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My time in Haiti: Short trip, large impact

Posted on Apr 29, 2018 09:42 pm by Victoria Green, RDH, MEd

“Splash, plop”; I look over my loupes and as my eyes adjust to the dark room, I notice two drops of my perspiration being soaked into the shirt of my patient below. I squint as more perspiration burns my eyes and look at the 15-year-old boy smiling up at me. Ernst takes this opportunity to sit up from the recliner that is doubling as our “dental chair” and spits into the bucket at my feet.

Service and community health are an integral part of the fabric of dentistry. This was personally one of the most drawing factors of the profession. I love being able to see at the end of 45 minutes to an hour of work that I have been able to make a positive impact in my patients’ oral and systemic health, as well as boost their self esteem. I have had the opportunity to develop and implement oral health education and fluoride varnish program in East London, South Africa, and to volunteer with Operation Hope India in Secunderabad, India where I designed and implemented dental health education, and preventative dentistry services for 120 orphaned children. When I was asked by my friend to accompany her in service to the orphanage and school, Enfants de l’espoir, in Port-au-Prince, Haiti in December 2017, I was excited for the opportunity to help an organization that has personal connection.

As I prepared for this trip I grappled with many complicated emotions and thoughts about the ethics and efficacy of short-term service. Do trips like this and the services provided make a large impact? What is the risk if I provide care that needs follow-up and I am not there to provide those services? Does this have more personal gratification than actual value for those receiving services?

With many of these thoughts still swirling in my head I went with one simple quest: I was going to provide the highest quality care to the children that I met and provide them with the education and tools that they could continue to use preventative means to mitigate serious dental disease. 📷 Our objective was quite daunting with 5 days to complete 64 prophies and fluoride varnish treatments for the children resident at Enfants de l’espoir between the ages of 4 and 17 years old. I used almost entirely donated supplies for this program and was able to sterilize my instruments with a stovetop pressure cooker that we ran back and forth between the orphanage and the open air kitchen. The facility had no running water or electricity. With the temperatures in the high 90’s with high humidity, I often felt weak and dehydrated. Surprisingly, I encountered relatively low dental caries with the children having an average DMFT score of approximately 3. I encountered copious amounts of calculus on many of the children. The calculus was often extremely tenacious and layered. From my observations of the environment, I would attribute the low caries rate and high calculus deposition to be associated with their nutrition and resulting salivary composition. The children often have little to eat and are exposed to few refined sugars.

Through the course of treating the children, I encountered 5 adolescent boys with Aggressive Periodontitis. For most of the boys the disease affected all of their first molars but one boy had periodontal involvement on all of his incisors as well. Another boy presented with suppuration and an 8mm probing depth on #3Mesial. I have to think that their immunosuppression and virulent bacteria associated with this disease is related to malnutrition factors as well. These are research questions that I would love to explore in the future.

This trip was personally and professionally enriching. I learned many lessons but my most condensed offering is as follows: Learn the language and don’t be shy to stumble through with your sloppy accents. Continue to be open and flexible with plans and try to let go and adopt the cultural norms that do not impact the quality of care provided. The children wanted to sit very close and watch treatment provided to their peers. This seemed like it may be too traumatic but the children did not share ill reports of their experience and the opportunity to watch the process provided context that was completely absent. Additionally, I learned that service can create meaning in other ways; Yvette is an intelligent 15 year old girl at the orphanage who aspires to be a lawyer. She watched me work for hours on the children. Later, she wrote me a letter, sharing that my work inspired her to be perseverant, to work hard even when you are tired, and to be committed to excellence for the benefit of others. These were wise and unexpected observations.

Much of my passion for international dental service has been inspired and informed by two books that I highly recommend, Second Suns by David Oliver Relin and Mountains Beyond Mountains by Tracy Kidder. These books have inspired me to reach for excellence and optimal provision of care irrespective of location and the opinion of the masses with regards to impact. You may feel that your impact is small and irrelevant in the larger picture but if you can make a difference for one person, or inspire one person to reach out to another, the impact can be exponential. We can keep making an impact and fight futility by continuing to contribute our part and doing the sludge work that others may shy- away or tire in pursuing. The great tide of need and poverty is only steamed by our continued efforts. “… and right action is freedom from past and future also. For most of us, this is the aim Never here to be realized, who are only undefeated; because they go on trying.” – T.S. Eliot, Dry Salvages Victoria Green, RDH, MEd

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