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					Thurlow-Begg, Richard. (2007) "Tell them we can do" - a dental elective in Dar
es Salaam, Tanzania. BDS Elective Report.



http://hdl.handle.net/1905/738

16th January 2008




                                 Enlighten
                     http://www.gla.ac.uk/enlighten
 “Tell them we can do”
-A dental elective in Dar es Salaam-
              Tanzania




             0308958

          Word Count: 4009
               CONTENTS
1) Plagiarism statement                                              1

2) Introduction                                                      2

3) Aims of elective                                                  2

4) Choosing where to carry out my elective                           2

5) The country of Tanzania and dentistry there                       3

6) Preparation for going to Tanzania                                 4

7) “Welcome to Tanzania” (Arrival in to Tanzania)                    4

8) First day in the dental school                                    6

9) Initial disappointment                                            6

10) A deviation from our original aims                               7
       -Oral surgery in-patient ward                                 7
       -Oral surgery theatre                                         10
       -Paediatric department                                        11

11) “Tell them we can do”                                            12

12) Reflection after the elective                                    14

13) References                                                       15

14) Appendix 16
      -Cases seen within the In-patient ward at Muhimbili hospital   16
      - In and around Dar es Salaam                                  19
      -Zanzibar                                                      20
      -Kilimanjaro                                                   21
      -Other places to visit                                         23

15) Bibliography (Useful books/websites)                             24

16) Acknowledgments                                                  25




                                         1
I have read the information on plagiarism in the current BDS Course Manual
and in Section Gen. 13 in the University Publications, “University Fees and
General Information for Students”. I understand that plagiarism is an act of
academic fraud.

I, therefore, certify that this piece of written work is entirely my own or, where
the work has been conducted jointly with (an)other student(s), the proportions
ascribed to each individual are duly acknowledged. Where any work by other
authors has been consulted and applied in this work, I have duly acknowledged
the source and referenced it appropriately.

To guarantee anonymity in the assessment by the members of the elective
committee students -

1. must not put their names on the cover of the report, or within the report.
   The cover should identify each student only by his/her matriculation number.

2. must not include their supervisor’s name in the acknowledgement list.

**STUDENTS SHOULD ALSO DISPLAY THE WORD COUNT ON THE
FRONT COVER AT THE BOTTOM OF THE PAGE**




                                         2
Introduction

This elective report consists of an account of my elective to Tanzania. I have aimed

to make the following account useful to future readers so they can not only get an idea

of the kind of dental experience they can expect to encounter if they carry out such an

elective as I did, but also a flavour from what they can expect from the people, culture

and country as a whole.



Aims of elective

The aims of my elective were to go to a country where the level of dental treatment

provision was greatly limited and to help bring dental care to that region/country. In

addition to this, I also hoped to be able to gain an insight into the current level and

quality of dental care in that particular region/country as well as take in the different

cultures and experience the country as a whole. The main areas of dentistry that I

aimed to focus on were paediatrics and the provision of outreach dental care.



Choosing where to carry out my elective

Firstly I had to choose a country where I believed I would be able to meet my

objectives set out in the aims of my elective. From a young age I had always been

very interested in Africa with relatives of mine having worked and lived in Africa

during the late 19th and early 20th century. They had brought back many ‘treasures’

and photographs from Africa which has inspired me to visit the continent. I had also

been inspired to climb the mountain of Kilimanjaro since a man from Tanzania had

visited my primary school when I was 7 years old and told us about his country and in

particular Mount Kilimanjaro. This basic desire to visit Africa fitted in greatly with

the aims of my objective, as there are many countries within Africa which have very



                                           3
limited levels of dental care. After investigating into the countries within Africa that

it would be possible to carry out my elective study in, I came up with the country of

Tanzania as an Ideal country for this purpose. After discussion with fellow dental

students it also became clear another student, Jaclyn Gilliland was also enthusiastic to

carry out a humanitarian elective in Tanzania, so we set about organising our elective

to Tanzania.



The country of Tanzania and dentistry there

Tanzania is a country with a population of about 38.4 million people but only has 1

dentist per every 300,000 people. 1 This is compared to the UK, where many people

believe ‘It is impossible to get a dentist these days’ at a ratio of 1 dentist per 2,100

people. This highlights the lack of dentists in Tanzania, resulting in very limited

access to dental care. To further enhance the problem of providing dental care,

Tanzania covers an area of 945,087sq km (Britain only being 242,514sq km) and 70-

90% of the population live in rural areas. Most of the dental professionals are situated

within the cities of Tanzania such as Dar es Salaam. Again this causes further

problems for providing access to dental care.



