June 5, 2013
Ed. note: When we learned that UW students would be heading to Haiti, we asked them to write about the people they helped while they were there — to tell their stories of courage. Four students — Mehak Ahluwalia, Sean Collette, Esther Ra and Ryan Zentz — did just that. Here, in their own words and pictures, are their experiences.
As I stepped out of the plane onto the terminal I felt a gust of warm wind and the faint sound of the steel drums floating through the air. “Wow,” I thought, “I really must be spending my Spring break in the Caribbean!” Although we certainly landed on a Caribbean Island, our team had just arrived into the poorest country in the western hemisphere, Haiti.
Sharing the Island of Hispaniola with the Dominican Republic, Haiti occupies the smaller western portion of the island. Haiti was not only the first independent nation of Latin America and the Caribbean and the first black-led republic in this world, but it is also greatly poverty stricken in terms of its economy, education, government, and health care. Fewer than 30 percent of the country’s children make it to the sixth grade, and more than 90 percent of the children suffer from waterborne diseases and parasites due to their lack of proper educational system, sewage infrastructures and health care access. With the country already struggling to survive, a 7.0 earthquake devastated Haiti and its most populous city and Capitol, Port au Prince, on January 12, 2010. The earthquake left the country in ruins and exaggerated its need for stability and order. More than three years later, I was able to walk the seemingly unchanged roads and experience the aftershock of the earthquake as if it was only yesterday.
Along with four of my fellow third-year classmates from the University of Washington School of Dentistry, I had the great pleasure and irreplaceable opportunity to spend our spring break with the remarkable organization, Medical Relief International, and its humanitarian team of professional dentists, dental assistants and volunteers in their mission to bring Haiti dental aid in their overall scheme of providing “sustainable worldwide wellness.” Our team was split into three different locations that would each serve a different community in need. My team was led by Dr. Mark Walker, and included my fellow classmate Esther Ra, Chrissie Leiren (a dental assistant), Steffan Clements and John Judd. We were located in Port au Prince, and our days consisted of moving and setting up our dental equipment in local houses or communities and trying to treat as many Haitians as we could. The official language is Haitian Creole and French. Since none of us spoke French, the language barrier was a challenge that we would have to learn to overcome.
Despite not knowing more than a couple of phrases to get us through our day, I can clearly remember one particular girl whom you didn’t have to speak to, to understand and see the pain and danger she was in. Her name was Mary and she was only 14 years old. She arrived the first day in an oversized, worn T-shirt, alone and terrified with tears steaming down her face. As she walked into our small crowded room, it was apparent the root of her pain was coming from a severe fascial plane infection on the upper right side of her face. I had seen examples of these types of dangerous infections in class, but never did I think I would experience it first hand. Knowing the potential systemic involvement and immense danger she was in, Dr. Walker sat her down immediately to discover a severe expansive infection that was destroying her upper right quadrant. Screams and cries of excruciating pain escaped Mary with every touch and movement of her mouth. Unable to calm her enough to treat her, we provided a ten-day regimen of antibiotics, explained the importance of taking them, and the dire need to return the next day…it could mean the difference between life or death.
It was our last day of clinic, and we all were praying that Mary would arrive. As the day flew by, we grew more worried that she would not come and as a result would grow more ill as the days passed. After a solemn lunch, our spirits were raised when we saw Mary sitting in one of our chairs waiting nervously for our return. It was immediately apparent that she was not only feeling better, but her cellulitis had decreased from the previous day. Still in immense pain, we identified the culprit tooth and knew that it had to be removed in order for the infection to start resolving. After several agonizing and tear-filled deliveries of local anesthetic, we were able to remove the tooth and debride and clean the area as best we could. Once the tooth was removed, it was clear the infection had deteriorated her buccal cortical plate and had spread up into her maxillary sinus. After speaking to her and her father, we determined that Mary’s infection had started with a fever more than three weeks prior, and had been getting worse since. Mary was not only the second youngest to her other seven siblings, but she was the first one to be seen by a doctor. Jobless, her father and mother could not afford any type of medication for their ill daughter. Desperate for a solution, her family was told that a doctor would be in the next town. Mary and her father had traveled from four cities away to come see us that day. Although they could not afford to ride the “tap tap” (Haitian taxi), the compassion of the Haitian people brought her to us.
