Dental Tribune United Kingdom Edition

W erner and his wife Natalie, both from Belgium, are run- ning one of the countless NGO’s (Non Government Organisa- tions) that keeps Uganda tick- ing over and that together with other kinds of foreign aid makes up more than 40 per cent of the gross national product. In spite of Werner and Na- talie’s best efforts, Uganda is still struggling with poverty. Half the population, that is 15 million people, don’t have food security. That same group of people have little or no access to health care and dental care. There is one dentist for every 158,000 people in Uganda, compared to one for 3,000 or so, in the UK. Infected teeth can fes- ter for years, which not only makes the sufferer miserable, but also according to the WHO, accounts for a loss of working and school days comparable to Malaria or HIV, thus perpetuating poverty. Unlike the headline catching diseases, no billions of dollars are going into re- search, no massive projects are being launched by the UN and no Nobel prizes are handed out. It’s a silent, slow burning disaster. That’s why Linda Dobinson, the prac- tice manager, Maria Shilling, the dental nurse and myself, a dentist, from the Port Erin Dental Surgery in the Isle of Man, have signed up for this DENTAID mission. Kanungu I am writing this on a rick- ety bus, travelling to the Kanungu district in south western Uganda, near the Rwandan border. I’m trying to keep the pen steady to the paper, while the red dust that much of Africa seems to be made up from slowly penetrates every nook and cranny in the vehicle. We are carrying on the bus a port- able dental hospital that can be set up in anything with a roof on it and shortly there- after start seeing patients for the next eight hours or so. Along the road I can see small towns or villages with small, one room brick houses, fire burning outside for cooking and some- times one small business or another going. The roads are occupied mostly by lorries, sometimes with the flatbed packed with people and numerous Chi- nese or Indian 125cc motor- cycles with anything up to eight (8!) passengers. It is not safe, the accident rate is hor- rendous by UK standards. 10 people die every day on the Ugandan roads, accord- ing to ICCU (The Injury and Control Centre Uganda) and the motorcycles, or Boda Boda, as they are called here, are involved in 70 per cent of these deaths. Having ridden motorcycles myself since the early 1980’s, I find it easy to believe. Beaten track The quality of the road is steadily deteriorating as we get further off the beaten track. Stephen, our driver, is in spite of a lifetime on these roads, struggling to keep us going at more than 30Mph. Stephen is a good man. A father of three, when not driving the bus, he is help- ing out in the clinics, looking after children that have lost their steam after an extrac- tion, or provides oral hy- giene instruction for them. His dance routine that goes with this is mesmerising! Between the villages, the roadside is strewn with small farm houses, surrounded by a small patch of land where Matooke, a kind of banana that is cooked and is a bit like a potato, beans or cassava is growing. The people in them are surviving on subsist- ence farming, meaning that they can only just survive, as long as all goes well. There are no margins, no backup, so when a parasite strikes and destroys the crop in an area, there is nothing to help and the result is a local famine that never reaches our media. No headlines, no UN planes dumping food, no Band Aid. Just hunger. Not enough Still, when everything is go- ing well, it is not enough. Most children get enough calories in the day, but not enough protein, leading to stunted growth in children and difficulties in follow- ing classes in school, if they have one to attend. When there is some protein, say eggs or beans in a household, the parents are sometimes faced with the choice of feeding their children with it or to sell it to get cash for things like shoes or school fees. We some- times see the effect of this in our clinics as well. Children are sometimes exhausted, un- able to stand up properly after simple extractions. A sugary drink helps this very quick- ly, strongly indicating that food was the problem in the first place. It would be easy to dismiss Uganda as failed and hope- lessly corrupt. As always, the truth is far more complex than that. The Ugandan gov- ernment, unlike many of its neighbours, is in full control of their territory. And efforts are being made, although a European, parachuted into Uganda, might not rec- ognise them as such. One ex- ample of this is Kampiringisa, a facility for children, one hour outside Kampala. It is called a “ Social Rehabilitation Centre”, but looks very much like a prison. Children are being picked up by the police for various offences, or swept of the streets of Kampala when it needs tidying up. Conditions are grim. The children are fed once a day, beatings and abuse is not un- heard of. At the age of 18 they are sent out to fend for them- selves. Hygiene is virtually non existent. Still, it is argua- bly better and safer for a child in there than on the streets of Kampala. There is food every day, they do get de-wormed and Dentaid manages a visit every month. This is also where Wer- ner and Natalie spend their efforts, salvaging a number You can not get used to Africa You either like it, or you don’t, but you can’t get used to it, says Erik Ahlbom Fig 1. Inmates at Kampiringisa, a ‘Social Rehabilitation Centre’ Fig 2. The portable dental hospital. This can be set up in anything that has a roof on it! ‘There is one dentist for every 158,000 peo- ple in Uganda, compared to one for 3,000 or so, in the UK’ Fig 3. A recently arrived child at Kampiringisa, with a grossly swollen tummy, most likely due to worms Fig 4. Erik extracts a tooth from a local witch doctor, or ‘traditional healer’ as they are now more respectfully known as 10 Feature United Kingdom Edition November 26 - December 3, 2012