Dear administration,

this letter will present our opinion about our stay in Hopital des Enfants at Pellegrin from 10.12.2009 to 11.12.2009.
We decided for Hopital des Enfants because our son (2 years old) has problems with upper teeth. Upper teeth started to decay
very early, at the age of about one year, although his lower teeth remain healthy until now on. We did several attempts to treat
the caries, but our son was too young to accept these treatments. He was crying and screaming very intensive, trying to escape
from the chair all the time. We visited three dentists (Dr Carat-Sarracanie, service d'odontologie et de sante buccale a l'hopital
Saint Andre and Dr Aouidad) before we came to Pellegrin. All three had suggested different treatment for the same teeth.
Therefore, we are sure that opinion of doctors are not unique. Moreover, our son could not ``enjoy'' any of these treatments and
we started to look for a treatment under general anesthesia. Such a possibility seems to exist only at Hopital Pellegrin.
Moreover, we have heard several positive opinions about the hospital. Although Hopital Pellegrin can obviously provide
a high quality service, we are not completely satisfied with the treatment and care our son actually got.
This letter shall be a feedback, which hopefully can be useful for improving Hopital Pellegrin.

The first negative point we would like to mention is the absence of contact with the doctor before the treatment. We received an
appointment for ``treatment and extraction of teeth'' per post. The only foreseen occasion to communicate with the doctor was
per phone. My wife called to Dr Nancy (doctor who treats children's teeth under general anesthesia in Pellegrin) and asked whether it will be a meeting before. The answer was ``no''. She expressed our
wish to keep the teeth. The response was that the doctor will possibly treat and possibly extract teeth according to the
necessity to preserve the health. We started to worry after this communication because we have heart different opinions about the
same teeth from different doctors. However, we did not cancel the appointment because we hoped for a spare, modern,
sophisticated, wise and human treatment.

We had a couple of weeks before and visited our last-before-Pellegrin dentist (Dr Aouidad, Talence). Fortunately, she was ready to
communicate and her opinion about the treat ability of teeth we rather positive. She did a ``radio'' and even wrote a letter to
Dr Nancy with a ``radio'' image attached to the letter. We gave the letter to the nurse boy, who take care of our son before
anesthesia. It remains unknown whether Dr Nancy actually read the letter, but her decision was probable unaffected. She extracted
six teeth because ``they were totally decayed'' without our prior agreement. None of the upper teeth has been actually
treated. It is painful for us because our experience tells not to believe the doctors. Instead, we believe the treatment was too
simplistic. Such an ancient behavior of the dentist (extract teeth without convincing reason and any prior agreement of
responsible persons) is not acceptable today. This is the second negative point we state in this letter. One day, such situation
may also result in a legal process, but we believe that Hopital Pellegrin will gradually change in right direction.

The third negative point is the absence of personal approach to the patient. We decided for the treatment under general anesthesia
because we hoped to relieve the suffering of our young son. Unfortunately, the existing procedure does not fulfill this hope.
Either of us was allowed to participate at the beginning of anesthesia. After actual treatment, we had to wait about two hours
without to see our son. He was surely scared to death and screamed a lot because he strained his voice
when we finally got him back. We think this rigidity can be relaxed, especially if the mental development of the patient or other
reasons (our son does not understand French yet) lead to such nonhuman procedure. Many private clinics achieved much more human
conditions already (couple of clicks gave me this info first in German, second in Russian.

One more observation we did is the difference between word and deed. The evening before treatment a doctor came to my wife and son
in order to facilitate the anesthesia. My wife asked whether it would be possible to see the son after he wakes up. He answered
``yes if everything will be in good order''. We did not see the doctor again. Instead, we had to wait two more hours after
treatment. We conclude that the doctor was careless with his promises. Or, maybe he did not take into account two hours? In this
case, he did not clearly represent the procedure. Anyway, we rarely have seen a medical personal twice---there is no person who is
responsible for a patient. Maybe it is done on purpose, but it lowers the quality of stay and the quality of actual treatment.

The fourth negative point is rather controversial, but we would like to express it nevertheless. It is an unwise opinion of
Dr Nancy. We have seen her twice. Twice she said that breast feeding damages teeth. Who can prove it? Are there medical
studies on this? Yes, there are studies, but to the best of our knowledge, all studies say that breast feeding does no harm to
the teeth. Our knowledge is ``limited'' to the Internet first in Fench, second in French and to our own conclusions, but we
were unable to find any contra against breast feeding. For instance, the anti-breast-feeding hypothesis does not explain
why only upper teeth of our son started to decay and all lower stay healthy. In our personal opinion, the breast feeding
can not cause the damage for teeth. However, we met at least three dentist, who thinks that breast feeding is dangerous
for teeth. If the latter is true, then it would be wise for Dr Nancy (and probable for many other dentists) to arm
themselves with the results of corresponding studies (maybe in form of booklets or brochures) just to become convincing.
As a result of this arming they may start to think, that can not be too bad.

The fifth point is also controversial although not that critical. This would be an inadequacy of the before-treatment procedure.
My wife and son had to stay overnight in the hospital. She had no bed to sleep, only a recliner (armchair). As a result, the night
was terrible for her. In our opinion, such an extended stay might be diminished in many cases. Main reason for such stay is to
stop the feeding at certain time before anesthesia. We think that doctors could rely on parents at this point, or enforce a proper
behavior legally: by signing an agreement with responsible persons.

The last point we mention has purely administrative Nature. We have a basic medical insurance ``securite sociale'', which does not
cover all the cost. Therefore, we asked several times about the prices. Unfortunately, we could not get any clear view of this
question because prices changed from 250 Euro (response we got by phone) to 3000 Euro (response we got in the hospital at the
evening before operation). After the operation, a representative of ``secirite sociale'' visited us in the ward. Even she could
not estimate the cost.

Finally, we would like to mention several positive points because we strongly believe that the Hopital Pellegrin is a good and
probable unique hospital in the whole Aquitaine. The reception was quick, without any queues. There were only two patients in
the ward. The medical equipment in the ward is well maintained. All the personal was friendly and acted adequate. The doctor
responsible for anesthesia, who visited my wife at the evening before, knew that it is enough to stop the breast feeding four
hours before anesthesia. The representative of ``securite sociale'' came to us and suggested to pay our part of the cost by
parts, which is essential in our case.

We hope this letter will help to improve Hopital Pellegrin, which can become not only unique but also the best hospital in
Aquitaine.

With best wishes,

Petr Koval

Natalia Koval

14.12.2009

http://www.links-vom-rhein.de/anaesthesiologie/kinderanaesthesie.php

http://www.dentalfantasy.ru/index.phtml

http://www.lllfrance.org/Allaiter-Aujourd-hui/AA-54-Caries-et-allaitement.html

http://www.lllfrance.org/Etudes-sur-l-allaitement/Caries-et-allaitement-quelques-etudes.html