No need to worry

 

 

adult ambulance care clinic

 

While I was studying to become a dentist, I took advantage of an optional fortnight shadowing anaesthetists. It was not a hands-on experience, but it was totally fascinating watching anaesthetists keeping patients healthy whilst they were deeply anaesthetised.

One day during a morning coffee break, I was sitting having refreshments with a senior anaesthetist and his team. Suddenly, I heard a shrill prolonged sound coming from a nearby room. I asked a technician what it was. He told me not to worry about it.

A few moments later, the senior anaesthetist asked me:

“What is that high pitched noise?”

“Oh, it’s nothing to worry about, ” I answered confidently.

“Really?” I was asked.

“Oh, yes. there’s absolutely no need to be concerned,” I advised the senior anaesthetist.

If it had been fashionable at that time, I might have told him to ‘chill’, but in those days chilling was reserved for cold weather and refrigeration.

“Hmmmm,” he replied.

After a few moments, he said to me:

“Well, actually that signal is the warning sound made by an oxygen cyinder that is about to become empty. I would really worry about it, young man.”

At that moment, I felt like a complete idiot and hoped that the ground would open up and swallow me.

 

Photo by Pixabay on Pexels.com

 

 

 

It has its uses

Psychedelic headscarf_240

 

In the UK, unlike some countries in Europe, we have a fairly liberal attitude towards Moslem women covering their heads and faces to a greater or lesser extent. In the last dental practice where I worked until I retired, our patients came from all over the world. A not insignicant number of our female patients were Moslems who wore some kind of head covering. A few of them insisted on being treated by female dentists, but most of them did not mind seeing one of the male dentists.

One of my female Moslem patients came to the UK from a north African country. She always wore a loose-fitting headscarf, but did not cover up her face. One day, she needed to have a front (incisor) tooth removed. I explained to her that the situation was such that she would have be without any replacement for it for 24 hours – I cannot remember why. 

Will you be able to cope without that tooth for a day. The gap will show every time you speak or smile,” I said.

Picking up the end of the scarf she was wearing, she covered her mouth with it, and then said humorously:

This has its uses!

And with that comment, she allowed me to remove the troublesome tooth, and then left the surgery with her face covered. She looked like a typical Moslem woman wearing a face-covering. Nobody would have guessed that she was missing a front tooth.

Dentistry and dictatorship

Between 1944 and 1991, Albania was ruled by a Stalinist dictatorship under the leadership of Enver Hoxha until his death in 1985, and then under Ramiz Alia. The country was even more isolated from the rest of the world than North Korea is today. It was impossible for individuals to visit the country unless they were members of a tour group. In May 1984, I joined one of these groups and spent a most interesting fortnight in the country. Our hosts, the state-run Albturist company, made sure that we had little or no contact with Albanians other than our tour guides and driver, who was a trusted Communist party member. Our hosts hoped that we would only see what the authorities wanted us to see. Their aim was to make us come away from Albania feeling that its repressive regime was one to be admired. I was the only dentist in our group. I managed to gain a tiny insight into the state of dentistry in Albania. The following extracts from my book “Albania on my Mind” reveal something of what I learned. ‘Aferdita’ and ‘Eduard’, mentioned below, were our Albanian tour guides. Although their job included keeping us ‘under control’ and away from other Albanians, they were curious about the world beyond Albania’a watertight borders.

ALBDENT 0

Our tour began in the northern city of Shkodër.

“Our coach headed out of Shkodër along the main road leading southwards. Once we were out of town, Aferdita delivered the first of her brief daily lectures. Every day, she treated us to a discourse on one of a variety of different aspects of life in Albania. The one that I can recall best was on the subject of medicine. She informed us, whilst we were travelling towards Sarandë some days well into our tour, that since the advent of the communists not only had malaria been eradicated, but also tuberculosis and syphilis. After extolling the virtues of her country’s medical facilities, she offered to answer any questions that had arisen in our minds as a result of her lecture. No one said anything. Then, Julian, our British chaperone, knowing already that the young lady doctor travelling with us was a reticent person, asked me, the dentist on board, to pose a question. I asked whether antibiotics were readily available in Albania. My reason for asking this was that I believed that the country, which was clearly trying to be totally self-reliant, would have been reluctant to import costly pharmaceuticals. Aferdita replied indignantly: “Why, of course they are.”

