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PROJECT ARCHIVES

JANUARY 28th TO FEBRUARY 4th, 2002 - Monterrico and Antigua, Guatemala

Introduction
Our 2002 Guatemala dental project occurred between January 28th and February 4th, 2002. We operated independently with the support of Kindness in Action (KIA). Our team consisted of myself (dentist), Elizabeth Galarza-Lee (administration, translation), Monika Brenne (Dental Hygiene) and Maritza Galarza (dental assisting, translation).

Monterrico
Monterrico is a small town on the Pacific coast of Guatemala. It is approximately 2 1/2 hours by car from Guatemala City. The population is 663. The people are considered “Ladinos”. There are several schools in the town as well as in the surrounding communities.

'El Puesto De Salud'
The ‘Place of Health’ is a medical clinic located in the middle of town. It is usually attended by a nurse. The facility had four rooms and a lobby. It had been thoroughly cleaned in anticipation of our visit. The lighting was good and electricity and running water was available. Cabinetry was available and stocked for medical examinations. The building is brick making it sound and secure. However, ventilation in the clinic was poor. Multiple fans provided much-needed relief from the heat of the afternoon.

Basic dental supplies were available. All dental supplies and equipment belonged to Poco a Poco Service Society. Jill Sampson was aware of our project. The equipment included a portable ADEC unit, generator, chemiclave, high and slow speed hand pieces and a dental amalgamator. All was operational. Sundries included disposables and restorative material of which most were stale-dated. Local anesthetic was stored in a large refrigerator. A generator powered by electricity was placed outside the building. Sterilization was adequate. The chemiclave was functional although the door had to be ‘jiggled’ for it to pressurize. Since no chemical solution was available, water was used instead. top

The clinic was opened according to the hours we set to operate. We treated patients Monday to Thursday. The Health Promotion Committee staffed the clinic with some community members to schedule patients. The committee members are Nelson Barillas (President), Carmen Plante (Treasurer) and Carlos Pazos (Secretary). Carmen is bilingual so she and a Spanish language instructor named Giovanny Colorado took care of the administration. Numbers were given out to patients wanting care so that patients were seen in an orderly fashion.

Treatment was conducted out of two rooms. The second room did not have an ADEC unit so Monika used it for hygiene appointments. When it became apparent that we couldn’t possibly attend to everybody, she helped with extractions of primary teeth. I administered the anesthetic and supervised the procedures.

Translation was not a problem since two of our four team members spoke Spanish fluently and the other two had some working knowledge of it. To introduce dental care and encourage it at home, handouts were given to the parents. Handouts were typewritten in Spanish with specific instructions on how to properly brush teeth and information on identifying and treating gum disease. We hoped that the parents could read the literature and reinforce good habits at home.

"El Dormido"
El Dormido is a small community of 25 families situated south of Monterrico along the Pacific coast accessible by road and by boat. It is a remote village without any electricity. The livelihood of villagers was based primarily on fishing. Only one school existed. The school was built using private funds, with the effort of one foreigner named Lucas Belair, a social worker from Quebec, Canada. His efforts over the past three years are evident in the school. It is the largest structure in the village and seats approximately 30 students comfortably. It is still being improved. The students are divided into two rooms separating grades 1 to 3 from grades 4 to 6. top

Our objectives were to teach the children oral hygiene, perform dental screenings, and advise the teacher on supporting oral hygiene and observing the signs of urgent dental problems. We saw all the children for screenings, of which approximately five had pain. All children had dental problems, many with impending symptoms. Unfortunately we had no means of actively treating problems. Children were advised to seek the attention of a private dentist in a nearby town. We gave the teacher six complete regimens of Penicillin to dispense in the event of a dental emergency. He was advised to use discretion and observe for signs of an allergic reaction.

"Instituto Indigena Nuestra Señora del Socorro", Antigua
"Indigenous Institute of Our Lady of Help", Antigua)

This school was a boarding school for young Indigenous Guatemalan girls from rural areas throughout Guatemala.

Comments
Our objective of servicing the community of Monterrico was met on this project. Those the worst problems were seen in those four days even though some were untreated. In total, 130 patients were seen.

