The Contribution

Weary, yet fulfilled, today was our final day of treating patients. We rose early at 4:30 and headed southwest for about 1.5 hours close to where we were yesterday. I remember this village from last year. Leaving the highway, we headed down a dirt road that eventually brought us to a large monastery. Last year we worked while monks chanted over a loud speaker, celebrating a festival. It was enchanting and eerie at the same time. 

This year the monastery was quiet, but the roads were as narrow as I remembered, and all the houses sitting on stilts provided an obvious indication of the floods that come during monsoon season. 

Our numbers were low compared to yesterday. A little over 100 children examined, and the percentages requiring treatment were in line with the previous week. 

But the slower day gave me time to gather my thoughts and reflect on the week. First let me share something that I learned on this trip. It's called a "contribution".  I have mentioned in previous posts that no matter how poor the kids are (with the exception of orphanage children), all the kids have money tucked into their shirt pocket. We had always assumed this was for candy, and we were partially correct. What we didn't know is the rest of the money goes to the teacher. Without this payment, the children aren't taught, don't take tests and instead they are virtually ignored.  And this should come as no surprise, all power in this country is often bought, and once the power is achieved, the payback begins. 

But at the same time, this trip reaffirmed my confidence and respect for the Cambodian people. They are kind, peaceful and, as Budhists are known to do, they accept their fate.  And as such, life has not been fair to them. 

Life is changing here, many large international corporations have discovered the abundance of cheap labor in this country. And there appears to be an emerging middle class. 

As I sit in a quiet village,where large coconut palms cast shadows over the thatched huts while cows wander freely on dirt roads, I am left to wonder if the villagers who leave for the city or take jobs in the sweat shops are really improving their lives by earning a higher wage? Many people will live their whole life in this village, well fed and surrounded and supported by friends and family. Is moving into the middle class really a step up here? 

But this is not for us to judge. As I heard from Stella, who runs several NGOs, "just when you think that you have Cambodia figured out, it takes everything that you'd expect and turns it upside down."  And I couldn't agree more. 

All for now. Goodye from Cambodia. 

A Full Day

All week we've been happy to help children who have desperately needed dental intervention, yet, at the same time, we've been somewhat disappointed about the number of patients that we've been able to reach. That changed dramatically today. Our numbers were outstanding; 344 children were seen, 180 of whom required dental treatment. Some 200 baby teeth were extracted while 40 permanent teeth were extracted too. Everyone had fluoride and/or varnish treatments. 

Leaving Phnom Penh at 6 am under a tired full moon, we headed southwest past the airport to Stella's village. Stella is a Dutch woman who lives in Belgium and travels to Cambodia regularly to oversee her several NGO's.

Like COLT, Stella's groups are well run without the corruption so common in this country. 

And, as we've seen before, the children who have had previous regular care have beautiful, healthy teeth. The youngest new patients have the greatest dental need. If they are local school children, they will decline our treatment despite their obvious discomfort. If we are lucky a teacher or parent may be able to convince them to take advantage of our care. 

Today I was lucky to have Sross as my translator. She is a 14 year old who lives in the Unacas Orphanage with her brother and sister. She quickly understood the dental concepts and was able to not only translate for us, but also explain to the children why our treatment was so necessary. Most children walked away smiling, confident that we would be able to help them. 

While I am exhausted, I am unbelievably proud of my mentor, Dr. Bob. For those of you who visit my office, you've probably heard how me tell how this energetic 72 year old man walked on a misdiagnosed broken hip for a month and a half. His surgery was a couple of weeks before this trip and his rehabilitation consists of sitting in his wheelchair examining some 100 to 200 patients each day. I am floored by his stamina which is fueled by his desire to help needy children. 

Our trip is winding down, tomorrow is our last day. We will visit another village that Stella oversees. We've had some very difficult experiences, a young woman who came to our clinic didn't look well. A group of Australians who are helping us took her to a hospital today and have found that she has typhoid. It's a very hard life here with a much shorter life expectancy than we enjoy at home.   

But there are many happy moments too. Last night we had a long laugh when we realized that our Israeli friend, Eli, was not talking about a Russian doctor who would arrive next week, Letitcooloff, but rather, warning us not to burn our mouths. 

 

Arun's Story

As promised, today we visited Arun's village. Arun is a man of unknown age, that our leaders, Bob and Purobi, befriended. The story of his unknown age is riveting, but you'll have to be patient, I'll get to it. 

