by Dr. Reza Ardalan, Dental Slang Podcast
The first time I met Dr. Emma Zennie, I really didn't know her background, but I was immediately impressed with her diverse set of clinical skills. Later, I had the opportunity to hear her speak and tell her story. After wiping away all the tears from the emotional experience, I thought, "I need to get her on the podcast so we can share her story with more clinicians."
Listen to the full podcast on DentalSlang.com, or read the recap below.
______________________________________________________
Dr. Ardalan: Hi Emma, thank you for joining me today. I'm excited to share your story of being a clinician in Haiti and to discuss your journey. Let's start with your dental training in Florida. Was it always your intention to return to Haiti to serve your community?
Dr. Zennie: Absolutely. I like to tell people that I feel as though my life was put on pause for the amount of time that I lived in the United States while training because I was never going to stay. The ultimate goal was always to find my way home. So, the short answer is yes.
Dr. Ardalan: When the major earthquakes consumed Haiti, what specific role did you play as a dentist in order to support your community?
Dr. Zennie: I was around for the second to last major earthquake and that was in 2010 and actually at the time I had just graduated from dental school and I was home on holiday. It was definitely an experience that helped me value my education and my training as a dentist. We're incredibly useful in field hospitals because we can clean wounds, we can put sutures in, and there's a lot of things that we can do even triage and pharmacy that lay people cannot do or even other doctors cannot do, like radiologists. I like to think that I received more than I gave during this time because it helped me value myself as a healthcare practitioner and also helped me value the important role I can play in my community in being a steward of health.
But, yes, in general it's not all dental. I had a patient show up with a major laceration of the lower lip. So we're at like 20 to 22 level, but his lip is completely lacerated. And I'm hearing the voice of my oral mysofacial surgery professor saying, oh, one day you'll have to give a block through the face. And I'm sitting in class going, no, I won't...
And I'm like, OK, well, I guess the mental foramen is somewhere around here, so I numb it up, clean the wound and suture it, you know, layered sutures which are things that we didn't learn in school but that I had seen done. I used common logic and knowledge of medicine to literally reconstruct this person's face. He came back three weeks later and I was the one who took his sutures out. He was fine. So, I guess I did okay.
I’ve also ended up doing other things that we're not trained to do, like deliver babies.
Dr. Ardalan: That’s incredible. Speaking about dental training, elaborate more on the level of dental education in Haiti and how you've contributed to providing a more fundamental education to the dental profession there.
Dr. Zennie: The State University of Haiti houses a dental school with 17 chairs, and there's another recently opened dental school with the same capacity, although I'm more acquainted with the State University as I've been a professor there since 2011.
Currently, I am responsible for the microbiology course, which I've structured to review general microbiology, followed by antibiotics, pathways, and biofilms and control of biofilms. This microbiology course is specifically tailored to dentistry, reflecting my background as my bachelor's degree is in microbiology and cell science.
The other course I teach is periodontics, as I didn't have the opportunity to do a residency but have accumulated over 350 continuing education credits in perio, implants, and grafting. My focus and expertise lie in periodontics. Recently, I revamped the perio program with the aim of training our students to be active preventive dentistry practitioners. Given our predominantly Afro-Caribbean population, my goal is to address issues such as tooth loss, periodontal disease, cardiovascular diseases, and diabetes. I collaborate with the Diabetes Foundation, training nurses to diagnose periodontal disease and refer patients to dentists.
Living in a country with limited medical infrastructure, preventive care is crucial, being cost-effective and accessible. Despite not engaging in elaborate procedures like those taught in the U.S., our dental school excels in catering to the population's needs. For instance, our students surpass American counterparts in prosthodontics, crafting their own dentures and partials. Their proficiency in extractions is notable, given the financial constraints limiting root canal procedures.
I've encountered incredibly talented individuals persevering through challenging conditions to pursue their education. Their commitment to the dental profession inspires me, driving my dedication to bringing back knowledge acquired during my education in the United States. It's a way of giving back and contributing to dental education in Haiti.
