0:06

Hello and welcome to Behind a Smile

0:08

. I am Dr Chantal

0:11

Ambrose and I am a dentist

0:13

. I host a healthcare business

0:15

podcast where I interview healthcare

0:17

practitioners around the world , sharing

0:20

tips on how to improve your healthcare

0:22

practice , innovate and

0:25

grow , while living your best

0:27

life . We share products

0:29

and information from healthcare partners that

0:31

can help you in your practice journey

0:33

, be it a startup , a family-based

0:36

business or a multidisciplinary healthcare

0:38

team . Most of the information

0:40

provided here is based on personal

0:43

experience and opinions . Of

0:45

the information provided here is based on personal experience and opinions , so please

0:47

supplement what you learn here with approved research , studies and professional

0:50

advice . Thank you to everyone

0:52

who has subscribed and I invite

0:54

you to join our community

0:57

. If you haven't , we would love to

0:59

hear from you . If you would like to

1:01

be on the show , drop me a mail

1:03

at behindasmile2 at

1:05

gmailcom . Let's make

1:08

it happen together . So welcome

1:10

once again . It's Chantal from Behind

1:12

a Smile . I haven't been around for a while . It's

1:15

been an emotional rollercoaster

1:17

of having lost my dad

1:19

. Today's one of those very special

1:21

tributes . It's something

1:23

that I wanted to dedicate to his memory

1:26

and was something that I

1:28

think that he played a huge

1:30

part in the way I was able to

1:32

manifest a business and

1:34

get step-by-step mentorship

1:37

and eventually get to

1:39

the point where I'm at right now . But

1:41

I've been lucky enough to have more than one

1:43

mentor in my life along my journey

1:45

, and today I get on my

1:47

show yet another one of my

1:49

mentors that I've been lucky enough to

1:52

. Somewhere during my really I

1:54

think we were going through to a

1:56

teaching meeting and

1:58

I was lucky enough to meet my husband

2:00

at one of these meetings and today

2:03

I have him on our show . So

2:06

I want to introduce to you Dr

2:08

Kabir Rajkumar , and

2:11

I've been lucky enough to work

2:13

alongside him for a number of years . But

2:15

I've also been lucky enough to actually

2:17

learn a lot from him , and the

2:19

reason we're doing this show today is not

2:21

due to any nepotism , because you

2:23

know by now that I actually am

2:25

one of those super ethicals that

2:28

if I go wrong I will apologize

2:30

and I will move on , but I will also put

2:32

in place a lot of processes and systems

2:34

so that that mistake doesn't happen again . It's

2:37

actually so that you can realize

2:39

that anything is possible if you are

2:41

able to put your step in the

2:43

right direction and somewhere along the line

2:45

you meet the right people , and I've been lucky

2:48

enough to have met him . So

2:50

just a little bit about

2:52

his CV . It's

2:58

quite humbling to read digital dentistry

3:01

and the application of technology

3:03

to offer the ease to

3:05

dentists with speed , reliability

3:08

, convenience , serving patients

3:10

in a modern way to solve

3:12

age-old problems . Now

3:15

he claims his purpose for a decade

3:17

is to offer his services to patients

3:19

suffering from trauma as well as pathology

3:22

in the maxillofacial and oral region

3:24

, and he has a number of accolades

3:27

, and I see that he hasn't really touched base

3:29

on many of them , on many of his

3:31

qualifications , which again

3:33

is part and parcel of

3:35

the package of Dr Ash Kumar , and

3:37

I think that a really wonderful

3:40

part of his written

3:42

CV here is that

3:44

he's been given a rare glimpse

3:47

into the lives of South Africans

3:49

and how , when the basic

3:51

humanity and kindness is stitched

3:53

together with clinical expertise

3:56

, not only do you get

3:58

to improve their ailments but

4:01

add a smile to their scars

4:03

the way very few

4:05

practitioners can . And

4:07

so I'm very humbled to introduce

4:10

to you Dr Kabir

4:12

Rajkumar , very well known

4:14

as Dr Raj , welcome

4:16

.

4:17

Hi everybody . Hi , chantelle Babes

4:21

, it's great to finally have

4:23

earned the right to be on your show . I've been begging

4:25

you for quite a while to get on and I'm glad I'm

4:27

finally there . Yeah , it's a bittersweet

4:29

day . As you know , we've laid your

4:31

dad to rest today , so I'm really really sorry

4:34

about that , and he's a man who I've held

4:36

very close to my heart . What

4:40

I've learned from him over the years has been massive , and hopefully I can grow our

4:42

lives and plants the way he's

4:44

grown his , and that's what

4:46

I want to try and get done to make him just

4:49

a little bit proud of my lifetime .

