toothbrush and take care of their teeth.
The children all go to school until the sixth grade, even in remote areas. So the Smiles team works with the teachers to distribute toothbrushes and toothpaste, and show videos "if we have electricity" promoting dental hygiene.
"We get the older kids to help -- they carry on our mission," she said. "If we do not have continuity, if we do not go back again, the gains are lost."
Given the terrible amount of pain we all suffer if we have an abscess or cavities reaching the nerve, it is sad to know that 90 percent of the people in Thailand -- and in many other developing countries -- lack all access to dental care.
Aid groups often focus on major medical problems such as HIV/AIDS, TB, malaria, measles and maternal mortality. Dental care seems to be an afterthought.
Even in the United States, dental care for those without money is problematic. When a mobile dental clinic set up in the Middle West a couple of years ago, it drew thousands of people who slept in their pick-up trucks to try and get treated by a dentist. Some 27 percent of third graders in Missouri had untreated dental decay in 2011.
Aside from the Northeast Thai villages the Smiles team visits twice a year since 2003, the team also serves survivors of the Great Tsunami of 2004 which killed nearly 5,000 people in the south near the Thai resort island of Phuket.
The Tsunami-hit village is not as remote as those near the Burma border, but dental care is scarce because few dentists chose to practice so far from the big cities. And most of the adult patients are day laborers and can't afford to lose a day's pay waiting for an appointment.
"If people have money, they are ok. But most people can't afford a dentist visit outside of the government hospital," said Dr. Bunnag.
Dentists study six years after high school and need to pay back loans, which they cannot do by serving in a rural area. "Nobody wants to go work in a rural area -- it is like a death sentence," she said.
Smiles on Wings has raised funds in the Washington, D.C. suburbs where Dr. Bunnag has her practice; and it won a grant from the Australian New Zealand Women's Group in Bangkok. That grant is allowing her to begin doing root canals.
The American dental teams now head to Thailand in late January for two-week missions in the North; and then in July and November smaller teams go to the South and other sites.
Smiles on Wings has also set aside about $35,000 to send five Karen girls to college -- first in their communities.
Smiles is looking for other sources of funding: "we are growing and capable of growing," said Dr. Bunnag. "I need funding to help me. I don't sleep."
In 2009 she got a grant from the American Dental Association Foundation, which allowed her to expand work to the villages in the south affected by the Tsunami.
Now she is beginning to build a permanent clinic there and is also looking for funding from the U.S. Agency for International Development, the world's largest foreign aid donor.
"It's not easy to get a grant -- you don't see the impact right away from dental care," said Dr. Bunnag. "In the past I got pretty discouraged. I need money to do an audit so I can get accredited" by USAID and other donors.
Above all she wants to hire an administrative assistant to take over auditing, financial accounting and other such duties -- all of which she does herself.
She is also concerned because at age 51, she had been using her own income to cover some of the costs of the missions and she worries how she will provide for her own retirement.
Her husband suffered a stroke a few years ago and she also is his care giver.
Despite his stroke, her husband accompanied her on the missions, even if it meant that his wheel chair had to be carried down steep slopes to the Salween River for travel to distant villages.
CORRECTION: An earlier version of this post indicated that Dr. Bunnag received a grant from the U.S. Dental Association Foundation. She received the grant from the American Dental Association Foundation.