Final Bittersweet days in Cambodia

After a fantastic break in Siem Reap, everyone returned to Phnom Penh ready to complete the last week of clinic to the best of their ability. With only two days remaining at the PIO school and with many students feeling unwell or run down, we really had to come together as a team to complete as many students as possible in our short time. At the completion of our week at PIO, we had seen over 280 students.

It was incredible to see the fantastic effects of SDF (silver fluoride) during this time, with the students who were in year 3 or above, having minimal caries and evident areas of arrested caries as a result of their six monthly fluoride applications and regular screening. It was so encouraging to see that the efforts of the One2One charitable trust and Dr. Bethy’s PhD research was really benefiting the children in this area and those attending PIO.

To complete our placement at the school, each child was provided with a toothbrush, a tube of toothpaste and a bar of soap. As we handed these out through several classes, the children were overjoyed to be receiving something that they could call their own. It was a sad goodbye on this day, as we had all began really enjoying visiting the beautiful children who attended PIO.

The following day we began our three-day rural placement. Once again the Phnom Penh traffic was a huge shock to us, as it took 2 hours to travel just 40kms to ‘Le Refuge’ in Oudong. 

The bus arrived at a beautiful garden, where children were playing on the grass or on the playground. We were greeted by Dr Saram, the founder of ‘Le Refuge’, who gave us a tour and explained to us how the place began. Dr Saram lost his wife and children during the Khmer Rouge genocide in the 80’s, he was shot in the neck as he made his escape to the Thailand border. He miraculously survived and migrated to France, where he studied to become a heart surgeon. After living in France for some time, Dr Saram returned to his home nation to give back to his people. He moved to Phnom Penh and started working in a hospital, before noticing that many of his patients were from the region of Oudong. This motivated him to open an out-patient clinic in Oudong, so his patients did not have to stay in Phnom Penh far away from their families and homes during their recovery time.

With funding from his friends and colleagues in France, he continued expanding ‘Le Refuge’ to house up to 25 children who did not have parents or whose parents had moved for work. He provides these children with shelter, clothing, education and food. He also provides every child in Oudong lunch three times a week. 

Through the ten years of ‘Le Refuge’ it had expanded to also include a dental clinic and optometry clinic. As dentists from Phnom Penh only regularly visit on weekends to volunteer at ‘Le Refuge’ the children were rarely seen, as they would be working or helping their parents. Dr Saram’s story was truly inspirational, and we all felt motivated to see the children of Oudong as they had no access to dental care.

The next three days we screened 80 children at ‘Le Refuge’, providing fluoride applications and fissure sealants. It was quite challenging, with so many children to see in only three days, we really had to come together as a team to practice efficiently in this fast paced clinic with minimal supplies. 

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Days were long, having 11 hour days from the time we would leave the hotel to the time we would return home, and our energy levels were running low, however our motivation was high. Knowing these children’s access to care was rare, we all came together to help each other and work harder when students were unwell. It did become overwhelming at stages, when we couldn’t address the child’s immediate needs, such as pain. With the healing process being delayed due to the humidity, deciduous teeth would not be extracted unless it was necessary. While also focusing on long term preventive treatment, it did not provide us with that immediate reward. However, having applied over 200 fissure sealants and fluoride applications at Oudong, it was reassuring to know that we potentially saved 100’s of permanent teeth for the children in this area. 

After our final day at Oudong on Friday, we travelled to our Farewell dinner at FCC, a beautiful restaurant overlooking the Tonlé Sap and Mekong rivers. We shared a three course meal with three of the dental students that helped us throughout our Antipodeans placement and with our in-country partner Linda. We all exchanged gifts during our meals and exchanged stories of our experiences throughout the two and a half weeks together. It was a fantastic evening and a bittersweet end to an amazing trip.

We were all excited to head home to our families and friends but we were also very upset that the amazing experience was coming to an end. It was reassuring to know that we accomplished so much in our time in Cambodia and made a difference to almost 400 children’s lives. 18 days had flown past so quickly but it was incredible how many experiences we squeezed into our short time in Cambodia.
   

