November 1, 2016
by Michael Carabash, B.A., LL.B., J.D., M.B.A., C.D.P.M.
The 2016 Dental Outreach Volunteers pose on the beach in Negril, Jamaica on September 4, 2016. Photo courtesy of Michael Carabash.
On Saturday, September 3, 2016, a group of strangers from across Ontario gathered at the Toronto airport. Their mission: head down to Negril, Jamaica to provide free dental treatment and education to impoverished Jamaicans. This was the second annual trip organized by Great Shape! Inc., the Sandals Foundation, and DMC LLP.1 The volunteer group included dentists, hygienists, dental students, Henry Schein representatives, dental lawyers and non-dental support personnel. Most of them had never done anything like this before.2 There was little to prepare them for what was about to happen in Jamaica for the 10 days they were there…
Shock and Awe
When the volunteers first approached their temporary makeshift dental clinics at the town of Little London and the settlement of Grange Hill, they were shocked by what they saw and heard: hundreds of people had lined up at the doors from the early morning in the hopes of getting a ticket to see a dentist or hygienist sometime that week. As dental hygienist June Jennings (Thornhill) put it: “I’ve seen lineups like that back home for concerts; not for dental cleanings and treatments!” Dr. Irish Malapitan (Kitchener) definitely felt the pressure: “I was like, Oh my God! How are we going to see all of them? Is our clinic going to function properly? I was worried.”
Then, when the first patients sat in their chairs and opened their mouths, it was another shock. June Jennings recalls a particular three-and-a-half-year-old boy (a caretaker’s son) who sat in her chair for a cleaning: “I really wanted to help him. He never had his teeth cleaned. All of his primary teeth were decayed to the roots, except for the 4 lower front teeth – which were the only ones I could clean. I think they were giving him sugary juices to go to sleep. One of the dentists at our clinic recommended to the boy’s dad that he be taken to the hospital and have all of his primary teeth removed. It was sad”.
The final shock the volunteers experienced came from the patients themselves – but in a positive way. Dr. Joseph Fava (Toronto) described it as follows: “Amazingly, the patients were stoic while in the chair. Opening wide. Never closing. Never complaining. Salt of the earth. They really appreciated what we did for them. Such small things we do on a daily basis back home had such dramatic effects on their lives.” Patients often brought volunteers local fruit and dishes – like sugar cane, genips, avocado, june plums, tripe and beans, curried chicken, stew pork, ackee and saltfish, boiled / fried dumplings and boiled bananas. Many volunteers received warm smiles, thumbs up, high fives, and big hugs from their patients. Some patients would come back a few days after being treated to thank the volunteers again.
Not all patients were comfortable seeing the dentist, however. Over at Grange Hill, Dr. Christina Bodea (Elmvale) had a young female patient named Tiana who was extremely nervous about the needle; she wouldn’t let Dr. Bodea anesthetize her for a much-needed filling. Then Dr. Bodea and her assistant, husband Stefan Atalick, noticed that Tiana was interested in their hair. Long and straight; perhaps something Tiana wasn’t accustomed to. So Dr. Bodea and Stefan encouraged Tiana to touch their hair. And it did the trick! Tiana got so comfortable that she eventually got the filling without incident.
Over at Little London, Dr. Malapitan and her assistant Jason Brown (Henry Schein) had an eight-year-old boy who was very scared to see them. He was crying in the chair. So Dr. Malapitan and Jason tried something different: they started singing Jingle Bells. Soon the whole clinic joined in. The boy’s mood changed. He smiled and relaxed enough to let Dr. Malapitan treat him. Per Jason: “That memory will stay with me always.” Singing Christmas carols or doing a ‘booty-bounce’ dance with dental hygienist Jazz Cohan (Toronto) were some of the things Dr. Malapitan did to make patients laugh and feel more comfortable.
Christine Martel and Dr. Joseph Fava having fun with baby Matthew. Photo courtesy of Michael Carabash.
Michael Carabash with community volunteer Lelite, Papa Joe, Dr. Mary Berkmortel and Christine Martel.
How Did Things Get So Bad?
