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Western quality in the jungle / PVNF’s dental team is committed to children in remote regions of Vietnam

By Keith Cousins / Photography: Lucio VillaClick any image to see slideshow.

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The process is quick. Pre-screening takes no more than a minute using a small LED flashlight. A stamp is used to mark extraction or filling. If the teeth are fine, the patient gets a “Dental OK” stamp, and proceeds directly to the gift area – where they are given a bag with a toothbrush, toothpaste, notebooks and some candy.

It is always a race against the clock. Too many patients, not enough time.

As the haze settles in for the day, a truck drives through winding dirt roads and arrives at the village of Nà Phặc in the province of Bac Kan. Tom Tran, a retired aerospace engineer, begins yelling orders for the unloading process. An assembly line unpacks dental instruments, sterilization equipment and additional medical supplies. Two volunteers remove a generator. In less than an hour, the Project Vietnam Foundation sets up a Westernized dental clinic six hours north of Hanoi.

Founded by Dr. Quynh and Chan Kieu in 1996, PVNF is a non-profit organization that provides medical assistance in Vietnam.

Tran and his wife Catherine Pham, a dentist, heard about Orange County-based PVNF and in 2005 joined the organization to provide dental care. Pham’s sister Bich Le, also a dentist, and her husband Thanh Tran, an electric engineer and Tom’s brother, also accompany team along with other volunteers.

“I started from nothing to the point that I was able to support my family and a little more than that - so I decided to give back some,” Tran said. “To me, the most important way to give back is to give back to the poor people back in Vietnam.”

A shot of anesthetic is administered prior to extracting a tooth.A shot of anesthetic is administered prior to extracting a tooth.

Tran, a refugee of the Vietnam War, came to America in 1975. Starting out mopping bathrooms at Burger King, he worked his way up and became a successful engineer. The chance to remake his life after the war is one Tran is forever thankful for. Unaware of the expectations for their first mission with PVNF, the then small dental team went to Vietnam expecting to treat 250 children in a week. Upon arrival however, the team saw just how much their services were needed.

“The need was so, so, so big here that we hunkered down and on the first mission we worked (on) around 600 to 700 kids,” Tran said.

After the first mission, the team’s primary focus was on organization and improving the number of patients they could see. For six consecutive years, the team has served around 2,000 children each mission.

“We are all professionals in America,” Tran said, while moving dental instruments from a chlorine dioxide bath into a pressure cooker where the instruments will steam at 125 degrees Celsius. “Instead of having to think a lot about it, we make plans as if we are making plans at work. We follow the plan and improve the plan every year. “

The dental team’s mission in 2011 was no exception. Working with no power or running water, Tran proudly said they were able to provide “American quality in the jungle.”

The Assembly Line

Thanh Mia, in the Bac Kan province is a remote village seemingly cut out of mountainous jungle. On March 8, the PVNF team sets up at a middle school surrounded by jungle on the edge of town. A power generator rumbles as hundreds of children wait anxiously in line to see the PVNF dental team.

Roger Lutz, an engineer who serves as technical support for the team, gives the go ahead to the dentists after double-checking the power supply.

Roger Lutz takes tally of both the days patients and the days procedures at a school in Vinh Phuc. The PVNF dental team saw 1100 children over the course of a week.Roger Lutz takes tally of both the days patients and the days procedures at a school in Vinh Phuc. The PVNF dental team saw 1100 children over the course of a week.

“We’re cooking,” Lutz said. “The kids are smiling, at least when they come in.”

The process is quick. Pre-screening takes no more than a minute using a small LED flashlight. A stamp is used to mark extraction or filling.

If the teeth are fine, the patient gets a “Dental OK” stamp, and proceeds directly to the gift area – where they are given a bag with a toothbrush, toothpaste, notebooks and some candy.

It is always a race against the clock. Too many patients, not enough time.

First time volunteer, Robert Dinh, a practicing dentist of 12 years in West Covina, said, “ it’s not like we can schedule these patients tomorrow.”

With that in mind, the dentists focus on both the top and bottom first molar. These teeth usually come in when a child is around six and are critical to eating.

“The teeth we do focus on, if we don’t save those teeth and they get rotten and come out – there is not another tooth that comes out to replace that,” Dinh said. “We usually focus on teeth that are going to last them a lifetime.”

Children hold onto slips of paper throughout the procedure. This slip lets the team know how many fillings and extractions were done. It is also the only visible sign the children display of discomfort throughout the process. There is no kicking and screaming. No crying. The only indications of pain are the crumbled patient slips that are handed to Lutz.

The generator rumbles on as the team works through the day, only taking an hour break for lunch. In the course of their time in Thanh Mia the team sees 292 patients. Some 492 fillings and 82 extractions were preformed.

While working as a dental assistant in Orange County with Dr. Catherine Pham, Brian Loc Nguyen, 26, was compelled to join work side by side with his dentist and the rest of the PVNF team. The result was also a homecoming 19 years in the making.

Brian’s Story

With no power, PVNF's dental team relies on a generatorWith no electrical power, the team brings its own generator.

Prior to 2010, Vietnam was simply flashes of childhood memories for Nguyen. He did not remember anything concrete. Sometimes it was images of a rickshaw driver pedaling passengers to their destinations on run-down roads in Ho Chi Minh City. He was only seven when his immediate family immigrated to America as a result of the UN Orderly Departure Program. But 2010 changed things for the dental assistant. Urged by the example of Dr. Pham’s work with the dental team, Nguyen made the decision to return to Vietnam and participate in the medical mission.

“I figured, lets just go for it and see what the project is like,” Nguyen said. “I would get to explore my country, but I was there to help my dentist – that was my goal.”

