This is my 5th and perhaps final blog about our 2016 Jamaica dental outreach program. Here’s the first blog, wherein I mainly talked about preparing to go down and how much better we were at it (compared to 2015!). In the second blog, I talked about clinic set up, equipment failures and how we had to adapt. In the third blog, I talked about how we worked hard and played hard. In the fourth blog, I talked about some shock and awe that we all experienced. And in this blog, I’m going to tackle the interesting topic of REVERSE culture shock.
Reverse Culture Shock
Papa Joe and I warned everyone from the beginning: when you get back home, you’re going to be in for a shocker. You won’t be used to anything. You may find yourself missing your team and ESPECIALLY your patients. You may be wondering what the heck you’re doing up here and if it’s making any difference at all. That’s what Papa Joe calls reverse culture shock.
For me, when I did this trip the first time, I had difficulty adjusting at first. I kept thinking: I had such a big physiological impact on the lives of so many in Jamaica over a short period of time; I feel like I’m wasting away up here. I need to be back there, helping out. I’m definitely not making the most of my life by typing and talking and phoning, etc. I wasn’t depressed; just in a daze for a few days. And I wasn’t the only who felt that way. This time around, I felt it a little bit; but not as much as some of the other volunteers. Here are some examples:
Dental hygienist Nina Nguyen after returning:
“I was missing going to the beach after work (every day). So I did a painting last night of the sunsetting at Negril beach.”
Dr. Irish Malapitan after returning:
“I was sad when I got home. I was more thankful for the things that we have. I truly loved the patients in Jamaica. They had so little but gave us so much”
Dr. Jacqueline Geroche after returning:
“I walked into a store and bought a patty. It was 5:00 p.m. and I need a patty. I’ve never done that before. I’m withdrawing and I can’t deal with this right now. I see the privilege that we have as Canadians and we have it so good and we take it for granted. And I know there’s still barriers to dental care up here, but it’s nothing like they have down there.”
Dental hygienist June Jennings:
“I have been missing our group already.”
For my fellow lawyer at DMC LLP, Jonathan Borrelli, it sunk in when he returned home and saw the tall buildings.
FYI, in Jamaica, they’re just called Patties. Here, they’re called Jamaican beef Patties. I saw this at the Toronto airport upon arrival and had to take a pic:
So what’s my recommended treatment for reverse culture shock?
Step 1: Reminisce about the good times, the challenges, and think about how good we’ve got it up here.
Step 2: Call up other volunteers and meet up.
Step 3: Come down and volunteer every year. It’s guaranteed to be the best 10 days of the year and some of the best memories of your life!
As I mentioned in the Oral Health Office article that’s coming out about our mission trip: this is a temporary solution. Papa Joe has a wonderful dream of acquiring a piece of land close to Montego Bay (currently listed for USD$1.2-million) and developing it as a public dental clinic. A clinic that can accommodate 50 people and which will see dental and non-dental volunteers from North America and Jamaica spend 1 week at a time providing free dental treatments and education to impoverished Jamaicans. I believe we can help Papa Joe with his goal. It won’t be easy. We need to fundraise, and also get donations of sundries and equipment; and we also need volunteers to work there all year round.
This is the fourth blog about our second dental outreach trip to Jamaica. Here’s the first blog, wherein I mainly talked about preparing to go down and how much better we were at it (compared to 2015!). In the second blog, I talked about clinic set up, equipment failures and how we had to adapt. In the third blog, I talked about how we worked hard and played hard. In this blog, I’m going to talk about some of the shock and awe that we saw at the clinics. In the next blog, I’ll discuss reverse culture shock.
Shock and Awe
Dental hygienist Nina Nguyen:
“What definitely shocked me was the line up on the first day outside our door. There were so many people. I guess it was my first experience with something like this. I didn’t know that there would be so many people. When I heard that so many of them had been there at 6:00 a.m. and we only got there at 3:00 p.m. to start setting up. It’s a long time to wait in the heat. I felt emotional just seeing that. Seeing all of these people so desperate to seek dental care. And knowing that they wouldn’t have the opportunity otherwise. It made me very eager to help. It made me appreciate how good we have it. I felt emotional just watching them. I guess I’ll always remember that.”
