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The Nuts and Bolts of Global Dentistry

Ken Pierson DDS

Description

Objectives

1. To provide real world, practical tips for excellent dentistry and an effective dental practice regardless of location. 

2. Illustrate the importance of medical missionary service locally and internationally and its impact on patient outcomes. 

3. Discuss how to apply professional talents in responsible stewardship. 

 

We are all called to something beyond "normal" or "average" in our careers. God can use you and your unique talents and abilities in great ways, if you allow Him. Explore and redefine what responsible stewardship is in your career. Uncover practical tips for excellent and effective dental practice. 

Presenter

Dr. Pierson graduated from LLUSD in 2000. After graduation he worked as an associate in a large group practice for five years. During this time he met and eventually married Crystal Edmister LLUSD 2005. Ken and Crystal moved to a little island in the Pacific called Saipan after Crystal's graduation from dental school. They worked as medical missionaries at the Saipan Seventh-day Adventist Clinic from 2005 to 2018. They have four young daughters, each born in Saipan! They recently moved back to California to be closer to family. 

Conference

Recorded

  • October 26, 2018
    2:00 PM
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All right so Carlos help me come up with some objectives. Just go over them real quick to provide real world practical tips for excellent dentistry and effective dental practice regardless of location illustrate the importance of medical missionary service locally and internationally and its impact on patient outcomes this cause discuss how to apply professional talents to Responsible Stewardship well after kind of doing a little bit more looking into it I was like Man how my going to talk for an hour and then I was thinking how am i only going to talk for an hour because I was a little too much to kind of bite off in just an hour but anyway this little bit about us. I think I know most of you but Crystal Here is my beautiful wife and we have 4 daughters. And really that was taken a few months before we left. Upon the hill and you can see kind of ocean in the background. Tinian Yeah that Indians the neighboring island that's right over there that was when it was still pretty because just a few days ago it got stomped by a major super typhoon so I'll show you pictures in just a little bit but. Graduated School of Dentistry 2000. Christa graduate in 2005 and right after she graduated. We took off to site pan and we've been there. Until just this last July actually there was about a 11 month period when we came back to California which was a planned kind of. Return back to California to help out the family and work at my dad's practice and then we went back for 2 more years and then just came back in July. I did a little bit in Malawi right after dental school and I thought there might be some dental students here but I don't think there's any dental students are you OK So to you specifically right after graduation is a perfect time because you've got Guess what 6 months grace period so I guess if you're really smart you'll learn that he you know you'll spend time earning some money to make that 1st payment easy and with the amount of debt these days that might be necessary but anyway when I graduated I went straight out to Malawi and covered a mission practice longway Atmos clinic for 3 months while the guy that was stationed there went on furlough and it worked out great it was really awesome to go that's where I'd grown up so I was awesome to go back. Then I was in a group practice here in San Bernardino or from 2001 to 5 and then we've been at the site and something of a clinic until July and then since July we moved back to the Central Valley California and joined my dad's practice and he has a very unique practice it is the sufficiently pediatric general anesthesia dentistry so it's kind of the end stop for everybody that has extensive decay or problems or issues behavioral whatever it is to prevent them. Or on the spectrum or whatever it might be to prevent them from having dental work done and then they come to refer to us and we do everything under general anesthesia. It's an actual surgery center so it's Jayco certified ambulatory surgery center which is pretty unique. Arfield dentistry. Anyway so some getting used to working with kids that are all asleep but that's what I had done 2 years prior and actually we had gotten that going inside pan so there was we made connections with the local anesthesiologist there was 2 of them at the time. At the hospital inside Pam and so they would give us kind of their post call days. And so they would come over who would have these kids lined up maybe do 4 or 5 cases in a day and they'd give us about 5 days a week so that was really it was a it was great for the island because you know there's a way that these kids could be treated because you see so much rampant decay and you know that goes back to habits and stuff anyway so now we've got our for 4 girls and the 3 my brothers 3 girls all together they were able to come out to site pan a couple months before we actually left Sea in that time clicking down and having never made it out there for like 13 years these they found these super cheap tickets on coming through Hong Kong and so they nabbed them and they came out to see us so now it's just crazy all the time whenever