Jean's Miracia Hospital Story

Hope for Haiti from About Themselves on Vimeo.

This is a video of Jean telling his story and his work in Haiti.

FHI Haiti: 2013 In Summary

FHI Haiti Mission Team 2013- Club Indigo, Haiti

Back in the U.S. once again after my second medical mission in Haiti. Its wild that days ago I was waking up to roosters calling, children singing in Creole, underneath a mosquito net, in an unfinished hospital. This year's trip was just as eye opening, if not more so than last years. I'm again conflicted in my perspective, and am coming to terms with the drastic differences in lifestyle, and outrageous inequalities in the world. With some thought and reflection I hope to come to some sound conclusions and feelings. All things considered, it is an incredible honor and privilege to serve in Haiti alongside the Haitian medical professionals and translators.

FHI Dental Team 2013

Our dental team this year consisted of 9 people, which was an upgrade from the dental firestorm of myself and Ryan last year. The team included Christine, James and Sarah from NYU Dental, Katy, Amrita and myself from Buffalo Dental, dental oncologist Dr. Ryan Lee, Pediatric Dentist Dr. Esther Yang, and General Practitioner Dr. Shin Kim.  We worked wonderfully together as a team, and as usual, we had our most efficient day on our final day of clinic. Having a larger team allowed me time to experience more of Haitian culture, speak with the local people at our clinic sites, and gain a deeper appreciation for Haitian culture.

Dental Triage, Arcachon 32 Clinic

I spent New Year's Eve with Jean Filostin, the director of Institute of Grace in Merger, Dylan, a friend of mine from Buffalo, and Remy, a psychologist from the US who started an orphanage in Haiti after the earthquake. That night Remy and Jean shared with us things about Haiti and their lives that I couldn't have imagined. Jean's big project is Hopital Miracia, which is the hospital portion of Institute of Grace. Jean also runs a school nearby and cares for a number of orphaned children in the village. There are many children always running around the outside of the Hospital. I had always thought they went home to their parents at night. The truth was that most of these children's parents had died from infections, HIV, or other conditions that are endemic in Haiti. Jean takes these children in because these children also attend a school he also is involved with. Others who take in these children may literally enslave these children, and have them work in the house instead of attending school. Many of these children also have medical conditions that they cannot afford to treat, and may not receive any care if it were not for the NGOs involved in Haiti. I was floored that these things were happening, because most people I came into contact with are so welcoming and the children all seemed so happy to me. 

Remy's story was another inspiration in itself. Remy was born and raised in Haiti, and was one of many siblings. He was always involved in his church and missionaries had always been a part of his life. A missionary was actually the person who granted him the funds for his education. He stressed to us the importance of having a healthy relationship with money and never letting fear change you. His story and views on life are incredibly inspiring and is a testament to the things that can be achieved if one has a passion for helping others. His orphange is still growing and we are hoping to involve it as a site for future FHI outreaches. The children we saw in Haiti actually had relatively healthy dentitions. The amount of decay in adults however reflects a change in diet or behavior from childhood. 

1st Entrepreneurship Conference, Club Indigo, Haiti

Both Jean and Remy's stories about their ventures are the perfect segway into another experience that was particularly memorable: FHI's first Entrepreneurship Conference. FHI's vision is to see Haitian medical professionals reform their own health care system with their own ideas. Our approach involves educating the doctors, nurses and other members of the healthcare system to begin thinking of their problems as opportunities for growth and change. Over time, the hope is that ideas will arise, and a competition will be held where Haitians present their ideas. An international panel will judge the ideas and providing funding to the best business plan. The conference was held at Club Indigo, near Montroius, along the coast. The club was unlike any place I've ever seen in Haiti. Dr. Chen lead the conference, speaking about what entrepreneurship was, and how it could be used in Haiti to reform healthcare. Tim, a non-medical member of the FHI team presented a case study as an example of social entrepreneurship in India. The Avarind Eye Care System provides cataract surgeries to more patients in India than was ever thought possible. Through their system many of their patients receive free care.  Avarind's system is complex, but at it's core is the optimization of the cataract surgery process, minimizing cost without compromising care. Another case study was presented by Dr. Lee which focused on improving access to care in rural Africa utilizing a network of motorbikes. After the presentations we broke into groups and discussed different problems within Haiti's health care system. My group in particular kept returning to education as a core problem, ergo, a prime opportunity. Other issues such as transportation, access to materials, and access to doctors also came up. The interesting thing I found was that some of these problems, if not all are problems in the U.S. as well. I'm really excited to see where this leads in a few years.  