Although Haiti is considered a part of the Caribbean, the country is far from what we call “paradise”. The damaging earthquake in 2010 in addition to its lack of order, stability and chronic health care shortage, makes Haiti one of the most impoverished counties in the world. If it wasn’t for the compassion of the Haitian people in combination of our presence that day, Mary could have died in a matter of weeks. The experiences and memories that I have attained from this trip will forever remain with me. It has not only shown me the significance and impact of dentistry, but more importantly the need to share it with the world.
I had been on several humanitarian trips to Central America before attending dental school and was introduced to the challenges of poverty. My experience in Haiti was another sobering reminder of the scale of unmet dental needs in developing nations.
Spending one week in Ferrier, a rural farming town with little infrastructure, led me to appreciate several things about the people. For example, when our truck got a flat tire several miles from town, we waited a few minutes for a traveler to show up. A motorcyclist arrived, recognized our trouble and taxied our driver and flat tire to be repaired at the next stop. Repairing tires is routine. After about 30 minutes, they returned and we were back on our way. Some people may walk several miles to reach a final destination, and it is common for drivers to pick up strangers and shuttle them.
We had several Good Samaritan Haitians helping our dental crew. One of our assistants, Erlin, translated during the last two days. He grew up in a large family from another farming area. He taught junior high school for two years before deciding on his career path. He is now a 3rd-year law student with a dream to plead for Haitians. Death threats are leveled against lawyers from time to time, but that risk doesn’t deter him. He’s more intimidated by the task of writing a thesis and defending it next year.
But very few in Ferrier will have educational opportunities like Erlin. Most don’t go beyond honing survival skills, farming, trading and recycling. Only two people in the town have a medical background: a recently employed nurse trained in the United States and a Haitian pharmacist. The pharmacy has limited resources. Some locals traveled over 180 miles to the capital to find a dentist, but gave up the search after a week.
Dentistry is desperately needed in Haiti. As soon as the permanent teeth erupt, they face the insults of sugarcane and carbonated beverages. Decay was rampant in many mouths I examined. Even teeth with restorable lesions in the US may be non-restorable in Haiti. This was the first time that I helped people out of lifelong chronic pain and I felt a strong sense of reward. It is easy to understand why they showed us warm gratitude on our arrival and thanked us again at our departure.
Their kindness and appreciation reinforce my commitment to future humanitarian service.
It was mid-afternoon when I met Andre, a 41-year-old Renaissance native who reluctantly sat in my lawn chair deemed suitable for patient care. I greeted him with a smile but received a faint murmur in response. It was obvious that he was trying to conceal his friendly disposition by refusing to raise his upper lip above resting position. I leaned him back and asked what was bothering him today. He slowly widened his lips revealing dark interproximal decay on his upper anteriors. I had never seen such a defined and organized pattern of chaos. I nodded and gave a firm pat on his shoulder and proceeded to remove all the decay. The situation was far worse than initially assessed clinically. Perhaps it was to his benefit that we did not have access to radiographs or his four front teeth would have had the dire fate of extractions without any mercy. My slow speed round was sinking fast and sinking deep into a soft brown haven. I became increasingly nervous but was determined to rid him of his disease. My goal was achieved but not without sacrifices. Pulp exposure was inevitable but with proper management and medicament, the odds were on our side. After about an hour, I straightened my back and handed Andre a mirror. He slowly lifted his lips. He had forgotten how to smile all these years. Surprise and disbelief is what I could interpret from his expression.