they're together I mean it's all 7 girls all together or you know it's just it's crazy. How many singles in the room how many married OK So everybody I guess there weren't any single so yeah my mouth about. This is a must read you guys have to get out your phone and snap a little picture of that and then go on Amazon and buy it for $15.00 or whatever it is or get it used or buy the audio version. This is top notch. It's is not the kind of how to fix your marriage book it's understanding marriage from a biblical perspective and it is excellent so I just wanted to throw that in there highly recommend it we were listening to it on the way down again and it's excellent so. This is what I do now every day. And you know it's. This type of thing just rampant you K. and. So these teeth all came out. And crowns on the ones that you can say and so actually I think this case was inside Pam I don't think this one of the ones that was that was here in California access to care is a little better here so things don't get quite as advanced but we still see crazy stuff so OK moving on I'm going to start from the bottom and move up because it's going to give our foundation so we'll talk about the clinical stuff a little bit and in a minute and practice stuff but just want to talk a little bit about your professional talents and stewardship and I think a lot of times we when we think about stewardship stewardship we kind of automatically go to. Want money right it kind of always when you think of stewardship you're thinking about managing a lot of times I think about managing my money giving money that type of thing I believe that we have to change our understanding of stewardship and understand that money is just a small little Raksha of stewardship. You know I. Your time your talents. Everything that God has given to you is a gift and it's not actually something that is in the yours it's something that God has intrusted to you and you have the ability and responsibility to move forward in using that talent for God's glory and benefit. The parable of the talents you guys all know that story you remember. The owner. Is going to go on a long trip gives each of them a talent or talents and then returns and says What have you done and. So you know I would not say that it's I believe that all of you are here because you feel that you have been called and you have a responsibility or service so. Just. Moving forward in that kind of mentality like understanding that you know a lot of times I remember when I 1st graduate I'm like I busted my tail to get through dental school and it's very easy to kind of think that it was you that you know it was because you studied hard because you're smart enough because you had the discipline whatever it is but think of it like this who gave you the ability to do that who gave you the brains who gave you the motivation who gave you the Dr who gave you the ability to actually complete your dental school or your residency training whatever it might be and when you think of it in those terms that it wasn't wasn't something that originally originated in you it just helps in being able to be a good steward. Couple pictures of the clinic that's my youngest daughter Laya right there she would always come over the clinic and kind of help out with. You know this was her classmate actually being a small island you know everybody kind of knows everybody and so she would come and help out this was Frank he was a dentist in the Philippines and a dental therapist in sight pan and. Anyway. We would do a clinic with a heart kind of based off of the clinic with the heart that Loma Linda to always did and so this is on one of those clinic with the heart days where we get the kids out there helping and everything and. They're seeing a little kid. Just a baptism that you know. Out in the lagoon this looks very very different now. All these are completely stripped many of them are down. And I'll show you a few pictures. In a 2nd work with a heart filled with an earnest longing for souls do medical missionary work thus you will gain access to the hearts and I think that is the theme of this conference and that should be. Our theme no matter where we are or what we're doing if we're in a practice somewhere in the United States whether we're going on a short term mission trip where they were on a long term mission. Call whatever it might be if we have this and understand this as being how powerful it is as as a way to minister to people in need it would just it changes changes your perspective it changes what you accomplish and what you can get done for God. OK So moving on to a little bit of clinical stuff has anybody had a had this happen have a patient was sensitive after a crown prep that eventually led to doing root canal treatment. So that happens a lot frequently and in my experience I will be that it is because it's iatrogenic it's because of overheating and I have actually unintentionally experimented on my dad I did a crown prep on him. And the piece was working great and did a lot of water a few had a lot of water and it was seemed nice and cool the year a few years later I did a crown prep on another 2 I did in his surgery center office and we didn't really have a good A We didn't I didn't have an assistant and. The water control usually worked dry a lot of times you do a lot more dry when you do in GA dentistry and he had sensitivity on that tooth for 6 months eventually he didn't have to have a root canal but so I truly believe that when they're