R & R and Final Post

Saturday, Sunday and Monday was for relaxation.  Sunday we headed out to a private island for snorkeling and baking in the sun.  The snorkeling was good, the sunburn was immense.  We all screened and rescreened, but all of us got burned.  Rochell’s first time in the ocean!  She did great snorkeling, and loved it.  But, she said she isn’t moving to Malibu.

We did see a couple of sting rays, some smaller fish and I got real close to a pelican who was diving for food.  Otherwise, I stayed in the shade.  Rochell and Gloria went out a second time to snorkel and got fried.

Monday we went to Rio Blanco for a day of jumping off a rock into a deep pool.  Kids loved it, I relaxed.  Last picture is of all who helped on our dental team.  Eight days was a challenge, but we did help a lot of people.  A great team, I would welcome any of the docs on a future team.  Thanks to all who helped.

8th and Final Clinic Day

We made it!  Normally our trips are composed of five days, eight is a “personal best”!  But it comes with costs.  We are sore and tired.  I usually have a sore back from the bending and twisting dad after day.  Add a sore right arm to this trip.  There were so many teeth to pull.  Maybe I need to train before the next trip!

This was our transportation, the “jaguar bus”  Tight fit for 12+ of us and all of our equipment and supplies.  Quite a spectacle as we drove from village to village.

We were in a new Mayan village, Columbia.  Again, we didn’t get to work in the health clinic, but next door in the community center.  The Health Clinic was closed, so our access to trash cans, chairs, water, etc. was through the villagers.  They were very accommodating.    One man went home to get a couple of plastic chairs for us to use.  It is hard to do dentistry with the patient sitting on a long, low, narrow bench.  We did scrounge around the area for some concrete blocks to elevate a bench for Mike to see kids.  His chair was a 5 gallon bucket turned upside down.  We found an old tee shirt/rag in the bus to soften it a bit.  BTW, having a children’s dentist on the team was incredible.  He took all the kids, dealt with them brilliantly, allowing us to focus on the adults.  Thanks Mike and his wife Princess.

This is our typical “waiting room”  Some people end up waiting all day to be seen.

Zach and his dad had to head back to Loma Linda this morning, we really missed him. Dan had over 30 ENT patients to see, including a surgical removal of a mucocele from a little boys lip. Nice bit of surgery for him to do, and us to watch.  Our procedures were fairly routine.  We, again, extracted many teeth, and I was able to see several people who requested fillings.  One particular patient that was gratifying for me was a 13 year old girl.  Lots of decay, we decided to place fillings in her lower 4 molars.  Her six year molars were severely decayed, her 12 year old molars moderately decayed.  With a little bit of luck and a lot less soda, she may be able to keep these teeth through adulthood.  That is the exception in these communities.  It is rare to see an older adult with more than 10 moderately healthy teeth.

Dan in surgery.  Brave little guy.

This was our longest day.  We didn’t get back to Punta Gordo till after 7pm.  We decided to gut it out and finish the list of patients that wanted to be seen, then to come back the next day.  The extra two hours was made possible since this block building had electricity.  Those 4 bare bulbs hanging from the ceiling gave us enough light to keep at it till everyone was taken care of.

    

Why our backs hurt.  No headrests for the patients, that is what your knee and a bench is for.  Combine that posture with pulling an upper tooth equals “can I get out of bed the next morning?”

These smiles make it all worth while.

7th Clinic Day

Day two in this location.  Sorry, can’t remember the name, they are starting to flow together.  Not quite as busy today, although a few came back from yesterday for more work.  I also did more fillings today.  Jim would numb them up, then I would do the restorations.  Plenty of extractions, as always.  Rochell got to take one out today as well.  Pictures today to tell the story.

Today is Zach’s last day, he and his dad fly out tomorrow morning so he can get back to school on Monday.  What a great help he was, and I think he learned a ton. I told him that this was like his Bar Mitzvah.  He came in a Boy Dentist, and he is leaving as a Man Dentist.  Congratulations Zach, thanks for all your help.

 

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Here is the Fearsome Foursome. Zach, Jim, Dan and Gloria.  Pulling teeth like crazy.  I was behind Jamie, the photographer, doing fillings, and Mike behind me seeing kids.

Jing with our next patient. Uh, he knows what is coming next.  He did great after having two baby teeth extracted.