4:50

I appreciate that . I think that it's

4:53

a hard day for both of us and I

4:55

think that it's important that we

4:57

still have something to give to our

4:59

audience . I always feel like it's a little

5:01

gift that we give every single time

5:03

that we record , and it comes from

5:05

incredible people that we give every single time that

5:08

we record , and it comes from incredible people

5:10

that I've had on the show , you being

5:12

one of them . I think that it's always wonderful to have someone behind

5:14

you every step of the way . That will give

5:16

you something positive about what you're going

5:18

to do , and I think that I'm very

5:20

grateful to have that from you . But

5:23

I think from all of the time

5:25

I've met a lot of dentists , from all

5:27

of the time that I know you , I think the most

5:29

humbling thing about you is that

5:31

the way you do community-based

5:33

health is absolutely epic

5:36

. I've never met anybody

5:38

that is so committed to their job

5:40

but more committed to their patients

5:42

. They're nearly almost

5:44

to that point where they

5:47

could probably drop almost anything to

5:49

get it right , and it doesn't

5:51

necessarily mean that you need

5:53

to be particularly wealthy or

5:56

you need to be someone to get great

5:59

treatment . Now , I can't say that

6:01

is true for everyone , but I

6:03

do think it's true of you . So can

6:06

you tell us what has led you to

6:08

that community-based journey

6:10

?

6:11

As a practitioner and as someone who's

6:13

just trying to look out for my patients and their best

6:15

interests , being able to serve communities

6:17

. It started for me very , very early on

6:19

, even in my undergrad actually . In fact , I

6:21

was on the teleprompter train where we were

6:23

all the way in Saldana attending to patients

6:26

there , and it was something which , for me

6:28

, I had the opportunity to treat patients

6:30

who I'd never seen before , never experienced

6:32

before , and learned a lot from them and were able

6:35

to give them a little bit of relief in their mouth

6:37

for a bit and I thought that was a reasonable exchange

6:39

at that point in time . And you know , this stemmed over

6:41

all the way into community service for

6:43

me those who know I was in Pofana

6:45

, which is Moira of a clinic . So you

6:47

know , apart from seeing a lot

6:49

of patients every day , from the

6:52

least I think I'd get to see is about 10

6:54

. And the most went up to 40 or 50

6:56

a day for a single practitioner at that stage

6:58

was massive . And I was lucky

7:00

enough to be able to have excellent

7:03

resources at my lovely clinic with my previous

7:05

CEO , mrs Lachwayo . It was an absolute

7:08

treat for anyone leaving university

7:10

and being thrown into the bushes literally

7:12

to practice dentistry and

7:15

to offer expertise and a perspective

7:17

of your mouth to patients . Amongst

7:20

my friends , I believe I had the most best

7:22

kitted out surgery at the time . We had a fully

7:24

functional chair equipment . We had two

7:26

autoclaves . I even had a

7:28

Kodak RVG and

7:30

an x-ray sensor for me as well

7:32

and an assistant . So I was very spoiled

7:35

for choice in what I could have done and at

7:37

that stage I had reached out to

7:39

one of the guys at head office in Peter

7:42

Marisburg and I asked them for filling material

7:44

. I asked him for root canal stuff and

7:46

off I went , because naturally you just

7:48

left university knowing crown and bridge

7:51

and root canals and a whole lot of shallow

7:53

chamfers and deep chamfers in terms of your

7:55

preparation for crowns , and now you're just going

7:57

to do extractions all day long . It's not something

8:00

I was prepared to do . So I pushed for

8:02

that and I got it done and you know it was

8:04

one of the best things . Where at the local

8:06

supermarket I would go to

8:08

just get little groceries or whatever . And

8:10

one of the patients who I did composite

8:12

veneers for she had fluorosis . So

8:14

I just did a six to six composite veneers

8:17

for her and as I'd walk past she'd

8:19

say Togatela and she'll smile at me

8:21

and

8:29

she'll show me her teeth and everybody else would look and think what is going on between these two

8:31

. But you know it's very humbling and very grateful to have been given that as a gratitude and

8:33

as a thank you rather than just thank you . So that's where there's a bug for

8:35

reaching out to communities that don't experience

8:37

dentistry , let alone aesthetic dentistry

8:40

, at that level where you're able to actually improve somebody's

8:42

smile . You know the

8:47

stuff that you'd like to see on Instagram and all of that , and you're able to reach

8:50

out and improve these patients' lives . And that facility grew so big that we

8:52

ended up being booked out for a few months

8:54

. In the two years that I was there in Moira

8:56

, my ex-assistant Siabonga and we

8:58

got up to lots of fun , and you know part of reaching

9:01

the communities . He's taught me Zulu and I've

9:03

become quite proficient at speaking Zulu . So

9:05

you know it's being able to reach out , to touch

9:07

people's lives , and they touch you in return

9:09

in a way that this bug bites

9:11

you and you want to do community-based stuff

9:13

some more After

9:19

Moirova . I've then left and I joined Gray's Hospital in Peter Marisburg , as you know where

9:22

I'm currently based , and you know I joined a maxillofacial and oral surgery unit and

9:24

the community service still hasn't stopped

9:26

. We still see a massive drainage

9:28

of population from the KZN province . If

9:31

you just go back and have a look at 20 census

9:33

, kzn's estimated population is about

9:35

12 million and the various districts

9:37

which we drain are five of them all the

9:39

way down from Kockstad , all the way up

9:41

to Newcastle , from

9:46

Cox's Dad all the way up to Newcastle . So that's a massive drainage of the interior

9:48

region of KZN known as Area 2 , which we drain and see for maxillofacial and oral

9:50

surgery problems , trauma complications

9:53

from dentists in the periphery

9:55

and we're able to assist them and chat

9:57

to patients and get to meet them and help them

9:59

out with whatever they may need . Sometimes

10:01

it includes surgery . That's how I look

10:03

.