24 patients were examined only. 31 patients received hygiene care. 37 restorations were placed and 133 teeth were extracted. The Friday visit to El Dormido was unplanned. Although we did not perform any procedures, it was a highlight to teach 30 children something that they had never learned before. Oral hygiene instruction in this remote community may be more beneficial than any procedure would be. top

Personally, this project was special to me. In all my prior experiences, I have not witnessed the sincerity of so many people towards the cause. I sensed this despite my limited understanding of Spanish. Community members themselves became actively involved. They included members of the Health Promotion Committee; the local restaurant/hotel owner, Esperanza Rodriguez; the boat operator, Carlos Barrios; and Pablo of the Monterrico Nature Reserve. The mayor of Monterrico, who we met on two occasions, also supported our efforts.

A special note goes to Real DesRosiers of Adventure Travel – he was truly the instigating figure behind this project. As the liaison between the community of Monterrico, our team, Poco a Poco and Kindness In Action, he had prepared for our visit weeks before our arrival. He recruited the help of his son's father-in-law, Carlos, a local dentist in Antigua, to survey the dental supplies. He contacted Hermano Pedro hospital to borrow a portable dental chair. He arranged to have flyers distributed throughout Monterrico and to all the surrounding villages in the area notifying them of our visit.

It is Real DesRosiers’ and my own firm belief that the people of Guatemala help themselves as much as they receive help from outsiders. The success of this project was evidence that they could effectively contribute to the well being of their people. Future projects will most certainly be more successful with this attitude and behaviour.

The people of Monterrico are gravely lacking dental care. The town does not have a dentist or physician. There have been recent illnesses and deaths because of poor accessibility to medical care. At the clinic, we observed a high incidence of baby-bottle caries. The cause was partially due to infants sipping Coco-Cola from a straw and drinking excessively sugared coffee. Dental pain and/or infection were common. Every child had a dental problem. Only children received hygiene appointments. We soon realized that we were running out of days to see everyone. Appointments for treatment were being denied as early as Tuesday afternoon. Our criteria for treatment changed to treating only patients with pain or infection. We left a lot of decayed primary teeth untreated hoping that they would last long enough to exfoliate before causing pain. The two treatment options were extraction or restorative. top

The Guatemalans were most grateful for our help. We sensed some initial doubts that our care was being offered at no charge. People voiced concerns about costs as soon as they entered the room. That changed quickly when our first patients spread word of our goodwill. Line-ups formed for appointments. Children were quite cooperative and resilient. We saw many children after extractions shortly walking around town.

Future dental teams to Monterrico would benefit from fresh supplies of anesthetic; a curing light for composites; analgesics like Ibuprofen, Acetaminophen etc. in tablets and liquid form; Amoxicillin in tablets and suspension, and hand piece lubricant. These were the items that we brought which were either used up or taken back home for future use. I am protective of dental supplies after witnessing their waste from neglect.

We worked only one day at “Instituto Indigena Nuestra Señora del Socorro”. On Monday February 4th, between1:00 to 5:30 pm, we treated 13 patients in total. Treatment included: 8 examinations; 8 extractions for 5 patients; 3 composite restorations and 14 amalgam restorations. The equipment performed flawlessly. Dental sundries were abundant except for bonding resin, which we were pleased to donate from our supply. The students were a pleasure so work with – timid, yet cooperative and cheerful despite their anxieties. My surprise was with the severity of their problems. The comfortable confine of the school was certainly no indication of their oral health. These girls had multiple urgent problems possibly worse than other Guatemalans that I have seen. Perhaps the cause was neglect from their past village life combined with a current high sugar diet in Antigua.

The experience at the School for Indigenous People was enlightening for two reasons. It showed us that the dental needs of those in more urban areas like Antigua could be just as great as those in rural areas.

Future Projects
Monterrico most definitely has a need for dental services. I hope that we can continue to support this community with regular visits. Perhaps then we can see changes in attitude toward oral health. Future dental projects can be most effective with the ongoing support of the community for such ventures. Fluoride supplements would be a feasible and cost-effective way of controlling caries. top

Tim Lee