Dental Project Peru Trip 5

2^nd -9^th October 2004

02 October 2004

I met Liz and Graeme Roberts at Cusco airport when they arrived (yesterday, 1^st Oct).  Immediately I knew this was going to be a great trip.  They were excited about the trip and delighted to be in Peru.  They came to the house (today) about 10am packed and ready to go.  Fabian, our driver with the Ministry of Health truck, arrived about the same time and we got loaded up.  I had requested that Fabian take smaller cylinders for petrol in order that we could fit the generator in for this trip.  I knew most of the villages we were going to did not have electricity and I wanted the generator with us in order that we could carry out fillings.  So we got everything piled in – a very full load but it all fitted.

We set off, saying goodbye to Clark, about mid-day.  There was plenty of space for us all since the 5^th team member, Marly Larabee, was planning on meeting us out there.  She is a Pediatrician from the USA.  Unfortunately, she never made it for this trip as she had a horrible mugging experience before leaving for Cusco.  But she will come with us on the next trip.

The drive over to the Apurimac was, as always, beautiful.  Graeme is an engineer and works with road planning in the UK.  So his wonder and amazement at these roads and how the wind their way around the mountains was great.  The sun was shining and we seemed to talk and chat and find out about each other for a lot of the way.

6 hours after leaving Cusco, we arrived in the town of Coyllurqui.  This would be our base for the next 7 days.  We headed to the Health Post where we were met by the doctor.  He welcomed us and told us he had arranged with the Mayor, for us to stay in the town Alberque.  So we went up there where we found a nice room with 4 beds and running water!  Luxury!  We slept well that night and were ready to go in the morning.

03 October 2004

It was a short but beautiful 15 minute drive to the first village of Chahuay.  On this trip, we would be visiting villages that would not have Health Posts.  The plan was to set up and work in the local schools.

We arrived at the village expecting to see waiting patients.  But there was no-one around.  The doctor at Coyllurqui Health Post had promised he would inform all the communities of when we would be arriving.  But on arrival, it seemed like this had not been done.  Eventually, the President of the village came to speak to us.  He opened the school and assured us the patients would come – and they did!!

There was no electricity in the school.  But some local boys ran a cable from way up on the hill done to the classroom – in true makeshift, no health-and-safety, Peruvian style.  This provided power for the sterilizer but was not enough to power the compressor.  So we got the generator started up and were able to do some restorative work.

Liz and I set up side by side.  DPP now has a new Portable Dental Chair.  It is great.  It means that no-one has the aches and pains of trying to work with the patient in the wrong position.  Liz has a little knowledge of Spanish but for most patients I needed to translate and often Fabian was involved with Quechua translation.

Fabian was working outside.  He took all patient details and organized the crowd.  He then gave out the medications and toothbrushes.  Greame was chief sterilizer.  He cleaned and sterilized the instruments and kept Liz and I with cups of tea all day – much appreciated!

We were all pretty tired by the end of the day as the light was fading.  We had seen a lot of very bad mouths and done many full clearances.  It was good; we had seen all patients that needed treatment and done a few fillings.  We returned to Coyllurqui for dinner and bed.

04 October 2004

I had planned our itinerary with the staff at the Health Post in Coyllurqui on the previous trip.  We decided to have 2 days in Acpitan.  It is a large community and many people from surrounding communities would come here for treatment.  So we headed out today for our first of 2 days.

We had a warm welcome from the local children and school teachers.  There were two very elderly women who seemed very pleasant at first until they started a fight between themselves about who would be treated first.  Crowd control had to be enforced early on!  We set up in the school classroom again.  The only power socket in the whole village was in this classroom so we took full advantage of it, although the power supply was quite temperamental.  So Graeme had to constantly change from electric sterilizer to the sterilizer which is used with our camp stove.  But nothing seems to bother Graeme.  He continued to sing and entertain us - and the children throughout the entire day.  He is fun to have on our team!

The people of this village were very nice.  They were all extremely grateful for their treatment.  They were all so very respectful and every one of them thanked us kindly for their treatment.  This makes such a big difference to us – it really keeps our spirits up to see we have done a good service for our patients.

