Dr. Z goes to Kenya

Dentistry on Nabugoye Hill

If anyone told me four months ago that I would be taking out teeth and caring about the future of dental health in Uganda, the land of Idi Amin and the Raid on Entebbe, I’d have told them they were crazy. I knew I was going to Kenya for Operation Smile, as a dentist on a team treating children with cleft palate, and sent in a deposit to go on a safari after that. But a string of events led me to Samson Wamani, Medical Director for the Abayudaya community in Uganda— and helped me realize there’s a huge difference between what is dental care here in the U.S., and what is available to fellow Jews of the Abayudaya. This was more important than seeing lions.

Learning about Uganda

There are books and websites about the Abayudaya, a group of near 800 Ugandans who trace their Jewish history to 1919, when a tribal leader, Semei Kakungulu, led his people to begin practicing Judaism. I sought to read as much as possible. One book by Richard Sobol at Michigan’s Grad Library has wonderful pictures and a CD of community members singing songs and prayers they sing during their Shabbat service, some in Hebrew, others in their native Lugandan. I loaded this CD on my iPod and listened to it constantly. There were also pictures of community members, young and old, living in a rural, rustic setting. Many of them live on Nabugoye Hill, outside the city of Mbale, Uganda’s third largest city with a population of 75,000 in the foothills of 12,000 foot Mount Elgon in the southeast corner of the country.

I emailed Samson back and forth for a couple of months, asking questions and finding out more. Samson grew up in the community and always wanted to be their first physician. He recently graduated from medical school in Kampala, and his tuition was partially supported by some individuals from Rochester, New York. Did the community need dental care? Did they need equipment or personnel? He told me there was no dentist in the community, and that there was only one in Mbale. Access to that dentist was difficult both because of the challenge of transport and the cost of care beyond reach of most community members many of whom are subsistence farmers. In the health clinic was a military field-style dental chair which several dentists from California brought a few years ago when visiting. They held a clinic for three days and each day a line of people waited to have a tooth extraction. This told me that it was likely that there were people with dental pain in this community.

Before leaving, I gathered supplies to treat patients in Uganda. I sent an email to dentists in the Detroit chapter of Alpha Omega Dental Fraternity, and people came forward and sent me anesthetic needles, extraction instruments, and offers of money. I purchased some supplies, including glutaraldehyde (cold sterilization solution) from a dental supply company. I “borrowed” anesthetic solution from the dental school.

Operation Smile in Kenya

I arrived in Kisumu, Kenya and spent ten days with Operation Smile. Kisumu is in western Kenya on the east side of Lake Victoria, and north and west of Kisumu is Uganda. The mission of Operation Smile is to provide repair of cleft lip and/or palates. Dentists check the teeth on everyone, remove any teeth that were problems and could affect the cleft repair, and make special prostheses called obturators to cover the cleft palate for those who could not have surgery. To be honest, except for the first couple days of screening, I wasn’t terribly busy. This is likely because the children’s teeth in general were in good shape, and only one child needed an obturator. But it was great to be a member of a team that was doing important work and changing lives. I worked with my fellow prosthodontist and new friend, Dr. Omondi. Omondi was from the area and of the Luo tribe, but had traveled to Nairobi and then London for his prosthodontic training. We enjoyed working together and have kept in touch, especially recently with the turmoil going on in Kenya post-election.

The Journey to Uganda

I had told Omondi of my need to get to the Ugandan border to meet Samson and he was truly helpful in finding a car and agreeing to drive me to Busia, the border town. I didn’t want to rush him, but I wanted to get to the Abayudaya community before dark to make it to Kabbalat Shabbat services. He got the car late, and we left late. We drove off, first through the busy Kisumu downtown, then out the main road, with potholes that made this Michigan resident feel very much at home!

]]> When most Americans in northern states think of “crossing the border”, they think of driving their car up to the Canadian customs window and answering a few questions of the customs official. Busia is a busy border town that straddles both Kenya and Uganda as in Kisumu, there was commerce of various forms along the street and in the street. Omondi helped me through this maze and I obtained a visa for $50 at the Ugandan office. It was there that I finally met Samson; it was like meeting long lost relative ---while we had never met, we knew we had a strong bond.

