Arusha, a city located at the foot of Mount Meru in Northern Tanzania, became my home for two months this summer whilst I undertook my fourth year dental elective. I worked with an organisation called Work the World, alongside a team of medics and HIV project workers and spent my time volunteering in several busy dental clinics across the city.
I was kept busy undertaking routine dental treatments on patients who presented with pain or particular concerns regarding their dental health. For the most part my time was spent carrying out extractions and placing temporary fillings; however in the more affluent clinics of the city I was surprised to undertake several root canal and composite veneer treatments.
The equipment available in the clinics varied across the city. Most had sufficient basic hand instruments and a limited range of restorative materials, though local anaesthetic was often used sparingly due to lack of supply, and functioning rotary handpieces were often hard to come by.
The local dentists, however, were able to adapt to almost every situation, utilising the limited equipment available. This was demonstrated to me when a patient presenting with a mandibular fracture was treated by intermaxillary fixation after a swift trip to the local hardware store to buy a coil of telephone wiring!
Dental fluorosis poses a huge problem for the people of Arusha due to water in the region being naturally fluoridated to levels of approximately 3.6mg/L. Skeletal fluorosis is also found in a large proportion of the population due to these high levels. I found the vast majority of the population had evidence of dental fluorosis to some extent, ranging from unsightly staining to extremely brittle/absent enamel resulting in an increased susceptibility to caries.
Traditional Tanzania diet is largely based on starchy foods such as beans, rice and the country’s national dish ‘ugali’ (stiff dough created from maize flour). However, largely due to the increasing availability of carbonated sugary drinks, sugar intake amongst certain groups of the Tanzanian population appears to be rising. Coupled with severe dental fluorosis, this appears to be having a negative effect on dental health.
As well as gaining valuable experience treating patients in the city, I was also given the opportunity to visit the Paradiso Children’s Home, an orphanage in the city. The home is run by an elderly couple and the number of children in their care is increasing rapidly year on year, stretching their limited finances to breaking point.
Communication was challenging, though our team visited frequently to play with the children, relieving the physical burden on the couple for a few hours a day. By means of drawings and actions, our team were even able to give the children some tooth brushing instructions!
At weekends the team and I were able to take time out from our placements to explore the region. We experienced the Maasai (tribal) culture at first hand, witnessed the spectacular scenery of the Ngorongoro Crater and Serengeti, and of course saw an incredible array of wildlife on safari in Tanzania’s numerous national parks.
All in all, my time in Arusha was hugely rewarding. The upbeat outlook of the local community and the resident dental team’s enthusiastic hard-working attitude was truly inspirational.
I hope to go back to Tanzania in the next couple of years in order to help out in a few of the dental clinics – I’m already counting down the days until I return!
Sarah Armstrong is a fifth-year student in dental surgery at Newcastle Dental School.