The scene outside of Grange Hill community centre on day #1
Dr. Irish Malapitan:
“The kids. That’s what shocked me. When they opened their mouths, I couldn’t believe how rampant the decay was. How could they have it for such a long time and not be in a lot of pain? Either poor education, treatment not being available, too expensive. It also seemed to be cultural: the mentality is once it’s broken, I don’t need it anymore. People seemed to function with gums. One older patient had only 1 tooth!”
But what also shocked the dentists and hygienists was how appreciative patients were.
Dental hygienist Jazz Chohan:
“The thing that touched me the most were how appreciative they were. My first patient was 80. She had to save up USD60 to get 1 cleaning – basically 1 week of salary. She saved up and did it once. She told me: ‘The fact that you are doing this, thank you. Lots of people wouldn’t do anything like this.'”
Dr. Millie Calko:
“Patients were really grateful. A lot of them would say ‘ what can I bring you?’ One lady left and came back and brought me an exquisite candle holder. I did some work for her; she was so happy and made me feel like I literally changed her life. She was jumping out of her skin with gratitude.”
We can’t use the word “AWE” without mentioning baby Mathew over at Grange Hill. Basically, Christine Martel was working as patient check out. She left her spot near the door and the next thing everyone knew, she showed up with a cute little baby! That got our attention. Here are some great shots with 5 month old baby Mathew:
Baby Matthew with Christine Martel and Dr. Joseph Fava.
Tashi Malcolm with baby Matthew.
Interesting story: my wife Parastou Carabash had brought down a baby Bjorn baby holder (pictured above). We didn’t really have a use for it (our pudgy 7 month old Daniel had outgrown it). I noticed that Mathew’s mom, Tashi, was lugging this cute little guy everywhere. He was not light 😉 I couldn’t believe they didn’t have some kind of strap or stroller, etc. So I gave her this thing and showed her how to use it. I was so happy the baby passed out while she was wearing it. I hope it makes her life easier!
P.S. if anyone wants to send anything down to Tashi for little Matthew, her address is:
3686058 Belle Isle Rd
Grange Hill, Westmoreland
This is the third blog about our second dental outreach trip to Jamaica. Here’s the first blog, wherein I mainly talked about preparing to go down and how much better we were at it (compared to 2015!). Here’s the second blog, wherein I talked about clinical set up, equipment failures, and how we adapted to make the best of the situation. Now, in this blog, I’m going to be sharing only a LITTLE bit of the some of the fun we had at the clinics and back at the resort. In the next blog, I’ll talk about some of the shock and awe that we saw at the clinics. And in the final blog, I’ll discuss reverse culture shock.
Having Fun… Perhaps Too Much Fun!
I can’t divulge everything; you’ll just have to come down to experience the fun yourself. I do recall Dr. Mille Calko saying it was the funniest 10 days of her life and that she’s never laughed so hard!
Working Hard / Playing Hard
I don’t think there was a day when I went to bed before 1:00 a.m. And yet everyday I was up around 6:30 a.m., ready to get started on the day. I think I can speak for all of us: we were running on adrenaline every day. Some of us got sick after a few days because our bodies were tired and we were just pushing them to the extreme. I mean… think about it… during clinical days, we would get back to the resort around 5:00 p.m. and then go to the bar, grab a patty, hit the ocean, then go have dinner, and then hit the club, etc. Do that for a few days and you’ll understand why some of us were getting sick. We ended up loading up on soup and antibiotics to get us through the week. But it worked! Some of the volunteers got home and, when they finally gave their bodies a chance to recover from the adrenaline rush, their bodies turned against them and got them sick for a few days!
