Health Outreach - Dedicated to overseas charity projects

PROJECT ARCHIVES

FEBRUARY 2001 - Rio Dulce and AK'Tenamit, Guatemala

Airport in Guatemala
We were not expecting our donations to be thoroughly examined by customs. We were made to open each bag and personal went through many of the items. The itemized list of goods was obviously not good enough. We were advised that stale-dated medicines and products were being confiscated. Luckily, all of our goods passed the test.

Rio Dulce
This was our third charitable dental project in Guatemala, Central America. This time, we were venturing "deep" into the country. In a remote area called the Rio Dulce (Sweet River), on the east coast of Guatemala, are villages situated along the river's edge and in the surrounding rain forest. The people, called Q'eqchi, are of Mayan descent. They number over 10,000. They are relatively new communities less than 50 years old. This is because many of their inhabitants were displaced from their original homes by powerful landowners. Many of the evictions were due to the search for more fertile land to create coffee plantations.

AK'Tenamit" ("The Project")
Real dropped us off at Fronteras where we waited for an AK''Tenamit cargo boat to pick us up. The ride up the Rio Dulce was about one hour. We met Steve Dudenhoff and Katy Mitchell that day.

At this time, we discovered with certainty that the dental boat was not operational. (Katy forewarned me of this). Steve informed us that the wood had rotted the floor and walls such that the boat was deemed unsafe. AK''Tenamit was in the process of repairing it but it would not be ready for us. top

"Clinica"
The "Clinica" or medical clinic was at the water's edge. A dental operatory was set up for our stay. The dental chair from the dental boat was transferred to one of the medical examination rooms. The lighting was good and electricity and running water was available. A small cabinet, stocked with basic dental supplies was present.

There was a dental amalgamator and a light-curing unit for composite fillings. Most items were stale-dated. We had brought fresh amalgam, composite, and local anesthetic. A generator powered by electricity was placed just outside the building. Sterilization was done by hand using solutions. A pressure cooker served as a heat autoclave.

The "Clinica" was open 24 hours a day even on weekends. It was staffed by international volunteers. Villagers would arrive from the river and simply wait outside for medical and dental care. We were stationed at the clinic all week, using it as home base for our day trips to villages. top

"Lampara"
Lampara was one of AK'Tenamit's largest villages. 120 families averaging 5 persons per household reside in Lampara. It only took us five minutes by boat to arrive at the base of the hill where Lampara was situated. That was the easy part. From there we hiked over slippery rocks, through mud, and under a canapé of rainforest before reaching the main river separating us from the village itself. The river had risen high from a downpour the previous night. We had to roll our pants above the knees to cross. Coincidently, we witnessed a new bridge being constructed over this river. This was sponsored by AK'Tenamit. We crossed a field to reach a small cabin with a sheet metal roof - this was to be the dental clinic. There were two entrances. The floor was dry, cracked mud. Lighting was adequate because of the sunlight that entered readily. The village was expecting us. School children arrived in groups of five. There was no dental chair or anything similar. Screenings were done with the child sitting on a chair with their mouth open. Children with problems were asked to consult with their parents and return in the afternoon for treatment. We saw approximately 80 children for screenings, of which approximately 15 returned for procedures.

The parents accompanied their children back, quite interested and appreciative of the work we were offering them. There were two treatment options: extraction or filling. Since we were only equipped for extractions, 13 children were asked to make their way to the Project on the Friday for restorative treatment. Every child had a dental problem. Our criteria for treatment was pain or infection. We left a lot of decayed primary teeth hoping that they would last long enough to exfoliate before causing pain. Language was another problem. The children spoke Q'eqchi and we had one translator who spoke both Q'eqchi and Spanish. When I had a specific request or question, I asked Liz to repeat it to the translator who then asked the children. You can imagine how inaccurate this could be so I relied a lot on my clinical exam for diagnosis. Another obstacle was the fear that the children had over having their teeth extracted. They often denied having pain, even though we later found out that they indeed had discomfort but were afraid to tell us. Miguel, the health promoter and translator, recorded every child who was screened and had a procedure.

It was with great surprise that the 13 children who we advised to return to the Project for treatment were waiting for us Friday morning of that same week. It was satisfying to know that we impressed upon some the importance of following through with our recommended treatment. top

"Laurreles"
Laurreles was a small remote village of 100 people. It's inhabitants were independent trying not to rely on too much outside help, especially from AK'Tenamit. Apparently, the village leader was very independent-minded.

