We returned to Happy Land today and sure enough one of the first faces I saw was my friend from last year, Srey Roth. She is only 5 years old but she understood when I showed her a picture that she and I took together on a swing set last year. It brought laughter from her friends and a shy smile from Srey.
It was fun to see familiar faces from last year. As with the COLT orphanage, we have developed strong ties with the leadership of this organization. Happy Land is run by Stella, a woman In her mid thirties from Belgium. She laughed when someone asked her age. Only recently did she realize that she was no longer 32, but rather, about to be 35. She had lost track of her three years in Cambodia.
But our day wasn't easy. Happy Land is still accepting new children, which means that we had a lot of work to do. So many choices had to be made regarding whether to extract or whether to save a tooth.
A bit about Cambodia itself; you may have heard there are riots in Phnom Penh. This is true, though we didn't see it firsthand. Cambodia is a modern communist country with a strong capitalist tilt among the ruling elite. The average worker makes about $150 per week. Though food is very cheap, the money does not go far. The workers are rioting to raise the weekly pay to $160 per week. High ranking officials in government, the police, and the military also own the big Cambodian corporations. When it's advantageous to do so, the protesters are dispersed. Just before we arrived several protesters were shot.
As a visitor in this country I am most struck by the kindness of the people. The tuck-tuck (motorbike taxi) driver who goes out of his way to help me with walking directions and the little girl who worked in her family fruit stand. She did not sell coconuts, so she took me by the hand around the corner to a vendor who could help me. It is hot, dirty and sometimes sad, but still a beautiful place in its own right. That's why we're sad that tonight we'll pack and leave this place for another year.
I've said it before, Cambodia is a land of contradictions. They are the most aggressive drivers that I have ever seen; but there is no road rage. There are opportunities that are beginning to present themselves for children to become educated and escape poverty; yet few families place a premium on education. And most notably, they are kind and peaceful people; yet they were slaughtered by their very own leaders 40 to 50 years ago.
Saturday, February 15, 2014
A day in HappyLand
Friday, February 14, 2014
Valentine's Day
The great thing about getting up early is that we finish most of our work by lunch and thus 'beat the heat'. We worked in Kampong Speau today, about 30 km outside Phnom Penh. Our treatment room was in a one room school house, while exams, fluoride and patient education were in the yard outside the school.
The waiting room was in the school barn; the cow having been displaced to the corner of the school yard. She seemed happy with the move and she didn't seem to mind the duck and the ducklings that ran about her feet.
Today we saw only about 200 patients, not many considering we've seen up to 400 per day on previous trips. What made this day so interesting though, was the look of the village we were in and the fact that today is Valentines Day. The village was a series of small plots of land, each with a fence of branches delineating the border of the property. Most had very skinny cows grazing on the little bits of grass that were available. The yards were mostly dirt, maybe a quarter acre in size. No one seemed to have a car, this was not a wealthy village; we did see the ever present motorbike. The homes themselves were made of well weathered wood with shutters instead of windows and wood or metal roofs. If the house was on stilts a hammock would be suspended in the shade beneath the house. But what was most notable about this neighborhood was the tall shade trees. I'm told that prior to the civil war, this country was filled with shade trees. Today it's rare to see a forest or a tall tree.
It being Valentines Day, schools and Government offices were closed. In Cambodia it is traditional to give your sweetheart a rose. Cards, chocolates and jewelry are not part of the Khmer celebration. Today was a day for families to get together have a family meal. In the background, the local monastery played a recording of a comedy routine between and man and a woman that sounded like a Khmer version of the Honeymooners. The soundtrack was blasted over speakers and could be heard at least a quarter mile from the monastery. It made for a bizarre backdrop to our work. A sort of laugh track that accompanied the extractions.
Yesterday, our patients were timid probably because they live in a dangerous area of the city. In fact we had a few 'runners.' We do our best with these kids but sometimes we just can't win them over. Our patients today were 'country folk'. They were outgoing and eager to try out their English. Nowadays, they learn both English and Chinese in their schools.
We are planning a large goodbye dinner this evening. Tomorrow night we'll begin the 24 hour journey home. Tonight we'll say goodbye to our friends from England, Germany, Australia, Los Angeles, San Francisco, Minnesota and Seattle.
Purobi is a tough leader, demanding our best at all times; but maybe that's part of why we come. To see if we can measure up? But we can't let up yet, tomorrow we visit Happy Land orphanage. In my office I have a picture of a student there whose jaw dropped and eyes grew large when she saw a picture of my 165 lb Bullmastiff, Wilson. I know I shouldn't have a favorite, but I can't help it....