Here’s the tiny boat team Grange Hill (plus Dr. Jackie Geroche) took to Rick’s Cafe one evening. What a ride!
The World Famous Rick’s Cafe! Only Dr. Joseph Fava was brave enough to jump the 60 feet! Dr. Christina Bodea and husband Stefan Atalick jumped from the lower level.
And I don’t want you to think that there was a clear separation between work and play. We played on the way to and from the clinics. We also played at the clinics. For example, at Grange Hill, we played music on the van ride, played music at our clinic, and sometimes we took photos and posed with patients after a treatment. Our group theme song was…. Ghostbusters! Why? Because that’s what my son Michael currently loves as his favourite song. So I just kept playing it and we kept signing it.
Over at Little London, they were singing Christmas Carols like Let it Snow and Jingle Bells. Sometimes, while waiting for a patient, Dr. Irish Malapitan and Jazz Chohan would start doing ‘booty bounce’ dances at the clinic. All of these things made patients laugh and feel more comfortable. Here’s what it looked like
The official slogan for team Little London was Bar – Patty – Ocean. Here’s how it came about, as per Dr. Irish Malapitan: “We were on the bus; we were figuring out what we were going to do next. Oh no let’s go to the bar. No let’s go to the ocean. It was a time we could as a clinic group, think about the day and trouble shoot about how we were going to get better. By Friday we had it down to a science.”
We had fun, regardless of where we were of what we were doing. Back at the resort, we would do things together like play “Apples to Apples” at Cafe de Paris; go for a stroll by the beach late at night; hit the water park and go down the slides; hop on a boat and head out to Rick’s Cafe to jump 60 feet into the water (for the record, only Dr. Joseph Fava did this!).
I think we were having too much fun. But that’s what made it work. That’s what kept us motivated. To get through the hot days, poor ergonomic conditions, lack of available instruments and equipment failures.
We had a group of characters who would tell us incredible stories (like Dr. Mary Berkmortel or Dr. Jacqueline Geroche); we had funny nicknames for lots of people (like Candlestick for Stefan Atalick and Dr. Propa Touch for Utech dental grad student Tevin Carter). Sufficed to say, there was a lot of love in the air. And it all started from the beginning of the trip.
Some of the Nicknames
So apparently, “Irish” means potato in Patois. And that’s why a patient thanked “Dr. Potato” when referring to Dr. Irish Malapitan. Papa Joe explained at breakfast early in the week that Jamaicans referred to rustic potatoes as Irish and from that day it just stuck.
“My Man Child”
This name was given by Dr. Irish Malapitan to Jason Brown (Henry Schein sales manager). Basically, when team Little London was deciding on who was going to assist who, Dr. Irish said that she would take Jason Brown (a completely inexperienced assistant). “He’s my man child” said Dr. Irish.
According to Jason: “Dr. Irish and I clicked from the onset. Over the five days, I learned how she worked and what she needed. By the end of the week, we were able to practice four-handed dentistry. Doctor Irish was very patient and I have a lot of respect for her.”
Jason Brown (a.k.a. Dr. Irish Malapitan’s Man Child) and Dr. Irish Malapitan treating a patient at Little London
Dr. Potato (Dr. Irish Malapitan) with her Man Child (Jason Brown) and dental hygienist Jazz Chohan in the back
Dr. Propa Touch
So on the first day of clinic, I was going around and asking everyone how they were doing; whether they needed anything; how much time they thought they had left before I could bring them another patient. When I was talking to UTech Dental Grad Tevin Carter (which DMC LLP sponsored to be there), I asked him if that was going to be a difficult extraction. His response: “No. It just needs the propa touch”. And it was like a light shining over me: he would be called “Dr. Propa Touch”. I would henceforth introduce him as Tevin, aka “Dr. Propa Touch”. Everyone laughed.
