Tuesday, May 25, 2010

Azami Al Moftee Palestinian Refugee Camp

Since about 1948, refugee camps started as tent cities, then slowly transitioned to concrete blockhouses, and then to densely populated urban ghettos. There are 10 Palestinian refugee camps in Jordan. My most memorable Fulbright opportunity was working with our Jordan University of Science and Technology students and faculty at one of them, the Azami Al Moftee Camp in Al Husn. Our mission was to provide service learning community-based experience for the junior and senior dental hygiene students, oral health education to the teachers and Palestinian children living in the camp, and dental screenings and referrals for Palestinian refugee children. Our original goals also included fluoride varnish therapy for each child, but product proved to be unattainable.

At the Azami Al Moftee elementary and intermediate school, two buildings about a block apart afford separate learning environments for boys and girls; and within each building, two distinct schools operate-an AM school and a PM school-each with separate teachers, principals, staff, and children. The schools are funded by the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA). To support our efforts, Colgate generously contributed 1000 toothbrushes, 1000 packages of dental floss, 1000 tubes of toothpaste, and educational pamphlets and posters in Arabic.

After much planning, the welcome we received from the administrative staff, teachers and students was overwhelming. Just walking into the school generated throngs of children vying to get close. Their repetitive questions included "what's your name, where are you from, how old are you, are you married, where are your children." Two seventh graders asked me if I liked Jane Austin and Hanna Montana. My uncovered, curly brown hair was particularly enticing and I had little hands touching it on a regular basis. They exhibited a strong desire to connect with others foreign to the camp. In the classrooms, we were greeted with proudly performed songs and chants, and the children were quite conversant in English.

With the manpower, enthusiasm and expertise of about 40 dental hygiene students and faculty, product and educational resources from Colgate, and lessons planned and delivered, we were able to reach over 40 classrooms, and provide oral screenings and referrals for over 1500 Palestinian refugee children . Although this may sound like a lot, about 4000 children attend the schools and we only focused on the girls in grades 1 thru 7. We targeted young girls because of the opportunity for disease prevention and because research shows that females are more likely to transfer their health knowledge and behaviors to their families than males. The level of oral disease in this young population is devastating to health and appearance, and there is an unfortunate acceptance of oral disease, a disease which is totally preventable. We could have just stayed in our University offices and simply checking all of the boxes on our dental screening and referral forms-rampant caries, abscesses, gingivitis, poor oral hygiene, dental stain, calculus, needs sealants, needs professional prophylaxis, needs fluoride, needs dental care, needs urgent dental care-without ever examining each child. The children were referred to the Jordan University Dental Teaching Center where their needs can be met at a very low cost. Boys in grades 1-7 will be targeted in the fall.

This project is the beginning of a sustainable partnership between the dental hygiene baccalaureate program at Jordan University of Science and Technology, Colgate and the Azmi Al Moftee School.

Wednesday, May 5, 2010

Students Being Themselves

I am greatful that the students have kept a smile on my face and I want to share some of their great faces! THEY ARE WONDERFUL PEOPLE TO KNOW AND WORK WITH.

Truth or Consequences

One surprising clinical observation is that so many adult patients here in Jordan have no significant findings on their health histories. In the US, one finds complex medical and pharmacologic histories of patients to be the norm. For example, US patients will frequently report cardiovascular problems, diabetes, emotional challenges, and /or kidney disease coupled with a daily routine of several prescription medications which all carry the potential of side effects and which influence the professional care plan.

It is not that Jordanians are healthier than Americans, rather I believe that a number of unique cultural characteristics influence the patient assessment process and theoral healthcare encounter, ie, 1) people here are very private about their health or disease status and reluctant to share their health problems; 2) many do not see their physicians frequently enough to know or understand their health / disease status; and / or 3) they fear discrimination if their true health status is revealed. This makes dental hygiene care particularly challenging because medical emergencies can be prevented, risk factors for oral iseases can be identified and used as a basis for patient education, and quality care can be provided only if the practitioner knows the health status of the patient. Not knowing the status means that standard patient management protocols may not be appropriately implemented. Without an accurate health and pharmacologic history, students gain limited experience in clinical decision making and collaboration with other healthcare professionals around the needs of the patient. Unfortunately, it also gives students the false impression that they need not worry about the health status of the people they treat. Partients too loose because they continue to be unaware of the oral-systemic risk factors that eventually manifest disease. With time devoted to good patient-practitioner communication, establishment of trust, case analysis, and emphasis on patient education, some of these problems slowly can be overcome.

Friday, April 30, 2010

Traditional Foods of Jordan

While talking with a colleague about the evolution of belly dancing in Muslim cultures, she quickly asserted that Jordanians ARE NOT belly dancers ..... Jordanians ARE belly fillers.Wherever you go, food is abundant, zaki (delicious), and always shared. Jordanians love their lamb and mutton, and the Al Ramtha area where I live also is known for its tradition of eating camel meat. In the spring, people carry bushy bunches of green hummous and bags of green luz (almonds) and orange askadinia which they eat as snacks. Roadside stalls and markets of fruits, vegetables, spices and nuts abound. Although I have not found anything that I don't like, I am particularly fond of maashowi (skewered lamb) and lazagyat (extremenly thin bread dipped in olive oil, then sugared and rolled ... just like a French crepe) made outside over a wood burning fire. I have learned to make karkaday, kussa (stuffed squash) and dowali (stuffed grape leaves). Another favorite is the national dish of Jordan, mensaf! Its origins are Bedouin and it is made of boiled mutton over rice which is then covered with toasted almonds, parsley and a tart yogurt sauce. The hard, ball-shaped yogurt used for mensaf is dense like a brick. Developed by the desert dwellers, this form of yogurt lasts until it is rehydrated for mensaf. The mensef is served on communal platers and we all eat it with our right hands. By the way, I did eat the meat from the sheep's head too!!!
While visiting a colleague's home for the weekend, we enjoyed traditional breakfasts where it was pointed out to me that one came entirely from the garden (hummous, khubez, falafel, makdoos, s'laata, tabbouleh, bandura, zaytoon, abugines, jezer, fuul, shy marrameeya and shy nanna) and one came entirely from animals (lahmeh, asal, bayd, jibneh, labneh, zabazdi, zibdeh). Her aunt, who had just returned from an umrah shared with us water (zam zam) and dates from Mecca.
And then, there is always Arabic coffee which is ground with cardommon spices straight from the coffee bean roaster, and the gastronomically beautiful and zaki Arabic sweets like k'naffy, baglawa, hareeseh, mehallabiyyeh, and halwa which are certainly not on the Weight Watchers recommended foods to eat list. I have easily adapted to the Jordanian custom of "belly filling".