The waiting room was in the school barn; the cow having been displaced to the corner of the school yard. She seemed happy with the move and she didn't seem to mind the duck and the ducklings that ran about her feet.
Today we saw only about 200 patients, not many considering we've seen up to 400 per day on previous trips. What made this day so interesting though, was the look of the village we were in and the fact that today is Valentines Day. The village was a series of small plots of land, each with a fence of branches delineating the border of the property. Most had very skinny cows grazing on the little bits of grass that were available. The yards were mostly dirt, maybe a quarter acre in size. No one seemed to have a car, this was not a wealthy village; we did see the ever present motorbike. The homes themselves were made of well weathered wood with shutters instead of windows and wood or metal roofs. If the house was on stilts a hammock would be suspended in the shade beneath the house. But what was most notable about this neighborhood was the tall shade trees. I'm told that prior to the civil war, this country was filled with shade trees. Today it's rare to see a forest or a tall tree.
It being Valentines Day, schools and Government offices were closed. In Cambodia it is traditional to give your sweetheart a rose. Cards, chocolates and jewelry are not part of the Khmer celebration. Today was a day for families to get together have a family meal. In the background, the local monastery played a recording of a comedy routine between and man and a woman that sounded like a Khmer version of the Honeymooners. The soundtrack was blasted over speakers and could be heard at least a quarter mile from the monastery. It made for a bizarre backdrop to our work. A sort of laugh track that accompanied the extractions.
Yesterday, our patients were timid probably because they live in a dangerous area of the city. In fact we had a few 'runners.' We do our best with these kids but sometimes we just can't win them over. Our patients today were 'country folk'. They were outgoing and eager to try out their English. Nowadays, they learn both English and Chinese in their schools.
We are planning a large goodbye dinner this evening. Tomorrow night we'll begin the 24 hour journey home. Tonight we'll say goodbye to our friends from England, Germany, Australia, Los Angeles, San Francisco, Minnesota and Seattle.
Purobi is a tough leader, demanding our best at all times; but maybe that's part of why we come. To see if we can measure up? But we can't let up yet, tomorrow we visit Happy Land orphanage. In my office I have a picture of a student there whose jaw dropped and eyes grew large when she saw a picture of my 165 lb Bullmastiff, Wilson. I know I shouldn't have a favorite, but I can't help it....
Thursday, February 13, 2014
Heat on 15th Street
Schools have a separate morning and afternoon session. We are getting very busy now with children who went to school this am. More later.
While yesterday we did few extractions and lots of fluoride, today is the opposite, everyone seems to need teeth removed. That's because this is a poor slum versus an orphanage where children are well cared for.
On a break I walked down the street. The homes are mostly the size of a garage. The wealthier families build a second floor. Some homes have a small business on the first floor with a living space above. And it seems as if there are children everywhere. Lots of young children. Due to poor nutrition ages are hard to estimate, but it is not uncommon for an 8 year to be in charge of a toddler regardless of the traffic or any other dangers.
The dental team this week is good. No one complains about the work load, but the heat is another story; in this sweltering city Every one is complaining. Most of the students are from Columbia University. Parobi Philips and Bob Renner, who run this program, subsidize the students costs out of their own funds. The doctors pay their own way, but really, after the airfare, the food and lodging are very inexpensive.
We're beginning the shutdown process. We won't examine any more patients and we'll work to complete the fluoride and varnish treatments for all and extractions for some. We should be packed up and on the road in an hour or so. When we reach the hotel we'll unpack and have a debriefing where we discuss what worked and what we have to improve. It's exhausting but I wouldn't trade it for anything.
Wednesday, February 12, 2014
COLT Orphanage
It's 6:15 pm now and we've just returned to the hotel. We must be on the complete opposite side of the world from New Jersey because there is exactly a 12 hour time difference for us from home. I also understand a big snowstorm is forecast for Thursday; that too, couldn't be any different. It is about 90 degrees as the sun is beginning to set, after a sweltering day. It is very humid too.
We spent the morning at the COLT (Cambodian Organization for Living and Training) Orphanage. It's a Dutch Orphanage that I have mentioned in previous blogs. While they only accept 30 children (their facility is small), they do treat these children very specially. These former 'street children' not only learn the usual subjects in the orphanage school, but they also learn about values and responsibility. Many of the children were abandoned and/or abused. Freida, who runs the orphanage is very much a surrogate mother, creating a sense of belonging and family in these children.
