Dental Project Peru – Trip Report

October 8^th-15^th, 2006

Trip 5

Jacqui, Clark, Daniel and Judy

Written by Clark Kotula

October 8, 2006 – Depart Cusco

As a change from the usual………me, Clark (Jacqui’s Husband) is writing this trip report.  Just want to warn you ahead of time that this report will be lacking a few key words you are used to such as “wee”….

For this trip there was only one foreign Dentist volunteer that joined us, Judy Wheble, a very strong, well traveled and confident lady originally from Scotland but resides in the London area.  It was very reassuring as Judy has spent considerable time volunteering in Tanzania with another organization and our project was recommended to her from a previous volunteer we adore named Liz Roberts.  We knew she would be able to handle herself well out in the field and we were not disappointed.  We had the opportunity to get to know her before the trip started as she was in and out of Cusco visiting the sites.  We liked Judy the first night we met to have dinner in Cusco and looked forward to the trip with her.

Yesinia Lopez was the second Dentist volunteer on this trip, a local girl from Cusco who has become Jacqui’s “right hand girl” when it comes to running the trips.  A very kind soul who is extremely easy to get along with although she thinks I am as she says “you crazy, Clark!!”  Jacqui and I have both enjoyed getting to know and working with Yesinia over the years, it is a wonderful feeling having a local Cuzquenan to work with us.

Last but not least we had the company of a distinguished “holy man” from Lima, Daniel Salazar.  I met Daniel a few years ago while doing tourism sales and marketing work in New York City, we ended up sharing horrendous hotel rooms in some of the larger metropolitan ghettos of the east coast for nearly a month.  Interesting enough, Daniel is (was) an ordained priest until he was nearly 30 and then left that to explore the “other” things in life.  Needless to say I really liked Daniel and asked if he would be the one to pronounce Jacqui and I “husband and wife”.  He agreed and was the “father” who married us this year on May, 18^th.  Daniel has a way with people that puts them instantly at ease in his presence, he is fluent in English/Spanish, and is just plain fun to be around whether you are working towards spiritual enlightenment or seeking the wicked path of sin.

So that is our team; Clark, Jacqui, Yesinia, Judy, and Daniel.

We all met at our new house at 6am I order to load the truck up and get an early start, it was going to be a very long drive today.  Judy was about 20 minutes late as her taxi driver had no idea where he was going and was ashamed to let her know, instead, preferring to drive all over Cusco until Judy noticed passing the same statue after the 4^th time.  Ok, time to load up the truck;  there are 5 people and their personal stuff, 5 sleeping bags and mattresses, 8 days worth of food, stove, pots, pans, associated cooking equipment, the air compressor, 3 dental chairs, 2000 toothbrushes, two 5 gallon water jugs, 14 gallons of additional diesel fuel, 4 crates of dental instruments and supplies, record keeping files, banners, the drill, spare parts  The final pieces of equipment and personal effects are packed in with surgical precision between our hips, legs, seats, etc before we are ready to shove off by 9am.

There is always such exhilaration and delight in setting off on an adventure.  We were all loaded into the truck with all the equipment and provisions to not only be self sufficient and mobile for the next week but also armed with the capacity to deliver pain relief and education to hundreds of people we would meet along the way.  The truck was heavy and had a mind of it’s own as we chugged up and out of the Cusco valley, dodging mangy street dogs along the way.

After the traditional stop in the bustling market town of Izcuchaca to buy coca leaves, bread and bananas our tires traded smooth asphalt for rough dusty dirt track towards Cotabambas and the Apurimac canyon.  It was a roasting hot day with puffy clouds drifting across the sky as we rattled along.  I always love to see people’s expressions as we begin the descent into the Apurimac gorge when they notice the 6,000 foot drop just inches from the vehicle and succession of zigzags descending into the canyon.  Beginning our descent down the 21 zigzags to the canyon bottom, a Mitsubishi pickup truck outfitted like many of the mining exploration vehicles in the area zipped past us going about 20mph faster.  I remember thinking as it went by how I would not like to be a passenger in that vehicle as these roads are so very dangerous, there is no room for error.

There is always one major “drama”, “trauma” or “incident” on every trip that stands out.  Half way down into the gorge, where the twists and turn are right on top of each other, I saw something that made my hair stand on end and my foot slam on the brakes.  Right at a little ravine where the road goes over an improvised bridge, there was a blue Mitsubishi pickup-truck gone over the edge- smashed up, windows broken and lying on it’s side about 40 feet down the mountain.  I pulled our truck off the road in order to not cause any more accidents.  We were all out of the vehicle running towards the cliff edge with a spooky feeling and dreadful thoughts about what we were about to encounter inside the vehicle.  It was hard to see through the glass as it was all shattered but not broken out.  After a quick examination we discovered that nobody was inside the truck and this had obviously happened the day before as there were a few pieces of timber stuck under the vehicle to insure it would not slide any further down the ravine.  There were many deep breaths as we got back into the truck and carried on.  These roads are the most dangerous thing on any trip and having this scare was a good reminder to reiterate how careful I must be.  The truck is loaded with 5 souls aboard and probably over a ton of equipment; it would not stop easily if I wanted it to.