10:03

Okay , so we know that . Now perhaps

10:06

community is not something that you chose

10:08

. I think community chose you from

10:11

the sounds of that story . I think

10:13

that in private healthcare what happens

10:15

is we really get to

10:17

see maybe just a few

10:19

parts of South African

10:22

stories . So when

10:24

we talk and I don't think many of our

10:26

guests won't understand that sometimes our

10:28

dinner conversations are often about

10:31

some graphic trauma cases that you

10:33

may have done , or some really difficult

10:35

pediatric cases that I have done , or

10:37

whatever it could be . Sometimes we'll work together

10:40

, sometimes we work with other teams . So

10:42

what's really , I think , critical to

10:44

understand , and something that I've learned from

10:46

you , is that I've always been

10:48

in private health care , but I've

10:50

never truly understood

10:53

the requisites of public health care in

10:55

South Africa until you really

10:57

share a little bit of what that looks like . Now

11:00

we talk about the health care crisis

11:02

in South Africa , but I don't

11:04

think that we truly understand it until

11:06

you walk that path Right . So

11:09

can you tell us a little bit about what

11:12

in the hospitals are you seeing

11:14

? So what kind of trauma are

11:16

you seeing in the dental chair ? Are

11:19

your dental chairs working ? How long

11:21

are you waiting for beds

11:23

and how long are you waiting for theatres ? What

11:25

is the South African perspective in government

11:27

hospitals ? And I'd like to mention that this

11:29

is a perspective , but I do know

11:32

that some of our government

11:34

hospitals are some of . Actually , they

11:36

may be comparative , if not better than a lot

11:38

of our private institutions . In fact , we

11:41

would love to hear . What is that when

11:43

you walk through those doors and you're

11:45

not going in as a patient , you're going in as

11:47

a doctor and you're part of the

11:49

maxillofacial department . What does that

11:52

look like in government ?

11:54

Well , from my experience , you know , fortunately

11:56

in Grey's Hospital we are tertiary unit , so

11:58

we've got a lot of facilities that are available

12:01

to us . Things look nice and pretty , they

12:03

are kept as best as possible , and this is

12:05

my experience of it . And you know

12:07

, we've all heard and seen the horror stories

12:09

of patients lying in hospitals

12:12

without cushioning , lying on the floor , sleeping

12:14

on the floor . These are all true . These

12:16

are all true as far as I've seen Not as

12:18

much as perhaps other people have , but I

12:20

can certainly confirm . I've seen these things

12:22

with my own eyes and it's unbelievably

12:25

humbling and you leave being completely

12:27

grateful that you are a little better

12:29

off than someone right next to you . But

12:32

it also leaves you with the understanding

12:34

that you can offer more to

12:36

these patients just because of their situation

12:38

. It doesn't mean that the bare minimum

12:40

would be adequate , the bare minimum being

12:43

you'd see the patient in your chair with whatever

12:45

they've got , check on them , find out how

12:47

their treatment plan is going , do an x-ray

12:50

check if everything is in order

12:52

. Is there anything getting better ? Is it getting worse

12:54

? Do you need to do anything ? And thank you

12:56

, goodbye , here's your next appointment . You can visit

12:58

the pharmacy on your way out . I think if 90%

13:01

of South Africans receive that kind of service

13:03

they'd be all right with it . It won't be the best thing they've

13:05

ever received , but they wouldn't complain terribly

13:07

much about it . Then you go a little bit deeper

13:09

and something in you will ask well , where are you

13:11

from ? And the patient will give you a response

13:13

and they will tell you well , you know , doc , I've actually

13:16

traveled two and a half days to

13:18

get to you . We've slept overnight

13:20

in the hospital that has referred

13:23

us and from there we've had to take

13:25

a taxi or we've had to take public transport

13:27

or a family member has had to drop them

13:29

off and they are a certain distance

13:32

away from that family member or

13:34

transit point as well . So

13:36

these patients , they travel unbelievably

13:39

far distance . They have to travel with their blankets

13:42

, their pillows , change of clothes , food

13:44

, and some of these patients that we see are

13:46

children as well . So it's really

13:48

unbelievable the amount of distance they

13:50

will travel to see you . And when

13:53

your service is just adequate , it's just

13:55

not good enough in my eyes . You need

13:57

to be able to offer so much more and more

13:59

than just your service . It's just that human

14:01

connection , just a basic . How are you

14:03

doing ? How's things going ? Hey , I see you've

14:05

traveled from here . You know I have a friend who's coming

14:08

from there . You know how

14:14

far are you from this hospital ? This is where they work at Just a little bit of chit-chat

14:16

, basic raw . But you're still able to relate to that even though this patient is so far

