By Kelvin Hill, ABW Dental Service Director.
Our adventure began with notice that the flight from Calgary to Amsterdam had been delayed 3 hours – later found out that it was due to line ups for plane de-icing in Amsterdam. I suppose they don’t have the capacity of a Canadian airport so the snow there caused havoc. At least we were able to spent the extra time at home rather than waiting at the airport. The late departure meant that our connection in Amsterdam was tight – we made it but of course our luggage didn’t. Upon arrival in Nairobi it took over an hour to get through immigration then another hour to deal with our lost baggage. Finally got out of the terminal and on our way to Ole Sereni Hotel where Eric had arranged food for us and set up with the local telephone/communications specialist. Off to bed for 5 hours of sleep.
Monday morning found us back at the airport waiting for our baggage to get cleared through customs. After another hour or so wait, Ron Sydenham, ABW Board Chair, managed to get it all through. Our letters of invitation, including one from Joseph Limo (MP) helped. Now we were ready to begin travel out of Nairobi and to the Gilgil area. Stopped for a break at the overlook to the Rift Valley, then on to Lake Naivasha for lunch and a boat safari. I declined the latter but rather went ahead in the luggage van to our clinic site to begin scoping out how we would set up. The site is a walled compound with church, medical dispensary and a few small buildings owned/run by the Trinity United Methodist Church. Local social worker and the bishop very helpful in coordinating for this. Lovely people.
I arrived to see dozens of people sitting around waiting for us – they had apparently been told that our clinic would start today! After surveying the facility, I obtained permission to set up in the church which was the only room large enough to be feasible for us. By the time the rest of the team arrived, we had the equipment van unloaded and items set out for each station. The team then got to work with setting up, a long process as usual for the first time working together, but that will get more efficient as we move along. We decided to triage in a separate adjacent building, so as soon as Lenni could, she and Marty began evaluating the crowds that had been waiting for the day. We didn’t have the heart to send them home with nothing. They went home with wrist bands identifying priority and a treatment card indicating what needed to be done. We lost count of how many were seen, so today will be very busy. Hopefully we can get through them all in the next couple of days.
Left the site around 6:30 pm for Lake Elementaita Lodge which is only about a 10-minute drive away. Eric did a good job with his scouting. Apparently it is a historic site – former British estate now turned into tourist facility with numerous guest houses. I can report on the view overlooking the lake once the sun comes up. Supper last night was on the veranda which apparently also had a view of the lake.
So begins the clinical component. Team is working well together and I am excited to see what will be accomplished. Please pray that as we serve these patients they will feel the hand of Jesus.
I awoke about an hour ago with a disturbing nightmare, though it can’t have been that bad because I have already forgotten what it was about. Not sure if it’s the jet-lag, Malarone or going to bed on a full stomach, but probably a combination of the three. The jet-lag should get better, Malarone is a presumed necessity, and I’m not likely to change Africa’s late meal time. I haven’t felt too bad during the day though, with the exception of an unusual number of nose bleeds. I have attributed that to my routine three nights on a sleeping pill though it could be the combination of that with the dusty dry heat and the Malarone. Why do we do this? You all know – we are compelled by the need.
We have come at a particularly crucial time in the political world of Kenya – all government physicians and dentists have been on strike for 70 days. There are no physician services at any government facilities, and those who cannot afford to go to a private hospital are having to deal with things on their own. I am told that an extraction would cost 2,000 KSH which at the current rate would be about 20 USD. Not feasible for this community. The bishop who two years ago opened the dispensary where we are working told me that the day before we came a guy had shown up with a swollen lower left jaw. His story was that he had a tooth ache so bad that he pried it out with a roofing nail, resulting in the subsequent swelling from trauma and no doubt infection. I try to put myself in the position of these people and am moved to compassion. Is it worth the cost? Yes. Could we do it more efficiently? One feels so helpless to make a long-term difference.