The children were wonderful too.  We had a number of schools come.  One entire school (of about 30 children) walked about 2 hours to us.  By the time they arrived there were already over 50 people waiting in line.  I wanted to treat the children as they had walked so far but when I suggested this, the queue of waiting patients starting shouting and objecting.  They would not allow the children to skip the queue.  So I decided to do a screening of the children and then only the ones needing treatment would have to return the following day.  This seemed to appease the waiting crowds.  The school teacher was so nice and understanding and told me not to worry – these children are used to long walks like this!

So I did the screening outside in the sun.  I must look so strange to these children.  A white woman with yellow hair wearing a white tunic, mask and headtorch.  Their faces seem to tell me exactly what they are thinking – “what is all this about?” They all stand in line and come forward one by one and open their mouths.  Many of them tip their heads so far back they almost fall over.  So I wrap my legs around them to keep them from ending up in the mud.  What a funny and strange system – but it works.  It is very obvious as soon as they open their mouths if they need treatment or not.  I am amazed at how many of these children (often as young as 4 years old) have painful abscess – often multiple abscesses.  They live with this pain for months!

All the children were so well behaved and co-operative.  We treated over 30 children and not one of them screamed or refused treatment.  It was a pleasure.  They are so beautiful.

We worked until it got dark.  As we were clearing up for the night, a wee boy peering in the window said the funniest thing.  Graeme had his head torch on which had two small bulbs.  The little boy said “look, that man’s eyes light up”.  He was so excited!  He thought the lights were Greame’s eyes. 

The village Mayor arranged a man to come to the school and sleep in the classroom to watch our equipment.  So we left it all in his capable hands and headed back to Coyllurqui to sleep.

05 October 2004

We knew there would be a lot of patients today, so we got up early and were back at Acpitan and started working by 8am.  But arriving at the village was an early morning adventure!  It had rained a lot the night before and the track that leaded into the village was muddy on a dry day!  Today it was almost impassable.  We slipped and slided in the mud and all held our breaths as we came dangerously close to the cliff edge a number of times.  Thankfully, Fabian was our driver and with great skill, got us passed safely. 

When we arrived there was already an orderly queue of over 20 people formed outside the classroom.  We started with these people.  Then the school children from the day before came – we treated them.  The queue continued to grow.  Then I had to do a screening of the school children of Acpitan and then treat them.  We continued throughout the day, stopping for 30 minutes for lunch.  As it got dark there were still 16 patients waiting.  We decided to see them all – how could we turn people away who had waited all day?  We finished at about 7.30pm having seen 99 patients in total.

Of all the kids today, we had only one wee girl who screamed.  It is so terrible for everyone involved when this happens.  Whoever is treating the patient really has to persist more than you would have to if you were in the UK because there are other options there.  Here, you either persist, and manage the extraction in the midst of tears or do not even start the treatment.  Neither option is particularly pleasant.  But fortunately, the majority of these children were like angels!

Many of the children we treat seem so much older than their years.  They do not complain or moan.  They are so very polite.  But so many of them have such sad eyes, together with the ragged clothes and dirty faces and feet – I just feel like crying sometimes.  These children endure so much at such a young age.

We had a few funny moments in this day.  One lady came in with her 2 children.  Both children had their patient cards with them and so we treated them as normal.  Before leaving the mother approached Liz, produced 3 eggs and presented them to her saying thank you so much for treating my children.  We were all very touched and said thank you in return.  But then we realized this offering was more of a bribe.  Once the eggs had exchanged hands the woman proceeded to plead that we treat her too.  She did not have a card and had arrived at the school once there was over 75 people waiting.  But her children had been in line and so she came in with them and now was asking for treatment.  It was very sneaky of her but how could we refuse!

Another patient that had us all laughing was a 4 year old girl.  She had a big abscess on her upper deciduous molar.  But she giggled and laughed throughout the treatment.  She thought the entire process was hilarious and had us laughing with her!

It was after 8pm by the time we finished.  We took the last 4 patients in all at once and anaesthetized 2 and then swapped the other 2 while we waited for them to numb up.  It was quite funny as it seemed to turn into musical chairs.  One woman had her baby with her so the baby got handed from one patient to the next as everyone was swapping chairs – I even found myself holding the baby at one moment!

