It was with some trepidation that I embarked on my B2A trip in November. Having flown from Newcastle to Heathrow I was able to meet the rest of the team before boarding our flight to Addis Ababa. From the very start the team, lead by Andrew Paterson, formed a close bond which would last with us throughout the trip. We then caught flights to Dar es Salaam and Mwanza where we meet with the rest of the EH4ALL team.
EH4ALL team
It was then a 6 hour coach journey north, around the side of the Serengeti National Park and towards the Kenyan Border. Our destination was Shirati located in the Rorya district on the shores of Lake Victoria. Arriving in rural Africa is always an assault on the senses! The noise, the heat, the smell, the colours and general craziness of it all take a little getting used to but we were all excited to get started with the training program.
Our hotel for the trip was the Owen which although basic, suited our needs very well and was an ideal base with friendly and helpful staff. Apart from the local catholic church, it was one of the most impressive buildings in any direction! It was from here that we took all our evening meals and held our daily debriefs. We were fortunate that the hospital in which we were working for the first week was only a 20 minute walk away and provided us with an ideal start to the day. We would be able to watch the locals going about their daily business and chores; collecting water, herding goats, children heading to school and any number of businesses at the side of the road.
Children carrying out their morning chores
Our clinical base for the first week was the Shirati Hospital which was funded by the Mennonite community. It was here that we were introduced to the Clinical Officers lead by the much-respected Dr Nila who was one of the Regional Dental Officers. We learnt that in Tanzania it is customary to maintain a handshake during introductions as a sign of respect and engagement, it is rude to point and that we should address each other using our first names preceded by Dr which I really rather liked! Formal yet informal.
The clinical officers were an impressive and great group to work with and were already providing many medical services in their local communities. Some of them would spend all day training with us before heading back to assume responsibility for the delivery of babies! This they thought was easy compared to learning how to extract teeth! It was a privilege being able to help provide training to this group who work in challenging circumstances every day.
Our Clinic
The clinic was basic but provided a space for us to all work together in the same room. Our clinical stations were set up around the room with a central sterilisation area at one end. The training consisted of theory-based learning, demonstration, supervision, tutorials and knowledge-based assessment. There were no facilities other than what was set up in our workstations. There were no radiology facilities and little scope to provide any treatment other that oral health education and extractions. This reflects the conditions which the clinical officers will be working in after the programme.
We treated a whole range of patients during the programme many of whom had been suffering from dental pain for many years. Tragically we came across 2 patients with undiagnosed stage 4 oral cancer. Many of the patients presented with challenges which we would not normally seen in general practice. The HIV rate in Tanzania as a whole is around 4% of the population but in this area it is around 11%. Many of the patients were taking antiretroviral medications which are funded by the state. We also had to manage sickle-cell anaemia and patients suffering for other non-diagnosed diseases. Unfortunately it is often the case that where disease has been diagnosed the patients are then unable to afford the medications to manage it. Everyday we had to manage patients who had travelled up to 20km on foot without having anything to eat or drink and on average we were managing around 100 patients per day. The Rorya district was an area which didn’t have any dental provision at all before our programme. Now there will be 6 officers who will be able to manage patients’ dental pain.
Clinical Station set-up
One patient in particular who stands out for me was a 23 year old woman who presented with a draining extraoral sinus which had been present for 6 months. She had suffered from toothache for 3 years previously to this from a carious lower wisdom tooth. This type of problem can have a significant impact on a person standing within their own community. She subsequently underwent the removal of the offending tooth by myself and my clinical officer and hopefully to a full recovery emotionally, physically and socially.
All the clinical officers had to deliver oral heath education to larger groups of waiting patients and their own individual patients. Most of the patients spoke Swahili exclusively and so the clinical officers were invaluable with their translation and high standard of English. We were very fortunate that one of the UK dentists could speak fluent Swahili having grown up in Kenya and was able to connect with the patients on a much more personable basis.
Delivering Oral Health Education
On the last few days of our programme we were joined by 2 representatives from the Malawian government. This spring, B2A is hoping to roll out their first DTP in Malawi headed by our very own SCL Andrew. I found Andrew and his assistant clinical lead Liz to be great leaders and I wish him all the best in Malawi!
I was great being able to watch the clinical officers progress over the training programme and we were all very impressed with their ability to learn difficult skills over such a short period. It was rewarding to report that all the clinical officers graduated from the course and they should all be extremely proud of themselves.
Graduate Clinical Officers with their new kits
On a personal level I have found this DTP to be a rewarding and challenging experience. It was a privilege to be invited to help the Tanzanian people and to leave a sustainable, lasting legacy. The UK and EH4ALL team members are a great and dedicated group of people and help ensure that B2A continues to go from strength to strength. Lastly, I would like to thank Mydentist who were the sponsors of my trip and the support of my own team at Sunderland Road Dental Practice who have been as enthusiastic as ever throughout.
Keith McClean BDS