14:18

removed from where you currently are location-based

14:21

. But you're still able to develop

14:23

and establish a connection with it . And

14:25

you know I have this problem of fly fishing

14:27

and fishing in my life . So a lot of the

14:29

places I know which are out

14:31

regions are famed for fly fishing

14:34

and river destinations . So you know , I chat

14:36

to the patients about it and a lot of them look at

14:38

me and , yeah , this guy doesn't

14:40

understand . Man , there's no rivers near us . That's

14:42

a good , far long walk away . You know

14:44

it's a lot . It's a lot and state

14:46

hospitals do have a lot to be

14:48

desired . But it comes with this

14:51

burden of health care and oral

14:53

health problems that we have in South Africa

14:55

. And I firmly believe , even if

14:57

you have that volume of patients

14:59

and that number of morbidity

15:02

and mortality that state hospitals

15:04

have to bear , if private hospitals have

15:06

to bear that same load , I think they won't look far

15:08

off . It's simple numbers . It's

15:10

a simple numbers game , I feel . I just feel

15:12

that there are some which are needing

15:15

a lot to be desired . And then you get

15:17

our very own in Durban , in Kosi

15:19

Albert Lutuli Central Hospital , which has got

15:21

phenomenal support , beds

15:23

, status , facilities and doctors

15:25

. And one must not forget that the very

15:28

same doctors who are in private hospitals are

15:30

also those who are sitting in

15:32

government hospitals on a part-time

15:34

or a permanent basis . So

15:36

it's not as though the hands that treat

15:38

are different in the private sector

15:40

. A lot of the time it is shared and it is the

15:42

same , and the difference is probably the mindset

15:45

of the practitioner , or maybe it's the facilities

15:47

that they have at their disposal . And you

15:49

know , a lot of the time it's something

15:51

that is a little bit of ingenuity

15:53

which needs to happen in the practitioner's head

15:55

. They're needing to problem solve at a level

15:57

which you won't find in South African dental

16:00

journal or somewhere on Google . Very quickly

16:02

. It's about applying principles which you

16:04

have to fix your problem . It's not

16:06

ideal , it may not look pretty , but it will fix

16:08

the problem at least as best as you possibly

16:10

can . Yeah , so you know , that's what

16:12

public health looks like in South Africa at the moment

16:15

. In my eyes and you know I'm not sure

16:17

if it's always a budget issue

16:19

that is the problem , but a lot of the time it may

16:21

be people not placing orders

16:23

in time to replenish stocks at

16:25

certain levels it's smaller system

16:28

errors that I feel could be corrected . But perhaps

16:30

it is budget issues , perhaps it is political

16:33

pressure from different sides which I'm not

16:35

all clued up about , and I think these all

16:37

culminate in sometimes a situation

16:39

which looks very , very hard , sore when you

16:41

look at it from the outside , but unfortunately

16:43

for these patients , they've understood this

16:46

to be a normality For them . They've grown

16:48

up . This is how you attend a hospital

16:50

, this is what it looks like and this is how you need

16:52

to prepare to go for it , and that

16:54

, for them , is a normality . And hopefully they

16:56

find some people along the way who are

16:58

able to at least make that doctor-patient

17:00

interaction a little bit pleasurable , even though

17:02

it shouldn't be because you're coming for an illness

17:05

or an ailment , of course . But if you can make that

17:07

just a little bit better and just give

17:09

more than just oral healthcare advice

17:11

or more than just your clinical

17:13

perspective on what's going on , I

17:15

think that human interaction is very valuable

17:18

. It is what will make us human after all . But

17:20

perhaps if we do that more we'll find a little

17:22

bit more light in the world .

17:24

It's a very special person that gets to

17:26

be able to still have that empathy

17:28

by the end of the day , because , you know , if

17:30

I had to take into perspective what my patient

17:33

load on a busy day looks like and what your

17:35

patient load on a busy day looks like , I

17:37

think that even the strongest practitioner

17:39

, with the best intention , will have it hard

17:41

to have not eaten for the day and still have

17:44

15 patients waiting in line

17:46

. And

17:48

I think that what's also

17:50

quite incredible is the type of procedures

17:52

that are being done in the chair , because

17:54

you know , when you're in private , it's not

17:57

something where you would be hands-on with

17:59

fractures in a chair or you're actually

18:01

doing excisions in a chair . So

18:03

can you share what kind of procedures

18:05

?