And then, spreading her hands wide apart, she exclaimed:

“When we reach the next town, I will get you a packet of antibiotics this large.”

Sadly, she never fulfilled this unusually generous offer.”

ALBDENT 1

Flash flood in Shkodër, 1984

“After an unexceptional lunch, I roamed around the streets of Shkodër. I came across a small public garden, which was dominated by a chunky statue of Joseph Stalin. Even 30 years after his death, Albania continued to honour him. It was the only country in Europe still revering that illustrious Georgian. There was even a town, Qyteti Stalin (now known by its pre-Communist name as ‘Kuçovë’), named in his memory, but we did not visit it. I am pleased that I saw this statue, because although I did see many other statues on our trip, they were mostly depictions of Enver Hoxha.

I discovered a bookshop near to Stalin’s monument, and being addicted to such establishments, I entered. I was surprised to find an Albanian textbook of dentistry prominently displayed there. Though crudely illustrated with line-drawings, I could make out that it was quite up-to-date. To the evident surprise of the shop’s staff, I purchased it and another dental book. I still treasure these two unusual souvenirs from Shkodër.”

ALBDENT 2

Backstreet in Gjirokastër

Later during our tour, we visited the historic city of Gjirokastër. Its hotel, like others in Albania, was equipped with a night club, where we, the foreign guests, were entertained by musical ensembles in splendid isolation: no Albanians apart from our guides and a waiter were permitted to enter the club. Incidentally, wherever our group ate in Albania, we were isolated by screens or curtains from other (i.e. Albanian) diners. I later learnt that this was because in 1984 there were great food shortages in the country. We were well-fed, but it was important that Albanians were not able to see that.

“That evening after dinner, a number of us sat with Aferdita and Eduart in the hotel’s night club. Each of the hotels in which we stayed had one of these. With the exception of our two guides and the musicians who performed in them, these clubs were out of bounds for Albanians. This evening we were entertained by a small band that played western pop music, mainly tunes originally performed by the Beatles. The noisy background of these clubs provided our two young guides with opportunities to ask us about life beyond their country’s tightly sealed borders. However, it was clear that Aferdita was trying to eavesdrop on Eduart and vice-versa. As the musicians strummed away in the semi-gloom of the club in Gjirokastër, Aferdita turned to me, rolled her lower lip away from her teeth, and asked my opinion of her gums. She wanted to know if they had been treated properly. I told her that I was unable to give her an opinion in such poor light.

The following morning, I spotted some tubes of Albanian toothpaste on display in a locked glass display case near the hotel’s main entrance. I tried to communicate to the receptionist (who did not understand English) that I wished to purchase a tube. I used to collect toothpastes from wherever I travelled and was curious to taste its contents. Whilst I was doing this, Aferdita appeared, and asked me what I wanted. I told her. She explained my desire to the receptionist, and moments later I had become the proud owner of a tube of Albanian dentifrice.”

ALBDENT 3

Many years later…

“In 2001, long after my trip to Albania, I began working in a dental practice in west London. Many of my patients were, and still are, refugees from the places in the world, which are stricken by military and political conflicts. Algerians, Iraqis, Afghans, Kurds, Palestinians, Eritreans, and many other others who have fled their far-off disturbed homes sit in my surgery and reveal the ravages that life has inflicted on their teeth. During the terrible conflicts in the former Yugoslavia, many of my patients hailed from Kosovo, and usually spoke poor English in addition to their native Albanian. Many were the smiles that I elicited from them when I quoted the old party slogans, undoubtedly poorly pronounced, and wished them ‘Mir u pafshim’ instead of ‘Goodbye’ at the end of their appointments.”

