Rwanda pilot

The patient waiting room

Three stalwart volunteers for the leading dental charity Bridge2Aid have recently returned from Rwanda where they formed part of the first ever pilot programme to run there.

Previously only working in Tanzania, June saw Bridge2Aid's inaugural dental volunteer programme take place in this second East African country where there are reportedly only 11 resident dentists - which equates to one for every 1 million people.

Two dental nurses, Janine Warwick from Bromsgrove and Sarah Brennan from Southport, and dental hygienist Jeanette Grimley, who is also from Southport, joined five volunteer dentists who had been hand-picked to take part in the pilot programme.

Sharing skills

This is a huge new step for Bridge2Aid, which provides emergency dental care and makes a lasting change through training. Its Dental Volunteer Programme (DVP) allows dental professionals to pass on their skills to local health workers in East Arica's rural communities, providing safe and sustainable access to dental pain relief where otherwise there is none.

During the two-week pilot, the volunteers treated some 580 people, many of whom had been in pain for years.

Since 2005, Bridge2Aid has trained more than 260 local health workers, who have gone on to provide access to safe emergency dental care to over 2.6 million people. Another four health workers have successfully completed the recent dental training in Rwanda where they will now care for an average of 25,000 people in their community. During the two-week pilot, the volunteers treated some 580 people, many of whom had been in pain for years.

An amazing experience

Janine supporting on clinic

Bridge2Aid's ultimate goal is to provide emergency dental training for health workers in all remote communities in the developing world. So, expanding into another country was a major milestone for Bridge2Aid – and something the three dental care professional (DCP) volunteers were incredibly proud to have been part of.

'It was an amazing experience and I was so honoured to be asked to go and be part of the pilot,' says 47-year-old Janine, who had previously volunteered for the charity in Tanzania three times since 2008. 'I must admit that I did have my reservations with everything that's happened in Rwanda but I shouldn't have worried because there is a great feeling about the country and I felt very safe. This was a very different experience to Tanzania because we were living in the heart of the community, which was lovely. We lived in a mission house attached to a health centre and we have never had such a welcome. There were songs and clapping and we were given bunches of flowers – it was so special to be welcomed like that.'

During her time in the Rwandan village of Kirambi, fellow volunteer Jeanette, 43, kept a wonderful journal, 'My Ramblings from Rwanda', which is available to read in full by visiting http://myrwandadvp.wordpress.com. About this welcome, she writes: 'Clinic is just a short walk away which is a real treat, no long journeys in 4x4s over dust roads means our training time will be longer, an added bonus. We are greeted by the staff of the health centre singing a welcome song to us, a spine-tingling moment if ever there was one. They come to the end of the greeting and proceed to hand each of us a posy of day lilies and sweet smelling roses wrapped with white paper. It's just incredible that when someone has so little they can give so much, I feel truly humbled. A very special moment.'

The volunteers' intense experiences in Rwanda mean the women are now all firm friends.

'This is my second trip with Bridge2Aid,' says Sarah, 29, who visited Tanzania in February 2012.

'The people you work with while you're out there become like your family. It's an emotional time but I'm definitely going to volunteer again, it's amazing – I didn't want to come home. It has been a pleasure to take part in the pilot and to see that it works, that's been really rewarding.

'I have done other charity work in the UK but Bridge2Aid is really important because we are passing on knowledge and that stays long after you've come home. It's about empowering local people and training health workers in additional skills such as emergency dental care, cross infection, sterilisation, communication and oral health. They are all so keen to learn and spread their knowledge throughout their community.'

Sugarcane and sugar water

It's so difficult to criticise a parent giving their child sugar water in place of a meal when these are calories that cost less.

As part of the training, Jeanette was asked to deliver oral health education to the trainee health workers. She says: 'There are many children attending with shocking rates of caries: a three-year-old with four decayed anteriors; a six-year-old with ten decayed teeth. The queues are long, the treatment need evident. As one father talked to us his child sucked on a sweet biscuit type snack. Sugarcane is widely available and cheap. Very few of the community brush their teeth and rarely is toothpaste used. The oral health messages really need to be taught here. It's so difficult to criticise a parent giving their child sugar water in place of a meal when these are calories that cost less, where a meal cannot be provided, and yet it's heart breaking to see that child in agony and at great risk from infection due to lack of treatment.'

It's not just the pain of toothache the Rwandans are experiencing. One man had suffered an abscess for almost three years. He, like many in his situation, had been ostracised from his village, was unable to work and had no chance of getting married. The emergency dental treatment he received will change his life.

Determined to succeed

As part of their trip, the volunteers visited the Genocide Memorial Museum – a place Janine says left no-one dry-eyed. In her journal, Jeanette writes: 'Some 800,000 people were wiped out in such a cruel, humiliating and dehumanising way. The mass grave sites are all over Rwanda and we drive past a few, prominent at this time of year due to the beautiful flowers adorning the graves in this commemorative annual period of 100 days of mourning.

'Walking around the centre, looking at the photos of babies, children, young boys and girls with their whole lives ahead of them, men and women, young and old, it is so hard to imagine the horrors they experienced. The continual consequences of such horrors are still evident, how does a nation reconcile and rebuild itself after this? And yet, there is reconciliation, a country working hard to recover and regenerate. An inspirational testament to a community determined to succeed.'

Sarah blowing bubbles

One legacy of the genocide became evident for the team when taking medical histories or making polite conversation about people's families or children – questions they soon discovered were best left unasked. One patient said he was on heart medication but looking at his tablets it became clear he was being treated for post traumatic stress disorder. Another woman had serious mental health issues. She had been beaten and raped during the genocide and was lucky to escape with her life. Unfortunately none of her family members survived and this has had devastating consequences for her. Just half an hour away is a big refugee camp that still houses 50,000 displaced people.

The health centre has no running water, no electricity and the surgery consists of a wooden dining chair for the patient. But Jeanette says that the Care Quality Commission (CQC) would be proud of their work: 'Everything runs like clockwork. Sarah, Janine and I have a good routine in place and clinic is kept well-stocked with clean instruments. A courtyard separates the rooms we use for treatment and decontamination and initially I find this challenging. Having the two rooms apart makes it more difficult to assess what is needed in clinic but we soon work out a system, carrying clean and dirty boxes of instruments between the two rooms whilst keeping an eye on the clinic's needs. We work on a rotational basis as scrubbing instruments and putting pressure cookers on kerosene burners in a confined hot space can become intense after a while.

'The dentists and trainees work so hard. I am always in awe of the teaching skills implemented by Bridge2Aid's volunteer dentists, breaking down all language barriers to train under often challenging circumstances, and the keen enthusiasm evident in their students. Their dedication and hard work is truly inspirational.'

2014 volunteers

Bridge2Aid is currently recruiting dental professionals to volunteer two weeks of their time during 2014 in East Africa, treating patients whilst training health workers. In the next three years, Bridge2Aid aims to train another 366 health workers in East Africa, which will provide over 3.5 million people with emergency dental care. For more information about taking part in DVP please contact Bridge2Aid's Visits Team by emailing visits@bridge2aid.org or by calling 0845 8509877.

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