Dentistry/Pre-Dentistry Shadowing & Clinical Experience

Travelling to Kenya for merely two weeks was not nearly enough to experience such an amazing culture and amazing people full of joy in their hearts. This trip opened my eyes to the challenges countries in Africa face when compared to other countries and what a blessing it is that a program is going above and beyond to give to those deserving yet underrserved. Even though I was there for a short time, I gained so much knowledge from compassionate an selfless doctors and hopefully have impacted the lives of those during educational sessions. This experience marks a pivotal turning point in my life and will always be grateful for the chance to educate the people of Kenya while also learning from them as well. I will remember this moment in my life and hope to continue the characteristics IMA has instilled in me, teaching what I have learned and carrying the tradition of providing to those less fortunate - changing their lives!

One of the things that stuck out to me the most during my time in Kenya was that no matter the circumstances, the people of Kenya always manage to find a reason to smile. On top of that, they showed a side of strength that I have never seen before. During my 3 weeks of shadowing the doctors in the dental unit at CGRTH, I was able to obtain a different perspective on dental care. They gave me tools that I will forever cherish as I continue my career in dentistry such as the way they approach extractions, how to handle kids, and operate minor and major oral surgeries. I am grateful to have been able to see how they work to ensure that the patient is getting the care they deserve. They showed me how teamwork is essential to problem-solving when performing a procedure and assessing a patient. I cannot express how thankful I am for how welcoming everyone has been to me and the rest of the interns. Being able to visit schools and educate the students about hygiene and women’s menstrual hygiene was so rewarding. Everyone expressed the most welcoming and kindest smile. Lastly, I’m blessed to say that I made lifelong friends with the people I met. I was enlightened by the city of Mombasa and all it has to give. These experiences have been life-changing and given me a different perspective on healthcare, life choices, and friendships. In 2019, I was a senior in high school. A senior that is just beginning to think about what career to pursue for the rest of my life. Finding a career that I find rewarding and helpful to others. A job that could fulfil my goal in assisting people. With many dentist and orthodontist appointments, I soon realized that teeth were very fascinating to me. Teeth are very interesting because you might think that they are all the same, but in reality, they are all different. I soon began to realize this as I interned with the dental unit in CGTRH. The dentist would observe the panoramic of the teeth and roots when preforming a procedure on the patient to make sure they approach it the correct way. They would show us that some teeth have very short roots, or some have very long ones which would take a longer time to get out when extracting because they don’t want the roots to break off. It was very interesting to see how each individual dentist approached a patient and what they did to preform the procedure. During my three weeks in Kenya, I have gained knowledge, resources, and friendships. Before coming to Kenya, I had my mind set on being a pedodontist. I really enjoyed being around kids, so I thought being a dentist and working with kids would be the perfect job for me. I shadowed one of the Dentist, Dr. Ian, to see how he approached the procedures when dealing with kids. He did a beautiful job of calming the kids down and explaining what he would be doing, but I soon realized after watching a couple procedures be done, that pedodontist isn’t for me. That is one thing that I am grateful for as I shadowed the dentist at CGRTH, I got to see what interest me and what didn’t. All the Dentist in the unit were very knowledgeable and help explain the procedures to us as we were watching. They made sure that every patient was getting the care that they need even when they had limited resources. Right from the start of shadowing the dental and facial unit in CGRTH, I was immediately shocked. With the cases the doctors observed and how they handle and went about them was incredibly amazing to experience. They explained that they had a lack of resources, and they would only use some instruments on a patient if they really needed it. They mentioned that they could use an elevator on a patient’s tooth when extracting it, but only if the tooth really needs it because they might need it more for the next patient that comes in to get an extraction. This was one of the big differences between Kenya and the States. In the United States, we tend to take advantage of the resources we have. For example, the private dentist I work with explained to me that they would rather use more resources on a tooth, like cement for a crown, so they know that it is going to stick and be easier for them to work with, rather than use a smaller amount to where they might run into more issues when preforming on the tooth or in the future. Whereas in Kenya they used only what they needed and never used more because they couldn’t afford to waste material and instruments. The first day at CGRTH was one of the most intense days I have ever experienced. The pace of the hospital and what they saw daily was a complete culture shock. I saw more intense cases then what I am used too with my internship with the private dentist in Michigan. Dr. Grutter, a dentist I work with back in the States, explained to me that the “bread and butter” -what they see and work on every day- are crown and bridges. Whereas for the dentist in Kenya, their “bread and butter” is extractions and root canals. There is a big difference in the dentist in the States and in Kenya. For example, the dentist in Kenya went straight to dental school after high school whereas the dentist in the states must go to