Dental Project Peru Trip 4

19^th–26^th August 2004

19 August 2004

As usual, I was excited for the next trip to the Apurimac.  I met the volunteer dentists last night.  One volunteer, Nadia Strock, was the year above me at Glasgow Dental School.  Lesley Rooney is the other volunteer.  We graduated in the same class from Glasgow Dental School.  So it was great to catch up with these girls again!  They came to the house about 11am to get packed up and set off.  We then got to meet the other members of the team.  Eliana Pauca is a friend from Puno.  She owns a travel agency there and is involved in Social Tourism.  She is to be our very valuable assistant.  The final member of the team is Fabian, our driver.  From the first moment, he seems like a lovely, jovial man.  He proves himself as an excellent driver together with translator, steriliser and pharmacist!!!!

The truck has been provided by the Ministry of Health again.  I am simply to pay the driver and buy the petrol.  These are our greatest costs and so I am grateful not to have the cost of hiring the truck as well!  The truck has a 50 gallon cylinder in the back for the petrol for this trip.  Unfortunately, this means our generator does not fit.  But everything else gets squeezed in.  The equipment, materials, medications, food, toothbrushes, sleeping bags……. Definitely a full load!  We set off about midday.

The drive, as always, is spectacular.  The sun is out, the sky is blue and we are treated to magnificent views at each and every turn and bend of this bumpy road.  We are in Cotabambas only 4 hours after leaving Cusco.  Fabian could be nicknamed “Speedy Gonzales”!!  I had planned to set up our base at the Health Post in Cotabambas.  But on arrival, I hear of a Convent that might be more comfortable.  I check it out.  The nuns are lovely and very welcoming and we are treated to a lovely room with clean beds.  To be our home for the next few nights!  We meet the 110 girls who live in the Convent/Orphanage.  These girls all come from different backgrounds but share the common misfortune of being orphaned or from troubled homes.  A lot of them have suffered greatly.  But they seem happy here with the nuns and treated very well.  They are curious as to where we are from, what we are doing and why my hair is yellow?!

We have our first meal of pasta (not to be our last) and after a cultural insight into the tradition of eating Guinea Pig by Eliana, we hit the sack.

20 August 2004 – Colca

Up at 5.15am.  Bleary eyed, we make the hour drive to Colca – our first Health Post of the trip.  But when we eventually arrive, the Health Post seems to be abandoned.  After 30mins of wandering what could be happening, a local boy came to tell us that they had moved to the “Municipalidad”.  So we drive there (a big empty room in the community building) and get set up.  There was a tecnico, Sergio, working there.  A very nice guy who has taken a course on Tooth Extraction.  But unfortunately, he has no instruments.  So I am going to see if I could put a basic kit together for him so that he could at least do some basic pain relief.   Sergio’s wife, Dora, proves to be a great help throughout the day.  She helps with Quechua translation and generally reassures patients. 

From the off, the day is busy.  We see over 130 patients in total!  Both the primary and secondary school come.  But it is impossible to see them all, so I do a screening which quickly distinguishes the children in need of treatment and those who are not.  But, of course, they all get a toothbrush and we do numerous demonstrations throughout the day.

Lesley is on a year long, round the world trip.  She has not been working for 10 months now – so was a little nervous.  But her first patient got her confidence right back up.  This little girl was about 11 years old but appeared about 7 years old.  She was slightly mentally retarded, but could understand what was happening and what Lesley was saying to her.  After some time playing with her and gaining her trust, Lesley managed to extract 10 of her painful, carious teeth.  A great service and achievement.

Nadia is a qualified dentist, currently studying medicine.  She has had a lot of experience in Oral Surgery and so was a great person to have on the team.  This first day, she did not hesitate in grabbing the drill to split roots of a difficult upper first molar!