We arrived at the compound to see a line of people (as usual) who patiently waited in the sun most of the day for service, some of whom had to return home with only the hope of trying again tomorrow. We were up and running fairly quickly given that we had set up the night before. The first day of clinic is always a challenge. By afternoon, the team had fallen into a good routine and was working as well as expected under the circumstances. As in 2015, we are operating out of three stations with delivery unit, dental chair, doctor stool, assistant stool, and overhead light. The demand for Irma’s hygiene services is great so we are thankful for her dedication and most grateful for the donation in Alberta that allowed us to purchase the ultrasonic scaler. Marty and Dale were quickly on top of the sterilizing process and dealing with the routine challenges of keeping the three compressors pumping enough pressure to keep these inefficient vacuum units sucking. Lots of condensation in the tanks and air hoses from the heat I suppose. We have electricity on site so no need for the generator here. Glen and Scott cranked through the extractions and fillings while taking time to make patients comfortable and crafting (Scott) balloon sculptures for the kids. Chair-side assistants already working well under Rebecca’s tutelage such that Glen is threatening to hire her when we get back (Rebecca currently works for me at SLDC). Lenni and I basically worked the front end – she directing traffic and I doing most of the initial anesthesia. The latter is a challenge for my neck and back but conditions are improved by having patients sit on a stack of lawn chairs to get them higher. The count was 48 patients seen, which now makes me wonder if I calculated enough supplies for another 7 days. We have discussed our need to be conservative and may need an extension miracle on the anesthetic.
A brief word on my guiding philosophy in dealing with the dilemma of how much to do for each patient. Treat the most urgent condition (usually an extraction) in a given quadrant, then do restorative work (simple fillings) as needed in the same area covered by the prior anesthesia. Most individuals beg for work in multiple quadrants but we must move on.
The shower was wonderful before our debriefing meeting and a Valentine’s supper on the outdoor veranda. Nice gentle breeze to protect us from mosquitoes (a more pleasant solution than Malerone). Such are my thoughts on the day and now I will make a second attempt at sleep. It is 2:10 a.m.
Things are improving on the jet-lag front – I slept until 3:00 am today.
Our second day at Kikopey (the local area of Gilgil where our clinic is) was not as productive. I think Lenni’s report was 36 patients. I was the one not contributing to the patient load in the morning as it took me a couple of hours to get an order for more anesthetic and needles ordered. The bishop put me on to a company called MEDS (Mission for Essential Dental Supplies) that he purchases his medical supplies from for his dispensary. This is a company owned and operated by a conglomeration of Christian churches that provides medical supplies at reduced cost. With his account I was able to purchase 400 carpules of anesthetic and 400 needles for the equivalent of 15 USD. Not a bad deal, which includes over-night shipping. So the order is expected to arrive here before we leave the area in the morning. I was dreading the prospect of arriving at our last clinic site without enough anesthetic to treat anyone.
Of course, part of the time was in conversation with the bishop as he was selling me on the idea that A Better World should equip a dental clinic for his compound after he had local people build it. He had a plan to sustain it with fees for service charged to those who could afford it. That’s how he currently operates his dispensary. Fees are 50% of what is charged at private clinics (malaria testing is 1 USD, HIV 1.50 USD), and that is sufficient to hire the help that he needs, including a lab technician who after three years of post-secondary education works out of a tiny room with a rough hewn table supporting a microscope and clinical centrifuge. The well-put-together young lady told me that jobs are hard to find.
The first afternoon issue was a sudden loss of suction on Irma’s delivery unity. Her cavitron uses excessive water so suction is necessary to avoid drowning her patients (probably a rare occurrence in this dry dusty land). Dale and I spent a couple of hours tracing and blowing through air lines and got it working again, only to have the problem reoccur after a few minutes of operation. We suspect moisture in the lines is the problem so I will try to find in-line moisture traps, among other necessities, in Nakuru when we pass through today. The second reason for less productivity in the afternoon was an early shutdown due to tension outside the clinic door; apparently the bishop had brought into the compound some of his inner circle of people for treatment, resulting in arguing and raised tempers with those who had been waiting in the sun and dust since morning. Lenni said enough is enough and we were done! I’m glad she is taking the brunt of that. I am very pleased with how the team is working together; they were able to pack the whole operation up in an hour or so.
We move on today to our next site in the tea-growing area of Kericho. I will probably travel in the baggage van to accommodate errands that I need to do in Nakuru, then on to survey the clinic site as it is new to me. Still not sure if we will have electricity there. I will let you know!
Day 4 was easier for most, though I had some interesting challenges. While the rest of the team travelled on toward Kericho and an apparently delicious lunch at Ray’s Place in the midst of green tea fields, I remained behind to wait for the backup supplies that I had ordered from Nairobi. Turned out the anesthetic was made in Mexico, so why so much cheaper here? Time did tell.