undergrad before attending dental school. Also, the dentist is Kenya did everything from oral diagnosis, exodontia, periodontics, paedonotics, conservative dentistry and endodontics, prosthetics, orthodontist, and minor oral surgery and the dentist in the States usually specialize in one thing. This was so fascinating to me because it showed how diverse they were in dentistry. They can do any of those procedures and do a great job at it. One of the cases that stuck to me the most was this 5-year-old girl with a sarcoma. It was my first day at the hospital when she came in. She was held by her mother who looked worried and anxious for her daughter, but still made sure to comfort her daughter during the whole procedure. Dr. Solomon, a maxillofacial surgeon, attended the patient with great care and observation as he examined her face. She had what they thought was a sarcoma on her right cheek. As they were done examining her face, they started to clean it out to try to get rid of the infection that was causing this. She was in so much pain as they did this, but she was able to sit there and not make it hard on the Doctors. She was one of the strongest girls I have ever met. Every day she would come back for daily cleans knowing what was going to happen, and still willing to get it done. She never gave the Doctors a hard time when they were cleaning her infection. After this case, I soon realized that the people of Kenya are a different bread of toughness. The people of Kenya gave me a new prospective of what toughness and kindness is. No matter the circumstance they were always grateful and happy. They always had a smile on their face and made sure we felt welcomed. Something that can be uncommon in the States. The dentist that we worked with took us out and gave us a once in a lifetime experience. They gave us a tour of the city of Mombasa and made us try food that they enjoy and that are common in Mombasa. This just showed that even though we are all from different parts of the world we are still human beings. This experience not only gave me great knowledge and tools to use towards my journey towards dentistry, but it also gave me lifelong friendships and memories. Being able to visit schools and educate the students about hygiene and women’s menstrual cycle was so rewarding. Everyone expressed the most welcoming and kindest smile. I’m blessed to say that I made lifelong friends with the people I met. I was enlightened by the city of Mombasa and all it has to give. This experience taught me so much and made me realize that once I become a dentist that this is the type of work I want to do. I want to travel the world while helping as much as I can with dentistry to keep the world smiling. This experience has been the most rewarding and challenging thing I have ever done. I am grateful that I was given the opportunity to push myself to go out of my comfort zone because I’ve gained so much from everyone I met in Kenya. This was a life changing opportunity which will shape my future as I continue my journey in dentistry, forever advocating for equality in the healthcare systems around the world.

I loved my time in Mombasa with International Medical Aid. From the moment I met the team at the airport, everyone was extremely welcoming and very accommodating. I learned so much during my time at the hospital in the dental clinic and am so grateful I got to shadow such knowledgeable and accomplished dentists and oral surgeons. Some of my favorite parts of this experience included when we got to go to the schools and teach the health and hygiene lessons - I loved all the community outreach we did! The IMA program was undoubtedly a life-changing experience for me and I would 100% recommend it to any pre-health students who want to witness healthcare in a different country. When I received my acceptance email into a pre-dental internship with International Medical Aid, I was overjoyed. I recall immediately phoning my mom to inform her of the great news, and she mimicked my elation. After a few days of discussion about the logistics of the feasibility of this sort of large scale trip, it had been decided - in 2 months time, I would be headed to Mombasa, Kenya for 3 weeks. I had rather straightforward goals for what to gain out of my time in Africa: to learn as much as I could about dentistry and oral healthcare, to help wherever and however I could, and to immerse myself fully in a completely new culture and continent. In the weeks leading up to the trip, I remember feeling extremely excited for the adventure I was about to embark on but also nervous about the cultural and medical differences I would be experiencing. I have had ample clinical experience in the past, with 100+ hours spent shadowing in both hospitals and dental offices, but despite this, I knew that none of that would prepare me for what healthcare would be and seem like in Africa. Flying into Mombasa, I knew I was in for the experience of a lifetime. The sheer amount of information I learned from my internship experience with International Medical Aid was staggering. Spending 5 hours a day, 5 days a week, for 3 weeks, in a clinical setting, particularly one that is characterized by being a fast-paced, high-energy environment, provided me the unique opportunity to see a variety of new procedures each week and gave me exposure to many cases that I would likely never have the opportunity to see firsthand in the US, some of which will be discussed later. As for procedures that I observed and learned about, I was able to witness many that were both common and uncommon in US dental clinics. I observed many extractions, scalings, and root canals (which I learned are actually 3 different procedures: extirpation, biomechanical preparation, and obturation), which I had a certain level of familiarity with from my time spent shadowing in America. While the methodology employed to conduct said procedures were quite similar, the materials used were oftentimes very different. When I inquired about what some of these different materials were (such as using silver fillings instead of composite) and