Dental Project Peru – Trip Report

27 August – 09 September 2008

Written by Jessica Rowley & Margaret Foxton

From 31^st August - 6^th September 2008 Margaret and I were honoured to join Yesenia, Leo and Daniel for the trip to the Apurimac.  Margaret is a 50 year old dentist working in the south of England and I am a 27 year old dentist who works in Scarborough.  

Sunday 31 August 2008

We’d read the trip reports, we’d seen the DVD, now it was time for the real thing!  Early on Sunday morning the process of packing up Juliana, the 6^th member of the team, began. (Perhaps first member of the team is more appropriate!)  Margaret and I agree that Leo must be excellent at jigsaw puzzles as the amount of kit he manages to pack into poor Juliana is almost beyond belief.  We quickly realised that you pass the boxes when asked, and do not attempt to interfere with his system!

Of course things are never straight forward and we quickly hit a snag, a flat tyre.  The same tyre had been repaired on Thursday before our trip out, but obviously there was still a problem.  Daniel and Leo changed to the spare and we faced the difficult task of trying to find someone to effect a repair on a Sunday morning.  Eventually the job was done and by 11.30am we leave tarmac on the road to Apurimac.  Margaret and I initially giggled and then sang our hearts out as we bounce along the road to the accompaniment of “Caught Between the Moon and New York City” on Daniel’s I-pod!

The roads are impossible to describe, and simply must be experienced.  Snuggled together in the back of Juliana, Margaret, Yessie and I had a good work out for all the muscles of our bodies as we tried to reduce the number of times we bounced off each other.  Leo’s driving was phenomenal and despite offers to let us have a go, we resisted the temptation.  The scenery was breath-taking; we were quite literally on top of the world.  As we sat having lunch in a deserted spot looking out over this sparsely populated landscape we felt contented and peaceful.  As we dropped down to Tambobamba and the sun began to set the surrounding mountains appeared golden.  We arrived to find the locals in high spirits as there was a festival that day and spent a very comfortable (if somewhat noisy) night in Tambobamba.  Nowhere near as rough as we were expecting. 

Monday 1 September 2008

By 8 am we were loaded up and off to Pisacassa.  The journey was as enjoyable as the previous day, but I felt a sense of apprehension about reaching our destination.  Suddenly it was real, and my biggest fear was being a useless member of such an amazing team. 

There was some debate about whether the local population was aware we would be coming, there was certainly an element of surprise at our arrival.  However, we dutifully unpacked the equipment, and had our first lesson in setting up the chairs.  We decided we’d have a race doing this on the last day as we would surely be quite slick at it by then!  Once everything was up and running we sat together and had our briefing.  What the procedure is, where the instruments go, how the cards are written up.  It was just like starting a new job anywhere in the world.

The start was slow, with only a trickle of patients, but this was just as well as my first patient was very challenging.  The lady needed 7 molars removing all of which were very badly decayed.  As Margaret and Yesenia started on their second and third patients I fought with the last lower wisdom tooth for this lady.  She struggled, but finally got there; she was a brilliant patient.    I couldn’t help thinking that if all the treatment was this difficult then her worst fears would be realised.  It must have shown as Daniel kindly offered me a break.  However, I was determined not to let them down and carried on.  Thankfully it appeared to have been an unfortunate start and the rest of the day passed with nothing so horrendous.

At the end of the day I felt very strange, all the emotions possible seemed to have hit me at once.  I stood alone at the bottom of the yard trying to make sense of everything.  I looked out at the night sky admiring for the first time the Southern Cross, the Milky Way and watching the shooting stars.  I suddenly found that out of nowhere I was crying, it was overwhelming, I was so happy to be there.    

After a very welcome meal of chicken and chips we spent the night in a hostel in Chalhuahuacho.  The five of us squeezed into a room just big enough for us to all lie down, but I don’t complain as we all had mattresses to sleep on.  A few days earlier I would have been thoroughly embarrassed about this sort of situation, but we were already quite a close group by this stage and it was just fun!  It reminded me of sleepovers as a child, with the exception that nothing would stop me sleeping soundly that night. 

Tuesday 2 September 2008

On day 3 we arrived in good time in Curca.  Margaret and I were told that although the road ended a good distance (uphill) from the health post, it was much closer than the previous year.  With the help of the lovely villagers and their children we managed to get everything down to the post and set up, however I couldn’t help wondering how the altitude might affect the return journey. 

There was beginning to be a joke that my first patient of the day would always be challenging as the first occupant of the chair today was a 4 year-old boy with two abscessed lower molars.  I went through the usual struggle with emotions that I do every time I do this sort of thing; I know I’m doing the right thing for the child and possibly preventing a small infection becoming a life threatening one, but it’s always hard to see a child upset.  However, I was absolutely amazed by his behaviour.  He was frightened and cried loudly the whole way through, but allowed the treatment without question.

There was a steady stream of patients throughout the day and I was very pleased that we were able to carry out so much restorative work as well as extractions.  The equipment kept me endlessly amused as the amalgamator bounced across the floor while mixing and I couldn’t seem to manage to get a 3 in 1 tip on without squirting myself with water.  I stress that this is nothing to do with the quality of the equipment; it is only a reflection of my own ineptitude! 

During the morning the children came across from the school to be treated and assembled outside on an embankment to go through the Charla with Leo.  I was informed by Daniel that they wanted to introduce us to the crowd so the children would not be frightened of us.  An excellent idea, and one that Margaret appeared quite relaxed about, but that scared me much more than any other thing I had been asked to do.  I put off the moment for as long as I possibly could, but Daniel was quite rightly insistent and eventually I was pushed out of the door to join Leo.  The sight I was greeted by was such a lovely and humbling one, and children clapped and cheered as Leo introduced me.  It’s sometimes hard to remember that we’ve come to help them and they just want the opportunity to show their gratitude no matter how uncomfortable it may make us feel.   

