Dr. Nowland: AKA, "Dental MacGyver"
"Are you up?"
"Why wouldn’t she be? It’s 11:25 in the morning! Oh wait, its 11:25 AM where I am standing in Lubero, DRC. That means it’s 2:25 am in Colorado. Oh well, my text will likely go unanswered for a few hours.
“I am” comes back quickly. I wonder why, but assume it has something to do with one of our small children that generally precludes her from a restful nights sleep.
I then further intrude on her early morning and select the button to call. The whole process amazes me. I am standing in the corner of a small poorly lit exam room in a hospital built by the Belgians in 1925 in a remote village in the Virunga Mountains of eastern Congo and I have no trouble reaching my wife, a dentist, who is lying in bed in the middle of the night in Colorado. In a place with no running water and only rare electricity - generally by solar or generator - I have excellent cell service.
“Hey, I am seeing a 7 year old male with a broken and abscessed tooth. Do you think I should pull it?”
“Sure! Have you done that before? Do you have the right tools?”
“No - never done it. Not sure on the tools - doubtful though. I drained a large abscess a few hours ago, so I know there is lidocaine and that there are some instruments available. There is surely something that will work.”
“OK. Have you ever blocked a lower tooth?”
“Sure! I’ve done lots of shots in the mouth for trauma.”
“The condition can be tough to get to, and you will need an elevator.”
“Sure...OK, I’ll see what I can figure out. Thank you! Sleep well!”
The 7 year old is in obvious pain, but stoic. He has traveled to the relative safety of Lubero with his mother and siblings in order to escape the violence occurring only 10 kilometers to our south. He has had tooth pain for a while. This is never good and can result in a host of medical issues - issues that can worsen quickly and severely in a displaced child, and in a resource-limited environment. The top of the tooth has recently broken away and an abscess is protruding from below. He needs the tooth extracted and there is no where close where this can safely be done.
Global Refuge started providing care in the area just a few days before. There are no other outside groups working here. The violence is too close and the situation too unstable for others to come. Displaced people continue to arrive from the south. This has overwhelmed the limited medical care in Lubero. Global Refuge plans to stay in the here until the situation stabilizes and the displaced people can safely return home. This could be several months or more. There is a UN base in Lubero, so we hope that the violence will not spread further in our direction.
Along with an interpreter, I set off to find the supplies that we might need to accomplish the extraction. A room to work and local anesthesia were easy to locate, but there were no sterile instruments. No problem. It’s early in the day. I asked, could we get them sterilized by this afternoon? I was told it would take longer than that. The autoclave runs on kerosene and generally takes some time to complete the sterilization process. So, we started the young man on antibiotics and made a plan for him to return in the morning. This would allow me to chat with my wife a bit more - generally a good thing.
This is the first trip that my wife and I have been able to have communicate consistently. Global Refuge generally works in remote regions near or in conflict zones, so communication is often sketchy. This time we have had fairly consistent cell coverage in Butembo and Lubero. This certainly helps keep us connected and helps my whole family be involved in the trip. It’s really fun to send pictures of crazy things I have seen to our older children and hear their reactions. It’s also fun to hear about conversations my wife has had with our two little ones. Like after seeing a picture of me sharing her otoscope with a small child at our clinic in Lubero, our 3 year old daughter declared that she “wanted to go to Africa!” "To help kids feel better?" “No mommy...to eat bananas!” She had apparently heard us talking about how bananas were a part of every meal and was jealous.
When we returned to the hospital in Lubero the next morning, I was happy to find several trays of sterilized instruments. I carefully searched for something that at least looked like a tooth elevator. My wife had sent me a picture the night before, so I at least had some idea. She had also talked me through the procedure in detail, so I felt ready. My assistant, who was aptly named Kandu, readied the room.
A very brave young man arrived with his mother shortly after our team and we went to work right away. I did my best to place a block - very thankful for the instructions I had received from home. With fair anesthesia and more courage than most, he allowed me to proceed. I’m sure it took me longer than any dentist, but the tooth was finally free and the young man free of the source of his pain and infection. Praise God for my beautiful spouse who was willing to answer the phone at 2:30 am and to give me detailed instructions on how to proceed.
Even though she was 8500 miles away, she made a significant contribution. I’m truly thankful for her and for all of those who choose to contribute to the work that Global Refuge undertakes.
“Got it” was the message sent along several grisly pictures of an infected tooth. I also sent a picture of the instrument I used to elevate the tooth. I’m not sure of its usual purpose. It was not an elevator and there was only one in all the instruments, but it worked.
“What was your plan if you didn’t get it?” my wife asked once the procedure was completed.
“Umm...to call you back.”
In this part of the world with limited resources, there often isn’t a second option. Without help from outside groups, the suffering goes unchecked.