Michael Carabash, dental lawyer with DMC, speaks about the dental volunteer outreach trips to the Caribbean that he organizes for dentists, hygienists and students across Canada.
Read the audio transcript below:
Dr. Luisa Schuldt (LS): Hi everyone. Welcome to Brush Up, presented by Oral Health Group, the dental podcast where we speak with industry experts to discuss a variety of topics such as technology, finance, and practice management. I’m your host Dr. Luisa Schuldt, Prosthodontist and Periodontist, based out of Fonthill, Ontario. I am joined today by Toronto dental lawyer Michael Carabash, who is a founding partner of his own law firm, DMC, which has worked exclusively for Ontario dentists since 2009. His practice focuses on preparing, marketing, and selling dental practices. Back in 2015, Michael started to recruit local dentists, assistants, and hygienists to go down to Jamaica to provide free dental care to locals in need. Since then, the program has ballooned to include many more volunteers, including dentists and hygienists, but also assistants, dental students, hygiene students across Canada, going down more often to the Caribbean islands to give back. He’s been involved in raising money for various charitable endeavors in the Caribbean. It’s so great that you’re here to talk about this amazing and valuable work you’re doing. Thank you so much for joining us, Michael.
Michael Carabash (MC): Thanks Luisa and thanks for having me.
LS: I know dentists, a lot of us are very involved in our business and the care we routinely give to the people in our community, but it’s really great to see you motivating practitioners to do a little bit more and I’m sure a lot of us got into healthcare in general because we love helping the people around us. This kind of fundraising and community work is just amazing. The extent and how it’s grown – do you want to tell us a little bit about how this started? The trips, the foundation and the work you do.
MC: For sure. So how it all started was about a decade ago. I, as a dental lawyer, was just pushing paper, selling practices, transferring money, and there was just something missing, right? I wanted to be able to give back, as I’m sure a lot of people listening would love to give back and we’re not doing it for anybody other than ourselves, right? And so, I happened to be at a U of T gala that was honoring Dr. Tim Milligan. And he went up to give his acceptance speech, and he talked about how the best 10 days of his life were with his daughter, Melissa, who’s also a dentist, in Guatemala, fixing and pulling teeth. And I’m in the audience. And I’m thinking, damn, I don’t have 10 best days of the year. And, you know, what can I do as a lawyer? I’m not a dentist. I can’t fix people’s teeth or make their smiles pretty or put them out of pain, but I work with a lot of dentists, so I figured one thing I could probably do, even though I don’t know how, is organize groups of dentists to go down to places that were in need of free dental and hygiene services. So that was about a decade ago, and then fast forward a few months later, I happened to be on a family vacation in Jamaica on my 33rd birthday. And I was with Dr. Christina Bodea, one of my clients, and her husband. And it was late at night and I was doing a card trick cause I wanted to show them how to do my one and only card trick and I needed a volunteer. And I asked the bartender if he would be the volunteer. He said no, no use this guy over here, a burly guy with a big ponytail, this American guy who spoke fluent patois. Walks over and he said I’ll be your volunteer. And so I did my card trick and it went off without a hitch. And then I said to him, OK, so, what do you do? And he said, well, I bring big groups of American dentists and dental students and hygienists to the Caribbean to do free dental and hygiene work on the locals. And the Sandals resort that we were staying at provides the rooms and the food and the amenities and the drinks for free. And it was just like this light bulb moment. And I said to him, you got any Canadians? And he said we got Dr. Pat and I said, how would you like to have a lot more? And I’m sure he’s heard it before, but that was a decade ago. And we started off the following year with just a small group of, let’s say, 20 dentists and a couple hygienists from Ontario going. And this year, it’s ballooned to multiple countries in the Caribbean, multiple weeks and new projects like sealant projects or raising money to replace dental equipment or even put a young girl through dental school in Jamaica.
LS: That’s amazing and I’m so happy when I hear you mentioned Guatemala. We have a referring office that we work with really closely. Dr. Perry, Doctor de Palma, they also go to Guatemala and they find that contact with the community is so enriching. My colleague here in the office was just in Uganda providing care as well. So it’s such a great opportunity to remember some of the basics, get in contact with countries who are people are just not as fortunate as we are in in some ways. And we learn so much ourselves during these trips. You mentioned already a little bit about what inspired you for this. What would be maybe your most memorable story, or a recent success that you’ve had on one of these trips?
