Cape Verde lies in the vast expanse of the blue waters of the Atlantic Ocean between Europe, Africa and South America. With its perpetually mild climate, wonderfully diverse scenery plus a unique cultural mix and exotic flair, it has long been a well-kept secret among sun-seeking tourists looking for a once-in-a-lifetime experience. These leisure visitors generally remain blissfully unaware of the problems of this picturesque island state. But there are others who travel to exactly these areas in a voluntary capacity with the aim of offering urgently required medical treatment to people who otherwise often have little or no access to such services.
A deceptively idyllic tropical paradise
With an area of slightly over 4,000 km2 and a population of around 520,000, Cape Verde (Portuguese: República de Cabo Verde) is one of the world's smaller countries. The archipelago located approximately 500 kilometres off the coast of West Africa comprises 15 islands, of which nine are inhabited. They are divided into two groups: the northern Barlavento Islands (windward islands) and the Sotavento Islands (leeward islands), i.e. above and below the northeast tradewinds. Cape Verde, a former Portuguese overseas province and a sovereign state since 1975, has managed to climb in the international development ranking in recent years.
However, the country has neither mineral resources nor the natural requirements for a successful, export-oriented agricultural economy. In addition to foreign economic assistance, the country’s main sources of income are from the export of fishery products, textiles and semi-finished goods as well as the slowly developing tourist trade. With an unemployment rate of 21 percent, another important source of income is money sent from relatives abroad, which is received by around two thirds of Cape Verdean families and helps to secure their livelihoods.
Healthcare system offers bare minimum of treatment
With just 50 doctors per 100,000 inhabitants, the state healthcare system in Cape Verde can only offer basic treatment, and the equipment in the hospitals and doctor’s surgeries is far below the OECD standard. In the whole country there are only 20 dentists, half of whom are in private practice. The majority of the population simply cannot afford private healthcare, due in part to the cost of the treatment itself and in part to the comparatively high travel costs involved.
The dental practices, be they private or state-owned, are not distributed evenly across the islands, meaning that the cost of the flight or ferry trip to one of the larger islands, or directly to the capital city of Praia, is a significant factor when deciding on treatment. For this reason, many inhabitants of Cape Verde have never seen a dentist. The standard of dental treatment in the country is also comparatively low. Concepts such as caries prophylaxis, fluoridation, sealing of pits and fissures, root canal therapy, orthodontic treatments and periodontitis therapies are practically unheard of here and, due to lack of materials, extraction is often the primary course of treatment instead of restoration.
DWLF brings dental aid mission to São Domingos
To ensure that at least some people receive the help they desperately need, the Dentists Without Limits Foundation (DWLF) regularly organises missions such as the one to the island of Santiago in April 2016, in which Dr. Carina Angeli (33) from Sontra, in northern Hesse, and three other German colleagues were involved. Their destination was the “Centre de Sãude” hospital in São Domingos, approximately 20 km from the capital city of Praia, in the south of the nation’s largest and most populous island. Over two weeks, the four dentists treated a total of 299 patients aged between two and 83 in a makeshift surgery. Two thirds of the patients were children and adolescents.
Extremely high caries rates in the young population
The dentists observed that caries was a huge problem, especially in the children and adolescents. This is due partly to the lack of awareness of adequate dental hygiene and partly to the roaring trade in sweets and sugary drinks sold from simple stalls all across the city and even outside schools. Older patients presented with considerably less caries, but severe calculus and untreated tooth gaps. In the case of very old patients, particularly women, many of those treated still had all of their teeth, although they were often severely abraded. In addition, quite a few children of around ten years of age presented with untreated anterior trauma.
Dr. Angeli was clearly shocked by the cases she encountered: “In many of the children and adolescents, the residual dentition had already decayed down to the gumline. That's not something we come across regularly in our day-to-day work in Germany. Unfortunately, there were also a large number of deciduous teeth among those extracted. None of the children had ever been to see a dentist before, and preventative care is simply non-existent. Instead, the majority of the children constantly eat the sweets sold on every street corner. We even saw one two-year-old child whose deciduous teeth were all affected by caries.”
Summary of the two weeks
During the two-week treatment period, the four German dentists removed a total of 267 teeth, placed 144 restorations, removed calculus from 49 patients, reconstructed 12 anterior teeth, completed two root canal treatments and performed numerous topical fluoride treatments. Applying the cheapest rate available from a German public health insurance company, the combined cost of all the work would amount to approximately € 25,000. With the aim of anchoring the importance of proper and regular dental care in the children’s minds, the dentists spent their last day in the country in a school in a remote village. There they showed 80 children in years 1 to 7 how to clean their teeth properly, which they then practised together with the youngsters using the toothbrushes the dentists distributed. Dr. Angeli is very happy that she was able to help in São Domingos and gain valuable experience at the same time. “Working in Cape Verde and Germany is like two different worlds. That took some getting used to,” said the young dentist.
Photographs: Carina Angeli