To reach Arun's village we drove for about an hour out of Phnom Penh until we reached a ferry boat. This ramshackle ferry carried our three vans and a variety of local people in trucks, on scooters, bicycles and by foot across the Mekong River. 

From there we drove on dirt roads, past rice paddies and wooden shacks on stilts until we reached the schoolhouse in Arun's village.   

We arrived early, and by 7:30 the classrooms had been converted into areas for: examination; patient education; fluoride and varnish, a treatment room and a recovery area. 

Not long after we started Arun arrived. He is a middle aged man, just beginning to grey, thin - as most Cambodians are, and a little taller than most of his countrymen. He has a kind yet serious face, that is occasionally lit by a smile that is more paternal than happy. You see Arun is a survivor of the Khmer Rouge. The only survivor, in fact, of his whole family. 

When the Khmer Rouge came to power he and his mother were the only two in his family to survive. Because of her beautiful voice Arun's mother was not killed and rather, forced to sing recruitment songs for her captors. She hid her infant son away, until one day, he was discovered picking fruit outside her home. Though he was taken away, the reign of the Khmer Rouge was fortunately coming to an end. He survived the atrocities of the Khmer Rouge as an orphan. 

So here we are in Arun's village. No one knows the true name of the village, and no one much cares anyway. Arun is back on the land where his family lived for centuries and most importantly, he oversees the health and well being of hundreds of families that live in his community. He is the unofficial mayor. And we feel privileged to work here. 

As has been the case all week, we saw more patients today and did more procedures than we did in the preceding day. Ironically, another community school cancelled their visit to our clinic in the afternoon preferring to host a group that is traveling the area handing out small gifts and CANDY in exchange for listening to their religious conversion pitch. 

Our week is winding down and we feel good about what we've accomplished. Our greatest achievements may not be the number of extractions, but rather; our efforts to educate these communities about prevention. 

As one who does exams, I have made a special effort to educate and cajole the parents and children into accepting the extraction of certain baby teeth that are for the moment asymptomatic. Cavities are painful when they first begin. But once the nerve dies the tooth may become temporarily asymptomatic only to return as a painful abscess. Our translators have done an outstanding job of helping our patients and parents understand this. And I believe a lot of needless pain will be averted. And for these reasons, it's been a great day. 

Harvest of Hope School

Today we visited the Harvest of Hope school on the outskirts of Phnom Penh. This is a Christian NGO that receives funding from Australia. 

Though we anticipated a problem with the organizers of today's work, they turned out to be terrific. We worked closely with them to explain the rationale of which teeth had to be extracted. Sadly, and fortunately, many of the first children we examined this morning had visible abscesses and the need for extracting these teeth was painfully obvious. And the translators were instrumental in helping the children receive appropriate treatment. 

What we discovered today, was when a community has access to year round dental care, they will only utilize it for emergency situations. And that should come as no surprise, many in the US do the same thing. So today, much of our work was overcoming this mentality. The children will never know the pain that we were able to avert with today's timely dental care. 

Each day we are seeing more patients and doing more procedures. Our numbers today were 217 patients seen, 175 fluoride varnishes, 80 extractions of baby teeth and 20 extractions of permanent teeth. While the early morning patients were local students, later in the day we saw patients from the countryside. The children were "trucked" in to us from some 60 km away. 

Tomorrow we visit Arun's village. I have heard of this place for the past four years, but have always been here for the second week of the trip. Arun works at our hotel and has maintained a strong connection to his distant village. Sheri, one of our long time volunteers has teamed with Arun to provide regular fluoride treatments and solar lights to help students do their homework. 

The work is hard, but it is cooler than last year and each day brings an unexpected adventure. 

Sent from my iPhone

Day 4 At Colt Orphanage.

Today was a productive day for KIDS. We set up base at the Cambodian Organization for Living and Training, our old friends in Phnom Penh.

Frieda is our contact there; a wonderful Dutch woman who treats the children as if they were her own. And though they have heart wrenching histories she's not easy on them. Her parenting skills are designed to help them succeed in a society where much is stacked against them. And coddling them will only hold them back. 

Freida and her husband, exposes them to music, martial arts, sports, art and any other pursuit that will better their lives. And she see's that they are kept busy working hard to achieve their goals and potential. 

