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"When Deborah Hannigan (Anderson Dentistry) approached HDP for sponsorship towards a trip to help people with dental disease in the Philippines we were happy to contribute.  Deborah kindly provided us with an overview of her trip to show what a good cause she was working towards.  In this article she gives us a good insight into the possibilities when we decide that we can take our skills and use them effectively in developing countries."

Fresh mangoes on the beach for breakfast following a 6am dip in the glorious crystal clear ocean – what a way to stay the working day! This was just a part of my recent trip to the Philippines. After much fund raising and organization, my bags were heavy and bulging with countless numbers of toothbrushes and toothpastes. I had also purchased an array of extraction instruments, weighing in at an absolute ton. I managed to squeeze into the side pockets, a few pairs of shorts, t-shirts and the essential swimwear!! It was rather trickier than expected getting out of the country as my 3 children barricaded the way through to security. I flew out of Glasgow on 20th March 2016 to Dublin to meet up with the Irish team who were going out to work alongside the church and be involved in feeding mission programmes. From here we flew to Dubai on a seven hour flight and then an 8 hour flight to Manila. We were now projected 8 hours into the future - who said time travel doesn't exist?! During these flights I must have managed a combined total of one hour sleep.

From Manila we flew to Calbayog in Samar. Eventually, after four flights, a bumpy bus journey and a dodgy boat trip we arrived in the island of San Antonio. Here were able to rest up before the dental mission began.

Previous visit to the Philippines

 In the year 2000, I planned a dental mission to the islands off Calbayog where the vast majority of islanders lived in a constant state of dental pain. I had connections out there through my church and my father who has worked with and supported the church there for 30 years. Funds were sent which were used to buy a boat, facilitating access to the islands and to buy pigs for their livelihood.

The majority of islanders live simple lives and have no means for electricity. They live in, what we would describe as, a state of poverty and are largely uneducated. Most of the inhabitants have never seen a dentist as there is no dental care available to them. Healthcare resources are limited on the mainland where dental and health services are given a low priority by the government. Typhoons, volcanoes and earthquake zones lead to conditions of poverty where 50% of the population live on $2/day.

The islanders had mouths full of rotten teeth, abcesses and facial swelling. Surprisingly I discovered bamboo shacks selling sweets and coke which, within a self sufficient island culture was the main reason for the decay. I grew immediately in love with these people and after experiencing this, as a life changing event for me, I’ve always had a desire to one day return and be life changing  for them, in a very basic dental way. 

The ‘Root’ of the Problem

Travelling along in the ‘bumpy bus’ I counted 20 sweet shops in half a mile! Everyone and their pet monkey (no joke) seemed to own a sweet shack. There seems an underlying misunderstanding and lack of knowledge regarding the effect of sugar on teeth. On the remote islands many appear to be superstitious about the cause of the dental problems and recurring pain they endured. Education programmes and the supply of oral care products are a very clear starting point to addressing the dental problem.

The Dental bit 2016

With The team in tow as willing helpers, we rose early at 6am each morning  for a 7am setup.

On the first day of the mission we arrived to an empty outdoor concrete space with a roof. It was already hot and stuffy. I quickly started to plan a flow of patients through from registration to discharge. After assembling 2 borrowed rickety tables and rapidly transforming them with large sterile drapes I set to work organising and coaching the team on set up, cross infection control, contamination risks, oral health education and so on. The amazing thing was that although I had planned to do this mainly unaided, I seemed to have accumulated 3 local nurses who willingly gave up some of their working days to aid the mission and other locals who were keen to help and be involved. I was now also rich in helpers from the team in Ireland and I was therefore enabled to set up a pretty slick operation which facilitated me to focus purely on the "toothectomies".

The first station was for registration. Blood pressure was recorded here by a nurse as well as their past medical history. They moved on to the next station of oral health education where we demonstrated tooth brushing technique. Toothpaste and toothbrush were distributed to every patient. Next they waited, with extraordinary joy, to see me for examination and tooth removal. Five clinical points were set up with five chairs along a table. Two people assisted me here supporting the patients head, turning around dirty instruments, and re-setting new sterile drapes and instruments. I had a line of 5 clinical points with instruments set up at any one time and continually reset, for efficiency. Then they moved along to the postoperative station where they were given verbal instructions in tagalog and an information poster to read whilst they waited to be checked and discharged with antibiotics and analgesics as required.

The dirty instruments were washed, dried and placed into the sterilizer and so were turned around in good time for reuse. I had brought plenty with me!

I will never forget the first lady who registered on the first day. A glance into the oral world of the Filipinos was an image that, I imagine, will stay will me! This lovely calm, smiling lady had a look of relief from the moment she sat in the chair. Sadly, everything beyond the smiling incisors and canines was grossly carious to the roots and many were broken down and abscessed. Yes, the math is correct, she required twelve extractions! Unfortunately her mouth reflected the serious extent of oral health problems exhibited in so many others whom I treated

The word spread like wild fire and when I looked up – which I tried not to do! – there were crowds of people waiting to be seen. Mothers, children grandparents, teenagers…. I saw nearly 30 patients that day. I was determined to get through as many as physically possible. Although, after working outside in the 40 degree heat of day we weren't a pretty sight.

Other days we went to the villages in the mountains. This was amazing! I was waiting for King Kong to appear from the between the countless coconut trees splayed across the mountainous jungle.

Typically there was an outdoor arena with a concrete platform in each village – so of course I was escorted to the platform - where I felt I was centre stage performing surgery. The whole village looked on intently, almost as if it was entertainment not dissimilar to the historical ‘surgical theatre’.

There was a great atmosphere in the villages, it seemed like a real ’event’ for them. They have no means of access to dental aid of any kind being so remote. The children swarmed around the other team members as they played basketball with them and dramatized famous stories. I had brought and photocopied letters from the children in Aberfeldy’s Sunday club and the team were able to read and distribute the letters along with toothbrushes, toothpastes and stickers. They were so delighted, like all their christmases had come at once.

The days were hard work but incredibly successful. The team were fabulous and spirits were kept high. During this time hundreds of problematic diseased teeth were removed. We came away with an incredible feeling of bonding together and a sense of fulfillment that together we had impacted those patients on a personal level and may have made a mere dimple in the dental need.

After the long hot days working had ended we were often taken to cool off at waterfalls, freshwater pools and oddly – natural hot springs. The extraordinary beauty is hard to capture in  photographs.

In many of our experiences there is often one in particular one which stands out. For me, it was a beautiful 10 year old girl. Maybe it was because she was the same age as my own daughter as her dental disease wasn’t any worse than the average patient here. Upon examination her front 4 upper incisors were painful and grossly decayed. She asked for them to all be removed. It seemed so drastic, to render her permanent spaces in her smile. The realization that that child has no other option or alternative which is available and affordable to her. The understanding of how this will affect her speech, singing, biting and quite possibly her self confidence is saddening. This only exemplifies the belief that a short term dental mission to treat acute problems is far from an answer to the difficulties these people face. It needs to be turned around from the grass roots upwards. Oral health education and training, dietary education and the cause of dental disease all need to be addressed as well as setting up some sort of permanent dental outreach centre with a mobile unit which can reach the small islands and villages. So…. Once I catch a breath these are the things which are churning away. I have left the case of dental instruments with trusted friends in the Philippines thereby committing to the hope that I can again one day be blessed enough to return to these amazingly joyful and contented beautiful people. That being said, I am in no rush to go as a single dental practitioner again. So in closing let this be an invitation to YOU!! 

Deborah Hannigan