Friday, June 6, 2008

By Jennifer D. Foster

For five days in February 2008, Dr. Jack Cottrell and his Feed the Children Canada comrades gave nearly 500 children and adults something to smile about.

On a temperate afternoon in late February, 6,500 feet up in the mountains of the Saxsuy community of Guatemala City, Dr. Jack Cottrell bent over the febrile, dehydrated body of tiny three-year-old Ingrid. Travelling five miles on foot with her grandmother, Ingrid, who had never seen a dentist, was expressionless as the bright operatory light revealed 20 primary teeth completely decimated by dental caries and abscesses. After Dr. Cottrell removed two of her teeth, she was rehydrated, given antibiotics and taken to a local hospital to com­plete her treatment.

“I always wanted to give back — to help people,” says 58-year-old Jack Cottrell, who has lived and worked in Port Perry, Ont., for the past 33 years. He is co-partner of a thriving full-service clinic, which boasts eight dentists and 10 hygienists. An ODA member (and president for 1997-98) and a CDA member (and president for 2005-06), Dr. Cottrell’s impressive list of credentials includes being chair of the North American Regional Organ­ization of Dentistry, a fellow of the In­ternational College of Dentists and the Pierre Fauchard Academy and re­cipient of many honours and awards.

In Guatemala City, the boyishly handsome dentist’s dream to help the less fortunate became reality, as he, his wife Michelle, a dental assistant and the co-ordinator of the preven­tive dental program in his practice, along with the entire team from Feed the Children (FTC) Canada provided primary health and dental care for people in desperate need for one week in February.

Dr. Cottrell first became involved with FTC Canada via FTC Canada’s medical advisor, Dr. Tony Brown. Early in 2006 Dr. Brown, a family physician and anesthetist, returned from a dental mission to Honduras. Saddened that the three American dentists and three assistants could only perform extractions (they had no compressor or power source), he approached Dr. Cottrell upon his re­turn. “Jack is an extremely skilled dentist with superb technical skills and a fabulous bedside manner. And he’s probably the most energetic indi­vidual I’ve worked with, so that’s why I asked him to help out,” recalls Dr. Brown. Dr. Cottrell rose to the chal­lenge of providing free, mobile, first-class oral-health care abroad, envisioning clinics where teeth are re­paired and preventive dentistry is de rigueur. In the summer of 2007, Dr. Brown introduced Dr. Cottrell to FTC Canada president Ken Dick, and the rest is dental history.

In just five days in five different Guatemalan suburbs, Dr. Cottrell’s dental team — his wife Michelle (who monitored sterilization protocols and provided equipment maintenance), a local woman who’d assisted on previ­ous FTC Canada missions, a Spanish translator, a handful of Guatemalan dentists and a dentist from FTC El Sal­vador — treated nearly 500 children and adults. Dr. Cottrell and Michelle didn’t stop at all — even for lunch — during the long days. “Our feeling was, if you took 10 or 15 minutes, that was one less person we’d be able to see in the day,” he says. That sense of urgency was heightened daily by the armed police escort that shad­owed the team all day long, ensuring their safety and also preventing their pharmacy from being stolen by local bandits. Despite strict departure times, the team managed to squeeze in a few extra patients each day.

Patients received treatment in school classrooms that had become makeshift dental clinics, featuring state-of-the-art sterilization equip­ment, three to four portable dental chairs, dental drills and all the high-volume suction and high-powered lights critical for restorative work, bonding and extractions. The level of disease and decay they witnessed was catastrophic. “Everywhere we went we saw mouths at the end stage of dental disease. There was not one per­son who did not have something going on in their mouth,” says Dr. Cottrell.

And he attributes much of it to their diet. Soft drinks and tortilla chips — cariogenic food staples — are available at every corner store and are much cheaper than bottled water. Sugar cane, a primary export, is an­other daily foodstuff, eaten raw or made into a honey-like liquid and given to children in their bottles. Un­fortunately, many Guatemalans have never owned a toothbrush and have never been shown how to clean their teeth. “It’s not unlike what we had here in Canada and the U.S. 60 to 70 years ago,” says Dr. Cottrell. “People expected that they got to a certain point in their life, and they got all their teeth taken out — that was the norm.” But the natives “came to this clinic thinking they were having their teeth extracted, and some ended up getting restorative work, instead, which is really exciting,” says Dick.

Charity work is nothing new to Dr. Cottrell. From 1975 to 1981, he vol­unteered one or two nights per week at two different inner-city dental clin­ics in Toronto, treating immigrants, poor families, drug addicts and street people. He’s seen the effects of poverty firsthand on dental health and knows it’s a reality in any coun­try, “but when we take the neediest situation here, it doesn’t hold a can­dle to what exists in these types of countries,” says Dr. Cottrell, a father of four. “These people die from den­tal infections; they die from problems that would be unheard of to die from in our culture.” Dick concurs. “I wouldn’t think there’s an adult or child who could walk into any emer­gency department here in Canada and not be treated. Social services are here. There’s no transportation and no infrastructure in these other coun­tries. It’s pay before you get treated.” Why Central America? “It’s closer than Africa, so it’s less costly,” says Dick. “And we have Spanish transla­tors and an office with staff in Guatemala City, so that helps us with preparation.”

Dr. and Mrs. Cottrell’s first dental clinic experience with FTC Canada was so successful, they’re already booked for the next 2008 mission — Nicaragua in October. “We can hardly wait to go to Nicaragua, because we have now seen just a glimpse of the needs in these countries. We have found that we can make a huge dif­ference,” says Michelle Cottrell. And Dr. Brown is equally thrilled. “The Cottrells were very sensitive to the Guatemalans’ customs and practices. I was impressed with Dr. Cottrell’s bal­ance of sensitivity and his desire to teach new ways of doing things.”

And teaching and collaboration, says Dr. Cottrell, are the keys to all fu­ture dental missions. “My goal is to develop a comprehensive model of care — rather than a unilateral model of just extracting teeth — and teach the professionals how they can best use these preventive programs. I want to leave a legacy behind, where peo­ple learn how to look after themselves — that’s the key.”

What’s changed for Dr. Cottrell after this trip? “The need to get bigger faster,” he says. “There’s so much need, and it’s the urgency I sense now. It broke my heart to turn people away at the end of the day.” His solution is to train enough “sub-leaders” so that they can conduct myriad dental clin­ics annually, even without his pres­ence. Dr. Cottrell is also determined to introduce regular fluoride rinse programs at FTC feeding stations in all future missions.

Does Dr. Cottrell recommend other ODA members get involved? Without hesitation. “We live in a society of self-interest and self-indulgence, so it’s really an important part of our po­sition and our responsibility to give somebody a hand. The joy you get from seeing somebody appreciative, not even from the treatment, but from the fact you took the time to befriend them, warms your heart. You’re giving them hope. And that’s what it’s all about — hope for a better tomorrow.”

Reprinted with permission of the Ontario Dental Association and Ontario Dentist, 2008.

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