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The mouth is a vulnerable place: on a mother's fears and a cavity filled in Uganda


When Piper was three years old she ran face first into a wall. We were at her grandparents house in Ventura and she was jumping up and down, excited to play with her cousin.


“C’mon let’s go to the living room!” she screamed in delight. Then as she turned to sprint into the other room, she misjudged where the doorway was and two steps in smacked up against concrete.


This happened the day after Christmas.


I held her in Mikes parents dimly lit living room and rocked her as she sobbed. Her front tooth was dangling. After she had spit all the blood into a cup, what was left was a sad front tooth that stubbornly swayed back and forth.


We made a few worried phone calls and ended up finding a dentist who was open during the holiday week. We had to drive one town south, to Oxnard and see someone we had never met.


This is what it will be like in just a few short months, I thought- anticipating our move to Uganda. Being at my in-law’s house, out of town, made it so we didn’t have access to the best dentist ever...https://www.carmelmtndentalcare.com/. It highlighted the beginning of being uprooted, having to trust that God would meet our needs in new ways.


The next morning, we walked into this dentist’s office and everything seemed alright. The place was a little dingy and dated with fluorescent flower decorations from the Dollar Tree. and the smell of floral air freshener. Mike and Piper looked around at the massive fish tanks, which were well maintained, while I sat nervously flipping through magazines.


The man walking down the hallway towards us looked to be in his late 70’s. He was very tall, slender, and his hair was dyed the color of margarine. It sat on the sides of his head like it had been smeared on. He wore checkered Vans. If you put a bulbous red nose on him he could have passed as a clown. When he introduced himself, he was indeed, the dentist.


As we followed him back I peered into half empty rooms filled with disorganized stacks of paper. It smelled like Lysol but looked unkempt, which was just confusing to my senses. My confidence eroded the further we went.


I sat in the dental chair and put Piper in my lap. After a conversation and some x-rays, he had come up with his plan. He wanted to sedate her and extract her two front teeth. To ease the news he peppered his talk in a very enthusiastic Donald Duck voice that all of us were bewildered by. I started to question if he was sober.

We decided to go home and make Piper eat an apple instead.


The apple didn’t work.


But a few days later she woke up without a tooth. Mike found it in the bottom of her sheets.

We were glad that was done but it also left me with an underlying unease about dentistry in other places. I hoped we could forgo any major dental work for the next few years.


***


“Open your mouth a little wider…” I said to Boston while I peered around. It is close to a year and a half since we’ve lived in Bundibugyo and plaque is building up on the ridges of my children’s teeth. And now, I spot a dark black hole. Boston’s first cavity.


Mike and I decide we need to make the 8-hour drive to Kampala and bring the kids to a dentist.


“Nothing can be as bad as that Donald Duck guy.” He says. Then he books us all appointments at a place called Jubilee Dental, which sounds disarming enough for me to not completely dread what may be ahead.


***


Kampala is a city full of rolling hills speckled in terra cotta roofs and puffs of green trees. From a distance, the eye travels the undulations of each hill until it gently slopes outwards to the perimeter of the city. It is here that Lake Victoria sits waiting. Lake Victoria, the biggest lake in Africa and second biggest in the world, laces itself around the edge of the city while also stretching southward to Tanzania and eastward into Kenya.


When we manage to get an Airbnb with a view, the combination of the hills and the trees and the lake is something I revel in. Up high like that, there is often a cool tropical breeze and large birds ethereally floating past at eye level. If this were all painted on canvas, the land would make up less than half the horizontal composition, with the ever-changing sky dominating the rest.


Navigating through the city is a less peaceful experience.


“Driving here is an extreme sport!” one of my Uber drivers once shouted as she gripped the steering wheel and swerved past a few motorcycles.


Buses, trucks, cars and motorcycles fill the roads, often with only an inch or two between them. A few women walk up and down, breastfeeding children with heartwrenching deformities while looking into car windows to beg or just smile at our kids in the backseat. Others sell bundles of grapes or bags of shiny orange gooseberries. Pedestrians in business suits shimmy themselves between partially moving cars with timing that is close to miraculous. Men selling armfuls of sunglasses, or Steven Madden shoes, or face masks come asking for us to consider their product as they hold it up. Grey-black clouds of exhaust, thick with the smell of chemicals and dirt, release at sporadic intervals.