This had been a long but wonderful day.  Again, everyone had been very grateful and pleasant.  We returned to Coyllurqui exhausted but happy with our work.

06 October 2004

This was our planned “rest day”.  And so we rested!!  We enjoyed sleeping late and then showering and washing our hair – small pleasures!  After eating lunch, I spent the afternoon in the sun doing tooth brush demonstrations for the local children.  It was a lot of fun!  Liz and Graeme went for a nice walk.  The valley in which Coyllurqui sits is so beautiful and magnificent it was good for them to get out and see it!

07 October 2004

We had to be up at 4.45am to set off on our long journey to the village -  Ayumaqui.  This village lies at about 4,300m and so we were all a bit dizzy with the altitude by the time we arrived.  The drive was spectacular.

This village is so rural and poor – it did not really have any school or building we could use as our surgery.  After some time discussing our possibilities, we decided to work outside (despite the fact that it was cold enough to see our breath!)  The only flat piece of ground was occupied by a herd of llamas – so after these were kindly moved, we set up the chairs and equipment.

The views were incredible.  We could hardly believe where we were never mind the fact that we were going to work right there!  The villagers started to gather.  They were very timid and curious but all came forward for treatment.  There were 65 villagers and we saw them all.

We started work about 8am and it was very pleasant when the sun came out from behind the clouds.  But it was freezing otherwise.  Liz and I had our fleeces, hats and scarves on but our hands were freezing!  We managed to see about 15 patients before we felt the first drop of rain.  We continued to work and tried to ignore it as long as possible.  But eventually we had to cover everything and run for cover in the truck.  All the patients just sat it out.  They must have thought we were pathetic. 

After about 20 minutes the rain stopped and we started to work again.  I treated a very elderly Quechua woman.  She had been herding her llamas and sheep and stopped to come over and have her extractions.  She was very funny.  After giving her anesthetic she started laughing.  One of the local men translated for me.  She was saying she felt like she had a piece of someone else’s body in her mouth (she had never been numb before).  She thought it was hilarious.  

We worked for a couple more hours until, suddenly, the skies seem to open and launch a hail storm on us!  The hail stones were bouncing off the chairs and the patients.  We had to get inside – but where??

A very nice man offered us his “house” to work in.  So we, together with the people of the community, gathered up all the equipment and chairs and made a dash for his house.  It was a tiny little room.  We managed to fit both chairs in, plus Liz and I and that was all!  It was such a tight squeeze.  Liz and I had to plan our extractions because I could not work on my patients left side if she was working on her patients right side!  Everyone thought it was funny including the patients – so we were able to work with the situation.

The only off-putting thing was that we kept bumping our heads on the dead goats head that hung on the wall.  It went well with the mud floor and mud walls and almost pitch darkness – certainly a new surgery situation for both of us!

The best thing about this village was the children’s teeth.  They were, generally, in excellent condition.  I have never seen so many healthy mouths in one village.  There were no shops in this community and therefore no access to fizzy drinks or sweeties.  It was incredible to see the difference!  Even the oral hygiene of the children was excellent.  We were blown away!

Also, the teacher came with the children and she was very nice.  She really seemed to care for the children and knew all their ages and their past oral problems.  This was very reassuring and positive to see.  She even put herself last and told us not to worry when we could not do a root treatment for her.  She was very grateful to us for coming and treating “her” children.

Mid morning a man came with a plate of potatoes for us.  It was so kind of him.  So we tucked in but unfortunately most of the potatoes had maggots in them – and this is always a bit off-putting!  He also brought 3 chunks of sheep meat.  This is really touching because these people have very little meat and to give it to us is very kind.  Fabian ate most of it!

We had a 4 year old girl come with an upper deciduous incisor root protruding into her lip.  It really needed extraction but the teacher insisted we consult the father.  So we did and explained the importance of the treatment to avoid future pain and infection.  He was very unsure.  Eventually he asked the girl if she wanted the extraction.  She said no and so he told us we could not do it.  It was disappointing because we are sure it will pain her in the future, but it was nice to see a father respect his daughters wishes and actually take her feelings into consideration.

