When dentist Deborah Tuzo entered Howard University to do her orthodontic residency programme, little did she imagine that a friendship with a fellow student would lead to her spending her annual vacations as a volunteer with the AHEAD programme in Tanzania.

Now back from her second trip to some of that country's remote regions, she is tired but happy in the knowledge that she has helped to make a difference in the lives of the villagers.

Dr. Tuzo first heard about the US-based AHEAD organisation through its directors, pediatrician and public health specialist Dr. Irving Williams and his educator wife Elvira, whose son-in-law was also in the orthodontic programme. The couple had spent two years in Tanzania, during which time Dr. Williams noticed that the infant mortality rate for preventable diseases was very high, so he began an immunisation programme in 17 villages in the Shinyanga region.

Among her qualifications, Dr. Tuzo holds a Master's degree in public health from Johns Hopkins University, so when the Williams' suggested that she become a volunteer sometime, she kept the invitation in mind. First, however, she needed to continue her professional career, so she returned home to rejoin the Department of Health as a dental officer. In 1991, while retaining that position, she also opened her own orthodontic practice on a part-time basis. Two years later, she left to devote herself fulltime to her flourishing practice.

Finally, last summer Dr. Tuzo found the time to go to Tanzania, and she set off armed with quantities of supplies and equipment donated by Bermuda dentists, which she would deliver to the Mihumbili University dental school. The journey from Bermuda to Tanzania was long, tiring and at times arduous, but she was buoyed by a sense of purpose and excited that she could help.

If things were less sophisticated than she imagined at the dental school in the country's commercial capital, it was nothing compared to what she would see first-hand out in the country.

"The dental school is poorly equipped. The theory is good but they can't afford supplies, so the practical side is not as well developed," Dr. Tuzo says. "However, I found the dean, faculty and students to be very well motivated, and keen to learn any new information about dentistry. Therefore, I decided that my main thrust, on returning home, would be to to collect as many dental supplies as I could for the school, and also try to co-ordinate an `adopt a dental school' programme, whereby western dental schools could send surplus equipment and supplies to their counterpart in Tanzania."

Leaving Dar-es-Salaam, a two-hour flight or a 2-day train journey ends in the Shinyanga region where the Bermudian volunteer caught her first glimpse of African country life.

"It was the dry season and people were dipping water from six to ten feet below the river bed," Dr. Tuzo says. "It humbled me as to how fortunate we are. We have nothing to complain about in Bermuda when we compare our lifestyle with what I witnessed there. Yet the beautiful part was that the people are warm, friendly and generous. Whenever you go to their house they invite you in. Even if they have very little they want to share it with you, so I had lots of rice, potatoes and beans! On the odd occasion we would have chicken."

Trucks visit the villages once a week to deliver fruit, rice, kerosene and fabric.

"In the area I was in, women are discouraged from wearing slacks, so everyone wears long skirts, including we volunteers, and T-shirts and flip-flops," Dr. Tuzo says.

Villages in the area where she lived were built in the traditional manner, but the schools were constructed of concrete, and there was also a one-room clinic.

"When the nurses and the village health care workers conduct their clinics, women come from the villages and the surrounding areas with their babies. Some walk five to eight miles so their babies can receive health care," the orthodontist says.

Long lines of them can be seen waiting patiently under the shady trees and while they do so they are entertained. The AHEAD driver teaches them songs about the importance of health care and he also encourages them in traditional songs from their area.

To be weighed, the babies are slipped into special "weigh pants" which have long straps that can be hitched to a hanging scale which is often suspended from a tree. Each mother is given a pair of these pants, which have been donated by AHEAD supporters.

Dr. Tuzo's focus was oral health education and she worked alongside a Tanzanian dental therapist.

"Tanzania has several dental therapy schools where the therapists are taught to do routine dental extractions, oral diagnosis and cleaning, and dental education," she says. "The therapist I worked with was a very bright and astute young man who made excellent oral diagnoses and performed his dental procedures with great skill and competence."

Nevertheless, she was amazed to see that his operatory was not only shared, but had no running water and was also next to a TB clinic.

"He had only the simplest of equipment, and when he was finished with a patient he would stoop down under the table and dip a cupful of water into a basin to use with soap (to wash his hands). He boiled his instruments in a pressure cooker over a kerosene burner for 40 minutes to sterilise them."

So Dr. Tuzo, whose own practice is immaculate and well organised, helped the therapist to organise his office ergonomically, and she also gave him dental books.

Asked what she thought the biggest dental health problems in the areas she visited were, the Bermudian orthodontist said: "Peridontal disease and dental fluorosis and research is being done by the new dean of the Muhimbile Dental School - De, Mabeleya."

