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.

So long America!

Haiti 2012

Tomorrow I'll be taking off on my first ever international outreach! Ever since I decided on a career in dentistry, international work has been something that I've wanted to do. We'll be departing from JFK at 9AM and landing in Port-au-Prince early afternoon. I'll be traveling with For Hope International, which is an agency that a friend of mine traveled with last year. Our team consists of 30 volunteers who will be providing medical, dental, optometry and physical therapy services. With the craziness of the holidays, I've learned a bit of Haitian Creole to speak to the natives. I've heard some speak English, and Spanish which is great and I hope I run into them! I'll be keeping something of a journal of the adventure, and plan to bombard blogspot with pictures and stories when I return.

In terms of prophylaxis I've already been equipped with the Hep vaccines, MMR and others from my entrance into dental school, so the only supplement I needed was a typhoid vaccine. I also began Malarone, for malaria prophylaxis yesterday. The pill makes me a bit lethargic but that also could be a side effect from the constant eating of the holiday...nonetheless it's nothing significant.

But for now, back to Christmas festivities, Happy Holidays to all!

D2.5

Fall Semester, FINALLY OVER, and it feels incredible. Here's what our Finals Week looked like for any interested parties:

While I still need to do the actual Course Evaluation Surveys, I figured giving my own two cents here would be fun also.

Indirect Restorations I

Super frustrating course for me at first. Crown preparations are extremely specific. We're talking 1/4mm, or a couple degree differences and your restoration fails, specific. And Dr. Kim really drove that point home with the grading as far as I'm concerned. Nonetheless you learn a ton if you seek to. Like most things in dentistry the only way to really improve is a ton of practice. And when it comes to Indirect, not just doing a ton of crown preparations, but also critically evaluating each one afterwards. What really made things clear for me was doing one practice a day, then evaluating each aspect of it according to the criteria sheet given. I was lucky enough to have a tutor and upperclassmen friends who could also take a look and let me know if my self evaluation was correct. Indirect made me realize dentists not only need to have "golden hands" but "golden eyes" as well. Before you can create, you need the vision. I'm not ashamed to say, I definitely came from humble beginnings in that class after the first practical, but after the last practicals and competency I definitely feel competent and able when it comes to crown preparations. We also do some inlay and onlay preps, and go through the whole casting process...but I think we know that's probably never happening outside dental school

Lectures I thought were okay in the beginning, but really interesting toward the end of the semester when we talked about treatment planning and complex prosthodontic cases. Overall, I'm sure there are many complaints about the class, but I think it comes down to how much work you want to put in and the people you trust to help you.

Direct Restorations - Amalgams

The heading pretty much says it all. I personally just love direct restorations. They're quick and fun. There's lots of faculty walking around during lab so help isn't usually far. After the course I'm not really sure if I prefer amalgam over resin, or viceversa. The faculty really make it clear that both have their advantages and indications. I think amalgam is a little more strenuous at first to work with because you really need to condense well, but resin takes work as well. Carving amalgam takes practice. That may have been the only struggle I can think of in this class, but practice and you learn by the end.  Direct ruled.

Regional Anesthesia

So this one hour per week class on Friday morning is easily one of the most important in dental school. Dr. Hall is great and stands by his words when he says "he does not lecture, he teaches" and in my case, scares you into learning. Anesthesia is serious business and the complications are potentially fatal if you aren't careful.   You also get to give your first injections which is awesome. You receive one as well, which is also..an experience :).

Removable Prosthodontics

I thought this was probably one of the best taught classes we've had. It felt like we learned the same things over and over, but that's really just because Dr. Pusateri really keeps things to the point and makes it clear what's important. The lab periods were really helpful since the faculty again were great, at least in my part of the room. I'd say the one thing that could sneak up on people in this class is the sign off sheet. Since we have graded projects that are due on certain dates you tend to focus on those. But there's also a list of projects you're expected to complete on your own for a sign off. I honestly had some fun making dentures. The afternoon lecture wasn't as well attended as it should have been, but I felt it was useful.  You'll probably get burned with wax, or hot instruments, or feel incredibly frustrated setting posterior teeth when you can't get simultaneous bilateral contacts, or passive contacts on the anterior, but you get through, and will look forward to the day you literally create someone's smile.

