Dental Projects

As anyone who has ever had a toothache (and almost everybody has) can attest, oral disease — while rarely fatal — is very incapacitating.  Dental decay causes as much time lost from school and work as all of the diseases mentioned above.  Children with good oral health have better school attendance, self-confidence and general wellbeing.

In Zambia, especially rural Zambia, constant dental pain is the reality for most adults.  The entire country — with a population approaching 15 million — has fewer than 200 individuals trained to provide dental care.

The standard procedure of the Options dental team effort is to provide oral hygiene instruction as its starting point followed by registration of the instructed individuals and screening of them to record their oral health status. Those with no or moderate dental problems receive fluoride varnish treatments that reduce dental decay, while others obtain some tooth restorative work or extraction of unfixable painful teeth. Everyone receives toothbrushes and toothpaste donated to the team by their manufacturers.  To accomplish these goals, every team member has had to travel to Zambia with duffel bags filled with dental equipment and supplies in addition to their own personal items.

When Options first encountered the orphans residing at Kasisi Children’s Home in 2004, over half of them had moderate or severe dental decay.  By the third visit in 2007, the number had dropped to less than one in ten.  This record of success encouraged the Children’s Home leadership to raise funds for a fully equipped dental clinic in where the Options’ team, now the “official” dentists of the Home, have provided annual dental prevention and treatment efforts.

In the rural village of Muchila, the goals and procedures for dental prevention and treatment are similar, but the challenges are greater.  A makeshift surgical theater has to be constructed and logistical obstacles surmounted such as sterilizing surgical instruments in pressure cookers heated by charcoal fires.

Attesting to the community’s appreciation of the team’s dental contributions, the number of villagers appearing for dental education, screening and treatment has doubled over the years, peaking at over 1000 in 2013. An important aspect of this project was the participation of local volunteers.  After training by the Options team, they provided oral health instruction in the local language as well as translation of villagers’ symptoms.

Dental pain is a magnet that attracts community members when services to provide relief are available, and education that prevention avoids the need for such relief also activates community participation.   Other health measures, such as vaccination HIV counseling can be — and have been — piggybacked on the dental services.

Sickle Cell Disease.

 In 2006, Options’ co-founder Tom Stossel, a blood disease specialist, met with physicians at Lusaka’s University Teaching Hospital, and they started a collaboration to address the devastating inherited blood condition of sickle cell disease that is highly prevalent in Sub Saharan Africa in general and Zambia in particular.  Two years later, Tom was able to raise sufficient funds in the USA to enable UTH to renovate its run down pediatric ward where most of its sickle cell disease patients are hospitalized.  More recently, Tom has connected his Zambian medical colleagues with researchers in the Chemistry Department of Harvard University who have designed a device that can screen patients for sickle cell disease under conditions applicable to remote sites in developing countries.  Currently such diagnostic screening in Iow resource settings is not possible.  While no cure exists for sickle cell disease, early detection enabled by screening significantly improves survival and life quality of afflicted individuals.  The Zambian physicians have assisted the American colleagues in validating the device, are co-authors of publications in scientific journals describing it [LINKS TO PAPERS] and will participate in its field-testing in a rural health center in Zambia’s Northern Province this spring.

Achieving Sustainability: Health Workforce Recruitment.

 Options cannot possibly contribute dental care or sickle cell disease management for the thousands of remote Zambian locations that need it, and Options’ efforts initially depended on assembling teams to travel to Africa.

Options’ education of Kasisi children and of Muchila villagers concerning oral hygiene potentially reduces or eliminates the need for the treatment services it does provide for badly decayed teeth is a small step toward durable health improvement.

More importantly, however, the Options team made key contacts in the Ministry of Health and with the Zambian Dental Training School in Lusaka.  In 2009, the Deputy Health Minister and two Dental Training School faculty members visited Muchila with the Options team.  One consequence of this visit was that the Dental Training School dean and members of his faculty subsequently augmented the Option’s dental team during its Muchila sojourns.  As a result, whereas 29 surgical procedures were performed in 2008, over 100 took place in 2012.

Even more significantly, the dean met with the Muchila community volunteers, reviewed their high school grades and encouraged them to return to school to achieve sufficiently high marks to qualify for admission to the Dental Training School.  Options then financed two volunteers’ remedial education following which they performed sufficiently well on the Training School entrance exam to gain admission. Last year, these two students, one whose tuition Options provided (the other subsidized by the Zambian government), graduated and are serving in rural clinics such as Muchila.

Options’ recruitment of local citizens to the Zambian dental healthcare workforce now enables Muchila to take care of its dental care needs on its own. Options has also sensitized the Dental Training School to the needs of the rural population and has encouraged it to develop outreach programs, sending its students to other locations resembling Muchila.  It makes far more sense for Zambian than American dental trainees to be providing services in their own country.

Other Contributions.

 As a result of its continuous involvement in Muchila, Options responded to community requests to help the village.  It arranged for construction of a bore hole for clean water, financed by the Rotary Club, and donated cattle, seed, other farm assistance and some financial support and soccer balls for children orphaned by HIV-AIDS.  It also began to encourage the village women, incorporated in a club named Penga Ujane (rough translation: “Work rewards”), to make baskets that could be sold in the USA.

In 2008, Donna Golemme and her husband Rich joined Options board of directors.  Donna is a businesswoman and also a master bead craftsperson.  Although sales of Penga Ujane’s baskets had, for the first time, given the Club’s women some disposable income, transporting such bulky objects is difficult, and extensive competition from sources around the globe renders them hard to differentiate one from another as salable items.  With beading materials donated by Options, Donna began to train the very skilled Muchila women in bead crafting and now Muchila beads sell out rapidly in the USA. The proceeds return to the Muchila women.

In August of 2014, national and regional authorities convened to commemorate the near completion of a substantial birthing center also incorporating a dental clinic constructed with funds raised by Options.

Birthing centers, especially when located in the remote regions of developing nations such as Zambia, are essential tools for reducing what currently is an unacceptably high maternal and newborn mortality rate in such countries.  The centers are magnets that draw expectant mothers near term out of the bush to a location where skilled childbirth experts deal with the all too frequent complications that result in the deaths of mothers and newborns. Application of such skills makes a major positive impact even in the absence of sophisticated technologies available in the developed world.  These technologies require electricity and running water, neither of which exists in places like Muchila.

Options’ Impact: Overview.

 In summary, a largely self-funded low budget organization staffed by part-time volunteers — learning on the job — can accomplish important public health goals. The key ingredient for success is close contact with people at the point of care – on the ground.  This contact optimizes needs assessments and expectation management.   It also facilitates adaptation to changing circumstances and resolution of inevitable problems.  Close relationships also minimize misunderstandings.  The recruitment of and educational investment in the community volunteers benefitted immensely from repeated discussions and planning adjustments.  The community relationships also go a long way to neutralizing bureaucratic interference by distant officials.  Having delivered goods and services and established friendships make it easier to convey that the goal is for the community to take over on its own and that the team will move on to other sites.

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Voices of Zambia

Dr. Saylea
Dental Surgeon
Lusaka Dental School

“Many people with chronic painful dental problems have waited a year for the dental team to arrive. Some have traveled 70 miles desperate to receive dental treatment, sacrificing their meager income just to undertake such a trip.”