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Crossing Continents to Provide Dental Care
Despite distance, dentistry deemed important for orphans living with HIV in Uganda
Uganda native Barbara Namboyera has some serious problems. First, she is infected with HIV, the virus that causes AIDS.
Catherine M. Flaitz, D.D.S., dean of the UT Dental Branch at Houston, shares a little quality time with 4-year-old Hawa, who is HIV-positive and has come to the clinic in Kampala, Uganda, for dental work. Photos by Erika E. Hargrove
Second, she is a single mother with four children – who all have HIV. Third, Namboyera has no skills, and therefore, no job. She cannot afford food, clothing or her children’s education, so none of them are in school. And if all that weren’t bad enough, today her children’s unhealthy teeth are hurting.
Of all the monumental problems that Namboyera is facing, today her children’s dental care is at the top of the list. The condition of their teeth is affecting their ability to eat, sleep and play. Furthermore, it is affecting her ability to focus on solving the other problems, which really need her attention if her family is to survive.
On the morning that Namboyera arrives for dental care, the kids are in tow. She has just walked several miles from a neighboring village to Kampala, the capital of Uganda and home of the Mildmay International Centre, a clinic dedicated to providing care to HIV-infected children and adults who have limited resources.
This is where a team of U.S. dentists, including Catherine M. Flaitz, D.D.S., dean of The University of Texas Dental Branch at Houston, and Kishore Shetty, D.D.S., associate professor of restorative dentistry, are providing free care to these special children.
“I have nothing,” Namboyera says matter-of-factly. “I can’t afford to take them to the dentist. So when I learned that dental care would be free at the clinic today, I knew I had to come.”
A teeth cleaning in Uganda costs approximately 20,000 shillings, which is equivalent to $9 U.S. dollars. Twenty-thousand shillings is a lot of money for a family that lives in a home made of mud with no running water and no electricity.
HIV Widespread
There are 27.2 million people in Uganda, with over 500,000 having HIV, according to the U.S. Centers for Disease Control and Prevention.
At the Tororro Main Hospital, Kishore Shetty, D.D.S., right, director of the Medically Complex Patient Clinic at the Dental Branch, collects saliva samples from the children. Shetty worked with six other dentists on the team to provide restorative dental care.
“Almost everyone from Uganda has lost a loved one or someone they knew from this disease,” said Paul Musherure, D.D.S., a native Ugandan, who now practices pediatric dentistry in Minnesota. Musherure worked alongside Flaitz and Shetty during the mission. “I’m a Ugandan and that’s enough to keep me committed to this cause of providing dental care to HIV-infected orphans. I am glad others have joined me.”
The CDC also reports that about 1 million children in Uganda have been made orphans by the epidemic. But Namboyera said she is fighting to stay healthy and doesn’t plan on going anywhere, anytime soon. And if she does, “I want to make sure my children’s teeth are healthy.”
So she waits in line with a peace in knowing that by the end of the day, at least one of her problems will be solved.
Flaitz, who is a pediatric dentist and oral pathologist, in addition to serving as dean of the Dental Branch, traveled with Shetty to Uganda as a part of an ongoing effort by a group of independent dentists. The group is organized by John Sexton, D.D.S., a private-practice pediatric dentist from Denver.
Flaitz and Sexton know each other well, having spent years traveling to Romania for similar missionary work. However, this was Flaitz’ first trip to Africa.
“Essentially the world is the same, and pockets of significant poverty exist everywhere – with children affected disproportionably,” Flaitz said. “That is why I serve in places that have a very specific need.”
“This country is ravaged by HIV, which has produced a tragic number of orphans. Ignorance, fear and limited resources severely hamper efforts to provide oral health care to these children,” she said.
“On top of that, dentistry is scarce in developing countries, no matter what the socioeconomic status is of an individual. That is why we went to Romania and why we were drawn to Uganda.”
HIV brings with it a multitude of health problems, which most organizations, such as the Mildmay clinic, have done a comprehensive job of addressing. However, dentistry often is not included in the definition of “comprehensive.” Although Sexton has made strides to secure a dental clinic at the facility, it would be the first.
The presence, as well as the variety, of Sexton’s group is valuable.
The team includes dental assistants, pediatric dentists, an oral surgeon and general dentists, such as Shetty, who is also director of the Medically Complex Patient Clinic at the Dental Branch. Shetty was one of six dentists working around the clock to relieve children from their pain and restore their oral health with extractions, fillings and other procedures.
Flaitz added a special insight as an oral pathologist with her ability to screen patients for serious oral lesions and infections.
“Don’t pull any of this child’s teeth,” Flaitz said to her dental assistant with a hurried and concerned look to match the order. “She has active tuberculosis.”
Flaitz later explained that young Jane also had a blood platelet count that could make the bleeding nearly impossible to stop. And that was just one of many potentially life-threatening calls that Flaitz made while on the two-week mission.
“By diagnosing these serious illnesses before they receive treatment, we can prevent serious complications to the child and prevent the transmission of infectious diseases to the dental team. Providing oral care is more than removing decayed teeth – it is important to remember that those teeth are connected to a sick child whose condition may improve or worsen based on the care we give them,” she said.
‘Dr. Love’ to the rescue
As the first dentist that the children saw, Flaitz had the responsibility to staff the comfort zone. Like most children, these patients were scared and nervous in unfamiliar surroundings.
But “Dr. Love,” was to the rescue with her generous smile and gentle hug. Flaitz was given this nickname, due to her pet name for the children. “Scoot up for me, Love,” she said to the children. “Open wider, Love. There you go.” She admits that she called the children by this term of endearment because she could not remember or pronounce all their names. But “Love” seemed to calm them down, just the same.
Flaitz has traveled overseas to Romania for several years but readily admits that Uganda is an entirely different experience.
“The oral lesions in Uganda are better controlled here than when we first went to Romania due to the antiretroviral medications they are receiving at this clinic,” she said. “I have been doing this a long time, so I was somewhat surprised to see some diseases that I had never seen before, especially malaria, disfiguring scars and a high number of skin conditions. Ringworm, showers of flat warts from head to toe and widespread impetigo from infected insect bites were common.” Impetigo is a bacterial skin infection, characterized by weeping and swollen sores that are very contagious.
“It is natural to ask myself if we are making a difference when the time is so little, the need is so great and the laborers are few,” Flaitz said.
Carrying Hope
in a Brown Paper Bag
One way that the UT Dental Branch is leaving something positive behind in the community is through the donation of 30 dental chairs to the Mildmay Centre to be used in a permanent dental clinic that will be established by next year. These chairs became available after 120 stateof- the-art dental chairs were installed in the student teaching clinic as part of the Dental Branch’s centennial building project. The dental equipment manufacturer, A-dec, purchased the old chairs from the school and then donated them back to clinics in Houston, Mexico, Romania and Uganda.
During a dinner party to thank the team, Emmanuel Luyirika, M.D., director of medical services at the Mildmay Centre, assured the team that a difference is seen in the lives of the children. “When you leave, they are happier and healthier. They can eat and take their medication without being in pain,” he said. “It is always a blessing when you come.”
By Erika E. Hargrove, Public Affairs