FILLING THE GAP IN TANZANIA Dental Practice Vol 40 No 12 December 2002

Mwanza is the second largest town in Tanzania on the shores of Lake Victoria with a population of about 100,000. The inhabitants are mainly Africans. In addition, there are some 2000 Asians who control the businesses and a small proportion of Europeans who have returned for the second gold rush of the last century! By Tanzanian standards, the region represents a prosperous economy. Most of the wealth comes from mining (gold and diamonds), fishing, farming and raw cotton export.

The launch outside the clinic

By western standards, the medical and dental facilities in Tanzania are scarce and primitive. A small hospital, converted from school dormitories in 1980s, was serving as a local privately run hospital. This hospital is run by a local charity - the Hindu Union. Although there is a much larger government run hospital, this small institution is the preferred hospital for the locals and supposedly runs more efficiently. The dental clinic was to be the latest addition to serve the needs of many. Manny Vasant had collected various pieces of used and new equipment and materials in the UK. These goods were donated by GDPs and the dental trade. The trade included Austenal, Dental Directory and Nessor as principal donors. A local businessman and a philanthropist Mr. Prem Kapoor, was coordinating the project in Mwanza under the aegis of the Hindu Union. Our task was to sort the containers of equipment and help a local engineer set it all up and organize the clinic. This would have been quite a task in the UK, but given the fact that this engineer had never actually seen a proper dental surgery (he was an engineer in gold mines) it turned out to be a mammoth task! It was soon apparent that gold was the only common denominator between the two trades he was working for! In all fairness, he was trying very hard. On several occasions, we had to make telephone calls and frantic e-mails to England for some assistance or explanation.

The Hindu Union had organized an apartment for us about a mile away from the hospital. They also very kindly provided us with most of the meals (until we decided to have a break from eating out) and local transport. We would travel to and from the hospital by car - a very bumpy ride due to the numerous potholes, which were probably the size of moon’s craters! Apparently the last road resurfacing was done when the Brits left in 1961!

To get this clinic off the ground was a real challenge. We were faced with a room full of equipment parts and boxes piled high to the ceiling. Volunteers from Local community, Rotary Club of Mwanza and Hindu Union Hospital teamed up with us, and a local engineer, to put the jigsaw together. We managed to put all the bits together and selected the best dental chair an x-ray machine, an autoclave, a suction unit. We were seriously handicapped with our limited technical knowledge and communicated with great difficulty with the local technical staff themselves quite inexperienced in dental matters. However, after many trials and tribulations and sheer dedication and perseverance, we managed to get the turbine running! This was an achievement in itself. It was a relief that we did not carry the BDA’s Health and Safety advice sheet with us. If we had we could never have got started! More seriously, the course work module that we had put together for the MFGDP by assessment (which includes Health and Safety aspects) came in handy. Amongst the problems we encountered included finding a suitable compressor, providing an adequate and filtered water supply, and generally planning the clinic. Notwithstanding this, within a few days, the empty room was painted, cleaned, installed with fixtures and fittings and transformed into a more presentable working environment. We soon realized that the stock we take for granted in the UK were missing. Items such as silver alloy, air turbines, burs and aspirator tips had to be ordered from Nairobi, Kenya - some 1,000 miles away!

THE SCHOOL INSPECTIONS

The school inspections

Whilst the clinic was shaping up, we had an opportunity to carry out dental screening at a local Primary and Secondary school. Treatment required was recorded on cards and given to the pupils to bring along with them to the dental clinic. It became apparent that the majority of the children who required treatment were from the Asian community probably due to their higher socio-economic status and therefore their consumption of fizzy drinks and sweet foods was greater. In comparison the African children had little or no caries incidence.

THE MWANZA CLINIC

Due to the great demand for dental treatment we were eager to start providing a service for the long awaiting community. Once the equipment was in working order, our next barrier was the consistent power failures that hindered our ability to continue treatment. This was overcome by installing a large (and very loud) generator to power the clinic.

Initially an appointment system was adopted but we soon realized that this was not suitable as the demand was too great as a large number of patients would turn up for emergency treatment. Many of these patients had a traveled a great distance to seek dental help and would be willing to wait for hours to be seen. We were seeing at least a dozen unscheduled patients every day (in addition to our full book). Patients would continuously arrive throughout the day adding to our long queue in the corridor. We found that the majority of patients had one or more grossly carious or broken down teeth, which required either root canal treatment or extraction. However as we did not have the facilities to perform endodontic treatment, extraction was the only option.

To assist us we had a medical nurse whom we trained in dental procedures. The main difficulty we encountered was the language barrier with the African population; this was partially overcome with the assistance of our nurse who spoke Swahili as well as English. We also learnt a few of the basic words in Swahili to help us along. Since two of us are fluent in Gujarati and Hindi and one of us can understand Tamil, this helped us immensely when dealing with the Asian community.

The Mwanza clinic

We sifted through the emergency patients by assessing each one individually in the corridor waiting area using a mirror and torch. We took their name, date of birth, medical history and their complaint. They were assigned a numbered card with their personal details and the tooth or teeth requiring treatment, which was usually extraction. As there were three of us and only one dental chair we had to make do with carrying out extractions in normal chairs due to the large number of patients waiting to be seen. The dental chair was used exclusively for fillings, scaling and surgical extractions. This process became very efficient enabling us to see all the patients waiting. We saw approximately 60-80 patients a day working from 08:30 to 19:30 with no more than fifteen minutes for lunch.

Our finding during the school screening was also reflected in the general population of Mwanza. The African community of low socio-economic class tended to require one or two extractions of grossly carious teeth whilst those from the high socio-economic class including Asians and Caucasians, had smaller carious lesions in a greater number of teeth, requiring fillings rather than extractions. It was also found that the Asian population had a greater incidence of periodontal disease than any other ethnic group.

As our visit was drawing to an end provision had to be made for a dentist to continue running the clinic as there were still a large number of people requiring care therefore the clinic was left in the hands of a local dentist.

The experience we gained in Mwanza was certainly unique. It increased our confidence and experience in minor oral surgery procedures and we learnt about the many problems and pitfalls in setting up a dental clinic. On the positive side, satisfaction of establishing such an important and much required dental clinic was very rewarding.

However, it wasn’t all about the work. We experienced the life in Mwanza as we were invited to many community events as well as evening meals with the families of the town. Even with our large supply of ‘anti this and that’ medication one of us still managed to contract malaria and the other food poisoning! Our six week stay was unforgettable, adapting to the culture and new way of living and meeting people with a different and relaxed outlook on life. We felt privileged to have been involved in such an inspiring project that has improved access to dental care in the area with limited amenities. Manny Vasant is now planning on the phase two to modernize this clinic and replace the second hand equipment with new. He is currently looking for trade and sponsors to donate the equipment. Once the clinic is modernized, hopefully in the few months, he will be recruiting further volunteers and possibly elective from dental students in this clinic. We would recommend anyone to get involved in this rewarding scheme.

Dr M K Vasant welcomes volunteer dentists to work at the Hindu Union Hospital Dental Clinic in the town of Mwanza, Tanzania, for a minimum of 6 weeks. Travel has to be paid by yourself however local accommodation and lodging is provided. [Read More...]