Dr. Ardalan: That's amazing—the significant impact you're making on your community and the tremendous education kids receive in dental school. Here's the question I've been wanting to ask: For those of us who aren't Haitians, it's challenging to comprehend the daily life in your country. Given the tragic stories of crime and corruption often portrayed in the media, can you share a bit about your specific clinic routine and how you manage to pursue your profession despite these challenges?
Dr. Zennie: Certainly, one of my favorite quotes is from Louis Pasteur, who emphasized that nothing great is ever achieved without passion. Living here isn't easy; it demands commitment and a strong belief in what you're doing. While I could work and live in the States, I choose to call this place home.
Now, about my clinic—it's not much different from yours. I run a fully ADA-compliant operation, using materials, supplies, and equipment that are either ADA or CE certified and sourced from the US. The protocols and standard of care I follow are comparable, and often superior to many dental organizations and clinics in the developed world like the United States, Canada, and Europe. For instance, I use Dentrix in my office, and SOPRO Imaging is part of my common software.
What sets my practice apart is the staffing. While I'm aware of the current shortage in dental staff in the States, training here is a different challenge. I have an associate and four dedicated assistants who undergo cross-training to support each other since there's no school here for dental assistants, and the dental hygiene profession doesn't exist. Despite the challenges, my team's dedication and motivation make them exceptional, and I take pride in the training efforts I've invested in building such a capable team.
Dr. Ardalan: So, yeah, it really on the job training. Tell me more about your new clinic you’ve built in Port-au-Prince and what long terms plans do you have for it?
Dr. Zennie: Currently, we're experiencing delays with my ongoing project—a new dental practice. I've meticulously outfitted a brand-new clinic with state-of-the-art chairs and equipment, all imported from Italy. Despite its impressive setup, the project has been delayed by six or seven months due to political issues hindering the customs clearance of our supplies. Nevertheless, the clinic is in the process of being set up.
In my view, bringing progress means introducing new advancements. I firmly believe that we can't continue doing things the same way simply because we assume our patient population can't afford or doesn't understand it. It's our responsibility to educate people. If patients value the services we offer, they will seek our care. Therefore, the investment in creating a top-notch facility is worthwhile.
Ultimately, my goal is to establish a fully self-sufficient team of omni-practitioners, much like myself. As an omni practitioner, I aspire to have each team member focus on what they enjoy doing most. For instance, my associate loves prosthetics, and she should have the opportunity to specialize in that area. Personally, I thrive in perio and surgical procedures. If I can build a cohesive team, we can collectively offer comprehensive services and demonstrate that our practice is on par with any high-end facility in a developed country.
It's essential to clarify that having financial means in a third-world country doesn't negate the need for quality care. My primary job is to provide that care, but it's not to say that I don't engage in volunteer or humanitarian work—I do. However, my primary focus is to sustain the ongoing dental care for those who seek it.
Dr. Ardalan: You’ve talked a lot about prevention, which is music to my ears. Aside from your own efforts, what is the level of dental care in Haiti and how do dentists educate the population about the importance of oral health?
Dr. Zennie: In Haiti, cultural transmission often occurs through radio shows, which play a significant role in educating people about oral health. Considering that Haiti has a population of 14 million and only about 450 dentists in the entire country, there is an abundance of work, with demand surpassing the available resources. As a dentist, people frequently approach you with their dental concerns.
In my courses, I emphasize the importance of communicating to patients that dental care is not a one-time event but a continuous process. I often share monologues with my students, detailing what they should convey to patients about the necessity of ongoing dental care. While my assistants might be tired of hearing my monologues, I believe that patient education is crucial. However, I also recognize the potential for a more extensive and coordinated effort, involving teamwork among dental professionals.
Several of us actively engage with the community by organizing seminars, radio shows, podcasts, and social media content on platforms like Facebook and Instagram. I've experienced a high level of engagement on my clinic's Instagram page, with 30 to 40 people asking questions every time I post. I make it a point to respond to each inquiry individually. While it may take time, I believe that building awareness about the importance of dental care is not only possible but necessary for the community's overall well-being.