Nguyen has worked as a dental assistant for Dr. Pham for close to three years. In April, he will take two months off the full time job to study before he takes the first step in reaching his goal of becoming a dentist – completing the Dental Admission Test and applying to dental school.

“At first I didn’t want to be a dentist ... (then) I worked at her office and being a dentist is very stressful – but it gives you the opportunity to socialize with your patients on a very personal level,” Nguyen said. “I really liked that, I feel like going to work everyday is having a party.”

Working in remote regions of Vietnam is similar to the work Nguyen performs in Orange County, but with the unexpected thrown in. A constant stream of patients waiting for what is likely their first time seeing a dentist increases the pace of his work. Sacrifices are made.

Over the course of four days, 255 teeth were extracted by the PVNF dental team.	Over the course of four days, 255 teeth were extracted by the PVNF dental team.

“You make your consultation very fast and then you just treat the most severe of the areas,” Nguyen said. “You can’t treat all of them, so you have to pick and choose a certain area and go with that.”

In place of the patient interaction found in the United States there is focus. Nguyen said that in order to be successful on the mission, each member had to focus on one thing and do that thing well.

In 2011, the one thing Nguyen focused on was amalgam – the mercury solution that is shaken rapidly in a machine to make material for fillings. The task is essential to maintaining the fast pace of the dental team.

“Last year, I was assisting and sometimes we had to wait a long time because people weren’t paying attention,” Nguyen said. “The efficiency dropped because the amalgam wasn’t being mixed fast enough.

But this year, when the dentist say ‘mix’ or ‘more’, I run to it right away.”

Nguyen compared the labor-intensive work the dentist’s perform in Vietnam to running laps on a track. There is always the one lap after many where fatigue sets in. The lap that makes the runner want to give up. But for Nguyen, that is the time to push. To overcome the tired feelings and move forward, until all of the patients are seen.

Often, it is the thought of PVNF’s unique opportunity to serve in the rural areas of Vietnam that keeps him moving. The thought that children come to them for what will likely be the first and last dental examination of their lives.

“No one is going to try to go up to these locations,” Nguyen said. “To have the opportunity to go to parts of Vietnam and go to these areas – it’s pretty special, you are helping kids who are completely isolated.”

When the mission concludes, Nguyen will once again spend an extra week in Vietnam, visiting his large extended family that still resides in Ho Chi Minh City and surrounding areas. It isn’t the Ho Chi Minh of his limited childhood memories. Motorbikes have replaced rickshaws and the streets are more crowded. But for Nguyen it’s not about seeing the city of his childhood, it’s about reconnecting with his bloodline.

“To see them again and talk to them, to see their personalities – it really connected me to my heritage,” Nguyen said.

Nguyen is not only discovering his heritage as a result of his participation with PVNF, he is building much needed experience in the field to succeed in his ultimate goal of becoming a dentist – but his number one priority is aiding his dentist.

“For now, my main goal and function is to help my dentist,” Nguyen said. “That’s my main goal.”

Achieving his goal also enables the dental team to achieve their ultimate goal of providing care to the countless children in remote areas who have all but been forgotten.

A Numbers Game

'You spend one day here, we treat as many patients as we can and then it’s off to another city," Dinh said. "Some of the people that aren’t seen will probably never see another dentist or physician for a while, unless another project comes along. It’s pretty sad to see that.""You spend one day here, we treat as many patients as we can and then it’s off to another city,” first-time volunteer Robert Dinh said. “Some of the people that aren’t seen will probably never see another dentist or physician for a while, unless another project comes along."

Each morning after setting up their workstations, a line of children awaits Project Vietnam dentists. They laugh and giggle, while they squeeze as close to the entrance as possible. The scene repeats after lunch, and then daily for the course of the week. When facing a need of this magnitude, efficiency and speed are key.

In order to see as many patients as possible, the dental team makes plans to ensure success for each day in the field.

“It’s always very dynamic situations when we go to places where we don’t have 100 percent control,” Tran said. “As an engineer, when we setup the plan we always go for the worst case. We always have plan A, plan B, and maybe plan C in there too.”

As early as January, Tran begins to plan in order to ensure everything will be in place for the March trip.

Although, according to Nguyen, all the planning causes a great deal of stress to Tran – the end result is being able to respond to the unexpected.

“It’s always smooth,” Nguyen said.

Over the course of five days, 1100 children lined up to be seen and received care from the Dental Team. Every single child got at least a dental examination.

Cavities were drilled away and teeth were filled in 1371 mouths – 255 teeth were removed. Due to time restrictions, 275 dental packets were given to children who were unable to be seen by the team.

Although speed and efficiency enables the dental team to see the maximum number of patients, the team is only at a given location for one day during the mission.

Burning the trash at the end of the dayThe team burns the waste at the end of the work day.

“You spend one day here, we treat as many patients as we can and then it’s off to another city,” Dinh said. “Some of the people that aren’t seen will probably never see another dentist or physician for a while, unless another project comes along. It’s pretty sad to see that.”

The Pay-Off

At the end of each day a hole, two feet deep and four feet across, is dug in the tan jungle floor.

Sometimes a local volunteer does the digging, other times it’s a group of PVNF volunteers. Water bottles partially filled with gasoline from the generator are placed in the hole with used needles, medical garbage and other debris from the days work.

The pile is then lit on fire. Burned in order to prevent locals from trying to reuse the potentially harmful waste. As pungent black smoke trails off into the evening sky, the dental team loads the truck and leaves nothing behind.

“It’s an adventure,” Nguyen said. “You work your butt off, but at the end of the day you are going to feel like you didn’t waste your time.”