numb and you overheat that that is what is causing them to get that thing to eventually fail to just can't handle it. And you know eventually they just need a root canal so what I really tried starting to do started doing is slow down a bit. Don't keep the burr on the tooth use plenty of water and keep it cool and when I after doing that for the last many years I had a lot less that would have post-op sensitivity and have pain and. Hardly any of that ended up needing a root root canal. This right here is my new favorite material and I don't have lots of favorite materials I used to love amalgam and now I don't use it how many use it like 6 years. This right here is a lifesaver. I love it it's great I've had super strong super durable matches Well it's dual cure. Dual And I mean do so so it'll cure no matter if you put a light on it or not I use it just like a regular composite it's a little bit more runny it's more like a global composite but it's not a float composite so we've been using it in Pito I've been using it in Petone now for 3 it's only been out for about 5 years I think and I've been using it for about 3 to 4 years and. Way way way less Bowyer's than glass eye on them are and of course since I don't use them out them anymore I mean among them is is very durable very strong kind of kills all the bugs you don't get off as much recurrent decay but it's got Mercury I mean seriously I just don't think I just don't think that it's the best thing to be putting in patients mouse at this point in time knowing what we know so I think there's plenty of other alternatives that are superior. For a long time I was doing a sandwich you know for Class 2 that were down below the C.J.. Down on to the Denton I'd put like. 9 or 2 down in the bottom of the box and then do the composite up on top of that and that worked really great I have no problem with that but this. Has the same components as a glass eye on them or but it's much stronger and much more durable. Really well. And it actually has chemical release and chemical bond. Releases calcium possibly And so this is my new go to for all class 5 and all my paedo restorations and I highly recommend it if you haven't used it give it a try because it's such a big gun the handling of it is a little bit. Cumbersome at 1st but you just have to kind of stabilize it or you know get used to it it's really not that big of a deal. But I really like it and the so my dad does all the exams for the recalls and stuff that. And not all of them so we don't actually have a recall system but they get sent back if there's you know recurrent DK or if there's another problem or something and so he's the one that does all the exams we had a guy in the office that was using only flowable you could market a year and a half later all recurrent U.K. underneath of Lobel almost almost across the board you would have recurrent DK that on the. Whole margin of the box we have another guy in the office all he uses is packable composite he's very careful his do pretty well. But according to my dad now he is a little bit biased to act as well but he said that all the ones that I did in 2015. There's have held up really really well like he's not seen the marginal kind of breakdown where you get that brown line around your composite and the recurrent decay at the box there's another favorite of mine and. This stuff is in my opinion far superior to any other Paul capping material or anything that has any contact with the pulp. People don't use it sometimes because they think it's expensive or whatever else but you know if you have a pulp exposure on an adult tooth you better tell them that's a root canal like you have to say that you're going to need a root canal and just go ahead and schedule that root canal However with M T A. You can try sometimes you know you can give you know like especially if there's you know I've had to do a couple Perth repairs I had one lady come in she had a post kind of coming out the side of 2 like this I didn't do it if I had I I would still say I had but no I had a post coming out the side of the tooth and. I said you know I don't think that we're going to be able to save this tooth but we can try I've got this material that I really like Says done really well for me. You know we can give it a shot and see how you do but you know I you're probably going to have to have it taken out and have an implant place or a bridge and so we gave it a shot and. I did a post op that was to 2 years ago I did a post op on her and side pan before I left and I had put a new crown on that tooth and everything and it's doing perfect that that perforation was kind of right at just below the. P.D.L. and it had healed up to flee everything that was super stable and I saw it was really mobile and not really mobile had some mobility to it and anyway doing really well so you can use it for. Her for repairs. Vacation apex Genesis a fickle ectomy what I've kind of used at the most because I'm not a huge capping fan at all I'm definitely not a. Leathery layer kind of. You know they told us that and else and I have no idea if they still do that but it's like leaving an infection over the pulp I mean it just doesn't make sense to me so. This is just one that I just recently did because I still use the stuff all the time seeing a huge pediatric population you get these kids that are 78 years old 10 years old and this what you see right had a big no see what was done turned into decay OK you can't really from this to you can't really see but see the