Who We Are?

The Dental need in Liberia

Liberia has a population of over 5 million people. It is one of the few countries in the world that does not have any dental training facilities. The acute shortage of dentists and/or dental therapists in the health system has posed a serious public health problem.

Currently, only three out of fifteen counties in Liberia are providing any dental care services to the Liberian populace. There are only around seven dentists working in Liberia along with a handful of, lesser qualified, Dental Practitioners.

Oral diseases pose a major health burden for most people in Liberia. These affects are profound and affect people throughout their lifetime, causing pain, discomfort, disfigurement and even death. The impacts of poor oral health are far reaching across the population and have severe consequences for health, including the economic and social development of Liberia.

The most common oral disease observed in Liberia is dental caries (or tooth decay), which if left untreated can result in serious complications such as sepsis. Other oral diseases include periodontal diseases, trauma, oral manifestations resulting from general diseases and oral cancers.

Importantly, most oral health conditions are largely preventable and can be treated successfully in their early stages with access to basic and regular dental care. In addition to this, the burden of oral diseases can be reduced in the population by effective community prevention to promote oral health awareness, key prevention messages and self-care.

Trinity Dental Clinic

Trinity Dental Clinic (see here) was established in 2008 at ELWA hospital in Monrovia to help meet these needs. In 2019, the clinic expanded to a new purpose-built facility with 8 clinical rooms and currently employs 20 staff. These include a Liberian team of a dentist, a dental nurse practitioner, 4 senior dental assistants who extract teeth, 3 hygienists, 2 denturists, along with 2 expatriate missionary dentists.

In 2018, planning for the future, the Clinic sent one staff member to train at Nairobi Dental School, Kenya. He already had several years clinical and administrative experience, but no formal dental qualification. He is due to qualify in the summer of 2024 and return as team lead. In May 2022 and second staff member was sent to train at the Adventist University in the Phillippines. She will be due to qualify in 2028. These 2 will be fully qualified Liberian dentists.

The Clinic also periodically sends out teams on short, 2-3 day, dental outreach trips in rural areas. These provide dental extractions in places where there is no dental provision. But would it not be better if there were well trained people, spread around Liberia, able to provide dental care on a permanent basis?

The Liberia Dental Therapy School

The time is ripe to further the original vision for the clinic for dental training by developing a formal 2 year Dental Therapist training course. So, in June 2024 we hope to be graduating our first 8 Dental Therapy Practitioner (DTP) graduates. 4 of these are existing staff members of the clinic and 4 are new, external, students.

They will have completed a 2-year diploma course, approved by the Liberian Ministry of Health. This will be awarded by Cuttington University, a private University in Liberia and supported academically by Peninsula Dental School, University of Plymouth, UK.
They will be licenced by the Liberia Medical and Dental Council.
They will be returning to their home towns around Liberia, where they will work, fully equipped (using Dentaid field kits – see here)
They will be clinically supported, meeting dental needs, and generating their own income.

8 students began the course in October 2022 using existing facilities on the ELWA site.

We plan to take on more students in subsequent years, facilitated by the construction of a bespoke Therapist School building adjacent to the existing Trinity Dental Clinic. This will have an additional 6 clinical rooms, a waiting area, 2 classrooms, offices and changing facilities.

The 5 year plan

Although the established Trinity dental clinic is nearly self-financing from patient fees, neither the dental therapist students’ fees nor the patients’ charges are nearly sufficient to establish and run the Dental Therapist School, and so we need approximately US$ 1 million (£ 0.75 million) to fund our five-year development plan.

By to date we have raised a third of our total. This is where the money goes:

Trinity Dental Clinic & School ($000’s)	2022	2023	2024	2025	2026	TOTAL
Student Fee Income	1.8	6.3	10.8	14.4	17.1	50.4
Fees to local university (Cuttington)	3.6	9.9	12.6	14.4	17.1	57.6
Equipment for clinic & school	20.0	65.0	0.6	3.3	1.0	89.9
Equipment for graduates¹	0.0	22.4	0.0	16.8	22.4	61.6
Rental, staff & operating costs	14.0	31.5	26.9	26.6	27.1	126.0
Rental costs – schoolroom & student accomodation²	2.0	5.5	5.0	0.0	0.0	12.5
Building works – school & dormitory³	90.0	240.0	60.0	0.0	0.0	390.0
General contingency	15.4	38.9	12.1	5.9	6.6	79.0
Contribution to SIM services (levied on new donations)	26.5	58.3	18.5	6.2	6.4	115.9
Dentist training: two leaders abroad⁴	28.1	30.1	34.0	12.1	15.8	120.1
Total costs	199.6	501.6	169.7	85.3	96.4	1,052.5
Net expenditure	197.8	495.3	158.9	70.9	79.3	1,002.1
Number of 1st year students⁵	8	6	8	10	10	42
Number of 2nd year students⁵	0	8	6	8	10	32

1 purchased early for 2024 graduates to save on freight.

2 an unused room in an empty radio station forms the initial classroom, and local housing the student accommodation, until respective building works are complete.

3 including allowance for cost increases arising worldwide in spring 2022.

4 Eddie is studying dentistry at Nairobi university, expected to graduate in 2024.

Wannie started a six-year course in dentistry in the Philippines May 2022.

5 first cohort includes four current team members.

The Trinity Dental Clinic and Training Centre is a project managed through SIM Liberia, part of the Serving In Mission international Christian charity; training and treatment are offered to people of all faiths, and none. Due to the challenges of transport to Liberia, we are seeking support only in the form of cash donations which may be made here.

For further information, please contact Simon directly at strettondownessimon@gmail.com.

The project is led by Dr Simon Stretton-Downes OBE BDS, who has been the Principal Dentist at Trinity Dental Clinic, as a volunteer, since 2017 and led the construction of the new clinic in 2019. He qualified in 1983 from Newcastle University, and his dental experience includes eight years in Ethiopia with SIM, eight years as a civilian dentist for the UK Armed Forces and 16 years as a partner in practice in England. He was awarded an OBE for services to dentistry in Africa in 2021.