ADAHVO, in coalition to reach out to refugees

Kigoma, Tanzania鈥擶ith the help of dedicated volunteers and supporting partners, “one strand” of hope has been woven into the fabric of a new ADA/Health Volunteers Overseas program to serve more than 50,000 refugees living in the Mtablia Refugee Camp and in dire need of dental care.

Building on the initial planning and a site visit initiated by the ADA’s Center for International Development and Affairs in March 2006, the first four volunteers for the program arrived in Kigoma in November 2007.

Over a two-week period, working with translators who maneuvered between English, Swahili and Burundi languages, the volunteers were able to train a dozen refugee dental workers on the job; develop a 15-chapter manual on dental first aid; establish a referral system with the local hospital for refugees with serious conditions; travel with the medical workers outside the camps to participate in community dental health promotions at local schools, churches and community centers; and secure the cooperation of national and international partners working together to help the refugees.

Making the trip were two private practice dentists, Dr. Christine Lathuras, Olivette, Mo., and Dr. Jack Levine, New Haven, Conn.; Dr. Toni Roucka, director of Parkway Dental Clinic and clinical assistant professor at Marquette University School of Dentistry in Milwaukee; and Dr. Freder Jaramillo, a health scientist for the Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion in Atlanta.

All seasoned international volunteers, they agree that this mission trip was unique and that their varied backgrounds allowed each of them to bring different talents to the table.

“This was very different than an overseas mission where you do mostly extractions,” said Dr. Jaramillo. “This was a challenge and what we accomplished鈥攊t’s unbelievable. Our work could change the lives of thousands of refugees and offer them an incredible improvement in their quality of life.”

The dental health needs of these refugees is great, he said, since many of them have lived in the camps for a decade or more and the humanitarian services offered to them does not include oral health care.

With several years of experience working with Doctors Without Borders, an international medical humanitarian organization, Dr. Jaramillo was already experienced in working with refugees. But the setting was new for the other three volunteers.

“It was a totally different atmosphere to work in a refugee camp,” said Dr. Roucka. “These people have gone through so much. It was the most rewarding experience I’ve had, but the most difficult, too. It wasn’t physically exhausting but mentally exhausting at the end of each day.”

“I have volunteered in lots of remote areas in Nepal, Bhutan, the Amazon and other places,” said Dr. Levine, “but here, 55,000 people in camps with no dental care鈥攖his was an outstanding chance to make an impact, to make a difference, to leave something behind. After two weeks, we really got to know the dental officers we were training; who they were, where they came from, what their lives were like before the camp and what they’ve been through.”

“It was absolutely life-transforming,” said Dr. Lathuras. “This trip was different than anything I’d ever done. We taught health workers so when we left, dental care could still be done. It was very meaningful and very challenging.”

The mission was accomplished because of strong partnerships that cross borders, said Dr. Jaramillo. HVO, the ADA, the International College of Dentists, Henry Schein Inc., the Tanzania Red Cross and the Office of the United Nations High Commissioner for Refugees worked together to help establish the program.

An important task the volunteers shouldered was teaching oral hygiene and training the trainers to do the same in the refugee camps as well as for people in their own country after they are repatriated.

Compiling the “Emergency Dental First Aid Course” was another priority. The team, said Dr. Roucka, developed the curriculum, taught triage, anesthesia and extraction techniques and answered the health care workers’ questions as they came up in the field.

“We were working and treating simultaneously,” said Dr. Roucka. “We adapted to their environment as much as possible so that the health care providers have a realistic way to follow through with their patients.”

For example, although the volunteer team brought several hundred toothbrushes with them to distribute, there weren’t enough for every refugee, “plus, they will wear out,” said Dr. Lathuras. “So we showed them how to peel bark from soft branches and clean their teeth with them to keep the plaque off and the gums healthy.”

The team also took advantage of a rare privilege granted to them by Tanzanian officials鈥攚ho allowed the refugee medical officers to accompany the volunteers to local schools, churches and community centers outside the camps. The trainees learned first-hand how to conduct dental health promotion for children, adults and older adults鈥攁 skill they can use both in the camps and after.

The team also established a working relationship with a Tanzanian dentist at the Kabanga regional hospital, which will enable health officers to refer serious cases to the hospital when necessary.

Long before these four volunteers headed to Africa, the ADA’s Center for International Development and Affairs sought out donations for this program. The International College of Dentists donated two new dental operatories to the Kabanga Mission Hospital, and the hospital’s original chairs were donated to the Mtablia Refugee Camp. Henry Schein Inc. donated dental equipment and volunteers donated their own money and dental instruments in order to help equip the refugee camps with needed tools for dental care. They also solicited donations from fellow dentists, patients and others in their communities.

“I have been doing overseas mission trips since 1988,” said Dr. Levine. “My own patients have long offered donations to help support these missions. They ask me, ‘Where are you going next?’ and ‘Who do I make a check out to?’ One of my patients, a man from Africa, found out about this trip and he left a check on my desk for more than the cost of the crown he’d just gotten. It’s really touching to have support on the home front.”

Dr. Lathuras said her son’s class at school donated 300 toothbrushes for the trip. “Donations like this help more people feel involved,” she said. “We raised thousands of dollars and were able to bring about 60 instruments with us to donate. When we got there, they only had two.”

“It was great to be able to bring forceps and elevators, brushes and teaching tools to help these people,” said Dr. Roucka.

All the volunteers mentioned two goals they hope to accomplish in the future鈥攖o return to Tanzania and to help effect change in international policy by lobbying the UNHCR to add dental care to its services.

“It was a rude awakening to me that these people didn’t have dental care,” said Dr. Levine. “We hope through our work we can see a change in that policy.”

Dr. Lathuras says she became a dentist “so I could travel and help people. I’ve been doing it for 15 years. I’m blessed to have the skill I have. It’s a privilege and I’m so blessed to be able to share this gift with strangers who will let me help.”

“You volunteer once,” said Dr. Roucka, “and you’re hooked. You figure out you can’t just do it once.”

Health Volunteers Overseas is a private non-profit organization committed to improving health care in developing countries through training and education.

By emphasizing teaching rather than service, HVO aims to create an indigenous group of trained health workers who can teach others. This builds an ongoing capability that will benefit the population long after the volunteer has departed.

The Dentistry Overseas division of HVO is sponsored by the ADA, and all volunteers must be ADA members.

Dentists volunteer at sites worldwide, including Cambodia, China, Laos, Nicaragua, Vietnam and St. Lucia. Assignments range from one to four weeks.

For more information on this or other ADA/HVO projects, contact Health Volunteers Overseas at 1-202-296-0928, www.hvousa.org or the ADA’s Center for International Development and Affairs at 1-312-440-2726 or international@ada.org.

One strand

Editor’s note: Dr. Toni Roucka offers her poetic impression of her mission trip to Tanzania.

Mostly you can see it in the faces of the children. It’s different here, unlike any other place. There is something there; wisdom beyond years, sadness, knowing without knowing.

Most are curious. “Who are these Mzungus (white people)? Why have they come? How do they pretend to know our lives in prison?”

Promises of help then desertion; transient visitors in their world of hardship, they are cautiously friendly, knowing we will leave them. Why invest too much?

Hope鈥?/p>

There is a thread of it left. That’s all there is.

Others before us have weaved the delicate strands together. A fragile thread we hope to strengthen and build. Not a false hope, but one that will endure over time and grow long after we depart.

That is our mission here.

鈥擠r. Toni Roucka, November 2007