Oral Sciences

I don't have much to say about this one. Interesting subject matter at points, but I wasn't a huge fan. The long Monday afternoon lectures, then sometimes lab, and sometimes case study after were a little draining. Learned some cool things about the development of teeth though. 

Pathology

I liked this class. Dr. Nickerson really cares about the students and finds great lecturers. Dr. Heffner uses case studies a lot to teach diseases so that makes it a little easier to pay attention if you're not a morning person. Not much else to say about this one. The lab section with slide IDing wasn't popular with everyone. I enjoyed it because it was an opportunity to apply what we knew. But in general, just another science course where you study the notes, and memorize everything. 

We had a few rotations under "Clinical Dentistry" and "Integrated Dental Practice" and those are usually informative. Some moreso than others. I get the impression UBSDM really wants the students to get as much from their education and time here as they can and I'd say they're doing well. And so goes the Fall Semester,  I'll have pictures from the lab up soon. Happy Holidays everyone :)

West Side Community Center Outreach

Great outreach yesterday at the West Side Community Center in Buffalo! The Center holds health fairs every month or so to help educate, and raise awareness about health issues. Of course, there's some freebies to be had as well, but it's a great way that healthcare community here in Buffalo seek to reach more people. A dental hygenist from the University Pediatric Dentistry Clinic, a few other dental students and myself manned our table in the main room of the center, along with many other groups.  There was a large spanish speaking population so it was an awesome opportunity to interact with a unique population. Nadya, the hygenist was conducting oral health screenings for anyone interested, and there was definitely interest. We collectively informed patients about the services we have at the school, and what they can to do maintain superior oral hygiene  Of course there were free toothbrushes and floss.

I took some time to walk around and was enlightened by the different groups present. One doing cholesterols, a group of social workers, a kidney health organization and a representative from a smoking cessation group were present, to name a few. I almost always stop by the smoking cessation tables with the hope of learning something new to help future patients and friends quit smoking.

Fluoride-Free Toothpastes

No, no and no! For any patient in the market for a new toothpaste, the only thing that really, REALLY, matters if the product includes Fluoride! There's an increasing population of "green-minded", organic shoppers, which I personally can relate to, but on the issue of oral care, fluoride is essential. Here's why:

Our teeth are comprised of a hard outer coating of enamel, which is chemically made up of calcium and phosphate. When we consume carbohydrates, bacteria on our teeth ferment these carbohydrates, producing an acidic environment, which in turn begins to decay our teeth, creating what dentists call a carious lesion. These days, if carious lesions are caught early, they can be remineralized, naturally, or with the use of fluoride or calcium/phosphate products such as MI paste. So Fluoride not only protects our teeth from caries lesions, but it:

1. Increases the acid resistance of enamel
2. Has antibacterial properties - inhibits bacterial enzymes

On the topic of fluoridated water, this is also an essential for ideal oral health. While we can get fluoride from sources such as marine shellfish, tea and toothbrushing, the concentration of fluoride in water is so low that toxicity is unfathomable. In the United States, fluoridated water is kept at a concentration of 1ppm (part-per-million) or 1mg per 1L. Fluoride is only found to be toxic to humans at concentrations of 1500ppm, or 5mg/kg. At this rate you would need to drink more than 1000L of water to have a potential subacute poisoning! While this will continue to be a controversial topic, dental professionals will continue to advocate the benefits of fluoride in oral health. Nonetheless, the concerns of the public are heard, and if scientific data arose proving against what is currently supported, the  tides would change, but for now, fluoride is definitely a mainstay!