Day of the Dentists June 28, 2012

In an earlier post (Like a Lionfish in the Caribbean), I mentioned that I was with a guy from Kansas City who was helping out with a travelling dental clinic that was serving some of the outer islands.  Today the clinic rolled onto the grounds of Xavier High School and set up shop for six hours or so.

Here’s little bit of background.  The clinic is a group of three dentists, and maybe a dozen support volunteers who make their way from island to island, setting up in communities for a day, and tending to the needs of as many people as they can see.  Now this is nothing like your trip your D.D.S. or hygienist for your biannual cleaning

and fluoride treatment.  This was fillings and crowns and extractions and implants.  This was like M*A*S*H except Hawkeye was a periodontist.

Townspeople started lining up before the dentists even arrived, and by noon there were well over a hundred people waiting, hoping, to be seen.  Around 9:00 a.m. couple SUVs rolled in followed two flatbeds packed with equipment and personnel.  Within a matter of minutes, trucks were unloaded.  Dentil equipment–drills, surgical pliers, stainless steel scrapers and probes.  Pharmaceuticals–novocaine, anesthesia, antibiotics.  Hardware– retractable tables, lights, fans, generators and the gasoline to run them.  All offloaded from the flatbeds and set up in two classrooms in the student center.

As people filed in, they signed up on a waiting list for triage. But before I go further, let me digress.  Micronesia was a protectorate of the United States from the end of World War II until 1986 when, under a Compact of Free Association with the U.S., it became an independent state, The Federated States of Micronesia.  The U.S. held on to the islands for their strategic location and for their value to the military.  Now, contrary to  Rogers and Hammerstein’s portait, I’ve yet to see anyone around here like Ray Walston singing, “There Is Nothing Like a Dame.”  From what I hear, the military presence wasn’t too big a deal.  The navy paved the roads, helped support infrastructure, and were fairly benevolent as far as benevolent dictators go.  But upon leaving, they left something behind which has become a scourge and a plague–SPAM.  Oh, I hear you laughing, but check this out.  The military introduced sugars and salts into the local diet which, until the U.S. presence, consisted primarily of fish, coconuts and indigenous fruits.  Richard and Oscar did get it right when they penned, “We got mangoes and bananas you can pick right off the tree.”  We got plenty of that here.  But the locals have also developed a pension for canned meats, candy and all sorts or prepackaged, sodium and preservative laden goodies– the type of stuff that can be processed in Poughkeepsie and shipped halfway around the world and still taste incredibly fresh once that tin is peeled back and the vacuum seal goes “schwuuump”.  The result of all this?  At current rates,  it is predicted that 50% of the Micronesian population will have type two diabetes by 2020.  There are kids I’m working with who have holes through their two front teeth as wide as cigarette butts.  The quality of public education on the island is sinking quicker than the sea leves are rising, so as a result there is a huge population ignorant about basic nutrition and oral hygiene who eat garbage and need roving dental clinics to put their finger in the proverbial dike to slow down an ever-growing health crisis.

Okay, so as I was saying, as people arrived, they sign up for triage.  Due to the numbers arriving at these clinics, and the sheer limitation of equipment and manpower, the clinic has to prioritize based on need.  Need, in this case, is determined by: “How much does it hurt?”   The goal is to filter out people who just need a cleaning because the beetle-nuts have turned their teeth the color of tobacco juice and cherry soda. This way those who are in the most urgent need can be seen.  Preference is also given to children eight to ten years old.  One hundred and twenty people showed up today, but there was only enough time and resources to see fifty.

Once someone gets the okay to see a dentist, a bizarre game of leapfrog begins.  It plays like this: a patient comes into the dentist who does a quick look and shoots him up with novocaine.  The patient then gets up and steps to the side while another patient comes in who in turn is numbed.  By this time the novocaine has taken full effect on the first patient who is then brought back in while patient number two waits for the feeling in her mouth to melt away.  When a table opens up,  she gets it, and a third patient is given the numbing shot by the dentist who saw the first patient and is now done with him.  It’s an elaborate card shuffle, but somehow it works.

Meanwhile, there’s a whole network behind the scenes signing people in, making evaluations in triage, keeping the people in the waiting room comfortable, filling the generators with gas and keeping them running, and taking them on and offline seamlessly so as to not interrupt the power flow needed.

A lot of this was organized by a guy named Vid.  A Chuukese native, he graduated from Xavier High School, went on to college, and then joined the Jesuits.  He dropped out before becoming ordained and married a woman from the States.  He worked for several years at Santa Clara University and is currently at the University of Hawaii at Hilo where he works as an outreach counsellor/advisor for Pacific Islanders attending the university.  It’s easy to see how anyone from this environment would get a heaping tablespoon of culture shock upon entering an American University, even in Hilo.  I’ve been sucking down my own tablespoons of the stuff pretty much nonstop for nearly two weeks.  He’s an amazing guy who drips charisma as he shakes your

The “waiting room”

hand with a sold grip like a vice.  He’s been back on Weno now organizing this and a conference for Micronesian women.  He is a true activist and advocate in every sense of the word.

Out in the waiting room a man walks up to the desk where the triage list is.  He is very concerned about his son.  “His tooth is so loose. He needs a dentist.”  The attendant looks in the child’s mouth only to find that it is a baby tooth hanging on by a thread.  Anyone with kids or who has worked in an elementary school has seen this a million times.  The attendant advises the father to just pull it.  “I can’t.  I am not a dentist.  If I pull it, it will not grow back.  He needs a dentist.”  The man had no clue about baby teeth; that they just come out and grow back in. The degree of basic knowledge is that low among some of the islanders.  Another parent expresses shock when told she should not give her children Sprite and lollipops before bed, an almost nightly ritual in her home.  Meanwhile children run around with their new toothbrushes clenched in their jaws.

To a layman like me it is all overwhelming.  I’m talking to a dentist while he is extracting the tooth of an unconscious child. He says, that it’s overwhelming for him as well.  “I’ve seen some people today–  I can stay in their mouth all day, but I just have to address the biggest issue and move on.”

I had a friend in high school whose brother wanted to be a dentist.  He often talked about the cars the dentists in our town drove.  Dr. So and So has a Porsche; another dentist drives a Beemer.  This seemed to be his impetus for entering the profession.  I know he’a an orthodontist now.  I don’t know what kind of car he drives.  But I bet it couldn’t make it up the hill to the clinic I saw today.

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4 thoughts on “Day of the Dentists June 28, 2012

  1. Bonnie Jacobson

    Inspiring story, and right on target in terms of the prevalence of Type II DM as a result of these foods. Same thing happening in the U.S., if you look in the poorest communities. We used to evaluate a lot of kidney transplant patients from the PI (Saipan, Tonga, Guam) who had developed DM, hypertension, hyperlipidemia and renal failure as a result of the diet introduced by the American military and supported to this day by American commerce.

  2. I agree with Bonnie. We should be ashamed that our influence is causing so much harm. Thanks for sharing these stories, Chris – your writing is beautiful and captures your experience so well. I hope we can share another adventure one day!

  3. Pingback: Chuuk 101.5 Still More Random Notes on Culture and Perspective July 24, 2012 « Stranger in Paradise

  4. Al Rosato

    wait, wait – wait. so exactly *when* do I take the spoonful of sugar?

    Good stuff Chris. I’m wondering if the US-provided roads or the sugar-addicted mouths have more holes in them at this point.

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