Northern California dentist volunteers in Uganda as dental champion
May 13, 2020
Education: Dr. Jean L. Creasey teaches procedures for oral exams and cancer screenings to nursing students at the Uganda Nursing School Bwindi, operating under the Bwindi Community Hospital and founded by the Kellermann Foundation.
— Dr. Jean L. Creasey lists her hobbies on her CV.
One of them is, “travel with purpose.”
Traveling with purpose is what has led the Nevada City, California-based general dentist to a rural district in the southwestern region of Uganda over the past 15 years as a member of the Kellermann Foundation
, treating and helping educate the villagers on the importance of good oral health as a way to a better future.
“Ironically, I used to be pretty risk-averse and never expected to be a part of any project like this,” said Dr. Creasey, whose dentist husband, Dr. C. Craig Creasey, is also involved with the Kellermann Foundation. “But I am a true believer in the power of global health collaboration and grateful for an opportunity to share the message of hope with others.”
Dr. Creasey, a 2001 graduate of the University of California, San Francisco School of Dentistry, and former member of the ADA Council on Dental Practice, was a member of the board of directors for a number of years with the Kellermann Foundation.
The latter is a nonprofit that began to support the outreach work of Scott Kellermann, M.D., and his wife, Carol Kellermann, in rural Uganda, where they were conducting mobile medical clinics, often hanging IV bottles from trees, dripping quinine into the veins of children suffering from cerebral malaria.
Now an adviser to the group, Dr. Creasey has been to Uganda seven times, most recently this past September, with a team of ADA member dentists she recruited to join her.
In 2001, the Kellermanns founded the Bwindi Community Hospital in Kanungu, now a 125-bed facility providing health care to a population of over 120,000 people, with a mission of providing “hope and health to the Batwa pygmies and adjacent community in Uganda,” according to Dr. Kellermann. The Kellermann Foundation also financially supports the affiliated Uganda Nursing School Bwindi, a bachelor’s-level nursing program, as well as school scholarships for Batwa children.
While the Batwa pygmies and their neighbors have been welcoming, the remoteness of the region where the Kellermanns work has been intimidating.
Joy: Dr. Jean L. Creasey holds a newborn in a maternity ward of the Bwindi Community Hospital, where she spends time educating new parents on the importance of dental care for not only themselves but also for their children.
“In the rural southwestern Ugandan subcounty where we work, they have no paved roads, no running water and until just last year they lacked dependable electricity,” Dr. Creasey said. “In the rainy season, the roads can be impossible. They rely primarily on subsistence farming. The Batwa community is one of the most marginalized and poor people group in the world. They had lived as nomadic hunter-gatherers, for time and eternity, in the Bwindi Impenetrable Forest, alongside the famed mountain gorillas. When the forest was turned into a national park in 1991 to protect the gorillas, the Batwa were evicted without compensation. They have long been held in low status among the more dominant tribal ethnicities.”
The reason Dr. Creasey joined the Kellermanns in the first place was simple.
Dr. Kellermann was the Creaseys’ family physician for a number of years — “the kind of family doctor who would show up at your front door if someone was too sick to go to his office,” she said. When Dr. Kellermann and his wife, after spending a summer in rural Uganda conducting a medical needs survey on the Batwa pygmy community, decided to sell their home and medical practice and move to Uganda, many of his former patients, including the Creaseys, rallied to support their work.
The dental facility at the hospital is a modest one-chair unit and is chronically under-resourced, so Dr. Creasey has set out to expand it. But initially, she encountered a situation she didn’t expect, she said, that demanded attention.
On one of her first excursions in Uganda, she surveyed the young children’s dental health and noticed that 12-15% were missing their lower canines. Her investigations determined that local traditional healers had a tradition of extracting the lower incisors — a practice they called “ebino,” or otherwise known as infant oral mutilation. The lower canine tooth buds appeared prominent at times coinciding with mild infections in children due to the waning of maternal antibodies, Dr. Creasey said.
The tribal doctors associated the infections with the teeth, removing the unerupted canines as a presumed corrective.
“While results of this practice are usually limited to loss of primary canines and collateral damage to permanent teeth, occasionally there are consequences far more serious, including sepsis, tetanus, HIV transmission or death,” Dr. Creasey said. “The procedure itself is performed utilizing a variety of instruments, including wire, bicycle spokes or razor blades. Because this remedy has no relationship to the underlying illness, critically needed medical care is often postponed and complicated when ebino is performed.”
Dr. Creasey said that her ultimate goal is to design an effective community education outreach that will reduce the incidence of ebino.
“Dr. Creasey engaged the traditional healers and community members, concluding that the path to solving this situation was through education,” Dr. Kellermann said. “ She then initiated dental education not only among the [healers] but also in the community in general. The results are encouraging and the rates of ebino appear to be decreasing. Through Dr. Creasey’s leadership, vision and engagement, quality dental care and education will be brought to a remote region of the world where previously dental care was only a dream.”
“Being of service in health care seems to resonate as a meaningful experience with almost everyone and they are glad to find a successful, and non-corrupt, project to engage with,” Dr. Creasey said.
Routes of progress
Dr. Creasey has established a working partnership every year with the region’s lone dental health officer, providing lectures to hospital staff and nursing students and also giving presentations in the local elementary schools.
“I think increasing oral health literacy among the key decision makers has been important,” she said. “As far as integrating oral health at the hospital as a priority in overall health, it has been a long process relying on repeated messaging and a little consistent nagging. My sense was that in the early years, the hospital rightly focused its resources and attention on more pressing matters of malaria prevention, HIV, maternal health and childhood malnutrition. As better outcomes have been achieved in these areas, they now have the luxury to look to vision and dental care.”
Another strategy that Dr. Creasey said made a difference was creating a business plan for the dental officer to present to the hospital management team. It made a case for the cost effectiveness in hiring a dental assistant, with dental assistants a rare commodity in rural Uganda.
Hands on: Dr. Jean L. Creasey applies silver diamine fluoride to a child’s molar during a school clinic. It was a community outreach visit to an elementary school, working with a nursing student.
“The infection control standards greatly improved and with the assistant able to do very simple extractions, cleanings and interim restorative techniques, the number of patient visits has dramatically risen,” Dr. Creasey said. “Prior to presenting a plan that included conservative estimates of cash flow, the politics of the hospital had not been favorable for expanding the dental team. Now they are believers. I'd love to explore developing a dental assistant training program as well.”
Dr. Carol Gomez Summerhays, past ADA president, is a friend of Dr. Creasey and applauds both her service and character.
“Dr. Creasey is a great humanitarian who has spent a significant amount of time in improving health not only in California but globally, through direct care, teaching, lecturing, publishing and establishing clinics,” Dr. Summerhays said. “Beyond her significant work to improve oral health and overall health in Uganda, Dr. Creasey has kept the peace. There was a major dispute between two tribes of Batwa pygmies. Through Dr. Creasey's wisdom and mild manner, she was able to help negotiate peace."
Dr. Creasey recognizes the current and future obstacles she and others have faced in Uganda, but is optimistic.
“Coming as an outsider with an agenda into a community to make changes in their cultural practices can be risky business,” she said. “My expectations here are tempered by my experiences back home as a dentist who daily tries to inspire patients toward more positive oral health behaviors, always with mixed results. One outcome is certain though. Stronger relationships will be established, information will be exchanged, and friendships will be forged.”
Traveling with purpose is no longer a hobby for Dr. Creasey.
It is a way of life.
To explore international oral health volunteer opportunities, go to the ADA's international volunteer website