A Volunteering Award of just £2500 from the College helped to train six Tanzanian rural clinical officers in emergency dentistry and oral health promotion within Chato District, and helped directly provide dental treatment for over a thousand patients in the space of just two weeks. Andrew Paterson from Bridge2Aid tells us more in this article, which his reprinted from the latest edition of our membership magazine “College voice”
Chato District has a population of 365,000 people. In this area there are two fully trained dental staff, the district dental officer and a dental therapist. Additionally there are five clinical officers who provide oral health education and emergency dentistry. The district dental officer and the dental therapist have no functioning dental drills and no access to any restorative materials. In rural parts of the developing world like Chato, lack of access to emergency dental care leaves many with constant debilitating pain and infection which can affect livelihoods and lives. With significant inequality, access to safe dental care is almost non-existent in rural areas in many sub-Saharan African countries like Tanzania. The World Health Organisation (WHO) recognises oral disease as a major public health problem. In addition, oral health is worsened in rural areas as multinational companies such as Coca Cola provide cheap sugared carbonated drinks where there is lack of access to safe drinking water. UNICEF statistics indicate that basic safe drinking water is available to only 50% of Tanzanians and 37% of rural Tanzanians. Patients in rural areas are in most instances unaware of the benefits of tooth brushing and use of a fluoride toothpaste. There is thus a dire need to train rural health workers in the delivery of appropriate oral health education and emergency dentistry to their rural communities.
The main aim of this programme was to train six Tanzanian rural clinical officers in emergency dentistry and oral health promotion. In this instance one of the six clinical officers was the clinical officer for Chato Prison. The additional benefit of this was that, with the training of this clinical officer, for the first time prisoners in the district would have access to emergency dentistry and oral health promotion.
The secondary aim of our project was to provide relief of pain for the patients who attended the programme. In Chato District access to safe, basic dental care for the majority of the rural population is impossible unless they happen to live next to a health centre or dispensary where a clinical officer has been previously trained. These largely subsistence farmers simply do not have the means to travel to areas where access to care is possible. Many patients present to the programme for treatment having suffered with dental pain for over 10 years.
Lastly, we wanted to provide a positive volunteering experience for team members and to give them additional problem solving skills for use in their day to day work. It is recognised that individuals who volunteer can acquire personal and professional skills that are transferable to the NHS. For example, a recent policy report by the College, Global Citizenship in the Scottish Health Service, indicates that volunteers in developing countries return to the UK with a wide range of skills and a better ability to work in challenging environments for a minimal cost to the organisation. These benefits include building enhanced leadership skills, cultural competence, and a greater understanding of social and cultural diversity and of global health issues. For the full report visit rcp.sg/globalcitizen.
Bridge2Aid is considering putting the Tanzanian training model into Malawi in 2020 so this programme was also important to help us develop our strategy around the advisability of a pilot programme to Malawi.
Bridge2Aid has a Memorandum of Understanding with the Tanzanian Ministry of Health to support Tanzanian regional and district dental officers to train rural clinical officers in the WHO’s Basic Package of Oral Care. This includes training in oral urgent treatment including simple tooth extractions carried out by the clinical officers who are non-dental personnel, and oral health promotion. They were also trained in the care, decontamination and sterilisation of dental instruments via a WHO approved method. This requires significant “task shifting” and training of the clinical officers.
As the site clinical lead I taught, led teaching and assessed a competency based training programme which trained the clinical officers alongside of their district dental officer. The overall team consisted of seven UK and US dentists and three members of the oral health team together with two Tanzanian staff. This programme was located in two remote and rural clinics (Nyambugera Dispensary and Kachwamba Health Centre) within Chato district with access problems to the clinics, poor communications and supplies and lack of basic facilities such as clean running water and electricity which necessitated ongoing problem solving to deliver a successful programme.
Following the training, all six clinical officers were deemed competent by the district dental officer, myself and the team so they received a basic instrument kit to provide the basic package of oral care to their community. They will now receive follow up for eighteen months from Bridge2Aid’s Tanzanian team and their district dental officer after which they will be the sole responsibility of the district dental officer.
In addition to providing this training support, 1,021 patients received dental care through the programme. This is the highest number in 94 Bridge2Aid programmes over 14 years. All patients received group and individual oral health education and free toothbrush/fluoride toothpaste. 514 patients at Nyambugera Dispensary also received education in TB and HIV prevention from a local health worker.
During the course of the nine days of the Programme, which consisted of one day of theory delivered by the district dental officer and eight days of clinical training, the 6 clinical officers extracted an average of 122 teeth each. It is worthy of note that a UK dental graduate extracts an average of 31 teeth during 5 years of training.
During our time in Tanzania we also found time to build relationships with host governments and communities, allowing us to raise the profile of oral health with the local District Executive Director, District Commissioner, District Medical Officer and the head of the prison service for North-West Tanzania. This is important as oral health has been seen as a lesser health priority in many low and middle income countries.
One of the clinical officers was based at Chato prison and with this clinical officer being deemed competent this now also enables access to safe emergency dental care and oral health education for inmates at the local prison service for the first time.
What this project has achieved
The 6 rural clinical officers who were trained have already commenced providing emergency dentistry and oral health education to their communities in the Tanzanian wards of Kibumba, Kasenga, Kachwamba, Katete, Kinsabe and Mkiu/Chato prison within Chato District. These areas have an average population of 10,000 people and are mentored by their district dental officer.
All the volunteers who participated in the programme rated their experience positively.
Since the programme finished in September 2018 one volunteer has agreed to become a trustee of Bridge2Aid and two to help develop their communications strategy. Another volunteer has signed up to return to Tanzania in 2019 as an assistant site clinical lead. One volunteer has decided to change career from being a private cosmetic dentist to dealing with dental emergencies in a deprived area of England as a direct result of seeing the health inequality in Tanzania.
Undoubtedly this programme improved my problem solving and leadership skills which I can take back to the University of Dundee and NHS Tayside as a Senior Clinical Lecturer/Honorary Consultant. In particular I hope that it will inspire others, including undergraduates considering electives, to consider volunteering in sustainable programmes in low and middle income communities to be part of their social responsibility as ethical clinicians.
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