We had a few laughs throughout the day.  The first was when a small 6 year old boy had his teeth checked.  After a small extraction, he lept from the chair and, in Spanish, shouted “I’m cured”.  All the other children cheered and he spent the rest of the day telling all the patients how great the whole experience was.  I had another wee boy for an extraction.  He would not open his mouth except to scream.  But then, in mid scream – he stopped and looked at me.  He said in a very calm voice, “you can take my tooth out if I can wear your lamp”.  Within a few minutes, I had his carious wee tooth and he had my head torch! 

From this first day, I knew our team was going to work very well together.  Eliana and Fabian were already working together to get the instruments cleaned, the names taken, the meds given out and helping with translation from English to Spanish to Quechua.  Perfect.

Something I noted in this village was the number of laughing, smiling, playing children.  They were curious and asked questions.  Perhaps because of all villages I have worked in, this village is the closest to Cusco.  Maybe these children have seen foreign people before and were not so scared or mesmerised by us.

Back to the Convent to sleep and eat more pasta.  Lots of chat about the day and how strange and wonderful the work had been.

21 August 2004 – Nahuinlla

Up at 5am again.  Our next Health Post was in the village of Nahuinlla which was over 2 hours drive from Cotabambas.  The scenery on the drive was amazing.  The landscape got spectacular very quickly with jagged peaks unfolding one behind the other and with the snow caps visible in the distance.  We past some beautiful lakes, one in particular was bright green.  It was so nice to share this with people that appreciated it as much as I did.  Fabian was great and did not mind stopping – many times – for us to take photographs.

Arrived at the Health Post and met the Nurse, Obstetrician and an Anthropologist.  I was curious as to what the Anthropologist was doing.  He explained that Nahuinlla has 7 communities.  The women in 5 of these communities have accepted the importance of giving birth in controlled conditions under medical supervision.  They come to the Health Post to give birth.  This has been a nationwide project of the Government for a few years now, in an attempt to reduce the number of infant and maternal deaths.  In general, it is working very well.  But the population of 2 of Nahuinlla’s communities refuse to give birth under these conditions.  The Anthropologist is there to study the cause of this resistance.  

We set up inside and Eliana sets up her “reception” outside in the sunshine.  We are told that all the men in town had to leave today to go to a meeting to vote on the possibility of the opening of a Silver Mine in the area.  So we thought we might not have too many patients.  But we were wrong.  Dozens of women and children came for treatment.  And then the men came later as they hurried back from the meeting (4 hours walk away) as they knew this was the only day they could get treatment.

Unfortunately, there was no electricity so we were unable to do any restorative work – but there was so much demand for extractions anyway.  The population were clearly extremely poor.  All dressed in traditional dress (no western clothes) and these were so dirty and worn.  Many children did not have shoes.  Few people spoke Spanish.

I had a 3 year old boy come in with his father.  Apart from having carious teeth, his father was concerned about his stomach.  For 2 years, the wee boy had an extremely swollen and distended tummy.  There was no pain or tenderness, no vomiting or diarrhoea, normal appetite.  There might have been an incident of him passing worms but this was unclear.  Nadia thought it might be a congenital problem.  He may have been slightly retarded as he was very unresponsive.  But unfortunately, the outcome was that we could not help or treat him.  Sometimes it is so desperate and sad.

Lesley treated a female patient who came in with a severely swollen upper lip.  On entering the room she was already weeping with pain and even the gentlest of examination caused her to scream in agony.  She had four abscesses from her upper incisors.  This woman had had this pain for 2 years!  Seeing this poor woman cry in pain brought tears to all our eyes.  But despite this, Lesley managed to extract the infected teeth.  That is really life changing work.

We had our first minor disaster with equipment (we seemed to have a lot on this trip).  The plastic carrier for the steriliser got melted to the pot.  It is a mystery how this happened but the outcome was Fabian, Eliana and I trying to price the two pots apart.  Something had to break – the plastic carrier.  We had to continue to use it for this trip, but I need to, somehow, find a replacement!?!

We slept in the Health Post that night.  Not enough beds for us all so we had to draw lots to see who was sharing.  But unfortunately, none of us slept very well.  Let us back to the Convent!!