So what was the cause of the poor state of oral hygiene in large parts of Jamaica? Was it lack of dental education? Cultural misconceptions? Dental professionals not being available or too expensive? For Dr. Jacqueline Geroche (Mississauga), it was a combination of all of these factors:
The smallest exposure of Dentin – the second layer of the tooth under the Enamel – and the patient would want the tooth pulled instead of getting a filling. They have this misconception that the filling won’t last. To them, if it’s causing pain, just pull it out! Many of the patients I saw had never been to a dentist before. They’re either afraid, don’t have access or money, or all of the above. People seemed to function with just gums. The end game is dentures. And that’s how they operate. Not to mention that their diet consists of a lot of soft foods to accommodate their lack of functioning teeth.
We heard stories from patients in the clinics about a basic cleaning costing USD$100 at a private practice; this was a lot of money, given that the average minimum wage for a Jamaican working full time is about USD$50 per week. Access to dental care is also huge problem: some parts of Jamaica have a 1:100,000 dentist to patient ratio.
UTech Dental Grad Tevin Carter (a.k.a. Dr. Propa Touch) with dental hygienist Melissa Brunette and her mom, Christina Martel. Photo courtesy of Michael Carabash.
Marc Zdrojewski (Henry Schein, Toronto Branch Manager) posing with some happy patients at Grange Hill. Photo courtesy of Michael Carabash.
Fixing the Problem
In the week that we were there, team Little London treated 260 patients and team Grange Hill treated 383 patients. Patients were given toothbrushes and toothpaste and instructed on how to clean their teeth. Some of our volunteers also attended various primary schools and spoke to about 2,000 children about proper oral hygiene and distributed toothbrushes and toothpaste.
Great Shape! Inc. runs their program through the Sandals Foundation from late August to November, allowing them to treat about 20,000 patients a year in Jamaica and St. Lucia. They also run sealant projects and have plans to acquire a mobile dental unit.
Admittedly, these are all temporary fixes to a more widespread problem.
Long-term, Great Shape Inc.! wants to raise money to establish a free public dental clinic near Montego Bay that runs all year long and which can accommodate Canadian dentists, hygienists and support staff to volunteer a week at a time. There is hope. But equipment, sundries, funds, and volunteers are desperately needed. Great Shape! Inc.’s executive director, Joseph Wright (a.k.a. Papa Joe), is not one to shy away from challenges. He was instrumental in helping to establish Jamaica’s first dental school, University of Technology Dental College (UTech), along with Jamaica’s Chief Dental Officer and now Dean the University of Technology, College of Oral Health Sciences, Dr. Irving McKenzie. That happened by chance over drinks at Margaritaville. And because of that, in just a few years, UTech dental students and graduates have treated thousands of Jamaicans.
Let’s give a warm welcome to Papa Joe when he visits Toronto in May 2017.
The scene outside the Grange Hill community centre on day one. Photo courtesy of Dr. Christina Bodea.
Dental Hygienist Nina Nguyen and Dr. Millie Calko pose with a happy patient at Grange Hill community centre. Photo courtesy of Michael Carabash.
Group Camaraderie… More Like One Love
Teams were assembled based on personality profiles, competencies, rooming, and other factors. I don’t use the word ‘love’ lightly. But I actually believe that team members loved one another from the very beginning. They would eat and drink, swim, do karaoke, take strolls along the beach, dance at the disco, and take a boat ride to Rick’s Café – together. Nicknames naturally developed – like Dr. Potato (Dr. Irish Malapitan), Zee (Marc Zdrojewski), Dr. Propa Touch (UTech Dental Grad Tevin Carter), Man Child (Jason Brown), Nam (dental hygienist Nina Nguyen), Tetley (dental hygienist Jazz Chohan), La Machina (Dr. Mary Berkmortel), and Candlestick (Stefan Atalick). Unfortunately, there isn’t enough room to get into the (sometimes hilarious) origins of these nicknames.
Many volunteers shared intimate stories with the group. Like when dental hygienist Nina Nguyen (Toronto) told team Grange Hill at dinner an unforgettable story about how she had escaped Vietnam as an 8-year-old girl on a tiny boat with little supplies. She eventually made it to a refugee camp in Singapore before her uncle in Canada sponsored her. Nina’s mom spent 2 years in a Vietnamese jail for not telling authorities who had masterminded that escape (it was Nina’s grandmother).