The trek to Laurreles was most rigorous. From the Clinic, it was a 45-minute boat ride along narrow rivers to our drop-off point. Guides greeted us. Unfortunately, there was some miscommunication and the village was not expecting the dental team. This meant that dental supplies had to be carried by the team. This meant carrying on our backs a large duffle bag loaded with dental forceps, anesthetic, disposables and sterilization fluids. From the riverside, our path ran through a beautiful valley. It would have been more pleasant were it not for the mud created by the previous night's heavy rainfall. Our boots sank deep into the ground above our ankles. We gave up trying to keep dry 20 minutes into the hike. 45 minutes later, we reached a gate before a steep path leading into the rainforest.

This was the last passage through to the mountain-top village of Laurreles. Water ran generously down this path making the rocks slippery and trail muddy. Although it was treacherous for us, passing locals seemed quite skilled at negotiating through. On several occasions, we had to transverse rushing water that cut through the trail. Again, the streams were fast and muddy from the rainfall. The final yards were the steepest. This meant taking several breaks before finally reach the top. The village of Laurreles had a church, small store and school all built on open ground. We could see the river and AK'Tenamit from here. Further up the hill were the homes of the villages, sheltered by large trees. Immediately, word was sent to the homes announcing our arrival. The school was to be the site of our makeshift dental clinic. Our supplies were unpacked in a large classroom. Children anxiously sat on benches. Surprisingly, they were being taught Spanish over their native Q'eqchi tongue. Our initial focus was to instruct the children on proper oral hygiene. This took some time considering that this was the first toothbrush that they had ever owned. Even the adults, who were unaware of proper dental care, were inquiring about proper care.

We screened the children as usual looking mostly for painful or infected teeth. Certain children had they teeth extracted immediately. Again, we advised some to seek treatment at the clinic at AK'Tenamit. The elders however did hesitate to commit because of the traveling involved. This re-affirmed the poor accessibility that these people had to health care. In total, we saw about 40 children of which 10 required extractions. This was a significant number considering there were only 100 people on the village. top

Clinic at Monterrico
On Tuesday of the second week, we were brought by Real to the small pacific coast town of Monterrico. Several schools were in the town as well as in the surrounding communities. Last year a dental team did set up in the clinic and performed dental procedures for the people in the community. The clinic was closed at the time that we were there. However, I did get a good opportunity to examine the premises. My first impression is that the facility would be excellent as a clinic for a Poco a Poco dental project. It has numerous benefits. The building is sound. It is brick and is secure. Supplies would be well protected from the elements. With a continuous supply of electricity, all dental procedures could be done.

Lighting is excellent. Space is good and it is clean. Most importantly is that it has a regular staff person. This individual is known in the community and could quickly organize patient flow for the dental team. The remoteness of this community also makes dental care a luxury that many cannot afford. Of course, further investigation will be necessary. top

Analysis
Our objective of reaching deep into Guatemala to help those who most needed dental care was met on this project. Never has a team led by myself have ventured so far into areas so remote.

The people of the Rio Dulce are gravely lacking proper dental care. Their lack of wealth was only one factor. The remoteness was an obstacle to care just as much. Of the many children that we screened, only a handful had evidence of dental care, and this treatment was likely done at AK'Tenamit. When advised that the dental boat was not in service, we were reluctantly given the option of hiking to the villages. The previous volunteer dentists were apparently not in good enough physical condition to make the treks. I cannot see another dentist making it to Laurreles for many years.

Future teams to AK'Tenamit would benefit from real mid-calf high rain boots in addition to hiking boots. I would also suggest using discretion on how much to carry to the villages. As with previous trips, we found that previously donated dental goods were poorly cared likely because of medical staff's poor knowledge of dental materials. We did leave some materials although we were concerned about whether they would last in the humid environment. Their policy was to continue using products including medicines until one year after the expiry date. We brought with us a large supply of filling materials, disposables, and local anaesthetic. I would suggest that future teams use their discretion when leaving materials at this clinic. It seemed that some materials were in oversupply and became expired before they could be used. Some of our supplies were left with Poco a Poco in Antigua where there are more frequent dental teams to use them. Some materials were taken back home to be safely stored and for use on future projects. I have been very protective of dental supplies now, especially because of their increasing expense and after encountering the difficulty in getting them through customs. top

Tim and Elizabeth Lee