One must be constantly aware of every direction at all times and be ready to think outside the box in an instant. And like in any big city, we have learned the areas to keep our windows shut and doors locked, and the places where we can let them back down again.


As we made our way around the roundabout onto the less busy Wampewo Road, up to Jubilee Dental Clinic, we rolled our windows down to let in the cool morning air of the tree-lined street.


***


“Mama” the dentist looked at me and through her face mask and shield said, “I don’t think this will work. We will have to find another way.”


The appointments had all gone well. I'm super judgey when it comes to my kids mouths. My antennae was up, ready to zone in on anything that seemed like we should turn around and walk out, but nothing ever came.


The office was simple and clean, with doors that opened directly outside to a huge lawn where the kids collected seed pods while they waited. The staff were in matching purple and blue uniforms. They were friendly and professional as they opened their office to us, their first clients.


The dentist made each of the children feel at ease in her chair. So at ease, that she was tricked into believing Boston would allow her to easily give the two small injections she needed to numb his mouth and fix the cavity. He hopped up there and chatted with her about Paw Patrol and his imaginary friend Jack, then laid back and opened his mouth. She rubbed some special cream onto his gums, “to make his tooth go asleep”. But when he experienced the first poke, he clamped his jaw shut, lips pressed together and refused to open it up again.


His big brown eyes accused us all of betrayal.


I listened as the dentist used her soft voice and kid language to try and gain his trust back again. Winnie sat at the bottom of the chair and rubbed his feet. But after twenty minutes all our convincing was starting to make things worse. He was crying and squirming around, demanding to leave.


She was right. This wasn’t working.


“It looks like a deep cavity. And if you don’t get it filled, he will need a root canal. So let’s talk about what I’d recommend next.”


Boston fled the room with Winnie and they all went outside to play.


“It is important with very young children like your son that coming to the dentist is a positive experience. I’m highly doubtful he will open his mouth again. Usually what we recommend is to make an appointment to complete his dental work with our anesthesiologist present, under sedation.”


“We have to sedate him for 1 cavity?”


“Our other option is to have him held down during the procedure, but I don’t recommend it. It will cause him a lot of mental suffering and problems with the dentist in the future.”


I had so many questions that she gave me the anesthesiologists number. I called him later that day as I stood on the balcony, with a Crayola purple marker and a paper in my sweaty clenched hand, looking over the city. The kids were inside, dressed up and riding sticks like horses around the house. Mike was filling a pot to boil water for pasta.


I thought about the next few days and about all the moving parts of our life, and Uganda, and the pandemic.


It was Tuesday. Our plan was to leave Kampala by Saturday because President Museveni was speaking Sunday about the rising cases of COVID. Uganda was entering the second major wave of coronavirus infections. It had been a long time since he addressed the country and people were talking about what they thought he was planning to do. Would we be looking at a strict lockdown again? If so, he would most likely ban travel, and we could be stuck in Kampala for an indefinite amount of time if we didn’t get out soon.


Working backwards, that meant we had to decide about Boston’s tooth quickly.


The phone call was helpful. I wanted to know which medications he planned on using, what his experience was, and where we would be doing this. I told him about Boston’s history of asthma and that he was born with laryngomalacia, or as we used to explain to curious people “floppy vocal cords”. For the first half of his life, when he breathed he let out a plethora of sounds. Sometimes he sounded squeaky, like a dog toy. Other times he just sounded hoarse and raspy. When he fell asleep he sounded a little like he was drowning, which was disconcerting to the uninformed.


He wasn’t the baby family members held and rocked, his sounds made them too uncomfortable. When he was about a year and a half old, as his vocal cords grew and stretched, he became a quiet breather, just like everyone else. No more stares in public. A lot less questions from family and friends.


But in my history of being Boston’s mother, in all our trips to the emergency room, to throat specialists, and asthma care teams, to our four-day stay in the pediatric intensive care unit because his airway could not clear the amount of secretions his body was making- in all of this- I carry these experiences with me. If there is any part of his little 3-year-old body I trust the least, it is his airway.


So naturally, as a nurse and a mother, I was concerned about the worst-case scenario.

What if his airway collapsed under sedation? What if he couldn’t get the help he needed and died getting a cavity filled in Kampala? I’d read about these dental horror stories that happen in the US.


