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  1. 10 years on – a Tanzanian perspective

    December 16, 2014

    It’s one thing for us to say what we do works. But what about the partners we work with, those on the ground with the responsibility of ensuring it does?

    We talked to Dr Samuel Kalongoji – the District Dental Officer who worked with us to set up the Dental Training Programme about his thoughts, 10 years on.

     


  2. A mother’s pain…

    December 5, 2014

    MektridaMektrida: Mother of three, wife, cook, cleaner, firewood gatherer, collector of water, farmer.

     

     

     

    Debora 1Deborah: Mother of five, wife, cook, cleaner, firewood gatherer, collector of water farmer, local trader.

     

     

     

    Mariam 3Mariam: Mother of six, widower, cook, cleaner, firewood gatherer, collector of water, farmer.

     

     

     

    20140912_095123Metodia: Mother of seven, wife, cook, cleaner, firewood gatherer, collector of water, farmer.

     

     

     

     

     

    The list of roles and responsibilities goes on…educator, market seller, carer of elderly…

    As well as their extensive list of roles and responsibilities, the above four women have several other things in common;

    • Mektrida: three months in dental pain, unable to work and is only able to eat porridge because of the pain.
    • Deborah: three months in dental pain, unable to work and has not eaten for 3 days due to the pain.
    • Mariam: one year in dental pain, unable to work and has a reduced food intake due to the pain.
    • Metodia:  five years in dental pain, unable to work and eats only porridge, due to pain.

    All four women, suffering in pain because there was no safe dental care available to them locally, at a cost they could afford.

    Four women in pain means 21 children and three husbands  may miss out on decent food to eat and water to drink because their wife/mother is unable to cook. 21 children who may now have to miss school, stay at home and do housework because their mother is unable to do jobs around the house.  Three husbands who might have to take time away from earning an income or farming to help at home with the children which again might mean that the family cannot afford to attend school or even eat.

    Some 62% of patients attending dental training programmes are female. When asked, the majority of women refer to their livelihood as ‘farming’ however women in Tanzania traditionally have additional huge responsibilities within the household. When these women are disabled by dental pain, the consequences not only impact upon food provision and therefore their families’ nutrition, but also affects their ability to care for their children, collect water, firewood, clean the house, prepare food, go to market – all of the other domestic chores that are traditionally done by the women of the household.  This is why access to safe emergency dental care in the rural areas is vital so that the health, nutrition, education and livelihoods of women like Metodia, Deborah, Mariam and Mektrida AND their large dependent families are not impacted by dental pain.


  3. dental pain: costing an education

    December 4, 2014

    Agnes came with her mother to the training programme in the remote Tarime, Mara region in October 2014. She had a swelling on the right hand side of her jaw and was obviously in a lot of pain. She had walked with her mother for half an hour to reach the training programme from her village.
    For the last year, Agnes has been unable to sleep at night; she has only been able to eat porridge and has also had to take days off school because her pain was so bad.
    Agnes is only 7 years old. Agness 3
    Like Agnes, 16% of patients visiting a Bridge2Aid dental training programme are students. The majority (68%) of patients attending a dental training programme only have a primary school education, 18% have had no formal education and only 11% have a secondary education.
    15% of the patients questioned said that the dental pain had affected their education; of those, 8% failed to attend school, 6% said the pain reduced their ability to concentrate on their studies and 1% said it prevented them from allowing them to prepare for exams that would allow them to continue to next year’s classes.
    Education is already beyond the budget of many rural Tanzanian families; it is estimated that 15-20% of children under the age of 15 in Tanzania do not go to school1 due to reasons such as not having the correct school uniforms and equipment, to having to help with agricultural work or looking after younger siblings. Agness 2
    Based on our previous programme data, another 8% of primary aged children in the rural areas of Tanzania potentially will not attend school due to dental pain.
    Agnes was one of the lucky ones. The Clinical Officer found that she had a badly decayed, broken tooth which was causing the pain and the swelling and removed it. The Clinical Officer also gave Agnes and her mother some oral health information which will help them to prevent the same problem happening in the future.
    Agnes is now able to return to school, sleep at night and eat again properly, thanks to the Bridge2Aid dental training programme.


  4. A trip to the centre

    December 2, 2014

    tanzania-parliament

    Last week I was on the road for the last time this year. Just 4 days that took in Dar es Salaam, the commercial capital, and Dodoma, the seat of government and the official capital of Tanzania. It’s a bit like the Sydney/Canberra thing the Australians have, except that essentially Dodoma was chosen because it is dead centre in the country. That, and (so I’m told) because it’s the family home of a former President.

