What benefits will the new Dental Vision Clinic bring?

Credible dental healthcare is scarce in South West Uganda.

• Refined sugars have become readily available in the community which has resulted in a dramatic increase in the incidence of dental decay.
• Decayed teeth lead to pain, loss of school hours, diminished general health and quality of life. Gum disease and subsequent tooth loss has also increased as the population lives longer but lacks preventive dental services.
• The Uganda Ministry of Health recognise the great need to increase the trained workforce, especially in rural communities. Without a professionally operated facility, patients may obtain unqualified diagnoses and treatments may be conducted with primitive, non-sterile tools.
• Untreated chronic and acute dental diseases are extremely painful and sometimes fatal. Infected teeth may fester for years, which, according to the World Health Organisation, ‘accounts for a loss of working and school days comparable to malaria and HIV’.

Seeking to end the endemic and barbaric practice of Infant Oral Mutilation (IOM) is the cultural practice of forcibly removing the un-erupted primary teeth from the gums of infants by gauging them out with unsterile instruments such as bicycle spokes or sticks. 

• It is conducted by traditional healers in a misguided attempt to treat fevers and diarrheal diseases in infants and toddlers and is a common practice in rural areas throughout East Africa including Uganda.
• Infant oral mutilation has been surveyed in the Kanungu District of south west Uganda at an incidence of 12% of all school children.
• In the hope of eliminating this practice Bwindi Community Hospital have been engaged in efforts to increase oral health literacy but more workforce is needed.
• Typically, a parent may take a sick child to a traditional healer who will look in the child’s mouth and attribute the illness to the healthy bumps in the infant’s gums, diagnosing healthy tooth buds as ‘tooth worms’. The healer will then dig the ‘worms’ out of the gums without anaesthesia, inflicting terrible pain and suffering.
• At best, this practice traumatizes children, delays medical care and results in the needless and painful loss of teeth.
•  In worst cases, and not uncommonly, death can result as the unhygienic methods used can cause blood infections, tetanus, pass on HIV/AIDs.
• This dangerous practice is a strongly held traditional practice that can only be addressed through increasing health literacy and oral health knowledge, even among local medical staff.

• Whilst the introduction of an Ophthalmic Clinic Officer (OCO) at Bwindi Community Hospital in 2019 has since allowed patients to access treatments for simple eye problems (including ocular allergies, dry eyes, Vitamin A deficiency, mild ocular infections, spectacles for presbyopia), a wide range of common ocular conditions continue to go untreated. Cataract, glaucoma, diabetic retinopathy, retinal detachments, anterior uveitis, more complex refractive errors are beyond the treatment competencies of an OCO. 
• With the introduction of a dedicated Ophthalmology Operating Theatre and the promise of a trained Ophthalmologist it will be possible for local people to directly benefit from this project as they will be able to access affordable treatment for these conditions.

Quality eye surgery services will treat ‘avoidable blindness’ caused by cataract with the introduction of a dedicated Ophthalmology Operating Theatre. The Ophthalmology Operating Theatre will immediately accommodate the services of visiting ophthalmic professionals and when qualified, the resident Ophthalmologist; the theatre is deliberately spacious to allow qualified surgeons to teach junior colleagues and allied healthcare staff.

 Bwindi Community Hospital’s robust remote outreach services play a large role in reaching the most vulnerable patients, especially in our post-COVID world, as locals from remote communities are fearful of attending the hospital. The project will expand and fortify existing outreach dental and vision care services including remote evaluations, referrals and transportation to the Clinic.

Primary and Secondary Education is at risk in those children and teenagers with severe dental caries and periodontal disease; the same risk applies to those with vision impairment.

·       A child with sight impairment invariably drops out of education in Uganda and statistically is less likely to live into adulthood.

·       Preventative and early restorative interventions will be a focus of a public health centred care philosophy targeting school aged children.

Patients will receive timely dental and eye healthcare services

·       Currently, patients are referred to other centres to access specialist treatments (the nearest being a 4 hour + drive away in Mbarara).

·       Most fail to follow-up on referral advice due to the prohibitive costs/time involved.

This new facility’s large lecture room and skills lab will be used to provide adult education:

•       Students from Bwindi Community Hospital’s two teaching institutions (Uganda College of Health Sciences and Uganda Nursing School Bwindi) will be trained in oral health and ocular health through lectures, assisting in clinics and observing surgeries to further their understanding and enhance their skills set.

•       The Dental Health Officer at Bwindi Community Hospital, Onemus Keimus has recently completed a Master’s degree in Health Science & Education with the intent of leading the Dental Officer Training Program at Bwindi Community Hospital. The new dental clinic will therefore become a much-needed training centre for Public Health Dental Officers.

•       The community will be invited to attend lectures and learn about the importance of early prevention and intervention of dental and ocular disease. Expectant mothers, in residence at BCH’s waiting mothers’ hostel, will receive dental health education targeted at eliminating Infant Oral Mutilation practices.

•       Community health teams and teachers will be invited to attend lectures and hands-on demonstrations to learn how to vision screen children in the community and identify those that need to be referred to the hospital for further investigation and management.