“Are you available tomorrow?” the anesthesiologist asked. “I’d like to meet your son and I hope for you to feel at ease after meeting me.”


“Yes, we have an appointment at the US embassy at 10:30 am but anytime after that works. Thank you.” I said.


***


Cities don’t sleep in Uganda. They’re not quiet at night, or still. In the dark, dogs howl in unison, over and over. The wind picks up and rattles doors loose in their frames. Trees rustle. Christians pray loudly into microphones for hours. Muslims bathe the hills in their calls to prayer. Night guards turn up the volume on their small scratchy radios, as jubilant music bounces off into the night.


At times I hear our children talking in their sleep, or Mike snoring.


And often, there is the stealthy lone mosquito.


But this night, I can’t sleep, not because of the sounds, but because I don’t like my options. My mind is a leaf caught in an eddy, swirling swirling around in a loop of uncertainty. I keep hearing the answers of what the anesthesiologist said on the phone.


“Propofol. Tramadol.” What was that third medication he said he was also planning on using?


I saw an image of Boston sedated, his airway folding in on itself, his oxygen levels dropping and people scrambling around to find the proper equipment to save him.


I question myself in my exhaustion. Should I be listening to this? Is it trying to alert me to a bad situation? Or should I ignore it and trust that everything is going to work out?


Either way, it is incessant and it gnaws. We have to make our decision tomorrow.


A moment passes and I see the loophole. I can pray my way out of this. Or through it. I can hand it over.


Lord you see me. I’m lost in this. HELP ME.


I turn to my other side, hoping a change in position will coax sleep.


It does nothing.


My prayers turn frustrated.


Just talk to me. I’m listening. I need you to tell me what to do. Right now. Just say it. Talk to me!


I waited.


In the middle of this sleepless night, however dramatic or irrational it sounds, it was as if the decisions we were going to make had a very real chance of having life and death consequences. And I needed guidance. I was asking for it with full expectation that God was going to answer me, except that I eventually fell asleep waiting.


***

We show up late the next day for our embassy appointment and are told to wait outside in the socially distanced chairs. One benefit of this pandemic is the shift to not having to wait indoors. We pick the seats furthest away from people, partially shaded, with space to let our kids play.


There are two people speaking in American accents, and over the buzzing of a distant saw I pick up fragments of their conversation. Just before one of their names gets called, I hear the word ‘dentist’.


Then the woman goes into the building for her appointment.


The moment gets still. The word enlarges and I can’t escape it.


DENTIST.


My heart is light in my chest.


DENTIST? What I would give to talk to someone that could offer a second opinion. I only got three hours of sleep, and I am really feeling the weight of being outside of my culture this week. Learning to build trust in a new place can be hard.


I don’t wait too long before I walk over and blurt out “did someone say dentist?”. I’ve just made a strange first impression and I can see it on the man’s face, but I don’t care. I want another opinion on my son.


“Yes, that woman was saying she is a dentist.”


“Thanks.” I say and I grab Boston and walk into the building. The woman is sitting with a clipboard and a few forms, squinting as she writes.


“Hi.” I say.


She looks up.


“I heard you were a dentist?”


I’ve just made another terrible first impression.


“Yesss?” she says slowly, with an uptilt at the end.


She doesn’t trust me, I can tell.


“I’ve been up all night worried about my son. When you’re finished with your appointment do you mind talking for a few minutes? It’s about a cavity.” I can feel my throat crack.

Sure, it’s about a cavity. But I feel more like I’m asking someone if I should throw my son off a cliff or not. My eyes start to tear up and I demand them to stop. I will scare this woman away if I show her how I feel.


“Are you with the man out there that I was just talking to?” she asks.


“No” I say. “I just overheard you say you were a dentist.”


“Mkay. Ya. I’m not actually a practicing dentist right now. But let me finish doing this first and we can talk.”


I parked myself inside and over the next thirty minutes made side-eye with her as she progressed through her forms. I felt like a creep. Boston kept whimpering to me, “she’s a dentist? Mom, I DON’T LIKE THE DENTIST. I’m NEVER GOING TO THE DENTIST.”


Our name got called so Mike and I walked into an enclosed office with a big glass window and left the kids watching an owl on TV. I saw the clock mounted to the wall behind the window.