Dr. Ardalan: You’re doing a good job setting that as an example, and hopefully, the other 400 dentists in Haiti take that and do the same, continuing to pass that information forward. I heard through the grapevine that you're actually writing a book on your career as a dentist in a third-world environment. I've had the honor of hearing some of your stories, and I was hoping you wouldn't mind sharing a story from the book with the audience, one that best illustrates what you've been able to accomplish in such a difficult time.
Dr. Zennie: When asked to write the book, I initially questioned what I could share that would interest anyone, as I don't consider my work to be particularly special. However, as I participated in online dental groups, I encountered a discussion about the challenges new dentists face in rural U.S. communities due to a lack of support. It dawned on me that my book is not solely about being a dentist in a third-world country but, more specifically, about being an Omni Practitioner left to navigate dentistry without a referral network.
My book, titled "The Omni Practitioner's Handbook," aims to equip general practitioners who are new to dentistry and working independently with the tools they need to handle unforeseen challenges. One of the illustrative stories involves a patient with a previous sinus perforation from the extraction of tooth number 14. Initially, I proposed creating a cast partial and addressing the issue once it closed naturally. However, when the patient returned after a few years, the situation had become more complicated. Another dentist had placed an inadequate implant for tooth number 14 and exacerbated the sinus perforation on tooth number 15.
Despite the challenging circumstances, I was compelled to address the situation. The patient had pus extending under his orbit, necessitating drainage, PRF membranes, and reconstruction. The case turned out to be a success, becoming one of my first conference presentation cases. It highlighted the effectiveness of using sticky bone PRF with bone in one area and just PRF in the other, separated by a septum. The experience demonstrated that success and opportunities favor those who are prepared. Being continually prepared involves sparing no expense on continuing education (CE). While the U.S. dental field is highly regulated, I believe that staying well-prepared through extensive CE has been essential, ensuring that I am ready for any opportunity that comes my way.
Dr. Ardalan: That's amazing. Two things stood out to me after hearing you talk about that. Firstly, the realization that in certain situations, particularly in third-world or rural areas, there might be no alternative for the patient; it's either you or nothing. In metropolitan areas in the States, we are fortunate to have referral opportunities for cases we might not fully understand. However, your point emphasizes the universal importance of self-education. Regardless of the country, advancing one's education allows you to offer valuable services.
The second takeaway is that the complexity of cases involving sinus lifts, implants, and other intricate procedures discussed makes me thankful that I am a pediatric dentist. However, even in pediatric dentistry, there are moments when I'm thrust into challenging behavioral cases, and as a specialist, there may be nowhere else to refer them. It highlights the reality of being a pseudo specialist in various areas, presenting its own set of challenges.
Dr. Zennie: Last week, I had a seven-year-old with a completely avulsed tooth number eight. The schoolteacher had the good reflex of sticking it back in his socket, and he ends up in my chair, and I have to do a split. You have to be prepared for anything. When you're in dental school, you have to be ready, knowing what to do for whatever situation presents itself in your chair, or at least have an option.
Dr. Ardalan: So, this is a good segue. As you mentioned, we're both CE junkies. I'm frequently at meetings where, oftentimes, I'm the only pediatric dentist because I enjoy being out there learning. Would you say you have any particular mentors? Were there good examples of individuals who taught you both about clinical excellence and having a commitment to the community?
Dr. Zennie: Well, let me tell you something; I wouldn't have made it through my first year in practice without the continued support and mentorship of the faculty at Nova Southeastern. I maintain a good relationship with most of my professors. When it came to times where I had to diagnose cases of oral cancer, my first year out of school, I diagnosed verrucous carcinoma. Unfortunately, this patient passed away a few months later, but I was the one who found the cancer. I never neglected the oral medicine exam, the cancer evaluation, and everything they taught me. Dental school is essentially a cookbook, a step-by-step approach to learning how to provide services to someone who comes to you with a problem. Our heads are filled with a lot of information, but it's part of the job to remember and apply that knowledge. The mentorship I received from my faculty at Nova was priceless. I also received mentorship from the implant training I underwent at implant seminars. Later, as I transitioned, I have immense respect for and rely heavily on Dr. Sammy Noumbissi, who is my mentor. I started placing ceramic implants two and a half years ago, and I'm reorienting my practice towards biological dentistry because I believe the basis of inflammation starts in the mouth, and we need to learn how to control it. I practice a lot of that in my office. You need to know what you don't know and what you know. Recently, I called Sammy to discuss a course being given by another colleague. I thought the information was obvious, but Sammy reminded me that it might not be obvious to everyone, emphasizing the importance of continuous learning. If you're still doing the same things you were doing in dental school, you're missing out on advancements in technology and knowledge. Dentistry has changed a lot, and you must have a continual thirst for knowledge to stay updated. I often share this advice with young practitioners – keep educating yourself; it's crucial for professional growth.
