Roaring trade of Pakistan's street dentists

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More than 13,000 illegal, unqualified dentists sit on the pavements of Pakistan, providing services to people who cannot afford healthcare.

Latest reports say that 78% of Pakistanis do not have access to even basic healthcare facilities - and private medical care is unaffordable for most.

Nooruddin sits on the bridge overlooking an old railway track and dirty lanes.

Beside him, on a dirty sheet, is a rusty drill, unlabelled bottles filled with murky liquid. And teeth. Rows and rows of them in a smudged glass display.

Marginalised groups

This has been Nooruddin's dental clinic for the past 20 years. He offers on-the-street quick fixes to dental problems, but has no qualifications for what he does. His patients cannot complain.

A recent report in the medical journal The Lancet highlighted the fact that Pakistan has no health insurance system, which is why so many Pakistanis pay healthcare expenses themselves.

Less than 1% of Pakistan's GDP is devoted to the health sector - equivalent to under 4% of the government budget.

With no cohesive policy in the public health arena, the government has been struggling to provide even the most basic medical facilities to marginalised groups.

For those who are barely surviving, the rising costs of living means that taking care of the teeth is an unaffordable luxury.

As a result, improvised roadside medical services are a thriving business.

Widening gap

The Pakistan Dental Association says that roadside dentists operate in the side streets and back alleys of most towns and cities.

The authorities have initiated several crackdowns on illegal street medical practitioners, so they take often their portable medical clinics and set up elsewhere. There are plenty of poor settlements and slums where their services are needed.

"If you are rich and fashionable, go to a foreign-trained dentist," says Nooruddin. "I am the poor man's doctor and I am all that he has."

Meanwhile, the widening gap between the rich and the poor in Pakistan can be observed in Dr Anees-ur-Rehman's ultra-modern dental clinic in the shiny capital, Islamabad.

Inside, the walls are decorated with postmodern artwork. Classical music plays in the background, subtly drowning out the sounds of the dentist's drill.

Dr Rehman's clinic offers top-of-the line dental work - for those who can afford it.

A single teeth-polishing treatment can cost more than $200 - while nearly a third of the population lives below the poverty line.

Rotting teeth

The crowded waiting room of patients, sifting through Gucci bags and tapping expensive-looking shoes, suggests that the rich and famous of Pakistan consider money no object in pursuit of the perfect smile.

"People who can afford to will be willing to get our treatment, because functionally and cosmetically, we can make them perfect," Dr Rehman says. "And that is what everybody wants, to be perfect."

Professional dentists claim the reason for increasing dental expenses is the imported equipment and personalised care - fees need to be high to break even.

Just the basic dentist's chair unit here costs the same as a luxury car in Pakistan. And there are plenty of luxury cars parked outside Dr Rehman's clinic.

But street dentists are the only option for people like Ahmed, 60, who sells vegetables on a cart to support his family of six.

He is diabetic and his teeth are rotting and he desperately needs new ones.

Ahmed says that government hospitals might offer free treatment, but services and accessibility are limited for people like him.

Serious infections

The street dentist concentrates on using a red-tinted concoction to secure a new tooth in Ahmed's mouth, the occasional fly alighting on his hand, his tools and his patient.

At his side, arranged like a museum artefact, is a pair of dentures.

Medical experts say that the use of unclean equipment on dozens of patients can result in hepatitis and serious infections, but those who come here are driven by pain and desperate for the only relief they can afford.

"I went to the doctor, and he was asking for 3,000 rupees ($28)," Ahmed explains, showing me his brand new teeth which are stained with red dye.

"This guy was asking for 250 rupees. When I said that I couldn't pay that, he said: 'OK, pay 200 rupees.'"

It is a different kind of service with a smile.