“We’re late for the anesthesiologist now…” I whispered to Mike. It was one of those days where everything was getting pushed back. We had to put our phones into a locker before we entered the Embassy, so we couldn’t call to let him know.


Mike let out a deep sigh.


I let out a deep sigh.


Then the embassy consul made a mistake on our forms. “Since these are your own personal forms, you may need to go back out to a print shop and reprint them.”


I didn’t want to leave and do an errand. Errands aren’t simple. Extreme traffic. Heat. No bathrooms. Power outages. Police stops. Hungry kids.


Mike let out a few more deep sighs. Our stress levels were rising. The room seemed to get smaller and hotter in an instant. I peeked through the window and the kids were behaving but growing tired of watching the owl. I was afraid if we took too long I was going to miss my chance with the dentist sitting outside.


But then I remembered. If this truly was an answer to my midnight pleas, I didn’t have to worry about making anything happen. Answered prayers don’t need to be micromanaged.


“Can we look up a generic form online?” Mike asked.


“I’ll try.” She said. And she quickly found it. We waited for it to download and I told her, “If you hear all our deep sighing, it’s not you. My son needs a cavity filled and it is kinda complicated and we’re in the middle of that.”


“My daughter has needed A LOT of dental work here. We’ve lived here for six years and been to a bunch of dentists. I could not recommend Pristine Dental more highly! Dr. Osman has been amazing.”


That was unexpected. Mike wrote her recommendation down in his phone.


When we left the office, the dentist was waiting for us outside the double doors. She listened to me process through our limited options and then said, “Is there any way you can just give him a little Valium and get the cavity filled while he’s loopy but awake?”


“I don’t know.” I said. “We could ask.”


***


More pieces of the puzzle came together after we met with the anesthesiologist. We were over an hour late but he showed us warmth and understanding in the way he greeted us. I was grateful to be on the receiving side of a patient culture. It instantly put me at ease. He was open to all of our questions and answered them honestly.


“No, parents are not allowed in the room during the procedure.” I was disappointed but understood.

Yes we have a bag and mask available in his size for resuscitation.” That’s good.

“In my 40 years I have never had a bad outcome.” Really?

“Thank you for your suggestion, and I understand the doctors you know are suggesting Ketamine. Propofol is what I use.” It was worth a try. (I am certainly no expert in this area even though I have my opinions)

“Unfortunately, we do not have oxygen on hand.” Major red flag.

We couldn’t agree to move forward if there was no oxygen available.

But since you are requesting, I will find a tank of oxygen and have it there.”


On the drive home I told Mike “He lost me at the ‘no oxygen’ comment. I know he said he’d get some, but it’s the lack of preparedness that concerns me.”


Back at the house I called Pristine Dental and spoke with Dr. Osman. After a minute I trusted him. But he offered the same options as the other dentist, and ironically, he used the exact same anesthesiologist.


That left Mike and I trying to brainstorm different options.


“What if we did what that dentist at the embassy said and gave him some valium? And go to Dr. Osman where Boston doesn’t have any negative associations yet and hope he keeps his mouth open?” Mike said.


I called Pristine Dental back and asked if we could do this. He agreed, although it didn’t sound as if this was something he did with children. “Come in Saturday morning and we can try it then.”


I got a text from my friend saying when her son had dental work in Ethiopia (where anesthesia for children’s dental purposes is apparently illegal), she just held an IPAD in front of his face while he wore headphones and that distraction got him through his appointment.


Our plan started coming together.


We texted a few other people. Our best dentist ever agreed we needed to take care of this asap. Our pediatrician sent us proper dosing of Valium for Boston’s weight. One of my best friends in the US encouraged me by telling me this was exactly what she did for her anxious daughter, and it worked.


Mike went and bought the Valium and some headphones.


Even though I did not hear an audible voice from above, I could see clearly that my prayer was heard. The last 24 hours were my own desert wasteland, and with all the input now I was entering a garden of possibility.


***


“I think we should give him some more…” I said.


Boston was in Dr. Osman’s dental chair, watching Frozen on the iPad, with four adults around him trying to judge if the Valium had kicked in or not.


“Can you tell us what you’re watching?” I asked.


