Dear Friends, Supporters of my previous China Missions, Dr. Shapka, Ted, Miriam & Family, Norm, AND
Teammates of the 2013 KIA Guatemala Dental Mission Team:
Greetings from Edmonton!
Preamble:
Many of my close friends, former classmates, staff, supporters and patients have been following me through my photo-journals to Guizhou, China. If you are one of them, you may also find the following write-up interesting.
To my patients:
This will explain why I was away during the week in February Dianne my office manager told you I was not available. No, I wasn't in Hawaii, I was with the KIA, (that's KIA, not CIA !). Many of you also asked me to send you a write-up of what it's like to be working on dental team in an underdeveloped country. Well here it is; thank you for your interests.
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A word about "Kindness in Action":
This amazing organization was founded some twenty years ago by Dr. Amil Shapka, a dentist in St. Paul, Alberta where it has its head quarters.
In the site's introductory page, it says "Kindness in Action Service Society of Alberta is a group of concerned individuals, motivated by a belief in the dignity of all people and their right to basic human needs. ........".
The last sentence in its 2012 annual report by Dr. Shapka reads, "This year we have committed to 14 projects in 8 countries, providing close to 300 volunteers the opportunity to work from the heart."
Have a good look into the site. If you share their belief and wish to help, the site has information on how you can do it.
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How it got started for my participation:
To those who followed my precious volunteer travels, when I went to Guizhou with the Rose Society of Edmonton, I was the only dentist in their team of almost twenty physicians, gathered locally from Guiyang and surrounding areas, and Dr. Tai the Rose Soc. leader. While the work they do is extremely worthwhile - the free medical clinics in remote villages, the water projects, school visitations with gifts, school lunch program, financial support to poor students through their junior high and high school years, and so on - I was not able to do any hands-on dental work, other than merely looking into peoples' mouths and did some oral hygiene education with the lovely children. I was looking around for groups that do dental missions overseas, and read about the group Kindness in Action and their work in Cambodia. Later in the school, I spoke with a student who went to Guatemala in 2012. After meeting Dr. Amil Shapka in the KIA's annual meeting in the summer, I signed up to join, and was given a spot in the 2013 Guatemala team - going to the City Jalapa in the Department ("province") of Jalapa in southeast Guatemala.
Preparation - Started with a few needles!
On advice from the university's Health Services, over the months July 2012 to January 2013, I got poked a few times in the arms for immunization for yellow fever, typhoid, hepatitis A, and rabies. Erh.mmm...., what's a bunch of needles to a dentist, right? Wrong! The rabies shots hurt(!), despite the nurse' best efforts (3 shots about a month apart). I took oral vaccines for enteropathogenic E.coli and for cholera, and pills for protection against malaria.
More detail information about the mission began to arrive. Included in the list of my 24 fellow team members were two dental students. As it turned out, these are my own 3rd year students from the U. of A. Dental School.
About a week prior to departure date, a large plastic "tub" arrived at my doorsteps from KIA head office, marked "dental supplies". I opened it to take note of what's inside - layers of patient bibs, sterile gauzes, paper products, and dental anesthetics - so I could claim "I packed it myself" when asked at the airport. I thought this system of bringing dental supplies is very efficient. We would have 24 tubs, one carried by each team member, forming a pretty good "pool" of supplies and instruments.
US Custom clearance was no problem at Edmonton at close to midnight. The customs agent gave a nod of approval and a smile once I informed him where I was going and reason. My itinerary, arranged by KIA's travel agent, took me to Houston at around 5:30AM. Then I found out Mr Laheeb Qudusi from Devon, AB, one of my 3rd year students, was on the same flight with me. After a quick bite, we went to the gate and tried to get some rest before the 9:30AM flight that would take us from Houston to Guatemala City. As we woke up, we noticed a good size of people waiting for the plane, some wearing the KIA T-shirt issued from head office. We also found my other student, Mr. Arash Ravanbakhsh. (I couldn't pronounce his last name - too early in the morning!)
A word about where we were going - "Wells of Hope":
In the information package I received from St. Paul, it was mentioned that we would be staying at a "camp" near the city of Jalapa run by an organization called the "Wells of Hope". I thought all along that we would be sleeping in something like large army tents..... First question my wife asked me was "...wonder what the toilets are like?" Well, from years in scouting and camping, that didn't bother me one bit, except perhaps the thought of mosquitoes and flies......, then I had my shots, no fear!