    What this means is that a truck stop in the middle of nowhere, with hardly any commercial flights, has become the capital city.

    I’ve been here before, during a DVP we did a few years back, and enjoyed the sleepy town atmosphere and change of scene. I came with my wife Jo and we brought the kids on a 9 hour drive in each direction, with a 2 night stop in Dodoma in the middle. It was a great time, and as this was the first time we had done a DVP outside of the reach of Mwanza, a proud moment to see the team pull it off.

    This time was different. Because Parliament is sitting.

    The town is alive with activity and there are VIP vehicles everywhere. Every other person seems to be dressed in a sharp suit and every third vehicle is a government land cruiser – personal number plates of Ministers, Deputy Ministers, Regional Commissioners, even the Speaker of the House flash by.

    Bunge (parliament in Kiswahili) doesn’t meet all the time, so it’s a frenetic period.

    My reason for being here was to follow up on the visit we had to the 10th Anniversary DVP last month from the Deputy Minister of Health, Dr Kebwe. Having seen the programme, he wanted a discussion on how he could help to expand and strengthen the DVP.

    Sandwiched into his punishing schedule, we had a short but very fruitful meeting. Sometimes this job involves a lot of travel for a very short meeting, and this was one such occasion. I’ve got much better over the years at making them count – be very prepared, have 3 things you want them to understand, and 2 things you want them to do, and get to the point. In less than 15 minutes we had cemented the relationship and reached agreement to move forward on several issues with his support which will really help with DVP.

    As a former rural District Medical Officer who studied the impact of the absence of emergency oral health care on communities, Dr Kebwe understands very well the need for basic services to be available, and so is extremely supportive of our programme.

    Tanzania has always led the way on a pragmatic response to the fact there simply aren’t enough dentists, nor the funds to equip them in the rural areas of the country. But rather than do nothing, the Tanzania Ministry of Health health has sanctioned our work and the results have been very good.

    It’s a long way to go for 15 mins. But sometimes that’s enough, and I’m looking forward to seeing how this new level of support will create even more impact for communities in pain.


  5. Why is being able to get your tooth removed so important?

    November 25, 2014

    Even amongst good friends I sometimes get mistaken for a dentist. Don’t get me wrong, I would be very proud to be a dentist. If only I could stomach the sight of blood, saliva etc then maybe I would have trained to be one.

    But being a layman and being asked dental questions can be tricky. I have to admit on occasions I’ve been a bit naughty and given outrageous advice, before quickly retracting it once the joke was complete (calm down – no GDC referral necessary).

    But I did want to understand both personally and professionally just why toothache is so bad. Why does it reduce tough, grown men (and women) to tears, unable to do the simplest things?

    So I asked a friend (who has all the right letters after his name) to give me a simple explanation, and help me understand why we see some of the complications that are common when a toothache isn’t treated in time.

    So, with apologies for the graphic photo, here is what he sent me.

    The structure of a tooth has hard outer  layers, which act to protect and insulate the pulp in the centre of the tooth. This pulp space contains a nerve, so that as the outer hard layers of enamel and dentine are lost, this nerve becomes more vulnerable. With a diet high in sugar, bacteria produce acid that attacks and dissolves the outer hard layers of the tooth, creating a cavity.
     
    As this gets worse, it causes inflammation of the pulp (pulpitis), which gives symptoms of sensitivity progressing to pain. The problem is now, the outer hard layer of the tooth acts as a rigid case, preventing swelling of the pulp – which is part inflammatory process. This leads to the exquisite pain of severe toothache, where an inflamed nerve can be felt throbbing against the hard case of the tooth and it is hard to find any relief from this pain even with pain medication.

    Eventually the inflammation acts to strangulate the nerve, and the pulp dies and loses its nerve supply and blood supply. The painful symptoms of toothache cease. 

    So that’s what a toothache is. What I didn’t fully understand, was what happens once the pain stops. Because although the pain might be gone, things are going to go downhill, especially if you are on a poor diet:

    But bacteria present inside the tooth invade deeper and cause an infection around the root of the tooth. This infection creates an abscess at the end of the root. This abscess causes the tooth to be pushed out of the socket of bone, so it feels high on the bite and is painful every time the patient bites together or closes their mouth.
     
