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In sub-Saharan Africa, where HIV/AIDS has decimated communities and prevalence rates are as high as 27 percent in some countries, oral symptoms of the virus are seen among individuals who do not yet know that they are infected.

That's what Leora Walter, a doctoral student at Columbia's College of Dental Medicine, learned when she traveled to Ethiopia for six weeks last summer to help doctors and dentists identify and treat the oral symptoms of HIV/AIDS, which are often the first to manifest after a person becomes infected.

The 25-year-old from New Rochelle, N.Y., traveled to the town of Adama, located 140 miles from Ethiopia's capital city of Addis Ababa. The service trip was sponsored by the International Center for AIDS Care and Treatment Programs, which was launched by the Mailman School of Public Health to establish HIV/AIDS care and treatment programs in resource-limited settings.

Many of the doctors and nurses in Ethiopia had not been taught to search for telltale HIV symptoms inside their patients' mouths. "Many of the clinicians were just trained to say 'stick out your tongue and you're done,'" said Walter.

Leora Walter spent six weeks in Ethiopia teaching dentists and clinicians how to recognize oral symptoms of HIV.
Leora Walter spent six weeks in Ethiopia teaching dentists and clinicians how to recognize oral symptoms of HIV.

Image credit: ICAP

Under the guidance of one of her Columbia professors, Walter taught Ethiopian dentists and HIV clinicians how to administer oral exams. Symptoms can appear on the gums, tongue, roof of the mouth, and the "mucosa," the mucus-based membrane located inside the lips and cheeks.

Walter also spent time on the trip treating patients in an Adaman dental clinic where services are desperately needed. In a country of more than 82 million people, there are only 55 practicing dentists, many of whom do not treat walk-in patients, according to Walter. For every dentist in the country, there are approximately 1.5 million people who need oral health care.

"You can go into certain cities, and there are no dentists for miles," says Walter.

The Columbia-sponsored dental-assistance program was funded by the U.S. President's Emergency Plan for AIDS Relief.

For Walter, who is scheduled to graduate in 2010, the experience in Ethiopia was humbling—and one that she will not soon forget. After spending so much time in an AIDS clinic and witnessing first-hand the conditions wrought by untreated HIV, she returned to the States with images of people whose lives have been devastated by AIDS.

"My experience has led me to want to continue working with patients who aren't as fortunate as many Americans, and don't have the means for appropriate dental care, especially individuals whose immune systems are comprised."

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