Oral Healthcare in Tanga

The purpose of our visit to Tanga was to work alongside the dental therapists during their pediatric oral health outreach efforts. There is a school for dental therapy located in Tanga, one of two in Tanzania (the other is located in Mbeya). Sara introduced us to Dr. Komba, a vivacious, full of life, mother of 4 kids who taught oral surgery and pediatric dentistry. We also met Dr. Betson, the principle of the dental school whose aura exuded a calm presence and a love of teaching.

At the dental clinic

Central sterilization

Sara showed us around a tour of the dental school.

After a presentation in pediatric dentistry with the final (3rd year) students,  we enjoyed a traditional Tanzanian breakfast: coffee with taro, bread pastries, pakoda and a boiled egg. We then made our way to a primary school, where Sara and the dental therapy students gave oral health education. The children were extremely well-behaved and very engaged. While one student recorded our findings,  the other dental therapy students completed dental screenings. Letters were composed to send to the parents of the students, explaining what treatment the children would need and asking for their consent. The students would later be transported to the dental therapy school that Friday and receive all the treatment they needed free of charge. Sara was telling us that she would be meeting with government officials to discuss the findings of the outreach program and the impact that the efforts had. The oral healthcare outreach is sponsored by Miracle Corners of the World, a non-profit organization which includes oral healthcare as one of their core principles.

Sara and me at the school where out outreach was conducted.

After outreach, we had a traditional Tanzanian lunch back at the school (I gobbled down some watermelon, cabbage and this amazingly spicy red pepper sauce). Along with the dental students, Dr. Betson led a discussion on the complications of extractions. It was interesting to hear the dental therapists perspectives on how they would manage broken root tips or sinus perforations, even though the principles were very similar.

Sara then took us on a tour of TICC, a Norwegian co-operative and educational society. They bring healthcare students from all over the world (but mostly Norway) to Tanzania and allow them to immerse themselves in the global health opportunities Tanzania has to offer. We actually met Mama Ruthie, the Norwegian director, on our plain ride over to Tanga. She’s this BA Norwegian women who rocks skinny jeans and oversized sunglasses and is brimming with life and confidence. Coincidentally, she was being visited by the Commissioner of Tanga and the Secretary to the Commissioner (somewhat equivalent to the governor of a state and secretary of state). She was gracious enough to introduce us and the government officials were generous enough to let us take a picture with them.

We later went to the market so Sara could buy some supplies for the outreach for tomorrow. I went in to a fabric store and started chatting with someone who I thought looked Indian in Hindi. She was a third generation Tanzanian with roots from Gujrat, India. She entertained my efforts of speaking in Hindi with her and we ended up having a half hour conversation about the political climate in Tanzania and how she felt as a Tanzanian with an Indian heritage living in the era of President Magfuli, a staunch nationalist. She explained that he treated all citizens with respect, but the president did not appreciate the native need for dependence on foreigners who had no intention of becoming permanent residents. She also felt that Magfuli’s anti-corruption efforts were necessary, even though one of the side-effects is  increasing unemployment. After saying goodbye, she told me I was always welcome to try biryani with her family if I had time during my stay and I dualy told her she has a friend in Chicago if she ever wanted to visit. These interactions are what makes me love going to different places and realizing human wants and needs are universal.

Journey to Tanga

What an amazing journey this has been. I thought the excitement of Tanzania would evaporate once we boarded our plane to Tanga, but Tanzania’s spell is still cast on me.

On Easter Sunday, Sara Mtagwa, a dental therapist/oral health care fellow extraordinaire, escorted us to our Tanga trip. We flew a mini-airplane, reminiscent of  build-it yourself craft airplane toy. The windows gave us glimpses of the glittering blue belying the border of Dar and we arrived to the cute Tanga airport. The airport was scaled ten times less than the Dar airport.  The air of Tanga has a dewy, crisp ambiance that is carried above the city.