Because of our history with this group, her students have few dental needs. New children who move into the orphanage will have the greatest need, but her orphanage has been full for the past three years. Next year 3 of her students will move out into a subsidized housing where they will continue to study, some taking college courses while others begin non-degree jobs. And spots will open for three more orphans to move in. 

But  today we also saw students from other schools, as well as neighborhood kids, who may not be going to school at all. Some of the children were HIV positive, or the children of parents who have died of AIDS. Just as we do with all our patients, we reviewed our protocols this morning on proper capping of needles, disposal of waste and, of course, our sterilization technique. 

By the end of the day, the temperature was well into the nineties. We were satisfied having treated nearly 200 patients. Again some 80 or so baby teeth were extracted, 20 or so permanent teeth were taken out and nearly 80 patients received fluoride varnish. We are finding the varnish incredibly valuable in protecting the chewing surface of the lower first molars from the inevitable decay that these children will develop.

 

Tomorrow we will visit one of the many areas of town where families have been relocated. I have mentioned them in past years. When the government decides that property is valuable, the residents are moved away for any matter of reason. These people were told that they have AIDS and needed to be quarantined.....they don't have AIDS. An extremely expensive office complex sits where they used to live. 

We anticipate seeing about 300 children. I just met with the leader of their group. She would like to call every parent when an extraction is required. Of course the parents sign a permission slip ahead of time and having to reach each parent would compromise our ability to get the necessary work done. I am hoping that we have reached a compromise. She will be my translator and I will show her how we decide which teeth need to be removed. It will be a crash course in dental infection, tooth eruption timing, and space maintenance. I hope I can win her over. No matter what, it will be interesting. 

Day 3 On the Gulf of Thailand, Kep City

Our Cambodian patients today were exceptional. Most had never seen a dentist before but they accepted us with some curiosity and a little trepidation.   

We weren't sure what to expect. Though our visit had been scheduled for several months, we heard at the last minute that the school scheduled some tests for students and that we might not get a large turnout. As you can imagine a buzz moved through our group last night that maybe our long journey to Kep was in vain. 

Fortunately, the turnout was better than we expected considering the testing schedule we saw about 120 patients. For these patients we did 70 extractions of deciduous teeth and 19 extractions of permanent teeth. For our group, this is an extremely small number of patients. And we're left to wonder what would have been had the school administration taken advantage of our presence. 

But this is sometimes how it goes when we visit a new area. Not all new areas will be re-visited next year and surely Kep will be off the list. Tomorrow we return to the local orphanages around Phnom Penh that are our regular stops. Though we won't be here next week, the group will add a new area and if they are organized and present a large number of patients, it may become a regular stop on our trip. 

Sadly, there are more than enough towns to choose from. Cambodia is replete with poor underserved areas. Ironically people in Kep asked us to come, but weren't able to organize a busy enough day for our group to be able to return. 

Everyone here is giving up time in their own offices and no one wants to stand around. Again this year, the highlight for our group were the 18 year old translators who we brought from a Phenom Penh orphanage. They are terrific with our patients, empathetic and kind. And we love to hear how these former "street children" are working toward college or trade school admission. 

Arriving in Kep - Crab City

Sunday Frbruary 1, 2015

In retrospect, getting up at 5:30 and hitting the road by 7 am was a good idea; but that's not what I was thinking when the alarm went off. Jamie was already up and annoyingly cheerful having made her way to the breakfast room while I still enjoyed the deep slumber that comes from a time zone change. 

We had heard that the ride from Phenom Penh could be up to five hours long, but our early departure allowed us to arrive in about 3 hours.  Kep is a beachfront resort with an enormous statue of a crab about 100 yards offshore. 

Today was a travel day. The team spent last night organizing supplies and reviewing our game plan. Our early arrival here has allowed us the luxury of planning a boat tour of the coast with some optional snorkeling this afternoon. 

Tomorrow we will examine patients that we have never met before. Dr. Jim, a dentist originally from Nevada, did a pre-screening and reported the need for a trip to this part of the country. Several years ago Jim visited Cambodia on a dental trip and never went home. He has joined us in Mongolia as well. 

I am certain the idea of staying in a hillside hotel was a brilliant decision...... made before Dr. Bob had his hip surgery, but it did present some logistical issues getting him to his room. Luckily the team is creative and enthusiastic and the narrow cobblestone path and stairs were just a warm up for the problem solving skills that we'll get to employ this week.