22 August 2004 – Sorcco

Up early and left Nahuinlla to head to Sorcco.  About 30 minutes from the village the dirt track road just seemed to disappear.  So Fabian had to improvise a route to arrive at the Health Post – thank goodness for 4 wheel drive!  This town is very poor.  Very few structures or buildings except a marked out football pitch on the only flat piece of land for miles around!  The health post was very basic with hardly any equipment or furniture.  This did at least give us plenty of space to set up.

Yet another busy day.  The nurse, Josephina, had done a good job of letting people know we were coming.  She was a great help throughout the day.  We had a number of tricky cases.  The first was a man who needed 11 root extractions.  These were quite difficult as the gingivae had partially overgrown most of the roots.  The patient was bleeding a lot and was quite distressed.  After the treatment I had him stay at the Health Post for 30 minutes until the bleeding had stopped and he felt better.  Then I asked him to return at 2pm so I could check he was ok.  He came back and I was very pleased to see that the colour had returned to his face, he was not bleeding and he was feeling much better.  He was extremely grateful, despite the ordeal.

Another patient had similar treatment.  This lady needed 9 root extractions and these, too, proved to be very difficult.  And in the end she required sutures to one socket to stop the bleeding.  But all was well and she breast-fed through the entire surgery.  It shows how desperate these people are for treatment that both these patients, despite the stress, were so very grateful and repeatedly thanked me for the treatment.

In the morning an old lady brought us eggs and potatoes for breakfast.  This was very kind.  But we were overwhelmed later in the day…..

Nadia had treated this elderly woman.  She had her grandson with her who sat at her feet during the treatment.  This little boy looked so sad.  He just sat, never smiled, just sat.  After her treatment, Eliana gave her her medications and her toothbrush.  The woman then sat down outside and kept looking at Eliana.  Eventually, Eliana asks if she got her toothbrush.  The woman says yes and points to the wee boy whom she has given it to.  He then says he does not have one of his own.  So Eliana gave him one.  Then she watched as the old woman slowly took her bundle from her back and opened it in front of her.  There were all sorts of things in there, but the clean shiny packets of pills stood out.  She started searching through the things until she finally produced a bottle.  It was a dirty old plastic bottle filled with milk.  The woman handed it to Eliana and said Thank You.  Eliana said it was such a special moment and gesture of gratitude.  She was really blown away by it and I just knew how she felt when she was describing it.  It is an amazing feeling that fills you up – there is nothing more to ask for.

We drove back to Cotabambas and all slept very well.

23 August 2004 – Free Day

I was unsure whether or not to include a free day in the trip.  But after the last few trips and seeing how exhausting it is, I decided to give it a go.  The verdict was a definite – “Yes for the Free Day”.  Unfortunately, Nadia got sick and spent the whole day recovering.  But for Lesley and me, our Free Day turned into one of the best experiences – ever!  The day started well (except for poor Nadia) by us getting the opportunity to wash our hair!  A novelty, a cold novelty!!  Then we headed to Coyllurqui where we would be based for the next 3 days.  I had been here before on my first trip in 2002 and was delighted to find Pamela, the obstetrician, still there.  I first saw her as she drove into the Health Post in the Ambulance.  After kisses and hugs she asked if I had seen a birth yet.  She remembered how sad I was to miss baby Jacqueline’s two years ago (another story…).  I said I had not seen one and she then told me I was about to!

