Dental Project Peru – Trip Report

Trip 5 – 1-8 September 2005

Roma, Murray & Robin

Day 1

This is a very special trip for me.  One of the volunteers is Murray Kerr.  He has been my mentor, trainer and very good friend since I graduated from Glasgow Dental School in 1999.  The first year out of University is called a Vocational Training year.  Each new graduate dentist is placed in a practice which has been specifically screened and chosen as a training practice.  The principal dentist in these practices becomes the new dentists “trainer” and can play a key role in the development of their skills and confidence.  This is the idea but a lot depends on the relationship between the two dentists.  I was extremely lucky in that Murray and I got on very well right from the start and he guided me through my first year with great skill, patience and humor!

Now, here we are more than 5 years later – in Peru!  Murray has supported Dental Project Peru from day 1 and is actually on the Board of Trustees.  He promised me he would come out and volunteer one day – despite retiring in 2001.  He is a man that keeps his promises and despite never doubting him, I can hardly believe he is here and we are heading out to the Apurimac to pull some teeth!

I am excited about this trip even more since meeting the other volunteers.  Robin Castro is a friend of Murray’s and is like a breath of fresh air to be around.  This is the first time I have met him but I know I will enjoy his company on this trip.  He is a very expressive man and I love to hear his observations on just about everything that happens around him.  After being in Peru for so long, so many things seem normal to me.  So I love to hear Robin comment on the buildings, the stars, the roads, the trees, the mountains, the peoples dress…… everything.  I love it!  He is also a very good photographer and is constantly snapping his camera.  Be sure to check out the photos from this trip in the Photo Gallery.

The third volunteer is Roma Amabile.  I was delighted the moment I met her to hear a beautiful Scottish accent.  She had already met Murray and Robin and when I heard the ‘banter’ that was already in play between them I knew this was going to be a great team!  Roma has a very kind and gentle nature and has the ability to put people at ease immediately.

Our driver for the trip is my great friend and colleague – Fabian.  A great man and asset to Dental Project Peru.  He arrived at my house at 6.30am this morning after taking a 5 hour bus ride from his home town.  It was going to be a long day for him!

Murray, Robin, Roma and I all went out for dinner last night and enjoyed some good food and great chat.  We are all equally anxious to get on the road and begin this trip!  But beginning the trip was a challenge in itself……

After packing up the truck (which was a great team effort) we headed out of town.  Our destination was Haquira and to get there I decided to take a different route from normal.   I will take 8 hours as opposed to 10 hours.  As we neared the edge of Cusco we found ourselves in a somewhat entertaining situation jammed between two buses, a mud slide and a man selling freshly squeezed orange juice!  Laughing at our predicament, we waited for some people to stop shouting at each other and then somehow maneuver their vehicles out of our way.  And we were off……..

The drive was spectacular.  It was a nice change for me to come this way.  Although I had been before we did have to stop a few times to check directions from local people.  The views were impressive and we enjoyed a good packed lunch overlooking one of the 3,000 metre gorges!  Although the journey was long, it was broken by plenty of laughs, poetry reading (?) and photo opportunities.  We arrived in Haquira in no time…

Our friend, Dino, met us with a big smile and great welcome.  We installed ourselves in his modest kitchen and I cooked up a “lentil feast” for us…..  well it was lentils at least, not sure if everyone would describe it as a feast though!? 

During the evening my good friends Marly and Leo walked in!  I have known Marly for a number of years and enjoyed working with her in the Apurimac on a number of occasions.  She is a Pediatrician for the USA and has joined a number of DPP trips and been a great help and support for me.  Leo is a friend of ours from Cusco.  He is a driver in the region and has a great heart and desire to work with DPP.  I knew they planned to come out here but these things can be unpredictable!  So I was so pleased that our team had just grown from 5 to 7.  The trip looked like it was definitely going to be a good one!

Day 2

We were up out of our somewhat comfortable beds at Dino’s house, breakfasted and on the road by 7.40am this morning.  Destination – Ccocha.  But we were stopped in our tracks only 5 minutes into the journey.  Marly and Leo had planned to go to a different village by “local transport” as our truck only holds 5 people.  Or at least that was the theory……  We saw them at the side of the road flagging us down.  Their transport had never appeared despite waiting 2 hours for it.  So they asked to come with us to Ccocha.  I found myself in a dilemma.  The drive to Ccocha was going to be about an hour.  To squeeze in one extra person is always possible but where would I put 2 people?  But I could not say no and leave them there.  So – where there is a will there is a way!  Marly squeezed in with me up front and Leo (voluntarily) climbed on top of the equipment in the back of the truck.  There was just no other place for him!  He held on tight as we took off!

