The dental professional and educator from Seattle, Washington, jumped at the chance to spend six weeks at AKU-Karachi to help set standards and create protocols for a clinical practice where students could treat actual patients.
“My assignment was to have students see their first patient and develop a sustainable systems process, including: faculty/student calibration, how students were going to work within the system, and designing an evaluation process for them,” Salima explained.
During this short stint, she also lectured in theory and clinic and did community outreach work with urban and rural health centres. It was through her outreach with school-age children that she discovered that many of them would bring a form of smokeless tobacco known as Chalia — also a carcinogenic appetite suppressant — with them to class, contributing to red stains and dental decay. Cheap and widely available, its candy-like appeal is deceivingly attractive to young children, leading to life-long addiction.
In clinic, Salima observed the other end of the spectrum. “I witnessed a number of elderly patients who continued to be diagnosed with pre-cancerous and cancerous lesions, some presenting with extensive facial deformities.”
She also noticed an unusual number of younger patients with severe periodontal infections, an observation also made by Dr Saida Rasul, founding director of the AKU dental hygiene programme, who saw similar patterns when visiting Karachi in the early 1990s. Many such cases are preventable and can be detected early on through simple and routine screenings which dental hygienists are trained to do.
“Pakistan ranks amongst the highest globally in head and neck cancers and periodontal diseases, and there are no preventive programmes or public health policies in place,” Salima said. She reflected on how the university could implement simple intervention strategies at the local level while developing broader, more sustainable policy mechanisms to reduce the burden of non-communicable diseases in the country. “In the early days, our motto was – ‘simple solutions, big impact’ – for example, having clearer guidelines on infection control. How do you introduce a concept in the absence of guidelines?” This, along with setting basic standards of dental hygiene practice and care, remain the primary goal of the programme.
The need for trained and qualified faculty was clearly evident. “Every time I came back, I observed local needs and listened to the concerns of students, staff and faculty,” Salima said. “I attempted to identify key gaps and how best local faculty could address them. Over time, I began to understand the cultural nuances and learned how I could teach effectively in that environment.”
While Salima considered accepting a full-time position with AKU after her first TKN assignment, she was unable to do so at that time. However, she returned to Karachi several times over the next three years, as a TKN volunteer. All these experiences gave Salima a solid understanding of the needs and motivated her to consider a full-time role. In 2018, she successfully applied for the Director of Dental Hygiene position at AKU.
Due to limited dental hygiene faculty at the university, Salima is relying on a network of other faculty to teach the programme. This year, she expects several TKN volunteers to come and work with her at different times, creating a unique and collaborative model in dental hygiene education. Although the program is still in its infancy, it attracts students from Pakistan and from other countries including Kenya and Uganda. So far 27 students have graduated from the programme.
“Through my TKN experience, I’ve crossed paths with other TKN dental faculty and we’ve all benefited from the true spirit of volunteering and giving,” Salima said. “What binds us together is that we are dental professionals who want to give back. Even now, there are many I haven’t met in person, and yet they continue to support us in various capacities.” Salima adds that they bring with them a sense of quiet strength and comfort. “When a TKN volunteer teaches in our programme, they bring the ideals of ‘best practices’, a term repeatedly referenced by Mawlana Hazar Imam during his Diamond Jubilee.”
Dr Saida Rasul expressed high words of praise: “TKN volunteers have been the backbone of the dental hygiene program at the Aga Khan University since its inception. Without TKN volunteers, this programme would not have been possible to launch and sustain. The university is extremely grateful to all the volunteers who helped launch the programme, those who come on a yearly basis and those who continue to support us from a distance. We applaud and celebrate every volunteer, past and future, for their generous contributions.”
Stemming back to her grandparents and parents who exemplified a strong ethic of giving their time and knowledge, Salima feels fortunate to be doing this inspiring work. She hopes that this family tradition and her commitment as a TKN volunteer will always stay with her and encourage others.
