Last Week's Recap

On Wednesday last week, Nuala, the program director at NMMU, set up a time for me to follow a local dentist (Dr. Piasha Pillay)! It was an amazing experience! She answered all my questions about the government’s plan to grant oral healthcare plans to everyone, regardless of income. Like I thought, this plan has been a dream for the last 15 years and to date no one has seen any signs of actually implementing it.  I didn’t really know what to expect since most people in South Africa do not go to the dentist; they see oral hygiene as a luxury and would rather feed their families then seek preventative oral care. For instance, where I am volunteering at Missionville, a worker had a toothache and went into the bathroom and just pulled his own tooth out..done..fixed he said.  WOW! Many people do not have teeth because they remove them when they hurt; I guess similar to a hangnail for us!  

So back to Dr. Piasha and her patients.  We saw three patients. Three…that is it.  Only one was on the books and two were walk-ins.  The first lady got fit for dentures, cost about $100 US dollars. The other two patients came in willingly to have a molar removed due to pain. It was funny because prior to them coming in, I asked Dr. Piasha about pulling the teeth vs. fillings.  She said that she would rather fill them; in fact, she said she tries her best to persuade them to allow her to fill the teeth because having them removed decreases their quality of life because it hinders their ability to chew and eat certain foods.  No sooner after she said this lady (35 years) came in, wanting her molar removed. Dr. Piasha asked her to sit down, she numbed the area ONCE!!! And then took this tool that looked like pliers and just yanked the tooth out of her mouth (patient cost, around $40 US dollars).  The lady clutched onto the exam chair and tears streamed down her face. It was a brutal experience for her and for me to watch her in such agony.  Dr. Piasha placed cotton in the area where the tooth was removed and told her to bite down until it stops bleeding (which may take an hour). No stitches. Then she rambled off a bunch of instructions about eating, rinsing, and cleaning the site. The lady didn’t hear a word she said because she was in so much pain.  The entire time this is going on, I keep thinking, “oh my goodness! What a mess! No wonder people come to the dentist in South Africa! If they come in, their experience is terrible and they don’t come back; or they hear these stories from those who have and then they never seek care because of it.”  The lady left and then a man (30 years) came in for the same thing.  Again, Dr. Piasha, didn’t do what she told me about persuading them to fill the tooth, rather than pulling it.  She just numbed him once, and began to pull the tooth.  The man stopped her and said he was going to be sick, he was so nervous! He ran to the bathroom, got sick, regrouped and then returned.  He had heard stories from friends/family about the pain. She told him to settle down and to relax. I told him to take a few deep breaths, and he looked at me and said, “really, yeah right!” He knew what was coming.  When she began, his legs dangled in the air and he put nail marks in the arm rests. True pain! Again, Dr. Piasha rambled off some important home-care instructions (which he didn’t pay attention to) and then told him he could leave.  

After seeing this twice now, I asked her about what she said about pulling vs. filling. She told me that those were “too decayed and calcified”, which they appeared to be because they were about the twice the size of a healthy molar. Sill, in my opinion, educating them on why she has to pull vs. fill the tooth may prompt a cue to action to take better care of your teeth.  I also asked about a helpful take away sheet with information about what to do to clean the site after leaving the office, maybe something that lists how they should take care of the incision site. She said, “if they don’t listen, it’s their problem!” Then my next question, what about infection? Do many patients get infected because they don’t take proper care of the site? She said, absolutely and many people get very sick and develop infected gums. She also told me that most of her patients don’t return for a follow-up because they don’t want to find out they need more treatment done. It was a shame to see what happens here, granted it was only one dentist, I have a feeling this is how it is across the board. She asked me about the prices of care and dental insurance, as well as procedures in the States. I was honest and told her that none of what just happened today would happen back home.  Before treatments, typically we are numbed more than once, and although treatment isn’t very desirable, the initial procedure isn’t as painful as it appears to be here; that pulling a tooth is rare in someone under the age of 50; procedures are a bit more costly in the States and not everyone has dental insurance, so many do pay out of pocket like in South Africa; and many dentists give their patients typed instructions before they leave so that they have something to refer back to once they get home.  

Needless to say, if I had even slight tooth pain while here, I would grin and bear it until arriving in the US.  It was a great experience and helps me make sense of my data that I’ve collected for my dissertation.  Many people noted that they do not seek care at the dentist because of pain. They have either heard stories from others or had bad past experiences at the dentist. I offered Dr. Piasha the suggestion of providing patients with an informative sheet after a procedure, but I don’t suspect that she will actually implement it. Shame.

So, the dentist experience was informative and beneficial to understand the culture and care here in South Africa.  After that, I flew to Druban, South Africa! Durban is where the South African’s vacation to (similar to our Florida or California).  Durban is on the cost and is warm all year long! Perfect for this freezing lady! I traveled with Kayla, Chrissy, and Sheila. We spent four days there soaking up the sun (still too chilly to get in the ocean), shopping, exploring another South African City, and visiting our program director's mother and family whom live in Durban. Kayla and I went on a safari (see photos) and had a blast! We were the only ones on our open-air tour truck! We had a blast and found it very hard to return to the fidget cold Port Elizabeth.