Geographically, Tanzania is situated in East Africa, bordered by Kenya and Uganda

on the north, Rwanda, Burundi and the Democratic Republic of the Congo on the

west, and Zambia, Malawi and Mozambique on the south. To the east it borders the

Indian Ocean. It lies between 1˚ and 12˚ south of the equator, which results in hot

temperatures throughout the year, almost always being over 20oC during the day time.




                                           4
The major language spoken within Tanzania is Swahili, but many people also speak

English to various levels. There are also many tribal dialects which are spoken by

smaller groups of people. Most of the patients I came across had a grasp of English

that was good enough to communicate at least basic dental terms to, although I can

only account myself for patients seen in Dar es Salaam and not throughout the whole

of Tanzania.



Preparation for going to Tanzania

In order to carry out dental work in Tanzania, we had to find an organisation that

would be able to provide the framework for us to complete our elective under. After

researching into this, the charity Bridge2Aid seemed a perfect organisation in which

we could carry out dental treatment in Tanzania. After contacting Bridge2Aid, we

were unfortunately told that they would be not operating dental treatment within

Tanzania for volunteers during the period we were there. Very kindly though, they

put us in contact with Muhimbili Hospital in Dar es Salaam (The Commercial capitol

of Tanzania). From there we kept in contact with the acting dean of Muhimbili dental

School and Hospital, Mr Sinitra, who was greatly helpful in trying to set up the

chance for us visit Tanzania and help provide dental care there. Every email he sent

to us would be ended with a very warming ‘Welcome to Tanzania’!



‘Welcome to Tanzania’

A number of vaccinations later and what seemed like an age of waiting, the day we

set off to Tanzania eventually came. 14 hours after setting off from Glasgow, we

arrived in Dar es Salaam where we were very kindly greeted by Mr Sinitra (After

waiting about an hour to cue for a visa at US$50). Again we were warmly greeted



                                         5
with a ‘Welcome to Tanzania’ and a very friendly smile.              From the airport, a

University driver drove us to our accommodation that was recommended to us by Mr

Sinitra. On the journey from the airport to the centre of Dar es Salaam, 3 main things

struck me. This was first of all the heat! Although it was their winter, the temperature

still reached easily over 30oC. I, also wanting to bring a little bit of Scotland to

Tanzania, was dressed wearing a heavy weight kilt. Surprisingly this coped really

quite well with the equatorial climate. The second thing that struck me was the

amount of people travelling alongside the main road using tricycles, where the foot

pedals had been replaced by hand pedals. These were designed for people who don’t

have legs or sufficient use of their legs to be able to walk. Many of these people can

be seen in and around Dar es Salaam using tricycles to get around. Thirdly and most

horrifying to a dental student was the number of lorries carrying Coca Cola and Fanta.

The whole journey from the airport to our accommodation, I was able to see at least

one lorry carrying Coca Cola and or Fanta. In Tanzania, these soft drink brands are

all provided in glass bottles, transported in crates just like milk is transported by local

milk men in much of the UK. I later came to realise that bottled Fanta or Coca Cola

was cheaper to buy than bottled water. Also of note were the many large billboards

with Coca Cola advertisements upon them which were scattered alongside the road.

Coca Cola bottle shaped shops selling soft drinks were a frequent site too.



On arrival at our accommodation, the Tanzanian Young Christian School (TYCS), we

were shown our room. It was very basic, consisting of a desk, 2 small beds and a

small cupboard. Within the building there were 2 showers which dripped cold water

and were frequented with many ants and lizards. We loved it!




                                            6
First day in the dental school

We were picked up from our accommodation by a man who was to become pretty

much our own personnel driver to and from the dental hospital for the first 4/5 days.

After registration to Muhimbili university, at a cost of $US 170, we met the dean of

the dental school, in an air conditioned room, which was much welcomed! He

explained to us the history of the dental hospital and various aspects of dentistry

within the dental hospital and Tanzania as a whole. We were told that Tanzanian

government policy is to train 15 dentists in the Muhimbili dental hospital/school every

year. The dental school aims to train 25 students per year though and sometimes this

number can even increase to 40 students in a year, but this really stretches resources.

Government policy also aims to have an equal ratio of male to female dental students.