discoloration all the way around I mean my photos are not great this was just with a little intro oral camp. But anyway so 11 year old little boy number 19 he's only had that tooth were you know 4 years so remove the DK had to open it up it was huge of course you got a major publics voter like I said Never leave a leathery layer of infection bacteria on your paul get rid of it if you happen to get into the pulp Well then you got your choice what would you do if you take this tooth out or she save it I mean is quite a bit of tooth missing on the buckle side but on the on the top the cool surface not too bad so men take this out yes the orthodontist should you take out 1st maulers. No way I mean you've got to save those as much as possible so so what did I do. Controlled the bleeding Well 1st of all look at the color of the blood you know if it's serious kind of like really watery looking serious look in blood it's already too far gone. If you pop into the hall space and it's black. Obviously you got to be doing a root canal or taking the thing out but when you've got a vital Paul even though it was carious even though exposure the decay went all the way to the pulp. If the pulp bleeds normal like it usually does on a healthy kid that's never had any work done on that tooth before you've got usually got an open apex for the next 3 years after eruption for sure it's going to work if you've got an open apex 100 percent going to work if it's got a close apex most likely still going to work if they're young because you've got good lead supply. So cleaned it out use a little astringent or I used the troll groups. Used the troll to kind of control the bleeding and then. Use a little bit of so you have a claw right on a little cotton pellet the cleaning kind of disinfect clean it really well rinse it real well and dry it off and then apply M.T.A. So there's the only time I use an amalgam carrier nowadays is to place the M.T.A. and. That really works kind of well the package down in there when you place it and then you get your low condenser and pack it down. And then I used to when I was 1st doing this probably. 151415 years ago. I would temporize it with Cavett and then have him come back a couple weeks later and go ahead and restore Unfortunately what most of them would would not do is come back with a follow up visit so then you're. Left seen them couple years later and the tooth is pretty much destroyed you know sometimes you know it's just broken or really badly decayed because you didn't have the restoration in there so now what I do is I put some lime light directly over the pot or over the. You've got to make sure that you're sealing all the way around because if you don't seal it and if you have too much kind of empty a coming out from under the edge when you really wash it good and clean it that little things it's not a pop right off and going to come flying out so you just have to make sure that you have a nice clean border around your M.T.A. and you get that lime light all the way around it and then. Go ahead and. Bond and restore and that was when we were done you can see kind of the margin here and of course I use. And I think it. Came out good no pain post-operatively no sensitivity and I do probably. They come in come in waves but probably on average maybe one or 2 every other week like this. Yeah I don't. I bought fill up if it's really deep then all you know is really if it's beyond 4 millimeters then I will put down a bottom layer cure it and then build it up there but. It has one of the lowest shrinkage rates of any composite material so and like I said I haven't seen the pulling away. The lines that you could have easily get around composites that. Are right this next thing that I want to share with you also clinical. Is huge news gigantic news. This should change the way we all practice whether or not we learn more about it and get into it will be up to you but it is. Really profound so we have any hi Janice you know originally. Has anybody read this book or heard of this book. The Heart Attack gene by Bradley Bale and the and Amy. I would recommend this book start with this book because it will tell you. The it's basically this. Scene looking at heart disease cardio cardiovascular disease and how dentistry is poised at a very is very critical to actually making a difference for cardiovascular disease and heart and heart attack and stroke. This article this our UPS this article right here published high risk paradigm passages contribute to the pathogenesis of atherosclerosis and that was in the post grad Medical Journal 2016 this is new stuff. High risk oral bacteria is equal to is causal to heart attack and stroke from everything that I've kind of you hear about it's associated with you know it's like yeah it causes inflammation you know that type of thing this is taking it 5 steps beyond that it's not just associated it can be the cause of the heart attack or stroke and the research that has been done actually shows that periodontal disease the high risk paradigm pathogens they are not just saying do you have a deep pocket here no they're actually testing the oral bacteria have you ever heard of oral D.N.A. labs OK So they're actually you can do a Perry 0. 