Plane to Tanga

Eager to trek through the terrain of Lushoto (on a budget!) we scrambled to the Tanga bus station. Luck herself gave us her blessings for Lushoto -- right as we entered the bus station, a miniature local bus with the greetings of “TEXAS” was leaving for Lushoto. We paid the Tanzanian price of 7500 TSH (around $3.75) for a 5 hour path to the paradise that is Lushoto. In the blackness of the night, we felt the bumps and the winds of rocky mountain road to Lushoto. We arrived around 8:30 and the sky welcomed us by illuminating more than a million stairs. We really gave luck a run for her money by arriving at our lodge when the reception desk was closed and walking in to the common areas that were surrounded by Zungus (foreigners) and engaging conversations. The hospitality that was shown to us by the Irente Farm Lodge was paramount to the beauty of it’s landscape. They called the lodge owner, who woke up and gave us a room with a smile on her face. The Irente Lodge  was a camping lodge populated with wayfarers who find happiness in the simplicity of nature and the unassuming nature of African life. The stars were calling our name and we basked in the enormity of the sky that night.

As we heard the roosters chime their morning greetings, we prepared ourselves for what we heard was the most breathtaking view in Tanzania -- the Irente cliff in the homey village of Irente, that has a radius of no more than 7km.  The “mambos” and smiles from the townspeople were plentiful as we trekked through the mud that had been blessed with rain. The beauty of the small village enveloped in mist did not prepare us for what our eyes were soon to behold. We climbed above the steps that were carved in to the cliff and found we were literally above the clouds. My eyes were not sure if they had seen anything as magnificent before.

Irente Cliff Viewpoint

After consuming as much of the views as our eyes could stomach, we said our goodbyes to the village people and found our way back to the Irente Lodge. Our eyes feasted on the complimentary breakfast the Irente Farm Lodge prepared, and our stomachs also gladly complied. The Irente Farm Lodge is actually a biodiversity reserve that works with local farmers to produce the heavenly fruit preserves, cheese, fruit and beverages served at breakfast. I discovered a festering love for passionfruit I did not know existed before this breakfast. After exchanging our farewells with the harem pant-wearing travelers of the lodge, we decided to hike back in to Lushoto. The inclines paired with the views and the scurrying animals made it a hike to rival any. We patted ourself on the back when we came full circle and boarded another local bus at Lushoto back to Tanga. With 4 hours of sleep and pockets that were lighter than their normal levels of Tanzanian shillings, we arrived at Tanga  and managed to get off at a stop closer to our hotel than the one we departed Tanga from.  Using Tanga’s street art and traffic structure, we managed to walk back to our hotel without the use of a taxi fro the bus stop.

Sara, the gracious Tangan hostess she is, arranged a walking tour of Tanga.  Tanga was abuzz with the laughter and merriment that accompanies national holidays -- children were swinging by the beach, the library garden was hosting many families and the smell of food being prepared was floating. Sara made sure we had a physical representation of our friendship and bought us Tanzanian bracelets. After what seemed like a week, my day ended with my eyes closed tight and ready for the sleep that accompanies days you wish to remember forever.

Diversity of Dar

DIVERSITY OF DAR

This week, Dar’s diversity and cultural diaspora embraced me.  There is a plethora of different cultures in Dar -- you will encounter the magnificence of towering mosque minarets, the majestic bells of churches, the simplicity of Buddhist temples and grandiosity of Hindu mandirs.  You will see an array of individuals with differing skin colors and facial features conversing together in Swahili.

Mandir in the center of town

We started off our week with a trip to the Mwenge’s Woodcarver’s market. We learned a budget friendly traveler’s trick - find an item that is present in most of the stores and ask for the price at every store to see how much that particular store is overcharging you. The Market had everything from towering statues to embroidered javelin spears to intricately carved cutlery. We found a store that we fondly referred to as “grandma’s shop” -- a store that was run by two elder women who respectfully gave us reasonable prices. It was also our first tuk-tuk ride -- also known as bajajis in Tanzania. Even with the bumps of the somewhat paved side roads, the ride was a blast.

With a statue twice my size at Mwenge!

I visited my first African salon -- the treatment seemed much more herbal based and relaxing then what I am used to in the US. After my skin service, my skin felt incredibly smooth and had a certain glow that it never had before.

I decided to go back to my roots and explore Dar’s Indian heritage. That included a cumpulsory visit to India Street, a commercial hub. Like all visits to Indian places, it ended with me buying Indian mithai. Typical. In this part of town, I had the best ice cream sundae I had in my life. Visit Snoopy’s and get the Ferraro Sundae -- I promise, there will be no regrets.