MC: So, there’s, I mean, there’s lots of stories, but the ones that touched me off the top of my head… 2018, Jamaica. 80-year-old man on a walker comes in and he needs all of his teeth removed and there’s Dr. Arsalan Poorsina to help him out and he just starts singing our praises. I don’t know when the last time a patient sung your praises before going to get a mouth full of extractions, but that was incredible. That was touching to him and his assistant, Ron Fung, and myself. That same year we had a young 6-year-old girl with cerebral palsy and she had abscesses and teeth that needed to come out. And a lot of the dentists, they just shied away and there was one really strong doctor Maria Tuason, who said no, I’m going to do this. And I remember I held this girl’s feet down. She didn’t know what was going on and her mom held her down and Dr. Tuason got those teeth out and we were all crying at the end of it. Those were from Jamaica. More recently in Grenada, we had an oral surgeon from Ottawa, Dr. Amin Alibhai. This guy is the tooth whisperer because when we lost power on the very first day of the trip, he was running 3 surgical extraction chairs without touching a drill. And he really set the standard for just an amazing big heart. He goes on a lot of trips. And when the power went out and we were trying to run our sealant program, a program that had been put together for months and the first day we don’t have power, we had a group of about 15 hygienists, mostly Canadian, you know what they were doing? They were doing 4-handed isolation and drying to put those sealants on those kits, that was huge. And then last but certainly not least, also in Grenada, we were closing shop, closing up, all done. And I remember there was a security officer who brought his 16-year-old daughter, and she needed major restos and endos her 1-1, 1-2-2-1 and 2-2 were all bombed out and we were done. So, what happened was the very next day, this is a day off where our volunteers get to experience the Sandals Resorts or go out into the world of Grenada or Jamaica, or Saint Lucia or Turks and Caicos, and enjoy the resort on their day off. Dr. Kosta Abate decided no, I’m going to fix these teeth. So, we packed up an X-ray unit and all the supplies we needed, we went to a local dental clinic and for four hours she gave this girl a smile and that was incredible. Just seeing those kinds of things, they really impact you.
LS: And you get to see kind of this short term result this has but the impact it has on the lives of these communities long term, being out of pain, more confident, with a healthy, happy smile. It’s just, yeah, amazing. What are the most common problems you see? You mentioned decay already. What other challenges or other problems have you seen that the team alleviate for these communities?
MC: Oh my gosh. I mean, just to give you an idea, when we go down there, I’ll give you a synopsis. In Grenada, for example, we had about 3 weeks, 140 volunteers provide something along the lines of 900 cleanings, 900 expansions, 900 restorations to 2000 patients. We did 1800 blood pressure checks, 10 RCT’s and 700 fluoride applications and gave away 8500 toothbrushes, toothpaste and floss. And this is a country that has about 120,000 people. So for us to treat 2000 people, you know, getting close to 2% of the population, in a two- to three-week span and to do that in multiple countries, you know, St. Lucia, Grenada, Turks and Caicos, Bahamas, Jamaica and hopefully St. Martin. I’m working on that one. At some point the numbers are so staggering in terms of the services that we provide just from a number’s perspective. But that’s not why our volunteers are primarily doing it, right? They’re doing it because they’re selfish. And they want to make themselves feel further in love with themselves. So, they go down to do it, and whether they get a hug or a smile or a coconut or a mango or some local food, it’s besides the point, because they’re doing it for themselves.
LS: That’s amazing. I can’t imagine they’re just doing it for themselves, but they do reap huge rewards from doing it.