00 path. Screening with saliva and they will actually list out your paranoia pathogens and actually see which ones you have if they're the high risk ones moderate risk or low risk and if you have the high risk ones those little guys can actually it causes tremendous inflammation and this inflammation is not only just like systemic inflammation those little bacteria actually can become stuck in the intimate. And actually can be causal to the actual heart attack there's some US other research that I didn't. Put up but there's a guy in Italy I believe his last name is. High Sierra Pecci or something like that and he actually sucked out. Blood from somebody in that was having a heart attack and actually from the they actually threw fluoroscopy actually determine where that blockage was happening and sucked out blood and actually found 14 out of 14 of those patients had. The highest they all had the same bacteria that were found the primary bacteria that were in that lesion were the bacteria that were in their. Failed root canals I mean that doesn't give you a little bit of pause you know it's kind of because I've always been the guy like you know what it's not bothering you. You know don't worry about it you know I can't who does I mean anybody here do retreats I guess in insight Pan I got into doing R.C.T. retreats because there was no endodontist to send them to so you know and I kind of pick and choose because they're hard and so you know you have somebody with an able call lesion you don't have any pain no problems as the guy is saying no and you know don't worry about it you know if it's just a bother you then will take care of it not anymore now I see something with a big old lesion like that I say well we can try to retrieve it but I think I'd recommend taking it out. You can have something else later you can replace with a bridge or or a. Implant but you know so to me actually my dad read the book and he was inside pan a few months before we left and we took a hand on him and it's like that look at this big lesion that you've got on this root canal treated to. Doesn't bother me at all yeah look at that thing like take it out like. You sure take it out so I figured out so who knows he didn't how do bloodwork before and after which we should have done which would have been good to see because you've got actual. You know biomarkers So these guys actually have this whole They'll don't mean method which is where we actually as dentists and hydrous you partner up with. Medical practitioners that are doing following this veiled only method and you can actually they believe this or I mean believe it or not they actually guarantee that you are not going to have a heart attack or stroke while you're under their care. And they'll give you all your money back if you do that's how confident they are in the fact that they have heart disease figured out they do genetic testing to see if you have that's why they say this heart attack gene because that's part of it but then they have more than just H. C.R.P. right. C.R.P. is the influence of planetary marker and not just testing that I mean they're looking at a whole list of these biomarkers and they're seeing that they can treat everything else and not treat the periodontal disease or the untreated root canals or. Donna genic infections or failed root canals and. The inflammatory markers will be way up they take those out or treat paradigm Aziz all those markers come back within normal limits fascinating and I really think that you know we should jump on board they are looking for I just attended to lectures by Dr Bell and Dr Dhoni. At the Hawaii 80 a convention just last week and so I have read I read the book about 2 year and a half 2 years ago and ever since then it kind of changed the way I'm thinking about things. And I took They have a little online class that you can take specifically for dentists and dental hygienists so just visit. Bail don't need dot com This is one of the statements that they made the dental community has a substantial opportunity to mitigate the number one cause of morbidity and mortality namely cardiovascular disease by elucidating feasible effective management of paradigm of disease due to high risk pathogens so check it out. They you can go to a course that they that they're trying to get the word out there they're trying to get partnerships between medical and dental I took this book and gave it to some of the physicians inside pan and they were extremely appreciative. My my dad tried to give it to one of the doctor that he's the physician that he sees and he just said. Not really interested I can throw it in the trash as well as you can so maybe just take it so you know you never know how it's going to how people are going to you know if they think that these guys are quacks or not but I believe that they are on to something and within they believe and I believe that within 10 years this will be fully accepted I think I think it's it's unequivocal even today they're Merican Heart Association has already put out a statement that the evidence is that paradoxal pathogens and heard on Aziz are more than just associated they're causal. So. Let's talk a little bit about. Patient outcomes and making a difference which is one of the other things that how we do in. 10 minutes Right OK So you know you never know how you're going to make a difference you really never know what what things are going to present themselves. So I have a couple 22 well 3 little things 3 stories. Going to recognize this one so this young this young lady showed up what do you guys what do you think of like oh man that is a big infection right. Oh my goodness I have not seen an affection that big and I'm like let me take a look at her. That is not fluctuate at all that is rock hard. My goodness OK