In reality only about 17% of dental students in Muhimbili are female though. The

dean said this was due to many females having jobs to do after school, which greatly

impedes their ability to achieve academically and also that many females become

pregnant before even leaving school. Those female students who had previously

attended boarding schools were even given training for a couple of days at the start of

the dental degree on “How to deal with men”.



Initial disappointment

As we arrived on the Friday into Dar es Salaam, we had the next couple of days as the

weekend free to explore the city. Fortunately, a group of 4 medical students from

Liverpool were also staying in the TYCS and had been there for 2 weeks preceding

our arrival. This meant that they had already learnt where to go and more importantly

where not to go in and around Dar es Salaam and help to make settling in very easy.




                                          7
The weekend flew by and on Monday morning, we were again picked up by a driver

again, even though the hospital was in walking distance from our accommodation.

They were very keen to make sure we were well looked after! On arrival at the dental

school, Mr Sinitra asked us what we were keen to do at the dental school over the next

two weeks. We had previously asked about any opportunities to carry out dental

treatment on an outreach basis, preferably in a rural community and also expressed

our interest in paediatrics. Unfortunately it became apparent that they did not provide

this kind of outreach service, or at least not in the period of time we were in Dar es

Salaam. We were also made aware that the students at Muhimbili dental school were

in the middle of sitting their exams so we would not be able to join in with student

clinics as they were not running. In fact, much to my initial disappointment, it soon

became apparent that we would not get the opportunity to do hardly any hands on

dentistry.



A deviation from our original aims

Over the next 2 weeks, we did not get to carry out the humanitarian dentistry that we

had originally hoped to do. Instead we spent our time mostly shadowing in paediatric

department but also in the oral surgery ward and in the oral surgery/maxillofacial

operating theatre.



Oral Surgery In-Patient Ward:

We saw a number of cases within the oral surgery ward, where patients would stay on

an in-patient basis until receiving treatment or treatment plans were completed. I’ve

listed the cases seen in the appendix but will here give explanation of the cases that

struck me in particular.



                                          8
The first patient we saw in the in-patient ward was a middle aged male (see fig.1) that

had presented very late with squamous cell carcinoma. In the UK, we look at text

books showing photographs of squamous cell carcinomas, usually as small intra oral

patches of erythroplakia or leukoplakia. In this case the clinical presentation was

completely different with an extremely

obvious large ulcerated extra oral

lesion that ran from the right corner of

the patients lip to as far back as the

posterior border of the ramus of the



                                             Fig.1 Late stage extra oral presentation of sqaumous cell
mandible.       The cancer had also          carcinoma in a middle aged male patient

metastasised, clinically presenting on

the patients buttocks.



The second patient (see fig.2) we went onto see in this ward was also being treated for

something really quite different from what you would tend to see in the UK. This was

an 11 year old male who had been an in patient in Muhumbili hospital for 3 years.

This was not due to a disease but due to an accident where he had being playing with

a grenade he’d found when it

exploded, shattering his mandible

and maxilla. Some surgery had so

far been carried out, but further

reconstructive surgery was planned



for the future.      As with many          Fig.2 A young male with facial trauma resulting from an
                                           exploding grenade




                                             9
patients in the ward, the boy had a tracheotomy in place. He also wore a scarf around

his mouth to conceal his injuries and communicated with others using a pen and pad

of paper.



The third patient we saw (see fig.3) was also very interesting. This patient was a

middle aged male albino. There are believed to

be about 17,000 albinos in Tanzania 2 and these

people are all at increased risk of developing

many forms of cancer, especially basal cell

carcinoma. Indeed, this patient was undergoing

treatment for multiple basal cell carcinomas.

He had already been treated with a full course


of radiotherapy, but was now awaiting further         Fig.3 An albino patient with multiple basal
                                                      cell carcinomas

treatment in the form of surgery.