why they were being used, I was oftentimes responded to with the same answer: finances. Seeing the lack of resources available, and even the quality of materials being used, made me acutely aware of the sheer disadvantage that many of the dentists and practitioners had due to the materials they were working with. It was not uncommon for me to hear about how, when moving to work at Coast General, the dentists had to learn new ways and tricks to use the materials they had on hand and improvise in order to provide the patient with the best quality of care possible. One of the most advantageous aspects of my time spent at Coast General Teaching and Referral Hospital was the fact that the dental clinic had almost every aspect of not only general dental work but also specialties in-house, in the dental unit. In the US, when you go to visit a general dentist for a routine check up or cleaning, you would usually go to a clinic, or a stand-alone office. Then, if you need specialized care, such as to see an endodontist or periodontist, you would be referred to one of these care providers who has their own clinic, most times located far away from the original general dentist’s office. If you are visiting a prosthodontist, and need to get fitted for dentures or other similar mouth gear, while you may be fitted for such at the prosthodontists office, the molds taken from the patient will then be sent out to a specialized oral prosthetics lab where the new denture will be made. In Coast General, all of these aforementioned specialties in dentistry are located just a few rooms down from each other. This gave me the unique opportunity to be able to experience so many specialties, with such a wide range of procedures included in each one, each and every day. It was not uncommon for me to go from observing a patient getting braces put on in the orthodontics room to shadowing in the minor oral surgery theater where a different patient was getting sutures on their lip and mouth after being injured in a road traffic accident. I think that this set up could be advantageous to be used in America. Oftentimes, referring patients to further clinics requires extra time and planning, and can lead the patient to be untreated for a lengthy period of time than could be necessary. If dental clinics were set up similar to Coast General, with multiple specialties grouping together and having their own in-house or nearby prosthodontic lab, I think that the quality and efficiency of care could be increased significantly. One of my most poignant learning experiences was becoming aware of how different healthcare delivery is in Africa, particularly when contrasted with the healthcare delivery I am most accustomed to in the United States. Patient interaction and bedside manner is focused on much more heavily in the US (Reference 1). At Coast General, I became more accustomed to seeing limited patient-provider interaction, as reading from patient charts seemed to be the more common form of becoming acquainted with what the purpose of the visit to the hospital was. Then, the dentists would often do an oral examination, without much more direction for the patient other than instructions to open their mouth. Following this, the dentists, if multiple were present in the room, would briefly discuss amongst themselves a possible diagnosis and then determine the course of action following. To contrast this with the US, dental care providers would often initiate conversation with the patient about their medical history and what was ailing them, and there would be much more verbal communication between both parties. Some potential reasons for this could be cultural and social differences in dynamics between healthcare professionals and patients, perceived time allotment per patient, and level of healthcare literacy among the general population. That last reason is also something worth mentioning about differences in patient care. After a visit to the dentist, and especially after a procedure is conducted, either the dentists themself or a hygienist or assistant will give the patient specific instructions about how to care for the wound, any lifestyle or dietary changes that need to be made immediately follow, and any other things to look out for or change. This instruction sequence was not at all present at Coast General. It was rather shocking for me to learn that, other than occasionally telling patients to chew their food on the opposite side of wherever they had the procedure done, there was no instruction given on how to clean or care for the recently operated on site. I believe that a lot of the differences I was made aware of can be attributed to differences in the political systems and structures in place in Kenya as well as some of the many cultural variations interwoven in society that I encountered. One thing I noticed was, because Coast General is a government hospital, many government workers came in for procedures. There would be times when many members of what I assumed to be the Kenyan military would line up inside the dental clinic to get extractions or other such procedures done. This was somewhat surprising to me because I had assumed that those who were a little more financially well off, such as those with jobs in the government, may choose to get their dental and medical work done at a private or other such hospital; however, because of the way the government works in conjunction with the hospitals their, government workers and officials often had their medical care done in hospitals just like Coast General because of their verys subsidized or sometimes even free costs (Reference 2). There were also numerous cases of cultural differences I noted. One was the level of patient and family interaction, especially when dealing with pediatric patients. It was not uncommon for an 8 to 10 year old patient to walk by themselves into the clinic room to be seen by a dentist. In the US, parents are almost always accompanying the children, and it is rare, if ever, to see any patient under the age of 16 without a parental figure with them. The independence and