CMC - Day Fourteen

It is getting hotter by the day here in Vellore. I find myself wandering around outside in a bit of a daze, wondering what it could be that's making me feel so lethargic. It's the heat. Hot drinks are as good as cold for keeping one cool ('cause it makes you sweat) and i had a chai just now before seeking refuge in the library, with its cool pale aquamarine walls, its rows of flourescent bulbs and whirring fans. Ice cream is good in this heat. But when i bit into a frozen cone filled with chocolate icecream yesterday afternoon, i felt an ache, a sensitive pang, and it snapped me out of a growing denial. I've been having a tooth problem. Part of this denial is circumstantial. First time I came to India five years ago I saw something on the street that i'd never expected. On the occasional street corner, laid out on a dusty mat, one would find a "dentist," with his tooth extractors, some extracted teeth, some gold replacements, and no anesthetics. Yikes! Perhaps it's the first impression of dental care in India that has caused me to avoid seeking care for a "sensitivity" that i first noticed a few weeks ago. Ok, so i have saught dental care in India already. On the advice of an atypically enthusiastic English woman i met in Kerala, I sought out her dentist for a cleaning. She'd had gum transplants there on two occasions and was very pleased with the results. For 500 rupees (again, at 45Rs to the dollar), a teeth cleaning was a steal. I found myself in a somewhat dimly lit room with water- and mould-stained walls and took my place in a dental chair that was only slightly more antiquated than one i would find at home. I saw the autoclave and prayed that they used it. She, the dentist, pulled out a vibrating metal scraper, not the cleaner i was used to, and "cleaned" my teeth. It was at this time i noticed the sensitivity. I tried to hide my flinching smile whenever she passed over a certain bottom left tooth. When she asked, at the end, if i'd felt any sensitivity, I smiled and shook my head in a vigorous lie. I wasn't going to push it.

So over the past few weeks, with brushing, with cold water, i've pushed my dental dilemma out of my mind and imagined that I could take care of it when i get home. The problem is that it's just so expensive in America. You'd expect that medical students would be offered dental coverage, teeth being an important part of one's health, but no such thing exists. Not institutionally, at least. We do get (barely adequate) medical insurance. I wonder if it's the opposite for dental students. In any event, i've had to rely on my parents to cover my dental care - thanks mom and dad! As I get older, though, i feel more and more guilty about it. Last Christmas they bought me a fancy electric toothbrush, hoping, i imagine, that it might in some ways curb their dental expenditures. It was my favorite present, one i thought, given the current state of affairs, might have failed me. Seeing as how i'm in a relatively sophisticated Indian medical center i decided yesterday, after that provoking popsicle, to ask around for a recommended dentist. Dr. Mona immediately suggested Dr. Santosh Koshi. Having failed yesterday to arrange an appointment, i called this morning at 9:20 and was given an appointment at 9:30. I found my way to the dental outpatient clinic and encountered in the waiting room a rather compact, thin, and carefully dressed Dr. Santosh. I thanked him profusely for seeing me so quickly and, assuring me it was nothing, he quietly ushered me back to the a small cubicle and seated me in the dentists chair, this one no different from what i'd find at home. What we passed through on the way there seemed less a dental office than a dental factory. From three rows of cubicles i could hear the sounds of chisels, drills, and painful moans as the consequences of all that sugar consumption - Indians being the largest consumers of sugar in the world - were realized. Okay, so nobody was moaning. Young female dental hygeinists in clear plastic aprons shuffled about, room to room, delivering to hunched-over dentists sterilized instruments plucked with metal tongs from metal trays.

He sat me down, asked what my problem was, checked my teeth and noted that two of my fillings had fallen out. "Shall i schedule an appointment to have them fixed...i know you're very busy." "No, no no....we'll do it now." And so it was that not five minutes later i was staring, unanesthetized, at the sharp end of a dental drill bit. My fingers gripped the chair until they were drained of blood. Every muscle in my body was tensed. "Relax," he said. And he started to drill: whiirrrrrrrrrrrrrrrrrrrrrrrrrr.

And it didn't hurt. Not one bit. Dr. Santosh knew exactly what he was doing and as he drilled away at the bits he wanted to get out of the way, i wondered if, after all these years, my trips home from the dentist with a numb, asymmetrical feeling lip was really necessary. Mind you, i'm not going to ask them to withhold the anesthesia next time, but i wonder. He repaired my fillings within 10 minutes. "That's it," he said. "You're free to go." I asked him where i could pay. He said i needn't worry about it. I said i felt bad, so many people couldn't afford to pay but did. He said not to worry about it. I think that fixing the fillings was easier for him than explaining to me how to become an official patient at CMC. Most people have to figure it out on their own. So, in the end, i had excellent and free dental care in India. And i can highly recommend it to each of you.

I had a meeting yesterday with a Family Medicine doctor from Tufts, in Boston, Wayne Altman. He's here for a three day conference on starting Family Medicine as a specialty in India. I made a gaff at one point and said Family Practice. He corrected me: "It's family medicine. We're no longer practicing; we're good at what we do." It's a marketing decision made by the American Association of Family Practitioners (AAFP) last year. As an aside, how twisted that, in our health care system, different specialities have to make marketing decisions. Currently there are Family Medicine doctors in India. A handful of them. They get their qualification not through a residency, but through something like a fellowship. Dr. Altman (or Dr. Wayne, here) has been working with CMC to start a residency in Family Medicine, as well as a department in the undergraduate school. It would be the first of its kind in India. "For CMC to start a program like this," he said, "would be like Harvard Medical School starting a new department. Others could be expected to follow." Primary care is so desperately needed here and such a development would be, the conference concluded, a wonderful way to improve the overall health of Indians. With a residency program and a regular turnout of well trained family physicians, one could imagine the development of more community health centers, efficiently run by those who can care for adults, children and labouring mothers.

It also might help to deliver vital preventative medicine. I heard on CNN-IBN (India Broadcast News) this morning a report on Indians and heart disease. Indians have four times the risk of developing heart disease than any other race. Thirty percent of the cardiac patients in India are under 35 years of age. This is pretty shocking. Many speculate that this is due to a phenomenon called famine theory, or thrifty gene theory. Basically, a race adapted to famine develops a certain amount of insulin resistance. Fats and cholesterols were more easily stored in case food was not forthcoming. With a change in lifestyle, a secure food supply, and much of it rich in fats, this is a setup for heart disease. This is a growing health problem for India to contend with and better public health delivered by family physicians might be one part of the solution.

I don't want to think about fat foods anymore. I just had some delicious pistachio ice cream...and my teeth felt great!

justin