Thursday, March 30, 2006

2006 Day Five: Surgery

The second and final day in Vuelta Grande and the dental clinic jumped into full swing. Down the hill the medical clinic was relocated out of the school's classroom as class was back in session; the clinic moved into an adjoining room that was smaller but did have an exam table.

A line of patients sat at the door but Dr. Jan Paquette focused her attention on 10-year-old Guendi (pronounced "Wendy") who'd returned first thing in the morning for an operation to sever the ligand running the length of her tongue and anchoring it to her lower jaw.

Before heading up to Vuelta Grande that morning Dr. Jan and Dr. Bob MacIlveen, who would perform the surgery on Guendi, had mapped out the procedure they would use. They would start by sewing along the top and bottom of the ligand, and then cut it. This would, they expected, minimize the bleeding.

In the makeshift clinic Dr. Jan administered Benadryl to Guendi just before 10 a.m., to make her drowsy. Shortly thereafter it was determined that the dental clinic didn't have the right size suture for the surgery; Leroy Benham and Flor Caniz, a member of the Antigua Rotary who was helping translate for the dental team, jumped in the car and off to Antigua in search of a more appropriate suture.

Their errand took them to three different medical clinics or supply stores and delayed the surgery nearly an hour. Finally they reappeared, successful; Guendi, wrapped in a white sheet, was carried into the dental clinic and settled in.

"It's so small," Dr. Bob said of Guendi's mouth during his final pre-op exam. "I'm really hesitant."

Nevertheless he and Dr. Jan pushed forward, with Paula Benham assisting.

Her mouth numbed by a local anesthetic similar to Novocaine, Guendi sat wide awake for the whole procedure. The occasional tear slid down her cheek, but it wasn't until the suturing phase neared its second hour that she started to cry out.

Five minutes later Dr. Bob started to cut the ligand, and five minutes after that the doctors sat back, the procedure finished.

"I think it went well," Dr. Bob said simply.

Guendi sat quietly in the chair for nearly another hour, resting. She sifted thoughtfully through the goodie bag she received -- every patient in the clinic got a goodie bag of some sort -- and took in her surroundings with big eyes.

By the time an hour went by Guendi was already demonstrating increased mobility of her tongue. It will take time, perhaps therapy, for her speech to improve, the doctors noted, but for now things were already looking better.

Guendi and her mother were escorted home in the rental car that afternoon, as their home was in a village a 45-minute walk away.

Shortly thereafter the dental and medical clinics began their shut down.

That evening the team went to the home of Antigua Rotarian Vincent (Vince) DeGarlais for cocktails. Vince is an American who went to Antigua two years ago to study Spanish; a year later he packed up his Jeep and left his Denver home with the intent of driving throughout Central America for 15 months. He arrived in Antigua and has never left.

"I work with Rotary as much as possible because I see Rotary doing good things, and I get to work with Guatemalans to help Guatemala," Vince said of his adopted club.

His house, which blurs the lines between inside and outside, seems a stark contrast to the homes and schoolhouses the American's have visited throughout the week.

Here the Antigua Rotary takes the opportunity to welcome and thank the American's for their work, presenting each team member with a certificate.

Tuesday, March 21, 2006

2006 Day Four: Across the Mountain

The team headed up to El Hato one more time this morning to gather the equipment and move it to Vuelta Grande, a village on the other side of the mountain. The van was filled to the brim with plastic containers and the dentists went ahead to Vuelta Grande, where Leroy and Mike awaited them, while the rest of the team members stayed at El Hato.

Young men were playing a soccar scrimmage behind the school as other children milled about. Soon the now-familiar faces of the Aspuac family appeared. Ervin Aspuac is a teacher at the El Hato school who has been persuing further education through a scholarship provided by the Antigua Rotary Club; he has been instrumental in promoting the dental and medical clinics to the community through the children.