He recounted everything in perfect detail with great speed and 3-year old enthusiasm. The dental hygienist and Dr. Osman laughed.


“It’s been 45 minutes and he is fine.” I noted.


“Let’s wait a little longer…” Dr. Osman said.


I appreciated that he didn’t want to overdose my son but I also saw how much time he was spending waiting on our family. He had been sitting in the swivel chair the entire time, making conversation with us and putting our son at ease. I was shocked by his patience, as I often am here.


He ended up leaving the room and it was just Mike, the dental hygienist and I sitting quietly around Boston.


“What are you doing in Bundibugyo?” She asked.


“I work at a school and my wife is a nurse.”


“Are you missionaries?”


“Yes.” I say. She is wearing a hijab and I wonder what her thoughts are about Christian missionaries. I ask her what she thinks of missionaries.


“Oh, I am a Born-again Christian.”


“Oh!” I say, surprised.


“But its not a good story.” She says.


We end up having to give Boston a little more Valium which gives us time to hear her story.


“You see, my entire family has rejected me. And my husband died.”


“Oh no.” Mike and I didn’t know what to say. She continued.


“Then two years ago, I had a dream. In my dream my husband died. There were many details in this dream. The dream was very clear. It was a car accident.”


As she spoke I could tell this wasn’t something that happened too long ago, her face was solemn and the retelling was hard.


“2 weeks later, the same accident I had seen in my dream happened, down to the exact details, and my husband died in that accident just the way he died in my dream.”


“I’m sorry.”


“It was really horrible. I became so sad. My friend brought me to a pastor because I was having a very difficult time and nothing was helping. He said ‘you know about the Bible and about Jesus, but that is not the same as having a relationship with God.’ He was right. I had never had that. In school, as a child, I heard about Jesus and I read the Bible, but all of it was just stories to me. He told me ‘Jesus can heal you.’ And I wanted to heal, so I decided to ask Him to help me.”


“What has it been like for you since?”


“The pastor was right. I never did have what I have now. My entire life I feared Allah because that is how I was taught. The main thing is fear. But now I feel God is close. It is different. When I became born-again, I had something new that I never had before. I can speak to Jesus in my language, not in Arabic, and say whatever I want, the way I talk to a friend.”


“What does your husband’s family think?” I ask.


“His brothers have seen the change in me and they support this because they can see I am happy now. They don’t even mind that I am homeschooling my son and he’s memorizing Scripture. They are very supportive. I think that is how my husband would have been too.”


“Thank you for sharing all this.” We talked a little more until it had been long enough for us to check on Boston again. This time we turned off the show and had him walk down the hallway. He could barely make it two steps without stumbling like a tiny drunk person.


“It’s time!” We all agreed.


Boston didn’t need me staring at him nervously and expectantly, pressuring him to keep his mouth open. So I excused myself and stood outside the door, waiting to hear crying or screaming or even wailing. I wanted it to be done quickly. I heard the swishing and vibrating of dental equipment, but I didn’t hear Boston. And then, after a few laps around the parking lot I came back to the beautiful declaration of “All DONE!".


I walked in and with a glazed look in his eye and a side smile, Boston said “I was SUUUUPER BRAVE.”


I picked him up and squeezed him.


“THHHHAAAANNK YOUU!” I kept saying over and over to Dr. Osman and his assistant.


“You don’t even know… this is such a relief…you guys are so great… thank you for everything.”


***


Mike and I celebrated by eating Sushi in our parked car. Boston sat in his seat and finished watching Frozen, and we waited for the Valium to wear off. (yes, there is sushi in Kampala, and it is DELICIOUS)


We left Kampala early Sunday morning, and made it home as the sun sank behind the spray of banana trees, lighting the sky up in pink and purple. That night President Museveni announced that he was locking the country down again, including restricting private vehicles from driving between districts.


We made it in time.


We even triumphed.


Boston’s cavity was filled.


We had braved something new (and that I dreaded) and it had gone well.


We now have a family dentist we trust in Kampala. (https://pristinedentalsurgery.com/ )


I thought about the dental hygienist, the way in which she was sharing about her new relationship with Christ, how she just talks to him all the time. I recognized a certain familial bond with her. A closeness, that we share the same Father. And that throughout history, into the present and the future He is a God who hears and who cares, even about cavities.

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