May 2, 2017
In the UIC DMD curriculum, students participate in a broad range of community service learning opportunities that prepare them for careers in diverse settings and to encourage their interest in working with the underserved populations. One of these opportunities is the international rotation. The College has partnered with community-based organizations in a variety of countries including Guatemala, China and Tanzania to offer students a remarkable set of community-based service-learning experiences. In the international rotations, students have the chance to learn how dentistry is practiced elsewhere in the world and share their knowledge of American dentistry with their hosts.
Through international service learning rotations, students get the opportunity to:
- Serve the unique and complex need scenarios of a richly diverse global patient population.
- Study global oral health through clinical care and community outreach efforts to gain first-hand knowledge and expertise outside the US.
- Serve as ambassadors to the College to exchange cultural and clinical knowledge.
In this edition of My Service Learning Experience, DMD students Naheed Ahmad and Jessica Hyker share their amazing experience on rotation in Tanzania Africa. In this roation, Naheed and Jessica were working in Dar-es-Salaam (the largest city in Tanzania) at Muhimbili University of Health and Allied Sciences School of Dentistry and in Tanga at the Dental Therapists Training Centre. They also participated in community outreach programs in Tanga.
For a more in-depth tour of this service learning experience in Tanzania, check out Naheed's travel blog.
What was Tanzania like?
Most of our time was spent in Dar-es-Salaam (the largest city in Tanzania) along with a week in Tanga. The diversity in Dar is astounding. It is such a global city. There are native Tanzanians, but also large Oriental Asian and IndoPak communities that moved to Tanzania for trade. There is a plethora of different cultures in Dar -- you will encounter the magnificence of towering mosque minarets, the majestic bells of churches, the simplicity of Buddhist temples and grandiosity of Hindu mandirs. You will see an array of individuals with differing skin colors and facial features conversing together in Swahili.
We went to the mosque on Friday for Jummah prayer and it was soothing to see all Tanzanians of different ethnic backgrounds worshiping in unison and embracing each other after prayer was over.
What was it like to practice dentistry in Tanzania?
On our first day, we met the Dean and the Associate Dean of the MUHAS College of Dentistry. We also got a tour of the school, which is the only dental school in the entire country of Tanzania, which has a population of about 53 million people. The school is divided into three departments - Restorative, Oral Surgery and Pediatrics, with Endodontics and Periodontics within the Restorative department.
All patients who come for initial exams first get screened and examined based on their chief complaint in the Oral Surgery department. Afterwards, the patient is referred to the Restorative Department based on whether the tooth/teeth related to the chief complaint can be restored and if the patient can afford to restore the tooth. The patient then also has the option to extract the tooth on the spot.
Dental operatories at MUHAS OS
As far as access and payment, the government of Tanzania covers all of the treatment for these patients, minus about 10,000 Tanzanian Shillings (~$5 USD). If the surgery could not be covered in Tanzania, they would pay for the patient to go to India to get the surgery done. Despite this, most patients don't come into the dental clinic until they have reached chronic stages of care need. This is mostly because of a mis-trust of western medicine and lack of healthy literacy.
Most of the teeth are non-restorable and of those that are, 35-50% of the patients choose to extract the teeth on the spot. Around 90% of the patients do not seek comprehensive care and only come in on an urgent care basis. The government employees and their families are the ones that can mostly afford to restore their teeth instead of extract them, because the government provides dental insurance coverage to their employees.
It was a blast getting to know the other international dental students/dentists doing rotations at MUHAS! One of the Mauritian students also brought traditional Mauritian food and made us soya beans and vegetables in oyster sauce -- so delicious! We hosted a dinner at our apartment on Wednesday. One of the other international dentists is a native Tanzanian and he gave us an unofficial tour of Dar-es-Salaam!
How does dental care in Tanzania compare to the US?
One thing that is strikingly different about the Tanzanian dental experience is the de-commercialization of dentistry. At MUHAS there is a strong emphasis on disease control. Some of the cases that we saw were pain-focused, but there were also many cases where controlling the patient's dental infections was a matter of life or death.
Another big difference was the extreme cases of oral pathology that we've only read about in textbooks. Oral and Maxillofacial Pathology screenings were one of the most challenging aspects of this rotation. We would see between 50 and 70 patients per day. About a quarter of the cases were ameloblastomas, a quarter of the cases were squamous cell carcinomas, a quarter were sialoliths and a quarter were miscellaneous pathology. We got to see a plethora of procedures including incisional biopsies, wound dressing, intermaxillary fixations and incision and drainages of very large and life threatening abscesses. Despite the case load and challenging nature of the conditions, we were so impressed by the level of compassion offered by the schools's surgeons and other staff.