    Often the abscess drains pus into the mouth causing a bad taste and bad breath. This process is no longer driven by sugar but depends on the state of the immune system. In a healthy patient this infection may become ‘walled off’ and create a cyst. But in malnourished or immunosuppressed patients, chronic cases develop and it may cause further destruction to the bone, and pus may drain through the skin of the face causing a pointing sinus

    Open Fistula

    And that is what this lady has. It had taken just 3 months to develop, and as you can see, it’s extremely unpleasant. Not just for her, but the likelihood is she will be ostracised from her community because of it. But this isn’t the end, we have seen many cases of what happens next. In just one of the 24 districts we work in, they see one death a month caused by untreated dental infection:

    If the infection remains untreated and does not drain in this way, osteomyelitis (a deep infection of the bone) may develop. This serious infection causes whole pieces of dead bone to break through into the mouth and predisposes to pathological fractures. In patients who have weakened immune systems, the bacteria that invade the root canal system seed a virulent infection, deep into the bone, which may spread rapidly. This type of rapidly progressing infection spreads along tissue planes and can cause a dangerous swelling which occludes the throat causing asphyxiation (Ludwig’s Angina), can spread to the brain or overwhelm the whole body with a massive infection which can lead to death.

    This is the reality of toothache when there’s no access to help. This is what happened in the UK a couple of hundred years ago before dentists and antibiotics, and sepsis due to tooth infection was a leading cause of death.

    It’s what happens now in the rural areas we work in.

    When you understand what’s going on, and how it’s actually quite simple to prevent the nasty consequences described above, it makes you want to do something.

    We need to train more rural Health Professionals next year to treat these problems quickly and effectively when they occur.

    Please help us to do more to prevent this kind of suffering – click here to join us and our ‘What if..?’ campaign.


  6. Hope Dental working with the Street children of Mwanza

    November 24, 2014

    JJ photo Spilian and kids 1 copy 2

    Hope Dental Centre is not just any dental practice. It was established in Mwanza in 2004 to address the lack of dental provision here, and specifically to support the work of Bridge2Aid in providing training in emergency dentistry to health workers in rural areas of Tanzania. We provide a much-needed general dental service to the people of Mwanza, and play our part in extending that access throughout Tanzania.

     

    That means that at the heart of everything we do, and every decision we take, is not just a commitment to improving oral healthcare generally, but to contributing to Bridge2Aid’s work. For the majority of the time, that means doing what we can to maximise our profitability in order to pass as much financial support as possible over to B2A. Sometimes however we can take a more direct approach to reaching people who otherwise would have no access to relief from dental pain.

     

    We have started closing the practice for occasional sessions when we are able to examine and treat children who are living on the street or recently been found homes. We are doing this in partnership with agencies working in Mwanza with street children, such as Caretakers of the Environment, who brought some groups of children to see us on 20th November.

     

    This particular campaign has been organised through the efforts of Prue Preston. Prue won the ‘Colgate Unsung Hero’ award a couple of years ago for her oral health work with children in Mwanza. Colgate gave a financial award and Prue has asked us to use that money to see and treat as many street children and orphans as we can. This is an ideal situation for us in that we can, without financial cost, reach so many children in need we wouldn’t normally get to see.

     

    Our first street children session at the new Hope was rewarding and a lot of fun.

    Waiting room busy copy

    Some of the more memorable moments of the day included Dr Mo playing lego with three of the boys (a serious test of his hand-eye co-ordination), or groups of the children demanding photos, and then Jacqueline somewhat nervously handing over her phone so the kids could see their pictures. Some of our new patients were a little reluctant to head to the treatment rooms when called, but Rose would use her best receptionist -persuasion powers (and the bribe of a tooth brush) or Sophia would march them down the corridor ignoring all protests. One boy was determined not to join in, and we had all given up on him, until one of his older comrades cajoled him into the chair – “it’s not that bad”. It was a real pleasure to see the interaction between the children and the team; Juana surrounded by children eager to learn how to mix filling material, Dr Spilian walking a boy into the surgery with his arm around his shoulder, or Dr Yusuf just itching to help one particularly serious case.

    hope 1

    Of course we weren’t just having fun; we were there to do some dentistry, too. It was surprising how good the dental condition was of a couple of the younger children (Dr Mo whispered that one boy was in a better condition than most of our regular patients) – possibly the result of not having the money to buy sweets, cakes and fizzy drinks. One in particular described how diligently he cleans his teeth each day with his finger, not having access to any other means of cleaning. But there were plenty with significant problems. The worst case we saw during this session was a young lady with a serious infection, resulting in an extraordinarily painful swollen side of her face. Not a quick fix – we’ll be seeing her again, along with several of the other children who need more extensive treatment.

