Friday, July 15, 2016

In the Dentist's Chair

Medical stuff can be a little tricky in Uganda.  

Since I spend the majority of the year overseas, it doesn’t make sense to have a US health insurance policy.  I’m not chronically ill and I can’t afford it on my part-time salary (Newsflash: the Affordable Care Act is NOT affordable!).  So I bought travel insurance that covers me for catastrophic events both overseas and in the US, things like trips to the emergency room, medical evacuations, broken limbs, stuff like that.  Even by paying the extra “extreme sports” fee (since motorcycles are the main form of public transportation in much of the world), it’s incredibly affordable and even though it doesn’t cover routine care, it will cover just what I need it to considering I’m currently spending most of my time in a part of the world where everyday medical care is incredibly cheap.

There are obviously pros and cons to getting medical care on either side of the world:

Uganda pro: It’s SO cheap.  I mysteriously became anaemic last year.  The blood test, consultation with the doctor, and iron pills all cost a grand total of $8 and took less than fifteen minutes. 

America con: It’s SO expensive.  Even when I had insurance I would balk at bills, but without insurance that covers routine care, forget about it.  When I came back to the US for Christmas, I refused to pay $150 for a skin cancer check, so I found one clinic outside of Austin that does them for free.  Hooray!  I needed a biopsy and they quoted me $280.  “It’s not that expensive!” the doctor said.  No thanks.  On another occasion, I needed my teeth cleaned and found a $35 Groupon for x-rays and a cleaning.  They recommended two fillings for deep crevices in my molars for $450.  Nope, maybe later…

Uganda con: The facilities and environment.  That skin biopsy I needed?  I got it done in Uganda for half the price.  Granted, the procedure took about four times as long as it would have in the States, the power in the hospital went out twice, and the nurse spent the majority of the time squishing my face with her huge pregnant belly as she leaned over the table, but hey, it was cheaper!  What I hadn’t realized was that since tap water here isn’t potable, I had to spend the next two and a half weeks taking cold sponge baths and reminiscing about that time a month ago when I could go swimming in the Nile whenever I wanted.  Crap.  Was it really worth the savings?  I’ve also been in clinics here that didn’t have electricity or running water.  The service I got was perfectly fine and the staff did their jobs well, but sometimes I wonder when the last time the place was chemically sterilized.  

Anyway, it’s constantly changing game of evaluating risk vs. cost vs. convenience.  There are some things I’ll walk into any rundown African clinic for, and some things I won’t.  Dental work was one of those things.  It’s easy to go get a second opinion after visiting a clinic doctor (there have been times when I straight-up disagreed with an initial diagnosis here, and I'm not usually one to questions doctors), but it’s a little harder to recover from a botched filling or permanent nerve damage.  I’m not a worrier by nature (obviously), but teeth stuff freaks me out.  I figured I’d wait for those fillings until I got back to the States and either got dental insurance or found a Groupon.


Fast forward to lunch at the expat hot-spot in Jinja.  Most of us have screens in front of our faces.  I usually wear earbuds when I work on my laptop because it makes people a little less inclined to strike up conversations with me that end up lasting the better part of half an hour, and it’s a mental switch for myself that I’m in mental work mode.  However, especially at this particular cafe, I tend to not have anything playing on the earbuds.  Okay, it’s to eavesdrop on the other expats.  Since I’m not plugged into the NGO crowd or the “I’ve lived here since Apartheid” South African crowd, it’s tough getting to meet people and hear the news sometimes.  And yes, I understand the irony of my tactics.

To set the scene, man across from me starts talking to passing man in scrubs.  Turns out man across from me is the father of a friend, and man in scrubs, a mzungu, is a dentist.  Once I realize both of these things, I rip out my earbuds, ask the dentist for a card, and introduce myself to the man across from me.  Bam, two new friends!

I made an appointment with the dentist for the two fillings I needed.  I thought, “Great! He’s an American, I totally trust his dental qualifications and skills, and it’s bound to be much cheaper than getting it done in the States.”

