Dental Project Peru – Trip Report

Trip 2 – 9-16 July 2006

Gemma & Fionna

(Written by Gemma Dalzell and Fionna Burns)

DAY 1

The trusty steed ‘Juliana’ (see trip report June ’06, Day 3) is already being logistically puzzled together to form the tarpaulin draped tortoise back wagon that houses  everything from the dental clinic, pharmacy, a weeks food for five, our beds and wardrobes (it did seem like there was one inside my rucksack) and everything essential for survival and simple life at high altitutude.

We greet Jacqui with much enthusiasm, intrigued to meet this inspirational character who has pioneered the DPP charity that we feel so privileged and excited to embark on. We find her in her endearing studio apartment, laced with treasures of many travels, donning a warming smile, energetic eyes and a gentle determination, that we are to learn more about in the week ahead.

Fionna 25, and myself 26, studied together in Glasgow Dental School, a few years behind Jacqui, and volunteered for this trip after a two year Vocational Training programme in Scotland. We are both from Northern Ireland and found great solace in the Peruvian love for the potato!

Leo is our driver and previously saluted clinic helper and driver extordinaire. He is a gracious, willing hand, making things happen without our even noticing it. A priceless asset to the workings of the DPP adventures and endeavours.

Yesenia, a local Cusco friend of Jacqui, is a wise and regular pair of hands with DPP. Her dancing eyes and smile make her a treasure to have on the team, and she puts up with our ‘Spanglish’ practice throughout the road trips through the mountains!

I am awe struck as we leave the main road and find ourselves bumping along the gravel cliff edge roads, peering over the precipices dropping hundreds of feet below us.

By lunch time we are commending Leo’s driving and the difficult task he has of manoeuvring the vehicle along such narrow, winding paths. A very tiring journey that he embraces with apparent ease and his characteristic calming manner.

Lunch by the Apurimac river, one of Jacqui’s favourite spots was idyllic. We spend the day drinking in the panoramic views of the expansive breathtaking landscape with the backdrop of the sacred mountains as we drive, narrated by Jacqui’s anecdotes and wealth of knowledge and passion for this area gleaned from her four years working here.

We are treated to a comfortable nights rest at a convent in Cotabambas and a vigorous wrist wrenching game of volley ball with Jacqui wincing at the thought of losing a pair of volunteer hands to our determined efforts to match the skills of some of our tiny five and six year old team mates! I tell you, at the altitude here, the locals who farm at these heights could win any Olympic sport back home at sea level!

We cooked in our room and drank lots of Mate de Coca

hoping to combat the symptoms of altitude, as Fionna and

 I only had one day to acclimatise, and find our hearts pounding, with deep heavy breaths between sentences and slight light headedness.

DAY 2

Up with the sun, a pounding cold shower, and the brass band practice, the tune which was to become our hummed anthem for the rest of the trip in erratic moments of expulsion, of stress or joy!

We motor up the other side of the Apurimac valley, Leo being serenaded but the dentista chicas as we climb higher and higher and the climate changes before our eyes to barren expanses where cacti are the only vegetation to thrive. Our anticipation mounted as we did on and on, the clouds disappearing below us to 4300 metres. We now take field paths at this point, and for brief moments you feel like you are on sea level, flat land, and suddenly the astounding valleys appear again.

We arrive in Chacarro, and set up clinic with some coaching from Jacqui, who unfortunately had one hand in plaster on this trip. However this meant that she was to hand in a different way with translation which was a great help in starting out with the first patients and our valiant attempts to pronounce words in our Irish-Castillano lilt, which apparently resulted in expounding some phrases that were far from polite!

Adult patients appear on the first day as planned by the technico, the children with little faces peering from under sun bleached sombreros peer through the window. The hats, we learned had many uses from a storage space for medicines and things we gave them, to a spittoon, after which the hat was gingerly placed on the head again!

I’m intrigued as I watch the day starting. Village people wander from place to place silently, no rush, flocks in tow. Time knows different troubles here than our worries of full agendas.

No electric at this health post means no fillings.  We see many adults that day for extractions relieving many of them of long standing pain and infection. Leo sterilises on a gas run pressure steriliser which does the job very effectively.

That night we set up home in the birthing room, and as we sit under the stars and full moon that evening, the air is crisp. Frozen waterfalls on the way here show the extremity of the altitude, but with the southern equator sun, Fionna and I find it confusing and shed our layers mistaking our bodies’ resilience to these conditions which we regret later.