    Expectant patient 1 copy

    There weren’t quite as many children there as we had hoped; despite a pre-arranged pick-up, many had run away from the transport arranged to bring them to us (how many of us deep down share that impulse?). We are hoping that word will get around that a visit to Hope Dental Centre relieves rather than causes pain, and we have another session arranged for a fortnight’s time. Our gratitude to Prue and to Colgate for contributing to this aspect of our work and making the daily lives of some of our local street children just a little bit better.


  7. Time off…in pain

    November 21, 2014

    Ever had toothache so bad that you were unable to concentrate at work? So bad that you had to take time off to go for an emergency appointment at the dentist? Or so bad you had to take the day, or week, off work, unable to cope?…Sound familiar?
    You are not alone.

    Alfonce, unable to teach his students due to dental pain

    Alfonce, unable to teach his students due to dental pain

     
    Work days lost due to poor oral health care is a global issue. In a nationwide survey by the British Dental Health Foundation, more than 415,000 employees took time off work in 2013 due to dental problems. The same study also revealed that 1.1 million parents admitted taking time off work to look after a child suffering with their oral health. This came at an estimated cost to UK businesses of £36.6 million….this is in the UK, a country where the dentist to population ratio is approximately 1:1500.

     
    Now, imagine suffering toothache in a country where the dentist to population ratio is 1:400,000, where the nearest option for getting safe treatment would mean an uncomfortable two-hour bus journey which would cost you the equivalent of a week’s income – and that’s just the journey to get to the hospital; you may then have to wait a day to be seen, stay in town overnight and then pay more to register with the hospital and for the actual treatment.
    During programme after programme we meet patients who have been suffering for months, often years, unable to work.

    Ibrahim in pain and unable to provide for his family

    Ibrahim in pain and unable to provide for his family

    Elderly Ibrahim Kyakwaga came to visit the training programme in Bukoba district in September 2014. Like the majority of people in the rural areas of Tanzania he is a subsistence farmer. He and his large family depend on the bananas that they grow. Previously having suffered in pain for a number of years, he had begged, borrowed, sold possessions and managed to scrape together Tsh 100,000 (£37) so that he could afford to go and see the District Dental Officer, about two hours away by bus. When he visited the dental training programme he was in pain again; he had a grand total of four teeth remaining in his mouth. He told us this time visiting the District Dental Officer in the town was not an option due to the costs involved. He had not been able to work on his farm due to the excruciating pain. He and his nine children became dependant on his wife for everything, but she struggled to manage all of the family’s needs. Life had become even tougher for them.

     
    Alfonce (81), an English and Maths tutor, had been in pain for 15 years; pain for which he used traditional medicine. His dental pain had gradually stopped him from being able to tutor his students which meant that he wasn’t earning anything; putting more pressure on his wife and his sons and daughters to earn an income and help support the family.

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    Scholastica, dental pain prevented her from farming

    Scholastica (49), another farmer, was unable to work on her farm, eat properly and provide for her family due to dental pain which she has been suffering from for about a year – unable to access help.

     
    Faustine, Abubakari, Eradius, Restuta…the list of names and lives affected continues, programme after programme, day after day. Bridge2Aid training of Health Workers (Clinical Officers in Tanzania) has already provided access to around 3.3million people in the rural areas of Tanzania, though there are around 27 million more individuals and families whose work, education, health, reputation and relationships could be damaged if more is not done to give them access to vital, safe emergency dental treatment.

     
    And that’s why we continue to look for more Health Workers to train, more volunteers to fly out to Tanzania to help with the training, and more funds to support this invaluable work. So that fewer of the people eventually touched by our work will have to take time off in pain.


