Ethiopia, one of the poorest countries in the world, has barely any access to dental treatment. Outside of the capital, there are only around 50 qualified dentists for a population of 63 million people. One person who wants to help is Dutch dentist Frank Paternotte, who set off for the country in the north-east of Africa at the beginning of the year. The aim of his trip: four weeks of providing dental treatment to people in the small town of Dembi Dolo in the south-west of Ethiopia. Together with other colleagues, he participates in a dental aid project initiated by Rotary Doctors Nederland (RDN).
An empirical report by Frank Paternotte:
“A colleague and I are being hosted by the local Catholic mission and are allowed to stay in the Society of the Helpers of Mary convent. The staff help us with our work in the clinic, where we treat people suffering from toothache and trained members of the team remove plaque and calculus. If necessary, we also place fillings in children’s teeth. Adults requiring fillings are treated by the dentist at the local hospital. Our most important task here, however, is prevention. We explain to the patients how they can keep their teeth healthy. Consequently, each workday begins with a member of the health centre staff talking to a packed waiting room about dentistry.
They also offer advice on a variety of topics in the remote regions in the heart of the country. We are always on hand to help and advise as necessary. In addition to offering treatment in the clinic, we also visit schools to educate the teachers and pupils.
Cleaning teeth with a twig
A typical day at work here is as follows: after greeting the team, we prepare the large treatment room. It’s always hit and miss whether the electricity is working. Luckily, we always have a generator on hand. Then we visit the primary school with a nurse and our interpreter. Once there, we begin by washing our hands together with the teacher and her pupils before we start brushing our teeth. The main difference is that teeth here are brushed with a twig and fluoride-containing toothpaste. Proper toothbrushes are something of a rarity here, and those available are also too large for the children and too expensive. Addis Ababa University has displayed interest in this project and is planning to study the effect of brushing with a twig instead of a toothbrush.
As is there no running water at the school, we have connected up a 200 litre barrel with six taps, allowing the children to wash their hands with soap and water before cleaning their teeth. The barrel is filled by the kids who live on the other side of the river; They each bring a small jerrycan with three litres of water to school with them each day.
Back in the clinic there is already a whole horde of people in pain waiting for us. The treatment itself is exactly the same as at home. However, we have to be prepared to enter into lengthy discussions with the patients when we recommend having other diseased teeth extracted in addition to just the one which is currently causing the patient pain. We use a hand mirror to show the patient the fistula and rotten tooth. Using a large board, we then explain to the patient what has caused the “infected” tooth.
We reassure the patient that they will only have to pay for the tooth to be treated. Most of them then enter the waiting room with an anaesthetic and a little time to ponder their situation. During the treatment, some of the patients hold my hand tightly to ensure that I am extracting the correct tooth. We then advise them to come back for a check-up and, if necessary, further treatment and explain how to care for their teeth. In addition, we also inform them of the effects sweet foods and drinks have on their teeth.
When we treat crying children who are afraid of the anaesthetic, some people try to calm them with well-intended remarks. We often hear people saying “ma kuba” which means “it doesn’t hurt”. Then I have to interrupt the treatment and explain that they will actually feel the anaesthetic itself.
Catastrophic sets of teeth ruined by sugar and alcohol
Other patients that we treated included, for example, a girl with warts around her mouth that had been dabbed with nail varnish, a mother who came to have her teeth checked with her enchanting baby on her breast and a 12-year-old boy who had had an image of a dagger branded into his arm as a sign of belonging.
We treated a number of people with absolutely catastrophic sets of teeth, attacked and worn down by the regular consumption of khat (leaves of the khat plant, which have a stimulating effect when chewed and numb hunger pangs) combined with sugar and locally distilled alcohol. Many patients also presented with extremely worn teeth. The cause: they spend the whole day chewing cereal grains which still have grains of sand among them.
Our greatest challenge is now organising the project in such a way with the responsible people in the region that after three to five years they will be in a position to take it over and continue running it themselves. We are supported by two assistants who have completed a three-year course as dental therapists at Addis Ababa University. They are now learning simple dental treatments such as the administration of anaesthetic, extraction of teeth, placement of small fillings and education of patients.
We have intentionally involved national and local authorities in the project since the beginning with the hope that they will adopt an active role in it in the future.
All in all, I would have to say: it was a really intense few weeks. Once again, I was really impressed by the optimism, determination and the inventiveness of the local staff.”