Dental Project Peru – Trip report

June 4^th – June 17^th 2008

Written by Hannah Fielding

When Jacqui, founder of Dental Project Peru, contacted me out of the blue inviting me to return to Peru to take part in a dental trip, I didn’t need long to consider my response.  The opportunity could not have come at a better time for me.  It had been nearly three years since I last volunteered with the project and, whilst my memories of an amazing experience in the Apurimac still burned strong, the grind of Western nine to five dentistry was taking its toll.  A visit to beautiful Peru and her enchanting people was just what the doctor ordered!

I knew things would be very different this time compared to my last two trips with the project.  The plan was to visit four communities in the Ollantaytambo region of the Sacred Valley.  As these villages were all new to the project we did not know what to expect, especially in terms of living conditions, the patient need and the reception we would receive.  With Jacqui sadly already committed in San Francisco and no other foreign volunteer this time, I would be joining a fully Peruvian team of three, Yesenia, Daniel and Leo.  I was excited at the prospect of facing new unforeseen challenges and relishing the opportunity to improve my very rusty Spanish!

Less than seven weeks from receiving Jacqui’s invitation I was flying across the Atlantic to Lima.  Searching the arrival lounge of Lima airport for team member Daniel, I was surprised and delighted to be greeted by Clarke, Jacqui’s husband, who happened to be leading a tourist trip in the area.  Groggy and jet-lagged, it was wonderful to be welcomed by a familiar face!

The next day I flew to Cusco where I was met by Yesenia, a local dentist and good friend of Jacqui’s who helps run the dental project in her absence.  She accompanied me to the volunteer house in Cusco where I was to be based for the rest of the week, adjusting my body clock and acclimatising to the considerable altitude.  In the following few days I met the remaining members of our team, Leo and Daniel and knew right away I was going to enjoy our trip together.

Day 1

Amparaes, the first community on our itinerary, lies a mere four hours out of Cusco, no time at all compared to the long, winding journey into the Apurimac.  This meant for a relaxed morning in Cusco before meeting up at midday to pack ‘Juliana’, the project’s trusty truck.  Within the hour we were off, stopping just outside the town of Urabamba for lunch then deeper into the magnificent mountains of the Sacred Valley.  I felt very at ease with the world and myself, rocked in the back of the familiar pick-up truck, watching dusk settle into the Andes.  Spirits were high within the team and we were as happy laughing and joking together as we were passing the time in a comfortable silence.  Gradually some of my forgotten Spanish returned to me and my confidence grew as the team patiently made sense of my Spanglish!

We arrived in Amparaes at nightfall.  The town was significantly bigger than those I remembered in the Apurimac, with many shops along the main street though not many people.  Yesenia explained Amparaes is a larger central village supplying many smaller communities who tend to travel in during the day.  It remained to be seen if the scores of shops selling fizzy drinks and confectionary would equate to widespread dental disease in the community.  Stopping in at the health centre where we were to set up surgery the next day, Yesenia and Leo were frustrated to find that, since their initial visit to the post several months ago,  the community’s portable dental chair and light were lying dumped and unused in the same corner of the waiting room.  It transpired that Amparaes no longer benefits from the weekly visit of a Peruvian dental team and as a result the dental need in the community is high.

Our home for the next few nights was in a local boarding house for orphans and children of distant communities run by the local priest.  So many children, cats and dogs running around, very interesting smells and as Daniel commented the place was “In need of a woman’s touch”.  We decided the four of us would share a room together and by ten our heads were down ready for our first day of work in the morning.

Day 2 

Breakfasted and eager to get going we returned to the Health Post early and were warmly welcomed by the resident medical team comprising of a doctor, a midwife and a couple of nurses.  It was a treat to find that, not only had they set up the neglected dental chair and light but, we had electricity and running water in the room…a Dental Project Peru first for me!  We decided to set up our two portable chairs for extractions and to use the post’s chair for restorative work, a system that later proved to work really well.