Jessica and I went to the mosque on Friday for Jummah prayer (her first time!)  and like last time, it was soothing to see all Tanzanians of different ethnic backgrounds worshiping in unison and embracing each other after prayer was over.

Masjid Hakimi, by our apartment.

One thing that I will be eternally gratefully for is the diversity in the friendships that I have made in Tanzania. These friends have challenged me to push my boundaries and see the world through different eyes, whether it be trying Tanzanian “mix” beach side on Cocoa Beach, encouraging to sing my first karaoke ever or illustrating hurdles that dentists face in a different part of the world. Whatever it may be, the embrace of diversity from Dar has opened my eyes to how different corners of the world can allow you to unearth gems of discovery, both internal and external.

Kwa Safari!

I'm so excited to post about our safari trip! It was a culmination of everything I love - public transport, adventure and good deals :) .

All of the travel agents gave us estimates of planning a $500-600 safari trip, but we decided to be student-budget friendly and design a trip that ended up costing us less than $150.

Our safari adventure started bright and early with us walking up at 4:30AM to catch a 6:00AM bus.
We grabbed an Uber to the Ubungo Bus Station. Getting inside the bus station was among the most stressful 15 minutes of my trip to Tazania. We ended up getting at the bus station at 5:50, 10 minutes before the bus was supposed to leave. A head hunter tout escorted us to a bus that was headed west, towards Mikumi National Park. The bus ride was surprisingly very pleasant. The flat plains rolled in to hills that raised in to mountains among the back splash of a sunrise. Six hours, two elephants, two giraffes and one lion sightings later we arrived at Mikumi Village. We decided to try our like and find a hostel by just walking down the road, otherwise we would catch a taxi to Morogoro, a larger town an hour away.      

Arriving in a foggy Mikumi Village nestled in the mountains

We stumbled on to the Mikumi Veta. We later realized that the Veta was actually a vocational school and we would be getting serviced by students. That made me really excited and I wanted to meet some of the students. I went to the information desk and one of the students, Diana was exceptionally friendly. We quickly bonded over student life and she gave me a tour of the entire campus. We got to the dorms and she excitedly introduced me to all of the girls. It was one of those moments that you just thank life for.

Some of the students and I (Diana is the student directly to my left in the picture). 

In the Veta girls dorms.

Jessica and I then headed out to the Mikumi National Park. We returned the next day for the safari. I'll let the pictures of the park do the talking. Inside the National Park, we met three US citizens who were actually also working at Muhimbili's Medical Campus, as well. What a small world :) . 

When we got to the Veta, Diana and I had dinner and promised each other we would stay in touch.

The way back to Dar from Mikumi was a little bit more...adventurous. We waited on the side of the road with other Tanzanians waiting for a bus that would take us back to Dar. The buses came and went without set timings. After waiting an hour and a half & being told that three buses to Dar were too full  to take more passengers, we finally got on a bus. This bus was a little more full than our bus coming to Mikumi, but the conversation was pleasant. We arrived back to Dar around 8:30, and all we really wanted after this weekend more than anything was a nap and shower.

XOXO,
Naheed

Wiki Kwanza

Aaah it's been a while since I posted! That's a good sign of how much I enjoy a place ;).
Tanzania has been nothing short of amazing. The hospitality I have been shown, the friendships I've gained and the views I've been able to take in is priceless.

It has also been an invaluable asset to me as a a dental clinician and public health enthusiast. I've been able to see cases on oral pathology that I've only read about in textbooks. The doctors and interns have given me the freedom to as much minor surgery as I would like (I have been a little hesitant about it!). One thing that is strikingly different about the Tanzanian dental experience for me is the de-commercialization of dentistry. The commercialization of "teeth care"  is one of my least favorite aspects of dentistry in the US.  Maybe it's because we are working at a government hospital, but the emphasis is on disease control at MUHAS. A good amount of the cases that we see are pain-focused, but there have been many cases where controlling the patient's dental infections is a matter of life or death. More on my experience at MUHAS soon.