18:06

Oh , absolutely . You know , this is something that

18:08

we've started to develop within our unit and

18:10

I'm very , very lucky and blessed to have been

18:12

surrounded by a team who have got

18:14

exceptional clinical skills

18:16

, great team presence , and they're able to

18:18

just get it together and just

18:21

push work out in a orderly manner

18:23

to the best of their ability , get the

18:25

job done , get the patients moving and

18:27

keep them as comfortable as possible . I think

18:29

when you consider that , with

18:32

the volumes that we're seeing every day , every

18:34

week , every month , it's really a mammoth

18:36

task which my team and I

18:38

are able to succeed at and that's fantastic

18:41

. So , as you're aware , you

18:43

know , unfortunately we only have one theater

18:45

slate a week for anything

18:47

maxillofacial and oral surgery . That's not an

18:49

emergency . So anything elective

18:51

will be done on one day every week

18:54

, providing it's not a public holiday , of

18:56

course , and on that one day you

18:58

could get a maximum of four

19:00

to five patients done . Now let's

19:02

do the maths on that when we see patients

19:05

over Monday , tuesday , wednesday and Friday

19:07

for reviews , we are seeing an average

19:09

of around a week for the past

19:11

year and a half . So that's a massive number

19:14

and a lot of those patients simply cannot

19:16

be done in theatre . It's just that

19:18

their fractures cannot wait . It will be well

19:20

. Okay , let me say the fractures may

19:22

wait . You certainly are allowed

19:25

to put a patient on a waiting list and wait

19:27

and let this waiting list build up until

19:29

a few years' time . But there are other options

19:32

which you have . Wiring under chair

19:34

under local anesthesia has been done successfully

19:36

for a long time , and biopsies

19:38

and excisional biopsies have been done for

19:40

a long time as well under local anesthesia

19:42

. However , when you turn into consideration

19:45

the age of the patients that we're starting

19:47

to see , with problems with fractures

19:49

, with tumors , with growth starting to develop

19:51

, you need to think of a kinder and a simpler

19:53

and a gentler way to manage this . And we've

19:56

resorted to sedation , and by using

19:58

sedation , naturally , one would start with verbal

20:00

sedation . We don't have nitrous oxide

20:02

at our disposal in the clinic , but we

20:04

do have some ketamine which we

20:06

do use , and it just makes light of

20:08

a very , very difficult scenario . We've

20:11

been having to do ORF , that

20:13

is , plates and screws for fractures

20:15

on the chair , on a regular basis under

20:17

local , because we just simply can't

20:19

delay their treatment any further . Your

20:21

bookings are a few months in advance and

20:24

these may be acceptable for other types

20:26

of ailments , but for this kind of fracture

20:28

it's not advisable . The patient's difficulty

20:31

to manage basic everyday functions

20:33

with that fracture will just be too

20:36

difficult to manage . So we discuss

20:38

it with the patient and we tell him this is the

20:40

plan , this is how we're going to move forward , excuse

20:42

me , we get our consent and we move ahead

20:44

and we get the treatment done as quick

20:46

and as pain-free and as efficiently

20:49

as possible and the patient's on his way

20:51

. Naturally , ketamine is a drug

20:53

which can cause respiratory depression , so

20:55

you need to be very careful who you use it on

20:57

and you need to use the correct doses with these

20:59

patients . I've been able to do archbioelastics

21:02

for a three-year-old who's

21:04

fallen off a jungle gym and fractured their mandible

21:07

. We've done massive cysts . I

21:09

mean from 2-4 all

21:11

the way up to 3-6 . So that's almost

21:13

a complete mandible . This

21:15

cyst has been enucleated , luckily

21:18

. You're going to go for , or what would be

21:20

advisable would be a unicystic lesion

21:22

that you're going to enucleate and you're going to

21:24

naturally play to the presentation

21:26

that you have . Is this patient someone you

21:28

can consider this option for and are you going

21:30

to do any benefit ? Will you actually

21:32

will your effort and will the patient's sacrifice

21:35

? I'm going to say what you're going to put them through

21:37

, will that be worth what you will achieve ? And

21:39

these are very , very difficult to predict because

21:41

they're not only your factors as

21:43

a practitioner and your skill and your resources

21:46

and the chair time you're going to use , and

21:48

you also have to consider will your patient

21:50

be able to manage this ? Are they able , going

21:52

to be strong enough ? Will they just not manage

21:54

? Will they be too emotional to bear with

21:57

this ? And you've got time ticking away

21:59

because , as you said , you know there are patients

22:01

waiting in the queue wanting to know why they aren't

22:03

seen yet , because you're taking an extended

22:06

time for a procedure . So you

22:08

know , naturally you have your monitoring and

22:10

you wait for your patient to be completely

22:12

functional before you release them from your

22:14

care . So all these little factors which are

22:16

important and which will really help you

22:18

and your patients , it's a great advanced

22:20

procedures , not only in the chair but even

22:23

in the field . You know I had a course

22:25

where I did advanced wilderness emergency

22:27

medicine and this is where my introduction

22:30

with ketamine began .

22:33

Yeah , you know , it's fantastic to be able

22:35

to have a team where you get advised

22:37

on these drugs that

22:40

I think you will need advice on in

22:42

order to use them , and I think

22:44

that collaborative care that happens

22:46

in these hospitals

22:49

that are able to service patients

22:51

at the level that some of the procedures

22:54

you've mentioned would not even

22:56

be considered as an option to do in

22:58

a dental chair unless you have general

23:00

anesthetic , and given the fact that

23:02

these patients are traveling for days sometimes

23:05

to reach you , they haven't had a meal

23:07

and they're often kids sitting and waiting

23:09

in line and maybe refused

23:12

to be seen for a number of

23:14

different other general health

23:16

issues that take precedence

23:18

over the dental issues , even though

23:20

they have either pathology

23:22

or fracture related or trauma

23:25

related injuries . So , you

23:27

know , in all , I think the collaborative care

23:29

is something that is outstanding

23:32

. If you had to . I

23:34

recall a story where you were just

23:36

saying that a dietician asked you to do a frenal

23:38

release because there was

23:41

a baby that just wasn't feeding

23:43

well , and you know that sounds

23:45

like such a that sounds like such a

23:48

collaborative way to be able to

23:50

solve problems at . Maybe this , it's

23:52

this team at large , it's

23:54

even when a medical doctor asks

23:56

you know , do you have a chlorhexidine , at least

23:58

for the patient , because they're still needing to wait

24:00

in order to go to theater for weeks . You know

24:03

, it's almost as though each

24:05

person learns a little bit more about

24:07

somebody else's medical care

24:09

and then offers it

24:11

to people where they fall

24:13

within that category , and I think that

24:15

everyone gets better when

24:17

everyone collaborates and everyone

24:19

learns . So I think I recall

24:21

you saying to me that you were quite

24:24

involved in getting a

24:26

paperless system launched

24:29

in your hospital . Can you tell us a little

24:31

bit about that ? Yeah , I know that you're driven by

24:33

technology , so yes , no , no , no , no

24:35

.

