This feature appeared in the School of Dentistry's alumni magazine, DentalUM, in the Spring & Summer 2008 issue

Make no little plans. They have no magic to stir men's blood... Make big plans; aim high in hope and work, remembering that a noble, logical idea once recorded will not die, but long after we are gone be a living thing, asserting itself with ever-growing insistence. (Daniel Burnham, visionary Chicago architect, 1910)

A U-M School of Dentistry Dental Scholar has taken the first steps toward realizing her lifelong dream and professional goal of establishing the first dental school in her native country of Liberia.

Last summer, third-year dental student Nejay Ananaba returned to her homeland to spend two weeks conducting oral health research, talking to junior and senior high school students and their teachers about dentistry, and meeting with officials in academia and government to discuss her dream.

"I was well received and my idea was enthusiastically embraced by those I talked to, especially Dr. Tabeh Freeman, the dean of the medical school at the University of Liberia," Ananaba said.

She also talked to an official from the Ministry of Health and Social Welfare, Dr. Moses Pewu, about her plans.

A hoped-for meeting with Liberian President Ellen Johnson Sirleaf did not occur. However, Ananaba later met the president's son, a banker, told him about her dream, and asked that he share her dream with his mother.

Work on the summer trip began months earlier, in December 2006, when Ananaba briefly returned to Liberia during the University's winter break.

While there, she enlisted the help of her father, Charles, an insurance executive, and met with teachers and administrators at several schools in and around Monrovia, the nation's capital.

Only 13 Dentists

About the size of Tennessee, Liberia, which means "land of the free," was founded by free slaves who emigrated from the U.S. in 1822. Until the 1980s, the country was noted for its academic institutions and its iron mining and rubber industries.

However, a coup in the 1980s and a 14-year civil war (1989-2003) devastated Liberia's economy and led to a sharp decline in living standards. Ananaba and her family fled the country for a year in 1990 and then returned, only to flee again in 1996 and return the following year.

Since January 2006, a democratically elected government led by Liberia's and Africa's first female president has been trying to rebuild the nation's economy where annual per capita income is approximately $120 and life expectancy is about 40 years.

Currently, the country of 3.3 million has only 13 dentists, according to the World Health Organization.

Ananaba saw the effect of that scarcity everywhere she went.

During one of two nationwide radio interviews in August, she said that when she returned in December 2006, "As I looked at people's mouths and their teeth when I was talking to them, I noticed a lot of gum disease."

"No Idea What a Dentist Is or What a Dentist Does"

The country's lack of dentists was noticeable when Ananaba visited classrooms.

"What I especially remember was when I was in classrooms talking to students, most of them weren't aware of what dentistry is. They had no idea of what a dentist is or what a dentist does. And they knew very little about how to take care of their teeth," she said.

During her visits to nine elementary and junior high schools in and around Monrovia during the summer, Ananaba asked about 3,000 students about their oral health habits.

Among the 31 questions she asked included: Have you ever been to a dentist? Do you feel your teeth and gums are healthy? How often do you brush your teeth? Do you own a toothbrush and toothpaste? How do you clean your teeth?

Ananaba said that when she asked the sixth, seventh, and eighth graders how they cleaned their teeth, most said they used chewing sticks. "But others said they used baking soda, and some even wrote 'salt' and 'charcoal'," she said.

When they had problems, especially chronic toothaches, Ananaba said that most went to see a medical doctor who extracted the teeth but knew little else about oral health.

Others with similar problems who were more affluent, she added, "went to Ghana or another nearby country to receive dental care."

With that information in hand, Ananaba used every classroom visit as an opportunity to tell students and teachers about simple things they could do to develop and maintain good oral health. She repeated those tips in radio interviews.

In the classrooms, she also handed out toothbrushes and toothpaste and then demonstrated proper brushing techniques.

Flossing was another story.

"None of the students knew what flossing was," Ananaba said. "But I came prepared and brought some crocheting yarn with me. When I was at each school, I had the students hold up several fingers on one of their hands and then demonstrated how to floss by moving the yarn between their fingers."

Ananaba talked to the students about dentistry and answered their questions about how she became interested in the profession. She said they were amused to hear her interest in the profession began following a roller skating accident when she chipped several teeth and that, as she was leaving the dentist's office, she told the dentist that she "wanted to become his dental helper."

However, as she talked to the students, Ananaba was surprised to learn something else.

None of them had heard about the Internet or how it could be used to find information about dentistry or oral health care.

"As I was describing what the Internet is and the information that's available, I thought if I answered their questions as best I could and showed enthusiasm about dentistry and how dentists help people, then maybe some of them might begin seriously thinking about it as a career," she said.

As she left the schools, Ananaba told students, "Someday, I hope to see you studying dentistry at a dental school here in Liberia."

They responded.

"When I arrived at the schools, most said they wanted to become medical doctors, nurses, or lawyers. Not one mentioned dentistry," she said. "But by the time I was leaving, four or five said they wanted to become dentists."

She also encouraged the youngsters to become ambassadors of dentistry.

"I told them, 'go home and tell your mothers, fathers, and friends about dentistry and how to care of your teeth. Have your own Show and Tell program and demonstrate the correct way to brush your teeth and to floss'," she said.

"A Duty to Give Back to My Country, My Society"

Ananaba's preliminary research at the schools was well received by academic and government officials.

She said Freeman, the dean of the medical school at the University of Liberia, liked her idea about establishing a dental school in Liberia. "He added that a pharmacy school was recently established and that it's expanding the knowledge base of those in the medical profession," she said. "He thought a dental school could do the same and encouraged me to pursue my idea."

Currently, Liberians studying to become a dentist do so at a college or university in a neighboring country and don't return. Ananaba wants that to change.

During one of two nationwide radio interviews, Ananaba explained why she thinks it's important to establish a dental school in her country.

"We cannot always rely on other countries, or other people, to do things for us. We have to make things happen for ourselves," she said. "I see it as my duty to give something back to my country and my society."

In April, Ananaba spoke to the Liberian Medical Association in Alabama about her desire to establish a dental school. This summer she plans to return to Liberia. "My dental studies here at Michigan and the Dental Scholars program are keeping me busy," she said. "But I would like to, and build on the success of the meetings that I had," she added.

As she discussed her experiences, Ananaba said, "I don't think any of this would have happened had I not been here at the University of Michigan School of Dentistry or been accepted into the Dental Scholars program.

"What I have learned about dentistry and the dental profession by being at this School, and talking to others across campus, including those at the Business School, the School of Public Health, and the School of Public Policy, has helped me tremendously."

Nejay Ananaba received her dental degree from the University of Michigan School of Dentistry in May 2009 and is now a clinical lecturer with the Department of Periodontics and Oral Medicine at the School of Dentistry.