On to Mbale

Samson had hired a driver and we headed up to Mbale along some dirt roads. As it got darker, I made my first observation about Uganda: drivers don’t turn on their headlights until they can’t see at all. My second observation about Uganda was that the power goes out rather frequently. After almost two hours, we neared Mbale.

North of town, we drove up a very difficult dirt road up Nabugoye Hill, the main area for the community (there are several areas, but this is where the high school, health clinic, internet café and the largest synagogue are). The drive was made more difficult due to road construction, which narrowed the dirt road to a one car-width access. When we reached the synagogue, Kabbalat Shabbat services were ending. We were able to say hello to many people, and enjoyed a kiddush and motzi with Israel, the community leader, Tehilah, his wife and the nurse at the health center, and their daughters. After talking for a bit, it was time to go. The driver had still been waiting, and it was time for me to go back to town to my hotel.

I stayed at the Mt. Elgon Hotel in Mbale which is a fine hotel, but something bothered me about it. It distanced me from the community I was visiting, both physically by six challenging kilometers, and also personally. The Abayudaya were in their village, while I returned to a fine hotel frequented in large part by whites. The Abayudaya are currently building a guesthouse on Nabagoye Hill. This will not only make it more convenient to visitors and create a better experience, but also bring much needed funds to the community to retain potential lodging funds. My first evening at the Mt. Elgon, the power went out three times.

Shabbat with the Abayudaya community

Shabbat morning I made it up to the Moses Synagogue on Nabagoya Hill via piki piki (motorcycle with a seat on the back). I probably should have said an additional prayer in thanks that I got there without injury. I will not miss piki pikis. I approached the small but airy building and was welcomed by all and introduced myself to so many people. There were chairs set up about five on each side of the aisle, with women sitting on the left and men on the right. In many ways the service was very familiar. We used the same siddur as in the U.S. (complete with bookplates from New Jersey) and many of the melodies for prayers sung in Hebrew were similar. Then I heard the congregants singing the psalms in Lugandan, the same psalms I had on my iPod. While there was exuberance and joy in so much of the singing I heard, there seemed to be a little extra with these psalms. I think that’s because the congregants know these songs are theirs. They are likely the only congregations singing these psalms in this way in all the world.

This Shabbat there was a Bat Mitzvah for two of the girls of the community. This was especially interesting for me, because in two weeks, I would be attending the Bat Mitzvah of my niece back in Massachusetts. The Abayudaya girls did well and the community was quite proud of them. Aaron, the assistant spiritual leader, praised them for the good work they had done studying and their beautiful voices. It is a small community, so the youth are valued greatly. The rest of Shabbat was spent talking to people and going on some walks. Samson showed us the guesthouse, which is almost finished, the foundation for the new health center, which needs more work, and the view of Mbale in the distance. We met some teenagers and hung out talking, and then had a small Havdalah service.

Setting up for dental care

The next day, I arrived at the clinic not really knowing what to expect. Having only dental extraction instruments meant, well, that the only treatment option was extraction. It seemed so strange to me, because in the US when a patient presents with a toothache, after the diagnosis the next step is to explain to the patient what’s going on and what the alternatives are for care. But in Uganda, all I could do was explain what was going on and that we needed to extract the tooth. It was very funny then to read the patient’s expression, which basically said, “Of course I knew I needed it extracted; that’s why I’m here!” I guess it’s akin to listening to a barber give a long explanation about how hair grows and why it needs to be cut before he actually cuts it.

I had set up a clinic to perform extractions, but violated a couple of basic rules. I was not able to take radiographs, which reveals potential problems and assists in preparation. But there was no x-ray machine, only people in pain. Also, I didn’t have any instruments normally used if an extraction turns “surgical.” For example, if a tooth fractures below the gumline, I would normally use a “power tool” to relieve some of the binding bone around the tooth. Without that tool, all I could do was just hope that no teeth broke below the gumline!

My luck held out pretty well. I was actually pretty surprised how easily all of the patients achieved local anesthesia (“got numb”). Was it because I had brought some really good anesthetic, or were they already so relaxed and calm that the anesthetic worked well? Or perhaps they’re just a very stoic group of people. There were older men and women of various ages who were certainly uncomplaining. A young man named Samuel, who was training as a health care assistant, functioned as my dental assistants and interpreter. The younger patients were a bit afraid of the needle but with a little coaxing and help from Samuel, they became stronger and let us work.

Sam is a very common name in both Kenya and Uganda. It gave me a little comfort and made me feel at home. I taught Samuel how to give post-extraction instructions and I wrote prescriptions so that Tehilah, the clinic nurse, would dispense some medications for post-extraction pain control. Our little dental clinic got quite busy. As soon as one patient exited the chair, there was a new patient sitting there. But Samuel often forgot to clear away the used instruments and the extracted tooth! I had to show him how to do this and clean the room before seating the next patient.

Now I laugh as I remember little children (and an occasional cow), curious about what was going on, peering through the open window behind the dental chair. But at the time I got a little annoyed and shooed them away to be sure the patient’s privacy was respected. Dentistry is not a spectator sport! Time seemed to fly by and I was getting very thirsty. It was 2 pm and we had been working non-stop. Tehilah took a look at me and could tell I was hungry and went and got me a bottle of water and a chapatti. That was probably the most delicious chapatti!

Some difficult cases

All did not go so smoothly. There was one patient with a wisdom tooth that had decay and gave me a good work-out! Another patient had a maxillary second premolar unfavorably positioned and decayed. There was no easy way to grab the tooth with the usual dental instruments. I advised the patient that it there was a possibility that I would not be able to take the tooth out and gave him the option of having me try or not. He wanted me to try, and I spent quite a bit of time on it and may have gotten some movement, but in the end the tooth was not going to come out. In retrospect, considering my doubts about being able to remove it, I probably shouldn’t have attempted it. And it’s not a great idea to take out a “funky” tooth without a radiograph. There very easily could have been a curve to the root, which I would need to know beforehand. Both of these cases helped me realize how necessary it would be to have the proper equipment for taking and developing radiographs of teeth.

Reflections on dental health in Uganda

My assessment of dental disease in the part of Uganda I visited is not based on a large study, but rather on observation of about 20 people. Interestingly, the areas of decay that I saw were all on back teeth where they contact. I don’t recall seeing any decayed front teeth. This is probably caused by two things. First, in the foothills of Mount Elgon, the water is naturally fluoridated and fluoride strengthens the enamel mineralization. Second, exposure to sweets is primarily from chewing on sugar cane with the back teeth. Here in the U.S., when I see a person with significant decay on the anterior teeth, I can almost bet that it’s caused by an addiction and constant exposure to sugared carbonated beverages (i.e. sipping on Mountain Dew or Coke all day). People just do not have the money to become addicted to sweets or soda pop. Another thing I did not see in Uganda that we see here in the U.S. is older adults on multiple medications, some of which decrease the production of saliva. Saliva plays an important role in the prevention of tooth decay, so people with less saliva seem to have more cavities. This was not a problem in Uganda.

In the United States, the dentist to population ratio is estimated at one dentist per 1700 people. In Africa, it is estimated to be one per 100,000 people. In the area of eastern Uganda, it is probably the same or perhaps a bit worse. In Mbale Town, there was one dentist who did only extractions. There had been another dentist who provided more comprehensive care, but he moved. In the surrounding smaller towns and villages, there were no dentists. Some of the regional hospitals or health centers have “dental assistants” who can perform basic services. Basic preventive services, and dentistry performed with the intent of conserving teeth, rather than extracting, is distant for many. There is hope, however. There is a new dental school at Makerere University in Kampala, and a growing sense that dental health is a public health concern.

What’s next? First, I think a more comprehensive sampling to assess the dental health of the population in different age groups will give a good sense of the community’s needs. Second, the new health center will hopefully be finished soon, and it would be appropriate to have a dental unit equipped to provide the full range of dental services. I plan to submit a grant requests to help support the purchase of dental equipment, instruments, and supplies. It would be of great benefit to have a unit to take radiographs if future dentists are to perform any care. Finally, good thought needs to go into how this clinic will be staffed. It could be staffed by dentists from abroad as volunteers visiting for short periods. Or, if there were community members interested in a career in dentistry, funds could be raised to help pay for their education. It may not be prudent to tie to such a scholarship to a commitment to work at the community health center full time. This may not be financially viable for the dentist nor a long-term solution.

I believe we all want for our fellow Jews in all lands good quality of life. Dental health is a part of this. As winter comes to Michigan, I hope to keep my friends and family in Africa in mind, and keep working full steam ahead. After all, great things can happen when a group of Sams get together.

Want to learn more? Feel free to contact me, or visit one of the following websites:
1. The Abayudaya Community: http://www.abayudaya.or.ug/ (may not open if the power is out)
2. Kulanu, an organization which aids dispersed Jewish communities: http://www.kulanu.org
3. Institute for Jewish and Community Research, which is supporting the building of the new health center, http://www.jewishresearch.org/sc_projects_AJ.htm

Thanks to Sid Rosenzweig for his editing assistance.

Back in the U.S.

Thanks to those hwo have visited this blog and I'm sorry I haven't kept up well since I left Kenya...it was just a little harder to get to a computer. Now, I am back in the U.S., in Rhode Island for Thanksgiving. I am still on Africa time, so I'll try to use this time before everyone in the house wakes up, to fill you in on my last days in Africa and the journey home. Then I'll try to get some pictures organized back in Michigan for a final entry.

Uganda, including my visit to the Abayudaya community, was wonderful. It was a chance to be in a Jewish community that is living so close socially to one another and close to the earth. It reminded me so much of kibbutz life in Israel which I experienced in 1991, but even more rural and rustic.

]]> The community works, lives, and teams up so closely for so many needs, and it seems so much easier to do this there than in the U.S., probably because most doors are open and everyone walks rather than uses cars. The food is fresh as it is grown right there, and the prayers sung on Shabbat for example giving thanks for bread carry so much meaning. For a nice blog about two Americans living in Mbale, visit the blog of Adam and Maital http://mulembeuganda.wordpress.com/ . We had dinner along with Samson at a great Indian restaurant at the Landmark Inn and had a great time talking about life in Africa.
There are many challenges for the Abayudaya, including health care. For a day and a half, we provided dental services, which consisted of extractions only. In fact, there is only one dentist in the closest town, Mbale, and that dentist does extractions only. There was dentist who did fillings, but he left. I spent a lot of time talking with Samson, the community physician, about how we can change this with the building of the new Health Center. We would like to put a dental clinic in the new Health Center, one which provides preventive care and restorative care, with the goal that extraction should be a last resort and not a first choice. I believe we can do it, but I think it will require teaming up with others in the U.S., including dentists and dental supply companies, for their support.
Transportation is also very difficult and costly. Gas is up to $6 per gallon (2400 Ugandan shillings per liter) and with a typical professional wage of $3 per day for a nurse that means that walking, bodas bodas (sit on a pillow on the back of a bicycle) and shared transport are the only viable alternatives for most.

The journey back to the U.S. was long. Matatu (shared minivan) ride from Mbale to Busia, which broke down along the way, then another from Busia to Kisumu. I am very greatful to Aura, a young nurse I met on the matatu to Busia, who helped me when the matatu broke down and then guided me to a matatu to Kisumu and made sure I was on the right bus and would not get a muzungu price. She is an example of how kind I found the people in Uganda and Kenya. I met many people who were eager to help when I was lost, confused, etc., and this I will remember just as well as the beautiful countryside and delicious food.