In the in-patient ward, we saw a number of patients with ameloblastomas. From the

patients I saw, this appeared to be a relatively

common disease within the ward.            Further

reading into this that I’ve done since returning to

the UK, suggests that ameloblastomas are the

most common form of odontogneic tumours

found in Tanzanian patients, accounting for

80.1% of odontogenic tumours and having an



overall incidence of 0.68 per million of Tanzanian      Fig.4 A patient with a large ameloblastoma




                                          10
population. 3 This is actually similar to the incidence of ameloblastomas in European

populations. Mostly the clinical cases were again in quite a late stage due to late

presentation by the patients. Such a patient is shown in Fig.4



Oral Surgery Theatre:

After seeing such interesting cases in the in patient ward, we were keen to see the

treatment of these patients, much of which was carried in the operating theatre. The

oral surgery team had managed to obtain the use of a new operating theatre that was

originally intended for cardiac surgery, but somehow was available. We were able to

see a number of surgical procedures ranging from the excision of salivary gland

tumours to the excisions of lipomas. The case that stands out most in my mind

though is that of a 16 year old girl (See fig.5). She had come into the hospital,

presenting with a large mandibular mass, extending from the left side of the her

mandible. This was diagnosed as an ameloblastoma which was to be treated by

removal of the mandible (mandiblectomy).

It also soon became apparent that she

suffered from a number of other diseases

including Hepatitis B, Hepatitis C and

Syphilis. Her serology also showed positive



for HIV. The blood used for infusion for         Fig.5 A 16 year old female with an ameloblastoma
                                                 amongst a number of life threatening diseases

this patient was also HIV positive.



I found the oral surgery extremely interesting and felt privileged to be able to see such

surgery. The surgeons also actively encouraged us to take photographs so we would




                                           11
better learn from the experience and have the photographs for future reference and to

help us remember individual cases. This I found very helpful indeed. I did notice

though, that some of the oral surgeons had just been able to afford fairly basic digital

cameras. In Tanzania, such an item is a luxury and not many people can afford them.



Even though my knowledge of oral surgery is limited, I was very impressed by the

work that the oral surgeons were carrying out. They certainly had some advanced

stage diseases to deal with and appeared very confident in their ability to deal with

such cases. I had not expected to find such a set up in Tanzania where by a national

health organisation would be carrying out work like this and would have thought it to

be only carried out on a private fee basis.



Paediatric Department:

This was the department where I felt the treatment provided and even the set up to be

very similar to that in Glasgow dental hospital, although the equipment and dental

chairs were mostly not as new as that provided in Glasgow dental hospital. Most of

the time, I shadowed a Tanzanian female paediatric dentist who had spent some time

working in Holland before returning to Tanzania. Her English was fantastic, although

she spoke with an American accent. Maybe this was due to watching too many

Hollywood movies? She also spoke Tanzanian as her mother tongue and said she

learnt to speak pretty good Dutch whilst she was in Holland. Most of her patients

were being treated for caries. She was very good at making her patients feel at ease

using techniques we are taught at Glasgow dental school including various steps of

acclimatisation and praise for good behaviour. She would also sometimes leave her

patient (at a suitable point) to help other paediatric dentists who were not proving to



                                              12
be as successful in getting their patients to be compliant with the dental treatment.

Soon enough though, she managed to help make these patients more accepting to the

treatment they required. The one item she felt she would find very useful in carrying

out her treatment in Dar es Salaam was rubber dam. She was a great advocate of

rubber dam, which she had used extensively in Holland, but unfortunately due to

financial reasons, this was not used on a regular basis for dental treatment in the

Muhimbili dental hospital. The treatment carried out though was done with good

moisture control by effective use of cotton wool rolls. Nurses were not available to

help with this as the nurse to dentist ratio was not very high and often the nurses were

doing other jobs such as disinfecting instruments.       During my time shadowing

treatment in the paediatric department, I didn’t see a nurse attending a dentist all the

way through treatment. I believe this is the same throughout most of the dental

hospital and dentists there appear to work mostly on their own with the patient.



“Tell them we can do”

As mentioned before, the staff and people in general in Dar es Salaam were very

welcoming and friendly. The oral surgeons in particular were very informative not

only about dentistry but also about Tanzania on the whole. For example, when

walking through one of the hospital car parks, it was highlighted to me that about 95%

of the cars were Toyotas. It was then explained that this was due to the Japanese

second hand car market selling the used cars from Japan to Tanzania. The oral

surgeon who explained this to me said it was due to Japan using Tanzania amongst

other African countries to get rid of its unwanted cars, almost as a ‘scrap yard’.

Because most of the cars were Toyotas, people who bought other models of car such




                                          13
as Ford would find it almost impossible to get replacement parts if they had any

problems.