  8. Introducing Clinical Officer Daniel Masesa

    November 19, 2014

    introducing_daniel masesaPatients with any dental problems would have endure a 1hr 30minute uncomfortable, bumpy, dusty bus ride to see the District Dental Officer at Geita district hospital, Clinical Officer Daniel Masesa told us -a familiar story told over and over again by Clinical Officers who are trained on the Bridge2Aid dental training programme.
    Before receiving any training, the only options for a Clinical Officer when faced with a patient in dental pain are to prescribe patients antibiotics or painkillers or to refer them to the district hospital – a trip which the majority would struggle to afford and who instead suffer in pain.
    Daniel was trained on the November 2012 training programme in Geita region.
    At the time he was trained he had been working as a Clinical Officer from his rural dispensary in Nyamwilolelwa village and had previously had had no dental training.
    Following the training, Daniel told us he felt confident in all areas in which he had been taught; patient communication skills, carrying out an oral examination, diagnosis, administer infiltration and inferior dental nerve block injections, he learnt how to confidently carry out dental extractions in adults and children safely, he understood causes of oral disease and basic principles of oral health and he had learnt about cross infection control.
    He received a steriliser (pressure cooker) and basic instrument kit on completion of his training which allowed him to take his new skills back to Nyamwilolelwa dispensary and treat his own patients, taking them out of dental pain – no longer having to refer them to the district hospital.
    At Bridge2Aid, supervision and monitoring forms a large part of what we do. Once a Clinical Officer is trained, the District Dental Officer takes on a supervisory role in terms of clinical skills. In addition to this, and to make sure clinical skills are maintained, Bridge2Aid monitor patient numbers.
    We caught up with him three months following his training and again at six months following his training to find out how he was getting on with putting his new dental skills into practice;

    IMG_0726
    During the first three months following training, Daniel has seen 28 dental patients, averaging around seven patients a month. By February 2013 he reported to have seen an increase in the number of dental patients attending his dispensary for treatment, the majority of whom he was able to treat with extractions. This success was echoed in his six month patient treatment records where he averaged a very respectable 17 dental patients a month. A year on after his training he was seeing an average of 27 patients per month and had been able to treat 86% of them with immediate pain relief through an extraction.
    At 18 months post-training, the number of patients that Daniel was seeing had decreased slightly compared to that at 12 months, though still very commendable; averaging 14 patients per month and treating 95% of them with extractions.
    Daniel continues to use the extraction technique that he learnt during training; he also said that all of his dental patients have received oral health information too. This has dramatically reduced the amount of referrals to the district which will help ease pressure on his district hospital based colleagues. The District Dental Officer who works in the district hospital in Geita town estimates that he has experienced a 44% decrease in the number of dental patients as a result of Clinical Officers, like Daniel now having been trained up in the rural areas in his district.
    The success seen with Daniel is echoed generally in our monitoring data where up to a 82% decrease in the number of referrals to the urban district dental officers’ clinics can be expected and 64% fewer dental cases are being treated solely by painkillers/antibiotics as a result of patients immediately being taken out of pain by a safe extraction.


  9. Why Unity Partnership is a great thing to do

    November 18, 2014

    We recently recorded a 10 minute video with CEO Mark Topley and our friends Chris Barrow and multi-Unity Partner Colin Campbell about Unity Partnership.

    If you’ve ever wondered what it is and why it’s important, grab a coffee and sit back and listen to Colin and Mark talk about how it can be a win:win for both your practice or business, and communities in East Africa. And then click the ‘find out more link’ at the bottom to do just that – we’d love to talk to you.

    To find out more about becoming a partner, contact us here.


  10. What if your child had toothache, and no hope of help?

    November 13, 2014

    3 years ago this month we shot a video with our friends JSP Media about Bridge2Aid and our pioneering work training local Health Professionals to provide a simple, safe but vital emergency dental service. I spent the best part of a week with Jem and the team, and we travelled to one of our training sites to view the volunteer training team in action.

    The reason I tell you this today is because what I am going to ask you to do below was inspired in part by one of the children we saw on that trip. He was around 5 years old, and has probably been one of the most deeply impacting patients I have ever come across on DVP.

    Screenshot 2014-11-11 09.39.17
    He was in a bad way. His face was swollen badly on both sides, and he was having difficulty breathing.

    Ian, one of the training team, examined him and talked to his trainee as he did so…

    As Ian says – tragic.

    Not just tragic because he has such a bad swelling on both sides of his face, but tragic that he ever got into that position in the first place.

    The truth is, that if, by accident of birth, you hadn’t been born in the UK, or a developed country, this could be you as a parent,  sat with a very sick child in pain on your lap – this could be your child.

    Toothache is really common. So common that we don’t think about it much, such is the level of access to safe and free treatment we are fortunate to have.

    But what if that wasn’t the case?

    What if your child had toothache and no hope of help?

    With not even the most basic dental service available for the majority of people living in the rural areas of places like Tanzania, there are countless cases like this out there. And more than half of people with toothache will develop complications like this without access to basic treatment.

    This is the treatment we provide. It’s what we train and equip government Health Professionals who are already embedded in rural villages to do, day in, day out. And we need to do more – we need your help to do that.

    I want you to click here and join with us and our ‘What if?’ campaign.

    Simply enter your email and over the coming days we will tell you just how you can help and be part of making tragic cases like this little boy, a thing of the past.

    Thank you.