"Founded in 2004 by Ted Vander Zalm and his wife Miriam, the "Wells of Hope" organization is "a team of numerous volunteers with its roots in the Niagara Peninsula, Ontario, Canada." That's the initial description about WOH when you go to their website.
When we got there, it was a very pleasant surprise to a lot of us - the "camp" is no camp at all. It is a large compound with buildings, storage huts and facilities (see WOH website photos). We would stay in a large, well designed motel-like permanent building with many good size rooms, some with single, twin or more beds, others with bunk beds; clean washrooms and showers with drinkable hot/cold water from their own well. Our host couple, Ted and Miriam Vander Zalm started this facility many years ago - calling it "Campo Esperanza" or "Camp of Hope" (that's where the word "camp" comes from) - and use it as their "base camp" for drilling wells for the villages in this dry mountainous region.
They do have a rainy season, but there is no water collection or storage system, no streams or rivers in the area. What they have are small pools of stagnant, unhygienic water at the bottoms of deep valleys. The soil in these hills are sandy, desert like, does not retain much of the moisture. Villagers, often kids and women have to climb for long distances along steep hilly paths just to get a bucket of water. Ted and his family and their friend Norm go to this camp every year from February to May to work on well drilling and house building projects for the villagers, and the demand for their services are very high, Tod told me. Their major problem is financial support - there seems to be never enough, due to the tremendous demand.
One of us made an open comment at dinner time that often we are bombarded by requests for donation by all sorts of organizations and we don't know which ones are the best to give to, now "I have no more problem with that, it's coming here.....".
Some of us had tears in our eyes when we heard about the hardship and the poor conditions these very simple people living in these mountains.
Water, the source of life, here also becomes the source of love!
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Our tour of dental work:
We arrived at the WOH site in Jalapa by a large tour bus carrying us from the Guatemala City Airport - a seemingly never ending (~3 hour) ride through highways, then paved secondary roads, and unpaved dusty bumpy winding mountain roads; we were tired from the day's long journey, and hungry.
It was getting dark as we entered the compound. As soon as we entered the building, which I will call the Lodge, we were greeted by the most welcoming aroma of FOOD! Miriam, Ted's wife had our dinner piping hot ready for us. It was at dinner time that we formally introduced ourselves to each other and began as a group the development of trusting friendships.
Our daily routine would look something like this:
- Up early, probably around 6AM for most, wash up, and have individual breakfasts at the dining room.
- At 7, we would have a quick "briefing" for the day in the yard, a word or two from our team leader Cheryl. Sun would be quite bright by then. We help load the truck, and we take off in two vans to the school site for the day.
- About an hour later through the dusty mountain roads, we arrive at the school. Norm, Cheryl would lead a "scouting" team into the school to look for best locations to set up the heavy equipment: generators, compressors and vacuum pumps.
They would also decide the best locations for our various "work theatres".
- After seeing/treating all the children that show up for our visit, we clean up the classrooms, pack everything (including our begs of garbage) , reload the truck, and head "home" to the fantastic smell of dinner waiting for us at the Lodge dining room. Some would take advantage of the short wait time to have a quick shower; others would just relaxed and winded down a bit.
- Just before dinner, each of us would have to present a quick "review" of our day, stating a "high" and a "low" of our day's encounter with our young patients. That was fun, and it helped us verbalized our feelings about working with these lovely children - a great idea.
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Our work setting, and patient flow:
It seems like these Guatemalan village primary schools are all built following a more or less similar plan: a yard in the middle, flanked by two straight rows of building with 3 or 4 large classrooms. These classrooms had their chairs and tables stacked along the walls, leaving an open, spacious and clean area for us. These rooms had high ceiling, windows on both sides, no ceiling fans, very little or no electric lighting. Existing electric outlets were mostly dead or unreliable.
We would select a row of three such large classrooms:
- At one end would be the "hygiene suite", with 6 hygiene "chairs*" (probably limited by the number of cavitron (ultrasound) cleaners we had); (*same as our "surgical tables" - see below)
- The middle room would be our "restorative theatre" (for "saving" teeth with fillings). We had 2 restorative set ups, portable dental chairs with suction and dental drills.
- At the other end would be our "surgical theatre" where all extractions (for teeth that were deemed unsavable) and other related surgical work were done (such as removal of infected gums and incision and drainage of abscesses).
- Outside along the walls of these classrooms would be rows of chairs for kids to sit while waiting for treatment.