 

ALBANIA ON MY MIND” by Adam YAMEY may be purchased from Amazon, lulu.com, bookdepository.com, your bookshop. It is also available as a Kindle

Do exams maketh man?

STUDY 0

Today, getting a place to study a clinical subject (medicine, dentistry, and veterinary science) requires the candidate to achieve very high grades in the state university entrance exams (the ‘A Levels’). Grades lower than A or A* (the highest) greatly reduce a candidate’s chances of obtaining a place on a course to study for any of these three professions.

Note: in the A Levels, the top grade is A or A*, the lowest is E. Thus, A is better than B, and B beter than C … and so on

In 1969, I applied to study physiology at University College London (‘UCL’). In those days, most departments at the college required applicants to attend an interview session before they gave the candidate an offer conditional on the person achieving specified A Level grades. The Physiology Department invited prospective students to spend a whole day at the college. I turned up, not knowing what to expect.

During my day at the department, I was interviewed one-to-one by two different sets of staff members. They did not ask straightforward questions that could be answered if you had learnt the A Level syllabus by rote. For example, I was asked: “What would limit the size of the largest insect?” This is not something covered by the A Level syllabus. To answer this, I had to think ‘out of the box’, using my knowledge of insect anatomy and physiology. Another interviewer asked me about my hobbies. One of them was, and still is, collecting maps. “How interesting,” the questioner answered a bit dubiously, “It is also my hobby. What exactly interests you about maps?” I cannot remember my answer, but it seemed to satisfy him.

In addition to these intimate interviews, there were group sessions, during which small groups of candidates discussed topics with some of the academic staff. We were also given coffee, lunch, and tea. At each of these refreshment breaks, we mingled with students and academic staff, all of whom engaged each of us in conversation. By the end of the day, the members of the department must have gained a fairly detailed impression of the candidates they had met.

After a few days, I received a letter (there was no email in 1969) offering me a place conditional on my achieving at least three E grades (lowest grade of pass) at A Level. The Physiology Department and others at UCL made this kind of ridiculously low offer if they wanted a candidate. They knew from the extensive interview process what kind of student they were going to get and did not want him or her to have to worry about achieving high grades. Of course, they preferred their students to obtain high grades at A Level, and we all did. They would have accepted us with lower grades, but this was rarely necessary. Most of the graduates of the Physiology Department eventually moved on to completing higher degrees (masters and doctorates).

Until the early 1980s, candidates wishing to study dentistry or medicine were interviewed and offered places providing they achieved a minimum of C grades in their A Levels.

During the 1970s, I became friendly with someone who used to interview prospective dental students at UCL. She sat on an interviewing panel with the then Dental Dean, Mr Prophet, and another senior dental clinical academic. Each candidate was asked about aspects of his or her life, anything to get them talking. Each candidate was also asked whether they either played a musical instrument or did some kind of handicraft (for example sewing or model-making). Anyone who did either of these things was likely to be sufficiently dextrous to be able to practise dentistry. After the candidate left the room, the interviewers asked themselves only one question, providing the youngster they had just seen had satisfied them that he or she was dextrous. The question they asked themselves was: “Would we be comfortable being treated by him or her?”

Candidates, who had satisfied the interviewing panel, were offered places on the dental course conditional on them achieving mid-range grades at A Level: three grade Cs. The admissions panel were quite lenient. If someone they wanted under-achieved at A Level, say they only manged to get two Cs and one D, they admitted the candidate. It is worth noting that of all the dental schools in London at that time, that at UCL produced a higher proportion of dentists who went on to become dental academics than any of the other dental schools, all of which asked for students to achieve grades higher than Cs for admission.

