Bridging the gap
Despite the COVID-19 pandemic causing cancellation of 2020 Dental Training Programmes, the UK NGO Bridge2Aid sees a positive future
For the last 16 years, Bridge2Aid (B2A) has worked in Tanzania in partnership with the Ministry of Health, the Tanzania Dental Association, other local partners and local rural communities. B2A operates within the existing local healthcare frameworks to train Rural Health Workers so that they can provide safe and sustainable emergency dentistry (largely tooth extractions) and oral health education to their own communities. This ethical training approach is known as “task shifting” and is endorsed by the WHO(1). B2A trains using the framework of the Basic Package of Oral Care(2) which has been modified and enhanced by B2A over the years into a bespoke robust, culturally appropriate and modern training programme based on current teaching, learning and assessment principles. This is much needed as Tanzania has only 111 dentists for a population of 58 million people with most dentists working in urban areas, leaving virtually no dental care for 80% of the population who live rurally.
B2A’s staff and volunteers with the phenomenal assistance of much of the UK and Tanzanian dental communities have trained 580 rural health workers giving access to basic dental care to around 5.8 million people. That is equivalent to more than the population of Scotland. In addition 53,000 people have been treated for free during the dental training programmes.
More recently B2A has collaborated with the Scottish Government funded Maldent Project, Smileawi, the Dental Association of Malawi and the Ministry of Health of Malawi to introduce the training programme to Malawi where it is much needed. The first pilot programme was planned for June 2020 which sadly has been postponed to 2021 due to COVID-19.
B2A has additionally developed an Oral Health Training Programme for Dental Therapists working rurally after a request from the Chief Dental Surgeon of Tanzania and the Ministry of Health. Following successful delivery work is on-going on how best to cascade this programme to increase access for more dental therapists. B2A was part of the National Oral Health Survey for Tanzania in partnership with Tanzania’s Dental School (Muhimbili University, Dar-Es-Salaam) and the Ministry of Health and has been invited to help develop a National Oral Health Strategy for the nation.
Countries begin lockdown
B2A ran a very successful training programme in North West Tanzania in early February 2020 but unfortunately as COVID-19 spread across the world it became apparent relatively quickly that it was unsafe and inadvisable to send volunteers to rural Tanzania and Malawi.
As the situation developed at first it was an unknown as to how long training programmes would have to be postponed for and it was hoped that training could resume in the latter half of 2020. Unfortunately, as more countries went into lockdown and cases started to appear in sub-Saharan Africa, the inevitable decision was made that recovery was going to require much longer due to both the major issues faced by UK based volunteers and the potential timescale of COVID-19 hitting a peak in Africa later, so all 2020 training programmes were cancelled. It was bitterly disappointing to have to cancel all B2A’s 2020 programmes as the impact on those local communities meant at least another year without a dentally trained health worker and continued lack of access to basic care.
As UK dentistry shut down leaving only urgent care at specific centres there was a realisation that even this very limited dental provision is far more than many rural citizens in Tanzania and Malawi have, and unlike the UK, their situation is permanent.
Looking to the future
With cancellation of B2A’s 2020 programmes B2A has focused on what can be done rather than what cannot be done. Whilst planning continues for recommencement of training programmes in mid-2021 these can only take place when it is safe to do so.
B2A is currently planning a virtual conference in partnership with ProDental CPD titled Innovative and Sustainable Remote and Rural Healthcare: How can we do it better? With input from a variety of invited speakers from sub-Saharan Africa and beyond. Additionally B2A is developing online training resources to further support trained rural health workers on accessible platforms whilst taking the opportunity to enhance online resources and pre-programme materials to improve teaching and learning within the B2A Dental Training Programme.
In Malawi, where students at the Malawi College of Medicine, including the first cohort of dental students, have stopped face-to-face studies, B2A in partnership with the Turing Trust, the Maldent Project and the College of Medicine are striving to ensure that every dental and medical student at the college has a laptop to enable them to access online educational material whilst face-to-face teaching is suspended.
In Tanzania, B2A is working with the Chief Dental Surgeon to produce modular content to support rural and remote dental therapists and work continues in assisting development of the National Oral Health Strategy.
Finally, B2A tries to ensure that volunteers are adequately prepared for their global health experiences so online resources are in development to improve training on aspects such as ethical volunteering and cultural sensitivity to continually improve both the programme impact and the volunteer experience.
B2A has been and remain very worried and concerned about its local partners in Africa, rural communities and the trained health workers, many of whom have been at the front line of the COVID-19 response. Given that low and middle-income countries like Tanzania and Malawi have a significant shortage of health workers and facilities, particularly rurally, the potential effect of high numbers of COVID-19 patients on health services is a frightening prospect.
In Tanzania, there was no formal lockdown but an emphasis on prevention. At this stage, infection rates appear to be quite low with universities, colleges and older school students returning to studies from 1 June 2020. However, with less robust health systems in the Global South there are many unknowns as to how the pandemic will play out in vulnerable rural communities over the forthcoming months.
In Mara Region (home of the Serengeti National Park) the Regional Dental Officer (the only dentist for 2.2 million people) was heavily involved in coordination of the Regional response to COVID-19 and despite a raft of other duties B2A trained health workers continued to provide emergency dental care in rural dispensaries and health centres. Indeed, one trained health worker, Eustachius, who only trained in November 2019, extracted 54 teeth in his community of Utegi in rural Mara during the first few months of the pandemic.
In reality, the only thing during a pandemic that anyone can be certain of is uncertainty itself. B2A has much goodwill and support from UK dentistry in its widest sense and its partners and collaborators in Tanzania and Malawi. When this is combined with a multi-talented, innovative, resilient and well-trained staff and volunteer team, B2A hopes to emerge from these unprecedented times having improved its training programme so that its goal of a world free of dental pain can be better realised.
It is not the 2020 that was planned but B2A remains positive that the ongoing continued efforts in the absence of actual training programmes will make for an even more efficient, effective and sustainable training programme which will provide significant benefits for the underserved rural communities whilst raising the profile of the importance of oral health in the countries concerned.
About the author
Andrew Paterson, PgCert (Med Ed), BDS, LLM, FDSRCPS FDSRCS(Ed) DRD MRDRCS], is Senior Clinical Lecturer/Honorary Consultant in Restorative Dentistry, Dundee Dental Hospital & School, and a trustee and volunteer at Bridge2Aid.
- World Health Organisation. Task shifting to tackle health worker shortages. 2007. Available at: https://www.who.int/healthsystems/task_shifting/TTR_tackle.pdf?ua=1
- Baart J, Bosgra J and van Palentstein Helderman, W. Basic oral emergency care by auxiliaries for underserved populations. Dev. Dent. 2005: 6