Dr. Propa Touch (a.k.a. Tevin Carter) with dental hygienist Melissa Brunette and her mom Christine Martel
I’m sure the name will stick because… during our 2015 mission trip, when we were volunteering, we had a UTech dental grad student named Grantley Grant. I saw him spend over an hour with a difficult extraction. The cap had snapped and he was left with a bunch of roots. He asked me to bring him some instruments – east / west elevator, etc. I had no idea what he was looking for. I eventually brought him the right tools, which I called ‘a scooper’. And when “Dr. Scoops” (who was sweating it out trying to scoop out those roots using his trusted scooper) finally finished, everyone was overjoyed! “Dr. Scoops” or “Scoops” for short stuck with Grantley. Apparently, in St. Lucia in July 2016, Grantley was there. And he was still known as “Dr. Scoops”. Ha ha ha! Love it!
P.S. Can you feel the love?
Volunteers + Papa Joe going for a stroll at night at the resort.
Team Little London on the last day back at the resort.
Dr. Irish Malapitan, dental hygienist Jazz Chohan and dental hygiene student (Oregon) Sandra Busch out for a stroll in the rain after clinic.
This is the second blog about our second dental outreach trip to Jamaica. Here’s the first blog, wherein I mainly talked about preparing to go down and how much better we were at it (compared to 2015!). Now, in this blog, I’m going to be telling some stories about what happened in the clinics. The good, the bad, and the really ugly stuff… And how we had to adapt to keep going. In the next blog, I’ll talk about some of the funny things that happened in and outside of the clinics. In the fourth blog, I’ll discuss some shock and awe that we experienced. And in the final blog, I’ll talk about reverse culture shock.
By way of background, our Canadian contingent was pretty much divided into 3 groups: a small resort clinic (which had 1 dentist + 1 hygienist + 1 assistant and who worked on resort staff); a clinic at the Town of Little London and another clinic at the settlement of Grange Hill. The latter 2 clinics had about 12 or so volunteers.
Team Little London!
Team Grange Hill (with community volunteers!)
Clinic Set Up
Each clinic had 7 chairs. 2 of those chairs were used for hygiene. 1 chair for a dental student. And the remaining 4 chairs for dentists. We had a sterilization room with 2 autoclaves, ultrasonic bath, etc. In terms of sundries, we would initially set up the clinic with what we thought we needed and then make a supplies list every day for things we needed. Then we’d just go to the supplies room back at the resort and pack up what we needed for the next day. That’s how we got through the week. Our supplies were pretty well organized at the clinic.
Over the course of the 5 days that we volunteers, harsh working conditions coupled with equipment failures made it difficult (but not impossible) to work. Over at Little London, here’s how dental hygienist Jazz Chohan described it:
“Where do I start? Ergonomically, this was the worst week of my life. I’ve worked the hardest I’ve ever worked. My arm was killing me by day 3. My chair stopped going back. I couldn’t use suction. I didn’t have water. So no cavitron. The next day, they sent me a cavitron that didn’t work. I was doing hand scale the entire week. I do hand scaling at home; but I’ve never done anything this. Our compressors kept failing; we only had 1 sterilizer for most of the week until we got a second one. The second one came was taking too long (old autoclave); took a long time to get things cleaned vs. the 30 minutes for the other one. There were set backs with the availability of the equipment and also the use; assistant wasn’t trained so he wasn’t putting things into the autoclave strategically.”
Typical work station over at Little London
Dental Hygienist Jazz Chohan
Over at Grange Hill, we had cavitrons stop working, compressors fail (due to fuses being tripped), equipment not being available (we were waiting a few times for syringes to get sterilized). On our first day there, our saliva ejectors weren’t fitting properly into our adec units! Oh no!
