A different perspective for dental volunteering abroad: the case of Dental Team Gulu in northern Uganda
Sophia Signorini and Georgios Kitsaras discuss their experiences volunteering for the Dental Team Gulu in northern Uganda and what they took from the experience.
Increasingly, healthcare, medical and dental students are drawn to volunteering opportunities abroad (Seymour, Benzian and Kalenderian, 2013).
Volunteering abroad can take different forms. But the most common, and potentially damaging one, is voluntourism.
Voluntourism is defined as: ‘A combination of volunteering and tourism with mission trips, outreach expeditions, and other short-term (several weeks or less) global health-related activities’ (Seymour, Benzian and Kalenderian, 2013).
In the author’s opinion, voluntourism, contrary to responsible and sustainable initiatives, can result in damaging effects for those involved and those who receive services in country.
To counter voluntourism, some countries from the Global South have started implementing bans on foreign volunteering initiatives that fail to obtain government clearance and coordination prior to their involvement in the area (Seymour, Benzian and Kalenderian, 2013).
Giving back and helping those in need is by no means something negative. However, there needs a clear and well thought out reason for someone’s participation. As well as careful planning with special consideration on sustainability, alignment with local services and a deeper understanding of local communities.
Since 2014, the medical school at the University of Manchester sends a student-led team (Team Gulu) of medical undergraduate students to northern Uganda.
The team is a joint effort by Gulu University Medical Students Association (GUMSA), Gulu University and the North Uganda Village-Health Outreach Partnership (NUV-HOP).
Until 2016, Team Gulu has a solely medical focus with oral health missing from its efforts. The importance of oral health for overall wellbeing and daily functioning is undisputed.
Uganda, as a developing country in east Africa, is experiencing the effects of poor oral health in overall wellbeing, public finances and provision of health services.
Data on prevalence of dental disease and oral health problems are scarce. More recent epidemiological studies conducted by Makerere University found that 40% of children and 62.5% of adults had a DMFT >1. With mean DMFT scores of 0.9 and 3.4 respectively.
In 2007, a study by Mbarara University on the oral health status of school children in the immediate area (western Uganda) found a mean DMFT score of 1.5 (SD=0.8) with 27.1% of the children experiencing dental health problems.
That study also recorded high levels of plaque across the sample. And limited oral health knowledge and lack of established oral hygiene.
Dental Team Gulu
To complement the activities of (medical) Team Gulu and in order to focus attention on the poor oral health conditions in country, Dental Team Gulu was established in 2016.
Dental Team Gulu, from its inception, focused on a wide fundraising campaign prior to each trip. Grants awarded by the University of Manchester support the activities of the team in order to eliminate barriers in participation for those who might be able to afford it otherwise.
Dental Team Gulu closely aligned its operations with existing partners like GUMSA, Gulu University and NUV-HOP from the beginning. We also secured necessary approvals for the team’s activities.
In 2017, one member of Dental Team Gulu travelled to northern Uganda to explore the need of a dental team, liaise with local staff at Gulu Regional Referral Hospital (GRRH) and to gain a first-hand insight on the difficulties of establishing and operating a dental team in country.
The initial trip
Following that initial trip, in the summer of 2018, a team of four members was sent to Uganda, They consisted of three dental undergraduate students and one PhD in dental public health candidate.
During that trip, the focus was primarily on enhancing the links created with local healthcare staff. As well as delivering preventative oral health information and advice sessions in local schools with the support/participation of teaching staff, providing fluoride toothpaste and toothbrushes (with a provision for enough supplies for an entire year) and shadowing local dental staff at the GGRH to gain an even better insight on routine oral care provision in the largest healthcare facility in the area.
In total, over 750 students received oral health information and advice as well as supplies over a three-week period.
The summer of 2019 saw Dental Team Gulu’s expansion. It flourished from a solely preventative project to one with active involvement in the alleviation of dental pain experienced in patients in the Gulu region.
From our initial trip in 2018, we were able to witness first-hand the very real need for oral health intervention. As well as the pressure felt from the dentists in Gulu Regional Referral Hospital. This was on a daily basis to treat hundreds of patients in pain.
Patients experience abscesses with systemic involvement, grossly carious dentitions and fractured or non-functional teeth, which required extraction.
With four dentists and four dental chairs treating patients for oral pain in a the Gulu Regional Referral Hospital, and a catchment of nine million individuals, we were in awe of their work and wanted to alleviate some of that pressure. As well as venturing into rural communities to provide emergency dental extractions and antibiotic prescription to hundreds of patients. The majority of these patients had never seen a dentist before.
Over the course of the three weeks in northern Uganda, we planned to attend four outreach days. We initially hoped to treat 80 patients a day for emergency extractions. And we recruited a team of two dentists from the regional hospital. And three dental students from Gulu University to integrate as part of our team. This was following the relationships built from the 2018 trip.
We quickly exceeded the goal of 80 patients. By the end of the four outreaches we had performed 494 extractions.
Though we faced challenges, each day we became more efficient, treating every patient who approached us.
As well as rural community health centres, we formed relationships with local schools. We further developed our oral health education programme to involve preventative fluoride treatment. This resulted in the application of fluoride varnish for 600 primary-aged school children.
Learning from eachother
The synergetic relationship formed between our Manchester and the Ugandan taskforce is one we hope to cherish long term.
The main goal for the project is to further develop our international relations. And to run the project solely using local, rather than international, healthcare workers. This would indicate to us the creation of a sustainable project.
The dentists of Gulu Regional Referral Hospital are highly skilled. Their ability to adapt in every environment was extremely admirable. It was an honour to work alongside them and to learn from one another. As well as exchanging ideas about both the project and differences in dental techniques; when working in such a globalised world, it’s very valuable to learn from one another.
Shaping and changing lives
We believe that Dental Team Gulu’s approach managed to overcome some of the traditional limitations of dental volunteering abroad.
Despite shortcomings, Dental Team Gulu managed to achieve most of its goals. Especially in ensuring that it consults and includes local healthcare staff and the local healthcare systems across all stages of planning and operation in the country.
Also, the funding model adopted by Dental Team Gulu meant that each dental undergraduate student was able to participate in the team. This removed barriers for those from lower socio-economic backgrounds. It creates an equitable and inclusive experience for all.
Accountability and transparency were high across all areas related to the team’s practices.
Last but not least, Dental Team Gulu shaped personal and professional lives in an immensely beneficial manner.
Finally, a huge thank you to all the members involved in the trip’s recent success; Dr George Kitsaras, Sophia Signorini, Ali Al-Naher, Dylan Hamill, Melika Hedayat, Uthman Hamid. And our international taskforce; Dr Augustine, Dr Geoffrey, Dr Herbert Charles and Dr Norbert Onyanga.
Seymour B, Benzian H and Kalenderian E (2013) Voluntourism and Global Health: Preparing Dental Students for Responsible Engagement in International Programs. J Dent Educ 77 (10)