Upon arrival in Nakuru my driver, Rafael, and I began our quest for parts for our compressor(s). I was actually able to return to the store where we had purchased one of them two years ago. Through various levels of Swahili-English translations, I was told that they did not have the parts I wanted; later they did find two in-line moisture traps but only one threaded adapter the correct size needed to install them. After spending an hour or so to get this far I figured one is better than none so purchased what I could get. I was also told that they didn’t have a replacement for the broken drain valve on one of our compressors, but they found one of those too. While waiting there I asked to borrow a wrench to remove the remaining portion of the broken drain valve and subsequently severed it from the tank, rendering the compressor totally useless. Next to find an ‘engineering’ shop to drill out the broken piece and get it tapped for the replacement that I had purchased. That was interesting watching the engineer drill it out with an electric drill that had no plug – just the bare wires stuck in the socket! I guess they figured the risk of a 220 volt shock was not worth wasting money on a plug. I also watched two young Kenyans welding steel without the usual face shield – they just closed their eyes during the spark! After three hours we were on the road again, satisfying our hunger with the snack chips and GORP that Marcia had sent along with me for such occasions.
We arrived at our new clinic site a few kilometers of ‘African massage’ (bumpy roads) off the paved road from Chipseon. Momoniat Health Centre. A nicer compound with a couple of stone buildings, the newer one (still looked a few years old) not yet in service due to lack of a water supply. Our set up was hampered only by a power outage that happened to coincide with our arrival so we couldn’t test everything out. Hakuna matata, we will be back tomorrow. Our Exotica Hotel is 50 minutes away in Kericho, where we settled in for three nights.
Why is there so much social and economic disparity in the world? Whose fault is that? Surely not the people of Momoniat village where we are working today.
The inhabitants of the Kericho hills seem a little better off than those down in the Rift Valley. At least they have water here, as demonstrated by the thunder storm and torrential rain that passed over our clinic today. The valley is suffering from a three year drought, whereas here there is greenery despite less rain than usual. The resulting waterfall off the tin roof made our waiting clients move further inside the covered corridor between the two buildings where I provided local anesthesia most of the day. It’s relatively dark in there so I am most grateful for my good head lamp. The patients sit on an office chair raised to maximum height and supplemented by several folded blankets designed to save my back. Most were in good spirits as they laughed with each other about their unusual numbness and drooling into their spit cups. In general I find the dental health better here than at our last site where the local water supply obviously contains very high fluoride, resulting in extreme fluorosis and hypocalcified (soft) enamel. Still a lot of rampant periodontal disease and extractions needed but more single teeth rather than multiple adjacent ones.
Wonderful to see the team working like long-time associates. Dale and I had spent the last part of yesterday afternoon working on one of the dental units to redirect water from the air/water syringe to the ultrasonic scaler so that Irma could have better suction for the copious amounts of water that it uses. Of course we couldn’t test it then due to the power outage, but we found this morning that it was working OK with the exception of a slight drip that we contained in a bucket beside the unit. However, the change to a different suction unit now requires Dale to assist her full-time. Not sure if Irma is planning to make that a permanent position or not. Scott still takes a break while his chair is being wiped down between patients to make balloon animals for the children watching and waiting outside the window. Lenni is demonstrating her skills of diagnostic screening and telling people where to go (including us!). Marty is manning the instrument reprocessing like a professional though we have called on his electrical expertise a few times. Julie and Kaleena are now professional chair-side assistants having been under Rebecca’s tutelage for a few days. I am proud of how they have our supplies and instruments organized on three different tables supplied by the Momoniat clinic. Glen is holding up well in spite of his battle with gout; he consistently turns down my offers to spell him off for a break. That leaves me in the local anesthesia department when I am not trouble shooting elsewhere. Looks like the dentists are averaging about 20 patients each per day, and Irma 6-10. A small impact in the community but we hope more significant for the individuals served.
Our day ended a little earlier than planned due to the waiting clients needing to walk the two hours home before dark. They will do the return trip in the morning. Would you?
As we drove toward Momoniat this morning I noticed an early-teen girl skipping along the red dirt shoulder of the gravel (African size) road. She was dressed in a pristine white lace skirt. We were actually watching for the team of four donkeys that we had seen yesterday morning pulling a plough. Horses and oxen yes, but donkeys? No sign of them today so the job must have been completed. The line of eager people at the clinic gate was not as long as at the previous site so I suppose that the people two hours away hadn’t made it back quite yet. There were plenty there though by the time we were ready to work.
Knowing that we had to finish early today, in time to pack up and do some shopping in Kericho before supper, everyone worked hard. Staggering our lunch breaks, Rebecca and I kept one chair going while the others ate. Our box lunches were supplemented today with delicious vegetable samosas which were a nice addition to the usual hard boiled eggs and dry cake. Given that mangoes are in season right now, we were wishing for some of those; what we actually had were apples shipped in from South Africa. I think we were being treated because the apples are relatively expensive compared to the locally grown mangoes.