The locals appear wrapped in blankets, chatting hushedly in the dark. After an enthusiastically guzzled dinner we play cards by candlelight and I go to bed thinking there is no place I would rather spend my holiday time. I have seen more in two days in these villages hiding in the Andes than I ever dreamed still co existed with the western world.

DAY 3

We awake for another day of clinics in Chacarro to see the sun bathing the Andes peaks and people appearing with wood for their fires and water for the day.

We have a steady morning until 11 am with a few more adults from yesterday to see. They accept often difficult treatment with quiet gratitude. As things just begin to look quiet 267 school children arrive. The team worked well, with Yesenia up front teaching in Spanish, Jacqui in midfield screening which saved her hand, and Fionna and I in the clinic out back as the children trickle in. A constant four hours ensues with marvellous kids managing extractions of adult teeth and roots. There were a lot of decayed and retained deciduous teeth causing problems with alignment of developing adult dentitions.

Near the end of the day one little child cried which started the sequential pattern for the rest of the evening. But the ‘Globitas’ (balloons) provided worthwhile incentives for many children going through daunting treatments, getting numb and having numerous teeth out with little language on our part to reassure them. They were so stoic in managing what they did.

Again Globitas were a worthwhile salary for all the little hands that wanted to help load the truck, and it was done in no time, leaving the kids dancing around with glee for the digital camera. Leo deftly manages the roads and paths in the dark, a full moon lighting the way as it begins to peak from the horizon and we stop to watch with fascination as it rises above the mountain peaks.

As we drive along, a feeling of utter well being and humility comes over me. There is a sense that each member of our team has gained more from being in the villages with these people than we could ever hope to give. People questioned me as I went away for this trip as to why I would want to give up my precious annual leave to work! But this feeling is more exhilarating than any extreme sport or hobby I might otherwise have spent my free time doing.

It is amazing what Jacqui has achieved in setting the charity up, and going before us in recent years on foot, treating these people single handedly!

DAY 4

Back in the calm surroundings of the convent we awoke as the sun was rising…all was quiet…we held our breath awaiting the parp of a trumpet or the beat of a drum…but no…seemingly no band practice on Wednesdays! A peaceful beginning to another full day of activities and soon our troop were amongst it packing up the trusty steed, waving our goodbyes and pointing in the direction of Sorcco, our second stop of the trip.  Jacqui informed us that the village sat at an altitude of 4,200m, Gemma and I at that point were undeterred…we had only arrived one day before the trip started and not the recommended two, by this stage we had 4 days to acclimatize, surely it would be plain sailing as far as the altitude was concerned?!

It was a 3 hour drive to our destination but the time flies. There’s a fun vibe inside the truck, conversation buzzing between Spanish and English.  Gemma and I study our home made flash cards in an attempt to boost our Spanish vocabulary, we both quickly learned in Chacarro how limited we were in reassuring the patients we were treating and how beneficial it would be to have a full command of the language.  The scenery however grasps our attention and the flash cards are stored away as we excitedly anticipate what waits around the next bend.  The tourist trail has long since been left behind and I feel immensely privileged to gain a true appreciation of Peruvian life.

Our arrival in Sorcco was in contrast to that of Chacarro - this health post was slightly removed from the community and high on a hill top overlooking the village, so we attracted little attention.  However, as we got to work setting up our clinic word of our arrival spread and before long we had business gathering.   This health post was manned by a dedicated and charming tecnico, Nancy and was well equipped, electricity included-this meant the filling station could be brought into action- enabling us to offer a welcomed alternative to extraction, especially after viewing the tooth cemetery we amassed during our stay in the previous village!

The work day swung into action with Leo taking command of the Charla to the eager attention of the local school children whilst inside, the Northern Irish contingent got to work treating some of the adults and clearing the way before the influx of los ninos! Jacqui and Gemma did the screening providing a constant stream of little patients.  The work here mainly involved extractions of carious deciduous teeth and roots and carious first molars.  Communication was again tricky as in this area it was Quechua and not Spanish that was widely spoken, and we have the teachers to thank for their words of reassurance to the children and of course the old bribery with balloons worked wonders!

We all added extra layers at lunch as once we stopped we realized the drop in temperature that climbing altitude brings.  The first symptom that altitude sickness was about to strike!