As we rumbled across Hualpachaca Bridge, the heat was intense, dry and suffocating in the bottom of the canyon.  I popped the truck into 4x4 just for the added traction and we began the dizzying grinding climb up the other side.  The views emanating towards the river from this side of the canyon are one of a kind. It is also special for me because I first met Jacqui at that bridge while working as a River Guide and she was my passenger back in 2001.  Since meeting, Jacqui was the first one of us to actually cross that bridge and what she encountered on the other side has become a large part of our collective experience together in life.  From this point onwards, passing the bridge, I always feel like your way of looking at the world is about to change, well, in fact the world changes as you cross the bridge.  It really is an area where time is about 600 years behind the rest of the world, no tourists visit here, the language changes strictly to Quechua, the roads are seldom traveled, and you become what the locals refer to as “Virachoca”, or,  “not from our realm of experience” in their local language. 

We kind of settled into a stupor as the altimeter crept up to over 5000 meters and the magic of the landscape and her peoples infected us.  I was tired the last hour driving in the dark towards Haquira and our friend Dino’s house, our resting place for the night.  It is hard to describe how brutal the roads are in this area, and with tons of equipment packed into the truck it takes quite a beating.  To give you an example, one of the hinges that connects the “bonnet” or “hood” to the truck just snapped at one point today from all the jarring.  Something like this happens to the truck on every trip, last voyage it was one of the leaf springs that just snapped in two.  I was happy to settle for a broken hinge over a broken suspension any day, so just inserted a piece of rubber intertube between the two clanging pieces of metal to lessen further damage and the noise it created and continued to drive.   After 10 hours on bumpy, dusty roads we were ready for a quick meal and the chance to be horizontal.  When we arrived at the house we were staying, it was great to see the door opened by one of Dino’s superbly well mannered children.  We love these kids on this trip as they always say “Buenos Noches, Doctor” to each person individually even when we are in a group together.  It is just a nice touch to acknowledge every person individually and I thought about this as we drifted off to sleep………..

October 9, 2006 – Huancassca

We woke up around 5:30am in order to eat, reload the truck and drive to Huancassca which would be the first village we work in on this trip.  The drive from Haquira to Huancassca was beautiful and adventurous as we cross numerous small rivers hidden amongst the ravines.  We passed a few locals who were walking towards the village and chatted to many of them, advising them about the free dental clinic we were providing over the next two days. 

Arriving in Huancassca was frustrating.  We expected to find “Vanessa” who was the local Doctor at this post last year and someone we got along with well.  It turns out that Vanessa had finished her 1 year community service term just last week and now there was a new Doctor and Obstetrician who had just arrived at the Post, of course they had never been alerted to our arrival and knew nothing about Dental Project Peru.  Communication has been the single most frustrating problem with attempting to deliver dental care to very rural and spread out populations in the high Andes.  Jacqui has tried to do everything possible to coordinate with the Ministry of Health directors in the area to solve this problem; leaving notes, preparing schedules, making radio announcements, etc..  But these schedules of visits just get buried under other paperwork and forms and the word never seems to get out.  Thus so many people who are really suffering from dental pain and infection in these areas never know that they could receive free treatment when we are around.  It is painful and frustrating but part of life out here.  But things are changing.  As we stood at the entrance to the health post and talked with the new Doctor, Carlos, about how this lapse of communication meant that many of the more distant villages would not have the chance to be advised of our…..ring………..ring……..ring…..”what is that Carlos?”…”oh, it is the new satellite phone we have here at the health post; there is also internet in the evenings.”  We couldn’t help but laugh at the paradox of it all.  Here was a village that just received electricity last year, still has no potable water or sewage system, has sporadic latrines around the village, lies 14 hours by rough dirt track from Cusco, is at 15,000ft in elevation, the local people speak an indigenous Indian dialect, live off of potatoes and the occasional guinea pig, but you could now log onto the internet and possibly sell your handicrafts through eBay.  Strange!?!?  Good thing was that the new doctor was very “switched on” and went straight out to the local school and village microphone in order to begin passing the news that Dental Project Peru had arrived!!

The first time on a trip when we set up the clinic always takes time as we need to teach the “first timers” who were Daniel and Judy, how our process or system works.  Thankfully this village now had electricity 24 hours a day so we could sterilize instruments with the electric sterilizer.  In less than 30 minutes there were about 300 school children lined up outside the health post and waiting to see the dentists.  It is amazing that you can arrive in a village that seems virtually empty of people and then confront a mob of 300 waiting for your attention!!  We all assembled outside the health post and were introduced to the village children by the Doctor. Yesenia did a wonderful oral health promotion talk which always gets the children fired up and then Jacqui sat down outside to screen all the children in order to determine how many required treatment.  By mid-day we were up to about 80 children that required at least one tooth extracted and they were loudly playing in the health post waiting room.  Jacqui continued to screen the children piling up outside while Yesenia and Judy treated patients and Daniel and I took turns between providing medications, checking bleeding, sterilizing instruments and making cotton balls.  We fell into a good routine today and it was apparent that we would work well together on this trip. 

After seeing a total of over 100 patients on just the first day of the trip, we were all exhausted and ready to finish by about 6pm.  The Obstetrician at the health post, Kelly, kindly gave us her room to use as a bunkhouse and she was going to sleep in the “expecting mothers home” which was just outside with a few patients of hers who were due to give birth in the upcoming days.  These sleeping arrangements at health posts are always comical and have the feeling of a slumber party as we have to do with what space will allow us.  Jacqui and I could fit into one bed, Judy had her own, and Daniel used some camping mattresses and slept on the floor while Yesenia decided to sleep on a gurney in another consultation room.  We fired up a special meal of pasta and canned tomato sauce for the evening and called it a day.