MC: They become addicted. Yeah. And I just want to touch upon how this whole program would not be possible without some key players. First and foremost, the Sandals Foundation, which is the charitable arm of the Sandals and Beaches, five star, all inclusive luxury resorts. They give us all of the rooms for free, the drinks, the food, the amenities, the transportation to and from airport to resort and resort to clinic for free. So, they give us millions of dollars worth of free services and accommodations every year at these locations that we’re going to. So that’s they’re huge partner, along with the Adam Stewart and his family, who generously donate that. And we get dates from Sandals every February and that’s how we plan out the rest of our year. And then our other big partner is Great Shape. So Great Shape is a US not-for-profit, and they helped set up these temporary dental clinics for us, they staff them, they have the equipment, they ship the equipment, they do all the regulatory paperwork, liaising with our volunteers and the Ministry of Health to make sure everything is on the ground for us. They deal with Henry Schein Cares out of the US to get the sundries down there, so that our volunteers don’t really have to bring much with them other than their hands and a smile and a good heart. And so Great Shape and Sandals Foundation, those are two big players that make this all possible.
LS: It sounds like people really can make the best of this opportunity to get a day off, they get to contribute to the community. What are some of the other things they should be thinking about? Pros and cons, things that are really great or not so great, more challenging about these opportunities. How can somebody prepare for this?
MC: Ah, okay. So, if you’re thinking that you’re going to get your patients down there, uh uh. Let’s start with the patients. These are the most grateful people. They treat the dentist or the hygienist like movie stars. They’re going to hop on a bus at 4 in the morning to get in a line in the heat for 6 in the morning and wait until ten, eleven or twelve in the afternoon to get a ticket. To get the ticket for a chance to hopefully come later in the week because we have hundreds of people lined up outside of our big dental offices trying to get in to see the dentist. These are people who need extractions and they’re just so excited and they’re fighting again because they can’t afford it. And so, they’re so grateful to see us and they want us to have the best time so we keep coming back. So that’s the patient experience and I won’t speak to what patients are like up here, but that’s the experience of patients down there. Now when it comes to the sundries that we get generously donated from Henry Schein – amazing, just wonderful. They’re such a great partner to have in this as well. The equipment that we have is not going to be the same. I mean, I remember when Dr. Marina Polansky, who’s been down on a couple of trips to Turks and Caicos and Grenada, this is one of Canada’s foremost dental laser experts, and she doesn’t have a laser and she’s got to use a drill that may have a slightly dull bur and she may not have the elevators that she’s used to, and she’s doing an extraction. And on her first day of her first trip, you could see that there was some frustration. It’s just not up to her standard. She didn’t like how that played out. And then I saw her. She did this: (sighs deeply). And she said, I’m just going to do the best with what I have and what I have is pretty damn good. With that attitude, had an amazing time and has been coming back and promotes the hell out of the program, so those are kind of like the expectations from a patient equipment and instrument perspective.
LS: Yeah, you mentioned someone taking the bus to get there and, you know, getting up at four o’clock in the morning. I was volunteering some time ago in Mexico and it reminded me of a story that my colleague brought back from Uganda as well, Dr. Fritz. People also walk. Some of these people they’re so remote where they’re living that it’s 6-7 hours of walking to get to these locations. And it’s just amazing to see how much need there is if someone’s doing that, you know, hiking multiple hours. It sounds like this is incredibly rewarding, so valuable for the people that are being benefited by the care that you and your team, or rather the team that you bring along, provide.
MC: Absolutely.
LS: Some of these countries you are mentioning in the Caribbean, English is their tourist language. They may speak Spanish or French. How do you navigate the challenges that language can create? Cultures are all so different. How do you navigate differences in culture or what differences have you noticed?
MC: I’ve done this trip 13 times and in the worst case scenario we’ll get an interpreter. So, for example, if we’re in Turks and Caicos and we’re dealing with Haitian refugees at the clinic, an interpreter may not be an official interpreter. It may just be another patient sitting beside this patient who needs help translating or filling out their paperwork. It hasn’t stopped us. It hasn’t slowed us down. People have to wait long periods of time, and there’s always somebody who speaks the local language. A smile, you know, a hug. Those are forms of communication that go a long way. We also do training in advance. So, when our volunteers arrive, they’re not just thrown straight into the clinic. They get some time to settle in and then they do a formal orientation session where they’re told, well, here’s what not to say. Because the words that we use, like if you’re in Jamaica, you know you don’t say, when you’re trying to get the patient to confirm if the anesthetic is kicking in, you won’t say like ohh does it feel numb? You say does it feel heavy. And you don’t say I’m going to give you anesthetic; you say I’m going to Juke you with this needle with the cocaine. That’s what you say. So, it sounds funny for us to say it, but we do get that kind of training and we give it to the volunteers on the colloquialisms of the locals.
