How a Single Initiative Provides Dental Care to a Whole Island

Dentist at work

Here is a short article by Kathrin Paletschek, a volunteer dentist to OZ/ZHEP this year.

My name is Kathrin Paletschek and I live in Germany. I was a Dental Intern when I volunteered to work with Zanzibar Health Foundation in their Dental Clinic in Zanzibar for nine weeks during 2013. Here are some of my observations and experiences.

When you hear the name Zanzibar, words that come to your mind might be island, beach, sun, sea, palm trees, archipelago, fruits and vacation.

If you know a little bit more about the island and its history you might think of spices, Indian, arab, sultan, Indian ocean, Tanzania and Islam.

But people who spend some more time there than just a vacation, maybe work and live there for a while get to know other aspects in Zanzibari life. They will also say words like corruption, no health care, power cuts, poor education, crime, bureaucracy or poverty.

When talking to older local residents one hears the same story over and over. How prosperous the city of Stonetown once was, children got a very good education, women were able to wear skirts in public. It almost seems that not only development came to a halt but Zanzibar started to move backward.

In the Zanzibar Revolution of 1964, countless Arabs and Indians were killed. Thousands more fled with only what they could carry. Families were torn apart. In the middle of this, there were two young boys: Feroz Jafferji and Hassan Jaffer. Feroz escaped with his parents to England and Hassan all alone ended up in Canada. Hassan Jaffer pursued a career in corporate consulting and Dr. Feroz Jafferji specialized as a dental surgeon.

About forty years later they both returned to their native country for a class reunion. It must have been very emotional coming back to the country they were driven away from. There are quite a lot of expellees who never wish to go back even for a holiday.

Anyways, the two bonded over what they saw: Zanzibar belongs to the third world. Buildings that used to be monumental are falling into disrepair, the streets are dirty and people are poor. But even worse, children do not get a chance in life because education is insufficient. When a little child tells you how in her village any girl who passes the exams to get to secondary school would die (a local belief) it is hardly surprising that nobody has passed these exams for so many years! This provides a glimpse on how messed up things are!

Also, good quality health care is beyond the reach for most Zanzibaris. Usually, people only visit the doctor when their pain becomes unbearable. The journey to the next hospital is sometimes very long and when you cannot afford sufficient food for yourself and your family, how to pay for the bus?

The same is true for the dentist. On the whole island there is only a hand full of dentists and most of them do not have proper training. Self-appointed so-called “dental therapists” are not considered in this count and cannot even be bothered to be defined.

As Dr. Feroz Jafferji and Hassan Jaffer got along very well (they might pass for very old friends), approaching retirement and had the same opinions on Zanzibar, they founded the “Zanzibar Help Foundation” in 2010. It is a non-profit organization funded by donations.

So far, they literally built a primary school in a little village called Unguja Ukuu. It has all the supplies needed for an adequate education. In 2013, a computer lab was installed. Even the older village residents are very interested in learning computing. Teachers are trained Zanzibaris and volunteers. Volunteer teachers are always in demand as well as donations of stationary, computers, books and other school inventory.

Their second very successful project is the dental clinic. In the middle of the city of Stonetown, it has gradually established itself as an essential part of Zanzibar’s medical care and it is by far the best equipped and most competent dental clinic on the island. Nobody expects such a high-end clinic on an island like that. Foreign volunteer dentists are amazed by the possibilities they have. There is actually not much to be missed. Endodontic treatments can be executed just like in an ordinary practice in Europe. These are stated first as they are the daily routine in this clinic as well as extractions and fillings. But even prosthetic s like whole dentures, crowns and bridges are done.
Dental health consciousness among local residents is very low. They commonly do not know that sugar causes tooth decay or how often and how to brush their teeth. Toothbrushes and toothpaste are from their perspective very expensive, so they are shared tooth brushes and in use them for much too long. In consequence, there is a great deal of children with caries on every single tooth. Sadly, extractions of six-year molars at the age of seven or eight are sometimes necessary. With adults, heavy staining and calculus deposits (often causing gum or periodontal problems) are typical as well as dark cavities on the upper frontal teeth.

Of course not everybody in Zanzibar can afford a dental treatment. So people like foreigners or politicians and business owners have to pay for their treatment (compared to European prices it is still not very much and could be seen more like a little donation to the organization). For everybody who cannot afford to pay, which are actually most of the patients, it is completely free. So unfortunately, the system is not self-sustaining. This is why donations are always direly needed as well as volunteer dentists. A fair amount of dentists from all over the world have been working at the clinic within the last years. Most of them are young dentists who take a few weeks or months off from their work. Dr Jafferji is a retired oral surgeon and when working with him, one sees that he is not only great at his job but also loves practicing dentistry and helping people. Still, he will not be able to do this forever and is therefore looking out for dentists who would like to commit to the project in the long-term.

Without this practice, there are really not many options for people with oral health problems and the Zanzibari patients are aware of that. It is very rewarding to see how thankful, polite and modest those islanders are. Many have never seen a dentist before and there is not one who would not take their shoes off when entering the room. Some of the patients are unable to figure out the dental chair and effectively sit down the other way around.
It surely warms up a dentist’s heart when a patient comes back for his annual check-up although he is not in any pain. Awareness about oral health, prophylaxis and dental hygiene within locals is rising and all of that thanks to Dr. Jafferji and his team.

By: Kathrin Paletschek

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