October 10, 2006 – Huancassca

We were up early around 6am and ready to start seeing patients around 8:30am.  We managed to treat all the primary school children in the first day and those in secondary were going to come only if they were in pain today.  Our hope was that people would start arriving from the distant villages today. 

The main village that we set up our clinic in, Huancassca is just the one that the road reaches.   From Huancassca, there are about 12 satellite villages ranging from a 1 to 5 hour walk away, these are the people whom we really want to get the world out to.  What is difficult at times is that these villages receive word of our presence at the last minute, walk for up to 5 hours for treatment, and arrive in masses to see us in the evening of the day we are planned to go on to the next village.

It was great to see some very tired looking people sitting in the reception room even before 8am.  I asked in my faltering Quechua where they had come from and received hushed whispering answers like “Umajuro” and “Pataypampa”.  I consulted the posts map which showed distances in hours walking and was impressed to see that Pataypampa was 3 ½ hours walk!!  These people must have started walking to come and receive treatment before 4am!  The patience that most of these people show is incredible, as we explained that we would see the schoolchildren first before attending adults in the village.  They stoically accepted this and some were not seen until the early afternoon, they would just sit outside in the sunshine and spin wool.

The early morning hours in rural Andean villages are magical.  The air has that cutting crispness to it that speaks of cleanliness and purity, very light air that has the promise to heat up rapidly with the sunlight that is just now sending split rays over the ridgelines.  Men in dirty ponchos and ragged white hats hustle sheep and cattle between the adobe huts; you can see their breath wisp out as they huff out of town.  Smoke from cooking fires percolate out through thatched grass roofs and seem to hug the roofline for as long as possible before being carried away by the wind.  Children bounce down the lanes in colorful outfits towards wherever they are going, slowing down just enough to peer sideways in a quizzical manner at the weird white Gringo standing in the street.  Many women go past with blankets on their backs full of potatoes, corn and the occasional babies face sticking out the top while saying, “Buenos Dias Doctor” as they pass.  Out here in the Apurimac, if you are an outsider they will always address you as either “Doctor” or “Engineer” no matter what.  Even if you only have a miserable B.A. from some small hippy college like me, it kind of feels funny as there is no point in explanation, they are just being courteous and speaking from experience, always makes me giggle inside.   It is nice to keep this time for yourself when doing this volunteer work because by 3pm you know there will be hundreds of people demanding your help, they are in pain and you are the only ones here who can help them.  It becomes suffocating at times so I have found it very useful to take these morning strolls before the day goes crazy.

Our morning turns out to be pleasant with a steady stream of secondary school patients and the adults who have walked for miles being seen by Yesenia, Judy and Jacqui.  We never had more than 20 people waiting for their turn at once which is a rare feeling on these trips.  The people in Huancassca have always been very receptive to our work, polite and seem to be a well looked after community who take pride in their place and self.

A funny thing happened today in terms of gratitude.  We were doing an oral health talk with the secondary children, explaining what foodstuffs are good and bad for their teeth, how to brush, etc..  When along comes the Mayor of Huancassca.  He ambles up with two liter bottles of Pepsi Cola and thanks us so much for what we are doing for his village.  We embarrassingly take the gift while looking at this educational teaching tool beside us which displays the bottle of Cola squarely placed in the “BAD” section.  Nice of the guy, but, “what was he thinking?” to bring a bottle of Pepsi for the Dentists who are explaining to all his residents how bad this stuff is.  We got a good laugh out of that one and went back to work treating patients.

The patients kept coming until it was almost dark outside.  We finished up around 6:30pm and decided to pack up and drive back to Haquira for the night which provided better sleeping arrangements for us.  There was a great sense of accomplishment as we pulled out of the village and drove back to Haquira during the sunset.

October 11, 2006 – Patan

Since first beginning to visit the Apurimac department in 2001 together, Jacqui and I have seen some great improvements in infrastructure development.  The single worst road that had always existed was the road to Patan.  Today, leaving Haquira at around 7:30am we were amazed to find a beautiful new dirt road which did not require us to drive in 4x4!!   Patan is a beautiful little village that sits atop a knoll at the junction of two small streams and looked so perfect in the morning light as we came around the last curve and crossed the stream at its base. Awaiting us in Patan was a surprise when we discovered a brand new heath post!  Last year during our visit to Patan, the post was one of the worst in the entire region; dirt floors, no water or electricity, blood all over the walls and rusty metal furniture everywhere.  This new heath post was constructed so modern, we even noticed that they had disposable paper towel dispensers installed in the bathrooms…….when will the disposable paper towels arrive???  It is really encouraging to see this type of development in the Apurimac, but brings up interesting questions as we are out there filling a development hole at the moment in rudimentary dental care.  A nice new health post is great but this year they had one less full time staff member manning the post than the previous year, where do priorities stand?

We were pleased to see that “Urbano”, the health technician in Patan was still there.  He is a nice guy that genuinely seems to care about his patients and treats them in a humanistic manner.  Urbano has received some basic dental care instruction from a German dentist who runs another NGO in the Apurimac.  It turns out this post also had not been notified of our visit, but Urbano overheard heard radio chatter between us and another health post and figured we were coming to Patan also.  Since he helped us last year, Urbano walked around the village and notified the school, adults and heath promoters.  We were grateful for his assistance and the yard surrounding the post was filled with over 350 children in less than an hour after our arrival.  If you have never been in a situation like this, it is almost unbelievable to experience it the first time.  Having 350 indigenous children arrive needing treatment and knowing hundreds more are coming that same day is overwhelming.  It feels like you are about to embark into some battle or something; preparing Jacqui with fresh batteries in her headlamp, a tray full of probes and mirror, pockets full of examination gloves and handfuls of patient record cards, you can see Jacqui getting emotionally psyched up for her entrance into the courtyard…..