I was also told that many of the staff within Muhimbili hospital were still not happy

about the level of payment they receive. Although their wages had increased in

previous years, it was still not very high and this contributed factor contributed

towards dentists leaving to work in other countries and/or dentists from out with

Tanzania not being attracted to work there. The head surgeon that carried out most of

the work we saw in the oral surgery theatre said he was only paid about the equivalent

of £180 a month. This was working at least 5 days a week and after having done

medicine and dentistry degrees amongst other courses. Talking to the few dental

students that were present around the dental hospital, I also became aware that

becoming a dentist and being a dental student was not as ‘glamorous’ as it is in the

UK. Many people in Tanzania do not actually believe in ‘western medicine’ as

traditional medicine with witch doctors still prominent, especially in rural

communities. This aids the problem of late presentation to medical personnel. A

student was telling me that he believes dentists in Tanzania are not seen as highly in

the community as they are in the UK. I did get the impression that the dental students

in Muhimbili did dentistry for the love of the subject more than that of a career to

elevate financial status or social standing.



After spending the day shadowing one particular oral surgeon through a consultant

clinic within the main dental hospital building in the morning, we then went to the

‘Fast Track’ clinic where he was carrying out treatment in the afternoon. This was a

form of privately patient funded treatment and was carried out in a newly built



                                               14
building made up of surgeries for both dentists and doctors. These dental surgeries

contained more modern equipment and had better facilities in general than that of the

main dental hospital/school. Here we watched treatments such as restoring the form

of a fractured maxillary process and removal of fibrous gingival overgrowths. After

the working day was over, the oral surgeon and his fellow colleague were keen to take

us out to a restaurant near Muhimbili hospital. We got to eat some Tanzanian style

food (mainly based around chicken). Both the oral surgeons were keen to know more

about dentistry in the UK and what opinions we had about dentistry in Tanzania. We

explained that we were impressed by the dentistry and oral surgery we had seen.

Poignantly one of the oral surgeons went on to say that when we returned to Glasgow

that he would like very much for us to tell people about the dentistry we had seen in

Tanzania and to “Tell them we can do”. He believed that people out with Africa

thought of countries such as Tanzania as being significantly behind the western world

in every respect. It was therefore very important to him that we told people in the UK

that in Tanzania they can and do indeed do successful dentistry to a very competent

level. Indeed I do agree with this.



Reflection after the elective

On the whole my elective did not turn out to be what I had planned and expected.

Initially, after realising that we would not really get to do any hands on dentistry, I

was somewhat disappointed. I soon became very satisfied with my time spent in

Muhimbili hospital though and felt I learnt a great deal about dentistry in Tanzania. I

was particularly impressed by what I got to see in the oral surgery theatre and in the

in-patient ward. Here I got the opportunity to see oral-facial diseases at stages rarely,

if ever seen in the UK. Seeing the surgical treatment of such disease states was not



                                           15
only extremely interesting, but also helped to further increase my knowledge of

anatomy and gave me an experience of more complex oral surgery.



Before arriving in to Tanzania, I didn’t really know what to expect. I had tried to find

more information about Muhimbili dental school through the use of the internet but

still didn’t have a clear picture of what it would be like. This was perhaps a good

thing as I went to Tanzania fairly open minded and came away being very impressed

with the dentistry carried out there. Although they didn’t have the equipment and

resources that we are lucky enough to have in the UK, the dentists working at

Muhimbili hospital did what seemed a good job at providing dental care for the

people in and around Dar es Salaam. It did often seem though that they were left to

deal with diseases that had progressed to late stages. This appeared to be due to a lack

of education of the Tanzanian population about diseases such as oral cancer. Many

patients would only seek medical attention only when it became a necessity due to

severe pain or functional limitations.    This meant much of the dental care was

provided on a restorative basis or even disease limitation basis rather than preventive

care.



Overall I feel I have definitely gained from my elective experience. I feel privileged

to have seen dental care carried out within Tanzania and to have gained an insight into

the lives and opinions of dentists and dental students there. Although in the end, my

elective was not what I expected and originally hoped for, I still had a hugely

rewarding experience that was not only extremely interesting but also great fun too.




                                          16
                                      Appendix



Cases Seen within the Oral In-patient ward at Muhimbili hospital

Patient 1: Middle-aged male. He had a lesion on his right cheek and buttocks. This

was diagnosis as late stage squamous cell carcinoma.