Here's a recap of the things that we have done so far:

SATURDAY 4/1

Zanzibar time!! We took the ferry to Zanzibar. Due to the economy line not accepting paper copies of passports, we ended up buying VIP class tickets for $25 each. The ride was super smooth, comfortable and I enjoyed the views! When we got to Zanzibar, we got swarmed with "island tourism guides". We decided to trek it on our own to the spice market! It was hard at first, but we found some good spice and cloth deals. The spice shop owner and I bonded over our common Indian heritage and the Hindi language, leading to some good deals :)!

Afterwards, we checked out the botanical gardens, an art store and headed to the beach!

SUNDAY 4/2/17

Today I decided to go on a little walk and see where I would end up. I wanted to walk to a mosque that I thought looked pretty, and ended up seeing a different part of Dar. I wound up in Kariakoo, which has one of the biggest markets in Dar. It was for the most part closed, but I could see the astounding amounts of stalls that were set up. It was supposed to be about an hour walk but pleasantly ended up being double the time :) . 

We later met up with Sara and Frederick who are dental therapists in Tanzania! They work with Miracle Corners of the World as Dental Coordinators. It was great speaking to them about approaches to oral health in Tanzania and Africa as a whole. We ended up really bonding with them and decided to go out to eat at Mamboz Grill in the heart of the City Center! The food was amazing and I could see why it's always on the "Where to Eat in Dar-es-Salaam" travel guides.

Hanging out with Fredrick and Sara!

MONDAY 4/3/17

Monday was our first day in the Oral Surgery department at MUHAS. MUHAS Dental's "central" department is Oral Surgery, as contrasted to Restorative at UIC. All patients who come for initial exams first get screened and examined based on their chief complaint in the Oral Surgery department. Afterwards, the patient is referred to the Restorative Department based on whether the tooth/teeth related to the chief complaint can be restored and if the patient can afford to restore the tooth. The patient then also has the option to extract the tooth on the spot.

Central sterilization at the OS department

 Most of the teeth are non-restorable and of those that are, 35-50% of the patients choose to extract the teeth on the spot. Around 90% of the patients do not seek comprehensive care and only come in on an urgent care basis. The government employees and their families are the ones that can mostly afford to restore their teeth instead of extract them, because the government provides dental insurance coverage to their employees.

Dental operatories at MUHAS OS

On Monday, I was in minor surgery. I  got to see a plethora of procedures including incisional biopsies, wound dressing, intermaxillary fixations and incision and drainages of very large and life threatening abscesses. I almost fainted on two occasions- once during the morning incisional biopsy (it was extraoral and near the orbit) and the second during the incision and drainage after all of the incisions had been made. I was pretty involved in the intermaxillary fixation and got a chance to remove the IMF wires. I also did half of a intermaxillary fixation with one of the interns (side note: all dental students have to complete one year of residency also known as their internship in Tanzania).    

TUESDAY - FRIDAY

Jessica and I found out we live close by to Palm Beach. We walked about 20 minutes to Palm Beach from our apartment. It is nice to see the waves, but it was definitely not a beach for swimming in :) .  

It was a blast getting to know the other international dental students/dentists doing rotations at MUHAS! One of the Mauritian students also brought traditional Mauritian food and made us soya beans and vegetables in oyster sauce -- so delicious!

We hosted a dinner at our apartment on Wednesday. One of the other international dentists is a native Tanzanian and he gave us an unofficial tour of Dar-es-Salaam! 

Unofficial Dar Tour

Housewarming dinner at our apartment!

We went to K Tea Shop for street food on Thursday and I highly, highly recommend it! Their kabobs and chai were amazing. It was the best chai I ever had in my life actually. We also went to Level 8, an upscale rooftop lounge. The views were amazing!! We ended up on military property on accident. As chance would have it, one of the doctors we were with ended up being enrolled in the military and we all breathed a huge sigh of relief.

View from Level 8 

Kabobs and Tea from K Tea Shop

Friday was a National Holiday dedicated to the Vice President of Tanzania. We had the day off, so I went to Friday prayer at the mosque by our apartment. There was a lot of warmth in the community, after Jummah (Friday prayer) was over, everyone went around and gave hugs/handshakes to one another, including people they didn't know. It was reminiscent of the happiness of Eid prayers in the US. After Jummah, we went to Delhi Darbar, which is a fusion-Indian restaurant. I ended up getting oyster sauce chicken since I loved the dish that our Mauritian friend made us! It ended up being a quieter Friday night, since we had to be up at 4:30AM to catch our bus for a safari on Saturday morning!

