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My Week in Guizhou Province, China (Part I)__Vincent Lee (65)

My Week in Guizhou Province, China   Oct. 2010
Part I: The Medical Mission - with the Guizhou Rose Society of Edmonton
A typical day of "free clinic" to a village named Goa-Bor (高坡), about 1.5 to 2 hours by car going uphill.  I was told the village is located at the highest elevation (~1500 meters) within a 4 to 5 hour (travel distance) radius of Guiyang.  Here are some highlights of the day in point form:
- Arrived Quiyang from Chengsha the night before (after ~2 weeks touring Southeast China (江南) and Zhangjiajie (張家界).  Was picked up by the Guiyang bishop's driver at 7am and taken to Goa-Bor village; arrived at around 8:40AM.
- Met up with Dr. Tai and the physician and nurses from Singapore.  Met Guiyang's bishop, a friendly man, very supportive of all aspects of our work.  They rounded up about 13 or 14 Catholic doctors from Guiyang's hospitals and clinics, with Dr. Tai, the doctor from Singapore and myself, we had about 16 doctors from all disciplines; neurologist, paediatrician, gynaecologist, internists, general and orthopaedic surgeons, ophthalmologist....., a traditional Chinese medicine (TCM) physician-herbalist, acupuncturist, and a TCM-massage therapist.  I was the only dentist.  The entire group is made up of over 30 personnel including laboratory technicians, pharmacists, a few priests and nuns (to help guide patients where to go and whom to see).
- The "open clinic" site was a large concrete pad in front of the local village health station.  When I arrived, most doctors and volunteer workers were already there - some busily putting up the big "free clinic" poster-sign and banner, others carrying furniture (tables and desks from a nearby school) to set up the clinic benches.  I was allotted a desk space at one end of the long clinic bench, behind me was a post where I could hang up a poster of dental and head/neck anatomy.  I also brought a big model of teeth and a matching tooth brush that my hygienist and I used to teach kids how to brush at the office.  The mission group brought for me big boxes and boxes of Oral-B toothbrushes and Colgate toothpaste to be given away.
- I was told there was not too much of "pre-advertizing" of the free clinic other than by word of mouth.  At first, there were only a few curious villagers standing around watching, drawn by the poster-banner saying something like "Welcome to the free medical clinic at Goa-Bor Village ......sponsored by the Guizhou Catholic Church....." (歡迎貴州天主教愛心義診活動在高坡鄉開展),  The poster also bears the emblem of a large pink rose, representing the "Guizhou Rose Society of Edmonton, Canada".  Within an hour of our opening shop, we had a sizable crowd milling around, asking questions, and we had a line-up at the registration desk.
- The way it worked:  We had many school tables forming an "L-shape" bench, with a short arm and a much longer arm.  At one end (the "beginning") of the short arm was the "Inquiry and Registration" Desk; villagers who wanted help would fill out a Registration Form.  Next to it were a number of nurses who spoke with the registrants to decide which doctor or doctors (specialties) they would/should see - acting like a "triage" desk.

These nurses would also take the patients' vital signs (blood pressure, pulse...etc).  Then they go to the long arm of the "L" shape bench to look for their assigned consultant(s) - but before they do that, I think they were all directed to the Hematology desk to get their blood typed and screened for diabetes.  Most, if not all of them, were also directed to my desk after they consulted with the respective specialists, to get their teeth looked at if there were specific problems, or just to get some oral hygiene instructions and a tooth brush and a tube of tooth taste.  I also saw lots of children (and adults) who did not go through the line-ups - who just wanted their teeth checked and got the freebies.
(e.g. A young mother with a 3-yr old child: major complaints: headaches, some gynae. problems, child had a rash and runny nose......  They would go through the blood pressure desk, the blood screening desk, see the neurologist, gynaecologist, paediatrician and probably end up in front of me to get the kid's teeth looked at for development and caries, and the mom's mouth too.)
If they required medications, prescriptions would be written on their Registration-Consultation Form, and they would go the Pharmacy Desk at the far end of the bench to pick up their free drugs.
- At another location, they set up an actual "bed" for acupuncture and massage therapy.  I saw (mostly) older folks with crutches and limps being treated there all day.
- There were close to 400 villagers seen that day, according to "Registration Desk" numbers - probably very close to the number of tooth brush/tooth paste sets I (and my helpers) gave away by the end of the day.

We had a brief lunch break - the villagers insisted they would provide us with a bowl of hot soup and rice with preserved vegetables; very nice indeed. 
Highlights of my day:
- It was my first ever such "mission", so I had no idea of what would be involved.  After seeing a bunch of little kids, checking their teeth and showing them the basics of oral hygiene, three of them were hovering around my desk, asking if they could hang around to help out.  I gladly agreed.  Two little girls, age 10, 11 (grades 4 & 5), one on each side of me, with one holding a flashlight, the other peeking into our patients' mouths......, and the little boy (about 10) running around gathering tooth brushes and tooth pastes -- we were a lively team for the rest of the day.  These kids learned FAST!  After about six, seven patients, the girls were able to point out "cavity" in other kids' (and adults') teeth when they saw them!  When I gave oral hygiene instructions with my broken Mandarin, they both corrected my Mandarin mispronunciations (like instant replay, in stereo!) - e.g. I was saying Yar-Char (Cantonese-nized Mandarin) for Yar-Shoar (tooth brush), and they yelled out the correct Mandarin and laughed.....!  Eventually I gave up; I showed and taught them how to teach other kids to brush properly using the large models, and they took over - saved me a lot of talking!
- Then came the hard part:  At the end of the day when I was packing up, one of these little girls, the 11-yr old started to cry.  I asked her, "Why are you crying?" ("你為什麽哭?").  She said, "....You are leaving... so soon", and added "Are you coming back next year?"  Almost without thinking, I was up to the tip of my tongue in saying "Yes, I will...."; then I caught myself, thinking - if I say 'yes', and for whatever reason I can't come back next year, this little girl will be so disappointed.  I had to change my tune and told her "If I can, if I can, I will ....., and you will be in grade 6 then...."  I hope we are coming back to this same village next year!
- After thoughts:  I've heard from other dentists who go on missions in many other parts of the world including northwest China that the bulk of their work in remote villages has to do with infection control and emergency extractions to relieve pain.  Interesting thing about these villagers, their main problem was actually not pain or acute infections.  Their main problem was gum disease (or periodontitis), with tons of plaque and calculus.  There was certainly a fair share of cavities, but no acute abscesses.  There was almost universal occlusal abrasion in the older adults, with very little mobility.  It may have to do with their diet, consisting of mainly coarse fibrous food and very little sweets.  If I had the equipment and had to extract teeth, I would only have to extract 4 in 4 separate individuals, all older villagers, due to mobility and advance periodontal involvement.  None of them were in acute pain, probably because these sites were self draining (no pressure build up).  I put them on a course of antibiotics and pain killers, and told them these teeth would have to be taken out by a dentist if they hurt badly or if they gum/face swelled up.  Truth is, they would eventually become so mobile that they would fall out on their own.

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