Welcome to Cambodia! Oral health placement

Walking out of the Phnom Penh International Airport at 6:30pm, a gush of 29°C heat and humidity swept over us! ‘Welcome to Cambodia’ our tour guide said as we climbed on the bus.

As we began our slow journey, the incredible amount of vehicles, scooters and tuk-tuks on the roads was overwhelming. There are so many vehicles on Phnom Penh roads that a 10km trip from the airport to our hotel took us an hour! During this trip, our tour guide explained the culture and surroundings of Phnom Penh, she explained just how poor so many Cambodians are, with the average person surviving on only $1 a day. As we arrived to our home for the next 18 days and most of us were feeling quite miserable about the circumstances of the people here, feeling as though there wasn’t much hope. 

  

The following morning, we visited ‘Friends International’ a Non-Government Organisation (NGO) that is involved in keeping children safe and encouraging education and business within Cambodia, and preventing young and old from being involved in begging, drugs, sex trafficking and homelessness. It also supports businesses that hire marginalized youth and encourage education and employment within this sub-population. 

They provided us with an educational seminar on the ‘Child Safe Movement’ and how to prevent tourism that encourages the abuse of children. We then visited the public and private dental universities of Phnom Penh. It was incredible to see how similar both universities were to home! It was impressive to see how thorough the courses are in Cambodia. Both private and public universities had a dental clinic where the public could come receive dental treatment pricing from $1. The students also have the option to provide free treatment to individuals who seem incredibly poor and require treatment.

We all felt a lot more hope after this day, seeing how many NGO’s and individuals are motivated to encourage healthy safe environments for children and to encourage safe work for everyone within the community. The Universities provided hope, seeing how dedicated and motivated students were to make a change in their community and provide incredible, vital care in their home town. 

 The third day we had tours of the Palace, the genocide museum and the killing fields. This day was emotionally draining for everyone on the trip. It’s truly heartbreaking to see how much the people of Cambodia have faced with throughout the past 50 years, and how difficult it has been to rebuild from this. With so many fundamental issues still not having been resolved within the community, it seems difficult to address dental concerns.

Access to electricity, access to clean water, basic personal hygiene, rubbish collection and public bins are still not available throughout the whole of Cambodia. Issues such as water fluoridation and tooth brushing cannot be solved when basic human needs have not been met for everyone. On our tuk-tuk home, a few of us were waving to a child who was in the car next to us. When the cute boy broke into laughter, all his upper front teeth had decay.

This was quite a shock to us at the time as this would be a rare sight in Australia. However for a child in Cambodia, by the age of 6 the average DMFT score is 9. This means that on average, by the age of 6 a child will have 9 decayed, missing or filled teeth, being almost half the teeth that they would have by this age. 

We spent the next four days at PIO (People Improvement Organisation) School that was built along a rubbish dump to support families and educate children in this area, who had turned to picking rubbish out of the dump to support themselves. In conjunction with One2One Charitable Trust, we were providing silver diamond fluoride (SDF) to the deep pits and fissures of every child within the school, while also providing ART restorations and fissure seals to high risk patients.

There are 500 children within the school that require their 6 monthly SDF application, and we are trying to get through as many as we can within our 6 days at this clinic. Having four make-shift dental chairs, using tables and chairs to create our own clinic, it was quite demanding. With no triplex, suction, light or access to all our usual equipment or materials, working within these conditions really encourages team work and being versatile.

Making our own cotton pellets from cotton balls, creating our own autoclave with a pressure cooker for sterilising, manually writing down computer notes before entering them into the computer as quick as we can with the slow Wi-Fi access, working in teams of three with one person holding the flash-light and using bins for spit buckets are only a few of the changes to our usual luxurious dental clinics. Being within these clinics really makes you appreciate just how privileged we are, and after day one we were all wishing we had our dental chairs with suction and the triplex back!  

The children, however, make every hot day rewarding, and their beautiful personalities motivated us to complete each day. By the end of the week we were all ready for our three day trip to Siem Reap to explore more of Cambodia’s history.