so kapan Oh. Yeah any ideas. So. I had no idea what to do so I was called up my oral surgeon friend Dr Miranda right here and said LOS I have I need you we need your help this little girl she's I think she was 16 and 16 or something she's got Medicaid she's got There's nothing I mean there's no options for her she was depressed she's thinking about suicide. She's not going to school so of course Los is like Yo I am an oral surgeon but I did not do stuff like that I shot 3rd and that's all I ever plan to do so I'm just getting. So so anyway I twisted his arm I'm like come on those you can do it you're the only one you've got to help this girl and he's like let me see what I can do well one thing led to another he got. A company to. Fabricate and donate a plate. And ended up coming out with one of the residents and the 2 of them and me I kind of got to be in there and I didn't do too much but this fun to kind of be in there on the surgery. Got to resect this thing this was after surgery she was. Extremely happy. Because she looks. From that that this is how it looks so. They were able to retain the condyle and then they put in this plate they got 3 screws in right there hoping that that's going to last and 12345 screws down here and of course it wasn't I can't go into all the details it didn't. They had a little bit of a post operative infection that Carlos had to deal with then. Anyway she was doing really well well what happens if you don't get bone in there broke right there and so. I let low snow and came out and they fixed it they put in another one I don't have that X. ray I was waiting for stuff some stuff came through from Cyprus and but like we have the Cone Beam of it and hoping to show that but anyway the next one that they put in was just it's never going to break I mean it's like looks like a mandible the thing is like how thick was that probably 4 by 153 by 15. Yeah and that was milled So it really I mean it was beautiful it looked you know and they were they were still able to retain that condyle and. You know it's just nice and they can came all the way around and looks good. And that was. 3. 23 years ago I forget exactly but she's doing well in fact right before we left we were probably about a month before we left we're walkin. On that beach that I showed you and she's we're just with the family you know we got there and walk in the evenings and stuff and say doc like. A line the how are you doing and she's doing she's doing great she's out there walking exercising she's working at the airports and she's doing so so much better. And have as a normal life because of that I mean before she was she was you know really really down and out and. So you just you just never know the opportunities that are going to come your way I mean I'm sure you know Carlos didn't expect that and you know. But it made a profound difference in her life this is house and used to be. One of the problems that we have there is Beatle not now not is not that is chewed and this is actually pretty mild as far as like you can tell that she's spent lots of time rubbing it off so it's kind of worn I mean they kind of get this gritty stuff to rub it off so they have whiter teeth but one of the problems with the donut is. Causes Cancer oral cancer so. You know as a general dentist you know. Deal with cancer you deal with cancer I mean if you go through your entire practice and maybe do one biopsy or send them to the oral surgeon for the biopsy and send them off to to get biopsied I mean that that might be that might be it you know. But inside pan because of. Use We just saw a tremendous amount of oral cancer. And there was nobody to invite sees so I started doing biopsies started to try to you know learn as much as I could and. Became the kind of guy that they would send them to for biopsies you know even from the hospital you know they would you know I saw. Or a biopsy that the oral surgeon had done I mean not the oral surgeon the general surgeon and he just like whacked right through the gender and now they had a huge Perry 0 defect I mean they just you know just don't know how to handle stuff around the in the mouth and. So anyway they would they start sending me these these violent scenes to do. This particular guy his name is Melvin and he's. An oral cancer survivor we took this picture probably. I think it's a few days before we left we were packing up and he came by saying goodbye. But. I guess the. Point that was going to make is you just don't know exactly how. In what in what ways you're going to be able to. Make a difference so. Like in his particular situation he comes in. And he's got a big lesion on his tongue. I took one look at that thing as I man this does not look good and I spent some time explaining that you know it could be cancer we just don't know when to actually get the biopsy and I said you know there's nobody on the island that can do the treatment do you what do you want to do I mean you know I'm going to refer you off but it could take months I mean we could just take this whole thing out or we could just like take a little piece of it and he's like take it out like Are you sure because sometimes the oral surgeons in the tease don't like that and he's like no you take it out as I go K. so I took it out I mean the thing probably was a little hairy Actually I should be Sherron to the oral surgeon that I'm doing that type of stuff but I mean I was probably about. 