Spring2013

Back to the grind.
Removable, working on making upper and lower partials, Indirect, doing a 3 unit bridge, and Endo we're starting off with an anterior. Clinic starts in a couple of weeks and we've got to call our patients to see whose available and review their charts. Quizzes and projects galore 1.5 weeks in. Lets go.

FHI Haiti 2012: Final Clinic

12.31.12



Our site today was at a clinic in Carrefour, on Arachon 32 (a road). On the ride there I had no idea what I would be doing. I came prepared with the dental supplies, and luckily the Haitian dentists and students also arrived so the dentistry would continue! Initial setup was hectic since I had to basically create the dental clinic on my own. We were set up in a small room in a building next to the main clinic.  Terrible lighting, very small, but we managed to make do. We set up two chairs, one of which was a wheelchair, that locked in place, and we brought the mobile dental chair as well. Childrens' chairs were used as our tray tables, a bucket with a bag for dirty instruments, and clean ones on the other side of the room. Once again, we had a ton of patients, extractions and cleanings all day. Wilkey, was an awesome translator for me all day. He stood by my side through lunch and until the end where he refused to eat without me. At the end of the day when Dr. Marabishi Jasmin got us all together for a "closing ceremony", I know Wilkey must have said something to him because I was honored to get a shoutout for the hard work from Dr. Marabishi Jasmin.














(From left: Valesca, Sylvia, Jefferson(Haitian Dental students), Karen)



One moment that day I won't forget was when Wilkey started telling me that we'll have a special patient today. A tooth that has been bothering his mother for a long time needed to come out. I ensured him we would take excellent care of her. When she arrived however, I reviewed her medical form and found that her BP was much too high for us to do anything. My heart literally sank. There was nothing dwe could do and I felt helpless. Dr. Hubert and Watson also agreed that we needed to give her antihypertensives and wait. I talked to her with Wilkey about diet and exercise and explained the situation, and Wilkey understood. I know it's going to happen, but I never, ever want patients to leave my chair in pain.

Once again dental was the last to finish up and I had to turn away one patient since the traffic would be killer if we didn't stop when we did. New Year's is a big deal in Haiti because Haitian Independence day is January 1st as well. I was also told that the Haitian revolution was one of the only slave rebellions to lead to the development of an independent state during its time. So all the more reason to party hard. At the closing ceremony, Dr. Marabishi Jasmin spoke one last time and prayed. He presented our team leaders with a piece of Haitian artwork, and voiced his appreciation for the relationship we have, and the opportunity to work together to serve the people.

That night we had a bonfire and counted down to the new year. One of the best new year's ever.

FHI Haiti 2012: Empowerment

12.30.12

Incredible past two days of work alongside Haitian dentists, doctors, nurses and students. Yesterday we worked in a location in Carrefour where Dr. Marabishi Jasmin is trying to start a clinic. The people of the town had been expecting us for and were all very friendly and appreciative. We set up in a church. Registration and triage in the fron, dental in the back of the triage area, optometry a little further toward the back. Our dental team say about 17 patients, all extractions and cleanings. Worked through lunch as usual, but ate at one of the Haitian's house across the street, which was delicious. Chicken and rice, very well seasoned.

At the close of our clinic, Dr. Marabishi Jasmin gathered everyone, Haitians and Americans, in a circle outside the church. Hand in hand he said a prayer thanking us for our work and for the future of Haiti and those in need. He spoke sentence by sentence, the translator echoing his words in English. In those moments I knew what it meant to be connected, compassionate and genuinely happy. Afterwards I spoke with a Haitian who was volunteering in Spanish and that was really great. I had been adding random Spanish into my Creole unknowingly, so being able to just speak Spanish was great. He expressed such grace and gratitude toward our work, that all I could do was thank him and pull him in for a hug. I knew I wouldn't be able to find the words to say that they have given me so much more than I could give them.  He has dreams of becoming a doctor to serve his people and initiate change. I told him I hope I can be right there with him when he does.

Ryan and I carried the Haitian's dental chair down a muddy, rocky Carrefour street along with the others carrying supplies. We piled into the bus with the translators for the ride home. Spent the night on the rooftop of the hospital with the team with a couple guitars. Perfection.

Today clinic was held right at the Hopital Miracia in Merger. A bunch of us decided to take a hike up the hill but it ended up being much longer than expected. Got some gorgeous views though, and got a little bit of exercise. We did make it back in time for clinic, but time is always a scarce resource. The "Clinique Dentaire" had two operatories with actual dental chairs, however they were electronically nonfunctional, so no restorations today. While setting up I noticed the long line outside of about 30 people awaiting registration. Never a dull moment in Haiti. I worked with Dr. Timote and Dr. Noel who were very helpful and I really felt more empowered by their comments and teaching than I was empowering them. Dr. Noel was an amazing teacher, showing me exactly how to position the elevators and how to anchor the mandible with your free hand to get more leverage. Ryan commented to me about one maint difference of dentistry in Haiti vs. the US being the future planning. In the U.S. we always seek to restore missing teeth, whereas in Haiti the primary concern is removal of the diseased tooth, and prevention of infection. This allows them to be a little more aggressive with extractions than we may be here. Nonetheless, I still admired their ability to get these teeth out quickly and entirely.