Here’s the key thing to remember: be prepared for things to stop working. When they do, try your best to fix them and when you can’t, call in the experts. There were a few guys like Oshane and Roshane and Richard who worked with Great Shape! Inc. and who were sometimes available to help us with our equipment problems. But when they weren’t around and it didn’t look like we were going to get a working cavitron, we had to IMPROVISE. In our case, when we didn’t have syringes ready, I put all of our hygienists to work doing cleanings. This gave the dentists a break. Only 2 cavitrons were working and we typically had 5 hygienists, so I would send the little boys and girls to 3 hygienists to do hand-scaling and the older folks would go to the hygienists who were using the cavitrons. Then, once we got the syringes working again, the hygienists went back to assisting the dentists on extractions and fillings. Like I said: ADAPT! And when we noticed that the saliva ejectors weren’t fitting, we made some ‘adapters’ by cutting other surgical saliva ejectors to make it all work. And it did!
Another way in which we had to adapt involved registration. At first, it was just me doing registrations alongside DJ of Great Shape! Inc. Then we decided to get Dr. Christina Bodea to do triage. And her husband Stefan Atalick started helping out with the ticketing system. Things were going slow, but people were getting registered. But because we had a huge lineup outside our door on the first day, we needed to speed things up. So we decided to set up another table and have more people help with registration. This helped ease the tension and it definitely sped things up. I would register people on Mondays through Wednesday and DJ would register on Thursdays and Fridays. I only wish we would have done this from the beginning!
Grange Hill Set Up
Team Grange Hill getting instructions from Oshane about equipment
Over at Little London, they also had to adapt to their environment. They had a hygienist named Carla (their team leader who had done this mission trip before) who was able to freeze patients so the doctors would simply come over and start their treatment. She was trained in the U.S. on how to do this; apparently, Canadian hygienists aren’t allowed. This helped speed things up at their clinic. Another way in which team Little London got ahead of the 8 ball was by dividing the roles of patient intake (Jonathan Borrelli, DMC LLP) and patient flow (Anthony Archer, Henry Schein) after the first day. This helped speed things up tremendously.
FYI, here’s a cool time lapse video I took of us working a FULL day at Grange Hill.
And we’re back! This was our second annual dental outreach program in Jamaica. And it was a HUGE SUCCESS! A large group of us went down from September 3-12, 2016. Our volunteer group included Ontario dentists, hygienists, dental students, Henry Schein representatives, dental lawyers (myself and Jonathan Borrelli) and support staff.
The 2016 Dental Outreach Program Volunteers
Now, in this blog, and the next 4, I’m going to get into some of the things that happened when we went down and also when we came back (what Papa Joe calls ‘reverse culture shock’). In blog #2, I’ll talk about the clinic set up, equipment failures and how we adapted to keep going. In blog #3, I’ll talk about working hard and playing hard. In blog #4, I’ll talk about some shock and awe. And in blog #5, I’ll talk about reverse culture shock (when we got home) and some parting thoughts.
Now that we’re all back, I can say without a doubt, it was the best 10 days of the year for me (and likely many other volunteers). Everyone misses each other; the patients; the patties! But before I get started, I’m very happy to report that Oral Health Office magazine will be publishing an article I wrote exclusively for them in the October / November edition of their magazine. I’ll be touching on some of the stories that I couldn’t really get to in that article in these next few blogs… so shall we begin?
1 Year in the Making
When I returned home on September 6, 2015 from our first Jamaica dental outreach program, we got to work on promoting the success of that year’s program, as well as recruiting for our 2016 program. We were featured in the Toronto Star on December 26, 2015 (HERE). An article I wrote (HERE) about the experience was published in Oral Health Office. Ontario Dentist magazine acknowledged some of our volunteers who were featured in the media, as well as Dr. Tim Milligan (whose speech at the U of T Gala motivated me to start the whole program) (which you can read about HERE). And then we went on the road… talking to dentists and dental students about the program. I figured the hardest year was behind us and we could do a much better job recruiting and preparing volunteers the second time around. I was right…
Sending Down Supplies
The first year, we hit a couple of snags when it came to sending down supplies. Some dentists sent supplies down. Some brought them down with them. We also got a sizeable donation from Henry Schein, Patterson Dental, and K-Dental which we shipped down. We didn’t really know how to deal with all the logistics of getting our supplies down to Florida and then to Jamaica. There were delays. We had to spend weeks figuring out all the paperwork. It cost us a lot of money too. But at the end of the day, we got our supplies down there.