The work of A Better World in the Kericho area is heavily supported by the local MP, the Honorable Joseph Limo, and his wife Beatrice. Beatrice spent both full days with us, doing whatever she could to help. It is very apparent that the villagers love her and appreciate what they as a couple are doing for their people. As time drew nearer to shutting down for the day, the number of hopefuls sitting on the bench waiting for anesthesia grew. Beatrice told me that they were hoping for God to perform a miracle and have us stay two more hours. It even went so far as to offer me a house and a cow if I would come and live there for a while. Not sure that Marcia would comply. There were no riots this time. After encouraging them to use their chewing sticks for oral hygiene, they had the chance to ask me questions about dental care. Is it better to swish your teeth with cold or warm water? My professors didn’t cover that in dental school but I suggested whichever is most comfortable.
For the grand finale, our whole team was assembled in front of the crowd to receive their expression of gratitude. After several speeches we received their ‘flowers’ – they all raised both arms and shook their hands to imitate flower petals. The whole process took about half an hour, causing our arrival back in Kericho after the hardware stores had all closed. I need an air nozzle to facilitate clearing water from the air hoses. I did, however, happen to see Moses walking along the road with his crutches. Moses was one of Dad’s (Dr. Ken Hill) first patients in Kendu Bay when he came to work with the disabled children at Nyaburi School twenty five years ago. Dad fondly recalls Moses crawling in the dirt up to him saying ‘want walk, want walk.’ Well, he is still walking and credits Dad for this wonderful gift. We pulled over so I could chat with him and record a video of greetings to send to Mom and Dad. ABW has invested a lot in Moses, through his various treatments and education, to the point that he now has IT skills.
Eric had carefully planned a special evening for the whole ABW crew (dental, rehab and evaluation teams) since the rehab group arrived in Kericho today. The program ran late as the food arrived an hour late (he had ordered some good Indian food to supplement the hotel buffet) followed by being led in African dance by a local artist. It actually felt good to move in contrast to the sitting and standing routine so far. Late to bed on a full stomach again. Such is life in Africa.
By the way, the second last patient of the day was Sheryl, a thirteen-year-old girl dressed in a pristine white lace skirt. I guess the seven and a half hour wait was worth it.
The success of trips with A Better World in Kenya is highly dependent on the van drivers. These are professionals all working for Voyage Afrique, and trained not only in driving but also the history, culture, flora and fauna of this diverse country. Herbert is the driver of the reinforced African Nissan that I share with Scott, Julie, Rebecca and Kaleena. He is a smart looking chap with a good sense of humour. Martin is the driver for the other five team members; I believe that he has the most experience associated with ABW. Rafael, on his first ABW excursion, is our slow but steady luggage van driver. With the middle seats removed from his vehicle, he has room for our Honda generator, three electric air compressors, dental delivery units, portable patient chairs, doctor stools and overhead lights, two propane tanks, a double burner stove, twenty-litre water bottles and several suitcases filled with instruments and supplies. We always know that these gentlemen are looking out for our security and wellbeing.
This day was spent travelling from Kericho, via Bomet and Narok, to Oloolaimutia on the south east border of the Mara National Park. This is a journey of contrasts as one moves from the lush green hills of Kericho to the dry savannah of the Mara. The people change too, from the happy-go-lucky Kipsigis people to the more stoic but colorful Maasai. As some of you know, the road south of Narok is known for its bone-shaking manipulations, where the tracks in the ditch are smoother and quicker than the miles of washboard on the gravel road. I’m glad we weren’t driving my van as you can imagine how hard it is on the vehicles. A burst of smoke inside Martin’s van caused them to stop abruptly. We caught up to find him working around the battery housed behind the driver’s seat – the bracket holding the battery had come loose, allowing the battery to slide forward and the positive post to short out on the steel frame. Hakuna matata. After a few minutes and a push start we were back in the ditch again.