Ryan graciously took the time that night to teach me the method in which we write prescriptions, so that I would be able to manage patients in future clinics more independently. He also will be leaving a day earlier and missing the last clinic so the dental team would be me and the Haitian dentists and dental students, who are not familiar with the American pharmaceutical code. The template is as follows:

To prescribe Amoxicillin, the directions are to take one tab every 8 hours, for 7 days. We write this "1 tab q8h x 7d." Then we calculate how much to dispense, 24/8=3, times 7 =21 tablets. So the script would be:

Amoxicillin: 500mg
Disp: 21 (twenty-one) tabs
Sig: 1 PO q8h x 7d

"PO" = "by mouth".
Sig = Instructions
Disp = Dispense

For Ibuprofen we used:

Ibuprofen 800mg
Disp: 42(forty-two) tabs
Sig: 1-2 tab PO q4-6h PRN

PRN = as needed for pain

If patients had allergies to Amoxicillin, we had clindamycin. If they were irritated by Ibuprofen we used aspirin. Of course dosing would change based on the patient's age, weight and height.

Tonight it's hitting me that I'll really miss all this. The morning ginger/citronelle tea, breads, incredibly creamy avocadoes, the children that despite their poverty smile so brightly and always made my days; The dentists who guided me hand in hand and built me up, singing Haitian songs on the bus with the translators, and most of all the genuine kindness and good nature of the people. Astonishingly, almost every patient, except 2-3 had any sign of distaste, discomfort, or wincing. They were the perfect patients. I know a few months down the line I'll be bogged down with work but I can only hope that I keep in mind that dentistry is so much bigger than what we see and think.

FHI Haiti2012: Fond Parisien

12.28.10

Did my first extractions today! In a small hut in the countryside of Haiti, really felt incredible and I can't wait to do more. Ryan walked me through the procedure on the bus, and on a few patients before helping me out with my own. First we free the gingiva up around the tooth with a periosteal. Next, use the straight elevator to elevate the tooth from the buccal. Usually the mesio-buccal but distobuccal is also all right. Ryan advised against elevating from the lingual because you run the risk of injuring nerves and arteries. Elevation widens the alveolar bone  around the tooth. Once the tooth begins moving we elevate as much as possible before using a forceps. For mandibular molars, the cowhorn forceps lock into the furcation and we rock the tooth facio-lingually while making figure-eight movements. Controlled slow pressure. Once the bone is widened enough the tooth generally comes out easily. After a couple more guided ones Ryan and I manned our own chairs in our small hut. We saw about 15 patients between the two of us, and had some really complex cases, considering there was no electricity. Ryan mentioned that in the US a bunch of these cases would easily be surgical. We worked through lunch and were the last group to finish up. We prescribed the patients amoxicillin, and ibuprofen after their extractions and sent them to the designated pharmacy to pick up the medications. After seeing tons of extractions from shadowing, I was surprised at the strength of the bone and teeth. There really is a good deal of force necessary to take out teeth. Dentists really know how to make it look easy. 

(This was actually a church that was flooded after the earthquake, the small bit peeking from the water is all that's left)

                                                  (Our dental "clinic" was one of these huts)

This site is said to be the poorest, most devastated that we'll see, and the setting lived up to that. Upon arrival I was heartbroken by the sight of small huts covered with USAID tarps, hay rooftops, and children in tattered clothing. I immediately wondered what they ate out here, and it was clear that there wasn't much by the cries for food from the people as we disembarked. 

We spent the day working with a few Haitian medical students. Ryan and I grabbed Mackenzie, who was one of the medical students who knew a good deal of English. During our dental presentation the previous day he also answered all of our questions, and had really great ones of his own. I explained to him how we gave anesthesia, and the nature of the tissues we were targeting. Incredible experience. 

We closed up shop much later than expected and hit the worst traffic I could imagine on the way back. We had run out of water bottles, and there was definitely no stopping for food after dark. The Haitian translator's parents were calling them since generally you do not want to be out later than you need to be in Haiti, especially during the holiday. I spent most of my time talking to the translators and learning some creole. I had a really great conversation with one of the translators about how Haiti is her one and only home. She has been to L.A. and Florida for vocal competitions, but has no interest in leaving unless it is for education. Every day I'm presented with more reasons to admire the Haitian people, and their sense of nationalism really struck a chord in me. 

Once we got back, we had a very late dinner, and a few of us got together to clean off the blood from our dental instruments and pack and run the autoclave. Plugged in my headlight to charge for tomorrow, another day living to serve. 

