Cleanings in Cambodia

Alongside @kidsinternationaldentalservices

Cambodia Day 1

Today we arose early, eager to begin our first day of work in Cambodia. And, as our friends and family at home began dipping chips into bowls of salsa and guacamole and tuned into the Super Bowl, we raced across the Cambodian plains watching the sun rise to a small ferry which took us to our island destination.

And unlike the usual February vista of Cambodia, this year we found the island lush, green and filled with fruit trees and crops. This time of year, rain is infrequent and the foliage is usually brown. But weather is changing throughout the world and it’s no different here. It rained for a couple days last week and the temperature is only in the high 70’s.

There are four schools on this island and we have chosen the one closest to the ferry as our makeshift clinic. Throughout the morning our vans have been shuttling students from the other schools, and we have completed our exams and fluoride treatments for all the 680 children that we will see today. There is still a wait for emergency extractions that are required by about 13 percent of the students that we’ve assessed today. Approximately 80 children have required extraction of one or more teeth.

Though we are working about 20 miles outside Phnom Penh we are working today with Everett, an Australian, who runs an NGO along with his wife far away in Siem Riep.

He and I talked today about the changes he has seen in Cambodia over the past couple years. Some changes are terrific; healthcare, for instance, has become more accessible to the population. But he also told me about a disturbing change that may have a huge effect on the population; drug use among children and teens is on the rise.

You see, Everett and his wife run an NGO that is dedicated to helping drug addicted children. And, in the Siem Riep area there has been a spike in the use of ‘ice’, or methamphetamine, among teens. And perhaps more disturbingly, they are also finding a significant number of pre-teens addicted to sniffing glue. In fact, they are treating children as young as 6 years old for this habit, and the usual age for this addiction is 9.

Unfortunately, his is the only NGO that is dealing with this swelling problem. The government has a treatment center, but it is basically a jail with no substantive treatment offered. And as you would expect, the rate of recidivism is quite high. Everett’s goal is provide alternative’s to his charges through vocational training and then to reunite the children with their families. It is a daunting task.

And to some degree it leaves me wondering if what we do through dentistry really makes a difference?

But we’ll keep doing what we’re doing because we have met so many great people along the way. And not just on the volunteer side, but also on the patient side. And I definitely hope, that one day someone in Cambodia will pay it forward and do something good for someone else, because they remember that in February 2018 a group of strangers from another country did something good for them!

So save us some guacamole and chips, the day is almost done and we’ll be tired and hungry when we get back.

Cambodia Day 2

As they say ‘what a difference a day makes....’ Yesterday a small percentage of the kids required extractions, today it seems as if greater than 20% of the children that we are seeing require multiple extractions.

We are based at COLT, an orphanage that KIDS has been working with for the past 13 years. None of the 16 full time residents of this orphanage required treatment, but the orphanage also provides day care and other services for the community. And it’s within this population that we are finding a huge need for emergency treatment.

As with all the places we visit, our aim is to eventually provide sustainability, and to reach that end we provide education, fluoride and fluoride varnish. But with such rampant dental disease we are mostly providing emergency treatment, extracting severely infected teeth. Where possible we will do ART, atraumatic restorative therapy, small fillings in teeth that can be saved.

Years ago, the old dump was gated and a new dump was opened. And like a small economic center, this new dump attracted the disenfranchised populace from Phnom Penh and the surrounding villages. The government has done what it can to prevent the prying eyes of foreign NGOs from seeing the conditions at this new dump, but like the old dump many families call it home. Parents and their small children pick through garbage earning a meager wage. These people usually have no other options.

Many of the children that we are seeing today are ‘dump children.’ A few moments ago, I examined a girl of about 4 years. Several of her teeth are infected and will require extraction. She had two black eyes and I asked the volunteer from Aoogah, a NGO, what happened to her. She and her family were beaten when they refused to vacate their home to make way for New construction She was found on the street two weeks ago. And despite their efforts to find her parents, she will likely be raised in this orphanage. She is just beginning to communicate.

When she first arrived at the orphanage she refused to talk or eat. And though this isn’t the norm in Phnom Penh, it is the world in which we move when we come to do our work here. It’s a far cry from Bergen County.

Luckily the weather is cooperating again today. It is cool and a rare breeze is blowing. It has helped us to see 800 children: 130 of whom required treatment with 68 permanent teeth extracted and 200 deciduous teeth removed. 402 received fluoride and varnish treatments.

A brief word on the political situation here. We had heard that there was anti-American feeling in Cambodia, but we have experienced no such thing. The families and common folk harbor no ill will toward Americans.

Cambodia Day 3

Our host today is Denzil Sprague. I have written about him the past. We are at a primary school that he built in 2009. This Australian pilot, who stands six feet five inches tall, works tirelessly for the children of Cambodia. But, more about him later.