Anytime that I meet up with Juma is a pleasant occasion; he greeted me like an old friend. Juma has worked with ABW for many years, first during the Talek Medical Clinic development and now in a repeat process here at the Enketoria Clinic. He holds the position of Chief Clinical Officer, meaning that he takes care of every medical issue that arises between here and the Tanzania border. His clients come from miles around, braving the sun, thunder storms and threat of wild animals as they travel by foot or motorcycle seeking his compassionate care. He is Maasai and has experienced the traditional ear piercings, tooth removal (lower central incisors) and Moran. The latter is the ceremonial survival test involving a band of 16-18 year old guys who go out to live in the bush for a month to prove their manhood. Killing a lion with a spear is part of the expected routine, and upon their return to the community these young men get to be circumcised. This is a public ceremony where the young warriors must show no sign of discomfort in spite of the lack of anesthesia and the crude cutting instrument. After we had set up our clinic and checked into our rustic cabins at Aardvark Hotel, Juma entertained us with stories and pictures of selected recent cases: a lady and child bitten by a black momba snake (the child did not survive), removing a meter-long worm from a man’s hand, and repairing a man’s impaled thigh from a buffalo attack. Not bad cases for someone with training equivalent to a nurse practitioner.
No internet at this location. The brief periods of electricity are provided by a small generator that surprisingly lights the whole compound consisting of the lodge and 18 cabins. Hot water is dependent upon a local warrior stoking the fire under a tank on the hill behind the cabins. This is the same guy who escorted us to our cabins after dark, armed with a bow and quiver of arrows. No need for firearms here. I am not complaining about the facility as we have the luxury of being only a few minutes from our work site. The power just went off though so I guess it is time for bed.
I opened my laptop computer this morning to find three squashed insects within its folds. Such is the dilemma of waiting until the power goes off to go to bed!
A week is the magic number of days needed for me to overcome a 10 hour jetlag. Last night was the best sleep since our arrival here and the first time that I wasn’t awake before my phone chimed its morning alarm. Did I mention the phone? I purchased a SIM card here and spoke with Marcia today for about 20 minutes for the equivalent of about 1.50 USD. Kenya skipped the land-line generation and went straight to cellular at reasonable prices such that most Maasai on the plains can afford one. Charging their mobile phones is more of a problem than owning one.
Our clinic is set up in the same church that we were in two years ago, owned by the Deliverance Assembly which also operates the nearby clinic that Juma oversees. Pastor Samuel tells me that he has about 250 members and needs a larger building but there is plenty of room for us to spread out. We commandeered their generator to supplement our own because ours has outlet plugs sufficient for only two compressors. Patient flow was steady but not overwhelming. Now that we know how many patients we average in a day, Lenni is able to screen accordingly. Dental issues were similar to the last site so nothing too exciting to report. Of course we are up close and personal to observe their extensive ear loops and unique beaded jewelry. These people are not particularly emotional so it is hard to gauge their appreciation but Juma at supper reported otherwise. He is being told that we are the right ones to be taking care of their dental issues, referring to another group of well-meaning humanitarians who had set up dental shop a few months ago in a nearby school. They were from the USA. Juma figured that he ended up seeing about 60% of their cases with post-operative infections. That is hard to believe but the good news is that he couldn’t remember any problems after our work here two years ago. On this type of trip it is always a concern of mine that we are negligent with regard to post-operative care; at least we know that Juma can take care of any complications in Oloolaimutia.
I returned to my room to find a section of the floor wet from, well I wasn’t sure at first, though I knew it had rained. A later thunder shower confirmed that there is a leak in the roof and subsequent drips of water (?) coming through the plastic ceiling board. The worst part is that it smells like urine. Whatever critters live in the rafters I don’t know. Bats? All I’ve heard are the African doves that sit on the apex and slide down the tin roof when they loose their balance. As with the other regions of Kenya, rain is desperately needed here so the daily showers this week are a welcome reprieve.
The second day of dental deliveries in the Deliverance Church was fairly similar to the first, with the exception of the excitement outside. Tuesday is market day in Oloolaimutia and what a busy scene it was. The livestock exchange took place in a corral within earshot of the open church windows from where we could see various sized flocks of sheep and goats and herds of cattle being driven, pulled, chased and sorted by male humans of all ages over six years. The ladies were at the stalls on the other side of the village where there was intense bargaining over produce, grain and various forms of other merchandise. Members of our team took turns going out to experience the conglomeration of sight, sound and smell. I don’t think any tested their sense of taste. A few came back early after being mobbed by the local entrepreneurs selling their wares; most returned with treasures, some with none. My favourite memory is of the orange bus heading away from the market loaded to maximum capacity with baggage (strapped) and humans (unstrapped) on the roof. I am reminded of the passenger van that passed us on the road to Kericho with live chickens tied down on the roof. North America’s animal rights folks would have lots to worry about here!
