Since the dental students joined the rest of the team later in Arusha, and the need to sort out our work permits, we’ve only had the chance to be exposed to clinical work in the dental units for two days.
We took a trip up to Nkoaranga Lutheran Hospital, about 45 minutes North of Arusha, to spend some time in the dental unit under the supervision of Dr. Frank Akyoo. Within minutes of our arrival, he had us get to work, performing extraction procedures, draining an abscess, and even placing composite veneers. The patients that Dr. Frank typically see’s are those from surrounding communities that can afford to pay the hospital for the registration, procedure, and pharmaceutical fees. As many people would assume, this leaves a lot of the local population without dental care simply because it is not affordable, and people only seek treatment when it is emergent. Luckily, MedOutreach will be spending the next two weeks up at Nkoaranga (Meds and Nurses included), and we will be holding 4 days of “community clinic” providing dental care (costs covered by MedOutreach) to anyone who comes to the hospital from the surrounding areas. The hospital secretary has sent out a letter to close to 50 community centres, churches, and schools, to inform them of our upcoming clinic. We’re expecting long days of treatment – but are looking forward to being able to to help – one tooth at a time.
Dr. Frank Akyoo & Tara in front of the dental unit:
Even with only two days in his clinic, the differences between Canada’s dental care and that of Tanzania have become incredibly evident. More specifically, we’ve noticed how wasteful we can be in Western society, when we have so many resources at our disposal.
Comparing our clinic at school versus that of the dental unit in Nkoaranga highlights areas where we too easily waste resources that are eagerly conserved elsewhere.
At school, when we set up our cubicle for a patient, typically we grab a handful of gauze, some cotton rolls, a tongue depressor, and maybe a cotton tip applicator. We put out all of the air syringes, suction tips, and barriers as per standard set-up procedures – whether we plan to use them or not.
During the appointment, if we are using an instrument that may not be “perfect” for the task at hand, we do not think twice about picking up another, and another, and another, until you can get the job done. Most items we use are single use, and are chucked into the garbage following the appointment regardless of whether they were used.
When the appointment is over, we toss out everything disposable in our cubicles (whether it was used or not) and repackage everything into sterilization pouches (again, whether they were used or not). This is done because they are deemed non-sterile, which is valid reason to dispose of these items. We do not think twice about the fact that we did not use any of the cotton rolls, the cotton tip applicator, or that we only used one of the 15 pieces of gauze that we put onto our tray. We wipe everything down and do it all again for the next patient.
While this protocol is certainly the most sterile, and needed to maintain infection control for both patients and the student dentists, our lack of thought about what goes into our cubicles before our patients arrive creates a lot of waste.
In a place like Nkoaranga, Tanzania, where resources are scarce, we do not have the luxury of using materials in excess.
Before the patient comes in for treatment, we figure out exactly what will be needed for the procedure. For example, for an extraction we would need three (3) pieces of gauze: one to help control bleeding and saliva during the extraction (since there is no suction), one to clean up the area once the extraction has been completed, and one for the patient to bite on to achieve hemostasis. If more is needed, an assistant can retrieve an extra piece at that time. In Nkoaranga, Dr. Frank even cuts pieces of gauze that are larger than 2×2 into smaller segments because it is a waste of valuable material.
Before starting the procedure, we decide exactly which instruments will be used and try our best to ensure we only use those instruments to complete the treatment. They do not have an endless supply of instruments and the space in the autoclave (sterilization) machine is limited.
Materials are never deemed “one time use” if they can be dispensed away from the patients mouth and carried for use with another instrument (to prevent any contamination). This can make a tip of composite last for 2 – 3 patient fillings, rather than being used for just one!
When it is time for clean up, we have found we’re only left throwing out materials that have been used. We only need to sterilize instruments that were put to work and actually contaminated. Overall, there is notably much less waste produced, and were able to get the same job done and keep the patient comfortable at the same time.
While Tanzania may be behind in their access to resources, and limited income of both the clinics and the patients, there is a lot that can be learned in terms of resource management and limiting excess waste. After only a few days here, I know when we return to our school clinic in Canada we will be more aware of our use of materials, will make a conscious effort to be conservative, and avoid excess waste.
Nkoaranga Lutheran Hospital dental unit: