Dr. Z goes to Kenya

Dentistry on Nabugoye Hill

Sat, 08 Mar 2008 16:56:54 -0500

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!

Back in the U.S.

Thu, 22 Nov 2007 03:55:22 -0500

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.

Hello from the Abayudaya community

Sun, 18 Nov 2007 10:59:47 -0500

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

Sat, 17 Nov 2007 00:17:28 -0500

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?

Wed, 14 Nov 2007 11:10:15 -0500

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....

Screening patients

Mon, 12 Nov 2007 12:11:39 -0500

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)

Day 2 in Kisumu

Fri, 09 Nov 2007 09:09:14 -0500

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!

Wed, 07 Nov 2007 13:28:40 -0500

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!

Thu, 01 Nov 2007 10:25:10 -0500

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

Mon, 10 Sep 2007 21:45:13 -0500

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

Mon, 27 Aug 2007 21:29:13 -0500

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!