This time around, we got even more supplies. 20 large rubbermaid containers full. Plus, Dr. Monica Dinca – Toronto; Dr. Calvin Pike – Endo; Kitchener-Waterloo; and Dr. Joseph Da Costa – Toronto all donated sundries and equipment… and they weren’t even able to volunteer! I was shocked by their generosity.
Thankfully, we managed to use a different shipping company to get everything down and it arrived punctually right before we did!
Dr. Monica Dinca (General Dentist – Toronto) poses alongside her donation of equipment and sundries.
Notice the chair here in Jamaica? It came from Dr. Monica Dinca’s office!
Dr. Calvin Pike (Endo – Kitchener Waterloo) and his wonderful team pose next to their donation of sundries. Who’s car is that?
This was MOST BUT NOT ALL of the stuff that we packed up at DMC LLP to ship down to Jamaica. It took a few days to get it done.
In terms of preparing to go down, we were better this year than last. Thanks to Dr. Christina Bodea and her husband Stefan Atalick, we were able to put together a preparation guide (which you can see HERE) about what to expect when going down. It was reviewed / edited by myself and Papa Joe and Salli Jo and the end result was this: everyone had a better understanding of what to expect for the week. Having done the program twice, I think there’s definitely room for adding more. I also sent out a series of e-mails throughout the months leading up to our departure to discuss things like: airplane tickets, paperwork, meeting up for a photo-op at our ASM after-party, and how to avoid getting bitten by mosquitos and sand fleas.
Some of our volunteers met up at our ODA ASM After-Party to get this shot. Oh Stefan!
I know you’re very interested in the whole ‘how to avoid getting bitten’ part, so here is the email I sent out (for the record, everyone commented about how little they were bitten throughout the trip because of my tips ;-):
Sand Fleas – also known as “No See Ums”
In terms of next steps, I will likely send out one (1) more email before our trip so you can can be best prepared for our 10 day trip. But I did want to mention something important – preventing bites from Sand Fleas, also called “No See Ums”. The Caribbean beaches are plagued by sand fleas. You can’t see them. You won’t know when you’re bit. Typically, you’ll wake up the next morning with a rash somewhere and think there are bed bugs. That’s them! And they likely bit you the day before. They bite your feet and ankles and legs while you’re sitting on the beach working on your tan. And their bites are rash-like, itch and swell and don’t go away. Last year, some volunteers didn’t follow my advice and ended up getting bitten pretty bad (needing to see the nurse and getting some injections). Those volunteers would say something like: “Oh, I never get bitten”. My suggestion to have a an enjoyable trip: put your egos away and follow my advice (I tend not to get bitten by mosquitos or sand fleas when I’m travelling through the Caribbean):
Following my suggestions should result in a comfortable trip where you can enjoy the beach. You won’t be trying to scratch your legs while you’re trying to pull out a tooth at one of the clinics 😉
Think about it like this: I have to take a team of 10-15 strangers per clinic and get them to make a temporary dental office work for 5 full days. Things will break down. That’s guaranteed. The working conditions are harsh (hot; humid; fans blow hot air at you; low light; mosquitos; etc.). And there’s a huge demand for dental treatments and cleanings (hundreds of people lined up outside). So you’ll definitely need a positive attitude. And then you need to make sure that the team members get along throughout it all. Make sure you have dominant / leadership personalities paired up with detail-oriented worker bees, social butterflies, and highly-structured steadies to keep everyone together. You can’t have too much of one personality (particularly dominant personalities) or else there will be drama. And that’s the worst thing ever when you’re down there: when you’re not having fun anymore because of internal bickering. Thankfully, we didn’t have any this year at our 2 clinics. I was so happy it worked out.
In the next blog, I’ll talk about what happened when we actually got to Jamaica…
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