I will close now nd will try to put in another entry once I have processed some more photos. I hope everyone has a Happy Thanksgiving!

Hello from the Abayudaya community

I hate it when a long blog entry (like the one I just wrote) gets lost because of power difficulties. I'm now back in Mbale Town, but earlier I was up in the Abayudaya community, which is like a village. It is very rural and the roads to get up there are quite difficult. Yesterday I spent Shabbat there, which was really nice and interesting. Today, I provided some dental care, which around here consists of mainly extractions, unfortunately. We also talked about trying to improve the standard of dental care in the future.

I'll try to write more about this community and have some pictures in future blogs...but it is now 7 pm and this internet cafe is about to close!

Hello from Uganda

I left Kisumu for Uganda yesterday after the completion of the Operation Smile mission. Before leaving, I unloaded some of my "stuff" by giving some hats and scrubs to staff at the hotel. I gave the security guard a nice Michigan hat. Then my friend arrived with a car that he borrowed from a physician colleague. It was quite a journey. My friend, Omondi, was kind enough to drive me to Busia, which is the border town between Kenya and Uganda. Driving out of Kisumu was quite a chore...so much traffic. Unfortunately, I realized about 5 miles out of town that I had left my laptop computer sittig on the sidewalk outside the hotel.

So, we drove all the way back to the hotel, which was cutting into our time, and all the way I worried if the laptop was still there. Fortunately, the gentleman who had my M hat found it and kept it securely for me. I was so happy! One of my goals in coming to Uganda, was to bring the laptop computer to Samson, from the Abayudaya community which was donated by Sid from Rochester, NY. I would have felt so bad if it was lost or stolen.

So I am here now in Uganda and will be going to visit the Abayudaya community, a Jewish community here near Mbale. I hope to talk with their medical director about establishing some future for dental care here. More in the next entry...
Sam

It's Wednesday...is that a goat following me?

It's Wednesday and I'm submitting this blog and pictures from an internet cafe in "Mega Plaza" (an indoor shopping center)...which, in case you're wondering, in on Ogingo Odinga St. in
Kisumu, Kenya. I walked here, and shared the sidewalk with a goat. The power has gone out in this mall twice. First time I had just logged on so I didn't care, and left for a few minutes to buy something at the supermarket next door. For some reason,
they had power. The supermarket was really crampmed, but modern. It reminded me of a grocery store in Manhatten. Then, I returned to the internet cafe and it takes forever for things to load on websites at the internet cafe. It is not dial-up, but worse!
It is yet another example of the really bad infrastructure in Kenya...roads, plumbing, sewage, electricity, etc. Well, after finally logging in and beginning to load pictures, the power went out again. Oh boy.

Monday we began working on the patients who had been selected for care after screening. There were many, many, primary lip repairs, and to be honest, very few obturators and
not many extractions that needed to be done. So this means I don't have as much to do as I anticipated. Monday was fairly busy, though, but Tuesday was less so.

Click below to read more of the blog....

]]> There are three operating rooms...two of them each have two general anesthesia cases goin at a time, and one of them is for local anesthesia cases. Here are
Rose, a nurse anesthetist from Chicago, and Joana, a nurse from Richmond, VA, prepping a patient with a cleft lip for repair.

And here is a one-year old boy with unilateral cleft intubated and ready for surgery.

As you can see, there is a rotated and labially displaced tooth "E" and we have some discussions about whether these primary teeth
should be removed. On the on hand, leaving the tooth could irritate the wound and delay healing. On the other hand, if the lip is well sutured (which it usually is), then it could serve as an orthodontic force and lead to
improved contouring of the alveolus for the future. I tend to believe it's better to leave the tooth, and perhaps take it out down the road if
there's a problem. Don't throw the baby out with the bathwater, they say.

