Promising: Global Public Health Dentistry in Senegal

Promising: Global Public Health Dentistry in Senegal

Christi Berkseth*:

Feature

Transatlantic Continuing Education

AssalamMalikum! Naka nga def! This is the standard greeting in Senegal, West Africa, the land of Teranga (hospitality) and my home for the summer of 2006. My goal in Senegal, along with learning Wolof (the main language), improving my French, and integrating into their culture, was to carry out an independent research project on a topic of my choice. The intent of this University of Minnesota program was to make contacts in Senegal and research a subject with a 50-page thesis as the final project. With dental school in sight, the clear choice was something in oral health. I chose comparison of modern and traditional dentistry in Senegal. Now in my second year of dental school at the U, I continue looking for appropriate ways to honor my Senegalese research participants by sharing the knowledge gained during my investigations.

The field of global public health dentistry was virtually unknown to me in 2006, and this undertaking would not have been feasible without the expert guidance of number of people at the U. Professor Peter Berthold, Division of Health Ecology, helped me develop projects, work through problems, and find both knowledge and enthusiasm. Professor Victoria Coifman, Afro-American and African Studies Department, historian and expert in oral traditions of West Africa, was my guide to Senegal. The incredibly generous people of Senegal were my resources, cultural brokers, and friends: especially Anne Langdji, who helped organize portions of my research, and my loving Senegalese mother, DabaDiallo.

My adventure in Senegal took me from bizarre, comic situations in dark corners of the trading markets of Dakar, the capital city, to a horse cart traversing the bush by the light of the moon. In these moments that I hadn’t planned to be learning I actually learned the most critical lessons. I will never forget what one Senegalese woman said to me after an interview about her experiences with dental care. She essentially asked, “What are we going to get out of this?” I said I would do whatever I could to use the information for their benefit. Her weary response roughly translated to “promises, always promises.” The people of Senegal don’t need to have their suffering merely scrutinized; research and action must go hand
in hand.

 


The author and her patient, who taught her the real-world fact that "research and action must go hand in hand".

I hope the knowledge gained through my travels and investigation can be considered by dental practitioners in our rapidly diversifying Minnesota in treating patients of African origin. Customs vary widely, even within Senegal. I hope my knowledge and observations may
be a starting point for questioning patients about their oral health practices, implementing strategies
that will be acceptable to both patient and practitioner based on how patients experience dentistry in their country of origin and how that compares to and informs their experience here. Modern dentistry in Senegal roughly parallels that in the United States, albeit with a lag
in technology and materials. How traditional dentistry is incorporated into treatment of oral health problems was highly instructive.

Traditional Dentistry and the Guerriseur

In actuality, traditional dentistry does not exist: the mouth and teeth are simply other parts of the body requiring attention, not parts requiring specialized care. A traditional healer practicing in a clay and grass hut in Touba-Linguère, a village six hours from Dakar and 23 kilometers by horse cart from the nearest dentist, informed me that, “A guerriseur (healer) is the opposite of a specialist, and for this reason one would not find a healer that specializes in teeth.”

Traditional medicine in general is essential to Africans. According to Dr. Erick Gbodosso of the Association for the Promotion of Traditional Medicine, 80% of Africans receive their primary health care from their traditional healer. It is an essential part of the lives of most people that cannot be ignored when dealing with the health of Africans. A healer relies not on information gained through the Western system of education, but from wisdom and knowledge passed down through oral traditions or spiritual beliefs.

In terms of ability to treat tooth problems, the healer informed me that he does not have the ability to heal the tooth, but can help alleviate the pain. Toothache uses a specific formula. First visit: apply a curry and vinegar mixture to the tooth. If no relief, next came boiled leaves and roots of gisgis, a local plant. Neither of those working, he would use goleng, another local plant. In practice, if I knew my patient used traditional remedies, I would ask for specifics.

The Chewing Stick

The chewing stick has been used in areas of West Africa for centuries, likely as a result of Arab forays into the area.1 Depending on the user, its purpose may be hygienic, religious, cultural, or esthetic. In Senegal, one will see people with chewing sticks at all times in all places. An obvious purpose is cleaning the teeth, with other suggested hygienic benefits including tooth whitening, removing tartar to avoid calcium deposits, gum strengthening, stabilization or regression of dental caries, removing or killing bacteria on teeth and gums, and masking or eliminating bad breath.2 There is a tendency to use the chewing stick in an excessively rough manner throughout the day, primarily on the front teeth, which eventually has deleterious effects on both teeth and gums.3 A survey showed children begin using the stick between the age five and seven.4 Knowing a patient uses a chewing stick, the practitioner may attain better patient compliance by altering typical oral hygiene home care and may look for potential recession due to aggressive use of the chewing stick.