It’s 11:30 and we’ve seen all the schoolchildren that we’ll see today. The percentage of children requiring treatment is high. Exactly one hundred and one children have already required extractions. Bob and I had assumed prior to beginning our exams that seventy children in total would require treatment; perhaps we were optimistic about the dental health of these children or maybe we were just tired after our dental marathon yesterday.

With twenty children already awaiting dental surgery we have a bit of a back up. Bob will move off to help in the post op area and I will usually go to do some of the easier extractions. But the treatment room is very small today and there is no open bench for me to use. And I thus have a moment to write down my thoughts.

So, let me return to Denzil. He has been working with Children's Rights International and the Cambodian government to revise the child judicial system. And his work is proving valuable. Prior to 2016 there was no distinction in the court system between children and adults. Meaning children who were accused of a crime were sent to an adult pre-trial detention center. And as you might expect, if that child was’t a hardened criminal when they entered the detention center, they certainly were by the time they left this facility. Today there are about five interventions that have been added to rehabilitate a youthful offender. These steps include working with the parents and community and community service.

It is too soon to say if this will have an overall effect on the crime rate, but clearly the youthful offenders are being treated in a more appropriate way.

Though Cambodia is a traditional country that is working to embrace modern society, many of the beliefs that make the Cambodians so beautiful and unique create hurdles to a healthier population.

A couple of years ago the government created a widespread campaign to vaccinate children. In many of the rural communities parents kept their children home believing that the vaccines had been sent from Vietnam in a ploy to poison the children.

Today, we did not see all the children at this school. Some were kept home or told not to see us with the belief that extractions can endanger a child’s life. Ironically, many of the teeth that we are extracting have significant infections associated with them and the potential to cause systemic illness.

It is peaceful in the rural areas of Cambodia. And as our day winds down we are satisfied with the care that we have been able to provide today. 480 children were seen, with 101 children requiring extractions. 75 permanent teeth teeth were extracted and 120 deciduous teeth were extracted as well.

As the day came to a close we wished Denzil goodbye, unsure if we’ll be back next year to this country to which we have become very attached.

Day 5

Yesterday was a travel day for us, as we moved our team from Phnom Penh to Siem Riep. Though it’s not a great distance, the roads are narrow and filled with slow moving trucks and motorbikes. Our driver, Ritay, had the arduous task of delivering us safely in a timely manner. A couple of years ago, I was a passenger in a van that lost its driver side mirror in a passing attempt gone awry. No such incident occurred yesterday and we arrived in Siem Riep unscathed.

With no patients to see, Eli Davidyan and I rushed off to the temples of: Angkor Wat; Bayon; Baksei Chamkrong and Preah Khan. Though eager to see as much as possible, we rode our motor bikes with care, knowing full well that traffic laws in Cambodia are merely suggestions, and our team would never forgive us if we had to withdraw due to injury.

We arrived safely back at the hotel at about 8pm, and except for the bitter eggplant at dinner, Eli declared the day a success. I agreed.

Today we are at the Bayoun Middle School outside Siem Riep. It’s just past noon and we have finished examining the morning and afternoon classes. With 650 patients seen today and 112 requiring extraction, it will take some time for the 30 or so patients in the waiting room to be seen.

Every community that we visit has its own unique dental needs. It’s true with respect to their diet, the naturally occurring fluoride in the water, their dental awareness and, of course, the resultant rate of caries. But what is so unusual today is the number of decayed front teeth, and in particular, the number of front teeth that are infected. By days end, we will have extracted several front teeth and restored 65 others.

In our own private practices teeth would never be allowed to decay like this. Nor would our patients ever allow their teeth to look this way. And if per chance this were to occur, we’d have several options to save the front teeth. But those options don’t exist here.

Here, root canals, crowns and partial dentures are a luxury for the wealthy. And we can only extract infected teeth and perform the most basic cosmetic dentistry. And thus, when extractions are required, our logistics team needs to spring into action. Purobi, our group leader, will meet with the school headmaster to arrange a face to face meeting with a parent when a front tooth requires extraction.

And with the arrival of a parent, we perform a bittersweet consultation, knowing full well that the only real option for this patient will be an extraction. But it is our duty to fully explain the alternatives. Most of our patients today opted for extraction, a few declined treatment.

In retrospect, we feel good about the day. Though poor, the children were exceptionally well behaved and the school was beautifully maintained. The children were educated about dental disease and preventative measures were taken. Infected teeth were removed and aesthetics were improved.

We’ll drive back to our hotel today happy that we’ve been able to help these children. Our route will take us past thousand year old temples that saw one religion ousted by another in a see-saw battle for control of the region. And we’ll pass faded signs warning of unexploded ordinance that our country dropped some 50 years ago in an effort to stop the spread of communism. And we’ll have to conclude that we are often defined by our differences. But for today at least, we embraced our commonality.

