One charity’s novel approach to bringing dentistry to rural Africa. By Sue Nelson
The gulf between dentistry as it is practised in wealthy countries like Australia and in many developing nations around the world is stark—and is widening. There is a vast difference in the nature of the dental problems faced, the access to infrastructure and, of course, access to a stable workforce. Across the developing world, billions of people have no access to even the most rudimentary dental health care.
Many Australian dentists, at all stages of the career spectrum, are interested in how they can lend their considerable skill to bridging this gap. UK-based charity, Bridge2Aid, which has recently established an office in Australia, promises to provide the conduit between willing, qualified dentists from developed countries like Australia and the UK, and health workers in rural Tanzania, where the organisation has been deploying volunteer Australian dental professionals to train up a local health workforce that can provide safe emergency dental treatment to remote rural communities.
It is hard for many of us to imagine the kind of dental problems that still exist in many of the poorest developing countries. Such conditions extend way beyond the teeth and mouth—sepsis from untreated dental infections can spread throughout the body and become serious generalised medical conditions that cause chronic pain and suffering, amputations, and, in many instances, death.
“One of the big things we’re trying to do is to demonstrate to the health community what happens when you don’t provide access to basic dental treatment,” Bridge2Aid CEO Mark Topley says. “It doesn’t just carry on and cause a little bit of pain—when it tracks into the rest of the body it can cause some serious problems.”
Health, let alone dental, spending, in many developing countries is negligible. The USA—which hardly has a generous health budget—spends about $360 a head a year on dentistry. By contrast, Tanzania spends $110 a head per year on all its healthcare, and a tiny fraction of that goes on dentistry. “You can’t possibly sustain the kind of dentistry that we would have in the West, in Australia or the UK or in America, because it just costs too much,” says Topley.
“If you go to dental school either here or in the UK, you probably take out five teeth on average during your undergraduate degree. These guys are doing a hundred in eight or nine days.”—Mark Topley, Bridge2Aid
This is further compounded by a lack of synergy between health disciplines in countries like Tanzania: “The wall between dentistry and medicine and general healthcare does not help,” Topley says. “The doctors don’t understand what dental problems are, which means that they can’t talk about dentistry or advise patients on how to promote good oral health, and it also means that in some places people can’t access any kind of treatment.”
Volunteering in such an environment can be challenging. Australian dentists are used to high standards and a robust dental infrastructure—each procedure has mandated and specific fit-for-purpose equipment and rules around the way it is carried out. By contrast, improvisation is the name of the game in developing world environments.
It is surprising how much can be done, and has to be done, with very little investment. In areas where there is no plumbing or insufficient lighting, those providing dental training use props that would be inconceivable to their Australian-trained peers—for example, miners’ head torches, portable plastic chairs and, more often than not, another person propping up the patient’s head.
For dentists who have trained in Australia, where improved hygiene over the last half century means the practice of dentistry has shifted away from extractions towards cosmetic procedures, this experience can be character-building, to say the least. Dentists who participate in the volunteer program return enriched not only by a new perspective on global health care, and the role dentistry plays in it, but with enhanced clinical skills.
“I think the thing to remember is that nowadays if you go to dental school either here or in the UK, you probably take out five teeth on average during your undergraduate degree,” Topley says. “These guys are doing a hundred in eight or nine days.
“One young dentist, who was a couple years post grad, came out to volunteer. She wasn’t that confident in extractions—she relied on referrals for everything that she was even slightly unsure of. I met her three or four months later and she was talking about how her confidence had improved so much that now she was taking on things successfully in practice—she wasn’t referring. It had made her a better clinician.”—Mark Topley, CEO, Bridge2Aid
“Volunteers return as better clinicians because they’ve had to improvise and adapt. One young dentist, who was a couple years post grad, came out to volunteer. She wasn’t that confident in extractions—she relied on referrals for everything that she was even slightly unsure of. I met her three or four months later and she was talking about how her confidence had improved so much that now she was taking on things successfully in practice—she wasn’t referring. It had made her a better clinician.”
The volunteer experience can have positive and negative aspects on dentists’ attitudes to their lives and work—while it might mean a new tolerance for small inconveniences, it can also result in some isolation, because of the impact of the deprivation and suffering volunteers have witnessed during their time abroad.
Bridge2Aid provides a strong support network for returning volunteers, though Topley believes that most dentists come back with a fresh perspective on life, and a new network of colleagues and friends.
“That’s a whole process that we help people through when they come back,” says Topley. “Our teams are very supportive of each other, and they stay in touch.
“I think volunteering gives dentists flexibility—it matures them if they’re younger, and adds to their confidence,” he says. “For us it’s always about win-win, whether it’s working with practices or working with dentists.”