Gingival and Cutaneous Tattooing

Gingival and cutaneous (mostly lip and chin) tattooing is a tradition practiced primarily among women. In the past, it was essential for recognizing members of the same social class.5 It is not a practiced among all Senegalese. The tattooing ceremony takes place very early in a girl’s life and is done across all Senegalese ethnicities starting at the age of 15. It has three main purposes: initiation, esthetics, and therapeutics. The practice is almost akin to ritual circumcision among men and is necessary for a female to enter into womanhood in certain communities6. It is a mark of distinction, and honorable for the girl to endure the pain of the ritual without complaint. It is a mark of beauty, as it accentuates the whiteness of the teeth and beauty of the face. It is also believed to achieve a number of therapeutic ends, including curing migraines, improving vision, strengthening teeth and gums, and removing “bad” accumulated blood from the gums.7 It is traditionally achieved using a peanut-based pigment called pimpi and needles or spines from a plant.

This practice is obviously worrisome because it is not done under sterile conditions. The fact that extensive bleeding is necessary in order to achieve a satisfactory hue raises serious questions about blood-borne pathogens.8 Nonetheless, it continues to be practiced in many Senegalese populations.

Diastèmes

A diastème is gold or jewelry placed in a space between teeth. Widely practiced among 20- to 40-year-old women in larger towns and cities, it is a mark of beauty and distinction. They are a sort of prosthesis as replacements for lost teeth. One can easily find an artisan who specializes in creating these prostheses. The practice is learned and honed through apprenticeships and has no scientific or medical aspect.9

Conclusion

My experience in Senegal was a real-life continuing education course on cultural competency. I learned how critical it would be for me to be cognizant of my patients’ traditional practices and beliefs, and how these experiences shape their relationship with modern dental care. As a dentist I will see a wide variety of cultural backgrounds and cannot be knowledgeable about all of them. (I only scratched the surface of Senegalese traditional practices, after all.) I can use this awareness to understand patients’ difficulties with compliance to medical orders or frustration over a complex medical system. Above all, I can strive to be aware of and empathetic to how patients’ traditions influence how they respond to modern dentistry. I hope to act as a conduit for transmitting this knowledge between two distinct cultures to foster mutual understanding and benefit in patient encounters.

 


Sengalese commerce operates at a level very different from what we are used to
Global public health dentistry means meeting the global public

References

1. Grappin G, Di Pasquale C, Mawupe-Vovor K, Thiam CT. An investigation in Senegal on the traditional African “Sotiou” toothbrush. Rev SESDA 1974;(7)(7): 10-14.

2. Traoré, Modibo. Coutumes et Therapeutiques Traditionelles Odonto-Stomatoloquie au Mali. Unpublished doctoral dissertation, Université Cheikh Anta Diop de Dakar, Faculté de Médicine-Pharmacie et d’Odonto-Stomatolgie, Dakar, Senegal. (1975).

3. Wane, Mamadou Hady. Impact des pratique traditionnelles odotonogiques sur la sante bucco-dentaire des populations au Senegal. Unpublished doctoral dissertation, Université Cheikh Anta Diop de Dakar, Faculté de Médicine-Pharmacie et d’Odonto-Stomatolgie, Dakar, Senegal. (1992).

4. Grappin G, Di Pasquale C, Mawupe-Vovor K, Thiam CT. Aninvestigation in Senegal on the traditional African “Sotiou” toothbrush. Rev SESDA 1974;(7)(7): 10-14.

5. Thiam, Diabel. Le tatouage gingival au Senegal: facteur de risqué de transmission du VIH. Unpublished doctoral dissertation, Université Cheikh Anta Diop de Dakar, Faculté de Médicine-Pharmacie et d’Odonto-Stomatolgie, Dakar, Senegal. (2000).

6. Niang, Fama Fall. Tatouage Gingivo-labial: etude antomo-pathologique et chimique. Unpublished doctoral dissertation, Université Cheikh Anta Diop de Dakar, Faculté de Médicine-Pharmacie et d’Odonto-Stomatolgie, Dakar, Senegal. (2000).

7. Niang, Fama Fall. Tatouage Gingivo-labial: etude antomo-pathologique et chimique. Unpublished doctoral dissertation, Université Cheikh Anta Diop de Dakar, Faculté de Médicine-Pharmacie et d’Odonto-Stomatolgie, Dakar, Senegal. (2000).

8. Wane, Mamadou Hady. Impact des pratique traditionnelles odotonogiques sur la sante bucco-dentaire des populations au Senegal. Unpublished doctoral dissertation, Université Cheikh Anta Diop de Dakar, Faculté de Médicine-Pharmacie et d’Odonto-Stomatolgie, Dakar, Senegal. (1992).

9. Wane, Mamadou Hady. Impact des pratique traditionnelles odotonogiques sur la sante bucco-dentaire des populations au Senegal. Unpublished doctoral dissertation, Université Cheikh Anta Diop de Dakar, Faculté de Médicine-Pharmacie et d’Odonto-Stomatolgie, Dakar, Senegal. (1992).

 

*Ms. Berkseth is a second-year dental student at the University of Minnesota School of Dentistry, Minneapolis, Minnesota 55455.  E-mail is berk0086@umn.edu.