Meanwhile inside, with the background cheer of all the children outside greeting Jacqui, we all were preparing cotton balls, making last minute adjustments to the dental chairs, preparing the sterilizer, etc.  Jacqui is outside screening every child and I quickly realize the amount of children with treatment cards in their hands, running all over the place is mounting; it’s going to be a serious day.  Yesenia and Judy are both in the clinic room treating patients as quickly as possible, and it always almost seems like a place of calm amidst all the commotion outside.  The dentists may have 3 people “in the chair” and are able to focus on the immediate task at hand, meanwhile Daniel and I are constantly back and forth through the waiting room to sterilize instruments and keep the flow of patients in order.  By the time Jacqui came back inside and finished screening, we were already up to about 85 patients waiting and were only seeing patient number 6 of the day!  You can imagine how stressful any situation would be with 85 schoolchildren playing around inside a hospital waiting room, but it is amplified as these children have never seen people like us, heard a foreign language or seen people with flashlights on their foreheads!!   These situations can get stressful but it is important to work as a team and stay focused.  By doing this, the first couple of hours of the day were excellent as Jacqui screened the entire elementary school in one go, Daniel did a great healthcare and tooth brushing talk translated into Quechua and we had everything organized to get down to a day of work.

The day got into a roll and children free of pain and infection came to see Daniel and I to receive their medication and toothbrushes with cotton stuffed into their mouths. It is amazing the differences in villages that you experience when providing dental care in these areas.  The Quechua language is one of the most widely spoken indigenous languages in the world, with an estimated 12 million people that speak it from Colombia down to Argentina.  Estimates in the Apurimac are that about 98% of the population speaks Quechua as a first language.  In many villages you can see the education that students are receiving reflected in their command of Spanish.  They will always speak Quechua, as their immediate reality and life cycle of being farmers in the Andes is more associated with their mother tongue than it ever will be with Spanish.  Peru has made a lot of advancement in the area of respecting and protecting their Andean heritage, the Andean people are now recognized as being unique and special by all other class of Peruvian people.  Unfortunately, some community leaders in areas such as the Apurimac have taken steps that only Quechua should be taught in schools to protect their identity.  This is respectable as I feel strongly that these people should cherish and not loose their identity, but, it basically means that these children will never be able to function in any other capacity other than a subsistance farmer in the Apurimac.  Many large mines are moving into the area and wish to employ local people, but are not doing so unless they are able to read and write in Spanish.  Quechua is a spoken language and not until recently has it been written.  What hope do these children have unless they are able to speak with the rest of the world? 

The differences between the children in Huancassca where we had been for the last two days compared with the children in Patan was painfully obvious.  Maybe about 1 child in 10 could understand basic Spanish where in Huancassca you could hear those clearly speaking Quechua amongst themselves but could switch into Spanish without a problem.  The two villages are only about 10 miles apart but are a world of difference.  Daniel and I noticed something interesting as we were taking care of the children.  Every time a child came to the door it seemed that they were slamming the door back and forth trying to get in.  We would open the door and have some scared face staring back at us.  We realized as they were leaving the room they were having trouble with the doorknobs.  This new health post had modern closing doors with locking doorknobs and the people had never seen these before.  They would put a hand on the doorknob and just push repeatedly trying to get into our room without knowing that they needed to turn the knob for it to open.  Something so simple that we take for granted and realizing this little detail gave us an understanding of how basic life was for these people. Needless to say, we taught a lot of people to open doors in Patan during our visit.

Today was a hard day for all of us I believe.  We saw, educated and treated about 120 patients who were in pain.  We were not there to ask anything from these people, just wanted to help because we could.  With the overwhelming amount of people to treat and the huge language barrier it can be frustrating as you end up feeling that you are forcing people to accept your charity.  The language barrier results in our inability to describe what is happening to our patients; why they are in pain and what we need to do in order to fix it.  This makes the people scared of what is going on and we become frustrated with not being able to reassure them.  Sometimes it feels like we are struggling to make a difference or as some put it so eloquently “fighting the long defeat”.  There is just so much to do in order to improve the living conditions for these people I find my head reeling trying to take in the big picture.  At times like these I go into the treatment room and watch my wife, Jacqui, work with the people.  It is always so inspiring to see how she manages to treat each case separately and provide the due respect each individual deserves.  After seeing the wonderful care each person receives from Jacqui and the other Dentists with Dental Project Peru, I am able to walk through the waiting room with hundreds of people staring at me and smile at them, confident that one person at a time we are making a difference. 

It was reassuring to see that many parents came to the health post today to accompany their children with treatment.  This is a positive thing and shows support within the community.  Unfortunately the teachers in Patan disappeared after about an hour and took the day off, leaving all their children playing around the health post. 

At about 4pm, the crowds were dying down and we decided it would be best to drive back to Haquira again for the night.  One funny thing that happened today: Daniel and I were outside getting the truck ready to load up and I needed to siphon more petrol into the truck from a 15 gallon drum that we carry with us.  As I was getting the hose ready Daniel grabbed it and asked if it was ready.  I wondered if Daniel had ever done this before and just said yes as I hate sucking that damn tube coated with dust and oily diesel fuel.  And boy, can Daniel suck!!  With one huge lungful Daniel had diesel shooting into his mouth, out his nostrils and all over the place with extreme force. Luckily he managed to get the tube into the opening before stumbling away gagging and retching as Urbano and I struggled to stay upright as we laughed like crazy.  Thanks Daniel!!