24:35

This has been a project which I've been

24:37

involved in for a while now and we're

24:39

trying to . It's kz and health driven

24:41

, and what is trying to happen is

24:43

we're trying to create a health system

24:46

e being electronic health , where

24:48

the files that go missing and patients

24:50

who were supposedly

24:52

booked but are not expected

24:54

on a specific day , this electronic

24:57

system , which will be database

24:59

driven and stored up on

25:01

a database accessible to

25:03

South Africa at least KZN for

25:05

now , but countrywide in future

25:07

where all of the patient's details

25:09

their name , date of birth address

25:12

, what they attended , which hospital

25:14

did they get blood results , were there any

25:16

x-rays and all of this available

25:18

to a practitioner anywhere with access

25:20

to e-health . So you know it's something

25:22

that I really really like and you know I've tried

25:24

to prototype and develop one for our

25:26

own private practice . The point is is

25:29

that nothing can really be technology-driven

25:31

. It's always personally driven

25:34

, it's person-to-person , but the

25:36

technology behind it will make that easier

25:38

and faster and hopefully cheaper

25:40

as well . This is where technology will come

25:43

in . Technology will never replace people

25:45

. Ai is simply a tool for

25:47

people to use to make things

25:49

better , easier , cheaper , faster

25:52

. It will not replace people , at

25:54

least in the near future

25:56

. So with that in mind , the technology

25:58

is simply made to make things quicker

26:01

and streamlined and it doesn't make

26:03

people wait out for so long . You get

26:05

the complete patient on a single piece

26:07

of your laptop or tablet , whatever

26:10

you have at your disposal at that point in

26:12

time and that bit of technology

26:14

will help you see your patient completely

26:16

. You won't miss out information which

26:18

would be the patient may have forgotten to

26:20

disclose to you . Perhaps you're seeing a patient

26:23

who is unknown at the point in time

26:25

but based on their blood results , based

26:27

on other things , you're able to track this quite

26:29

quickly and get a name for this patient and contact

26:31

their family members and inform them of their

26:34

family member being ill or being found

26:36

at a hospital . So it's a fantastic

26:38

initiative and I think it's going to go

26:40

quite far in terms of reducing

26:43

that gap of lack

26:46

of or , let me say , suboptimal service

26:48

delivery . It will really improve that

26:51

, because all it will do is it

26:53

will make things much more efficient

26:55

. Everything is timest stamped and practitioner

26:58

stamped , so if you see a patient

27:00

on a certain day , it will be . Your name would

27:02

be written clearly , legibly , and

27:04

your notes are written in a orderly

27:06

fashion . It will even guide you through your

27:08

examination process . It's still in

27:11

its infancy , but it is progressing

27:13

and it is coming forward and should be implemented

27:15

in a few hospitals and rolled out in a few

27:18

more as we go on . So yeah , I was

27:20

very privileged to be involved with that

27:22

and that was exciting . I enjoy technology

27:24

and enjoy applying that to healthcare

27:26

systems and problems and that's fun , that's exciting

27:29

.

27:29

You know , listen , I think that the future

27:31

is something that may look actually

27:34

quite promising for our oral healthcare

27:36

public system , but what's your

27:38

perspective of that ?

27:39

So remember I currently think

27:42

that that's going to be magnificent . You

27:44

won't have patients with files missing . As I

27:46

said earlier , all your x-rays will

27:48

not be missing . They will be found in one place

27:50

. There's an app which

27:53

we're currently using which is called

27:55

Vula . Now a lot of practitioners

27:57

across South Africa are using this and it

27:59

is a referral app . So if

28:01

you're sitting somewhere and you find a patient with a

28:03

problem , you're not sure what it is , but you can find

28:06

out what this is . You've got access

28:08

to a phone and you take pictures of your

28:10

patient , you take pictures of the file of

28:12

your blood results and you send this to somebody

28:14

. Anyway , it doesn't matter and they will be able

28:16

to give you more information in real time

28:18

and tell you okay , maybe this isn't me

28:21

who will be able to attend to your patient's needs

28:23

, but I know who can , and you involve them

28:25

in that conversation as well immediately

28:27

, and this is tracked , so it

28:29

is stored , it is archived . So two

28:31

months down the line , if there is a problem

28:33

, I can go back and refer to this and I

28:35

say but , doc , you sent me this patient , but you

28:38

didn't send me what I asked you to send

28:40

me , and why have you not done that . I've

28:42

asked it repeatedly and you still haven't provided

28:44

it . And now we have a problem

28:46

where we're needing to solve this issue . So

28:49

that ability to go back in time

28:51

where notes can't be edited and you

28:53

know , from a medical legal perspective , this gives

28:55

you a very solid standpoint to

28:57

defend yourself from , because everything is

28:59

clear in black and white . The clinical

29:01

information is there , as well as the communication

29:04

, and it just makes it more efficient

29:06

. It makes it also when you get to

29:08

handover , it's quite clear in your department

29:11

or between your colleagues that this

29:13

is what was done , this is what I've asked for , this

29:15

is what I've received , this is when the patient is

29:17

coming . This is my plan . We're just waiting

29:19

for them to arrive to execute the treatment

29:22

. So it makes it very efficient , that streamline

29:24

and flow which happens , and it just makes

29:26

things quicker .

