Diary of a Bridge2Aid dental volunteer

Arti Hindocha reflects on some of the achievements made by Bridge2Aid and the satisfying and worthwhile friendships she has made whilst volunteering.

After carrying out volunteer work in North Brazil I came back to England with a sense of dissatisfaction. We had helped a substantial amount of patients but we had to return home, leaving nothing but a week's work of Fuji fillings and empty sockets. We had left so many patients in pain and no one to help. I started searching for a more sustainable way to help and thankfully stumbled across Bridge2Aid. Their concept of providing endurable care to those who were less fortunate in Africa hit a nerve. They talked about working together to teach and share dental skill sets with Tanzanian rural clinical officers. These clinical officers had a reached a certain level of medical and dental knowledge and were required to extract teeth, yet they had not even been shown how to hold a dental mirror.

As soon as my first year after graduation was completed I applied to be a part of the Bridge2Aid team. In January 2011 I made my way to Mwanza travelling with a group of dental nurses and dentists from all over England, Scotland and Ireland. Strangers united by our need to make a difference. We were to come together, essentially to teach minor oral surgery to 12 clinical officers. Underneath the excitement and anticipation there were some niggling doubts. Would I be able to teach? How would I handle the language barrier? As one of the younger dentists within the group, would my views and thoughts be valued and appreciated? We were to provide an intensive six day practical and theoretical training programme; much like the teaching of a third year dental student, however, intensifying one year's training into just a week. The January '11 trip happened to be the 20th programme since Bridge2Aid was founded. Our first evening in Mwanza was a celebration of this fact and that 135 clinical officers had been trained to date.

Before the clinical officers were unleashed we were given an orientation of how the next week was to pan out. Teaching and infection control protocols – such as double gloving and protection against needle sticks - were taught to all dentists. Infection control and Sterilisation was taught to the nurses. Sterilisation consisted of pressure cookers – it wasn't HTM-0105 but yet to fall short for the work carried out in Africa. The group was split into two teams, the first group was to stay in Mwanza and commute to two different sites within the week. The second group, of which I was a part, was to fly to Bulyanhulu Gold mine and commute from there to two different sites. The first site, Kahama, a bumpy two and half hour commute and the other site Ntobu, 20 minutes away. The groups were split between two sites so as many people could benefit at the time. Our group consisted of six dentists and three nurses. One of the dentists was our clinical lead and she worked in tandem with our Tanzanian coordinator Innocent. He acted as our translator and helped find suitable and safe buildings for us to set up temporary clinics. There was one fact to clarify before we started working. It wasn't about the number of patients we could treat as quickly as possible; it was about teaching the clinical officers meticulously and concisely. Teaching consisted of history taking, diagnosis, and positioning, charting and correct extraction techniques. We also had to make it clear to the clinical officer that they had to learn how to recognise their limitations and know when to refer.

Everything was basic from the 'clinic' to equipment. The patient's chair was a wooden upright chair more suited to a dining table. The dental light was a head torch. The Spitoon was a cardboard box. When you couldn't reach the patients mouth you stood on a crate. It became apparent as we started treating that some of these patients had been in pain, not for days but years. The highest number I heard was 12 years. It made the reality of how much we were helping almost overwhelming at times. Over the six days mini tutorials were given by each dentist on an OSCE based rotation system. Inferior Dental Block tutorials were in great demand. Throughout the week it was amazing to see the improvement in history taking – medical and dental; charting; examining of soft tissues (which wasn't even contemplated at the beginning); elevation and forceps technique. Several cases of pathology were stumbled upon including an oral cancer case (image 1), two ameloblastomas (image 2) and a fractured jaw. These were all great teaching exercises for the clinical officers as it reinforced the fact that dentistry will never be just about focusing on the teeth. The jubilation of a clinical officer when a tooth was correctly extracted was priceless. A tooth would be waved around in elation; infection control out the window. The clinical officers were continually assessed at the end of each working day by their dentists.

Once back at headquarters the dentists and nurses would debrief about the whole day and the clinical officer they were paired to. Nurses too had to assess if a clinical officer was knowledgeable about oral health education and sterilisation protocols. If they were any weaknesses exhibited then they were all discussed and the rotation of the clinical officers to a new dentist decided upon. It was at our discretion to decide if the clinical officers were ready to be graduated from the programme. They had to be practically adept, show continual improvement, perform extractions safely and had to pass a written exam on the last day of the training. All our 6 clinical officers were deemed safe to practise and all passed the written exam with flying colours. They would each return to their regions in Tanzania and work with a District Dental Officer to provide treatment to those around them. This experience has been one of the most rewarding experiences I have had to date. Not only was I able to share my skills, find teaching thoroughly gratifying in spite of the language barrier, it was an excellent learning curve as a young dentist. I was able to benefit from the expertise of the more experienced dentists around me. This has enabled me to bring back many tips to my daily practising life in the UK. If you can perform a surgical of a tooth in African bone with just a Coupland's elevator, you can take out ANY tooth!

As for my pre-conceived doubts, I need not have worried. I had the pleasure of working with a dynamic, talented and entertaining group of dentists and nurses. We started our experience as strangers and left Africa friends for life - a family away from home. As a volunteer charity the support you receive from the B2A team is priceless, you are fed and watered at all times. Losing weight is NOT an option. You are treated with the utmost respect and continually thanked for giving your time. You are the responsibility of the B2A team, no responsibility is left to you; from airport pick-ups, drop offs, packed lunches and detailed itineraries. There was no point at which I worried about my safety. There's even a treat for those who wish to spoil themselves with a safari at the end- yet another trip that is organised for you on request. In the past 20 programmes, 150 COs have been trained giving access to 1.5million people. The number of patients seen by clinical officers each month varies. In Kahama; the average clinical officer sees approximately 50 patients each month.

Considering that Kahama has 31 trained clinical officers, there are approximately 1550 people each month who receive treatment and are able to live without debilitating pain.

So while I'm chasing UDAs I'm comforted at the thought that in Tanzania a 150 clinical officers are able to offer safe and correct urgent treatment. This thought can get me through those 'never-ending' days and I'm proud to have been a part of a charity that allows you to truly leave something behind. I'm looking forward to my next trip – bring on the next batch of clinical officers, bumpy coach rides, debriefs, hundreds of patients and the B2A family!

Footnote: in memory of David Watt, an inspiration and wonderful man. Your memory lives on.