SAFARI POST COMING SOON!!!

Thanks for reading!

XOXO,

Naheed

Karibuni Kwa Tanzania!

Mambo friends!
If you don't already know, I'm in Tanzania for a month! I will mostly be in Dar-es-Salaam (the largest city in Tanzania) and will spend a week in Tanga.
Many of you have asked why I am in Tanzania. I've been lucky enough to be sponsored through my dental school ( the University of Illinoist at Chicago College of Dentistry) and Miracle Corners of the World to study global dental health. I will be working at Muhimbili University Hospital of Applied Health Sciences Dental School with dental interns and dental students in Dar-es-Salaam. The pathology cases we see are crazy! In Tanga, I will be working with dental therapists at the Dental Therapists Training Centre inTanga and participating in community outreach programs.

My time in Dar-es-Salaam has been great so far! The service with our Turkish Airlines flight was amazing -- our flight was 21 hours and had one layover in Istanbul. We arrived 4 days ago and have been lucky enough to have done something amazing every day so far.

Here's a little recap of things:


WEDNESDAY @ 02:00 - Flight lands, we pay $100 for a Visa and are greeted by our driver Muftaha. We go to our AMAZING apartment. Unfortunately, I got no sleep but eh my sleep cycle is always disturbed.


                            @ 13:00 - We met Regina, our liaison with Tanzania and Miracle Corners of the World! Regina was kind enough to show us around Dar-es-Salaam. We went to Slipway by the Yacht Club Beach . It was breathe taking, but not somewhere where the locals would go. We also did the routine traveling thing of exchanging currency, buying new SIM cards and getting our groceries.

    

         

                      Yacht Club Beach views   

THURSDAY   @  09:00 - First day of the Hospital! We got registered, met the Dean and the Associate Dean of the MUHAS College of Dentistry. We also got a tour. Interestingly, their dental school is only divided in to three departments - Restorative, Oral Surgery and Pediatrics. Interestingly, Endodontics and Periodontics fall under the Restorative department.
                         @15:00 We later went to Palm Beach which was a stark contrast to the Yacht Club Beach.  It was a very local area, but not a very swimming friendly spot.

FRIDAY
                   @ 08:00 - Second day at the hospital. We got to shadow in the Pediatrics Clinic and meet the interns and dental students. I was given a white coat because my scrubs made me look like a "villager".

******SIDE NOTE: The diversity in Dar is astounding. It is such a global city. There are native Tanzanians, but also large Oriental Asian and IndoPak communities that moved to Tanzania for trade.*******

                 @ 10:00 - Enter the Oral and Maxillofacial Pathology screenings. OMG. The Oral Pathology is crazy at MUHAS. CRAZY. We saw ~70 patients that day. About a quarter of the cases were ameloblastomas, a quarter of the cases were squamous cell carcinomas, a quarter were sialoliths and a quarter were  miscellaneous pathology. The attending Oral Surgeon had so much compassion and wisdom. Interestingly, the government of Tanzania covered all of the treatment for these patients, minus about 10,000 Tanzanian Shillings (~$5 USD). If the surgery could not be covered in Tanzania, they would pay for the patient to go to India to get the surgery done.

                @ 14:30 - We went to the Minor Surgery Ward and watched the BA attending Oral Surgeon re-position a zygoma on an automobile trauma patient with essentially the dental equivalent of a mallet. All under local anesthesia only. Wow.

                 @ 20:00 - There was a Poetry Slam in town that we attended. It was at the appropriately named Hideout Cafe, because it was tucked in a corner and took 2 wrong turns to find. The theme was women, and many pieces centered around single parenthood and AIDs. They had an open mic portion and I decided to perform two of my favorite Rupi Kaur pieces.

                                               

Performer at the For Better or for Verse Event

I'm so excited to be back to blogging! Stories from Zanzibar and Kariakoo coming at you tomorrow!

Mambo and XOXO,
Naheed