- There would be a triage desk out in the sun (for better viewing since we did not have dental lighting) where one or two dentists would do the initial exam. of a child's mouth to decide what urgent procedures needed to be done. These decisions would be written on a piece of dental bib, and the kid would wait in line outside of the various operating rooms. Often a child would go through hygiene to get a cleaning, then would go next door to get a filling or two, then to the 3rd room to have a tooth extracted or abscess drained. This streamlining worked exceeding well.
- Now comes perhaps the most crucial part of our working setup: the cleaning and sterilization station; without which we would not be able to "recycle" our dental instruments. A couple of very hard working ladies would wash and debribe our used instruments, put them through a series of disinfecting and serialization steps so they can be returned to the various locations for reuse. Then we had porters who ran between the operating rooms and the sterilization station to transport these instruments back and forth.
We had five dentists
- myself from Edmonton;
- Dr. Christopher Geradts from Moose Jaw, Saskatchewan;
- Dr. Claire Benmergui from Thornhill, Ontario, who came with her assistant Vilma;
- Dr. Thomas Pekar from Niagara On The Lake, Ontario, accompanied by his wife Judith, and two staff members, Tumadir
and Stacey;
- Dr. Kenneth Siemens from Medicine Hat, Alberta. Dr. Ken brought his wife Deanna, daughter Jayme, and three
assistants, Kristin, Jody, and Jaycea.
- and the two U. of A. dental students* Laheeb and Arash.
*At the school, at this stage of their training (3rd yr. 2nd semester), these students had most of the "theory" on oral surgery, but they are not out in the actual surgery clinical rotations yet - excepts perhaps as assistants watching/helping the 4th year students; but they already have had quite a bit of exposure to periodontics (treating gum diseases) and restorative (fillings) work. With their itchy fingers, they naturally wanted to utilize their learned skills in oral surgery. Since I am their teacher from the school, I was volunteered to be stuck with them, overlooking their shoulders in the surgical suite. Fortunately these are very good guys; and I enjoyed my assignment (see below). Since I did not work in the restorative theatre (other than sneaking in and out once in a while to take a photo or two and to put balloons on kid's shoes....., most of my "working" experience is with the surgical team. Good thing I don't faint easily at the sight of blood!
Our "surgical tables" were made of a couple of student tables lined end to end, joined with duct tapes. They were covered with garbage bags with a wrapped head rest at one end, and a garbage bag on one side for spitting (since we had no suction). Our illumination consisted of hand-band type headlamps and flashlights. We would take a look on what had been written on the patient's bib, and decide whether we agreed with the triage dentist. We would then select the most effective instrumentation for the job.
We had no rotatory instruments (i.e. the dental drill). Any "surgical cutting" of bone or teeth would have to be done manually, using a "cutting" instrument called the rongeur.
Day by day - play by play:
On day one, although I had my own surgical table, I spent quite a bit of time just watching over Laheeb and Arash, as they were starting out on the cautious side achieving anesthesia and making their surgical moves. Dr. Tom also came in to give excellent demos to these budding oral surgeons. They learned a lot of him - a wise man from the east!
On day two, these guys were functionally mostly on their own. I was called over only once in a while for advice on some very tough cases. Dr. Claire decided to come in and set up shop to help out - we had a long line up outside - and we had a busy day.
On days three and four, Laheeb and Arash were flying with their forceps and rongeurs, with almost no help from me or Dr. Claire. With this experience, these fellows are going to be way ahead of their classmates next year in their surgical clinics. Who knows, may be they will go to grad school to become hot shot maxillofacial surgeons one day, while I'll still be left behind (or retired) in the school showing some kids in the future, scratching my almost hairless* head, how to save a tooth with an 8mm pocket and 1.75+ mobility......!
"Oh what the heck, don't waste your time saving that thing! Just refer the case to Dr. Qudusi or Dr. what's his name with a rash (still can't pronounce it)". They will fire me from perio, but then who cares!
(*I have BTW a theory about my pattern of hair loss - in the centre on top like the Mediterranean Sea. Soon if I put a brown bathrobe on, find two pieces of bamboo chopsticks to make a simple cross, I could possibly sneak through customs, be mistaken as a Franciscan monk. It's from years of that ceiling hung dental light shining on my scalp! So watch out you young guys, and girls too! Wear a hat to work!)
In all of four days of busy surgery, we only had to send one patient next door - a young teacher in the third school - to have her badly decayed upper left first molar extracted with the aid of a rotary instrument (the drill), expertly done by my roommate Dr. Chris. There was no clinical crown to speak of, and the roots were buried in inflamed gums at or below bone level. I had absolutely no idea where her sinus floor would be, so after a while of working on it going nowhere, I told the students this lady had to go next door to have the roots cut out. We needed to learn and acknowledge our limits; I hope it was a good lesson. Dr. Chris skillfully dug out the three pieces of roots, and the young lady breathed a sigh of great relief. Who knows how long those roots had been hurting her.
