The final week

Tuesday 23rd July

I had great expectations for today: I challenged myself not to make a kid cry. Well that was an unrealistic aim. I'm sure we're yanking out some of these children's teeth when they're not completely numb!  However you can never really tell - children are unreliable as it is when it comes to distinguishing pain from pressure, now add in the fact they're thrashing about all over the place and won't even open their mouth.......you cannot get a decent answer out of them when asking if it hurts. And you certainly can't be Mr nice guy and wait half an hour for them to calm down (they never do). You just have to go for it, whip out the tooth so they only feel it for a couple of seconds, rather than prolonging the traumatic experience by tentatively attempting and re-attempting a painless extraction.
I got bitten again today - kids have quite strong jaws you know! The patient was crying hysterically and I was in the middle of extracting a tooth when his jaws clamped down on my finger. I literally couldn't move it for about 5 seconds (which is a pretty long time to have your finger locked between a set of nashers) and I let out a bit of a yelp (more like an 'AHHRGH!') I had to prise open his mouth to release myself. Our whole chair (nurse, parent, child, me) were all shouting one way or another (mainly telling the child to open his mouth wider throughout the whole procedure).

Wednesday 24th July
Frustration really began to kick in today...sometimes I feel like I'm losing my patience with the communication barrier: it would be hard enough to get a good history from kids in the UK, who may understand you, but here it's sometimes impossible. Some of the nurses aren't that great at English and I'm not sure they actually translate what I want to say. Some tend to answer 'yes' to everything: "which side is painful?" "yes"; "no WHICH side?" "Yes"; "where...left or right?" "Yes", even pointing at left then right doesn't help! They could be a bit more helpful sometimes. I do feel slightly guilty though, because they speak more English than I speak Khmer!
This experience has made me realise how important communication and language is in Dentistry - especially if you want any chance of having a cooperative patient. Even other communication means such as tone of voice and actions doesn't help if the kid doesn't understand your language. I definitely take that for granted in the UK.
I occasionally feel like just giving up and getting the child to come back another time, because how am I supposed to treat the problem when I don't even know what the problem is?! And there's an uncooperative child in the chair!? After feeling like this a few times today, I tried to stop being so selfish and actually imagine what's it's like to be that child.......Here you are, in an unfamiliar place for the first time, with a scary weird looking foreign person, trying to speak to you in your language, and now they want to peer into your mouth and fiddle about with your teeth.....of course you're not going to answer them when they say "choo moy na?" (where does it hurt?).
This experience has taught me to learn to be patient with everyone, to put myself in the patient's place and understand they're probably terrified and don't care that we have a tight schedule. I do however think I've learned a great deal about communicating in an unfamiliar language - which was one of our elective project aims.

On another note, we donated blood today! It felt good, especially as I didn't faint like last time <in the UK> (then got banned for a year for causing so much hassle as they couldn't find a vein or get much blood out...) The hospital here were very grateful, and gave us a goody bag containing a t-shirt, can of coke, box of crackers and pack of multivitamins.

Thursday 25th July
Today was our last day at the surgery as tomorrow, we'll be on a whole day of outreach at a  rural health centre 80km away.

Disceitful Cambodians...

Everywhere you go in Siem reap, you are greeted by friendy tuk-tuk drivers: "you want tuk-tuk lady?" And in the markets, hundreds of 'friendly' Cambodians trying to sell you whatever they can. I had a rather disheartening experience today when I was looking around the old market for a dress to wear on the beach. I thought they'd probably try selling it to me for about $8 and would hope I could bargain it down to at least $5. However this one lady insisted that she always sold them for $15 and could offer me a "very good price" of $14. Hmm EVERY SINGLE market seller tells you they'll do you a 'special price'...anyway I tried it on and after the woman gave me copius amounts of over-the-top compliments, I managed to bargain it down to $8. This was all very well and good, if she had then just let me leave. But no, she HAD to attempt to force another dress upon me (for "such a good price"), she even shoved it in my bag and tried convincing me she had no change so I had to buy two. Well I didn't want it and although she almost made me buy it, I ended up waking away with just the one that I wanted. After the stand off, she turned very sour and started complaining that it was "such a good deal" blah blah blah and when I thanked her and left, she just ignored me. So I guess all the sweet taking beforehand was all lies! I've had a couple of these encounters, where someone starts talking to you but quickly turns nasty once they realise you're not going to give them money. It makes me wonder how many Cambodians are genuinely friendly and interested, and how many are just trying to get your money.

Friday 26th July
I CANNOT believe it's our last day today!
We set off for outreach at 8am this morning (a nice late start compared to the normal 7.30 kick off). We went to a health centre in a rural village about 80km away. Rural Cambodia is so beautiful, I love all the colours: red dirt tracks lined by wooden houses on stilts and bright green rice fields interrupted by tall tropical trees. It was such a hot day today and this village had no electricity as it's too expensive so we couldn't make use of the fans which had been installed in the health centre. Patients come here if they're in pain or have a medical problem, however they don't receive any treatment here - they would have to be referred to a hospital in the city. It was the first time dental outreach had come here and they'll start coming every two months. We saw 28 patients today 23 in the morning and only 5 this afternoon. It was a lovely way to end our elective, not too stressful, just a couple dozen extractions back to back for both of us.

Quick after-lunch snooze in the hammock

It's the elections this weekend!

Cambodian road outside the health centre

Entrance to the health centre

Waiting to be seen in the dental clinic

Enhance to the health centre

'Clarking' patients (which tooth hurts....)

House on stilts

 These three weeks have flown by so fast, and we both feel sad to leave. This elective has been an unforgettable, enjoyable and challenging experience - I feel truly blessed to have been a part of AHC dental team and extremely grateful for this incredible opportunity. I don't think I'd have ever witnessed or experienced some of the things I have, if I hadn't done my dental elective here in Cambodia. I feel so much more confident in everything I've practised here. I had never extracted a child's tooth before coming here, but within the first hour of being in AHC dental clinic, I had already lost count of how many I had done. From the ones I recorded throughout the three weeks, I did about 160 extractions and saw about 145 patients (not including those at outreach).
I have also got used to all the screams and cries and tantrums and painfully ear piercing shrieks of children thrashing about on the dental chair. Going back to England will be a bit weird: the children will not be restrained and forced to have their teeth extracted (most go under GA if they need a lot out), there will be spitoons for patients to actually use and not just for holding cotton wool pledgets, we will have to speak in English and not Khmer, we will have time to: check for haemostasis (blood clotting) after an extraction, acclimatise the patient before embarking on treatment, gain a decent and accurate pain history, take radiographs (!).....the list goes on.

So after a full on three weeks of Dentistry, we're off on our travels tomorrow at the crack of dawn (think I'll have to set the alarm for 5am) we travel to Bangkok and then down to ko tao for what we hope will be a relaxing break from all our hard work!