LS: That last one was really interesting. I would not usually chat with the patient in that way. How about education? You mentioned you have students that go on the trips as well.
MC: Yep. So dental students from U of T, 30 to 40 of them, 30 to 40 Western students. These are third years going into fourth year. Same with UBC. And we’ve also got a small contingent from McGill, and we’re hoping to get contingent from University of Manitoba, Saskatchewan, I believe coming maybe in the future. And so, what’s been happening is slowly but surely, amazing, amazing instructors will take it upon themselves to help recruit and come down with these students and supervise them. So, we may have a team of 10 to 15 dentists supervising a group of 30 to 40 dental students. And these students have never pulled a tooth and their experience, I mean, I can see how scared they are to even just cut a tooth or to talk to a real life patient. And they’re not getting 3 hours to do a hygiene cleaning; they’re getting maybe an hour and it may be an extraction and maybe a restoration, so they’re getting on the spot, real life training under supervision from experienced practitioners. That’s how we benefit future generations on the practical side of things. And it’s night and day; by the time they finish those five days, they’re completely different than when they started. In terms of educating population while we’re down there, what we do is a few things. Number one, post-op instructions, we give post-op instructions with little care packages and we explain, you know, there’s a toothbrush in here, there’s floss, there’s toothpaste. And here’s what you want to do. We also have an education team that goes out to the primary schools. There are elementary schools we give away thousands and thousands of those care packages and show these little kids how to brush their teeth. And we also do things like talk with them, their local Ministry of Health and Local Ministry of Education, to try to introduce oral healthcare in greater amounts in their curriculum, in their school curriculum. So, education has a huge role to play on both sides.
LS: So, you’ve been able to visit some of the schools and share the education there that’s not just in the centres. That’s amazing. Prevention, we all know, is the way to do dentistry right.
MC: Well, absolutely. The thing that pains me is if a young girl comes in for an extraction on one of the social six, we call them; we don’t want to see that. We want to prevent that. We started doing a sealant program. And, you know, I’m a dental lawyer. I deal with dentists. I’m not really a…
LS: Clinician.
MC: I don’t work for hygienist, yeah. But they said, Michael, can you help us develop a sealant program for Grenada? And I said, what’s a sealant? You know? And so, we pulled together lots of amazing people, two hygiene schools, people like, Canadian philanthropy, hygienist, Bev Woods. Canada’s top philanthropic dentist, Dr. Sanjukta Mohanta and, you know, Fanshaw college professors Kelly Turner and Shelly Getty. And they were amazing. And we put together a sealant program where we treated like 600 kids in five days and placed 3000 sealants and did restos and fluoride treatment. And that was new. We’ve never done that before and this year we want to double it and we want to keep getting, you know, hygiene schools involved as well as the dental schools involved. Because it’s as you said, prevention is the key. If we’re successful, the oral surgeon won’t have a job.
LS: Michael, so we’ve talked a lot about how this works. As in, you know, you have dental students and dental professionals coming down, dental assistants. You have great supports as you’re mentioning through Sandals and materials and sundries. What exactly is needed from the person? What costs are involved? What’s the nitty gritty of how you run this program?
MC: So, Luisa, you want to come on one of these trips? You’re going to call me up and you’re going to say, Michael, I’m interested. What’s the next step? I’ll say, Luisa, where do you want to go? Which country? Right now we’ve got two weeks in July in Saint Lucia, two weeks in August in Grenada, two weeks in Jamaica with the dental students, two weeks in Turks and Caicos in October, two weeks in the Bahamas next January. You’ll say, hmm, I want to come to Grenada, I’ve heard good things. I sa, okay, first and foremost, register on this website. That’s the US not-for-profit Great Shape. They’re the ones that take care of all the administrative stuff and you’re going to just sign up. Once you’re approved, you’re going to pay a project fee, which is around $1000 US. Okay, it’s a heavily subsidized work occasion. It’s $1000 US per person. We generally recommend you come with a significant other or two other people. So, two or three people, because we have a certain number of rooms that we’re trying to fill up. Like in Grenada, we may have 20 or 25 rooms and we want to fill them up with three volunteers per room. You can have two volunteers as long as you pay for the third person to not to be there.
