Caren Abraham, DDS, always knew she wanted a career in which she could serve others in a way that reflected the message in one of her favorite Bible verses, Matthew 20:26, “Whosoever will be great among you, let him be your minister.” She came to believe that greatness is not achieved by what we can gain for ourselves, but instead by what we can give away in service to others. This message eventually led her to become a dentist and serve patients in areas with limited medical care. In 2020, in the middle of a global pandemic, she helped start a dental clinic at Kapsowar Mission Hospital in Kapsowar, Kenya, the first dental clinic in the region. She is currently committed to serve in Kapsowar for at least two more years, and her plan is to remain there for many more afterward. She connected with AGD Impact to discuss her first year of involvement with the clinic as well as to offer advice to other dentists interested in volunteering abroad. 

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Today is International Women's Day. Join AGD is honoring and recognizing the diverse group of women who support the oral health of communities throughout the world. 

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AGD Impact: How did the opportunity to start a dental clinic in Kenya come about? How has the process been, and how were things impacted by COVID-19? 

Abraham: Back in 2018, while attending the Global Missions Health Conference in Louisville, Kentucky, I met some representatives from Samaritan’s Purse, a Christian international disaster relief organization that also supports several mission hospitals around the globe. They connected me with a rural mission hospital, almost 8,000 feet up in the mountains of western Kenya, that had been offering medical care to the tribes in that region for almost 100 years. There had never been a dental clinic in the region before. Many of the physicians at the hospital recognized the need for dental care and reached out to Samaritan’s Purse, which is how I heard about the opportunity. 

I moved to Kenya at the beginning of 2020 and spent four months learning Swahili. It was during this time that COVID-19 became a global pandemic, and things started shutting down in the country. My language studies were put on hold as all schools were closed, and the small town where I was staying had tightly restricted movement. This became a major challenge because I could no longer get to the grocery store to buy food or supplies. While unable to shop for food, I learned how to pick spinach-like greens from a fallow field outside my school and fruit from trees around campus. 

Eventually, I finished language school, and it was time to move to the hospital — eight hours and several police checkpoints away and still during the time when only a limited number of people were allowed to cross regional borders. On top of that, there had been almost daily flash flooding in the area, sweeping away people, vehicles, houses and entire marketplaces. I wasn’t sure whether I would make it to the hospital or not. Incredibly, at each checkpoint, we were allowed to pass without questioning or hassle. We also passed multiple points where there had been landslides, but they had been cleared before we got there. In dramatic fashion, our prayers were answered, and I arrived safely in Kapsowar. 

What differences exist between practicing dentistry in the United States and in rural Kenya? How has this influenced your perspective of dentistry? 

Practicing dentistry in Kenya is quite different from practicing in the United States. For starters, everything is done in the British system — from tooth numbering, names of medications, units of measure, and names of equipment or supplies, to driving on the left side of the road. 

Because this is a rural setting, there are no other dental practitioners in the region, so I must be prepared to handle a wide variety of cases in and sometimes outside the clinic. I have had to clean up the damage caused by local “tooth doctors” who attempted to extract teeth in the marketplace, leaving patients with pain, infection and retained roots. I have also been called unexpectedly into the operating room to extract hopeless teeth without any dental instruments available, and I have even helped identify a child’s age using their teeth. 

The language itself also presents a challenge in that one Swahili word may have multiple meanings in English or vice versa. For example, in Swahili, the same word is used to mean “slow” and “gentle.” The first time I tried to check occlusion, the patient bit down very slowly, but also very hard, and broke the first filling ever done in the Kapsowar region!

Another difference is that almost all my patients have their third molars, and I extracted and restored more wisdom teeth in one month here than I had ever previously done. Our population has never been educated on causes of dental decay or periodontal disease, so I also spend quite a lot of time educating patients during their appointments. I also talk to people when I encounter them at the market or elsewhere in the community because there is so little knowledge of dental disease etiology. 

Serving here has opened my eyes to the multidimensional nature of dentistry. Dentistry is not just treating decayed teeth or replacing missing teeth; it involves a significant amount of community education, preventive care, therapeutic intervention and follow-up. There can be a significant emotional component to dentistry when it comes to restoring a smile that may not otherwise have had a chance. My vision is to see this region of Kenya transformed and a generation of children and adults rescued from rampant decay, pain and infection by educating the community about proper diet and oral hygiene, the dangers of receiving dental treatment from unqualified individuals, and the importance of both preventive and therapeutic professional dental care. As dental professionals, we are entrusted with an amazing profession, and to bring this kind of life-changing care to an entire region for the first time is challenging, humbling and incredibly exciting. 

What advice do you have for other dentists who are interested in working abroad? 

There are many ways to serve abroad as a dentist. Even a short trip can make an enormous impact in a person’s life — both the patient’s and yours. Some things to keep in mind: 

• Go with an open mind. Serving abroad is always an adventure. It can be an opportunity to learn a new language and a new culture, even if you are only going for a few weeks. But there will be things that confuse or frustrate you. Don’t let that discourage you. Instead, use it as a chance to grow. 
• It will be uncomfortable. When you serve abroad, you have to get outside of your comfort zone. There will be things you will have to go without, both in everyday life and in your practice setting. Be ready to think outside the box and learn from the people you meet. You may even change the way you live when you return home. 
• Don’t forget your mission. Even when things get tough or don’t turn out the way you expect, don’t forget you came to serve others. Things almost never go as planned here in Kenya, but, at the end of the day, I have the joy of having cared for my patients holistically — both in body and in spirit. Serving abroad allows you to truly impact another person’s life for the better. 
• Have fun! Dentistry is a blast, especially when you have the freedom to take your time and be creative. Don’t miss the opportunity to enjoy your profession.