Mouth cancer (also known as oral cancer) is when an abnormal group of cells, known as a tumour, develops within the tissues of the tongue, mouth, lips or gums. As a dental practitioner working out in Africa for much of the past 20 years, I have seen for myself how untreated oral cancer can lead to tremendous pain and suffering.
I was based in the Mwanza region of Tanzania, on the shores of Lake Victoria, running a dental health charity called Bridge2Aid (B2A). We took out (and still take) dental volunteers from the UK to train local health officers in basic tooth extraction and pain relief (we’re about to expand this service to Rwanda, too).
In Tanzania, few people have access to oral health care. Dentists are few and far between, mostly located in the cities. The majority of the people in Mwanza are still based in isolated rural communities: what little health care they have is often limited to ‘traditional’ methods and occasional visits from their local clinical officer.
I probably came across 20 cases of oral cancer during 2002-11. Some were caught early and we managed to refer them to the cancer unit in the capital, Dar-es-Salaam. Others were way past surgical help and were cared for by their families at home, sometimes without pain relief.
I first met Janni, an Asian Tanzanian man then in his mid-30s, in 2003. He came to our city clinic presenting a squamous cell carcinoma as a result of chewing beetlenut tobacco. Beetlenut is chewed by many across Asia as a mild stimulant, but research has shown that it has carcinogenic properties.
If we had been in the UK, Janni would have been sent for immediate corrective treatment. However in Mwanza there was nothing available. We did secure an offer of surgical treatment through some generous donors – which would have meant the family paying for his flights to the UK – but in the end this was not possible.
Over the six months we knew him, the tumour gradually ate away at Janni’s face. It left a gaping hole from the top of his jaw bone to his chin, draining smelly puss – his life was literally draining away. We were at least able to obtain Pethidine (pain relief) for him which gave some pain relief. As he died, his family cared for him in their home, a small room separated from the dusty street by only a rickety wooden door. We couldn’t save Janni, but his family were deeply touched and showed us their gratitude by bringing us chickens and traditional craft items.
Vumi was a young lady in her mid-20s. She lived with albinism and had spent much of her life in a government care institution.
Average life expectancy for persons with albinism in Tanzania is 30, with only two percent living beyond 40. In western countries those with the condition have the same life expectancy as the general population. With no skin pigmentation to protect her from the unforgiving African sun, Vumi was always going to be vulnerable to skin cancer.
Although over the years various people had tried to give her and the other albinos in her community advice about skin care, the message failed to hit home. The skin creams, sun glasses, umbrellas and hats usually ended up being sold for quick cash rather than being used for protection.
Vumi had developed small lesions on her fingers when she was brought to our city clinic complaining of toothache. We diagnosed skin cancer, which sadly we were not able to treat. We were able to obtain morphine from the regional hospital and she was given basic palliative care both there and in a rural hospital. She eventually died in her home at the government care institution, surrounded by her family and friends.
Both of these stories come from developing nations where we might expect conditions to be extreme and education poorer, with consequences more devastating than here. In many respects these would be correct assumptions. However we have to consider that here in the UK there are circumstances and habits that can lead to the devastating diagnosis of oral cancer.
Excessive alcohol intake coupled with either smoking or chewing tobacco is one of the main causes of oral cancer here in the UK, and an issue of prime concern amongst oral health professionals. During this national Mouth Cancer Action Month let’s learn from the lives of Janni and Vumi and aim to change our lifestyle where necessary and bring a positive prevention message to those we come into contact with on a day-to-day basis.
*Ian Wilson Bio: Ian graduated from the University of Edinburgh Dental School in 1987 and worked in UK general practice for 15 years while being involved in overseas volunteering since 1990.
Alongside his wife Andie he co-founded the charity Bridge2Aid which aims to address poor access to dental care for people living in rural communities in developing nations.
Ian and Andie lived in Mwanza, Tanzania for nine years, relocating back to the UK with their four children in 2011. In that time they saw the Bridge2Aid team and operations grow to the robust and effective charity that it is today.
As clinical director of Bridge2Aid’s Dental Volunteer Programme (DVP), Ian has had the privilege of pioneering the dental training model alongside the many volunteers who participate in DVP each year and gaining wisdom from those who have pioneered oral health projects into other developing nations.