The day was much busier than the previous one in Pisacassa and all the more rewarding for it.  As predicted, I found the walk back up to Juliana with a box full of forceps to be a good work out.  However, once again we had plenty of help from the generous, friendly locals.  Although I felt very tired at the end of a good days work, the mood was so buoyant that we set off from Curca belting out “Night Fever” as if we were just starting a night out. 

We headed for Haquira, a regular stopping point for the trips, and where we would stay for the remainder of the nights we were away.  The accommodation is effectively a dormitory with enough room for a bed each and a makeshift kitchen.  Very civilised compared with what I was expecting and there are even showers! 

Wednesday 3 September 2008

Days 4 and 5 would be spent in Ccocha.  We were told that usually the more local people were treated on the first day, and then people from a wider area would walk for many hours to come for treatment on the second day.  However, we very quickly realised that the situation might be a little different this year.  Apparently a priest had come to the village and as this happened only every few years there was a back log of weddings, christenings etc for him to get through.  And we thought we were working hard!  We went up to the main part of the village where the ceremonies would be held and Yesenia introduced us to the local leaders.  It was quickly established that we were second choice and no one would be visiting us today.  We were informed that everyone would be happy to come down on the next day however!   

We remained positive, set up the equipment, took some photographs and made lunch.  However, by 2pm we decided to give up, have a restful afternoon and steel ourselves for what would surely be a long next day.  We returned to Haquira and did some sunbathing and sightseeing.  Daniel was spotted by the local nuns and agreed to say Mass that evening in exchange for a bag full of vegetables.  Margaret and I had a go at cooking, much to Yesenia and Leo’s amusement, and then the four of us worked on our English/Spanish.  By the time Daniel joined us again we were really quite good at kitchen vocabulary, and Margaret and I had finally mastered the Spanish for filling!

Thursday 4 September 2008

We returned to Ccocha very early the next morning in anticipation of the hard day ahead, but found the building locked.  Thankfully it wasn’t long before we were up and running and the patients came thick and fast.  It was a busy day as expected and I admit to not remembering very much about it.  After the Charla and our introduction to the children Yesenia got on with the screening and Margaret and I got on with the extractions.  Frustratingly the electricity supply was not good enough to allow us to do any restorative work in the afternoon so we ended up turning some patients away.  It only goes to show that you can be as prepared as you like, but things don’t always go to plan.

As we drew to a close and had all but packed up the equipment a last few patients appeared in dribs and drabs.  Of course we couldn’t turn them away and Leo kindly went back and forth to the half packed Juliana to fetch back equipment for me.  I managed to carry out a last few extractions under the light of a single 30W bulb and my trusty head torch.  Eventually we ran out of patients, finished packing up and headed off, exhausted from our efforts but still able to sing.  In the evening we drank the all important bottle of wine and told jokes which Daniel kindly and patiently translated.  Margaret, Yesenia and I had an early night and I slept very soundly once again.

Friday 5 September 2008

The final two days we spent in Llac Hua and Margaret and I had our race with the chairs as we set up the equipment for the last time.  A small crowd of young children appeared from the school and as Daniel and Leo went through the Charla I could see another long day was on the cards.  No sooner had this thought entered my head then about four times as many older children arrived to join the group.  It was truly a daunting sight and we quickly got to work. 

Starting with the younger children and working hard, we had reached the 12-13 year olds by about 3pm.  Treatment was literally one out, one in and the chairs never had chance to get cold.  I was beginning to feel we were not even making a dent. 

One child sticks in my memory, a young girl for whom I removed her last primary tooth.  She had been quite nervous and when the task was completed apparently without discomfort she looked amazed.  Daniel asked her if she wanted to have her photograph taken with me and she flung her arms around me.  I don’t think I have ever before been reduced to tears by a patient and the photograph is one I will always treasure.  Not all the experiences were as positive.  Margaret had the difficult task of removing the unrestorable upper central incisors for one child.  Although this is of course a horrendous experience for a child, it is one which in the short-term affects the dentist almost as much.  I did not envy her at all and greatly admired the kind care and skill she showed during what turned out to be very difficult extractions.  

We soldiered on through a seemingly endless stream of patients until Yesenia finally called a halt.  We had treated over 100 people and it was decided that we’d pick up where we had left off the next day.  Back in Haquira Yesenia cooked dinner and we ate, but we were really a little tired to think of food.  I remember feeling physically exhausted, but I found it difficult to sleep.  I was thinking of a great day in which we had managed to achieve so much, and the sadness I was sure I would feel when we finished the following day.  I wasn’t sure I was ready to go home yet. 

Saturday 6 September 2008

On our last day we made an early start but when we arrived there was already a growing crowd.  We saw mostly adults on this day and were struck by how beautifully dressed they were.  A rainbow of colours met our eyes at every turn and we couldn’t help but smile.  On woman even came in with a parrot on her shoulder which sat patiently while she was examined.  Every time we opened the door to call the next patient we were rushed by a group desperate to be next in; a sharp contrast to the UK patients who unfailingly answer in the negative when asked if they would like to come through to the surgery. 

When I look back at the last few photographs taken of us that day I feel they sum up how we felt as it all came to an end.  Thoroughly exhausted, and so, so happy.  I will forever remember the wonderful people I met in the villages, and the even more wonderful people I worked alongside, with a smile on my face.