I qualified as a dentist in March 1982. A couple of years later, I re-connected with ‘Mr G’, the technical tutor, who taught me the art and science of removable prosthetics (i.e. making dentures). I used to see him regularly because he carried out some prosthetic laboratory work for my patients.

In the mid-1980s, things had changed at UCL. To gain admission into the dental course, candidates were required to achieve top grades (all As) at A Level. The first year of the dental course was then, as it had been in my time, not clinical: it was taught in departments other than those in the Dental School. The subjects studied were academic (rather than clinical): biochemistry, general anatomy, physiology, and special dental anatomy. In the second year, the students moved into the Dental School, where they began clinical their studies on patients without teeth – in the Prosthetics Department, which is where I first met Mr G.

During the second year, we burnt our fingers and got covered with plaster of Paris while making dentures for our toothless patients. We also studied dental materials, both practically in the lab and theoretically in the lecture theatre. The materials course involved some essay writing, as did most of the other courses we had to take. Nobody in my class year struggled over these. We might have resented spending time on them, but we managed.

One day in the mid-eighties, by which time all the students in the second year of the dental course had achieved high grades at A Level, Mr G told me something that surprised me. He said that many of the students entering the second year, were incapable of writing essays. So much so, that the Prosthetics Department had to put on a course of essay-writing to teach these high achievers how to write. Worse than that, when the students were told to look up things in the library, they turned around to Mr G and said things like: “Why should we? You do it. You’re paid to teach us.”

With such an arrogant attitude, how were these people going to handle the often-nervous patients in their dental chair?

STUDY 1

When our daughter and her class-mates applied for (non-clinical) undergraduate studies, the criterion for getting considered at all, was predicted A Level grades. If the predicted grades were low, universities would not even begin to consider a candidate. If they were high enough, then the chances of being given a conditional offer increased. Few universities bothered to interview candidates. They tended to rely on grade predictions, teachers’ reports, and ‘personal statements’ written by the candidates. It is said that a picture is worth a thousand words. I would say that a face-to-face interview  far more  valuable than any grade predictions or ‘personal statements’ as a means of selecting people seeking admission to a university, or even a job.

Photographs of students in Coimbra (Portugal), taken by Adam Yamey

Ouch! Pull it out!

dent 1

When I qualified as a dentist back in 1982, there was no vocational training period during which the newly qualified dental surgeon worked under the guidance of an experienced practitioner. Like others who graduated at that time, I was plunged into the ‘deep end’. I was fortunate that the owner of the first practice where I worked was understanding and helpful. He provided me with much valuable advice.

However, nothing can prepare you for the unexpected.

One day, a new patient sat in my dental chair. He spoke English with an eastern European accent. He may have been Ukranian. He said to me: “It is my philosophy that when I am having pain from a tooth, I remove it from my mouth.” Having just spent five and a half years training to save troublesome teeth, I asked him whether he was certain that he did not want an attempt to be made to save the tooth. He was adamant: he wanted the tooth out.

When he pointed at one of his upper incisors, a tooth that was visible when he spoke, I asked him again whether he would not prefer to save such a prominently visible tooth. Once again, he explained his philosophy.

With some reluctance, I administered the local anaesthetic to render the proposed extraction painless. While his jaw was going numb, I asked him once again whether he was sure that he wanted to lose the tooth. He did not change his mind.

It is usual to check for numbness the area around a tooth that is to be removed. This is done by prodding the area with a sharp-pointed probe. As I began to do this, the patient pushed my hand away sharply. Before I could ask him why he did this, he grabbed the offending tooth with his thumb and forefinger, twisted sharply, and cleanly extracted the whole incisor with its root intact. My assistant and I stared at the man, totally surprised.

He said: “All I needed was the injection. The rest I can do myself”. Needless to say, I did not offer him a discount.

 

dent 2

 

Pictures from “Der Zahnarzt in der Karikatur” by E Heinrich, publ. 1963