29:27

So your outlook is that the future

29:29

is good .

29:30

Definitely . I think it can only be good from

29:32

where we are at , and the only people

29:34

or the only reason it isn't better

29:36

is a human reason is people

29:39

not wanting to adopt technologies , not

29:41

wanting to use it for the best advantage

29:43

and also not looking to improvise

29:45

and take on how do you say calculated

29:48

risks that are still safe for your patient

29:50

, but risks that will certainly improve

29:52

the well-being of your patient , but is not

29:54

what is normally done in your facility

29:57

currently and that's going to only

29:59

improve your patient's well-being . And if

30:01

we are not advocates for our patients

30:03

, nobody else will be . There's no

30:05

one else who will fight for a patient other

30:07

than their own practitioner , and if that is what

30:09

we are doing , or if we fail to do

30:11

that , I think we really need to think about what

30:14

it is we're actually doing at that point in

30:16

time , because it must always benefit

30:18

the patient .

30:20

I wonder if many people know that you

30:22

are a very involved fly

30:24

fisherman and you've been featured in

30:26

a few fly fishing magazines and

30:28

you have been given some wildlife

30:30

photography accolades . So tell us a little

30:32

bit about that .

30:34

Well , I think , thanks , you

30:36

know , from a very early age you know this

30:39

. In my career at least , publication

30:41

was something I enjoyed . I enjoyed documenting

30:43

something and getting a photo of it and

30:45

printing it out in media . And Moira

30:48

started this disease of mine where

30:50

after work the sun would set at

30:52

about seven o'clock so you'd get at least a

30:54

good few hours of fishing before you got back

30:56

for supper . So you know , that's where this disease

30:58

of mine started . And when you're in such

31:01

pretty surroundings and you're chasing

31:03

this fish or you're just chasing this

31:05

chance to be around water or

31:07

be around a river , it's just very , very relaxing

31:10

, soothing and calming and that's fantastic

31:12

. It's really interesting and it's fun . And

31:15

it's also a technicality . There is

31:17

a rhythm , there is a muscle

31:19

memory which you find in fly fishing and

31:21

it becomes an art form when you look at it

31:23

after a while . Then you can take this art

31:26

form to various lengths and depths

31:28

according to your ability and will

31:30

and time . Really , you can tie flies , like

31:32

I do , or you can drive up to Lesotho

31:34

whenever you get a chance and do fly fishing in

31:36

the mountains there . But

31:42

you know , the funny thing is it also teaches you discipline and patience , and these are

31:44

things which you can apply to your everyday dental practice too . So there you

31:46

go you become a better dentist by

31:48

being a better fly fisherman . Comes from me

31:50

.

31:50

Well , I quite like that . I like any sort

31:52

of original spin on how to improve

31:55

our work and how to make it more

31:57

fun . So I really enjoy that tip

31:59

. But you know , coming back down to

32:02

what your main line

32:04

of work is , which is with oral surgery

32:06

, and you have a dip in oral surgery and it's

32:10

almost your love job that you do-

32:12

it is I think a lot of people

32:14

in private move away from

32:17

surgical extraction simply because they feel

32:20

ill-equipped to do so , and I'd

32:22

be interested for hearing from

32:24

you what advice do you have

32:26

to those dentists .

32:28

Well , I think , first and foremost , it's quite

32:30

clear to identify which teeth

32:32

you would suspect to be high-risk

32:35

teeth . Naturally those teeth which

32:37

are root-cannelled . They are more brittle and

32:39

more prone to fracture and therefore there will be harder

32:41

extractions . Premolars , we know , are notoriously

32:44

difficult to extract Impacted wisdom

32:46

teeth the same . So I think the practitioner

32:49

needs to guide or at least gauge

32:51

their ability in an honest

32:53

fashion , rather than you know what . I can

32:55

pull a few extra codes if I take out this wisdom

32:57

tooth here . That would be great for my

32:59

bottom line for the end of the month , and that's a dangerous

33:02

trap to fall in . It may work once or

33:04

twice , but there will come that time

33:06

where you get caught out and if you don't

33:08

have the ability or the tools

33:10

or the know-how to get yourself and

33:12

your patient out of that situation , it becomes

33:15

ugly quite quickly . So I think identifying

33:17

which patients are high risk for being

33:20

difficult in extractions is a number

33:22

one , it's foremost , and it begins

33:24

right there . The rest , what you can

33:26

avoid , you must avoid the rest . You

33:28

do the best that you can , while doing as

33:30

little damage as possible to your patients

33:32

, and identify when to

33:34

call it quits and when to explain

33:36

to your patient . Sorry , forgive me but

33:39

I'm not able to complete the job which

33:41

I've started . So this is my

33:43

plan going forward and I think it's important

33:45

to do that . And why I say this is over the

33:47

few years only from state

33:49

, I

33:55

need to emphasize some of the practitioners who contacted us were from private as well , where it