I was apprehensive waiting for the first few patients to arrive.  In the three years that had passed since last volunteering with the project I had become all too accustomed to the ‘luxuries’ of a modern dental surgery with good lighting, suction ,a super efficient nurse and being able to fully communicate with my patients.  I was wondering how easily I would adapt to dentistry out in the field and was conscious I did not want to let the team down.

I need not have worried.  By the time the first few patients trickled through the doors it was as though I had never been away.  As word of our arrival had not yet got out among the community, the morning was relatively quiet with a steady flow of patients.  This was a perfect start as it gave Yesenia time to show me the ropes and for us to bond on a professional level.  Daniel and Leo stepped in for translation while I endeavoured to master choice Spanish and Quechua phrases.  I was amused by the post operative instruction “do not eat fish in the next few days”, one I had not heard before but religiously passed on to my patients!  As I remembered, the Peruvian people were warm and gentle and I felt privileged to be treating them again.

We lunched back at the boarding house and, on our return to the Health post, were surprised to find crowds of people in the waiting room.  School was out and the people who had walked all morning from distant communities to receive dental treatment had arrived, it was going to be a busy one!  That afternoon Yesenia and I saw and treated approximately ninety patients.  The majority of patients required extractions although we were also able to restore a good number of teeth.  Yesenia is a lovely woman and a very competent dentist.  Increasingly less reliant on Daniel and Leo for translation I was thoroughly enjoying Yesenia’s company and support. We worked well together under the pressure and there was a palpable sense of calm and fun in surgery. 

Signing off the last of the treatment cards I felt a great sense of achievement, though by now I was feeling fairly weary and hungry.  We were invited by the Post team to join them for a drink and a snack.  Never before have a cup of hot tea and a fried egg roll tasted so good!  Returning to the boarding house the team was clearly tired but jubilant.  Daniel had a miniature bottle of Japanese whiskey which we sipped in turn enjoying its instant warming effect.  Leo watched and learned as I gratefully had my achy back cracked by the multi-talented Daniel.  I had a feeling I would sleep well that night.  I was not disappointed!

Day 3

With word of our presence in the Health Post firmly out in the community our second day of surgery was busy from the off.  By now Yesenia and I had established a good routine and we worked steadily, relieved we could shut the surgery door to the chaos of the teeming waiting room.  With the exception of a break for lunch, we barely left our room that day. I was shocked to discover that there had been a three hour torrential downpour that afternoon and neither Yesenia nor I had even noticed! 

One patient that sticks in my memory from that afternoon was a health post worker from a neighbouring village.  She presented with lots of pus draining under her upper lip associated with some very wobbly front teeth supporting a bridge.  The teeth were not salvageable and with the level of infection there was no alternative but to extract them.  While the patient fully understood this, her husband had to be called from the waiting room for his permission to perform the extractions.  I could not believe it when he started to deliberate whether or not to extract the teeth, despite his wife’s obvious pain.  In the end Yesenia joined me to help persuade him and he begrudgingly consented to his wife’s extractions. 

That evening, our last in Amparaes, we had arranged to eat with the staff at the health post.  We had brought along some cans of ravioli and a bottle of wine and they had prepared some delicious Chinese rice.  There was a good, warm atmosphere as we sat around the table sharing our food and exchanging stories.  A perfect ending to a great two days in Amparaes.

Day 4

It was raining when we woke the next morning, not the perfect conditions for packing up Juliana.  Still, despite the weather, we were soon on the road again heading towards our next community Accchahuata.  Despite being only thirty minutes away by caminetta from Amparaes, Accchahuata appeared worlds apart.  We pulled up next to the only tiny shop which loomed high on the mountainside above the mud brick village nestled in the valley.  Within minutes of our arrival, curious villagers, all in traditional dress, began to make their way up the mountainside to greet us and in no time we had gathered quite a crowd.  This proved very useful as we were going to need as many volunteers as we could get to help carry our equipment down the steep, rocky hillside to the school at the base of the vale.