One interesting patient is Prisca, a 15 year old girl from Luanda, Kenya, which is about 40 kilometers from Kisumu. She lost the left ala of her nose in an altercation. Surgical reconstruction is n option,
but the ability to peform that is limited during an Operation Smile mission...so, we are making her a prosthetic partial nose. We took an impression and made a cast. Here is the cast:

And here is the sculpting that we came up with, first on the cast:

And on the patient:

Now, I will take this back to the U.S., process it, and mail it to my friend, Dr. Ben Omondi, for delivery.

Take a look at the burner I have to work with...it's a lamp that people use for readin who don't have electricity.

I'm also making an obturator for a 9-year-old boy who will not be scheduled for surgery for various reasons. He has a small fistula behing the premaxilla, and a soft palate defect. Here is the cast with block out wax and design,
however the cleft soft palate os not really visible.

And here is the obturator.

Tomorrow I will add the bulb for the soft palate and I hope it works out for him!

Last night we had Chinese food for dinner. Can you imagine, Chinese food in Africa?! Well, to be honest,
even though I'm enjoying the typical African cuisine, it does get a bit tiring to have it every meal! Typically the meals we have have a meat, either chicken (which is really good), tilapia (a fish), or beef stew, then there is a starch, either
rice, or ugali, which is like polenta, but made of a white maize. Popular vegetables include kale, cabbage, and other greens. I've learned to take relatively small portions, basically because I really would feel awkward throwing out any food around here. Well, you're probably wondering how African Chinese food is...it was really good! I totally recommend
the "Chinese Oriental Resturant", located on the ian drag here, Ogingo Odinga Street. Ogingo Odinga was the first Vice President of Kenya and was from Kisumu. His son, Raila Odinga is running for President. Elections are next month and people are there are rallies all over.

Here's another nice sunset picture, looking out over Lake Victoria.

Screening patients

Hello from Kisumu. I'm going to bring you up to date on things. Last Thursday and Friday, we began
performing screenings of patients. We are at the New Nyanza Provincial Hospital, which is the main referral area
of the province. First thing you see as you park is a mssion statement of the hospital painted on the outisde wall.
The hospital was built in 1969 and funded by the Russian government, as an effort by the communists to bring Kenya into the eastern bloc.
It feels like a hospital that might be found in the former Societ Union (not that I have any idea what I'm talking about!)
The locals refer to the hospital as "Russia"

There is an interesting poster as you enter the hospital, listing the services, charges, and waiting time! In case you're wondering, we don't have
this type of poster at the University of Michigan Medical Center!

As you can see below, the hospital has covered pathways and outdoor waiting area. There is no air conditioning, but decent airflow and some fans.
When we arrived towards the Operation Smile screening area, we couldn't believe the large numbers of people waiting.
There were infants with their parents with cleft lip, there were adolescents with cleft palates, and many others with a variety of problems,
including keloids, burn injuries, and some very interesting pathology. I saw some things that I
had never seen before.

Here are some pictures of the waiting area...

Each service had their own room...one for the speech pathologists (see below)

That's Erika from Sterling Heights, Mich. and Kristin from Kansas City...both speech pathologists.

Also ones for dentistry, surgery, anesthesia, pediatrician, and a lab. To be honest, if I had to make a recommendation
for the future, I would have liked for dentistry to be with the surgeons so that we could have seen the patients together and discussed their treament.
It didn't really happen that way. The patients were first seen by the surgeons, and then they went to different areas, and the last was dentistry. (Click the link for more)

]]> We didn't have a great idea of what the surgeons had planned before we brought the patient for an exam,
and by that time we were backed up signficantly. Okay, I won't bother you with the problems, but let's just say
Thursday was VERY busy. We performed dental exams for 200 patients! Fortunately my new friend, Dr. Ben Omondi of Nairobi and Kisumu,
arrived to help. I couldn't do it all by myself. Below is a picture of Omondi examining a very cute boy named "Washington".

Speaking of really cute kids, have you ever known anyone by the name of "Loveline"?

If you look closely, you can see Loveline is holding a stuffed Mr. Potatohead. These were donated by Hasbro, which is
based in Pawtucket, RI, right near my hometown of Providence. I made sure to point out to the Kenyans that these toys came all
the way from Rhode Island. (But actually, I looked at the label and saw that they were all made in China (oops).