Patient 2: 11 year old male. He had been an in-patient for 3 years, since an accident

with a grenade. His mandible and maxilla were shattered and he wore scarf to hide

deformity. He communicated with others via pen and paper. A tracheotomy was in

place



Patient 3: Middle-aged male albino diagnosed has having multiple basal cell

carcinomas. He had been treated with a full course of radiotherapy and was awaiting

surgery to remove remainder.



Patient 4: 22 year old male. The primary diagnosis was myxoma. Review of histology

requested.



Patient 5: Middle-aged male that was being treated for an Ameloblastoma. A Semi-

mandiblectomy had been carried out to try and remove this. A tracheotomy was in

place,



Patient 6: Middle-aged male with a large ameloblastoma extending from the right side

of the patients mandible




                                          17
Patient 7: Middle-aged male with a large ameloblastoma, which had resultantly

greatly displaced his lower teeth



Patient 8: Middle-aged female. She had previously had a tooth extracted and an

odontogenic abscess had developed around the extraction site. She also had a skin

infection – possibly impetigo due to pattern along nerve tract. At the time she was

waiting on serology for diagnosis.



Patient 9: Middle-aged female with a submandibular abscess. 50ml has been drained

twice in previous 3 days to allow patient to swallow. She was on a course of

antibiotics



Patient 10: A young female with an ameloblastoma. She had significant amounts of

calculus present that was to be removed before surgery



Patient 11: A 4 year old male with a lesion on his right cheek. This was diagnosed as

Burkitt’s lymphoma. A tracheotomy in place.



Patient 12: A 28 year old female. She was in sevre pain.Clinically, she had an extra

oral lesion on her right cheek. This was diagnosed as late stage squamous cell

carcinoma. Treatment plan – radiotherapy and radiotherapy. She was also HIV

positive



Patient 13: Middle-aged female with an ameloblastoma. Her teeth were significantly

displaced by the growth of the ameloblastoma



                                          18
Patient 14. A young female with cemento-ossifying fibroma.



Patient 15. A middle aged female with Neuro fibroma (fibromatosis).




                                        19
Activities worth doing in you spare time in Tanzania

In and around Dar es Salaam:

During my elective in Tanzania I was also able to experience the country, culture and

people out with the dental setting. Dar es Salaam is situated next to the Indian Ocean

on the East Coast of Africa. To both the North and South of the city there beautiful,

white sandy beaches. Most of these are owned by hotels that are dotted along the

coast line, but for about 2000 Tanzanian Shillings (Roughly £1) you can go on the

beach and use their facilities such as outdoor swimming pools and showers. On one

of our free days during the weekend we were able to go to such a beach, which was

very relaxing.



Dar es Salaam also has a number of other activities to do. Of particular interest is the

fish market. Although fairly small, it is still worth while going to see locally caught

fish being sold at auction. There are loads of other markets to visit too including

woodcarving markets where you can barter for hand carved items ranging from chess

boards to bongos.



It is definitely worth visiting the national museum. This not only has displays on the

African slave trade, the German and British Colonial periods and famous fossil

discoveries, but also has wild monkeys that live in the museum grounds. Next to the

museum there is the Botanical gardens which contain a large number of peacocks.



A short trip out of Dar es Salaam, taking a dalla-dalla, which is an inexpensive

minibus used by the locals and extremely hectic at times, will take you out to the

Village Museum. This is an open air museum consisting of a large collection of



                                           20
authentically built houses showing the many traditional builds that were and are still

present throughout different parts of Tanzania. If you visit in the afternoon, there will

most likely be music and dancing performances just outside of this museum. During

they day there are also a number of small stalls selling items such as paintings,

musical instruments and even authentic Masai shoes which are constructed from old

car tyres.



Zanzibar

Zanzibar is an astounding Island to visit if you have a spare weekend or more. We

booked a trip to Zanzibar through a local legend of Dar Es Salaam named Ali Aba.

He arranged everything for us from being picked up from our accommodation in Dar

es Salaam to spice tour trips on the Island of Zanzibar and a beautiful beach-side

lodge for our accommodation, which was situated in a small village on the East side

of the Island. The sunrises and sunsets are amazing and a short trip away it is possible




to dive with wild dolphins and snorkel amongst tropical fish. Both of which we did.

On a night, the local children often play their bongos and drums on the beach around

a fire, dancing and singing traditional songs The Stone Town in Zanzibar town, on

the west side of the Island is great for strolling around and a number of activities can

be done here. The museum gives a great history of Zanzibar with exhibits relating to


                                           21
the British and German colonisation along with Arabian exhibits as the Island has a

strong Arabic association.