bravery of these elementary and middle school aged children was very impressive (Reference 3). Throughout each day at the hospital, I would take notes on different patients, cases, and procedures, as well as notes on any of the equipment, skills, and techniques being used. Over the course of my time there, I amassed dozens of pages of notes and saw hundreds of cases. Out of these huge quantities of procedures seen and people talked to, a few specific clinical cases did stand out to me. One of which was a 12 year old boy who had been diagnosed with epilepsy. He had been on medication to treat his epileptic episodes for a few months at that point, but had presented at the hospital with extensive oral tumors covering the entire roof and most of the walls of his mouth. When visiting him on rounds through the wards each morning, the dental team began to predict that the cause of these tumors was one of the specific anti-epileptics he was on, called phenobarbital. Dr. Solomon, who led the rounds, instructed some of the attending interns to do research and see if there was any scientific literature or previously published cases where this specific medication had resulted in manifestations of oral tumors. The dental and inpatient team was then put in the difficult position of choosing whether to keep him on the phenobarbital and work to remove the tumors individually or risk taking him off the anti-epileptic medication and see if the tumors reduce from that. Another case that stuck with me was with that of a 25 year old man who initially came in with zygomatic bone fracture and fibrous dysplasia, but who also had fibrosis. I was rather familiar with fibrosis because I have worked in some underserved communities in the US where fluorosis is also a rather common issue. Being able to juxtapose the specific treatment given for this diagnosis in the US versus Mombasa was very advantageous for me to see. A third case that I believe will stick with me far into the future was one of a young girl who was about to turn 6. When she initially came in, I thought she could be no older than 3 based on her small stature. She had a bony tumor on her left cheek that the dentists presumed was cancerous, so they decided to do a biopsy of that sarcoma. She had a huge ulcer on the side of the tumorous mass, and I watched as the doctors carefully cut a small chunk of her cheek out for a biopsy. When cleaning the wound, they found that not only did she have necrotizing fasciitis of the cheek and oral tissue but also of the bone, and one of her molars even fell out while they were treating the ulcerous area. This girl, before she even entered elementary school, would have to undergo a partial jaw resection. The severity of this case was quite shocking to me, but I found the work the doctors did with ehr, and were planning on doing with her into the future, very valiant. The quantity of notable patient interactions is not to be understated, either. One of the particularly poignant interactions for me was seeing an older man who was visiting the dental clinic after having had his jaw fracture treated with a maxillomandibular fixation. After 4 weeks of having his top and bottom jaw wired together, one of the dentists in the clinic assessed him and decided his jaw was stabilized to remove the wiring. This meant he was able to fully open his mouth and eat non-liquid food for the first time in over a month. After the wires were removed, as he was on his way out of the clinic, he approached each of the dentists and interns in the room, including myself, and grasped their hands saying “asante sana” over and over again. He had visible tears in his eyes, and the earnestness with which he was expressing gratitude for the team was very touching to witness. Another meritorious patient interaction I saw was when one pediatric patient, a boy around 5 or 6 years of age, was very hesitant to sit still enough to allow the dentist to inject him with the local anesthetic. He was obviously very scared about the lengthy needle that was about to be stuck in his gums, but instead of just brushing aside his nerves, the dentist took time to speak to him in Swahili and explain where and how the anesthetic would be put in, and how he would feel much better after it was injected. The dentist then repeated what he said to me in English, and it became apparent that the boy was much more relaxed after he knew what was happening. Despite his young age, the boy seemed to just be seeking some words of affirmation from the dentist who was operating on him, and it was very heartwarming to see how the practitioner took just a few extra moments to make the pediatric patient’s dental experience much calmer. This sort of care is something I hope to carry with me when I become a healthcare professional. I will undoubtedly use this newfound knowledge and the perspectives I gained throughout my healthcare career. Throughout my college career, I have always enjoyed community outreach and worked towards connecting volunteers and students from my school to the greater community and city that I live in. I have chaired multiple outreach committees in various clubs I am in on campus and am a frequent volunteer at shelters and mobile health clinics. I was able to pursue this passion on a much larger and a much more diverse scale while in Mombasa. My experiences in East Africa have influenced your interest in pursuing a career in healthcare because I now know I want to incorporate global outreach and service to become an integral component of my career. During my time observing, I was able to see a program known as Smile Train perform dozens of cleft palate surgeries on children, completely free of charge. This is a program I would love to become part of so I would be able to visit hospitals like Coast General and put my knowledge and skills to beneficial use to the community, especially at a low, if not free, cost. I am extremely grateful for all the learning experiences I had in Mombasa, and am sure they will stick with me for not only the rest of my academic and medical career but also for the rest of my life.