When the appointment comes around, I show up only to find out that the American dentist has gone on a village visit and that a Ugandan dentist, Mercy (no one used “Dr.” or her last name the entire time), would be working on me.  I panic for a minute and then plopped down in the exam chair after coming to the conclusion that if Dr. Absent American Dentist trusted Mercy, then I could too.

She and an assistant poked around in my mouth for a few minutes, saw the teeth that needed fillings, and then dropped the bomb: “The cavities are so small that I don’t think we need to numb you.”

Oooooh snap, this visit to the local dentist was going downhill very quickly.  I had not planned on putting “writhing in pain” on my calendar for that day.  I immediately expressed my severe disagreement with her suggestion.  She patted me on the arm and said, “How about this: I’ll go really slowly and if you’re uncomfortable, just let us know and we’ll numb you up right away.”  I agreed and they went to work.

Not only was it boiling hot in the clinic, but I was also sweating extra bullets and clenching the arms of the exam chair waiting for the pain to hit an 8 out of 10.  It probably only got to a 1.5, but I was so sensitive about it, I’d thrash my arms around whenever I thought I could feel something hurty.  The assistant noticed how much I was sweating and turned on the wall fan that was the size of a saucer that somehow seemed to make everything cooler.  And I knew this about Africans already, but I had forgotten: when you tell them it hurts, they say “I’m almost done!” and then proceed to continue with the same force and intention for another 10-15 minutes.  To say that Africans underestimate how low the pain threshold is for Westerners is a severe understatement.

When it was all done, Mercy took one look at me and dryly said that they wouldn’t charge me for the free shower I had given myself.  She also informed me that while they were at it, they went ahead and filled in a third tooth that had a teeny cavity in it, just for fun.  

Now that my mouth was free to flap, she and the assistant pelted me with questions about what I was doing in Uganda.  The minute they found out that I was dating a local, their reaction was the exact same as every other local woman that discovers this, in this exact order: *Squeeeal* “Do you have any children? When will you have children? You should really get going on making a baby soon. We want you to have lots and lots of African babies and stay in Uganda forever!!!”  I usually respond by telling them that we already have six children, which they think is hilarious, especially since everyone assumes I'm eighteen.

After I paid my whopping $48 bill, I walked back and had a Sex & the City-esque moment of reflection about what I had just learned (don't tell anyone I love that show!):

1. Westerners really are weenies.  I wonder how much money is spent on pain prevention when it’s not even needed.  If an American dentist even suggested that a patient not be numbed during any kind of procedure, they’d have lawsuits slapped all over them.  How much do we pay for peace of mind, when the issue can be taken care of with a little faith, a little sweat, and a whole lot less cost?  In the end, Mercy was right.  There was no reason I needed to spend the rest of the day wondering if rice and beans were falling out of my numb mouth as I ate and tried not to bite the inside of my cheek.  My respect for the American health insurance system continues to deteriorate steadily.

2. Crap, I’m really racist sometimes.  One of the hardest parts about traveling like this and meeting so many people from so many different cultures is that you often find yourself at a constant crux of feeling like your mind and worldview are expanding exponentially, but that your perceptions of cultures and people are becoming more narrow because you experience first-hand how true stereotypes really are and where they come from.  African kids see my skin and their hands automatically extend asking for money or sweets.  I see the black Ugandan skin of my dentist and immediately doubt that she knows what she’s doing.  These stereotypes all have roots in reality, but it's a horrible feeling to be confronted with how your own assumptions limit other people, especially when you take so much pride in being so worldly and open-minded.  And it’s really hard to admit that extended travel does often make you more prejudiced towards people from certain cultures.  It sucks.  I did not sign up for this, and of course you think it's never going to happen to you.

Travelers know all too well how much our lifestyle is glamorized and envied.  But behind those pretty Instagram shots and crazy stories about riding motorcycles across Vietnam (upcoming spoiler!), there are a lot of things travelers come face-to-face with in the world and in ourselves that we really struggle with and that will never leave us.  I certainly have days where I wish I had just taken the easy route and stayed in the States and would never have to work through any of this.  Ignorance is bliss, and bliss sounds really great sometimes.  But at least now I have a Ugandan dentist that'll clean my teeth AND ask me if I'm pregnant, all for the low price of $3!  Beat that, Groupon!

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