Fluoride & OHI - Fond Parisen, Haiti

Our visit to Fonds Parisen this year was focused more on Pediatric preventative dentistry, although we still did extractions. Dr. Lee's passion for public health and continually stressing "One child treated with fluoride is worth 10 extractions in my mind" definitely left an impression on me. In the US we sometimes take oral hygiene instructions for granted, but in places like Fond Parisen, these children have never, and would never have been shown how to properly care for their teeth, let alone by a pediatric dentist! The kids were excited and compliant in participating in our songs and games. We arranged a pediatric area where the kids sit on a few large branches and individually taught each child how to brush, provided fluoride treatment, and gave them toothbrushes and toothpaste. Dr. Yang was incredible to learn from and work with. Despite the language barrier, she engaged the children and I feel that our efforts will really make a difference. 

Fond Parisien, Haiti

Reflecting as a whole, I know that I surely took away more from my experience in Haiti than I could give. While our efforts to improve the health of these populations may or may not be appreciated, the magic of the experience is in the relationships fostered. My heart was touched by so many in the past week. The love shown to us by the Haitian people is overwhelming in the greatest sense of the word. 

Photos and journal entires to be posted in the coming days!
Happy New Year All! 

[Photo Credits: Kyungsik James Yang]

Glass Ionomers - The Fuji Bunch

So we had a pretty big final in Cariology, which includes treatment of caries, which is probably more than 80% of what we do in the clinic. Glass Ionomers are a material with many uses, and we use them all the time in the clinic. They release fluoride and some are stronger than others. I wanted to compile a little post to remind myself of what each one does so here goes:


Fuji Plus - Luting Cement 
Reinforced Luting Cement basically used to cement metal based, or all ceramic inlays, onlays and crowns. It can also be used to cement metal, ceramic or fiber posts.


Fuji II LC - RMGI
Resin Modified GI used for Class III and Class V lesions. It's good for the treatment of root caries, abfraction and cervical lesions. It's also used for restoration of primary teeth, as a base and a liner.
It is NOT used as a pulp cap.


Fuji IX - Heavy Body GI w/ Filler
Heavy Body GI w/ Filler Particles used on root caries lesions, or on roots of amalgams and composites with faulty margins. They can also be used in Class III and Class V lesions in patients with high caries risk. Fuji IX self cures (2.5 min).
It NOT used as a liner, base, pit and fissure sealant, pulp cap, a large core, or a definitive restoration in load bearing areas. It is NOT A RMGI, so does not handle loads well.


Fuji Triage - Flowable GI
Flowable GI used to seal pits and fissures when isolation is not possible, as a liner in deep restorations, or over CaOH, to fill an endo access or as a protective restoration. When used to fill endo access, Fuji Triage prevents Eugenol from the sealer from affecting the bond of the core. It's also pink and self cures (2.5min)
Triage is NOT used as a definitive restoration, base, direct pulp cap, core. It is NOT used to repair faulty amalgams or resins.


Vitrebond - Flowable GI
Flowable GI used as a liner in deep restorations, or over CaOH. It's used to restore endodontic accesses.
It is NOT used as a definitive restoration, base, direct pulp cap, to repair faulty amalgams/resins or as a core.

ECHM Town Hall

Our project of starting a community dental clinic is coming together, and is set to open to the public in February of 2014. On December 5th our group presented our progress thus far to faculty, students and staff in a Town Hall meeting. We wanted to give everyone an overview of whose involved, what's being planned, the location, population we'll be serving and how it's all going to come together. 

Kara, our project leader kicked off our presentation with introductions, and a summary of how we got involved, and an overview of what we all would be discussing. JoAnna then took it from there, discussing the surrounding area, and the need for a dental home at 1500 Broadway. She presented photos of the area, and elaborated on the fact that this is an underserved area. I discussed the collaborations that will be occurring at the clinic with LakeShore Behavioral, Catholic Health, Erie County and UB School of Public Health. We're hoping to be making many interdepartmental referrals, and seeing a different population pool than at Squire hall, which will be a great experience for students. Richie then engaged the audience with photos of our equipment and the blueprints and architectural renderings of the proposed facility.  Josh discussed when this would all be happening, and our plans for marketing and attracting patients. Since we're in an underserved area, we're expecting a large percentage of emergency-walk ins but we need to be prepared for many scenarios. By participating in the Buffalo Clean Sweep Initiatives, and marketing within the community we hope build some hype in the community prior to opening. Last but definitely not least, Hoda closed out the presentation with a discussion of how this clinic would fit into our schedules, what procedures would be done and our goals of going paperless. We plan to provide a broad range of palliative care procedures at first, however the vision is to become a comprehensive care clinic. More complex cases will be referred to Squire Hall, but simple operative, extractions and other procedures such as those could be performed on site. The logistics of how the rotation will work are being decided. Currently, the thought of having a vertically set up rotation, in which students rotate once a week through the clinic for the semester is gaining popularity as it would provide students with an experience that we do not already have. 

