MAF’s mobile dental clinic serves Liberians in a country with only 7 dentists

Last summer, MAF flew Dr Simon Stretton-Downes OBE and team to remote northern Liberia to conduct a mobile dental clinic. In Voinjama, which has zero dental provision, they extracted over 400 teeth in three-and-a-half days. During ‘National Smile Month’, Simon tells MAF’s Claire Gilderson why oral health in Liberia is nothing to smile about…

Ever grumble about the lack of NHS dentists in the UK? Spare a thought for those suffering from toothache in Liberia.

According to SIM missionary Dr Simon Stretton-Downes OBE – who runs Trinity Dental Clinic in Liberia’s capital Monrovia – there are only seven dentists in the whole country, which has a population of five million people.

In Liberia there is no such thing as a ‘check-up’ and currently nobody can officially train and qualify as a dentist in-country.

For many, oral health is inaccessible and unaffordable

Due to a severe shortage of dentists, many Liberians simply cannot access local dental services. For those who can afford it, patients travel from all over the country for treatment at Trinity Dental Clinic. Simon describes his weekly workload:

‘We see many face swellings caused by abscesses, dead bone in jaws from dental infections and great big tumours and cysts.

‘Most swellings are caused by rotten teeth, which infect the jaw, spread into the soft tissue, constrict the airway causing further infection, possibly death.

‘Every week, I drain small swellings but when the patient has difficulty breathing with a big swelling, I send them to hospital for intravenous antibiotics. After draining, they’re sent back to us for tooth extraction.

‘We also see many trauma patients – children who have broken their teeth from falling over or someone who’s been in a fight and had a rock thrown at them.’

Dentist Dr Simon Stretton-Downes OBE

For many, dental health is simply not a priority in a country where healthcare and education are not free says Simon:

‘People are very poor – they have to decide on either buying food for their family, sending their children to school or seeking healthcare.’

Superstition and witchcraft are widespread

Superstitious beliefs concerning teeth are very common in Liberia explains Simon:

‘We’ve seen people in the clinic who are afraid to have their “last tooth” (wisdom tooth) out because they think they are going to die.

‘In some parts of Africa – if a baby has diarrhoea – they remove one of the baby’s canine teeth. They believe by removing the perceived “worm” underneath the bud of the developing canine, this will cure the illness.

‘These “extractions” are often carried out with a sharp teaspoon handle with no anaesthetic, which can cause serious injury.

‘It’s a different world compared to what we are used to. British society tends to blame everything on something medical or scientific, for them everything is spiritual.’

Bad habits and traditions undermine dental care

In Simon’s career of 39 years, the last five years in Liberia have been the most clinically interesting. He has treated patients for conditions not usually encountered by dentists in the UK.

Broken jaws caused by motorbike accidents for example are prolific in Liberia. In the last three months alone, Simon has treated 12 patients with broken jaws.

None of the injured wear helmets sighs Simon:

‘There are usually three or four people on the bike driving really fast with no helmets. I’ve been told some of the drivers are on drugs to keep them awake.’

Another practice which is not conducive to maintaining healthy is eating bones. It’s the cultural norm says Simon:

‘Filleted meat means you have cheated them out of the best bits!

‘It’s a serious issue here – it’s not just chicken bones, it’s beef ribs that they are grinding to powder in their mouth. Everybody does it – even little old ladies.

‘They bite on the bone so hard with their virgin teeth that it literally splits the tooth straight down the middle.

‘I see patients every day in the clinic who have split their tooth on bone – it’s totally preventable.’

‘In Liberia, there’s no such thing as early presentation’

Many Liberians also ignore dental problems, which can lead to death if left untreated. Simon says most patients only access his clinic when their problem becomes unmanageable:

‘In Liberia, there’s no such thing as early presentation.

‘Most of the time I’ll see patients who have had a broken tooth for a long time – if it’s not hurting them, they won’t do anything about it. When they leave it, abscess develop and then they come to see us. We try and save the tooth especially if it’s a front tooth.

‘Other times there’s swelling and bone damage. When it hurts, they’ll try the traditional healer first and then when it’s really bad, that’s when they consider seeing us.

‘People with broken jaws come to see us after it’s been broken for two or three weeks. When we explain to them what we are going to do, some of them don’t come back for treatment.’

MAF takes around an hour instead of three days

Outside of Monrovia, the dental landscape is even worse.

For the last two-and-a-half years Simon and his team have been regularly conducting dental outreaches further afield.

Around six times a year, they serve Liberia’s most isolated communities who have no access to dental healthcare.

Last July, Simon and the team went to Voinjama – up north near the Guinea border – where there is no dental provision whatsoever. It was the team’s remotest outreach to date in a predominantly Muslim area.

On a good day, it takes ten hours to reach Voinjama from Monrovia by car. On a wet day – when the roads turn to mud – you’re looking at two or three days but with MAF, it only takes one hour and ten minutes by air.

MAF flew the team of seven including Simon’s wife Grace and Musa the evangelist (a former imam), plus all their essential equipment including portable dentist chairs.

Together, they treated, prayed and witnessed to 150 patients over three-and-a-half days and extracted 430 teeth!

Fostering home-grown dental practitioners

When Simon isn’t facilitating remote mobile dental clinics and running the practice in Monrovia, he’s project managing the building of a new dental training school. This is being constructed next to the existing Trinity Dental Clinic and should be completed in September.

Thanks to these new facilities, students will be able to formerly undertake a two-year dentistry diploma course approved by Liberia’s Ministry of Health.

From this autumn, students will be able to qualify as dental therapists at the first officially recognised dentistry training provider in the country.

They will be able to extract teeth, teach community dental health, undertake temporary fillings, descale teeth and examine, diagnose refer and treat patients where possible.

Liberia’s dire dental landscape is about to change concludes Simon:

‘We want to set up more formalised dental training – that’s what we’re aiming for. Once we’ve built the school, we’ll be able to take on more students – potentially up to 12 every year. I want to see how far we can go with this school – that’s my full focus.

‘I’ve had the privilege of really making a difference with my skillset in Liberia. I’m hoping to continue here for at least another three years.’

We wish Simon and the team all the very best with their endeavours. We pray that the new school will nurture and launch the careers of many desperately needed Liberian dental practitioners all over the country.

In the meantime, MAF will continue to enable mobile dental clinics for Liberia’s most isolated people whenever they are called upon.