We drove back to Haquira in about an hour, enjoying a wonderful sunset along the way.  It was the halfway point of the trip and we were all feeling it.  We ate some Quesadillas, a culinary highlight of every trip, and went to sleep early.

 October 12, 2006 – Patan

Driving back to Patan we were ready to see patients beginning at 8:30, there were about 10 adults that had walked in from outlying communities waiting for us when we arrived.  The idea is always to treat the children first, we feel like if we can start the children recognizing the importance of oral health early it will have the best long term effects for their community.  When adults arrive, if they are obviously suffering from pain and infection we will fit them in with the children.

A good thing about the secondary aged kids is that they know if they are having a problem or not and Jacqui does not need to screen every one of them.  Today there were about 40 secondary aged kids that we treated and they were all very cooperative and happy to be seen.  These kids learned Spanish in school before the new rules regarding Quechua were put in place so it was a welcome relief to be able to communicate with the patients today.  It also was sad to see the big divide between them and the younger children who came to visit yesterday, their chances of finding actual work and having the opportunity to go somewhere else are there. 

We were very thankful to have Judy on this trip as she is also an orthodontist.  In many of these villages and particularly in Patan there is a lot of inbreeding amongst the population.  This inbreeding results in many teeth popping out in very strange places and angles.  Without access to x-rays it is very intense trying to figure out the best treatment plans which will allow for the persons mouth to grow and accommodate the other teeth.  Judy has a lot of experience in this area and her knowledge came into play with various patients in Patan.

We were very pleased to see our little “Amiga” Esther for the third year in a row.  Esther is a young girl from Patan born with a cleft lip and palate. Three years ago when we first saw her, we were amazed that this girl had learned to live with the problem.  There are special patients that we have known in each village and Esther is the one in Patan.  Amongst all the faces, we spotted this shy little girl smiling and peeking out at us from a corner of the waiting room.  She was happy to see us and I believe she appreciates all the attention we give her each year.  It was wonderful to see she was healthy and still growing, although she did need one extraction!!

This day was full of Mother patients and their babies.  It seemed at every time that I entered the clinic there were little babies sitting on dirty Andean blankets staring up at me.  It’s comical when many women just leave the baby on their back and try to receive treatment while sitting in the chair.  We usually ask the women if there is someone else to look after their babies while they are being seen, second option is to put the baby on the floor, third…..”Oh, Daniel will take it”.  I’m always humbled by these people’s relaxed attitude and inherent trust in strangers.  It is refreshing to see a mother pass over her baby to some weird, alien looking white person who speaks in strange words and not even blink.

We finished up around 5pm and headed back to Haquira under a sunset full of muted pastel colors and villagers herding their animals back home.  We were excited to see Dino tonight as he was finally home.  For those of you that do not know Dino, he is the caretaker of another Non-profit organization’s base which is located in Haquira.  The home is used to house volunteers from this organization, serve as a base for training local leaders and also as an agricultural experiment station seeking to discover better ways to grow more nutritious crops at such high altitudes.  We got to know Dino through a wonderful American woman named Kali Erickson who was helping to decrease the infant mortality rate in the Apurimac region for many years.  Dino has come to be a great friend and has always looked forward to our visits as much as we do. 

Tonight turned into a very special night with Dino that I will always remember as a highlight of our times in the Apurimac.  As Dino is quite a community leader in the area, he suggested that he could do a community radio announcement to let people in Tambulla (our next village) know of our services.  Dino left to go down into town and use the local radio station to do a broadcast.  We sat in his little kitchen with a crackly transistor radio and listened to Dino’s sing-song voice boom across the airwaves.  “Friends, amigos, brothers…help has arrived from our friend Doctora Jacqui and Dental Project Peru…”  He went on for about 5 minutes between Spanish and Quechua advising the people in Tambulla and surrounding communities to come visit us at the health post over the next two days.  At the end Dino gave a funny remark to me over the airwaves, “Doctor Clark, save some beer for me, I’m coming back to the house.”

We sat around with Dino and began to reconstruct how we all came to know each other and the extended community of aid workers in the region.  It was a great night to realize how so many people from far off places of the world had come to love and care for this extremely remote and impoverished corner of the Andes, often with Dino’s assistance.  Dino went on and on about random experiences; visiting Cusco and seeing Kali there, her helping him out with an eye surgery he could not afford to have and subsequently visiting a street fair where he saw “Barney” the “purple bear” for the first time and met two French girls who danced with him and it melted his heart.  A true character, someone I really wish I could get a visa for and have him visit us in Europe or the United States just to hear his reactions to experiences.  Dino got out his guitar and wanted for me to film him while he dedicated a song to Kali.  It was beautiful and at one point I made eye contact with Jacqui, this was one moment which typified a magical journey we had made together and intertwined our connection to Peru forever. 

(To see the video, click this link: http://www.youtube.com/watch?v=LY5ZKJ-n4xA)

We eventually snuggled up into our sleeping bags upstairs and drifted off to sleep with Dino strumming his guitar outside, wailing away in Quechua about the “blue eyed peasant girl” to the silent mountains and sparkling stars crowning his small frame overhead, the music quickly dissipating into the crisp air.  I would hope that somehow his music reached other people lying in bed around the world who had the good fortune to know and learn to love Dino and the Apurimac as we have.

