In this GDPUK exclusive interview, Guy Tuggle talks to Dental Therapist Eleanor Ridge about her recent trip to Malawi with Dentaid.

Eleanor, thanks for talking to GDPUK.  Most readers will know of the dental charity ‘Dentaid’, but for the benefit of those who don’t can you briefly tell us about it?

Dentaid is a charity that seeks to provide safe, sustainable dental treatment to people in desperate need in poor and remote countries.  It supports dentists around the world  via outreach programmes and sends teams of volunteer UK dental professionals to help reach more patients.

At home, Dentaid and its volunteers provide free dental treatment to homeless and vulnerable people using mobile dental surgeries.

Overseas volunteer teams like the one I joined work with dental partners to run outreach clinics in schools, churches, remote communities, prisons, orphanages and refugee camps.

It sounds like  real ‘at the coal-face’ dentistry…

Well, yes it is.  Dentists, dental nurses, hygienists and therapists might spend one or two weeks volunteering in countries like Cambodia, Morocco, Malawi or Uganda, providing pain relieving dental treatments and oral health programmes for thousands of people.  It’s a great opportunity to use your skills in a different environment and know that they’ll make a real difference to people’s lives.

So what drove you to volunteer?  I mean you’ve got a comfortable lifestyle in Hertfordshire working as a hygienist and therapist.  It sounds like a great leap out of your comfort zone?

I became aware of Dentaid many years ago, back in the day when I was a dental nurse.   

I had picked up some bumpf off the Dentaid stall at a dental conference and tucked it away in my ‘to do’ pile one day . I’ve always felt very passionate about helping people, and wanted to experience volunteering in this way to meet people who may not otherwise receive any treatment at all.  Many of the patients I saw had never received dental treatment before.

I originally contacted Dentaid in 2018 and was down for the 2020 trip, initially to Kenya , although this was later cancelled due to the framework out there being unstable to receive us.  I therefore researched going to Malawi and started fundraising. After two false dawns due to the pandemic I eventually got to go in May 2022.

I’m guessing you went as part of team.  Can you tell us about the composition of that team?

We were a group of twelve dental professionals, dentists, hygienists, therapists and nurses. So a good skills mix.  

Dentaid volunteer coordinators organised the trip very efficiently through their network. Our team leader, Nick, also a dentist, had been to Malawi three times before and had established contacts with dental health technicians ( equivalent to our dentists ) out there and had hosts who looked after us at our lodgings.

How long were you away for and how did you fund the trip?

We were away for 2 ½ weeks and funded the trip ourselves by fundraising, asking for sponsorship and donations. Some people held fund raising events - it was a three foot rule of asking people to sponsor me !!!

I’m imagining things were pretty rudimentary.  How were the clinics set up and how did you navigate infection control, consumables and so forth?

Clinics were set up in school buildings, the first in a large science lab.

There was a large amount of dental equipment in storage which we picked up on the way from the airport.  We actually stayed over at the location of our storage base in a community hospital. Here we collected sturdy metal foldable dental chairs and gas cannisters - which were used for the decon and sterilisation set up.

After use, instruments were placed directly into buckets containing  medical grade sterilisation solution before being transferred into pressure cookers which were heated to the requisite temperatures.  

All procedures were well practised from previous trips, our team leader was very experienced and knowledgeable on the set up.

What equipment was available and what did you volunteers have to provide?

Not surprisingly given the history of the patients we saw we performed a large number of dental extractions and fortunately there was a plentiful supply of forceps, elevators etcetera.  However, consumables like gloves, local anaesthetic, aprons, antibiotics , painkillers , cotton wool rolls , gauze and all the other incidentals we needed to run the clinic were largely supplied by us and our fundraising efforts.  I’d raised £380 for local anesthetic which ran out the previous year. 

Were extractions the order of the day for most patients then?

Sadly so.  Our service was primarily extractions as a high percentage of patients presented with gross caries, severe periodontitis and acute infections.