There was lots of chat in the truck and somehow Fabian and I both missed the usual turn off for Ccocha.  By the time we realized, it was then necessary to take an imaginative detour.  We bumped down a rugged footpath and actually had to build a part of the path in order for the truck to continue.  But all the team helped and before we knew it we were arriving in Ccocha.  We drove across the football pitch to arrive at the edge of a steep sided burn.  There is a small bridge across to the Health Post but that was as far as the truck went.

I crossed the bridge and was frustrated to find the Health Post open but nobody there.  I had informed the personnel here of the dates we would be attending patients and had been assured they would be waiting for us.  But alas – that was not to be.  So we unloaded the truck and took over the deserted Health Post.  After the usual “tutorial” of how our surgery was set up and run everyone made themselves busy by getting things ready.  This was one of the best things about this team – everyone pitched in!

Second problem at the health post was when I realized there was no electricity!  There had been a power cut about 2 months ago and no-one had fixed it yet.  So that meant it was impossible to do any fillings.  I felt my frustrations rising but what could I do?  Deep breaths and carry on. 

Without electricity I needed to find an alternative form of power for our ‘non-electric’ sterilizer.  As I was racking my brains – Marta walked in.  She is one of the Tecnicos in the Health Post.  She had been away on her Free Days and left the other tecnico, Guido, in charge and with instructions that we were arriving.  But where was Guido?  I did not know but I was glad I was not him because Marta was angry and ready to give him an ear-full if and when he returned.

Full of apologies and eager to help us, Marta gave us her gas stove to use for the sterilizer.  Then she headed off to round up the primary school children and the town president.

The primary school children arrived and we did a good Education Talk with them and tooth brushing demonstration.  They really seemed to enjoy it.  I then did the screening.  We started treating the older children first on the theory that they usually don’t cry so the littler children then don’t get scared.  Unfortunately the first two patients cried – loudly – and this set a president for the morning.  But we all worked hard and by 12pm we had seen and treated all the primary school children.  But just as we were finishing the secondary school children arrived……

It had been a long morning so I said for the team to have lunch while I started the secondary screening.  They agreed but stopped only momentarily for a quick sandwich and then were back ready to work again.  From experience, I know how volunteers can get burnt out if they don’t take sufficient breaks.  So although I was very touched to see everyone so keen to get to work, I ordered a decent break so that everyone kept up their strength and motivation today and for the coming 6 days.

We treated all the secondary children in the afternoon plus some adults who had come from working in the fields.  One lady brought her 5 year old daughter in – Mariela.  She was tiny and so cute.  But she had a huge swelling on her right cheek from infected lower deciduous molars.  Her mother said she had been crying for days from the pain.  Mariela just stared at me and kept her wee hand up at the swelling.  I got her numbed up and took out the infected teeth – not a peep from her and no tears!

We finished treating all the waiting patients before it got dark.  So we took a walk down into what you might call the town centre.  It is such a pretty town with a ruined old adobe church.  The people in the village are very friendly if not a bit baffled by our presence.

Back in the Health Post we ate dinner by candlelight and even managed some brandy!  (Thanks to Murray & Robin).  Then it was time to find a comfy spot on the Health Post floor to bed down for the night.

Day 3

Today was a really great day.  We were all up at 6am because Robin is an early riser and when you live in such intimate conditions, “when one is up all may rise!”  It was great to have the chance to sit in the sun and enjoy the “calm before the storm”.  The first patients came at 9.30am and the last one left at 7pm!  And we only managed a short break.

I really enjoyed the working situation today.  As always, we all work in one room which is unusual for dentists who usually work alone.  With a bit of time a rhythm gets established amongst the team.  And I especially enjoyed the chat and banter that went on between us all.  Despite seeing a lot of patients today, the stress levels remained low.

There was one particularly interesting case today.  One of Roma’s patients came in with a hard, round, mobile swelling in his lower right cheek of about 2cm diameter.  It had been present and getting bigger for over a year now and despite not being painful was really quite disfiguring.  The man asked us to remove it.  Without x-rays and other tests, it is always a difficult decision whether to embark on surgery or not in a situation like this.  We discussed the options in length between the four of us.  We were almost 100% sure it was a cyst and could be excised.  The patient desperately wanted us to remove it.  Roma and I decided to do it – Murray and Robin wished us luck!