Julie (our team OR nurse) spent the first two hours of the day shadowing Juma in his clinic but she missed the birth of twins in the afternoon. The surprised mother had travelled two and a half hours to the market but things must have gotten too exciting for her. At the end of our day, Juma invited some of us into his crude delivery room to see the tiny humans wrapped in their colourful blankets. Ah, the miracle of life. Mom was still sitting on the delivery table looking ready to get on with life. This was her fourth delivery, hence the rapid recovery I suppose. Juma will be happy to have his new maternity ward finished by the end of next month as construction is well under way, compliments again of donors through A Better World.
Our tally for the two-day clinic in Oloolaimutia was 97 patients seen. Too bad we didn’t push for the 100 but we had already compromised our shut-down time by seeing a couple of ladies who had walked since 4:00 a.m. for treatment. I trust they were able to stay in town for the night before heading home. After a record 30-minute pack up we drove past waving children outside cow dung huts to our hotel for supper then enjoyed the privacy of our own cabins through yet another torrential thunder storm. Water resumed its drip through my ceiling but was not quite as heavy as the drip through my shower faucet in the morning. Fortunately my head of thinning hair is easy to rinse. Hakuna matata.
After a hearty breakfast we bade farewell with all the usual pleasantries and tips for our hosts at the Aardvark Hotel. Excitement in the van was running high in anticipation of our first drive through the Maasai Mara National Reserve. This trip was a bonus – we had been granted a free two-hour passage from the Oloolaimutia Gate to the Talek Gate on the condition that we don’t do a ‘safari’, i.e. we don’t put the roof up. Our vans are all equipped with roofs that lift approximately two feet, allowing passengers to stand inside and have unimpeded access to the wonders of the game parks. The best sightings were a pair of lions sauntering through the dry grass on ‘honeymoon’ (according to Herbert) and a troop of giraffe, including a couple of babies, that crossed the road in front of us. I think they are my favourite of the land mammals, awkward but graceful, curious but stately. We also saw the usual numerous cape buffalo, wildebeest, Grant’s gazelle, Thomson’s gazelle, topi, eland, impala, ostrich, water buck, a few warthog, and a herd of elephant off in the distance. Not bad for a two hour drive.
Arrived at the Talek Medical Clinic in time to set up our equipment before checking into Mara Loita Hotel and devouring lunch. I was a bit skeptical when Eric first told me that we would be staying at a hotel right in the village Talek because two years ago there wasn’t a room here that I would have considered for a night’s stay. But since then, the Loita has been constructed by one of the local chiefs and is quite nice. I am always fascinated by the Kenyan versions of practicality, what is ‘finished,’ and maintenance compared with those of European stock. Talek has certainly changed since my first time here in 2011 as western influences (‘development’) becomes more apparent. I suppose that A Better World has contributed to that, for the good we hope.
The Talek clinic did not seem as busy as when Juma was in charge of the facility but Eric assures me that the numbers show consistent patient counts. We provided dental services for the afternoon with me taking my usual position as dental anesthetist. The patient who won my compassion was the last of the day – Bisharo. Being a minority Muslim she was wrapped in several garments with only her face exposed, which she kept turning away or covering with awkward hand gestures. Eye contact was infrequent but when it occurred they flashed with intensity. Something was different. Was she shy? Embarrassed? Abused? Not supposed to be in such close contact with another man? She reminded me of the young Afghan lady in the now infamous National Geographic cover picture from a few years ago. Beautiful Bisharo opened her mouth to reveal such intense deterioration of her dentition that I knew she was also in pain. I saw twenty-four years of neglect. What could we do to help her? Though our interpreters could not speak ‘Islamic’ they were able to communicate with her in limited Swahili and convince me that she wanted as much done as possible, including the removal of what remained of her front teeth. Having confirmed that the lower left quadrant was the most painful she agreed to start with the left half today and do the right tomorrow. Glen filled three of the remaining four salvageable teeth in the lower left quadrant then performed surgical removal of the rest. While in the chair her profile indicated that she was pregnant. I then took over and removed the remains of all the two premolars in the upper left quadrant. After such trauma would she return for more?
The schedule has been rather hectic. Not all work, but busy just the same. Now that we are on paved road again I will try to complete my reports of the last few days.
Our second day of work at Talek Community Health Centre (incorrectly referred to yesterday as Talek Medical Clinic) was similar to the first with a steady flow of patients. Once word gets around there are plenty of volunteers to sit in the dental chairs. Kaleena and I stepped away for a few minutes in the morning for a meeting with the ABW evaluation team to discuss plans for the construction of another addition to the building to house an x-ray unit that has been purchased by Community Health Partners (CHP), the organization that runs the health centre. The director of CHP was there, and Kaleena’s expertise as an x-ray technician was invaluable to this discussion. The director indicated that they would also love to have a dental department in Talek so I expect that will be the next formal request. Should we invest our resources here or at one of the previous three sites where we worked on this trip? All of them could use the services but we need to determine which is most likely to partner with us and take ownership to make it sustainable. They would need to at least commit to funding a dental technician to keep the clinic functioning in our absence.