Cambodia Day 6

We finished our work in Cambodia yesterday but returning to the hotel I realized that I was too exhausted to write. I’m glad I waited because the time and distance have given me a perspective that I didn’t have when I was fully immersed in the sounds, smells and culture of the Khmer.

So it was hard to finish our last day in Cambodia uncertain of the country’s future. As Purobi led the ‘wrap up’ meeting, she recounted the history of KIDS in Cambodia.

Some 14 years ago she and Bob visited the country and established a ‘mom and pop’ operation. By 2009 they began bringing students and before long they grew into the organization that we know today. And while Purobi is not one to cry, Cambodia is her child. And she nurtured this child until forces beyond her control took it away. And as you might expect, this was, and is, very painful to her.

while we all knew, coming into this trip, that this would likely be our last year in Cambodia, somehow we hoped that through luck or divine intervention something might happen to change the situation. But as Purobi finished her wrap up speech, the reality of the situation took hold, and we all fought back tears.

Nonetheless, this was a successful trip and I’ll do my best to be brief as I share some observations from the final meeting.

James, our dental leader, presented our numbers which quantified our contribution to the children. 2952 children seen, 1500 received fluoride and varnish, 497 had extractions and 903 teeth had been removed. And a remarkable 109 restorations were placed, saving teeth that would otherwise have had to be extracted.

Sean and Nam, third year students from Columbia dental school, complimented the group, somehow naively unaware that the rest of us had drawn energy from their positivity and work ethic.

Krista and Steve kept it short. As a court judge, Steve had been a bit long winded during his ‘opening argument’ at our orientation meeting. Their respect for the team and under estimation of their contribution were evidence that we could not overlook.

Their daughter Katie, a fourth year dental student at Columbia, with an ability to ‘keep it real’, was a returning veteran. The future of KIDS is assured with young people like her.

My friend from dental school, Larry, who is one of the most honest and genuine people I have ever known, modestly talked about his experience during the week. And he hoped that he’d be invited back; he was unaware that his sweat soaked scrubs, about which he apologized, were an indication of his complete dedication to the cause. Nor did he realize how much the Columbia students admired him.

Jamie tearfully recognized how big a part of our lives Cambodia had become and all that we had gained from our association with KIDS, and Cambodia specifically.

I talked about our admiration of the Cambodian people and the changes that I’ve seen in KIDS over the years. And how very proud I am to be part of a group that constantly seeks to better itself.

Our groups founder, Bob, stoically wished that we could have done more in Cambodia, acknowledging that we never really won over the parents and school teachers. And without them, the unhealthy dental diets persisted. Ironically, the children without parents, in the orphanages, saw the greatest dental improvements with their educators following our lead.

Jeff, who was on his first KIDS trip, spoke about throwing money at causes, but instead he now felt more fulfilled putting his heart and hands to work for a cause.

Martin and Kevin from Australia vowed to continue their work with KIDS, but would always be sad missing their favorite week of the year.

Bernie and Barbara, who founds KIDS through their connection to Cambodia vowed to keep that connection alive.

Eli, who is dubbed our Dr. Root Tip, for his ability to step in and save the day, thanked Bob and Purobi for being his role models on how to “give back” to the world.

Shari, our neighbor from home, was grateful for having the opportunity to join KIDS and give of herself in such a profound way.

Teff, who is originally from Ethiopia, and on her second trip raised the team and our young patients.

And Elle, who hadn’t been able to speak when her turn came, composed herself and let our translators who are teenage girls from the Colt orphanage, know that they are always welcome in her life, like adopted daughters. She tearfully gave them presents from the team, though I’m certain that the actual gift was much less important to them, than our recognition of how much they had given to their fellow Cambodian children.

And finally, our Cambodian support team spoke.

Everett spoke first. He is an Australian transplant to runs a NGO for drug addicted children. He assured us that he would keep up the fight to help this population develop the life skills that were lost 40 years ago when the educated and the role models were killed by the Khmer Rhouge.

Mr. Hen, the former manager of our hotel in Phnom Penh, who was gracious enough to join us, spoke about how exhausted he was, yet energized by the spirit he felt in his soul from helping his country.

And finally, our translators thanked us for allowing them the chance to be part of a team that had such a big impact on the children of Cambodia.

And as the last one in our circle concluded their remarks, I realized that we too had come full circle in this beautiful country. Because the smell of burning wood that initially bothered me had become an aroma that welcomed me home. The lack of choice in a grocery store that had irritated me had come to represent the practical nature of this culture. And a child’s dirty school uniform that had made me worry about my own health, had become a beacon drawing me toward those most needy.

So, like a fleeting romance, or a pet that leaves us too soon, it is painful to leave Cambodia, but we are infinitely better for having known her.

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