We worked on the patient for about an hour.  I will spare you all the gory details but just to say we blunt dissected out the cyst coming precariously close to the nerve and actually coming clean through the cheek.  Once we were satisfied the contents were all removed, we stitched up the incision.  Roma and I agreed that we had done the right thing in excising the cyst and we were happy with the result.  The patient was delighted to be rid of the unsightly swelling and smiled at us with his unusual green eyes.  Everyone was happy!

A patient from yesterday returned today to have another tooth out.  His name was Marco and he brought his flute with him.  He played a beautiful tune for us to say thank you for helping him.  Very touching.

Maria was a 6 year old girl.  She was in a lot of pain from 3 deciduous molar teeth on the left side of her mouth.  After a lot of persuading I managed to get the anesthetic in but there were a lot of tears.  As I tried to do the extraction she was simply too upset and distressed.  I let her leave without treatment but told her if she changed her mind to come back.  3 hours later she was standing at the door asking to have the teeth out.  She jumped up into the chair and said she was going to be brave and have the teeth out because they had been so sore.  I got the teeth out but there were still a lot of tears that went with the procedure.  These cases are always exhausting and quite distressing.

We had a bleeder come back in the evening – Jorge.  I had taken out 7 infected teeth in the morning and now he was back looking quite pale and weak.  Roma offered to suture the sockets.  She did a very valiant job and was still working on him at 7 o’clock by candlelight as we all packed up around her.  What a star!

It was freezing cold and I could not have Leo ride on top of the truck.  So the seven of us squeezed into the warmth of the cab.  Fabian drove us back to Haquira where we stopped to buy some beer which put smiles on all our faces!

Day 4

Today we headed to Llac-hua.  This is one of my favorite villages.  The tecnicos there are Victor and his wife Meri.  They are so nice and keep the Health Post so clean and organized.  And they clearly care for the people of Llac-hua and the surrounding communities.

We said goodbye to Leo in the morning as it was time for him to head back to Cusco for work.  But we were glad to still have Marly with us as we would need her help in the busy days ahead!

Not long after we arrived in Llac-hua, there was an emergency.  A man was brought in semi-conscious.  He had been beaten around the head with a rock and a stick by, we think, his mother-in-law.  Apparently he had been drunk and was beating up his child and then his wife when the mother-in-law attacked him.  He was in a very bad way.  Marly attended to him, giving him an IV and checking him out.  She was not too concerned but Victor was more worried and so took him to Haquira.  From there he was taken to Cusco in an ambulance.  With head injuries like he had it was impossible to tell the extent of trauma so nobody wanted to take responsibility so he was shipped off to Cusco.  But not before the family was made to sign papers saying it would not be the fault of the Ministry of Health if he died en route.  Having dealt with that – the family were convinced the man would die and were obviously very distraught.  (As far as we know, the man made it safely to Cusco).

Our morning was more relaxed with only about 12 patients.  There was a market in Haquira and so a lot of villagers were there.  But when Victor returned at about 2.30pm from taking the injured man to Haquira - he brought patients with him!  We worked through solidly to 6pm. 

There was no electricity so we could not use the drill to do any fillings.  But Roma and I did hand clean some cavities and put some Glass Ionomer fillings in which hopefully saved some front teeth of some lucky teenagers.

We saw some great kids.  There was very little crying today compared to yesterday.  The children here understand more Spanish and so we were better able to communicate with them to ease their fears.  I remember 2 little boys in particular, Carlos and Mateo.  They both needed a first adult molar tooth out which is a tough procedure for small children (actually for anybody).  But they were so brave.  They listened as I spoke them through it and held back their tears despite the force needed to extract the teeth. 

Robin extracted a fractured lower wisdom tooth of a male patient.  Usually this kind of procedure is steered well clear of at home without an x-ray.  But without this luxury what can you do?  The patient was in a substantial amount of pain and had been for some months and the tooth was badly infected.  Although reluctant at first, Robin got stuck in and did the man a great service by popping that sucker out!

We finished the last patients by candlelight and were all feeling tired by the end.  Marly and Roma were in bed (or at least comfortably asleep on the Health Post floor) soon after dinner.  After 10pm, Robin, Murray and I were still sitting chatting when we heard a banging at the window.  There were shouts of “Emergencia” from outside.  I ran outside to see a young boy looking rather distressed.  He had brought his elderly grandmother back to see us.  She had started bleeding after walking home after treatment.  Robin had extracted 5 of her anterior teeth.