Everyone on the dental team worked as hard as usual on this last day of clinic. We had decided to not even set up our malfunctioning delivery unit at this site so Scott and Julie were designated as the ones to work without suction. While they cranked through the simple extractions, anything surgical or restorative went to Glen and Kaleena. Scott used books to raise his patient chair a few inches so that he could work standing up. That seemed to go well for him. Rebecca kept them well supplied with instruments, disposables and the filling material that she patiently mixed each time it was called for. Irma and Dale continued their hygiene duo chipping away at the cement-like calculus that had formed on these tough Talek teeth over the last few decades. Every patient needed hygiene services but we had to limit it to only the first few that Lenni screened. Speaking of Lenni, one incident today made it clear why she is so valuable on the team: after repeatedly telling waiting hopefuls to back away from our work area, I noticed that when she appeared in the doorway they all hurried away without her saying a word! Her diagnostic skills have also been remarkable. Of course, none of this work would have been possible without Marty consistently working the kitchen; clean, rinse, sterilize, clean, rinse, sterilize and return the instruments for another cycle.
One memorable patient of the day was Hassan, a 65-year-old man who sat patiently waiting with a balloon hat (made for one of the children) on his head. I remember him because he was unique – he had seen a dentist before. He asked for us to fill an upper right molar that had only the buccal wall remaining. After my first pass and suggestion that it needed to be removed he insisted that he wanted it restored. Upon closer investigation I saw that this tooth had been treated with root canal therapy and learned that he had it done in Siana. The Maasai Dental Clinic in Siana Springs, located near the Sekanani Gate to the Mara National Reserve, is another story – it was established by American dentist Raymond Damazo and is now operated by an independent board of volunteers in the United States. Hassan was correct in that his tooth needed to be restored, not just with a huge filling that we could try but with a post, build up and crown. The former had to suffice for now. I also pointed out caries on the teeth on either side of the endodontically treated molar, only to have restorations declined because those teeth were not painful (yet).
As we were determining who could be seen in the last 30 minutes of the afternoon who should appear but Bisharo, whom I had forgotten about since the previous day. She had followed through with our suggestion to come back, though later than anticipated. Although the remaining time had already been committed to others I could not turn her away. After confirming that she was ok from the previous day’s work and wanted to proceed with more, I anesthetized the upper right quadrant and waited for a chair to open up for her. While everyone else began to pack up equipment around me I removed all but one premolar in the quadrant. Bisharo was again timid but obviously trusted us enough to proceed with this surgery. Without us having time to do the final quadrant, her parting words were ‘thank you’ and she was gone.
So closed the clinical chapter of our trip. All in all we had treated almost 400 people and hopefully made a difference in their lives. I was most happy to return Juma’s antiretroviral prophylaxis kit to him, unopened, meaning that we had managed the whole operation without any needle sticks or cuts and I thank God for His protection as we worked in compromised circumstances. Given that this was our last evening together as a dental team, we were treated to a special supper in the gardens behind the hotel, followed by cultural performances by Maasai people around a lovely bonfire. Of our three men who were coerced into jumping with the Masai warriors, I think Marty performed the best, at least good enough for Lenni to stick with him.
My offer to provide dental training for clinical staff at our work sites was accepted by the team at Talek Community Health Centre. I arranged to spend a couple of hours with them this morning while the rest of our group headed off on their first official safari drive. Rafael remained with me with the plan to meet the others for lunch at our final lodging place – Sarova Mara Game Camp. The Talek team seemed appreciative of the brief crash course in dental anatomy, pathology, anesthesia and surgery, though I hesitate to share just enough knowledge for them to be dangerous. Helping them know when to refer is the main goal.
