Ten years of Confidence for Children in Osh

Weare sitting on the plane on our way to Osh. Ten years have passed. My thoughts go back to the early days. The orthodontics clinic is the jewel of the hospital and its veritable showpiece. Despite the old, used dental chairs, for which spare parts have not been available for years, the white room still exudes a modern touch. There are information brochures and pictures from Switzerland and Kyrgyzstan, and the shelves are filled with dental health items such as toothbrushes and interdental cleaning aids. It is a colourful collection that stems from variousdonations from Switzerland.  

The people we have been working with and teaching for ten years are still the same. They are chief surgeon and patron “Osh 1”, now Professor Abduyrakhman Eshiev, his son and Kyrgyzstan’s youngest professor Danijar, his son-in-law Nursultan and Asamat, another relative. If there is one thing we have learned in all these years, it is to accept the culture here with its good and bad sides and all of its quirks. We do not question the team, which mainly consists of relatives of Osh 1. We have come to know each other, and our stories, as well as only good friends can. We have become family members, and have been invited to weddings, birthdays and opening ceremonies. We have experienced both infinite hospitality and infinite gratitude from the cleft children and their parents. We immersed ourselves deeply in the Kyrgyz culture, which was strongly influenced by Russia during Soviet times, and now understand things – such as the reasons for certain actions – better.

We have been through highs and lows, and political upheavals such as the one that is occurring right now have shaken us, our work and the sustainability of the project to the core. The government is currently making a great effort to combat corruption. Of course this would be a wonderful approach if more money were to flow into the hospitals, if they were then able to buy the urgently needed supplies, equipment and instruments themselves, and if doctors were paid decent salaries. But sadly, that is not the reality. 

We have solved some problems; others we have not. It is precisely the difficulties that we have been struggling with for years that we should see as a challenge. We do not always manage to do so. Frustration and joy are often only one breath apart. We are still looking for solutions for organising the cleft consultation clinic and the recall system, for example. Cultural backgrounds and the (non-)performance mindset of our colleagues get in the way.

We enter the orthodontics clinic with excitement after being away for a whole year. In the run up, we have been informed that a treatment chair is defective, some devices such as the EMS no longer work and materials are needed. Every time we come, our arrival seems almost like Christmas for the team. They eagerly watch us unpacking our suitcases. This spectacle did lose some of its sparkle over the years, but now it is experiencing a revival due to the current political circumstances. Danijar accepts the plates and screws from KLS Martin with enthusiasm and gratitude and disappears happily into the sterilisation area. The first operations are already planned for the next day and have to be prepared. 

The doctors are full of excitement – and pride – as they present their patients to us. The results are quite acceptable and certainly of a high quality by Kyrgyz standards. Nevertheless, we cannot hide our disappointment with regard to thedocumentation and planning of cases. Their approach to a case is still “Kyrgyz style”. Look at the patient – assess what you want to do today and what you could do, and then get started.

The need for documentation is ignored. Instead of longer-term planning, the next treatment step is spontaneously redefined at each visit. Unfortunately, it is still the case that little to nothing is written down. As a result, an ongoing course of orthodontic treatment is hardly comprehensible for Marcel. This prolongs the treatment period by months or even years, which has serious consequences given the high levels of tooth decay. It is not uncommon for teeth to be pulled between check-ups because of pain, with the result that you suddenly find yourself faced with a completely new situation. 

With this particular mission, we are setting an additional example because cleft surgeon Dr Tine Jacobson is a woman in the otherwise male-dominated team. For a Kyrgyz god in white, as is still the prevailing view of doctors here, this is inconceivable. After this week, Danijar says with acknowledgement: “Until now, I could never imagine a woman being a cleft surgeon!” He now understands that if you have a good technique, there is no need to be particularly strong. He has had to change his mind and is looking forward to further operations with her, he says. He could not have given her a nicer compliment.

After years of discussions, our Kyrgyz friends have finally accepted that speech therapy has an essential place in any cleft team, for the benefit of each individual child. They asked for support and now Sabine Peter has joined us as a myofunctional therapist. The aim is to train women here in Central Asia who are highly motivated and have a strong interest in continuing to learn. It is always remarkable to see how people in emerging countries crave education and specialist knowledge. This week, a group of six speech therapists will share information, exercises and intercultural knowledge. Sabine sees a lot of satisfaction and recognition among the doctors, the patients and the incredibly grateful parents.

THANK YOU to everyone who has supported or helped us in any way to set up the cleft centre in Osh.