33:57

was an extended duration of an extraction , difficult extraction

34:00

from the beginning tooth snapped off and

34:02

multiple times there were teeth fragments

34:04

breaking off and after an hour and a half

34:06

, multiple injections , local anesthetic

34:09

, multiple lengths of chair time

34:11

, multiple x-rays . Later you got

34:13

a fractured mandible and that could

34:15

have been avoided at an early stage

34:17

. And I think it's important with practitioners

34:19

from the private settings who may be not doing

34:22

surgical extractions as frequently

34:24

, to know when to call it quits and when to

34:26

refer that off to a colleague maxillofacial

34:29

and oral surgeon or whoever you're comfortable

34:31

with sending the patient to assist , to

34:33

get that patient sorted , rather than

34:35

continuing and ending up

34:37

harming the patient in a greater way

34:39

, even though it was not what your intention

34:42

was , but that may land you in a

34:44

bit of trouble with our governing bodies . That be

34:46

Now . But with that being said , we've now

34:48

removed what we can from the problem

34:50

scenarios . Now we're going to go to the skill

34:52

level part and I find a lot of practitioners

34:55

don't open flaps quite frequently

34:57

and these are things which we were taught quite frequently

34:59

in undergrad and I find a lot of private

35:02

practitioners and even sorry

35:04

, I'm not going to say private , let me say general

35:06

practitioners don't open surgical flaps

35:08

up frequently . One of your principles

35:10

of surgery is access and vision

35:12

. You need to be able to see what you're doing and

35:14

digging with a crier into roots . Vision

35:18

you need to be able to see what you're doing and digging

35:20

with a crier into roots , into

35:23

how do you say cavities within bone that's bleeding makes it very difficult for you to see what's going

35:26

on . So , yeah , I think improving your vision and being able

35:28

to get those roots out would help quite

35:30

a lot .

35:31

What most generalists need to know is that

35:33

they need to know where their boundaries lie

35:35

, where their expertise lie , where their experience

35:37

lies and whether or not they're going to be able to manage

35:39

that patient and to recognize the danger

35:42

and then to communicate to the patient

35:44

with some sort of support . Absolutely

35:46

, so the patient's not left in the lurch to go to whoever

35:49

it is that's going to now just help . Whatever

35:51

situation it is , whether it's an OAC or

35:53

whether it's a broken root or whether it's a very

35:55

humbling premolar which I think every single

35:57

person I know has been humbled by one premolar

35:59

in their life , and if they haven't , they still have a number

36:02

of years to complete in their dental journey

36:04

. Absolutely so it's just

36:06

one of those rites of passage and

36:09

I think that , yeah , that's really

36:11

great advice for anyone that

36:13

is in that position where they

36:15

just feel like they're

36:17

not going to do any surgical extraction

36:19

simply because they're just not equipped to

36:21

, and now they know that they need to have

36:23

a few people on board to maybe gain

36:26

some of those skills and if they're not feeling

36:28

confident , maybe it is the best to just

36:30

refer on without

36:32

now leaving the patient in a lurch and maybe

36:34

still giving them some level of support . So we

36:37

have run out of time , and

36:40

my last question is what

36:43

inspiration do you have

36:45

that you can leave us with for

36:47

today ?

36:50

Well , I think that inspiration is

36:52

all around you , it is everywhere . It's

36:54

just you need to be open to the

36:56

perception of beauty , and the

36:58

perception of beauty can be found in simple

37:01

, everyday things . Or it can be found

37:03

in the magnificence of a blooming

37:05

orchid . It can be found in the magnificence

37:07

of casting a fly out into a river

37:09

and watching a fish bite your fly , or

37:11

just taking a photograph of a sunset

37:14

. You just need to be open to the opportunity

37:16

of it and receptive to that opportunity

37:19

, and sometimes the best sunsets

37:21

are those which are not photographed . Be

37:23

present in the moment that you're in , put

37:25

your phone down and just absorb it . Be

37:28

present in that moment with your loved

37:30

ones , with your family , and enjoy what you

37:32

can , because sometimes they're not there anymore

37:34

. Yeah , I'd like to close with that .

37:36

I'm highly appreciative of you being able to

37:38

share this really

37:40

intimate journey with me , for

37:42

today that's owed

37:45

to the death of my dad , and it's

37:47

really sad yet embracing

37:49

sort of . You know , your moments become

37:52

heavier and your days become longer

37:54

, and in that exact single moment

37:57

I actually really reach

37:59

out to every single person that has

38:01

to go into work tomorrow and still

38:03

have had something that made them

38:05

really heavy for the day and

38:07

still need to have to give off themselves

38:12

personally to their patients

38:14

, because really that is what we're meant

38:16

to do here . We have taken that oath for

38:18

improving somebody

38:20

else's life and I think in many

38:22

ways , you do that in every

38:25

way possible . So we're very grateful

38:27

to have worked with you , to be with

38:29

you and to have shared this moment

38:31

in time . Thank you

38:34

very much

38:38

. Have you ever wished

38:41

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38:43

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