Day 10, Children of ash and dust

We met at the dental clinic at 8 AM to take the bus to the Dzleka Refugee Camp. The bus ride to the camp gives me a chance to mention how road construction works in Malawi.

Any road under construction has a “diversion” dirt road running alongside of it. This dirt road often switches, apparently at random, which side of the inactive road it is on. This forces the driver to slalom back and forth over the main road, spending time battling through clouds of red dust from preceding motorists, ox-carts, and herds of goats. It makes for an interesting ride.

While we were making our way to the camp, I imagined we’d pass through a barbed wire fence with needy faces peering at us with hollow eyes. Instead, we arrived at a small health center about an hour from Lilongwe. The four rooms were like American walk-in closets, and there was a waiting room with three walls. The clinic was originally intended for children, but once the word was out, anyone and everyone showed up. Evidently, the camp was just over the hill and housed many people.

I asked our preceptors what nationalities were represented at the camp. Among those countries mentioned were Ethiopia, Somalia, Rwanda, Botswana, and the Democratic Republic of Congo. Language had been a barrier for our whole trip. In this instance, with all of the languages in a given African country, it almost proved insurmountable. I was reduced to a very rudimentary pantomime.

My first rotation was in ART (atraumatic restorative therapy). Due to a lack of facilities and space, I straddled the end of a bench. A Rwandan woman laid down on the bench with her head in my lap, and I began scraping out the decayed parts of her upper right first molar. After cleaning the cavity the best I could, I filled the hole with a glass ionomer filling material.

I then switched over to diagnosis. When I opened the door from the ART closet, I found the entire hallway literally clogged with refugees waiting in line. I bodysurfed/forced through the crowd, which was not the first time on this trip I found myself lamenting my enormous gut. Once through and into the waiting area, I saw the extensive collection of people waiting to get treatment.

After collecting names, tooth counts, and disease states, I transferred to scaling. Dedicated readers will be familiar with my stories of calculus, but again the bar was raised. When I walked in to relieve Anina, she smiled both gratefully and sarcastically while handing me a scaler. “Good luck – I’ve done the facial side of the anterior sextant.” When I sat down and got to work, I saw what she meant. An hour into my continued scaling of the patient, I had to call over the preceptor. I thought I’d broken a decayed tooth in half with the instrument. He assured me that I had simply knocked free a calculus deposit so large that it appeared to be an additional cusp. After it was removed, the gum was over a millimeter away from the tooth – the calculus had pushed it so far away. Needless to say, there was ferocious bleeding. He took it well, though, and said “God bless you, sir.”

I spent the rest of the day scaling. It was grueling, bloody work.

The ride home was again along the red-dust-diversion-laced roads. Malawians seem to set lots of fires, so the air is always flavored with the sweet tang of woodsmoke. The sun was setting, and occasionally, it would strike perfect silhouettes of the folk we passed between the road dust and the smoke. A cyclist hauling a load of sugarcane was enshrined in amber light as we crested a hill. Some boys playing soccer were perfectly framed in red and black as the setting sun set the colors of the dust on fire. If Malawians could market their sunsets, they’d be able to afford more dentists.

When we got home, I found that our housemates had purchased a pair of goats to celebrate the end of our collective time in Malawi tomorrow. I’m hoping I won’t be around when they’re prepared. It’s like stepping up to grad school in terms of the animal slaughter, and I’m content with my BA in chicken chopping. Hopefully the goats won’t eat my laundry before we eat them tomorrow.

Our last working day in Malawi is tomorrow. We’re going to see an HIV/AIDS support group in Salima, a town next to Lake Malawi. With any luck, we’re going to stop by the beach before coming back to Lilongwe.