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While traveling in Prey Veng the past couple days, we got to know three of the COLT orphanage kids. Piseth is 20 years old and one of the oldest in COLT. Pana is 12 and Dee is 13. They served as interpreters as we travelled through areas where few speak English. Piseth is very quiet but eager to help and quick to smile. He is preparing to take his college entrance exam and unsure of what he will eventually do. Dee is also quiet but acted as the interpreter for Bob Renner and I, as we examined the children prior to their treatment. Though only 13, he had the great responsibility of explaining to each child why they needed treatment. If a child strongly refuses our recommendations we can not treat them. Dee was able to convince the children about the benefits of our treatment. Pana, though, had the real people skills. He is gregarous and very out-going. He helped the children get through their procedures in the actual treatment room. Several times we saw him stroking the cheek of a younger patient reassuring them, that everything would be ok.
Mercifully, our day was short and easy considering the heat. Because COLT was one of the first orphanages to work with the KIDS program, they have some of the healthiest teeth. We worked outside today in a courtyard. With work complete we visited a market grabbing a couple bargains, had an early dinner. And as I finish writing this bedtime is not far away.
We spent the morning at the COLT (Cambodian Organization for Living and Training) Orphanage. It's a Dutch Orphanage that I have mentioned in previous blogs. While they only accept 30 children (their facility is small), they do treat these children very specially. These former 'street children' not only learn the usual subjects in the orphanage school, but they also learn about values and responsibility. Many of the children were abandoned and/or abused. Freida, who runs the orphanage is very much a surrogate mother, creating a sense of belonging and family in these children.
While traveling in Prey Veng the past couple days, we got to know three of the COLT orphanage kids. Piseth is 20 years old and one of the oldest in COLT. Pana is 12 and Dee is 13. They served as interpreters as we travelled through areas where few speak English. Piseth is very quiet but eager to help and quick to smile. He is preparing to take his college entrance exam and unsure of what he will eventually do. Dee is also quiet but acted as the interpreter for Bob Renner and I, as we examined the children prior to their treatment. Though only 13, he had the great responsibility of explaining to each child why they needed treatment. If a child strongly refuses our recommendations we can not treat them. Dee was able to convince the children about the benefits of our treatment. Pana, though, had the real people skills. He is gregarous and very out-going. He helped the children get through their procedures in the actual treatment room. Several times we saw him stroking the cheek of a younger patient reassuring them, that everything would be ok.
Tuesday, February 11, 2014
A Short Productive Day
Though it's only 1:30, our day is complete. We started early and by noon had already seen well over 300 patients. Two-thirds of our patients only required fluoride treatment and one third required extractions, and often multiple extraction of teeth. Don't get me wrong, the two-thirds who only got fluoride had cavities too, but we had to make decisions regarding the overall best dental choice. Without the ability to place space maintainers, the over-extraction of teeth could lead to severe malocclusions and their resultant problems. I feel a great deal of responsibility making these judgments, it's so much easier with X-rays.
This village is known as Tall House Village. It is likely a reference to the stilts upon which these houses sit. Interestingly, these children have cleaner clothes and healthier teeth than the patients yesterday. It's probably because the patients yesterday were new to the program.
As a group we are working well together. Each third or fourth year dental student is assigned to an experienced dentist. The non-dental volunteers are enthusiastic and enjoying getting to know the Khmer culture. Jamie and I are particularly proud of Michelle and Carol, who we brought with us. Michelle is both a friend and an employee. She joined us last year and is a skilled veteran. Carol is a newbie, but she is a quick learner. And as a part time camp counselor, she taught the children how to sing 'Head, Shoulders, Knees and Toes' while they waited to be seen.
This village is known as Tall House Village. It is likely a reference to the stilts upon which these houses sit. Interestingly, these children have cleaner clothes and healthier teeth than the patients yesterday. It's probably because the patients yesterday were new to the program.
As a group we are working well together. Each third or fourth year dental student is assigned to an experienced dentist. The non-dental volunteers are enthusiastic and enjoying getting to know the Khmer culture. Jamie and I are particularly proud of Michelle and Carol, who we brought with us. Michelle is both a friend and an employee. She joined us last year and is a skilled veteran. Carol is a newbie, but she is a quick learner. And as a part time camp counselor, she taught the children how to sing 'Head, Shoulders, Knees and Toes' while they waited to be seen.
Though we are exhausted, we are feeling very satisfied with our efforts. I have said it before, the Cambodian people area beautiful culture and the children, in particular, are so deserving of our efforts.