I mentioned that there was a great deal of interesting non-cleft related pathology. I'm not going to show these pictures, for privacy reasons, but if you are
interested, be sure to get in touch with me and I'll be happy to share these with you.

Here was the chair I had for sitting when I examined patients.

This really reflects much of what you see in Kenya. If items are in disrepair and there are no materials to fix them, they will continue to be in
bad shape. This is a poor country...no doubt, and this is a government hospital. There is not much money for repairs or new equipment. On the other hand, there is
plenty of labor, albeit low paid. I understand the nurses are paid $3 per day on average! The housekeeping staff is paid
even less. The housekeeping staff is very active. Even though the hospital is
low on equipment and repairs, there was not a speck of dirt or stains to be found anywhere. The
floors are swept and mopped, as well as the walls on a daily basis.

At the end of Thursday, the screening area emptied out. We were all exhausted.
I mentioned that the clinics were not airconditioned. We were also pretty hot.

When Friday morning came, as we ate breakfast we had no idea what to expect for screening that day. Would there be fewer patients,
because most people had sought to be first on Thursday, believing "first-come, first-served", or would there be more, because people
may contact their neighbors to tell them that we really were there and they should come. Well, the
former was true. We had a much smaller crew on Friday, and were even able to leave a bit before 5 pm.

Tomorrow is Monday, and we will start procedures for patients. I will be helping with extractions and making some prostheses. Of note, there
is a twelve-year old girl who lost part of her nose when there was a cooking fire in her home. As I mentione dpreviously, there are many, many poor people
in Kisumu who are living in small, shanty-like dwellings and very cramped quarters. They use the cheapest means possible to cook and fires are very
common, unfortunately.

I'll end again with the beautiful side of Kenya. It is now Sunday night as I write this, and today we went hiking through the jungles of
the Kakamega Forest, which is one of the last surviving forests in Kenya, and much of Africa. We saw monkeys playing in the trees and learned some interesting
things about the "social structure" of monkey families from our very knowledgable guide. When we reached the top of the hill, we had some nice views.

In the distance are the Nandi Hills. It is from here that come the great runners of Kenya. They live
at high elevations and have developed with higher hemoglobin levels, which allow them to run long distances with less fatigue.

Good night from Kisumu.

Day 2 in Kisumu

Day 2 here in Kisumu, and my eyes still bulge with all that I see. It is incredible.

By the way, the food is very good here for the most part. I know I have to be careful and avoid potentially dangerous foods, but so far I have found things to be tasty. The other day, I enjoyed for dinner fried tilapia in a spicy butter sauce. Delicious. And some friends had the chicken masala, which was equally good.

The Kenyans on the mission are very friendly and outgoing. There is Lois, the head surgeon, who has done Operation Smile for the past 20 years! And Stanley, the post-op nurse who is always asking me people’s names. I’ve told him five times that I am just as bad and can’t remember people’s names, either. We have a lot of blonde women in our crew, and I think he has a lot of trouble telling them apart!

Here are some pictures, for as you know, pictures speak a thousand words!
Below is the airplane we took from Nairobi to Kisumu. It was a short, 45 minute flight. But it sure beats driving…they say the roads are so bad, that it would have taken about 8.5 hours to go the 300 mile distance!

We arrived at Kisumu Airport. It’s pretty small.

But as you can see, even at Kisumu Airport you can find people text-messaging while they wait for their luggage!

Some schoolchildren watching planes take off…

I must admit, that the ride from the airport was an amazing culture shock for me. The streets are filled with people, and everywhere you look there is a makeshift stall where somebody is selling “whatever”. These stalls may be made from tree branches, from metal scraps pieced together, cinderblocks, etc. Or sometimes no stall is even needed…just sell! One woman is selling tomatos and plantain, while next to her a gentleman has shoes…and next to them is a “hotel” where you can stop and get a snack. Here are a few pictures…

Need your bike repaired??? There’s a place to stop for that, too!

