Tshopo, Democratic Republic of Congo — Traditional healers harness generations-old treatments to provide relief for cavities and toothaches.
With effortless ease and calm concentration, Jean Claude Lipaso mixes powders to treat the cavities of a 6-year-old girl sitting next to him. Over the past few years, the 38-year-old father of three has made a living treating cavities using ground snail shells mixed with traditional salts, a skill he learned from his grandfather. For close to two decades, Lipaso sat by the side of his grandfather, who died in 2019, helping him in his trade and absorbing his knowledge.
"My grandfather spent several years treating children's cavities, and I am now following in his footsteps. This snail shell dust has to be placed exactly where the cavity is. You need training like me to do that," Lipaso says, as he applies the powder to the teeth of his young client, Nanah Lokamba.
Lipaso explains that getting the snail shells and salt isn't difficult but knowing how to use them is. Though the skill has been passed down from generation to generation, he is the only one in his immediate family who learned it from his grandfather.
With this method, Lipaso has found an easy way to help the population, as there are many children with cavities in the community but a severe shortage of dental services in the city of Kisangani and the wider Tshopo province. Even when available, the services are prohibitively expensive. A single tooth extraction for a child costs the equivalent of 20 United States dollars or more, which means many people can't afford it. At about 8,000 Congolese francs (3 dollars), Lipaso's treatment is far cheaper. "I don't charge a lot of money like modern dentists do to extract just one tooth," he says.
Franci Baelongandi, the head doctor at Tshopo's provincial health department, says, "Tshopo is a large province in the country but only has five dentists." Two of those dentists are in Kisangani, the capital of the province. Baelongandi believes that this poses a major challenge for those with dental diseases, as some of these cannot be handled by general practitioners.
Does snail-shell dental treatment work?Augustin Sindani is a 36-year-old father of four children. Four months ago, Lipaso treated one of his children, and he's happy with the results, as he says his child had suffered a lot before that.
Lipaso also treated the daughter of Mado Mulamba, a 45-year-old mother of several children who works as a saleswoman. "My daughter has been dealing with tooth decay since she was 5 years old. She would have her teeth extracted one after the other but was always in pain -- nothing worked," Mulamba says. "But a friend came to show me this traditional practitioner who treats tooth decay in children, and once my daughter was treated, she no longer had toothache."
Mulamba believes treating decay by having teeth extracted doesn't fix the problem but is just a way to stop the immediate pain. She prefers the traditional treatment, which is also less expensive than the dentist.
"The extraction of a single tooth costs 20 dollars, so if the child has a problem with more than two teeth, it is a lot of money, while at the traditional practitioner, it only costs 8,000 Congolese francs for the whole treatment," she says.
For Mulamba, the ability to save the tooth is a bonus for the parents and their children. There is also the fact that each problematic tooth only requires one treatment, with no repeat procedures.
Scientific studies lend some credibility to Lipaso's assertions that his remedy works. Multiple studies have demonstrated the effectiveness of using ground snail shells in dental treatments. The dense, calcium carbonate-rich material can be a useful component for bone grafts or dental treatments. Some snail shells even have antibacterial properties, according to a study published in the American Journal of Chemistry.
"The particle size of snail shell is especially important because a reduction in particle size provides a greater surface area. A great number of these natural products have come to the market from the scientific study of remedies traditionally used by various cultures around the world," according to a study on the application of nanotechnology for cleaning teeth. Communities around the world have used snail shells to clean teeth.
The availability of snail shells in DRC
In DRC and particularly in Tshopo province, snail, or mbembe, as it is known in the Lingala language, is making a resurgence. According to the Ministry of Environment and Sustainable Development, several communities supplement their diet with mbembe snail.
In the past, only a few communities ate snail, but with economic challenges in recent years, it has become an affordable, nutritious protein source for many, including in Kisangani.
Doctors weigh in
Some believe Lipaso's treatments could be harmful.
"The treatment that these traditional practitioners give to children for tooth decay is much more dangerous because you don't know the amount or the dose to give to the patients," Baelongandi says, explaining that there are a few other traditional practitioners in the city who treat cavities in a similar way and his criticism isn't targeted at Lipaso.
Amisi Luando is one of only two dentists in the city of Kisangani, which has a population of about 1.4 million people. He has been practicing in the city for more than 10 years and agrees that the shortage of dentists poses a major challenge. Luando says dental diseases are quite prevalent in the city, as children eat a lot of sugary foods such as candy and biscuits. Parents turn to traditional medicine because it is a much cheaper option, but the dentist believes the treatments offer a temporary solution, meaning patients will have to go back for additional treatment. Luando says if patients visit the dentist at the onset of pain, the dentist can determine a permanent solution. But often, patients come to him too late, when they already have an infection, making the extraction more difficult.
Extraction is better than the administration of a drug, as is typical in traditional medicine, the dentist says, because the latter can have negative consequences like infections.
Lipaso, however, rejects the claim that traditional cavity treatment is dangerous, saying he is careful to calculate his dosages to ensure he can properly alleviate the pain of the children he treats.
Tradition vs. science
Science might not be enough to stop the skepticism of the medical fraternity in DRC against traditional treatments, a tension that has endured for decades.
Since 2001, there has been a traditional medicine program at the national level in DRC, but collaboration with the formal health sector is hindered by a lack of trust between traditional and science-based medical professionals. This is further complicated by the unstructured nature of traditional healers' profession and its infiltration by "charlatans," according to a 2016 government strategy document.
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Traditional medicine "constitutes a significant part of the health care offer. In some areas, it is even the first resort, due to the lack of modern facilities, poor financial accessibility and certain specific pathologies (fractures, mental disorders, etc.)," according to the health ministry's 2016-2020 plan.
Lipaso doesn't worry about what critics say about his traditional treatment. The most important thing for him is that it works, and that he can successfully treat his patients. He sometimes faces opposition from doctors in the region who consider his trade to be inferior to theirs, but he believes that his satisfied clients are proof of success. In busy months, he can treat 10-25 clients, though there are months when he may not have any patients. He says the procedure is always successful but cites a shortage of shells and traditional salts as his main challenge. Lipaso mostly collects his shells on the banks of the Congo River, but he is unable to access the side where he might collect more, due to recent flooding and conflict between communities.
He is one of few in Kisangani who have carried on this age-old treatment for cavities, but the resurgence of the snail in people's diets and as a natural remedy for cavities may portend a renaissance for traditional dentistry. Other communities have lately turned to ancient wisdom, as seen in the resurgence of ancient superfoods in Mexico or local egg varieties for herbal remedies in DRC.
Lipaso is optimistic. He says that as the costs of medical procedures continue to rise, more people will try alternative options.
"I see more and more people coming to consult me," he says.
Françoise Mbuyi Mutombo is a Global Press Journal reporter based in Democratic Republic of Congo.
TRANSLATION NOTE
Megan Spada, GPJ, translated this article from French.