October 13, 2006 – Tambulla

Judy’s birthday!!  She tried to be sneaky about her birthday but forgot that we had a copy of her passport and had figured this out before she arrived.  There is something nice about surprising someone with their own birthday in a far off land when they least expect it.  Yesenia and Jacqui had constructed a wonderful birthday card the night before by collecting wild flowers and gluing them together onto construction paper.  We each took a turn inscribing the card and gave her a little bouquet of flowers during breakfast.  It was another clear, clear day with the sky like sapphires as we loaded up the truck in the warming sun.  Dino had just recently installed electric showers which were a luxury to wash off the previous 5 days of road grime, dust and sweat.  We felt great except for a head cold that everyone seemed to have acquired at different times.

We were excited as we headed out for the last village of this trip and for 2006.  Jacqui and I love the village of Tambulla for its unique location and very strong indigenous roots so had planned for this to be our last village of the year as a sort of finale.  Tambulla sits at the end of a long, wide river valley about 30 miles north of the thriving mining town of Challhuahuacho.  It is amazing the growth that is happening in Challhua as a gargantuan international mining company, Xstrata, is undergoing a 10 year exploration phase with the end result being the opening of the largest gold and copper mine in the world.  The outskirts of town have sprawled with the building of temporary homes for the geologists and engineers who are carrying out the exploration; we were almost speechless when we saw an ATM machine in the plaza!  This is by far the pinnacle of modernization which has come to the Apurimac.  We figured it was put there by the bank that takes care of Xstrata’s account, as a way for them to pay their workers as otherwise it would involve a 10 hour drive to Cusco.  I wonder what the local indigenous people think of this strange blue box that magically dispenses money to people with the press of a few buttons?

The road out to Tambulla is exciting as it follows the river valley leading up to it.  There is not really a truly marked road, just an intricate lace of river streams flowing over small granite pebbles.  We just popped the truck in 4 wheel drive and motored across, through and up the river at various points.  Arrival at the health post was similar to arrival at all the other villages on this trip; the staff was unaware of our arrival.  But luckily Dino’s message had reached the ears of the people and there were patients waiting for us in the sunshine outside.  The staff had actually heard the announcement too but had never received anything official from the Ministry of Health.  They were accommodating but no too helpful so as usual we just kind of took over the building and began our set up procedure.  This health post had also received a “face-lift” with new tile floors and walls, but there was no electricity or running water expect for one communal tap outside.  This always poses a problem to us as we are unable to run the electric sterilizer and have to resort to using a sort of pressure cooker with the camp stove.  Lighting is also a problem for the dentists who have to rely solely on their headlamps for doing work. 

Dino had advised through the radio announcement that we would be seeing children the first day and adults on the second day.  Unfortunatly there was no school in session due to some holiday so it was up to the local parents to bring their children in for treatment.  Many mothers had in fact brought their children and the health post takes advantage of the situation to inoculate and test the children’s growth through routine weight and height records.  Working in Tambulla can best be described as managed chaos.  The local people are some of the simplest living out of all the villages, poorest in wealth but rich in their pride and traditions.  We have a very simple system where we hand out numbered note cards to each patient and then call them one by one for treatment.  In Tambulla about everyone is illiterate and they don’t even recognize the numbers written down.  So when a dental chair opened up we would just look for anyone with a note card and pass them through. 

One very strange thing we saw in Tambulla was children playing with syringes. We kept having these little toddlers running around with disposable syringes sticking out of their mouths!  It turned out the local healthcare workers were giving the children the syringes (without needle if you are wondering) as toys after they received their inoculations as a sort of incentive, strange but it was so.  Almost everyone in Tambulla who had a tooth extracted would ask for it also, Jacqui feels that it is really not hygienic to have the local people running around with bloody teeth that would most probably end up in their children’s mouths, and we agreed.  This might seem very crazy to those of you reading this, and it is!  This village is just incomprehensible and such a clash of culture in the way things are.  Another thing to get used to was the constant puddles of urine on the floor from children who are used to living in mud huts with dirt floors.  It would eventually get tracked around by other barefoot children who were running around as their parents were receiving treatment by us.  Just plain madness but there is not much you can do to get angry about it, this is how these people live and they see nothing strange about it.  There is almost a look of befuddlement when one of the healthcare technicians hands a mop to a mother and tells her to clean up the mess.   But on the other hand there is just this simple innocence to the people as nobody gets agitated or frustrated with having to wait for hours to be seen or with the complications of understanding what is going on with the Doctors or the procedure they are doing.  As if life was difficult enough for these people, there is not really any point in getting emotional about something so trivial as a 6 hour wait or their child urinating on someone else’s floor.  I would say out of all the villages we get more recognition and simple thanks in the way of “Gracias” from the patients than anywhere else which is surprising but a true reflection of their values.

Working with the people in Tambulla does have it’s complications as nobody speaks Spanish either.  We would often find the three dental chairs filled with patients; Jacqui, Judy and Yesenia all trying to communicate with the patients while the three patients chatted away in Quechua with each other trying to figure out what was going on.  Eventually about halfway through the day I turned to one very patient young man and ask him, “Is there anyone here who speaks both Spanish and Quechua who could help us out?”, he looked around the waiting room filled with dozens of people and looked back at me with a simple “no.”  Well, this guy had obviously understood me so before he knew it he had a pair of latex gloves on and was making his rounds from chair to chair assisting the dentists.  It turned out this same man, Juan, had helped us on previous visits and was an absolute godsend.  Such a bright young man and genuinely cared about his fellow villagers.  One confusing concept that the people often find frustrating is their unwillingness to take a tooth out unless they know another will grow in its place.  We often explain that with the children, yes another will replace the tooth taken out but in the case of Adults they can’t understand why another will not magically appear for them.  There are serious superstitions about loosing a piece of your body with these people no matter how much pain they are in, it is understandable. 

