I am too anxious to sleep though it is still early morning and I haven't seen a proper bed since before we left JFK three days ago. Will I extract a tooth? What kind of pathology will I see? Will we leave feeling as though we made a difference? I see kiosks selling candy, beer, and calling cards as raw meat attracting flies hangs from others. The children are smiling, playing happily in the dirt with makeshift toys. Their elder siblings and parents toil in the rice paddies or herd zebu along the road with faces hardened by the elements. I cannot tell by look alone if they are any less content than their adolescent family members. Many of the children wave to us excitedly as we hurtle past with our crates full of dental supplies packed tightly atop the vans. And it hits me like a brick to the face that this trip will be nothing short of unforgettable.
As we arrive in Berivotra, our first clinic site, I realize with equal force that this trip will not be a vacation. A dense crowd of people has already gathered in front of the schoolhouse that is to be our temporary clinic. Young and old, they wait for us; many covering their faces with hand-sewn shawls. The thought of treating all these patients in our limited time here is daunting but we are eager to get started. Both they and we have traveled far to be here; to receive treatment and to treat, and neither want to leave before the issues are resolved.
Nick and I have just finished our first year of dental school at Stony Brook University and are assigned the primary task of sterilizing instruments. Scrub. Rinse. Boil. Cool. Repeat. Every so often the application of sunblock is thrown into the cycle. We drink a lot of water. As hot as it seems working by our portable propane stove, the six soon-to-be fourth year students and our three professors always look drenched with sweat. They twist and contort their bodies to meet the angles necessary to treat their patients seated in foldout camping chairs (complete with cup holders, of course) and foregoing correct posture to do what is needed. They wear kneepads and headlamps; throw on a hard hat and you'd think they were working in the mines. Water bottles cut in half are used as spit cups as the question, Marary? (do you have pain?) echoes through the open-air clinic space. Nick and I spend our free time assisting the doctors, trying to learn as much as we can while we dab, retract, or suction.
Even in this severely remote location, our high caliber of care and dental technology drives us. We carry three portable dental units powered by a generator, which provide us with suction and high speed drilling capabilities for restorative, surgical, and even endodontic procedures. Our NOMAD (TM) X-ray unit helps us diagnose and guides us through the most difficult cases. We see countless root tips and worse, cysts and extraoral fistulas with suppuration. A woman is seated with severe periodontitis; roots exposed, multiple diastemata present, loose teeth attached solely by calculus. She conveys to us through a translator to only remove the nify (teeth) that cause pain. Before the anesthetic has even fully set in, she is out the door with sutures in place and ibuprofen in hand, content. As the sun sets on the crimson desert, I watch a surgical extraction of a potentially ankylosed molar, its periapical image projected on our laptop.
In Madagascar, my first year lectures have come to life and I understand the significance of what we do as dentists. I see the pathophysiology of infection developed in the oral cavity without intervention; only observable here, outside of modern civilization. I now eagerly await the start of my second year of dental school with a heightened anticipation to treat patients myself. By the end of the trip, the most important questions have been answered and our month long expedition feels like a whirlwind of remarkable experiences. Yes, we relieved pain. Yes, we may have saved lives. And yes, each of us is changed for the better having had this experience.
View photos of Mitch in the field.