We got her inside and sat her down to have a look.  There was blood pouring from the socket where the upper right canine had been – a big tooth.  So late in this evening, by candlelight I packed the socket and sutured it up.  The bleeding stopped and I kept the lady there for a while.  Before she left, I cleaned the dried blood that had covered her wrinkled hands.

After that it was definitely time to sleep.  We all bedded down on the floor and fell asleep to the sound of heavy rain outside.

Day 5

It was not just the sound of rain we heard during the night.  At about 3am a drunken, singing, dancing band passed two hours of merriment outside the Health Post window.  It was somewhat amusing – but 2 hours???!!!!......

Once asleep I was woken numerous times by a very friendly beetle who liked to use my face as a race track.  I was happy when morning came at last!

We were all a bit bleary-eyed but started work at about 8.30am.  There was a constant stream of patients until 6.30pm.  With only a short break for lunch, everyone worked really hard – despite a few meltdowns and temper tantrums……

Looking back I can see that this was an extremely demanding and busy trip.  We saw a huge number of patients and so it is not surprising that we all (except Robin it appears) had a “moment” on Day 5.  I lost my temper and refused to treat a 17 year old boy who was being extremely cheeky to me and the team.  He was showing off in front of his friends and he sent me over the edge!  Murray put his hand through the window as he tried to get rid of the children who constantly peer through the windows from sun-up to sun-down.  Roma had a mini meltdown and felt she could not carry on.  There were a lot of crying children this day and she felt so frustrated at not being able to communicate with them.  Marly stole a hat from a girl’s head and refused to return it to her.  The girl would not stop opening the window and pestering us while we worked.  So as you can see – the pressure was building…..But it often takes these moments of despair to get you focused, grounded and back on track.  We all managed to laugh and support each other and put things in perspective.  That makes a good team.

But other than those dramas, we had lots of great patients and special moments today.  As I was screening the 170 children outside, Marly came out with books and pencils for the classes.  In return for the gifts, the children sang to us.  Each class, from the very tiny children up to the older ones chose a song to sing and had us almost in tears. 

I had a little patient called Marisol who I will never forget.  She was 6 years old and needed an upper deciduous molar extracted.  She was happy to start and took the topical and then the injection very well.  But when I was about to start the extraction, before I even touched her tooth, she changed her mind.  She just kept saying “No Doctora, please Doctora, I don’t want it”.  She did not cry or scream but in a very calm and quiet voice was just insistent that she did not want this.  But what really got me was that she would put her tiny wee hands on my shoulders as she said this, then she would hold my hands and repeat the same thing.  Feeling her hands on me brought a lump to my throat.  But luckily we had a real connection and I managed to speak to her and convince her it was all going to be ok.  She eventually let me take the tooth and she did not cry – thank goodness or I think I would have too. 

We managed to see so many patients today.  This was largely due to the fact that we had Robin and Murray.  I don’t think they would mind me saying this – they are “old school”.  Once their anesthetic is administered and they are confident that it has worked, the extraction is carried out.  Where Roma and I might try to comfort or coach a child if they get scared or upset, Robin and Murray (if they know there is no pain) whip the tooth out and the child is on their way before they know it.  Luckily we had both approach options available to us on this team and that is why we worked so well together.

There was a great moment in the afternoon when we were all working away.  I had heard a few moans and sighs from Murray and asked if everything was ok.  He said yes.  He was just having a bit of a problem with a fractured lower right wisdom tooth that refused to come out.  I offered to help but he said he would persist.  Time went by and I was not hearing relief from either Murray or his patient.  Eventually I offered to help again and Murray agreed.  The visibility was zero with so much blood and soft tissue in the field of view.  And there was hardly any tooth substance to get hold of.  Five years ago I would have never attempted such an extraction and would have let out cries of help as Murray came to my assistance.  But today, this is what I do.  Working without suction, with poor lighting and with no alternatives has become the norm to me.  So I cleaned the area as best I could and, with my favorite instrument, I managed to lever the tooth out without actually seeing very much at all.  Murray and I looked at each other and he congratulated me.  This was a funny role reversal situation which delighted us both!