The day was fairly steady with patients coming and going at a steady rate but not overwhelming with hundreds of schoolchildren waiting outside as we had found in previous villages.  This was fortunate for us as without electricity the instrument sterilization process took much longer than usual.  This always seemed paradoxical to me how we were sterilizing instruments with extreme heat to prevent cross infection while the children were running around sucking on used syringes?

There were about 4 very serious cases today where there were teeth demanding immediate removal or the possibility of very bad complications of infection if we didn’t.  Mostly these patients were in so much pain they were very apprehensive about letting someone near their mouth.  Without the help of Juan, it would have been near impossible to have treated some of the people in most desperate need.  I always wonder what these people do the other 363 days of the year when Dental Project Peru is not present to treat these emergency cases?  I figure they must just simply live without the prospect of treatment and eventually either die of other complications from the infection or endure months of excruciating pain while their bodies reject the infected tooth and heal. 

There are reports that the Ministry of Heath has produced which indicate oral infection is one of the leading causes of death in this region, can you believe this?  Obviously there is development as each health post is receiving upgrades in the form of facilities but without the upgrades of staffing.  Case in point, Xstrata, the mining company has constructed a new hospital in Challhuahuacho as part of it’s commitment to the community but it is inoperative as there are no staff to run it.  There is already a good health post in Challhuahuaco.  As you could imagine though from my previous descriptions of this area, are there many qualified Dentists, most likely trained and living in Lima or other large cities who would want to live out here?  What is eventually going to happen to these people?  It is a hard theme to consider and has many conflicting cultural aspects which keep your brain in gear when spending time out here.  The change and loss of tradition and culture these people will suffer is sad, on the other hand they are at a crossroads of their development which to me seems worse as being in one boat or the other.  Their diets, language and lifestyle have already begun to change but they are not at a point yet to fully embrace, deal with or understand it.  They see the benefits and comforts of technology springing up around them with the development of this mining project but it has not trickled down to them, they live on the periphery of this development which only brings to light their own suffering and mediocre situation between their self sustainability and now reliance on others for goods and services.  Would it be better off if this place had been cordoned off around 1532 with the arrival of the Spanish and had no involvement with the outside world, carrying on their traditional way of life?  Probably, but it has not and cannot be protected in this altruistic manner.  Therefore we can only hope that this mine will bring a radical change in access to “material” wealth, “advanced” education and “modern” health services for these people while at the same time respecting their “cultural” wealth, “intimate” local knowledge and agrarian lifestyle techniques, and “traditional” healing practices.  Or in other words, facilitate the difficult change process with sustainability in mind.  It is so hard to experience the human suffering taking place at the moment that any alternative seems to be a good one; even a huge mine where the possibility for environmental destruction, eventual extraction of the only profitable resource they have and potential withdrawal by the multinationals once it has been depleted is scary and real.  Just being out here to provide dental care on a small grassroots level at the moment really gets your head spinning.  But until there are more local people who can go to that ATM in Challhuahuacho and extract their portion of the profits created from their ancestral lands in order to visit a good dentist who will take care of their needs whenever they need it, Dental Project Peru will be there to fill in the gap. 

Even without the organization we were able to construct in the previous villages, we managed to see about 60 people today and were proud of our efforts.  We were too far away to return to Dino’s house for the night so we would have to make do with sleeping in the health post.  There were no beds, just a couple of very “aromatic” mattresses nobody was interested in sleeping on so we had to get creative with our sleeping arrangements.  We decided the room we were using as the surgery would be our best choice and with night quickly approaching, we got down to business as Daniel scrounged up some powdered laundry detergent, tore apart his T-shirt to use as a mop and tried his best to disinfect the floor we would be sleeping on.  I broke apart the 3 candles we had, making them into 6 and looked around for flat rocks outside to use as candleholders.  The ladies took inventory of our food stock and whipped up a hasty meal.  We spent the evening playing cards by candlelight before all sprawling out in our sleeping bags on the clinic floor, laughing ourselves to sleep at our situation.

October 14, 2006 – Tambulla

Today would be the last treatment day of Dental Project Peru for 2006.  It was cold and silent as we started the day, aware that it may be slow as many villagers would be beginning their treks towards Challhuahuacho for the weekend market, their main source for acquiring other goods they could not grow themselves and for social interaction.  The good thing was that many of the patients we had seen the day before had walked back to their villages and informed their fellow villagers of our presence and treatment.  It always seems to work this way when say for example a hesitant Father brings his son in for treatment, sees how well he was treated and it was in fact free.  He then wants treatment himself and afterwards goes back to his settlement to bring down his sister, wife, cousin and others for treatment.  You can’t help but understand their hesitation but it seems that with every year that we provide this service to the people, they accept and appreciate what we are doing more and more.

We had a rush of patients beginning around mid-morning and lasting until mid-afternoon.  There were never really any more than 2 patients in the chairs at any one time so it gave the Dentists the ability to take turns, come outside and play with the children and just appreciate our surroundings for a while.  We brought a bag of balloons for the children and had a great time playing with them.