Patients whom came to seek help with us had a lot of pain from highly carious teeth some with acute infections, abcesses, severe perio , the occasional extraction for ortho , to allow teeth to naturally erupt into position as near as possible. Paediatric caries was rife because even in areas of poverty fizzy drinks and sweets were readily available, sadly . We saw all ages . Some were anxious , much like at home, but it seemed as word got round we were there to help hundreds queued to see us .

How did you organize yourselves to deliver care efficiently?

We worked in teams typically with one dentist , one hygienist/therapist and one nurse to each group running 5 chairs.

When the queue was incredibly long we became well practiced in our system of assessing and charting which teeth needed to be treated, patients would be called by number to receive treatment.

As time progressed we became mega-efficient and on the last day all hands were on deck, including the 3 Malawian dental technicians who attended to patients and assisted in the clinic.  They were very helpful for translation too!

We reassured patients and became very skilled at signing calming gestures and supporting patients to put them at ease during and after treatment, especially for the children.  We took pens, pencils and colouring books, toys and bubbles to give the children after their dental care had been completed.  They liked this and the gifts helped in most cases to lighten the mood.

Remember, most of the people we saw and especially the children had not seen a dentist for years if ever.  In the second village we set up base in I was told there had not been a dentist visit for fifteen years.

Was there much scope for health education?

We did our best.  The majority of care was extractions, no fillings were possible as there was no after care, but we did impart basic oral health education and gave toothbrushes and toothpaste to patients and showed them how to use them by gesticulating, signing .

Sugar cane is a popular treat in Malawi, as well as sweets, fizzy drinks and other western foods that are entering the country.  It’s sad that so much harmful food has entered the diets of these folk when there is invariably no dental service to mop up the consequences. 

I believe there may have been some toothbrushes and toothpaste in the stores locally but not nearly to the extent that we have here in the UK and little education to instruct about effective oral hygiene practices, although I am sure some people are understanding.

Water is available either bottled water or from bore holes / wells.

What about clinical waste?

The clinical waste was incinerated at a safe distance on a bonfire back at base in the evenings – the only safe and permanent way when in the remotest parts of East Africa!

And what about down time Eleanor?  How did the team chill out in the evenings?

In the evenings we ate out, played pool and enjoyed a well-earned drink or two and chatted with the locals who were always very interested in speaking to us and asking questions about what we were doing.  

They were so thankful having at first been a little suspicious of our motives. But once word got round they knew we were there to help and were grateful.

Were you able to call home?

We had Malawian sim card and mobile data , which was very popular to be able to get phone data cards to be uploaded onto the phone, inexpensively too, so we were able to keep in touch with friends and family at ease.

Looking back on your trip what are your overriding memories, your key ‘take-aways’?

The sheer volume of people we helped, was my overriding memory, on the busiest day 350 people came through and some mothers had one or two children. We really did make a big impact on the communities, relieving many people of dental pain or discomfort and it was lovely to have special interactions with people whom I would have never normally met .

One special memory I will always treasure is of a little girl running up to me, very proudly showing me her beautifully coloured-in colouring book that I had given to her days before – very sweet

Children loved walking with us from our lodge base to the nearby school, just one child on day one, then 10, 20 until a huge crowd of children would run from all directions to join us on the 15 minute walk and take it in turns to walk next to us, we would sometimes sing or just chat, others would just like looking at us and wanted to hold our hands.

Finally, what advice would you give to any dental worker toying with the idea of volunteering?

I would advise anybody thinking of doing this to not hold back.  For all the challenges in western healthcare systems we are so lucky.  It’s easy to lose sight of what other people are experiencing.

To share our skills and help really underprivileged people in this way is the greatest gift and most  memorable experience I will never forget.

Anyone interested just contact Dentaid overseas volunteer team to enquire about future trips and register your interest to join a trip . They will answer any questions you have and provide information on the trips.  Their website too is a fount of information. Go for it!

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