While we have made a great deal of progress, this is still a work in progress and the questions we received were all a great help. We're very excited to gain access to the building in January and begin our move in. If there are any other questions or concerns they can be directly to any of us via our emails. Hope everyone is as excited as we are about this new venture! 

D3 Fall Post Midterms

Crazy as it sounds, and as much sacrifice that this year has taken so far, D3 is great. Class all day Tuesdays and Thursdays is brutal, but seeing patients Monday, Wednesday and Fridays makes up for it. This past week we had exams in Fixed, Removable, Pharmacology and Endo. Pharm is the obvious killer. Public Health class is getting better, just hard to debate things at the end of the day. The other week we had an interesting talk about dental therapists. Talking about this issue in dental school makes me feel that I need to put in a little extra effort to get the whole story. For anyone just reading for fun, dental therapists, or mid level providers are dentistry's equivalent to physician's assistants and nurse practitioners in medicine. They would work under a dentist to provide care in uncomplicated cases. Simple restorations, preventative treatments and patient education would be their primary roles. The thought is that these practictioners will bring down health care costs in dentistry, and increase access to care in underserved areas of the nation. The concern about this strategy among dentists is that dental treatment is often irreversible, and complications arise without warning at times. Having a provider with less training and experience puts the patient at more risk than it benefits them. The issue has many more angles than I understand at my current position, but it's all very interesting. I've seen videos from states like Minnesota that are very appreciative of programs such as these and that patients that normally would not be seen, are receiving treatment.

The access to care issue is really interesting to me and it's disheartening to hear stories about the dental care crisis in the U.S. Again with many of these issues, there is are always many factors at play. I read an article the other day where dentists in Michigan are doing something really cool. Since dental insurance isn't as widespread as medical insurance, people often don't seek out continual dental care and end up in ERs with dental problems. The ERs are generally not prepared for these types of problems, and there is little that can be done many times, beside a referral to a dentist. Dentists in Calhoun County Michigan have set up a program where uninsured patients who have dental emergencies can recieve treatment, in exchange for community service. Since private offices established the program, there isn't as much paperwork as government run programs and they can run the program as they wish. The Medscape article can be found here. I'd encourage everyone to check it out.

But back to actual school. I've completed my first set of Interim Dentures! They'll be off to the lab tomorrow (fingers crossed). I set a lingualized occlusion, where the maxillary buccal cusps do not make any contact during excursions. There is 1mm of overbite and 1mm over jet. The next steps will be to finish and polish them once they are processed, then bring the patient back for extractions of the remaining anterior teeth, and insertion of the interims. Next semester we'll go through fabrication of the definitive upper and lower dentures which I'm looking forward to.

My first crown is finally back from the lab also! Upon initial evauluation on the cast, the mesial contact was actually open, but our lab in school was able to fix that no problem. There were no positives on the intaglio (inside) surface, the margins looked clean, and occlusion was correct. Moreover, the porcelain appears to be completely intact and sound. I can only hope the definitive restoration fits the natural tooth as well as the cast.

Also getting started on my implant case for this semester. Primary impressions were taken a while back. in the school the next steps involve meeting with an implant fellow, waxing in the tooth to be implanted, and creating a surgical guide. So far I've got the tooth waxed in but the guide needs to be done under the implant fellow's supervision because the machine we use is newer than the one we initially learned this with.


So in short, third year is great. Oral path exam this week and Medical Emergencies is finishing up also. More to come.

Cheers.

Buffalo Niagara Dental Convention 2013

Talks of 2013 were great. This year we got to stay for the full two days, rather than just one. Normally I'd lean toward hearing speakers outside of UB since it's nice to hear different perspectives, but this year I checked out Dr. Panteras Everyday Endodontics, and Dr. Brewer's Digital Dentistry. More than the talks, the vendors really appealed to me this year. Spending 3 days a week in the clinic, doing our own lab work and working with patients puts us in a much better place in terms of what we're looking for in materials and products. In the school we're using Straumann's Implants, but it was great to hear what else is out there. I spoke with AstraTech and got some interesting information on their system. I learned there are a ton of other bur distributors out there and I'm curious to try their products before graduation since one is a local company,