What was the community outreach experience like?
During our Tanga visit, we worked alongside the dental therapists in their pediatric oral health outreach efforts. There is a school for dental therapy located in Tanga, one of two in Tanzania (the other is located in Mbeya). The dental therapy students gave oral health education to large classes of young students. The children were extremely well-behaved and very engaged. Letters were composed to send to the parents of the students, explaining what treatment the children would need and asking for their consent. The students would later be transported to the dental therapy school that Friday and receive all the treatment they needed free of charge. After the education sessions, therapists meet with government officials to discuss the findings of the outreach program and the impact that the efforts had. The oral healthcare outreach is sponsored by Miracle Corners of the World (MCW), a non-profit organization which includes oral healthcare as one of their core principles. MCW also sponsored a grant that assisted in our trip expenses.
Tanga school where outreach was conducted
While in Tanga, we were given a tour of Tanga International Competence Centre (TICC), a Norwegian co-operative and educational society. They bring healthcare students from all over the world (but mostly Norway) to Tanzania and allow them to immerse themselves in the global health opportunities Tanzania has to offer. We met Mama Ruthie, the Norwegian director, on our plain ride over to Tanga. She was gracious enough to introduce us to the Tanzanian government officials working with TICC.
What were some of the ways you explored the local culture?
One of the best parts of an international rotation is getting the opportunity to take a break and experience the local culture! One of our favorites was Zanzibar, a semi-autonomous archipelago about 23 miles off the Eastern cost of Tanzania. Although it is officially part of the East African country, in almost all aspects—politics, religion, culture, food—life there is different. Whereas mainland Tanzania is a mix of Christian, Muslim, and indigenous groups, but Zanzibar, which the Sultanate of Oman ruled for centuries, is almost entirely Muslim. After departing from the ferry, we decided to trek it on our own to the spice market, where we found some good spice and cloth deals. Afterwards, we checked out the botanical gardens, an art store and headed to the beach.
We also explored the terrain of Lushoto, a highland town nestled in a fertile valley at an elevation of about 3,600 ft. Lushoto is the heartland of the Wasambaa people (the name ‘Usambara’ is a corruption of Wasambaa or Washambala, meaning ‘scattered’).
Lushoto Irente Cliff Viewpoint
While in Lushoto, we stayed at the Irente Lodge, a camping lodge populated with wayfarers who find happiness in the simplicity of nature and the unassuming nature of African life. The hospitality that was shown to us by the Irente Farm Lodge was paramount to the beauty of it’s landscape. The stars were calling our name and we basked in the enormity of the sky that night. In the morning, we were welcomed with breathtaking views of the Irente cliff in the homey village of Irente, that has a radius of no more than 7km.
The “mambos” and smiles from the townspeople were plentiful as we trekked through the mud that had been blessed with rain. The beauty of the small village enveloped in mist did not prepare us for what our eyes were soon to behold. We climbed above the steps that were carved in to the cliff and found we were literally above the clouds.
What was the biggest thing you appreciated from this rotation?
Naheed: I really appreciate how this rotation helped expand my horizons around public health. I particularly enjoyed the school outreach activity because I could see first-hand the huge impact even simple tooth decay can have on public health without proper access to care. I could see we were making a difference by educating the younger generation on the importance of oral health.
I will also be eternally gratefully for the diverse friendships I made in Tanzania. These friends have challenged me to push my boundaries and see the world through different eyes, whether it be trying Tanzanian “mix” beach side on Cocoa Beach, encouraging to sing my first karaoke ever or illustrating hurdles that dentists face in a different part of the world.
Jessica: I really appreciated how nice and friendly the Tanzanian people were. We opted for the bus to save money, and so we rode shoulder to shoulder with locals. We were also invited to eat local foods on several occasions with members of the school staff. Even though most patients didn't speak English, or that we didn't blend in walking down the street, or enjoy all the food we were offered, it was still worthwhile to 'step outside our comfort zone' and really immerse ourselves in the native culture. That's what really made it a memorable experience.
Service Learning at UIC College of Dentistry
Our Service Learning curriculum is integrated throughout all four years of dental school. It is a progressive curriculum, which includes didactic components as well as introducing students to a variety of community-based, hands-on experiences outside of the College.
More on service learning at UIC College of Dentistry