As for AHEAD's immunisation programme, Dr. Tuzo said this is flourishing and very successful.

"There are 17 programmes in the Shinyanga region. They have 6 nurses who are based in the central village and in each of the 17 villages there is a male and female health care worker who go out on a monthly basis and weigh and immunise the babies. In addition, they teach the people about nutrition and other health and sanitation practices."

Citing resolution of the lack of firewood in the region as one example, the Bermudian volunteer says the people have been introduced to the "cook it". Originally developed in refugee camps, this is a simple, foil-lined cardboard box. Raw food put into a black pot and left on it for at least two hours is cooked by the hot sun.

Because AHEAD's dental programme is still in its infancy, to improve oral health practices people were encouraged to use the "chewing stick" - shredded pieces of stick which they use to rub in a brushing manner around their teeth and gums.

Health care workers also give lectures and these are always very well attended. In fact, with so little entertainment such events are viewed as highlights of life and eagerly looked forward to.

In terms of education, the schools have less space than children to fill them and a typical primary classroom will contain children ranging in age from eight to 12. Where there are desks, they are of the attached variety designed to accommodate two students. In reality, five sit at each one and the rest of the children sit on the concrete floor at the front. All children are educated free at the primary level. In middle school and beyond, the parents must pay, so in a household of boys and girls, where parents can afford it, they educate the boys on the premise that the girls will marry and become part of the husband's family.

In addition to being struck by the friendliness and warmth of the people, Dr. Tuzo was interested to see how children cared so lovingly for each other.

"You would see older children carrying their younger siblings tied to their side or back and you can tell that they are very dedicated. They will feed and tend to the children's needs," she says.

Indeed, life for the African child is not easy.

"You would see the children walking, most times barefoot, to get to school, which generally started at 8 a.m. In most families, they would have been up at dawn to the take the family cow or goat out to graze and there is hardly any grass."

By the time the Bermudian orthodontist left Tanzania last year, she had made many friends, some of whom continued to write to her, and she was also very impressed with the AHEAD programme, and in particular Dr. and Mrs. Williams.

"They are the most dedicated people I have ever witnessed - so full of energy," she says. "They are greeted warmly wherever they go, and are very well accepted in Tanzania for the work they have done."

In fact, Dr. Tuzo was so delighted with last year's experience that this summer she again spent her annual vacation doing more volunteer work in Tanzania. This time, however, she was accompanied by two young Bermudians: financial planner Tamika Todd, who helped with AHEAD's finances and the outreach clinics, and health educator Kendele Smith, who worked with young people and hospital staff regarding sexually transmitted diseases (STD's).

AHEAD has a Teenage Action programme whose aim is to teach adolescents about the deadly effects of HIV/ AIDS, and STDs. It also works to improve their self-esteem through education and community support, and also establishes entrepreneurship programmes for self-sufficiency. Post-elementary school scholarships for girls are also provided.

This year, Dr. Tuzo was even more successful in taking supplies from Bermuda to Africa. Not only did dentists generously donate equipment and supplies, but so too did optometrists and physicians.

"In all, I had 18 boxes and suitcases filled to capacity to take with me, which were donated to the Dental School at Muhimbuli University in Dar-es-Salaam and the Mwanhuzi District Hospital in the Shinyanga region. They were absolutely thrilled to receive them - and in good time too, because they had run out of most of what I took last year."

Fears that lessons taught to the Africans last year might have been forgotten once she departed proved unfounded. In fact, Dr. Tuzo was delighted to discover that all the guidelines were being faithfully followed. The immunisation programme is a huge success, and there are also other significant public health improvements.

To combat diarrhoeal diseases, AHEAD has initiated a water pasteurisation programme led by microbiologist Dr. Robert Metcalfe and Mr.Masanga Salu, who teach villagers and health works how to collect and distil water, and identify e-coli bacteria with the aid of ultraviolet light.

In the absence of thermometers, wapi (devices containing wax which melts at 60-65 degrees Fahrenheit) indicate the temperature at which most of the water-borne bacteria which cause diarrhoeal diseases are destroyed when boiled.

Advanced technology is also beginning to show up with the arrival of a cybercafe in one village, and Dr. Tuzo is somewhat concerned that if satellite dishes follow, thus opening up a whole new world of entertainment, people might not attend health care lectures in the same numbers.

Looking back on her second visit, the Bermudian orthodontist describes it as "another wonderful experience, and an opportunity to give back to those less fortunate than you", but the demands of her busy practice and the long, intense days in Africa without any vacation have taken a toll, so she has decided to forego next year's trip and take a relaxing break instead.