I requested the assistance of an interpreter asking Andre if his life would be different now. He nodded and exclaimed that he could finally get married. He has four brothers and two sisters. His family network is extensive but he remains close to everyone. He works as an auto mechanic by trade and is the only remaining of his siblings to not be married. Despite the language and cultural barrier, we both laughed and exchanged hugs. I knew that I had made a remarkable difference in one man’s life. All it took was an hour of my time. I felt a sense of accomplishment and was reminded again why I fell in love with dentistry not only as a trade but as a way of life.
My name is Ryan Zentz and I am a third year dental student at the University of Washington. I was fortunate to be able to attend a trip to Haiti to promote oral health with a team associated with the Medical Relief International organization to provide people with dental care that they desperately need. The care that the Haitian people do receive in often inadequate and leaves the patient’s with severe pain as well as extremely unfavorable esthetic results.
Our patient was named Roberto. He is a member of the church in a local community named Merseilles (pronounced: m-air-zhay). This church was responsible for letting villagers know of services that our team (Medical Relief International) would be able to provide. Roberto, a single man, lives alone as he was not able to find a partner during his younger age due to the caries in his anterior teeth. The Haitian people place a heavy emphasis on the appearance of the teeth. Many who attended our clinic made it known that neither men nor women would find a partner without an esthetic smile. Roberto has no car, no bicycle, and no money to afford a “Tap Tap” (Haitian taxi which consists of a bed of a pickup truck w/ the canopy over it and bench in the back) he walked to our clinic from over four miles away. So it is no coincidence that he did not have the money to afford proper dental care as a young man.
Roberto presented to us with missing teeth #7, 8, and 9. Each of these had a severely infected socket and profuse granulomatous tissue. The sockets were explored revealing root apices buried within the tissue in each of the sockets. When asked of how this happened he replied in the native language Creole, “ My teeth were hurting and so I went to the dentist. He told me they needed to be taken out, so I let him.” He had seen this dentist over two years ago. It was clear that the dentist had simply removed the crowns of the anterior teeth with total disregard for the roots, leaving Roberto in much pain and with no front teeth.
Roberto was a rare case. He was missing a trio of esthetically concerning teeth, but with good posterior tooth support and occlusion that was suitable for a temporary removable partial denture. Dr. Michael Karr, my mentor on the trip and founder of Medical Relief International, guided me through the removal of the root tips. Once they were removed, I placed a series of interrupted sutures that were stable enough to allow an Alginate impression to be made. A stone model was fabricated and at night, by headlamp, Pastor Bill Mayes and I fabricated the TRPD through application of powder and liquid orthodontic resin to the stone model. This was placed in a small portable pressure pot and polished to the best of our ability on site.
As shown in the photos here, Roberto has a dramatic change to his appearance. Haitians are not accustomed to photography, and also very stoic in nature making a proper smile difficult to capture. However, when the partial was placed and Roberto left the clinic, there were crowds surrounding him to see what we had done. The next day there were countless patients desiring the same transformation that Roberto had gone through.
From my experience, I am able to reflect on a great deal. The dental aspects of the trip I will take with me in all of my future clinical endeavors. The lifestyles they live will inspire me each day. The country was in the media constantly following the earthquake but I never knew just what kind of damage this caused their people. The Haitian people have very low household incomes, most totaling less than $5 a day. It is no surprise that this results in very difficult and inadequate living conditions. The buildings are not sound enough structurally to withstand such a forceful natural disaster. Coupled with the lack of government infrastructure and the result is what we saw in Haiti each day. Piles of rubble and litter all over the streets and rivers; polluted sewage running freely through streets of villages and cities; and finally a nation full of people doing anything, everything that they can to survive. I will not forget my time spent there. I have never seen people endure so much pain and struggle with such a joy and zest for life. It reminds me of just how fortunate that I am and how much I can contribute to those who may not be as fortunate.