And then there was this time when an older kid had a similarly badly decayed upper first molar, worked on by Laheeb for a while and it refused to budge. He called me over, and we took the time to loosen up the roots without breaking the thin residual enamel walls. As I was doing the demo, all of a sudden I heard Dr. Claire's gentle voice giving it a play by play......., till we got it out; I guessed that was a touchdown! I think I took a photo of the tooth and the patient (who actually took the tooth out himself five yards before the touchdown). (See photo-journal, link below.)
During our stay at Jalapa, the weather was perfect. Hot but not too hot, in the mid-80sF, with little breezes now and then; except for the latter part of the 3rd day, when it got really "ovenly". I am amazed that there were very few mosquitoes, though I saw a few colorful insects probably with toxic bites. In the mountainous setting of the Lodge compound, the nights were lit with stars; the Orion and the Big Dipper and a few other constellations were easily recognizable, so were a few planets. I would have happily camped out in a tent, with a fire nearby!
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Post-log:
I'm coming to the end of this little write-up. I hope this would serve to stimulate interests, especially in the students, for participating in this kind of volunteer missions. My feeling is that once you've done something like this, and have seen the conditions of these poor villagers and children, you will never complain about your food... "I don't like this, I don't like that....", and about your living conditions back in Canada.
There is a drastic difference in the dental conditions of this kids population in Jalapa compared to those I saw in the SW interior of China (Guizhou province): these Guatemalan kids have far more cavities, badly decayed teeth and abscesses. Many of them were in pain. The Chinese kids have premature abrasions and some gingivitis, but no rampant decay. The difference? Sugar exposure! Coke and Pepsi drinks seem to be readily available. American influence seems quite heavy in the city folks' eating habits. When I went to Guizhou in 2011, one of us brought along a bag of nicely wrapped chocolate cubes to be handed out to the kids. Later on, we were told by our pharmacists that a couple of grandparents took these candies to the dispensary asking for instructions "How do you take this medicine?"
I think at the 3rd school we visited, it was a very good thing we did that we treated the teachers. If we could promote better oral hygiene in the teacher population, we get a better chance of seeing better teeth in their pupils in future.
Language is of course a big problem, except for Dr. Claire, who is totally conversant in Spanish. She sang along with her patients; there was never a scream from her operating table, while my ear drums were challenged to their limits on occasions with the younger children. But I must say, these kids were VERY WELL behaved overall. The little ones, four and younger: who can blame them for putting up a struggle when these total strangers, one crazy Chinese and two middle-east looking dudes, out of nowhere came poking needles in their mouths with drippings of foul tasting liquid.......! Some of them probably had never see a China-man every before, let alone one that would pull teeth! I even put my cowboy hat on trying to mimic a Mexican, didn't do much good for these smart kits!
Dr. Claire, you got some work cut out for you: Find or produce some simple oral hygiene instruction literature in Spanish, photocopy them, and leave them to the teachers for their kids......; something we can all think about.
To end this, I want to THANK YOU ALL for YOUR/OUR team work. It was truly amazing, with few exceptions, for 25 people who had never met before in our lives, to be working practically WITHOUT an on-site supervisor/coordinator, and yet functioned like one unit right from day one. May be we were all ants or bumble bees in our previous lives!
"There was never a single complaint or grumble.....", Norm announced at 2nd day's dinner time - but then when I grumbled (in Chinese), none of you would understand anyways - so that didn't count.
All in all, it was a very pleasant trip, an eye opener, and a loving experience!
Special thanks to Ted, Miriam and Family, and to Norm!
Below is a link to my photo-journal in Picasa3. I had fun making it, hope you too have fun and fond memories looking through it!
BTW, if I spell your name incorrectly, or label you as someone else, please yell at me - I can't spell at best of times! Using Arash's words: Spelling "is against my culture"!
Have fun, and see you in another KIA venture some other time!
Fond memories, and best wishes,
Vincent
from Edmonton
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P.S.: For the "number-minded" counters, I've used the numbers copied from Cheryl's sheets to formulate a Statistics table. This is for pure "illustrative" purpose only. I don't think any of us were thinking production numbers in monetary terms while doing our dental tour. I agree with Cheryl, the TRUE value I would give for this tour's work is "PRICELESS"!