More screening and treatment followed for the rest of the afternoon, work occasionally made more challenging by fearful patients- an infectious feeling which spreads and can lead to a noisy surgery but your heart goes out to these brave little souls who still preserved with the treatment.  As the last nino left, balloon in hand, Jacqui, Yesenia, Leo, Gemma and I were beckoned outside to a lovely scene which will remain with us all- the school children had assembled into three rows and directed by their teacher sang a song to show their appreciation.

Another day drew to a close, rewarding in so many ways- it is so clear that DPP contributes to the welfare of this community and I know that I for one have gained greatly from the experience.  The whole team made it work and that night we chilled out happy in each others company, eating together and then playing cards before crawling into our sleeping bags, complete with long johns and ear muffs for a contented nights sleep on the floor of the birthing room…or so Gemma and I thought!

Altitude sickness, which we had been oh so complacent about before, kicked in…first victim was Gemma, followed quickly by me….not much sleep was had!  We layered up and downed coca tea in an attempt to alleviate symptoms but being at 4,200m our bodies had minds of their own!  Our praise can only go to Leo, Jacqui and Nancy who nursed us back to health!

DAY 5

Day 5 passed in a bit of a daze for Gemma and I as we tried to shake off the effects of altitude sickness which lingered with us for the next 24 hours.  We began to realize just how serious this condition can affect the body if not acclimatized.  Despite our steely determination and attempts to get on our feet we were just not fit for work, much to our great disappointment.  The project work depends hugely on team effort and we knew our absence would have an impact on the workload of the others.

In spite of being 2 dentists down, the working day continued with Jacqui, Yesenia and Leo taking on the full work load undeterred.  Jacqui single handedly screened every little mouth while Yesenia did the work of 3 dentists by running a 3 patient surgery and rotating around the dental chairs-amazing!  Evidently a busy morning, and they collapsed into chairs in the early afternoon for a well earned lunch break.  Fortunately the rest of the day was a little more manageable but this was still no consolation for Gemma and me, we just felt bad to have missed out on the action. 

But tomorrow is another day……

DAY 6 & 7

We climb slightly higher again with trepidation as Fionna and I are still feeling slightly weak to arrive at Nahuinlla. A well organised clinic with a motivated Tecnico brought five schools that morning. There were lots of encouraging signs here, with kids sited with pieces of fruit in their hands and their ethnic blanket rucksacks. After screening about 300 of them, we treated about 60 children on the first day.

The second day brings some adults, and we are reminded of the inaccessibility of healthcare here as one gentleman walks seven hours on crutches with his two year old son to get treatment. Time and convenience is such a different concept here, but the people live peacefully in acceptance of the climate and its harsh geographical challenges.

Another little girl stands out from this village, exemplifying the reward we experience in delivering instant problem and pain relieving treatment as dentists here. Josephina is around 11 years old and turned up towards the end of our last clinical day in this village and on this trip. She had a rare condition (hyperplastic gingivitis?) which caused her adult teeth to fail to erupt. She had suffered a gummy smile and no front adult teeth for some years now. She was very anxious about having any treatment and at this late stage her loud crying was difficult to handle. Jacqui, undeterred and composed managed to calm the brave soul with the help of the tecnico who provided some intramuscular diazepam to sedate her, and the girls teacher who commanded a certain authority that the children do not fail to respond to.

The team worked quickly with all hands on board to improvise a surgical procedure with what limited materials we had, to expose the girls teeth. We worked as darkness fell, and left her with a new and dramatically different smile.

By the end of the week, we were able to pluck out any dentally challenging teeth and had managed with some frustration with the language barrier, having adopted an apt range of sound effects to help!

That evening as we pack up, a young mother who has given birth to a beautiful baby in the health post in the last few hours, inherits a Scottish hand made set of matching woollen garments which Jacqui’s contacts diligently make and send to her for this purpose.

We are all delighted as the young mother allows us to cuddle her newly clad pretty little treasure. I am touched and tearful as Jacqui suggests an adaptation of my late mother’s name, Frances and the baby is christened Francesca. It’s an emotional end to an outstandingly fun, challenging and insightful week, and the team hug and congratulate each other on our huge efforts. Again we drive off with that indescribable feeling of satisfaction, yet grave insight that we have met so little of the huge need in this world for the things we wake up to take so fore-granted in day to day life at home.