By Marjorie Ferrone

With a craving to “see dentistry beyond the domestic boundaries,” Tina Chou, a second-year student at the University of Pennsylvania School of Dental Medicine, seized the opportunity to advance dentistry in The Gambia in a unique internship opportunity this past summer.

The small, developing West African country faces diverse challenges that require more than money to conquer. After two months of living and working among locals, Chou emerged with the knowledge that time, energy and expertise are steps in the right direction.

Chou entered Penn as part of the accelerated Bio-Dental Program, in which students in one of five undergraduate programs can graduate with a bachelor’s degree in biology after three years and then matriculate to the dental school.

While completing the undergraduate part of the program at Muhlenberg College in Allentown, Pa., Chou lacked a study abroad experience and kept her eyes peeled for a Penn program in which she could travel while being “more than just a tourist.”

After reading a Penn News Today article about undergraduates who worked in Botswana through the University’s International Internship Program, Chou applied to volunteer in The Gambia. The Penn Global office helped connect her with Power Up Gambia, a non-profit organization that works to provide a reliable source of electricity for Gambian health-care facilities by installing solar panels. Both Penn Global and Power Up Gambia recognized the opportunity to involve health care trainees in the organization’s work.

Chou shared the experience with two seniors at Penn, bioengineering major Arielle Clynes and Janice Hu, a French and biology double major. Together, they were the first Penn students to support the health-care and energy-efficiency work at Sulayman Junkung General Hospital, located in the rural village of Bwiam.

“We all had open-door access to the hospital as the first ones,” Chou recalls. “Anything we were interested in, we could get our hands on.”

Chou’s goal was to establish an oral health education program at the hospital. She quickly realized, however, that there were obstacles in her path. Some involved the hospital’s limited resources and personnel. But the most crippling impediment was the language barrier.

Lacking an available translator in a region with four local languages, Chou adapted her intentions to fit the situation. Instead of instituting a more traditional education program, she conceived a way to convey information while reaching the widest possible audience through art.

She designed posters with colorful, instructional drawings of how to properly care for one’s teeth. The posters had captions in English, the country’s official language, but also emphasized visual aids that could be understood by anyone. Some were hung in the waiting area of the Sulayman Junkung General Hospital; others were distributed to hospital personnel working in remote villages where access to medical and dental care was otherwise extremely limited.

Chou accompanied the hospital staff to one of these villages to set up a mobile clinic, traveling from Bwiam in rugged ambulance-type vans. Once at the destination, Chou helped direct the mothers and children who came for free vaccinations and check-ups.

Chou also witnessed the “delicate hand” with which international dentistry projects must be engaged.

“By spending two months [abroad],” Chou explains, “I realized the importance of having locals provide health care and helping them acquire basic necessities on their own instead of just through donations.”

Such donations, Chou says, often miss the mark when addressing medical and dental needs in developing nations and lack the necessary education or follow up. She spent many hours trying first to find donated equipment already at the facility, then to determine whether or not it was functioning properly and finally to locate missing parts.

“I found it incredible that the dental clinic had a portable X-ray machine that stood in the corner, never used,” Chou says. “The machine worked, but they just didn't have X-ray holders and the solutions to develop the film.”

Chou was considered part of the hospital staff during her two-month stay. She assisted the hospital’s lone oral health care worker during tooth extractions by handing her the appropriate tools. She also observed two eye surgeries at the hospital.

Chou says her hands-on experiences and education at Penn helped her during the internship experience in The Gambia, not only in understanding the anatomy of a tooth and how to identify carious lesions (cavities), but also in anticipating the needs of the health-care workers she aided.

An Academically Based Community Service course she took her first year at Penn, Community Oral Health I: Health Promotion Introduction, provided skills that proved especially useful. In this course, Chou and her fellow students participated in Philadelphia elementary and middle school oral health education and were encouraged to think about how culture and health intertwine.

Those lessons were equally applicable across an ocean. Chou found that the relatively few private dentists that did exist in The Gambia were too expensive for the majority of the poorer population to visit on a regular basis. Even toothpaste was a rarity and prohibitively expensive for many families; a tube cost about seventeen times as much as a loaf of bread.

“Toothpaste is not a priority when you’re trying to feed your family,” Chou points out.

Gambian locals use a natural alternative, “chewing sticks” made from strips of twigs from certain shrubs.

“Chewing sticks are effective because you’re actually getting in the area between the teeth as well,” Chou says. “They chew the ends, which become frayed like a softer, bristled toothpick.”

Despite the use of chewing sticks, most dental cases reaching the General Hospital were emergency extractions. To help reduce these cases, Chou’s artwork conveyed the importance of periodic visits to the clinic. In The Gambia, Chou also created and promoted a record-keeping system, introducing a chart that each patient could leave at the hospital to track visits.

During the internship, Chou’s workdays were as varied as her weekends. In her free time, she sunbathed along the Gambian River, harvested honey at a local apiary, traveled to nature reserves with Peace Corps friends and attended a festive naming ceremony for a newborn baby.

Chou says the summer experience helped her strategize ways to tackle challenges, assist in tending to the basic needs of a remote community and understand how to handle different values and lifestyles in a health-care setting.