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Dentistry Comes to Karamoja

Donald L. Theriault

“I think we can improve on that” was my first thought as I listened to Pastor Al Tricarico’s frightening story.

Al and his wife Laurie were in Maine while on furlough from their work at the OPC mission in Nakaale, Karamoja, Uganda. Attached to the mission is a medical clinic run by Dr. Jim Knox. Although the clinic is able to provide a wide range of medical services there was no provision for relief of the pain and suffering caused by dental pain.

Pastor Tricarico continued his story of a Karimojong lady who woke up one morning with an excruciating toothache. In her desperation to obtain relief from the pain, she sought out someone in a nearby village for “help.” The man took a board with a nail driven through it, heated the nail in a fire and pried the tooth from her mouth. Al said that this was not an isolated incident but occurs frequently.

A dental abscess has been described as some of the worse pain a human can endure which explains why someone would be desperate enough to go through the board and nail extraction technique.

After hearing Pastor Al’s chilling story I began thinking about how basic dentistry could be introduced to the mission clinic. I’d already had success teaching the basics of diagnosis, local anesthesia and extraction technique in a similar situation in Central America so I was confident that it would work in Uganda as well. After a number of emails back and forth with Dr. Knox, the Tricaricos and others at the mission, a plan to introduce basic dentistry to the clinic was formulated. My wife, who is not a dentist, would also be involved.

With the encouragement of our pastor, Rev. Danny Patterson, and the support of our session, my wife and I began to share our plan with as many churches as we could. After several months and through the generosity of God’s people, we were able to raise enough money to purchase all the equipment and supplies that we would need.

In April of 2010 we finally arrived at the mission. Dr. Knox was incredibly helpful and assigned us a space to set up our equipment. The chair and dental drill unit that we brought is an impressive piece of engineering. It is designed by missionaries for missionaries and is lightweight, durable, versatile and easily transportable. It can be installed virtually anywhere and was ideal for our situation. On the first day after arriving we were able to get down to business. Doreen helped with the evangelism aspect of the mission and I began the job of unpacking and setting up the equipment. Once completed it was now time to begin training the staff.

We began with dental anatomy and local anesthesia and everyone learned how to load and use the syringes we use to anesthetize teeth.

If you’ve ever had a shot at your dentist’s office you’ll remember that the anesthetic can taste very bitter. I’m of the opinion that anyone who gives a shot needs to know what he’s putting into the patient’s mouth so I required all participants to taste some of the solution. Dr. Knox was assigned the job of squirting it into everyone’s mouth and I must admit, he seemed to really enjoy his job!

Over the next week I was able to train each nurse individually in the use of common dental instruments as well as the basics of dental anatomy, anesthesia and extraction technique. We also touched on the management of dental abscesses and minor trauma. I must admit that I found the staff to be a very willing and capable group of professionals. We practiced initially on models but there is no substitute for the real thing and for that, we needed patients.

After spreading the word through the “hinternet,” that name given to the verbal network that keeps everyone informed that a dentist was in the clinic, we sat back and waited for multitudes of people to descend. What we got was just the opposite. In fact, nobody came. Even when Dr. Jim said there would be no fee for the service we still got no takers. This was a bit puzzling as we knew there was a tremendous need. After some discussion we surmised that the people assumed I was the man with the hot nail and they wanted no part of it.

We were finally able to convince the sister of a clinic worker to come and have her painful tooth extracted. At this point I should mention that modern dentistry is totally foreign to Karamoja. It is not the case where it is available but too expensive. It simply doesn’t exist. Most of these good people have never dreamed that a painless extraction could even be possible, let alone available.

Our first patient’s extraction went very smoothly and she left surprised, relieved and very, very grateful. It wasn’t long afterward that we had enough patients for everyone to get some experience. God seemed to provide just the right patients at just the right time and the staff was able to see all of the most common dental emergencies and learn how to manage them.

I returned in 2011 and we were able to hit the ground running. I taught some new procedures as well as reinforced what they already knew. I didn’t make the trip in 2012 as Dr. Jim was away getting married but I was able to return for a third visit this February. This year we were able to introduce cleanings as part of our training. In addition to being a good service for the patients, it will provide a place for the mission personnel to get their teeth cleaned.

Nothing is ever problem free and this is certainly no exception but with the introduction of basic dentistry in the clinic, the people of Karamoja now have a place to go for help with some very painful and dangerous problems. Please pray for the dental ministry as well as for Dr. Jim and Jenny Knox and the staff of the medical clinic. Pray also that God would continue to bless this important part of the Karamoja mission. Let’s also give thanks that the “hot nail dentist” is out of business!

Donald L. Theriault, DMD
Periodontist practicing in Portland, Maine
Elder at Second Parish OPC, Portland, Maine

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