During a break in our session, Eric arrived to complete other business, and in response to his questioning about our time in Talek I told him about Bisharo. “Why don’t we sponsor her to get some teeth?” he asked. Knowing that he has the capacity to pull off such an idea I heartily agreed to facilitate it. How to find her? I had her name but no more. Ben from the clinic set off on his motorcycle to do the investigative work. About twenty minutes later into the compound walked Bisharo with her two children (aged 2 and 3 years) and her husband. My biggest surprise of the trip was to find that her husband was Hassan! He apparently could find a way to get dental treatment for himself but not for his wife. After making sure that Bisharo was doing well from essentially ¾ mouth clearance, I introduced the idea of dentures. Hassan was not too impressed until I showed him before and after pictures of a woman wearing dentures. That brought a smile to his face and definitely was what he wanted for his wife. Let alone the fact that it would help her eat for the rest of her life. We will see if they follow through with my instructions to go to the Siana clinic for completion of treatment before we facilitate trips to Nairobi for denture fabrication. Rafael later explained to me that most of the Muslim people in the area have come in search of a better life from the northern regions close to Sudan and Ethiopia. Those areas are so poor and drought stricken that fathers are desperate to marry off their young daughters for a dowry, hence 24-year-old Bisharo married to 65-year-old Hassan. Who will care for her when he is gone? Hopefully some teeth will make it easier for her to survive.
One more Talek story before we leave town. Hezron is a young entrepreneur with great aspirations. He was at the clinic yesterday and had two teeth removed but returned this morning with one site still oozing a bit. The attending nurse called me into the examination room to provide instructions and Hezron left apparently satisfied that he would be ok. On our final pass through the village square I saw Hezron standing outside his new establishment – a movie theatre advertising the latest African thrillers. With a big smile he assured me that he was now ok and enticed me in to see his pride and joy. In a small stone-block room he had constructed with rough lumber elevated vinyl-covered seating to accommodate 70 clients. Access to the rear rows was by climbing the 2” x 4” framework. The front row was about two feet from the front wall on which hung a medium sized flat screen monitor.
Rafael and I bounced our way across the National Reserve to Sarova Mara. Welcome to paradise. The Sarova chain of hotels is superb, and I think this is the fourth one that I have stayed in over my four trips to Kenya. This is when I really wish that Marcia could be with me to enjoy the luxury. The setting is in a treed valley, my personal tent (fitted with hardwood floors, electricity and a deluxe bathroom in the rear) is overlooking a small pond surrounded by lush greenery. A pair of dik-diks (small antelope) peer out from under the bushes while countless African songbirds perform their tunes. Our driver appreciation event was at dusk on the hill behind the camp overlooking the vast Mara stretching to the horizon in the west. Animal silhouettes went about their survival routines. We ate appetizers around clothed tables then sat around a bonfire as each van’s occupants acknowledged the skills and unique qualities of their driver. On our way back to camp, a hyena passed through the beams of our headlights. But we didn’t have to scavenge for supper; every meal at Sarova is a smorgasbord of tasteful delights.
Having seen most of the animal species in previous years I actually wasn’t too excited at the prospect of a full-day game drive. That attitude changed though when I was able to arrange for four of us to travel in a ‘birding’ van, meaning that we would take a more leisurely pace to seek out the feathered residents of this diverse landscape. I was going to say small, but the numerous ostrich we saw wouldn’t count. It took us 45 minutes just to travel the ¼ mile down the Mara Camp entry road. What a wonderful time we had marvelling at both the beauty of the birds and the ornithology knowledge of our driver Benson. Our final identified bird count for the day was 26 species, twelve of which were new for me. There were others that we didn’t identify.
By noon we had caught up with the rest of the group at the muddy Mara River, where we were led by an armed guide along the bank to observe dozens of mostly submerged happy hippos and a few of their crocodile compatriots basking on the shores. This was followed by the traditional bush lunch on the other side of the river, catered by another of the elite hotel camps in the area. Although we saw the usual safari animals, the highlights of the day for me were the rare sightings of a solitary black rhinoceros grazing in an open area and watching a cheetah eat it’s recent kill (a Thomson’s gazelle). We stayed until three white-backed vultures had arrived to await their turn. A great day in all, I just wish that the Narok County officials would spend some of the park fee revenue on road improvement. Eric noted that some piles of gravel dumped in the middle of the road and designated for road repairs have been there for two years!
Well it was the perfect end to a wonderful trip. I can’t express how grateful I am for the hard work and wonderful spirit of each person on the team; I would definitely do a repeat mission with the same people. Time will tell what happens next year. I would also like to acknowledge the amazing leadership of Eric, our visionary extraordinaire with the capacity to accomplish fantastic things. ABW trips would never be the same without his attention to detail and the marvelous surprises that he manages to pull off. Tomorrow we leave for the 6-hour drive back to Nairobi and the long wait for our late flights out. I will be going on to Dubai to spend a few days with Roland (my son), Scott and Julie are going to Tanzania for a couple of weeks, Lenni and Marty are going to spend a couple of days in Amsterdam, and the rest are going straight home to Alberta. Safe travels to all, and to all a good night.