Marly had her hands full with Crowd Control today.  There were literally hundreds of children running around and adults waiting for treatment.  Then a group of women from Patahausi arrived.  This is a community 3 hours walk from the Health Post.  Marly had to discretely allow them to skip the queue in order for them to have their treatment and then start the 3 hour walk home before it got too dark.  There was potential for a riot!  But she handled it very well and everyone got treated in the end.

We treated so many patients that we almost ran out of anesthetic!  I bought all that the Health Post had and crossed my fingers that we could get some more along the way. 

We packed up the truck in the dark and headed back to Haquira.  We were all exhausted and looking forward to sleeping in a bed.

Day 6

This was a very special day.  It was the 6^th of September 2005.  It was my mum’s birthday but also the birthday of a new baby.  Let me quote directly from my diary for this night.

“Pure raw emotion right now.  It is 9.30pm and Marly, Roma and I just saw a tiny wee baby girl being born.  She weighs 3.15kg.  Mother and baby are doing fine.  The mother was here all day and went into labor about 5pm.  Marly, Robin and Murray went to bed after dinner but Roma and I were still up playing cards when we heard the shouts from the ‘birthing room’.  I rushed in to see the final push and the wee girl pop out.  It is an absolute wonder to me.  As the two tecnicas dealt with the mother and the afterbirth, we were given the baby.  Luckily Marly came in at that point and knew what she was doing.  We cleaned her up and weighed her.  Then we dressed her in the pieces of dirty rags the mother had brought.  They were filthy and stank of pee!  It was such a sin to have nothing else to dress this new wee person in.  Here is a thought, every DPP trip we should carry a New Baby Pack with clothes and a few essentials for a new born.  It would at least be a clean start for the new baby.  We all held the wee girl and looked at her beautiful face in the candlelight.  The mother was exhausted and had no great interest in holding the baby for a while.  We were more than happy to assist!  The birth was amazing.  There is no electricity here so I gave my headtorch to Sonida who was delivering the baby.  She was so appreciative because doing it by candlelight is very tricky.  I let her keep the headtorch for the next time! I gave the mother and the tecnicas some food and then we left the mother and baby to rest.  Now I am lying in my sleeping bag writing my diary with the most wonderful feeling of joy rushing through me.  I hope the little baby has a happy and healthy life here in Curca.  It won’t be an easy life and there may be only small pleasures, but for now she is safe and warm.”

So that was the end of Day 6 but the day begin in Haquira as we said goodbye to Dino and his family and drove towards Curca.  The road does not go all the way to the village so we parked the truck at the roadside and prepared to hike down to the village.  There is no electricity in Curca so no reason to bring the compressor and filling equipment.  This at least lightened the load.  We were met by one man who said there were more men and a horse on the way to carry the equipment.  A lady arrived and offered to help too.  She took her blanket off her back and filled it with two of our boxes and headed off at a great speed.  I felt a bit guilty but she was happy to help us.  With all the equipment on its way, we set off too.  We left some equipment in the truck with two boys to watch over it.  Fabian would come back up in the evening and drive to the nearest town, Mara, to sleep.  This way the truck and equipment would be safe. 

Our loads were much lighter with just our personal gear.  The walk down was beautiful and not to strenuous.  At this altitude of almost 4,000 metres any exercise feels more demanding than normal so hiking back up this mountain tomorrow was on our minds.  But for now we were happy to take in the breathtaking scenery and enjoy the walk.

We arrived at the Health Post which was newly built.  Very nice!  This was such an improvement from the previous one which was a small, dark adobe structure with not enough headroom for the average Westerner.  We said lots of Thank Yous to all the people that helped us take the equipment down.  After getting set up we treated these helpers first.  They were all happy with this arrangement!

We had a good days work.  It was steady and not too hectic – a relief after yesterday!  We saw about 50 patients in total.  There was one young girl with Down’s Syndrome.  It is very unusual to see mentally handicapped people living here.  Unfortunately we were unable to treat her as she could not cooperate with us.  But she did enjoy the balloon we gave her! 

The people here are the poorest we have seen on this trip.  Very few patients speak Spanish because of the remoteness of the village.  The children are wonderful and are so playful and warm towards us.  But it breaks our hearts to see how they are dressed – or not dressed as the case may be.  The majority of them are in rags.  Literally, their clothes are in tatters and hanging off of them.  They are filthy and cold.  Marly has brought some children’s clothes with her so we dress as many of the children as we can. 

At about 4.30pm we stopped to do an Education Talk to all the Health Promoters and parents who had gathered at the Health Post.  This was a great opportunity to address the community and teach them a bit about Oral Health.  Fabian did a wonderful job giving the talk in Quechua.  There were even questions afterwards!