One funny moment we had today which I remember quite well was of a man who was in for treatment yesterday that brought his wife down to be seen today.  She had some horrible infection and was very scared of being treated, although Jacqui had explained that it was very necessary to her husband so he was eager to facilitate the process.  He was cute as he wanted to stand by his wife’s side throughout the treatment to comfort her.  This is quite rare in their society as men do not often show their soft side in this manner.  He was dazzled by Yesenia’s headlamp and midway through the treatment asked if he could wear it.  This brought his wife to giggles as he proudly wore the headlamp and pointed it in his wife’s mouth for Yesenia as she extracted the infected tooth.  Afterwards he wanted pictures taken of him with the headlamp to see the digital image of himself on the small display.  He was quite serious and proud throughout the whole process and gave the headlamp right back to Yesenia while saying “Thank you Doctors for treating my wife” as they walked out the door.  Just a good moment to experience.

There are some wonderful women back in Scotland who have kept abreast of our project in Peru and decided they could contribute by knitting and constructing what we call NBP’s or “New Baby Packs”.  They have put together with their own hands countless care packages of baby grows, sweaters, booties, gloves and hats for us to distribute to mothers in the area who do not have adequate clothing for their newborns.  We were able to give out two of these gifts today and it was wonderful to see how comfortable the babies appeared and how excited and proud the mothers were to receive them.  The mothers just traditionally wrap up their babies in whatever rough cloth they have lying around, rough burlap sacks, torn rags from dirty old sweatshirts, pieces of disintegrating alpaca blankets, whatever.  It was wonderful to strip off all of these soiled rags and button up the babies in clean cotton suits with images of Whinny the Pooh on them.  We even had some plastic nappie shields which we taught the Mothers to use by first wrapping the bay with soft absorbent cloth and then using the plastic pants to protect the rest of their outfits.  This was a new concept but they seemed to like the idea and proudly walked out of the clinic, smiling baby on their back to begin the long march home.

Around 3pm the village just seemed to disappear and a complete silence overwhelmed the area.  As a team we all sat outside in the sunshine and talked about the trip, laughed and made introspective reflections about what we had just done as a team.  These trips are overwhelming in their intensity with the new experiences and problems you encounter every day.  It is often not till long after that it begins to come to light. 

We had a very long journey back to Cusco ahead of us and decided it would be best to start packing up.  Three people showed up for treatment while we were in the process but we kept a chair available and we treated them while the rest of the equipment was packaged and loaded into the truck.

The ride out was beautiful as always, splashing through the river in the truck and waving back at the local people as we went along.  The local dress in Tambulla is beautiful with the women in black vests very heavily decorated with colorful buttons sewn on everywhere; they also use a type of head shawl which proved to be very useful for covering up their mouths when the strange effect of Lidocaine took hold.  The men wear rough white alpaca trousers that come just to calf level and white bowler hats with a very ornate woolen cap underneath.  Many people were walking in complete families, some couples on horseback, and some children hiding behind earthen banks peeking at us from behind. 

You develop a special bond out here with the people and the landscape doing this type of work and become intimately attached to the environment.  Jacqui said it best one time that while she is out in the Apurimac and surrounded by all the wee white hats and the mountains, it feels there is no other place she would rather be.  I agree with this but will point out that “while” is the key word in that statement.  It would be wonderful to be able to just spend all our time out here providing free health services to these people, but it is not so easily done.  In order to provide this standard of care it takes funding, planning and support to make it happen, we are acutely aware that we are just at the tip of a large pyramid that allows this work to be carried out. Without the help of all you out there who make gracious donations of time, money and materials available to us: none of this would happen.  People (you know who you are) who have never been to this part of the world and experienced it firsthand but through our humble attempts at describing it in words, pictures and expression feel inclined to support us in whatever way you can.  This is a magical landscape inhabited by people with magical beliefs and traditions, made all the more special when you realize it might not be around forever.  We may be here in the physical doing the work but it is not without your efforts, that Dental Project Peru is able to contribute something to these people in a time when they are undergoing a drastic and uncomfortable change.

We all were occupied with our own thoughts that afternoon as we bounced across the high Andean landscape and wondered what the world was up to with this place, content in the moment but with an uneasy feeling of hope, despair and complexity that never allows you to come to a conclusion about anything.  Sunset narrowed our senses to the bit of dusty twisting road illuminated by the headlights before us and the creaking thumping chorus of the truck cabin.  We rolled into Tambobamba in the darkness to spend the night at an old Hacienda that spoke rumors of the areas past.

October 15, 2006 – Return to Cusco

Exhausted, we loaded up the truck one final time for the week and roared upwards out of Tambobamba towards Cusco.  It was a fitting end to this trip and this year of work in the Apurimac that the sacred peaks of Salcantay, Umantay, Veronica and Chicon were all blazing white in the sunshine through some of the clearest air you could have imagined as we crested the highest pass on our way back to Cusco.  The previous evening’s concentration on complexity was melted away with the pristine morning light and fresh air that had a feeling of perfection and optimism flowing through it.  It felt good to be out here and to have done the work we did, all told, we visited 3 villages and saw over 350 individual patients, extracting over 650 painful and infected teeth and distributed over to 1200 toothbrushes to the local people. 

All of this triumph fades temporarily away upon arriving back to Cusco and having to wash the blood and dust off of every surface and out of every corner of our vehicle, equipment and bodies while there are the mountains of phone messages, emails and paperwork to be attended to, but in the end it is all part of the experience.

We would like to thank all our individual donors for their support to Dental Project Peru and hope that you will stick with us in the years ahead.  If you would like to see photos from this particular trip, please go to www.dentalprojectperu.org and after clicking on the photos link, select “Trip 5”