I was amazed how much the villagers, especially the women, could carry.  No sooner was a box of supplies unloaded from the truck, it was wrapped in an intricately woven blanket, hauled on their backs and, with tottering children clinging precariously to their mothers, bounced down the hillside.  Viewed from above, a spectacular caterpillar of brightly coloured blankets, hats and skirts, children, dogs and donkeys could be seen winding its way over the river towards the village school.

The school is a lovely building, well built and supplied thanks to the recent efforts of a Dutch NGO.  Over one hundred villagers gathered in its central courtyard for our introductions and Leo’s entertaining Charla, a promising turn out, or so we thought.  We were soon joined by the Doctor and some of his team from Amparaes who had brought us their generator and planned to see villagers in need of medical attention.

Yesenia, having screened the villagers and handed out dozens of treatment cards, joined me in surgery to begin treatment.  Unfortunately the generator was not powerful enough to run our handpieces so we were only able to offer extractions.   During the morning the school’s head teacher informed us that the villagers wished to cook us lunch in honour of our visit.  My heart sank for, as generous as this offer was, I had a sneaking suspicion the Andean delicacy cuy (or guinea pig) maybe on the menu.  I was not wrong.  Smiling, and not wanting to appear ungrateful, I tentatively gnawed on its crispy hind leg.  To her obvious amusement, Yesenia noticed that I was struggling with her favourite meal and thankfully polished off the remainder of my rodent!

In the afternoon we observed that many more treatment cards had been distributed than the number of patients arriving for treatment.  It was then that Daniel informed us that most of our patients were leaving.  It transpired the Doctor had been purposefully vague about the treatment we would be offering and the villagers had been expecting more general medical care from us.  In addition, he was also using the opportunity to begin vaccinating the villagers against Hepatitis B as part of a national immunisation programme.  The villagers, generally opposed to the vaccines, were leaving in hoards, forfeiting their dental treatment.  This was very frustrating for us as we know we would be leaving that night with a lot of dental disease untreated.

Beginning the process of packing up surgery I was touched when four young girls pulled me aside and serenaded me with a little song in Quechua.  We then all scrambled back up the hill under the glow of the setting sun.  Sparing them the five hour walk home, a mother and her baby joined us in the cabin of the truck, while her husband, who had helped out with crowd control and translating all day, clung onto the back in the cold night air.  On the road again to our overnight stop in nearby town Calpa, we reflected that, although we would have liked to treated more patients, Accchahuata and her people had been particularly enchanting.

Day 5

What a difference a hot shower makes!  We had spent the night in a religious boarding house in Calpa and all felt instantly revitalised by a hot shower, change of clothes and a good nights sleep.  Packed up with the motor running and ready to go, to our dismay Leo noticed one of the rear tyres had a puncture.  Leo, with super efficiency, changed the tyre and we made our way to the main town of Ollantaytambo, a town dominated by a huge Inca fortress and, luckily for us, complete with a tyre service shop.  Extracting a three inch nail from the offending tyre, at the cost of approximately two British pounds, the serviceman had us on the road again in less than fifteen minutes, remarkable!

We were welcomed at the Health Post of our third community, Patacancha, by Luz, nurse and sole employee of the small but well maintained government building.  Inviting us to join her for a matte and some biscuits, Luz explained that when she arrived at the deserted post she had spent her first month just cleaning before receiving patients.  Now, nearly a year on, with her family living in Urabamba and only a small radio for company, Luz was very glad of some visitors at last!

It again took a little while for news of our arrival to spread amongst the community but gradually, bit by bit, our waiting room filled with the burnt orange colours of the local dress.  I particularly liked the way the women of Patacancha wear their hats off centre at a jaunty angle, very becoming!  We worked steadily and were particularly impressed by a local school teacher who had the foresight to send his students down to health post six at a time avoiding the hoards of board school children. 