The atmosphere here is great.  There are lots of people waiting around to help us in any way they can.  At one point in the afternoon I went into the toilet (which did not have any running water) and found 5 trout sitting in a bucket of water.  Someone had brought this from very far away (the nearest river is miles away!) and the tecnicas proceeded to cook it for us.  It was very well received by us – especially Robin and Murray who munched it down quick smart!  These gestures from our patients are the most precious.  Reciprocity is a key part of the way people live here and it is a wonderful feeling to know that what we are doing is valued and appreciated.

We finished work today tired and happy.  Fabian hiked back up to the truck which I was very grateful for.  We ate in the Health Post and toasted Happy Birthday to my mum with the last of the brandy.  Then the exciting events of the evening followed……..

Day 7

I was woken this morning with tea in bed from Roma.  Very unexpected and nice.  We were all up and working by 8.30am.  We had to aim to leave early enough to reach the truck before it got dark.

There was a steady stream of patients – both adults and children.  One man came back with some bleeding so we sutured him up and kept him for a while to check he was ok.  A group of about 20 school children arrived from Mocabamba which is a 2 hour walk from Curca.  90% of them were in pain and needed treatment.  They were great kids.  Some were a bit frightened and we did see some tears but the majority were brave and let us treat them with no problems. 

The father of the new baby came in the afternoon.  He was full of thanks for our help last night and was very proud of his new daughter.  I had mentioned it was my mum’s birthday last night and he came to ask what her name was.  He wanted to call his baby after my mother.  I was so touched.  He made me write the name down and which country it was from.  So now there is a little ‘Freda’ in Curca.

The father had us do 5 extractions on him.  He had also brought his other 4 children with him plus his sister-in-law.  So we were kept busy!  Then the tecnica told me the mother was asking for treatment also.  She was still lying on a dirty mattress in the birthing room with the new baby by her side.  She was not able to move yet.  I suggested maybe this was not a good idea considering she had just given birth a matter of hours ago but she insisted.  So I knelt down on the mattress, numbed her up and extracted 3 of her lower molars that were rotten and infected.  Despite being very tired and weak she took my head after the treatment and thanked me.  I can hardly imagine such a desperate state as to want a triple extraction just hours after giving birth. 

By 3pm we were finished treating the patients.  A group had gathered to help us take all the equipment up to the truck.  We had 3 men, 2 tecnicas, 8 kids, 2 women and 1 horse.  The kids all wanted to take something so we gave them light loads of sleeping bags and mats and they raced off up the hill.  The 2 dental chairs were strapped to either side of the horse and everyone else took boxes and bags.  The walk was really nice.  It took less than an hour and the scenery was as beautiful going up as it was coming down.

We said our goodbyes at the roadside which was quite emotional.  The people of Curca were wonderful and I think we all took good feelings and memories from this place.  Fabian drove the 2 hours back to Tambobamba.  It was a good opportunity to reflect in our own thoughts from the past seven days.  For me it was quite sad as this was the last trip of the year and it would be more than 8 months until I was back.

We stayed the night in an old Hacienda and ate chicken from a local restaurant.  On the way back from the restaurant a young couple stopped us in the street.  They were beautifully dressed in traditional clothes and asked us, in Quechua, to look at their new born baby.  They were worried as it had diarrhea.  Marly was able to check the baby out there in the street and reassure the parents it was ok.  She gave them some advice and put their minds at rest.  The perfect way to end a perfect trip.

Day 8

We drove home today on the familiar road which crosses the Apurimac gorge and gives us a magnificent view of the 23 switchbacks.  During this journey we all spoke about the past week and what it meant to us all.  To hear such positive feedback from Murray, Robin and Roma gives me a great feeling of satisfaction.  To share this special part of Peru with people who seem to understand it in a similar way as I do is important to me.

This trip has been an opportunity for me to show my good friend Murray how I have used the skills that he taught me.  I was proud to take him to my “surgery” and show him how I have chosen to use these skills.  At it was a special moment when he told me he was proud of me. 

I want to thank Roma, Murray and Robin for making this trip so memorable for me.  They worked so hard and actually broke all DPP records for the amount of teeth extracted in one trip – 920 in total!  The humor and support I felt amongst us all throughout the trip was very special. 

Please be sure to check out the photos of this trip which tell a thousand stories.