Always an audience.

 

 

She makes it easy to get up every morning at six to head out to the clinic

6th Clinic Day

New location.  This clinic is closer to Punta Gorda by half an hour, just beyond the road construction.  Much more modern than the one by the border, hey, they have electricity!  Except the staff won’t let us in the building to work!  They want us to set up in a block building next door, no electricity , no water, but windows to open up for light and air circulation.  But, we were all in the same room, so we could share instruments much more easily.

    

Charlie and Rochell doing a filling.  I am sitting on a bench, the patient is in a recliner, and Rochell has to stand up to see, the patient is the only one comfortable.

Dan saw a host of ENT patients.  Everyone piles in to watch as well.

Mike and Princess worked on the kids, I set up in the middle of the room to do fillings and surgical extractions, Dan on one wall to do his ENT consults and ear-cleanings, and four chairs set up for Gloria, Zach and Jim for the more routine extractions.  By our count, we saw over 70 people today, double what we had seen the last two days.  Some tough extractions, lucky to have had the dental unit and handpieces to get the roots out. 

Here is our list for the day.  Lots of people to see.

Zach and Jim working hard, Jamie is behind, writing people’s names down.

What a team we have.  Jamie, Lolo, and Jing have been with us most of the week.  Gabby rejoined us, and Angelia for the first time.  Everyone had their jobs and they all did them well.  As you can see from the pictures, the building was surrounded by people, with many inside just watching.  I only had to kick one dog out today.

5th Clinic Day

Day two at the clinic by the Guatemalan border.  Its cooling down at bit, what a relief.  A nice group of patients today. Similar to yesterday, most needing or wanting extractions.  Several wanted fillings, but the teeth were so badly decayed, they were told the teeth needed to be extracted.  One lady wanted a lower molar pulled because ever since she had a filling placed in it by a local dentist it had hurt.  The tooth probably should have been pulled at that time.  I also ended up pulling her two upper front teeth.  Very deep decay, at first she wanted fillings, but she and I agreed that the teeth needed to come out.  She will get a stayplate or flipper in Guatemala.   BTW, we saw our second stayplate, (a plastic removable partial to replace missing front teeth) with gold stars in the two front teeth!  Rochell got a nice picture of her smile.

Dr. Dan with one of his patients.

We had a little 6 year old come in with severe decay.  All of her front baby teeth were decayed to the gumline and starting to abscess.  Mom and I agreed that they needed to come out.  In this case, (no cooperation) it takes 4 people to hold her down and steady, I numb the area and pull the teeth as quickly as I can.  4 teeth….3 seconds.  We named ourselves the “scream team”.  No pain, but she was very scared. 

This is Rob, Zach’s dad.  He is a contractor taking a break from the building project.  We put him to work as a member of the “scream team”, and applying fluoride on the kid’s teeth.

On our way back, it rained! And, it is at least 20 degrees cooler.  What a blessing.  Our evening was very pleasant.  Maybe more rain tomorrow as well.  Oh, we did find out why we are seeing practically no men.  They are all harvesting their crops.  We heard that the small time farmer has to walk up to two hours to get to his little plot of land.  Theirs is a hard life.

    

This is how mamma’s carry their babies.

    

4th Clinic Day

After yesterday’s sweltering day, we woke up to a cooler morning and an overcast sky.   Nice.  We had an hour and a half drive today to a village just on the Guatemalan border. Although they are in a multi-year project of regrading and paving the road to Guatemala, the last 45 minutes of our drive was either on road under construction, or road ready to be excavated.  As the road heads west, electricity follows. 

Our clinic was a three room block building, fairly clean, and interestingly, had lights, plugs, and switches, but the closest electricity was probably 30 miles east.  They are ready when it arrives.  Nobody was waiting for us when we arrived but the sign was in place, after asking around a bit, the director appeared and patients started to queue up.  Today we had Mike seeing kids in the triage room, with him sitting on a sack of beans and the kids laid out on a bench.  Gloria, Zach, and Jim in the larger room, doing most of the extractions, and Dan and me in the smaller back room either doing fillings or checking people’s ears.