Later that day, Luz introduced us to Elizabeth, an American girl who was two weeks into a six week experience living in complete immersion with a local Patacancha family.  I did admire her bravery!  Despite being able to speak Spanish near perfectly, Quechua was the only language spoken in the very rural home.  Elizabeth spent her long days in the bosom of her new family, learning to spin, helping to cook and tending to the animals.  She was only too happy to accept our invitation to join us for a warming glass of wine that evening and to our delight came armed with a bar of Green and Blacks chocolate!

Day 6

Awaking from a very cold night and congratulating myself on my decision to buy a four season sleeping bag, it dawned on me my time with the project was coming to an end.  It saddened me to realise that I probably would not have the opportunity to return to Peru for some time.  Over breakfast I had commented that I would really like to try potatoes cooked in a Huatia oven, basically a mud hole dug into the ground, and was so excited at lunch time to discover that, with the help of a local, Daniel and Leo had been digging in the morning to prepare a feast of potatoes.  They were delicious, taking on the smoky flavour of the ground, although I did find a disproportionate number of worms in mine compared to the rest of the group!

Nearly every villager in Patacancha wears traditional dress and Daniel did wonder if this is for the benefit of the tourists who pass through the village in large tour groups almost daily.  Dishearteningly we noticed that compared to the other communities we had visited, where the children enjoyed having their photos taken and delighted in seeing their images, the children in Patacancha would request payment in return for a photo. 

Later that day, on our visit to the local school, we were to see yet another example of the negative aspects of tourism in the area.  Visiting each classroom to screen the children, Daniel and I knocked on the door of one class and asked the teacher if we could examine the children’s teeth.  She had a group of approximately twelve tourists standing in the back of the class and dismissively told us we would have to come back when she had finished talking to them.  We couldn’t believe it!  Daniel argued the case with her and she rather reluctantly let us look at the children.  The tourists then left, leaving behind the customary bag of sweets for the children…we despaired! 

That evening, as Luz needed to get back home, we left Patacancha and headed for Urabamba for the night.  Passing through Huilloc, the last of our communities, we decided to knock on the mayor’s door to remind him we would be coming to work the next morning.  A ruddy faced and extremely drunk man propped himself up against the side of our truck trying desperately to remember who we were and what we would be doing in his community…it didn’t bode well!  After quite a struggle we managed to find a cheap guesthouse in Urabamba for the night and agreed to pay the extra few soles for hot water.  Hot it was not and while Yesenia, Daniel and I braved the tepid water that evening, Leo delayed his shower until the next morning.  The next day we watched enviously at the plumes of steam escaping around the bathroom door as Leo enjoyed his deliciously hot shower!

Day 7

Setting off for our last day of dentistry we were wondering how we would be received in the Huilloc after the previous evenings encounter with the mayor.  After some searching we found the local teacher who came to open the school for us, clearly not remembering that we were coming though he tried to claim otherwise.  Deciding to wait and see the patient response before setting up surgery we waited for villagers to arrive.  We waited and we waited.  No patients!  Hoping to drum up some ‘business’ Daniel and Leo took to the streets in search of potential patients but were only approached by a very old lady who wanted her eyes looked at!  It turned out that Saturday was market day and the town was near deserted…well this was a research trip after all!

We made the group decision to head back to Cusco.  On our journey we came across an old lady hobbling along and clearly in a lot of pain with her left leg.  We pulled over and she explained that a dog had bitten her leg the day before.  She had received no medical attention and had only wrapped her leg in bandages.  We gave her a course of amoxicillin and some fresh drinking water to clean the wound, hoping this would help prevent any infection.  She may have been our only patient that day but we all felt that we had made a real difference to her. 

This was a wonderful trip.  Peru was as picturesque and fascinating and her people as charming as I had remembered in my fondest memories.  I feel so privileged to have been given the opportunity to return to my most favourite corner of the world and to have enjoyed the company of such a special team.  Thank you Jacqui, Clarke, Yesenia, Leo, Daniel and of course beautiful, beautiful Peru.