It’s Work Day 1 of the trip, and after a two hour bus ride to a church in a rural town called Clermont, we arrive at our work site. We get off of the bus and chaos ensues as children and adults alike greet us, anxious to get inside for care. We scatter, converting folding tables into surgical stations and hygiene bays. The second year dental students man the hygiene station, excited to see our first patients that aren’t our classmates. The morning flies by. After a blur of cleanings one after another – scaling-prophy-fluoride, scaling-prophy-fluoride – I am called over to do my first local anesthesia injection since our certification workshop in class two weeks earlier.
An instructor presents the case to me: 22 year old female presenting for extraction of tooth numbers 8, 9 12, and 13. Patient plans to visit local dentist post-extraction to receive a removable partial denture. I look at her, but only quickly as I try to mask my nerves. I run through my steps in my head as I move: infiltrate using 2 carpules of 2% Lidocaine with epinephrine 1:100,000 for maxillary right and left central incisor, left first premolar, and left second premolar. Remember my anatomy. Dry the area, apply topical, load my syringe, check my path of insertion, make sure I’m parallel to the long axis of the tooth, don’t forget my finger rest, insert the needle, always aspirate, go ahead and inject. Now the palatal, check for blanching, repeat on the next tooth, recap the needle, be careful of a needlestick. Breathe. I review my process in my head, and I am pleased with my technical execution of one of my first ever injections.
Then, for the first time, I really look at my patient. I was too nervous beforehand to acknowledge the fact that she was probably immensely more nervous than I was for what was about to happen. So I looked at my situation again; this 22 year old girl, who was just two years younger than I was, came to our clinic asking for us to remove four of her teeth, two of which were her “two front teeth,” because they were causing her so much pain. She was 22 years old, too young to be losing these critical teeth. She said that she had plans to visit a dentist and to get a partial denture, but a nagging voice in the back of my mind wondered if she would actually have the chance to follow up on this, if she would have access to a local dentist who could prevent her from living without two of her most aesthetically significant teeth for the rest of her life. I got so caught up in the fact that I was doing an injection on a real live patient that I didn’t even take a second to think about the teeth that I was anesthetizing for extraction on this beautiful, articulate, and otherwise healthy young woman. Immediately, I was overwhelmingly disappointed in myself for getting lost in the technical aspect of this woman’s care and failing to see the person behind the procedure.
After that moment, I finally saw my patient not just as someone who could help me hone some new dental skill, but as someone who could teach me so much more than that; I saw her as someone who could bring to light for me the discrepancy between dental care in places like rural Jamaica compared to certain areas of the U.S. I saw her as someone in a situation that would probably never happen in my hometown in New York. This is when it really hit home for me that participating in global outreach and showing up for just one week is not enough. Our work is not done after only one visit to a country. This has to be a continued effort that focuses not only on treatment of symptoms, but on prevention of the problems that cause these symptoms in the first place, and on education about how to do so. This way, the next time we see this 22 year old woman, she will be coming in for a regular cleaning rather than to have four more teeth extracted.
I now know that one of the most essential things I learned in Jamaica was not the best angle to approach an IAN block from, or what a Cowhorn is, or how much pressure to use to pop a stubborn chunk of calculus off of a tooth. The most important thing that I learned had nothing to do with the technical skills of dentistry. Rather, I learned how to be both a provider of care and an empathetic person at the same time, how to integrate both scientific and interpersonal skills into one experience for my patients. As second years, every single bit of this trip was almost brand new to us. We were sponges trying to absorb as much information as we possibly could. However, I realized the importance of stepping back to acknowledge that I was no longer working on a typodont or on the person who sat next to me in class for the last two years. I was working on children who had never been to the dentist before, or on grown men who were more anxious than their children to be sitting in that folding chair. Learning how to speak to these people in a professional manner, but also in a way that would comfort them in the midst of the fast paced, hectic buzz that is the atmosphere in one of these improvised clinics where 300 to 400 patients shuffle through each day was one of the hardest things I’ve had to do. It’s certainly not something I could have learned in class, no matter how many times I read about it in a book.
I admit that after being immersed in an entirely patient-based setting, it was difficult to return to Tufts and jump right back into the 10 PM nights in preclin followed by 2 AM nights of studying before exam blocks. In the same way that in Jamaica I neglected to see my patient past the needle of my syringe, I now sometimes forget to look past every seemingly impossible project or every grueling exam block to see the big picture: that we are working so hard now to be able to give our patients the best care that we can, whether at home or abroad. So in this way, the perspective I learned in Jamaica has come back with me, even though we are not yet in the clinic seeing patients.
One of the most profound things that a professor said to our class is that it is not in every profession that you can put your hands on someone and take away their pain. I don’t think I really grasped just how much that meant before we went to Jamaica. Seeing people come to us in pain, go through a foreign and frightening procedure, and yet leave happy as can be because we got rid of their pain was one of the most gratifying experiences I have ever been a part of, and I could not be more excited to spend the rest of my life doing just that.
-Kelly Barbera