What I really loved though about this convention was the labs that were there. Spent some time talking to Vincent Martino Labs, which I got the impression was a small lab up around Buffalo. What I really was impressed with was Evolution Dental Science Labs. I have this intrinsic admiration of lab techs for what they do. Most of the magic in dentistry is all in the lab. The beautiful restorations all come from them for the most part. As dentists, we decide what is in the patient's best interest, and how to handle the case, but the technicians actually fabricate the solutions, and that's something incredible. Anyways, they're a bigger lab, that always has a presence at the convention. They're cool new thing this year was a system for digital dentures. The dentist takes upper and lower impressions and bite registration, and sends it in to them. They then have a digital scanning system that scans the impressions, digitizing them and allows them to create a denture virtually with sockets for the teeth to later be cured into. The design is then milled into a material denser than the usual denture acrylic. This material is denser, thus houses less bacteria and is stiffer, leading to a better, healthier fit. Since the denture is milled, there is no shrinkage to account for which alters the fit of traditionally made injection molded or compressed dentures.

The dentures they had ready made as models were great, normal looking dentures, but what I found really cool were these wooden dentures they had just for show. Not the greatest quality picture, but pretty cool having machines that can mill different materials.

I really admired the techs that were there that I had the opportunity to talk with and spend some time with later on at their sponsored event. They're passionate about what they're doing and willing to share their knowledge. Since we do our own lab work at the school it also was great to get some feedback from others doing the same work at a much higher level. A couple invited me out to the lab to check things out which I'd really love to do. Hopefully in the near future. 

Dr. Paul Farmer visits Canisius College

Dr. Paul Farmer was amazing last night. I think I might have been a little lost in the hype at first but he’s an incredible person. For everyone who doesn’t know, Dr. Farmer is one of the founders of Partners In Health, a large non-profit that works to bring medical care to the poorest places in the world. Dr. Farmer started PIH while he was a medical student at Harvard Medical school. He's also one of my personal role models and an inspiration as an aspiring health care professional. According to Kidder’s biography, Mountains Beyond Mountains, Farmer would skip classes during the week his first couple of years to work clinics in Haiti, and return to Boston for exams and clinical rotations. His passion for people and health were evident. 

Dr. Farmer premised his talk with a overview of the health care system in general. There were three parts in his eyes: Discovery, Development and Delivery. Discoveries made in labs, such as vaccines, medical equipment etc, need to be developed into products that can be utilized in the delivery of care. As a physician, Dr. Farmer sees the system in realm of delivery. He spoke about the enormous amounts of people in the world without access to care and sought to change that, and to a great extent, he has.  He mentioned the negative mentalities that people in high places had for years in terms of providing care to the poorest nations. Statistics about how it could never pay off, and was completely unfeasible. My favorite part was definitely his citing of  a couple quotes from a couple government agencies, which basically was them giving excuses why these poor nations are not worth even trying on. Dr. Farmer responded to these quotes with fervor, tearing them down and totally disproving them with his entire career. 

Issues of cost in health care came up as well. The vast disparities between cost of drugs and medical supplies in the U.S. is obscene. He mentioned that health care is a strange field in that aspect. If any other good or service ranged in cost to the extent that health care does, heads would be turning, but given the complexities involved in health care, somehow they get away with it. Nonetheless, even in the face of cost, Dr. Farmer was able to raise money and secure medications for his patients abroad in order to treat AIDS/HIV, Tuberculosis and even cancer in the poorest nations in the world. 

The motif that we can learn from these nations was recurring. The idea of “community based healthcare” and how in some parts of Rwanda, higher percentages of people are gaining access to health care than in parts of the United States. 

All in all, Dr. Farmer was inspiring. Despite what people say about him not being a great family man, he’s an incredible person. He found something worth fighting for and changed the world. Given the unbelievable turnout I know many others agree. After his talk he took 8 questions, but stuck around to speak with the long line of guests that waited to meet him. 

All Dr. Farmer spoke about medicine is even truer in dentistry today in the U.S. Costs of oral care are often too expensive for people, and insurance has not done much in the way of solving this problem. This article on DrBicuspid.com talks about America's Dental Care Crisis, and the people of Wisconsin, Minnesota and other states who are in pain, suffering from a lack of dental care. Dentistry as a whole requires a change if care is to be extended to the underserved populations in this country. Overhead for dental care in general is miles above that of a primary care physician's office. Progress is being made in the way of Community Dental Care Coordinators, to aid in the access to care issue. Today dentists, possibly even moreso than physicians should be concerned with our delivery of care, and how we can extend care to those in greatest need.