Tomorrow I hope to share pictures from our first day of screening. Needless to say, it was a very busy day, and the amount of pathology is enormous. I wish I had brought my oral pathology textbook.
Best wishes from Kisumu, Kenya, and the nice view from my room at the Sunset Hotel.

Hello from Kisumu!

Our team arrived in Kisumu this morning. There are about 20 people from North America, and 20 from the local Kenya group. This includes surgeons, anesthesiologists and anesthetists, operating room nurses, pre- and post-op nurses, child-life specialists, speech pathologists, photographers, and a dentist!

We visited the hospital today and it is a bit on the old side, and quite sad walking through the wards. We definitely take our health care system in the U.S. for granted...we pay a lot, but we get a lot. (sorry...not going to get too public healthy...)

Africa is pretty amazing. There are many, many people and there is significant poverty. Streets in the towns look like one big flea market as everything is sold on the sidewalks. Boda-bodas are bicycles with seat on the back behind the driver fgor paying customers. I haven't ridden on yet! Oh...there are monkeys playing outside the hotel and I heard some growls from hippopotami in the lake behind the hotel.

Tomorrow we perform screening examinations for those patients who are coming for evaluations. Different stations for screening...by the surgeons, speech pathologists, anesthesiologis, and the dentist (me!). I'm hoping another dentist from Nairobi will join me but so far there have been logistical issues. You have to be really, really patient here in Africa. Things go at a snails paste. I've found that out and I've only been here a day!

Thanks for reading this blog and if you have any questions about Operation Smile and/or Africa, fire away...I'll try to answer.

"Dr. Z"

Leaving next week!

Next week I'm off to Kenya for Operation Smile, and as a new added twist, I'll be going to Mbale, Uganda, to visit the abayudaya community and talk about their dental issues. I've been really impressed by the generosity of so many who I have asked to help me bring things. Example: Uhler Dental Supply in chicago sent me 1000 sets of denture teeth! I asked them for 12, but now I have enough not only for this mission, but probably for all future Operation smile missions for the next 20 years!

So be sure to visit in the weeks ahaead...I hope to have some interesting stories and pictures. Feel free to post comments and ask questions.

Getting ready

It was nice talking with the Operation Smile student group today. I really hope I can share some interesting stuff with students. I also think it would be great if I could bring something from Michigan to children there. I hear office supplies are very desired in Kenya!

So what is it going to take to get ready to go? There are the personal issues of course... the vaccinations, pills, DEET, etc, the various forms, insurance, etc. What kind of clothes to bring? I hear the one sportcoat and tie is probably not a bad idea in case we need to go fancy one evening...

Then there are the preparations for the work to be done. I spoke with Dr. Rich Persiani on sunday who gave me a laundry list of things I need to bring. I will need to get a hold of some extraction set ups, and perhaps also a curing light. We'll be using triad to make obturators because it is not possible to transport polymethyl methacrylate.

Oh well....

Still working on learning some swahili!

First Entry

I am going to Kisumu, Kenya in November with Operation Smile. To be honest, I'm not sure exactly what I'll be doing there, but here's what I think.... I think I'll be performing dental examinations on children and adolescents with cleft lip and palate and other craniofacial anomalies. I think I'll be making removable prostheses, either obturators or transitional removable partial dentures, as needed. I think I'll be doing extractions.
I'm pretty excited. I'm starting to learn a little Swahili. If you know Swahili and would like to teach me some, I'd love to learn. I would especially like to learn dental terminology. My sense is that I really don't need to learn Swahili in that most people speak English and that there will be plenty of Kenyans in the mission to speak with the patients, but I still wouldn't mind learning.

So the reason I am doing this blog is that I would like for students and others to share in my experience when I am there. I am starting now just to get practice with the blog.
I will be in Kisumu. Here is a map of Kenya Kisumu is on the southwest side near Lake Victoria.

Well, that's it for now. Hope this blog thing works!