 

   

Out back was our generator and compressor, and everything worked great.  It took an hour to set up everything to do fillings.  Rochell and I worked off of a wooden bed, with a thin mattress, we both stood up.  That is a bit hard, because I have to use a foot pedal to run the dental handpiece, so, it is the same as standing on one leg.  Rochell, had her back against the wall for support. Over 30 patients with lots of extractions.  Teeth weren’t as bad as some locations I have been at.  This is an agrarian culture, with little sugar in their diet.  It makes a difference!

Everybody had a good experience extracting teeth.  We got Zach right in there giving anesthesia and developing the techniques necessary to get the teeth out.  I had only a couple of patients that needed fillings, but I got to bail out several patients whose broken or decayed root tips defied 1st world techniques of removal.  Tricks of the trade when you don’t have a surgical option?  Patience, cradle the patient’s head in your belly, steady pressure, and you can usually get them to walk out.  The “tooth whisperer”.

Whoa, it is 7pm, and the lights just went out in the whole city!  It is dark, and without A/C, it is starting to warm up.  Enough battery in my laptop, I will keep going.  For now.  Oh, no WiFi either I guess!

9:30, electricity AND A/C back on.  We were told that electricity frequently goes out in Belize for between 2 hours and 2 days, we were lucky.  Time to turn the AC back on and upload for the day.

3rd Clinic Day

3rd and final day at the San Antonio Clinic.  To celebrate, we cranked up the A/C.  Again, not real busy.  Several factors, the clinic is closed on Sunday, so people aren’t used to coming to the clinic on Sunday.  Second, it is Palm Sunday. The majority of Christians are Catholic in Belize, so this would not be a day to go the the dentist.  Also, it is hot!  Unseasonable so.  People stay home in the shade.

We welcomed to our team, Zach, first year dental student.  Introduced to his patients as Dr. Zach; he liked that.  As a freshmen, it is all bookwork, no real patient contact, so he will definitely have a leg up on his colleagues after this trip.  He observed numerous extractions and restorations, and tried his hand at a few injections.  Go Zach!

Dr. Dan, our ENT doc saw more patients today then the previous two.  He wished he could take out some tonsils, but no, they need to go to the hospital for that.  Because we weren’t overwhelmed with patients, we had time to organize their dental cupboards a bit, unfortunately, I was unable to get their dental unit working completely.  I needed more time and tools, I didn’t have enough, and they had very few. 

A few pictures follow.  The one with the patient is our “team” that treated him,  he wanted a picture of us all,  Rochell got his address so she can mail it to him.   His team is as follows: Gloria cleaned his teeth, I did three fillings, Jim numbed him up for me, Rochell assisted me, and Nicole screened him.  Happy guy! Next picture is our full team in front of the clinic, and finally the notice that was posted throughout the village and on the front pillar of the clinic.

Now, the next 5 days will be in villages that, we were told, have no electricity.  This means we take a compressor, and two generators in order to run my portable dental unit for fillings.  We always triage patients first, extractions take precedence over fillings, so we will see.  Extractions require a  chair a table and some shade, fillings require………….  Finally, it is an hour and a half drive to the next village, and we have been assured no A/C.  Oh boy!

Day off

Saturday was a day off.  We start up again on Sunday for 6 days.  So, we got up a bit later, went to church and headed to Blue River Cave for the afternoon.  We attended the closest Adventist church to where we were staying; only a 10 minute walk.  Although, after the 10 minutes, the sweat was soaking thru my shirt.  Both English and Spanish speakers attend this church, so lots of translating.  The main project for our group is building a new church for the Spanish speakers.  That is where we will attend next Saturday.

The place was packed.  A good, old fashioned church service.  Lots of singing, special music by our group, and Jon, our Associate Pastor gave the sermon.  Even tho there were 7 fans going and all the windows open, the place was sweltering.  We are hitting 100 degrees now, with the humidity in the 90’s.  HOT.

The real treat for today was the hike/climb/swim in Blue River Cave.  This 75 acre parcel was gifted to a gentleman from the Mayans in the 70’s since he had been so kind to them.  He has built some very nice cabins on the property for college groups to study the area and it is free of charge.  He was actually at the river when we were there.  Nice guy. 

Looking out the entrance to the cave.  Beautiful.

Rochell in her first caving experience.

A very interesting cave. Water runs through it at a pretty good clip, sometimes the water is deep, other times you walk. Everyone wears a headlamp so you can see where you are going. We went in quite a ways, good workout. Pictures are tough because of how dark it is. A few to give you an idea of what it was like. Very memorable adventure, actually.