Dr. Ardalan: Emma, let me ask you this. Many people listening to this podcast will be amazed by your story and the incredible work you do in such a challenging environment. If there's something specific you'd like us to know about how we can support your efforts, is there anything that those of us in the States or anyone listening to the podcast could do to contribute to the advancements you're trying to make in Haiti?
Dr. Zennie: Well, you know, I have a lot of plans and things I want to do. Right now, I'm focusing on establishing my new private practice. People interested in following my work can find me on Instagram, @dr.emmanuellezennie. In the future, my goal is to establish a foundation with the premise of education. This foundation aims to provide education not only for patients but also continuing education for local dentists and specialty training for nurses to become dental assistants and dental hygienists, roles that don't currently exist here. Ultimately, I hope to contribute to the profession by training additional professionals. I'm tired of seeing everything being so dentist-centric in my environment; I want to shift the focus to expand training to the entire team. So, if you're following my journey, you'll be aware of these developments. Many people have already expressed interest in coming down to teach, and I'm excited about the potential for CE training and sharing knowledge, as stagnation occurs without sharing.
Dr. Ardalan: Okay, so before we end this fantastic conversation, I wanted to ask more about living in Haiti. Given the absence of the rule of law at this time, it seems that you're exposing yourself to risks such as kidnapping, theft, vandalism, and trauma at every turn. Considering all these challenges, why is it that you do what you do?
If you wanted to, you could leave tomorrow, come here to Florida, and you've got your license. Both you and I know there would be a dozen dentists in high-end practices that would kill to have you be a part of their practice. So, how and why do you continue doing what you're doing in spite of all of this?
Dr. Zennie: I'm crazy. For me, you don't choose your home. Recently, the last three or four years have been particularly hard, and we've been going down a path to hell with absolutely no law and no order. We've had an accelerated brain drain in the last few years where young, qualified professionals are leaving, and I can't blame them. They want a better life. I will not lie and say that my life is hard in the sense that, you know, I'm a comfortable person. I live well. But when I leave my house in the morning to go to work, it's a crapshoot whether I come back. Every day, there's someone I know or someone I've heard of that is kidnapped. Members of my family have been kidnapped recently and held for ransom. These are things that are part of our everyday life, and it's terrifying. If I told you that my heart is not in my throat every day when I go home, I'd be lying. You have to be aware of where you live. But the reason why I do it is because we can't all leave. Like, you can't completely drain a country of all its resources, and honestly, that's how you don't pick your home. This is my home. This is where I live. I have to say, many of my friends have left in the last 18 months. Some people in my family have left, so the rows are definitely thinning, and you know, it's kind of sad when you can't find someone to even go have lunch with because you don't know anybody anymore. But I think we're going to get better. I think that we're going to wake up, and the people that are left that actually really want to be here are going to be ready to rebuild when the reconstruction happens. It will happen, and I'll be there.
Dr. Ardalan: I admire your positive attitude, and it's amazing because the way you view it is, instead of leaving, you've already shown by your actions what you continue to do. It's like you're going to stay, you're going to make an impact, and you're going to help rebuild the country from the ground up. So, I so admire everything that you're doing.
If there are folks that want to follow your story, your journey, or find ways to help out, can you give us the best ways to contact you?
Dr. Zennie: Again, you can follow me on Instagram @dr.emmanuellezennie or listeners may email me at Dr.Zennie@gmail.com. And I always answer everybody who emails.
Dr. Ardalan: I encourage all of our listeners and readers to make sure to follow you and follow your journey. This has been an awesome, awesome conversation. I so appreciate you taking the time to be on the podcast.
