On a balmy summer’s evening in 2003, in return for a curry, I made the mistake of driving Ian Wilson to speak at Dentaid’s tenth anniversary celebration – an evening that changed my direction in life completely.
On that night I was blown away as I learned about the impact of oral pain on the quality of life for people living in developing nations. The extent of the problem was huge.
Today I find myself the chief executive of a dental charity. Over the past 5 years since Jo and I moved to Tanzania, I have tried to learn a bit about teeth and specifically how oral pain impacts people living in countries like Tanzania.
Over the coming weeks, interspersed with other ramblings, I plan to blog about this. Don’t expect academic papers or in depth clinical discussion. This will be my honest perspectives based on the last few years of living and working in this wonderful country.
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For those of you who are new to this, here’s the deal:
Most countries in the world don’t have enough dentists.
The problem is, people living in them suffer the same levels of tooth decay and pain as we do in the west. Tanzania for example, has about 60 dentists, mostly located in the cities, caring for a population of 40 million people.
But 75% of people live a long way from the cities. The vast majority of them won’t have any access to a dentist who can help them when they have dental pain. And most of them will experience pain in any given year.
So it’s not about teeth – it’s about people in pain, and what we can do about it?
How about just increasing the number of dentists – that would work?
Or would it?
Even if we could bring about an instant increase in the numbers of trained dentists – the economy couldn’t support them.
Dentistry is an expensive part of healthcare to implement – equipment costs a lot of money, and dental graduates expect a certain standard of living. In countries like Tanzania, there isn’t enough money available to fund graduate level dentistry in the small towns, villages and hamlets where most people live. So although more dentists are needed, focusing on that alone wont address the problem. It’s going to take many years.
In the meantime people suffer.
My opinion, based on what I’ve seen and learned in East Africa, is that in this generation at least, for places like the one where I live, what is needed is not simply more dentists – but instead to train the army of healthcare professionals already present in rural areas to help people in pain.
Someone who has got toothache and has been in pain for months – or even years – simply wants to know;
Can you get me out of pain?
and
How did I get into pain in the first place?
That’s why our programme is built around answering these two questions – training local health workers in emergency dentistry to relieve pain in their communities, and educating rural populations about the causes of tooth decay. By training those already there, the impact on the prevalence of pain can be tangible.
I also believe that we should keep building capacity. Let’s keep training dentists! But we must be pragmatic – the pace of development is slow, and it will take many years before economies and infrastructures in this part of the world have grown to the point where the oral health care system can put a dentist within reach of every remote community.
Waiting to implement a developed world model in places where it is not yet appropriate isn’t good enough. People are in pain, we need to do something about it – now.
Mark