Returning to Prey Veng
It's 5 am and we have assembled at Smiles Restaurant which adjoins our hotel.
Yesterday, we completed our first day of work in Prey Veng Province, near the border with Vietnam. After work we travelled three hours to our hotel, heading north and paralleling the Vietnam border. There were many homes along the route, a major highway in this country, though it would be a secondary road at home. The houses were raised up high on stilts to protect them from the floods of the rainy season.
Sadly, there are limits to what we can do. The need to make good treatment planning choices for the children is multiplied by the fact that there is little follow up in the event a tooth doesn't react the way we hoped. Without drills, we are best prepared to extract painful carious teeth and sometimes clean and patch small cavities. But we are also limited by aeveral things: knowing that baby teeth are important in preserving space for adult teeth; we can only anesthetize part of the mouth at a time; and we need to leave enough teeth for the children to be able to eat.
Yesterday, we completed our first day of work in Prey Veng Province, near the border with Vietnam. After work we travelled three hours to our hotel, heading north and paralleling the Vietnam border. There were many homes along the route, a major highway in this country, though it would be a secondary road at home. The houses were raised up high on stilts to protect them from the floods of the rainy season.
The roads, mostly paved, were filled with motorbikes and slow moving trucks. Our caravan moved quickly though, with the horn constantly warning the slower traffic of our intention to overtake them. I had to suspend my concern for safety and convince myself that 'this is how it's done in this country.
In the van we talked a bit and dozed after a full day of work. We had returned to the monastery in Prey Veng where where we had worked last year. There were many familiar faces. Though the older monks had moved on to other monasteries,we did recognize many of children who attend the local schools. Returning children have paperwork from their last dental visit. It was encouraging to see their improving dental health. Yet some of the younger and newer patients had mouths full of cavities, making their teeth almost unrecognizable.
Sadly, there are limits to what we can do. The need to make good treatment planning choices for the children is multiplied by the fact that there is little follow up in the event a tooth doesn't react the way we hoped. Without drills, we are best prepared to extract painful carious teeth and sometimes clean and patch small cavities. But we are also limited by aeveral things: knowing that baby teeth are important in preserving space for adult teeth; we can only anesthetize part of the mouth at a time; and we need to leave enough teeth for the children to be able to eat.
Still, we rest assured knowing that the children have benefited from our visit. We have renewed our acquaintances and made new friends.
Saturday, February 8, 2014
The Jet Lag is Gone and I'm Ready to Work
Before we arrived, our last trip to Southeast Asia seemed a lifetime ago; yet having been here for a couple of days, Jamie and I are beginning to feel at home, as if we never left. We arrived a couple of days ago in Chiang Mai, Thailand. Perhaps due to the jet lag, our first full day in Thailand seemed like a dream.
We spent that surreal day at the Patara Elephant Sanctuary. Each of us was assigned an elephant to care for during our visit. Mine was a 16 year old mother (ideally they live to 85 years). Her one year old baby, YaYa, was never far from her.
We learned how to evaluate an elephants health. Flapping ears, dirt on their back and sides, a little sweat by the toes and a voracious appetite all indicate a healthy pachyderm.
Yet we weren't there to observe them; rather, we were caretakers for the day. Our chores included: feeding the elephants, a quick cleaning of their backs and a 45 minute ride to their favorite waterfall. Here we swam with our new friends and scrubbed their skin clean. They rolled on their sides giving us access to the hard to reach places. And finally, we were rewarded for efforts as they squirted us with blasts of water from their trunks, much to the entertainment of their handlers.
I would like to say that I had a terrific Thai dinner that evening, but exhausted from the travel and the day, I went to bed early.
On day two, we travelled to Bangkok and reunited with our friend from dental school, Phira. Phira returned home to Thailand after completing his dental and prosthetic studies in the United States. He is Vice President of Bangkok University, the oldest and largest university in Thailand. He also lectures in the school's dental program and maintains a private practice. He is one of the nicest people I know, and was a terrific host showing us the sites in Bangkok and introducing us to real Thai food.
Now adjusted to the time change, we woke before dawn this morning and flew to Phnom Penh. We are energized and ready to work. Our team meetings begin this afternoon. We know the first two days will be challenging. We will work near Phnom Penh tomorrow then drive to the border with Vietnam, where we'll work on day two.
We are trying to remember to be like the elephants that we met. They make careful, well considered decisions and move powerfully and steadily toward their goals.
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