The sun eventually came out and so Liz moved her chair outside for the last few patients.  We kept working until 3pm without a break in order to finish before it got too cold again.  We packed up and headed off in the daylight.  We had had an excellent experience with these people.  We knew it was a good community with the caring teacher and the kind, helpful people.  Also, children clearly took care of their younger siblings which is always beautiful to see.  Everyone was very grateful to us and we were grateful to have shared this time with them.

08 October 2004

This was a great last day.  We woke to the most beautiful blue skies and sunlight.  We drove about an hour to the village of Chisquahualla.  When we arrived, we realized there was no way for the truck to get into where the school was.  There was an adobe wall built around it.  Fabian spoke to some local men and before we knew what was happening, they were plucking the cacti from the top of the wall and dismantling the mud bricks to make an entrance for us!  Amazing!

We set up in a big, bright airy classroom – a pleasant change from yesterday!  We started work at 8.30am and work solidly until 7.30pm seeing 80 patients.  We were exhausted by the end of the day but very happy – again!

The mouths here were in a terrible condition.  Liz and I found ourselves doing a lot of clearances – Liz had a patient who needed (and had) 19 extractions!!

But we did have some other interesting cases.  One man came for his treatment and during it told me that his wife was very sick.  She had a very swollen face and was in bed in terrible pain.  I told him he must bring her to see us!  A couple of hours later she appeared.  It was one of the largest swellings I have ever seen.  The whole of her lower right face was hugely swollen and very very hot.  She could only open her mouth about half a centimeter.  She was weeping and moaning constantly.  The frightening thing was the swelling had spread under her chin and to the floor of her mouth.  This can be very dangerous.  If the swelling continues, there would be a chance that this patient could asphyxiate and die.  So I knew I had to not only give antibiotics but extract the causative teeth.  On examination the infection seemed to be coming from the lower molar roots.  However, every tooth further forward in the mouth also had smaller abscesses.  My priority was the molar roots.  Achieving anesthetic was difficult with only half a centimeter to work with but eventually she was numb.  Despite her pain, she was very co-operative and because of this I managed to extract all the teeth on the right hand side.  I think she understood the seriousness of her condition because, despite her continued wailing, she took my hands at the end of the treatment and thanked me sincerely.  I was just so happy she was now out of immediate danger.

Liz is an Orthodontist.  It was great to have her on the trip to give advice on certain overcrowding cases.  We usually see a number of cases on each trip and with her advice I will be treating these cases a little differently in order to get the best aesthetic results.  It is sometimes a little bit difficult to make the patients understand why you are taking one tooth and not another to solve their problem as the immediate result is not always what they want, but the result in 6 months will be 100 times better. 

During the afternoon, a patient brought us a huge bag of potatoes.  We ate some but had already eaten lunch.  So we gave them to some children peering through the windows.  They seemed very happy, but 30 minutes later they returned with the potatoes in a bowl – peeled!  They had taken the potatoes and thought we were asking them to peel them for us.  So they did and brought them back to us.  We could not believe it.  I explained that the potatoes were for them and then they really did seem happy.  How strange they would think we asked them to peel them and did it so happily for us.

We thought we were finished at patient number 72 – but there were still 8 patients waiting.  Unfortunately, the first of these patients starting crying and this set the agenda for the final hour.  These all seemed to be very difficult cases with a lot of infection.  It felt like we were being asked for the very last we could offer.  We were exhausted and very drained by the end of the day.  But we knew we had seen everyone and done a lot of good work.  We also knew we did not have any teeth to treat tomorrow so went home and slept very well!

09 October 2004

Our final day.  We had to get up early again – 5am.  But today we only had to sit in the truck and look at the beautiful views.  Fabian wanted to leave early in order to get back to Cusco and then on to Abancay in the daylight.  He is an amazing man to drive for so many hours on these difficult roads.  And again, during the entire trip, he was invaluable.  His special ways and kindness with the patients show how much he loves his people.  He is so appreciative that we are there doing what we are doing but I always let him know how much we value his participation.  The trips would not run as smoothly without him and my job would be a lot more difficult.  I am extremely grateful to him and always hope we can work together again in the future.

The drive back to Cusco was wonderful.  We stopped a lot on the way to take photos – it really is breathtaking!

Safe and sound back in Cusco and sad farewells to Fabian. This was a wonderful trip with a wonderful team.  Very special people.