“How old are you? When is your birthday?” Seem like standard questions, right? However, here in rural Kenya, the answer is usually a child’s blank stare or him/her blurting out a jumble of numbers in hopes that we would accept one of the answers as “correct.” Thinking we were experiencing a language barrier, we asked one of the community health workers to help determine the children’s ages. To our surprise, she raised each child’s arm and folded it over their head. Each child’s age was based on how long his or her arm was in comparison to the opposite earlobe. Using this technique, children were sorted into “age” groups -- as if the approach yielded a definitive, scientific answer.
However, what happens when they stop growing? I guess they stay fourteen for the rest of their life? That’s a question that the next brigade must find out! The fact that birthdays and age are not nearly as important here as in other parts of the world was just one of the amazing cultural differences our team learned to embrace and adapt to as we provided care to the community.
Team members Grant Gleason and Matt Orlando
To backtrack a little, our small team from Boston University Henry M. Goldman School of Dental Medicine consisted of: two dental students (Grant Gleason and Matt Orlando) and the Associate Dean for Global & Population Health (Dr. Michelle Henshaw). We met the rest of the team from Bridge to Health in the Nairobi airport en route to our destination, Kisumu, and were eager to reach the first community. Within no time, the dental team was up and running. The first patient was a woman who had a severely broken-down tooth due to dental decay. But she was the first of hundreds that we saw during our time in Kisumu.
Day after day, the number of patients we saw grew as knowledge of our presence spread like wildfire. Local people arrived early in the morning and waited all day in the hot temperatures to be seen by the various medical and dental services offered by Bridge to Health, and local partners: the Kisumu County Government and non-profit organizations Africa Cancer Foundation and SNAR Foundation for Advancing Community Health. Our dental team became a well-oiled machine—able to triage and treat patients of all ages and conditions efficiently. We had various stations including: deep cleanings, oral hygiene instruction, fillings, and extraction/surgical.
Matt Orlando, Dr. Ira Sankiewicz and Solomon Aspro
In our training, we are taught how to do challenging extractions with the use of surgical handpieces (a drill that helps to facilitate the removal of teeth). However, in rural Kenya we had to rely totally on our extraction skills. We picked up some useful tips from the four other seasoned dentists on how to manage these situations. In no time at all, we all adapted to the environment and were more than capable of tackling any situation.
We saw such a variety of oral pathology and developmental deformities, which we had only heard about in our lecture series. As an example, a 30-year old female walked into the clinic with a large growth on her gums, a pyogenic granuloma, that had been slowly growing for many years until it was the size of a large grape. We removed the growth, no doubt improving her ability to eat and speak as well as her overall quality of life. In a number of instances, we saw children, adolescents, and adults with supernumerary teeth (an extra set of teeth). Typically, these extra teeth displace the normal teeth and affect how your jaws come together. It is best to remove these teeth, which allows normal development to occur.
There were patients with such severe dental decay that we had to extract more than 10 teeth in one visit. There was simply no other option as the disease was rampant and had the potential to turn into a systemic infection. Seeing these patients with this severe level of disease was an eye-opening testimony to their lack of access to care, which requires them to become accustomed to living with orofacial pain.
The most heartbreaking moments were treating the pediatric patients for whom extraction of their first permanent molars was indicated. These children were younger than 10, but had already developed such severe dental decay that their molars had only lasted them four years. It was gut-wrenching to imagine the rampant dental decay they would have when they grow up. This example is exactly why Bridge to Health, their local partner organizations, and Boston University Henry M. Goldman School of Dental Medicine have placed such high importance on preventative dentistry. If we are able to instill preventative measures within the community, then children will not have to go through such a traumatic experience at such an early age.
As a first step in making this vision a reality, we met with the local community healthcare workers to train them to deliver oral health education and provide them with the necessary tools and resources so that they could continue educating children and families once we left. We also taught them how to place fluoride varnish on children’s teeth, which would translate into bi-annual preventative treatment for the children with the hopes to greatly reduce the incidence of dental decay. The next afternoon, we encouraged the community healthcare workers to teach the elementary school class about oral hygiene. They were complete naturals and relayed the information in a manner that the children could comprehend and later follow. This was very exciting to see: Since we were only there for two weeks, it left us with the sense that our impact would still be felt for the other 50 weeks of the year, until we return and build upon the foundation we laid during this trip.
Dr. Michelle Henshaw, Tina Papacosmas and Community Healthcare Workers
It is a bright future for the students we met and we are hopeful we’ll see their gleaming smiles for many years to come.
Asante and Kwaheri!
(Thank You and Goodbye in Swahili)
Grant Gleason, Matt Orlando and Dr. Michelle Henshaw
Boston University Henry M. Goldman School of Dental Medicine