66 centimeters by 4 centimeters and had to do a little tie off because there had a spur in there you know as he was clamp it. With a hemostat and these little tricks that Lohse taught me and. Title suture in there will suture would quit leading and then put some big sutures through the tongue to kind of synch it down and prevent any bleeding and start the referral process so he was in Guam seen in T. probably about it happened pretty quick in his situation is about 6 weeks later and. That in T. saw that the of course that the. The path report was swimming so I saw the saw the empty the M.D.C. it you know we need to go back in there make sure that there's all the margins are clear. And do a radical neck so he did that I encouraged him to do it in fact is insurance wasn't going to cover it and he's like you know I feel like I've got to do this otherwise going to send me to the Philippines and it's going to take another month or so before I get treatment I might just do the surgery so he did the surgery and it was a 16 hour surgery. They removed you know all the lymph nodes up underneath and there were there was one really big one that was already affected and then he went on to the Philippines for radiation and this is when he came back. He had lost I think I think it's said he lost about 40 pounds and you know he's pretty pretty thrashed pretty weak but he's alive and I think he's probably going to. Going to survive because of it this is the school now so this is you know we were looking at pictures. Just on the way down here this morning and some of the ones that show really even more of the devastation. We did we're able to get on here because these are just the ones that we got yesterday. But you know trees are. Trees are completely stripped this there was a. Amin or like a covering that was built right along here last year last summer uniform was like a gathering place and have their morning chapel and everything right underneath this big awning that went in front of the school so this is the upper level and round level of the sign fence something of a school and this was the big awning they're all gone all these trees down. This is just flipped cars over I mean it's just is just crazy. That the pictures that are coming out of there are just you can't believe it's that used to be an airplane that's wrapped up in the in the chain link fence at the airport that's inside the domestic terminal just thrashed That's just outside the domestic terminal that just I mean that things just I mean he imagined that huge structure just got just got. Pummeled I mean he said to take down this steel and concrete structures like this this is out in front of the clinic you know the clinic actually fared very well. So we just praise God for that. But the power pole is kind of half down there and. You know trees are down no windows were broken though. That's tin sheeting from somebody's roof probably across the street because Trans America across the street just got thrashed I mean it's just this demolished that is the gymnasium at the local public Catholic school that's got thrashed. So we set up a crystal set up a Go Fund Me page. To. Try to raise money to help. The people in the SO THIS IS WHAT IT IS Go Fund Me dot com slash site pan dashed wrong dash typhoon dash You Tube So if any of you are able to contribute. We ask for your prayers for everybody over there Dr creed Warren sitting here is now the clinic director inside pan and. He'll be flying back he was just over to the 80 A and now they meant conference he is flying back later or next week. So as soon as the flights are back up and running you know he'll be back over there. What's the update is admin estate going to send out he people and stuff address Yeah so if you if you have connections talk to myself or Dr Creek here as far as like any ideas or you know aid or support or anything this this storm that just hit last I mean just this Wednesday just a few days ago there people are just getting out now to actually go and survey the damage but it is there was one US World and News New News and World Report that said it was the strongest storm to make landfall on any U.S. soil crazy so that means stronger than Katrina stronger than the one that hit. Puerto Puerto Rico. Stronger than the other ones that have hit the islands we had a really bad one inside pan 3 years ago I mean this is just way beyond that supposedly they had sustained winds of 180 miles an hour I went directly over Tinian which is the neighboring island we haven't been in touch with anyone in Tinian yet but I'm sure that that place just got devastated site Pand got winds for a long time but they were just to the outside of the eye so when you're at the eye you get the strongest winds right at the outer edge of the inner edge of the outer edge of the eye the inner edge of the of the hurricane or typhoon and those winds were 180 miles an hour sustained and then you get twice see it comes over and then you get a little bit of reprieve and while the eye is directly over you and then you get hit the other direction when it goes past so anyway keep them in your prayers please and if you have any financial support or any other support that you are able to give that would be really. We do and. So that's what I have no time for questions. This media was brought to you by audio 1st a website dedicated to spreading God's word through free sermon audio and much more if you would like to know more about audio 1st if you would like to listen to more sermon leave to visit W W W audio verse or.

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