There was also a touching moment on Tuesday, September 6th involving dental hygiene student Sandra Busch (Oregon). That day marked the first year anniversary of the tragic death of her sister from lymphoma. Sandra brought some of her sister’s ashes to spread on the beach. When Dr. Geroche found out, she encouraged Sandra to share that story with the Little London group. A circle formed in the ocean as the sun began to set in the background. Sandra shared her story. There were tears, hugs and condolences. And then Sandra, a gifted singer, sang How Great Thou Art to commemorate her sister. “I truly was touched by it all. You all became family to me in such a short amount of time”, said Sandra.
These kinds of stories and experiences made us feel human again and brought us closer together.
There were also lots of funny moments. These typically occurred after leaving the clinic and returning to the resort. The official chant for team Little London was “Bar – Patty – Ocean”, which they practiced religiously upon return from their clinic. One day, when they were congregating in the ocean, they egged Jason Brown to join them while he still wearing his scrubs – and he did! Everyone laughed really hard. His reasoning: “Making happy memories!” Apparently, he still has sand in those scrubs.
And who could forget the team Grange Hill’s sleepers? Like Dr. Bodea, who passed out on the ride back one day while still hanging onto the supplies list! Or Marc Zdrojewski, who fell asleep on the ride back numerous times; other volunteers would make funny faces beside his while we snapped photos.
The last day at Grange Hill was particularly memorable: it was dental hygienist Melissa Brunette’s (Ottawa) birthday. We were nice about it: we only doused her in beer and made her sit on a towel on the ride home. Her mom, Christine Martel, commented that the van smelled “like a bar”. On that same ride back to the resort, we almost got stuck in a flash flood. A tiny Toyota Corolla ahead of us was brave enough to get through without incident, so we followed suit and made it through too!
Dr. Christina Bodea sleeping with the supplies list still in hand with husband Stefan Atalick looking on. Photo courtesy of Michael Carabash.
Volunteers bonding in the ocean after a hard day’s work at the clinic. Photo courtesy of Jazz Chohan.
Why They Did It
They met as strangers at the Toronto airport. Leaving behind comfortable lifestyles, their practices, family and friends to venture into the unknown. When they finally got to the clinics, the working conditions were far from ideal. Per Dr. Millie Calko (Toronto): “Extreme humidity. Low light. Ample mosquitos and other insects. Primitive and sometimes malfunctioning equipment. Low resources. Sore muscles. Scrubs soaked through with sweat.” But she never complained or took a break. In fact, nobody did. They all knew it was going to be hard work. So why did they do it? In Dr. Calko’s own words:
We all get caught up in the rat race that is our lives. And at some point, we lose our sense of purpose. But when a group of dental professionals and support personnel work as a team to selflessly treat those in desperate need, we feel personal fulfillment. Love from our patients and support from our teammates creates an abundance of energy that pushes us to keep going throughout the day. We truly felt as though we were one.
Many thanks to Henry Schein, Patterson Dental, K-Dental, and Dr. Monica Dinca (Toronto), Dr. Calvin Pike (Endo, Kitchener-Waterloo) and Dr. Joseph Da Costa (Toronto) for their generous donation of sundries and equipment for our 2016 trip.
1. To read about our first trip, see Michael Carabash, “Mission Accomplished!” Oral Health Office (October 2015) pp. 24-25, 28-29.
2. Returning volunteers included Stefan Atalick (spouse of Dr. Christina Bodea), Dr. Christina Bodea, Melissa Brunette (hygienist), and Michael Carabash.
About the Author
Michael Carabash is a dental lawyer with his own law firm, DMC LLP. His websites are www.DentistLawyers.ca, www.DentistLegalForms.com, and www.DentalPlace.ca. He can be reached at 647-680-9530 or firstname.lastname@example.org. Michael is currently recruiting dentists, dental students, hygienists, equipment suppliers and support staff to volunteer in Jamaica in September 2017. Contact him to learn more.
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