I asked Eliana and Lesley if they wanted to come.  Eliana is not a big fan of blood and pain so declined but Lesley jumped at the chance.  So we were both very privileged to witness and assist the entire procedure.  The woman, Nellie, was early 30s, second baby.  Once the contractions had started she had begun the 5 hour walk from her village to the health post.  The Health Post was radioed and the ambulance left to collect her en route.  The father was present and looked terrified throughout.  When we went into the room, Nellie was standing having contractions – alone.  Pamela and I made up the bed and then got the woman onto the birthing table.  I will not give you all the details, but to say that the pushing started immediately and it was not long before we could see the baby’s head.  Lesley turned a wee bit green at one point but soon recovered so we could push with Nellie (I am sure this did not help Nellie at all, but Lesley and I could not help but breath and push too).  The father did his bit by standing on a stool and when Nellie pushed, he pushed, with all his force, on her bump.  This seemed a bit unconventional but who were we to comment.  Nellie was amazing.  With no pain killers (they could not afford any) she silently pushed only whimpering slightly.  But her face showed how much pain she was in.  Eventually, the head started to appear and with one more push the head was out, quickly followed by the rest of the tiny blue body.  The few seconds that followed were intense as there was no crying.  Lesley and I clutched each other.  Then came the most beautiful sound – a scream as this brand new wee boy took his first breath.  Incredible.

He seemed quite big.  They guessed about 8lbs.  Pamela cut the cord as the nurse sucked gunk from his wee mouth.  Then they took him over to a table where the nurse and I cleaned him up a little bit and dressed him.  It was quite sad, the family had no money.  They had no nappies and only one wee peach outfit.  So we found a nappy in the hospital which was enormous and dressed him.  Then we had to wrap him in rags that the mother had brought as he had nothing else and he was getting cold.  So as the nurse and Pamela tended to the mother, I was asked to hold him to keep him warm.  It was amazing.

He visibly started to change colour from blue to pink.  He had lots of hair on his arms and face.  To me, in those few moments, he seemed like the most precious, perfect wee thing I had ever seen.  Who knows what lies ahead for him?  I hope a healthy and happy life – but who can tell.  His chances are below average simply because of where he entered the world and the circumstances which make up his life.

I was aware that the father might want to hold him but when he cried the father just got further and further away.  And poor Nellie was exhausted and still in a lot of pain.  So Lesley and I held the wee man – happily.  After a few moments I took him to his mother to feed.  I was curious as to how the parents were feeling – they showed no emotion.  (Unlike Lesley and I who could not stop smiling).  I congratulated the father and for a second he smiled and seemed quite proud.

It was time to leave them alone.  But just before we left, Pamela told them who we were and what we were doing here.  I could not believe it – Nellie sat up, opened her mouth and started pointing to her tooth asking me to extract it.  I was amazed.  I told her not today because she had been through enough, but yes I would treat her.  How desperate must you be for dental treatment to ask for an extraction 10 minutes after giving birth – desperate!

Lesley and I then went around this little town and bought every nappy we could find.  We also bought lots of little blue baby clothes and a blanket.   We gave them to the parents who were extremely grateful.  I hope our little friend will at least be warm!  He did not have a name, so we made a suggestion – Fabian.  Our driver was such a kind and caring man that it seemed like a good name to take. 

24 August 2004 – Vilcaro

This day was another good day of work with lots of patients treated.  But visiting this town, Vilcaro, was so sad.  There are problems of alcoholism and incest like I have not witnessed anywhere else.  There is no water in this town so nothing grows.  There seems to be no-one there educating the people or having a positive effect on the population.  Two years ago I visited Vilcaro and felt it was the saddest place I had ever been.  Driving there today, I truly was hoping things had changed for the better.  I was very disappointed.  How will things ever get better there?  Today I cried in desperation at the poverty.

We took Nellie, her daughter and new baby “Fabian” back to Vilacaro in the truck.  But even the joy of the birth was tarnished when we discovered that the father had gotten Nellie’s sister pregnant and she had had a baby boy 2 days earlier and while Nellie was in Coyllurqui, her sister had moved into her house and was stating her claim on it.  Needless to say, a fight broke out.  What a start to a life.

We heard a lot of stories and saw a lot of signs (in children) of the results of incest, violence, alcoholism and malnutrition.  There were a few abandoned children – one little boy did not even know his own name.  Many children were bare foot and in rags.  It rained all day and it was freezing cold.  The children were not laughing and playing in Vilcaro.  They did not speak to us; in fact they seemed terrified of us.