LS: So, partner in crime?
MC: So you’ve got 1000 US and that’s the project fee, and you pay for your flight and flights to Grenada could be around $1000. And what do you get? You basically get nine nights, 10 days at a five star, all inclusive luxury resort. Food’s included. Drinks are included. Amenities are included. Transportation from the airport to the resort. From the resort to the clinic, all included. And what about the schedule? So, we show up, let’s say on a Friday. That’s your day, just settle in. Enjoy the resort and the amenities. Saturday, most of that day is yours. There may be a getting to know you orientation at night so you can meet the 60 or so other volunteers that have come down with you. The next day, there’s going to be about 3 to 4 hours of formal orientation at the resort. You won’t be going to the clinic because it’s being set up in the background and you get the rest of your Sunday to just enjoy the resort as well or the country. Now, Monday to Thursday, you’re going to have breakfast with the team around seven am. You’re going to be at the clinic, which is being held at the National Cricket Stadium, a big 20-op clinic with digital X-rays and 20 autoclaves and a team of equipment people. They’re all waiting for you. You show up there around 8:00 to 8:30, you know, patients start to get registered. Blood pressure check, temperature screening, all that stuff. So maybe first patient in the chair around 9:30 or 10:00 am. We’re going to keep working until around four o’clock. Eight until four then we were going to clean up. We’re going to cycle our unit because we’ve got proper dental chairs and proper dental units. We’re going to cycle it. We’re going to clean our area. We’re going to get our next tray ready for the next day and we’re going to repeat that till Thursday. Friday is a kind of partial day because we want people back at the resort to enjoy that sunset beach for the last time. You know, their experience is coming to an end, and we have a farewell party. So, we want everybody grouping together because throughout the week you may not be eating dinner with other people. You may just be having dinner with your little roommates or your friends, small groups and things like that. So, we want a big farewell kind of banquet party where a lot of people give speeches. Some of us cry. I’ll try not to cry, but I always do. And that’s it. And then Friday night’s a big party. Saturday’s another free day. And then Sunday you may be going home. So that’s what it looks like on the ground in terms of costs and in terms of what you’re doing, you know, when you’re there.
LS: It sounds like a really amazing experience, both because you get to contribute and because you get to enjoy it at a beautiful place. A lot of other mission-type projects do not include a nice, warm, soft bed.
MC: And I want to say something about that. I want to say, if I was going to look at this objectively, I would say I don’t know how I feel about, you know, groups of dentists and hygienists from Canada going down and staying at a Sandals. You know, maybe they should be sending money down to those countries instead or sponsoring people to go to local dental schools down there. And maybe that’s a better way to help. But in my opinion, people here – the dentist, the hygienist, the dental students, hygiene students, the support staff, people like me – we need healing too. And part of that is being selfish. I say be selfish and do selfless. That’s my motto. So, what does that mean? Be selfish, go to the Sandals Resorts, go and enjoy the five-star food, the foie gras and the steak dinners and the drinks. And in moderation, of course. And go and enjoy the beach and the pool. You earned it. You deserve it. You’re a rock star. And then when you go out there and you’re personally healing from the experience, you will also heal others and you’ll have fresh hands and eyes and mind to give us your best. So, I would say that yes, it’s not going to be an experience like Uganda or Guatemala, but this is a safe, cost-effective way to get a lot of Canadian volunteers down to have a customized experience, not just to help people, but to help themselves.
LS: Well, I really hope this conversation inspires a few people out there to sign up for your program. For people who can’t travel and maybe can’t join your program, I hope this inspires them to do a little bit more for their communities or however they can. There are so many opportunities to give back and be selfish and selfless. Thank you so much for joining us today, Michael. This is a really great conversation. I’m so happy to have learned more about the program.
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