Our best picture of what the cave was like

2nd clinic day

First, a run down of our providers:

--Gloria, RDH, she has been doing these trips for years, now pulling more teeth then cleanings. 

--Jim, DDS, specializes in root canals. He has no work here. So….he is pulling the teeth he would usually save.  Paradigm shift for Jim.

--Dan, MD, ENT specialist.  Pulled a few teeth in residency, anxious to learn what is going on a few inches from where he usually works.

--Mike, DDS, specializes in children’s dentistry.  He is right in his element.  He gets all the kids, and handles the “screamers” well.

--Zach, freshman dental student.  He just arrive this afternoon.  Spring break for him.  His first real introduction to dentistry.  Eyedropper meets fire hose.

--Charlie, DDS, old dog.  The backup guy for the tough ones.

Dan and Rochell getting a tooth out.

A great crew, with help from Princess, Mike’s wife, Nicole, Jim’s wife, Jang, our student and sterile tech, Rochell, future Dental Hygienist, and LowLow; blood pressure taker and greeter.  She is 9, our youngest team member.

Mike, with Princess, LowLow and mom working on a little guy

A good day.  All providers busy.  Most patient’s want fillings, many need extractions.  At any one time, three providers are extracting teeth and one is doing fillings.  The key is triage. The clinic staff have been determining the chief complaint, we will now be doing that.  There is less waiting for the patients.  We will be working on this more when we return on Sunday. 

LowLow taking BP.

Oh, yesterday’s picture….Gloria and I are the only “docs” that have gone on mission trips, and really the only “docs” that have pulled a lot of teeth.  Dan, the MD, doesn’t. Jim, the endodontist, rarely pulls a tooth, and Mike, the pedodontist, only pulls baby teeth.  So, lots of cross-training.  And, by the end of the second day, all were pulling teeth with the best of them!  Congratulations guys.

First Clinic Day

6:30 wake up call.  Our kitchen isn’t set up yet, so we went down the street to a local eatery.  Nice food: coffee, banana-mango smoothies, eggs, beans, homemade bread.  All you can eat, $6 a piece, a great way to start our adventure.  45 minute drive in our half-school bus, pictures later, and we arrive at our clinic location for the next three days.

We have worked in “clinics” before, and they are little more than a somewhat freshly painted block building, half abandoned.  This was a mini-hospital.  Probably 10,000 square feet, multiple treatment rooms, and emergency room, maternity ward.  A couple of local docs seeing patients……and a dental suite.  A nice dental unit and chair, but does it work, NO.  Jim Gearing and I spent almost two hours trouble shooting the dental unit, got the patient light, water and compressed air going, couldn’t get the suction to turn on.  So….I ended up using their compressor attached to our portable dental unit.  Luckily I brought enough fittings to jury rig the conversion.  And away we went.  Sorta.

By the time we got the facility scoped out, choosing a room for extractions and another on the other side of the building in the dental suite for fillings, we really didn’t start seeing patients till after 11.  And, most people who had queued up when we got there at 9, had left!  We discovered that the Mayans question your integrity if you say one thing, (they were told we would be there at 8) and do another.   Not a good start!

We ended up seeing about 20 patients.  Not a personal best, by any means, but we did get the ball rolling.  Now the providers:  Five, non having done mission dental work before except Gloria and me.  More on that tomorrow!

This is an unusual setting.  A doctor assisting a doctor!  Details tomorrow.

Day 1 Home to Belize

A variation on a theme.  Rather than leaving at 1am for the 6am flight, we arrive at our church at 10pm to organize all the bags for 35 people and pile in the school bus for the drive to SFO arriving at 2:30am.  Brutal, but at least I wasn’t driving!  Great group of people, should be a good time.   Once the ticket counter opens, another wait, then a flight to Dallas, short layover, then on down to Belize City.  From there a six hour bus ride to Punta Gordo, our destination. 

Another church, from Canada, attempted to do the same on Monday, they still haven’t arrived.  The mission bus broke down, they spent an extra two days getting south.  We have arranged for a commercial bus to take us down south.  Nice.

Around 200 pounds of dental equipment and supplies.  Mostly in 4 bags with a smattering of supplies tucked away in our suitcases.  I asked the other docs to bring some supplies too.  Preparing for 400 plus patients requires a lot of disposables.