One boy needed his 2 upper incisors extracted.  They were broken down to the gum level and were abscessed.  His remaining teeth were not carious.  I sadly explained to him that I needed to extract these teeth and that no other ones were going to grow in their place.  I told him that maybe one day he could get a prosthesis to fill the gap (although I know that is unlikely).  He just repeated “si Senorita, si Senorita” in a whisper.  He seemed not to be there.  Just staring forward.  I had to hold back the tears.

I understand it must be difficult for the 2 nurses working in this village.  But the hardness of the life here has worn off on them.  They speak to the patients with no respect.  I had one mildly retarded woman for a lower 8 extraction.  She was very scared.  The nurses came over when they heard her saying she was scared – I thought they were coming to help.  But instead they were laughing at her.  They pushed her head back and pulled her hands away from her face.  They laughed and shouted “It will hurt less than when your husband beats you”.  I could not believe this.  This is supposed to be “health care”?? 

To look at the village, especially in the mud and rain, was depressing.  I looked at the dirty little children sitting in the mud with the animals, the dogs and pigs.  But these children are not animals and they need more than this to live.  As human beings – they deserve to live better than that.  And we, as human beings, have an obligation to do something about that.  We cannot ignore this.  These people exist.  But this town has been forgotten about and ignored since the effects of terrorism less than a decade ago.  These people were an easy target for terrorists to gain control of.  They offered them a better life and if they did not accept the conditions – they were shot, like animals.  Lots of people were killed in this village.  Lots of people are still living with those memories.

As we left Vilcaro, Nellie came running to the truck.  She gave us big hugs and showed us “Fabian Jnr” dressed in his nice new clothes.  She was so proud.  A moment of joy and happiness – a saving grace.

25 August 2004 – Pfaco

We had an excellent day in Pfaco.  We had our busiest day, treating over 130 patients!  It was non-stop.  The people of Pfaco seem very nice.  The school teachers came with the children – over 120 of them.  Parents also came with their children and people seemed to generally care what was happening with their mouths.  That is not to say their mouths were in good condition – far from it!  But people asked questions and listened to advice. 

I had to do another screening of the school children.  There were just too many of them to see them all inside.  So I checked them all outside in the sun, deciding who needed treatment and who did not.  Then we got the ones in that needed extractions.  They seemed like lovely children, that is until they sat in the dental chairs.  Unfortunately, the first couple screamed and cried so this set the trend for the next 2 hours.  It gets very stressful when the three of us all have a screaming child in the chair.  And frustrating when you know they are crying from fear because their friend is crying and not from actual pain - it is more difficult to take away the fear than it is to take away the pain.

Poor Lesley got a biter!  This wee boy was very nervous and during the injection he bit Lesley’s thumb.  But he did not let go.  When the nurse and I realised what was happened we both went to him to tell him to open his mouth.  So the wee guy is being shouted at in English, Spanish and Quechua to open his mouth and stop biting.  But he just gets more scared and bites harder.  I could see Lesley’s thumb turning blue.  I could also see how scared this wee boy was of us all shouting at him.  Thankfully, he suddenly opened his mouth.  Relief.  And I spent the next 20 minutes comforting him while Lesley recovered from her injury.

Our last patient was a pregnant woman.  She had a large abscess from her lower right first molar.  It needed to be extracted. But this tooth had broken and the gum covered over it.  It was to be a surgical extraction – the last patient of the trip!  But Lesley and Nadia handled it very well without too much stress.

The whole team was exhausted at the end of the day.  Everyone had worked so hard.  We returned to Coyllurqui to sleep on our make shift beds for the last night.  We were sleeping in the store room of the Health Post on mattresses laid on top of wooden pallets.  Not the Hilton but it did the job.

26 August 2004 – Return to Cusco

We woke to bright sunshine and blue skies.  We were all very happy at the prospect of returning to Cusco to shower and eat something other than pasta.  The drive home was beautiful although we all missed bits as we fell in and out of sleep.  But, as always, Fabian did his job wonderfully and got us all home safe and sound.