Dental Care in The Gambia

The Gambia is situated in West Africa and is home to a population of approximately 2 million people. It is one of the poorest countries in the world and after 19 years of being run by a dictator, has recently re-joined the Commonwealth. Despite this recent Governmental change, poverty continues to blight the people with poor infrastructure and minimal health and educational resources. Dental care is rare with only 10-15 dentists registered within the country, all based in the coastal region surrounding the capital, Banjul.

I have spent time previously within the country, providing dental care to children in a town called Soma, situated in the middle of the country. The work is carried out in association with a Swedish charity called Future in our Hands, who primarily focus on building schools and providing an ongoing teacher training programme. The work for the dental team involves creating a clinic within a room at the schools and treating the children with dental disease. Sadly, decay affects approximately 85% of the children and the work simply involves extracting hundreds of teeth. This year I was determined to begin a preventive programme for the children and the bursary from JOA allowed me to provide all equipment necessary to begin this process.

I had not visited Gambia since before the Covid pandemic and this was the smallest team I had joined. There were only 2 dentists, me and Jette who heads up the “Afrikaada Teethsavers” branch of the charity. We were joined by a group of regular local teachers and members of the Gambia Health Authority who have been supporting the programme for many years. They are a fabulous bunch who translate for us and act as nurses.

Soma Proper is a large school with just over 1200 pupils enrolled. The school day runs in 2 shifts with one group attending in the morning and another in the afternoon. This allows for the maximum number of children to attend, and the teachers work very hard with the average class size of 45-50 pupils. Over 10% of the children are orphans. Life expectancy in The Gambia is 62 years and it is common for children to live within extended families. Many come to school with no uniform and can’t actively take part in the lessons as they do not have pencils or exercise books to write in.

This trip was not without its challenges – no running water or electricity, 39-degree temperatures and challenging dental cases with limited resources. Despite this, it is always rewarding and to be able to begin some serious prevention work this time around felt like real progress.

With so many children in pain it was hard not to simply extract teeth all day, but we began each day by attending different year groups and doing some basic oral health education. Each child was given a toothbrush and we carried out guided toothbrushing sessions. Buba, our local health official, had been trained in oral health, so he explained to the children the key elements of maintaining good oral health. Jette and I helped the children brush and then applied a Fluoride varnish to their teeth to help protect them against decay. Ideally, this needs to be done every 3 months on this high-risk group of children and we had long discussions on how to establish this to allow for sustainable dental prevention in the future.

This is a mainstream of any prevention programme designed to reduce the incidence of dental disease. This was the first time we were able to carry out this treatment in Soma and it was a pilot trial to see how easy it would be for a local nurse to do every 3 months and how long it would take. Future in our Hands is currently building a new school in the town, and it is hoped that an Oral health/nursing clinic will be incorporated into that building to provide a base for continued, sustained oral health education and care.

Teaching the children the benefits of good oral care and the importance of regular brushing is key to establishing good habits for life. Sadly, that’s not so easy here as very few have toothbrushes and even fewer have toothpaste. However, this simple lesson will raise awareness and allowed the children to understand the concepts on how to keep their teeth healthier. The teachers were also involved with this and now remind children to brush each day. The children are so well behaved, listen carefully and really get stuck in!

Most of the day was then spent carrying out dental treatment on the children. This involved the removal of scores of teeth and trying to alleviate pain. Although it is possible for us to fill some teeth, sadly the majority are beyond saving. Previously, I had noted that the kids all love sport, especially football so before I left Jersey, I asked a few friends if they had any old kit to donate. Their generosity provided me with so many shirts I had double my luggage allowance! It was a lovely treat for the kids to choose a top after having dental treatment – which as you can imagine, wasn’t always the nicest experience.

After the schools closed for the day and the children had all been seen, we treated as many adults as we could with priority given to the school staff. Everyone is struggling in this country. Our days were usually 12 hours long, with a short break for lunch.

On previous visits to Soma, the children had all received a hot meal at the school, cooked in the school kitchen. This visit the kitchens were closed due to a lack of continued food and grain arriving from the world food programme. The impact on the lives and health of the children was noticeable and upsetting. After a week, we move to another school, Soma New and repeat the process. The day we were planning to pack up and move the equipment, we heard a pupil had been killed outside the school in a hit and run incident and the school had shut. It was extremely sad, and we decided it was inappropriate to move there. Instead, they brought the children who required treatment to us, but we were unable to carry out any education or prevention at that school.

Thank you to JOA for the bursary to help support this dental trip. The money was used to provide new equipment, anaesthetic, Fluoride varnish and begin a very exciting prevention programme.

Life is tough in The Gambia and dentistry is always overlooked by the medical profession and aid agencies. Yet toothache and dental decay is largely preventable and perhaps this is even more important in communities who have no access to any dental care.

I do hope I have been able to give you some insight into the amazing work that Future in our Hands carries out in The Gambia, and I am very fortunate to have the pleasure of working with a talented and dedicated team. Many thanks for your support this year.