Kilimanjaro

Since I was seven years old, I have always wanted to climb Mount Kilimanjaro. This

is the tallest mountain in Africa and is one of the highest free standing mountains in

the world at 5896m high. I had 10 days left in Tanzania after carrying out my dental

elective so jumped at the opportunity to spend this time climbing the mountain. The

actual expedition to the summit of Kilimanjaro and back to the bottom took 6 days as

time is needed to acclimatise and reduce/prevent the effects of altitude sickness.

Many people actually choose to spend 8 or 9 days to climb the mountain in order to

allow for extra acclimatisation. Unfortunately not everyone makes it to the summit.

This is mainly due to the effects of altitude sickness which is not predictable in whom

it will effect. Levels of fitness do not correlate with altitude sickness in general and it

can affect people who have had no problems at the same altitudes previously.



The expedition was incredible, with a number of various terrains, wildlife and

stunning scenery that varied every day. I could not recommend enough attempting to

climb Kilimanjaro. Even the trip to the bottom of the mountain in a 4 wheel drive

was a great experience with the driver showing great skill in keeping the vehicle on

the so called ‘road’.



Guides and at least one porter are compulsory for climbing Mount Kilimanjaro. The

best way to organise this is through a trekking company. There are many companies

who operate expeditions with some better than others. I climbed with a company



                                            22
named ‘Team Kilimanjaro’. I booked this well in advance when I was still in

Scotland to make sure I would be able to do the climb with them. They arranged

accommodation for before and after the expedition as well as transport to and from

the airport. From my experience I would highly recommend this company as the

guides we professional as well as being extremely friendly and informative. The

assistant guide actually took us around his home Town of Arusha, near Kilimanjaro

after the expedition in is free time. He showed us the ‘real Tanzania’ taking us away

from the beaten tourist track to see where he and his family lived and to a restaurant

where many the locals went to.




         A view of the sun rising taken from the summit of Mount Kilimanjaro




                                           23
Other Activities and Places to Visit

Of course there are many other things to do and places to visit in Tanzania. Many

people choose to visit national parks to go on Safari, something I unfortunately didn’t

have time to do. World class Scuba diving is also available, especially around the

island of Zanzibar. The Lonely Planet guide to Tanzania gives a comprehensive

account of many places to visit and many things to do. I used this to decide on a lot

of the places I visited and would recommend it to other people.




                                          24
Bibliography

The following are very useful sources of information

Books:

●Lonely Planet Guide to Tanzania. Mary Fitzpatrick. 2005

- A very useful book with much of what you need to know before and whilst visiting

Tanzania



●Lonely Planet Swahili Phrasebook. Mary Fitzpatrick. 2005



Websites

●www.muchs.ac.tz

- The website for Muhimbili hospital. To go to the dental pages see

www.muchs.ac.tz/dentisry



●www.bridge2aid.org

-The website for bridge2aid which do humanitarian charity work around the world,

incorporating the Hope Dental Centre in Mwanza



●www.fco.gov.uk/servlet/Front?pagename=OpenMarket/Xcelerate/ShowPage&c=Pa

ge&cid=1007029394365&a=KCountryProfile&aid=1019745099478

-The UK foreign office website with an interesting profile on Tanzania



●www.teamkilimanjaro.com

- This is the website for the company I climbed Kilimanjaro with.          I highly

recommend them



                                         25
Acknowledgements

Many thanks to the following for helping to make my elective possible:



Mr. P Sinitra. For his great help in arranging for us to visit Muhimbili hospital in Dar

es Salaam and his continued help and friendliness whilst we were there



Dr I. Wilson. The executive director of bridge2aid, who put us in contact with Mr.P

Sinitra and provided support on any questions we had about Tanzania and dentistry

there



The staff at Muhimbili hospital. They were all very welcoming and helpful in making

our elective experience an excellent one.




                                            26
References

1
    http://bridge2aid.org

2
    http://news.bbc.co.uk/2/hi/africa/2982116.stm

3
    Elison N.M. Simon DDS, Matthias A.W. Merkx DDS, MD, PhD, Edda Vuhahula DDS, PhD, David
Ngassapa DDS, MSc, PhD and Paul J.W. Stoelinga DDS, MD, PhD. A 4-year prospective study on
epidemiology and clinicopathological presentation of odontogenic tumours in Tanzania. 2003




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