Third World Dentistry

~ Monday 21st July

I wouldn't call it a culture shock as such, but it sure as hell felt like it after my first day in the dental department.

I'll admit, I had a pretty awful day. I was due to start at half 8 but when I went in, I was told to wait for the dentist I was scheduled to shadow which was fair enough, until it hit 10am and she was a no-show. I was feeling the tiredness from the last three weeks catching up with me and I was just so annoyed at having to sit around doing nothing (despite me asking twice where on earth she was and if I could just be placed somewhere already).

Eventually they had to relent and let me sit in on the procedures as it became clear that this dentist wasn't going to turn up. So an overview of their system; Malawi, and basically Africa, don't have an appointment system in place whereby the public regularly visit the dentist/dental clinics for a check up. The general awareness on oral hygiene is seriously lacking because the government simply cannot afford to fund dentistry as a whole when they have to divert all their attention to life-threatening illnesses such as HIV and AIDS, alongside TB and malaria. That's understandable, but it means that the country has zero importance on dental health so patients only get their teeth seen to when they experience (severe) pain and are left with no choice but to visit the hospital to get it checked out.

The dental department is a stand-off building which simply consists of a single long corridor made up of three surgeries; extraction unit, restorative, and oral surgery. Towards the end there's a dental lab and a small room leading to operating theatre whilst lining the surgeries there's a bench crowded with people. I guess you'd term that their waiting room. They initially go to reception, report their problem, and they sort of get assigned to a surgery that would be deemed appropriate for them. It's almost like an unofficial diagnosis.

At 10 when my placement finally started, I was placed in the extraction unit where yep, you guessed it, they carry out extractions. Don't get me wrong, they're a massive part of the dental field, but there are only so many you can watch (especially after having seen over two weeks worth in England) until it becomes outright boring. The most exciting part of my day was when the dentist asked me if I wanted to inject this poor woman in pain and extract her tooth, completely unfazed by the fact that a) I am not a dental student let alone a qualified dentist, and even if I was, I wouldn't be able to do that in my clinical years, forget anything else and that b) I would probably kill the patient off in the amount of pain I would put her in. I promised you that you'd be the first to know if I had the opportunity to put pliers to mouth, but I didn't promise to take them up on the offer. I do have some form of humanity and just common sense in general.

I was more fascinated by the blatant carelessness of not only their job but also sterility and compassion. They just don't care. I'm genuinely struggling to word it, to express just how little they care about what they're doing, or why the patient is in pain, or the fact that he's just spat out a mouthful of blood on the dentist's uniform. Or the fact that there's a piece of cotton wool soaked in blood casually lying on the floor. The sterilisation of their instruments is the dumping of them in a bucket of chlorine.

And to add to this uninterested attitude of theirs; in the whole dental department, there are two qualified dentists. Malawi doesn't have a dental school and education abroad can't be afforded so students study dental therapy (which is the only dental related course that the government fund) meaning that the rest of the staff are all dental therapists. Technically, on paper, they can only perform fillings and the occasional extraction but because of the shortage of dentists, they do what they're not qualified to do, to the extent of performing complex surgeries that they've never learnt or been taught to carry out. Reassuring, no?

In England we have one dentist assisted by at least one and sometimes two dental hygienists. Here we have five mini surgeries within the extraction unit, each with a "dentist", and one dental hygienist between them. So all in all, you're on your own, handling a patient in pain, the equipment, and the drills you have to balance within their mouth.

It's worlds away from dentistry in the UK...it's just so unbelievably backward and I'm struggling to accept how different it is from back home.

The number of times I saw the dentist leave the patient in the chair mid-extraction (bearing in mind they're the sole person in the surgery) to get something or the other, and don't come back for over 15 minutes, I probably can't even count on one hand. To top it off, obviously because all the patients are emergency patients, there comes a point where there are none left. So at 11, the waiting bench for extractions was empty so everyone working in the unit just upped and left, leaving me waiting entirely by myself doing absolutely nothing productive with my time.

It was horrible. Maybe I got too used to the people in the labs being really passionate about what they do and throwing me into work, and I know observation is tedious and dull, but my God the people in the dental department knew how to enhance that. And maybe I just can't get my head around how different it works over here.

I'm in operating theatre tomorrow so fingers crossed it's a much better experience than today. I hope to God it is. If I have to spend four more days like this, I'm going to be so tempted to walk out and bail on the experience altogether.

On that note, this post won't be up till I'm back in England and my seven weeks in Africa are over, which isn't brilliant because I wanted my posts to coincide with my days here but unfortunately, my data and internet can't keep up so I'm having to write and have it on a scheduled upload when I get back.

I apologise for having a crappy day (and hence this post nearing a rant) and also for the timing issues.

*vows to make the next post a good one*