My trip to Arusha Tanzania
Leo (Wong Yin Ho) (Dentistry)

I went to Arusha and worked in the dental unit in the Mount Meru Regional Hospital, a government hospital that caters to a large surrounding area.

My placement was a huge learning curve as it was very different to what I was used to. The dental unit has one senior dental officer, the department head, 2 dental officers and only one dental surgery assistant. The hospital provides a large variety of treatment; ranging from simple extractions, minor oral surgery, restorations, prosthetic treatment, orthodontic treatment, incision and drainage, simple trauma management, to intermaxillary fixation. The dental officers will perform all sorts of treatment and the dental surgery assistant will only focus on the sterilization and infection control. The treatment we provided the most was extraction - because patients delay visiting the dentist, the tooth is no longer restorable. Having the tooth extracted is also one of the cheapest treatments - the price for a simple extraction is Tsh1500, which is around $1USD and so affordable for most of the population.

Equipment is minimal and far from brand new. There are four dental chairs in varying state of function, and only one dental light. Some of my Work the World friends suggested taking my head torch with me to work - a great piece of advice. There was different restorative materials available - resin composite, glass ionomer, amalgam and IRM - and also an X-ray machine and suction system, although both were seldom used. When we did extractions we had to use gauze to keep the mouth dry and look at the socket, using lignocaine without adrenaline as an anaesthetic.

I found the infection control standard incredibly different from home. It is rather loose and takes some getting used to! Used, contaminated instruments are left in a sink until there is a pile, and then the whole lot goes into a pressurized pot to sterilize. Blood contaminated gauze and biological waste are all disposed of into a plastic box and dealt with at the end of the day and used hand-pieces are only cleaned by swabbing with iodine solution. Generally, the facilities are just good enough for performing simple dental treatment, but infection control is poor. Unfortunately this is the case in hospitals all over the developing world.

For the first two days I mostly observed, but then I started treating patients under supervision, performing restorations, scaling work and extractions. The root of the teeth in African people is longer and the bone density is really high so it takes longer and requires more effort to mobilise the tooth before extraction. Unfortunately on my first day treating I did break a few roots, but staff helped me and gave me lots of advice on how to use the forceps to get a better grip. I soon found my way and everything went smoothly from then on. I saw many cases of periodontal disease and fluorosis, which my supervisor told me this was due to the water supply from Mt Kilimanjaro and Mt Meru, which have high concentrations of fluoride occurring naturally.

What I found most interesting during my placement was the chance to see cases that rarely occur in Hong Kong. A patient came in one day suffering from Ludwig's angina, with severe swelling at both sides of his neck and his airway partially obstructed. After examination it was confirmed the case had a dental origin so the team performed an incision under local anaesthetic, allowing me to help drain the pus. Though it was a bit smelly, it is really a good chance to see such case and be a part to the staff. We also had a patient who had fallen from the tree, suffering from lacerated soft tissue. I was allowed to clean and suture the wound.

I found my placement to be a really good and memorable experience. Although you cannot practice up to date techniques, working on basic skills is very useful and I enjoyed helping people as a volunteer. My time in Arusha also gave me a broader view of dentistry in the developing world. Many people assume it is poor training but the Government only provide a limited subsidy to dental education and without funds it is hard to develop higher standards of treatment or equip surgeries properly. The dentists here cope with what they have and deal with every problem as it arises and it has taught me that no matter if I am developing a complicated treatment plan or performing a simple extraction, the patient is the priority.

During the planning and my actual stay in Arusha, the Work the World staff were really helpful - arranging our visas and the placement for me, then providing great accommodation, food and Kiswahili lessons (official Tanzania language). Without these it would have been hard to communicate with patients during treatment so it is definitely worth paying attention!

Living and working with students from all over the world was great, and we all became good friends. The staff provided us with information and ideas for travelling and a few of us would group together to arrange trips. I trekked up Mt Meru, the third highest mountain in Africa, went on safari to get a closer look at the animals and then when my elective ended, visited Zanzibar to relax!