FHI Haiti 2012: Medical Education

12.27.12 - Day Two

Woke at 5:30AM in my hospital bed to the sound of roosters, dogs, goats, and many other sounds, guarded by my mosquito net. Arrived back at 11:30PM. Incredible day of empowerment in a city right outside Carrefour. Today was about helping educate the Haitian nurses and medical students further on common diseases in Haiti, and on topics which they had specifically requested (like dental!!).  Presentations on Hypertension, Diabetes, Cervical Cancer, dentistry and a few others. Ryan had the poster prepared but since it was in Haitian Creole we reviewed what we wanted to focus on and how the talk would run. Ryan started off the day with his presentation on the oral manifestation of different diseases. Afterwards, we broke into our teams, and the medical and nursing students were divided into smaller groups as well so we could give our presentations.

We covered the cause and mechanism of dental caries, how plaque forms and its relation to gingivitis and periodontitis. We discussed the importance of diet in the etiology of caries and talked about many ways to prevent caries, and concluded with the importance of fluoride treatments, which we provided in the hope that the nurses would continue their use after our departure. We got a handful of questions from each group we presented which was great, but also gave me the impression that many of them had friends or family suffering from dental problems. After our presentation to each group, we called up participants in pairs to present back to us the presentation that we gave to ensure they were learning, and sure enough they were.

What really made the day great besides giving the talks themselves were the connections and relationships that were forming. A couple of the nurses and medical students had asked for Ryan and my contact information to keep in touch. I was especially happy to have gotten to spend a great deal of time with the translators learning about them and hearing their stories. One translator named Dickens especially stood out to me. He's 18, and fluent in Haitian Creole, Spanish, English, French and hopes to learn Dutch, on his own. I was floored. He was the dental  translator for our presentations and did an awesome job getting the information across.

On the way back from the education event we had to stop by a clinic in Carrefour to pick up the medical and dental supplies for our clinic session tomorrow. Our driver parked the bus and Ryan, Moses, Will and I walked down a narrow rocky road to the clinic, which to our surprise was locked since we had been told it would be open. After about 5 minutes of searching from an alternate way in, and calling our primary contact , a boy that was no older than 6 walks up to the door and unlocks it! Even though we got in we still had to struggle in the dark with flashlights to find the supplies we needed, but luckily everything was retrieved.

Once we got back we had dinner, and the night was spent doing medical and dental inventory, and autoclaving instruments. Our autoclave is a rice cooker- looking thing that probably confused people who saw me carrying it.  The power cut out right after our first load, so we had to autoclave our second batch in the morning. Looking forward to tomorrow, according to the team leader Moses, once we get past it, we should be all right for the rest of the trip. We'll be heading out to the countryside in Von Presse.

FHI Haiti 2012

Back in the US and totally exhausted. Left Hopital de Miracia this morning at 8AM and had many heartfelt goodbyes from the children, staff and people who lived around the area. The most touching was when we gave our bus driver his birthday card. He was almost brought to tears by the gesture and could not find the words to thank us, but he deserves so much more. Now that I'm here I'm still in a bit of culture shock.

I kept something of a journal while in Haiti and I want to share it on here. I'll be posting one entry from it for the next few days, starting today:

12.26.12- Day One

Flight to Haiti, spent mostly getting to know a few of the team members and studying some French Creole from the app I've been using. Actually got the chance to practice with the woman who was in our row. She didn't speak much English and was more than happy to help us learn.

Arrival. While approaching Haiti from the plane, I peered out the window and was immediately struck by the state of affairs. It was clear, even from afar, that the country was not in a good state. After retrieving our luggage, and meeting up with other members of the team coming in from California, we met our bus, but not before struggling through crowds of people at the exit. I was pleased to hear members of the team were very surprised at the amount of progress that has been made on the Port-au-Prince Airport. Since last time they had came, everything we experienced was not there. On the bus I spoke with Jean, the man who has built the Hospial Miracia that we'll be staying in. He told me a few surprising things about the country, like how change is very difficult politically, because the government employs most of the poor people, and does not educate them well, so things are very slow to change. When I asked about the cholera epidemic he shared that cholera actually was not in Haiti until many aid workers came and brought the disease with them. The drive through Port-au-Prince was devastating. The amount of trash everywhere, due to lack of sanitation was incredible. Since there is no trash pickup, refuse is burned, usually in fields on the sides of the road. Sometimes the fumes are so thick that cars must slow down due to the lack of visibility. In these times we scrambled to shut the windows on the bus before passing through.  The most interesting vehicles I'd seen so far were the Tap-taps which were buses, or trucks that people used as taxis. They were overpacked, and people even hung off the sides or boarded the roof. The Tap-taps almost always had some religious writing and artwork which I found really cool.

Tomorrow we'll be heading to our first site to give lectures on diabetes, hypertension, cervical cancer, dentistry and a couple other things to a group of Haitian nurses. Ryan and I will be covering the dental lectures, and fluoride treatment presentation. We'll be doing fluoride treatments for the children later on in the week, but the plan for tomorrow is to teach the nurses how to do the treatment, so more children can be treated. The goal of the presentation is to drive home three points. Our three were: Brushing 2x a day, maintaining a healthy diet and regular dental visits.

As I'm here writing this, and hear music from the houses in the distance - Black Eyed Peas - Where is the Love? This trip is completely about love.