Auggie, Maureen, Julia, Alia, Andrea and Renee -- a woman Auggie and Maureen met in Antigua and invited along to help with the clinics for the day -- followed Aspuac's daughters up the dusty road to their home. There they proudly showed off the three tin shed buildings that make up the kitchen, master bedroom and children's room. The kitchen boasts a new stove that burns more efficiently than an open fire, but the Delmi, 9, and Evelin, 7, are more interested in demonstrating how they've learned to write their names.

Delmi and Evelin are left in charge of their two younger siblings while their parents work or attend to children. Today their parents are in Vuelta Grande, where Ervin will get a chance to visit the dentists.

Over at Vuelta Grande the dental clinic set up went smoothly, due in large part to the previous day's re-organization effort. Whereas the El Hato school formed a rectangle of buildings with a courtyard in the middle, the Vuelta Grande complex consists of two buildings about 50 yards apart. The school, a two-room structure with brightly painted murals of Guatemala on the walls, is where the medical team stretches out. Uphill lies the one-room "community center" building, or "situation room" according to a small hand-written sign posted on the wall. This is the space the dental clinic occupies. It's smaller than the room in El Hato, and the windows are open holes in the wall that children and adults alike peered over until curtains could be hung.

Ervin, whose children had so graciously opened their home to the Americans, was one of the first patients. He sat down for a cleaning and dental hygenist Julia spent two hours working on his gums and mouth.
"He had heavy tartar buildup under his gums which caused the gums to be severely inflammed and causes the bone supporting the teeth to dissolve," Julia said. Without the deep-scaling treatment she did, "he'd have lost his teeth eventually. They'd have fallen out."

After the cleaning Ervin moved to Dr. Allen to have two cavities filled.

Ervin was one of many men that streamed through the clinic today. By offering the clinic on Sunday the team hoped to be able to help more men who usually worked the rest of the week. This also changed how the treatments were provided.

"At (El Hato) we did exams and said, okay, today we do extractions, tomorrow fillings," said Maureen who has been working as a dental assistant. With only one day to concentrate on the men, the dentists sought to complete treatment on each patient that came before them at that time.

Down the hill at the school building the medical team was kept plenty busy. Women again lined up with children in tow, and even some men stopped in. Like in El Hato the team saw quite a few viruses amongst other problems.

"I found another little kid with a heart murmur," Dr. Jan noted.

After lunch a ten-year-old girl named Guendi (pronounced "Wendy") was brought in with a sinus infection. During the exam Dr. Jan noticed that her tongue was tied -- that the ligand under her tongue, something present in everyone, was abnormally long, extending almost to the tip of her tongue. This held her tongue to the base of her mouth; she couldn't open her mouth widely and touch her tongue to her upper lip. It also gave her a speech impediment.

"The mom elaborated on how it was affecting her life" after the doctor mentioned it, said John, who's been working as a medical assistant. "She couldn't go to school, kids were making fun of her." Guendi was eventually pulled out of school because the torment was too much.

But with the help of this team, that was going to change.

Tied tongues aren't all that uncommon and can be treated by cutting back the ligand. With a dental team and complete dental set-up just up the hill Dr. Jan had all she needed to make the repair: the chair, a light and surgical tools. An excited Dr. Jan ran up the hill to confer with the dental team about their supplies and Guendi's mouth, and found that Dr. Bob had actually performed this surgery once before.

When Auggie, the translator for the medical team, told Guendi that they would be able to fix her tongue, she received the news with a serious face as if concentrating on every word. She nodded her understanding, but it wasn't until Auggie turned away that a bright smile flashed across her face. Likewise Guendi's mother paid close attention to the instructions on Guendi's pre-surgical care -- she shouldn't eat anything in the morning -- and the description of the procedure.

As mother and daughter left the clinic their excitement was tangible despite their stoic nature. They were hardly out the door before the mother began telling the other women in line about their new hope for Guendi.

"It's just a miracle that we have everything coming together," Dr. Jan said, not trying to mask her own excitement. "It's just great."

That night over dinner Dr. Jan, Alia and John chattered hopefully about Wendy's story.

"They were just walking on a cloud," Dr. Jan said. "They just couldn't believe someone offered something to them."

Monday, March 20, 2006

2006 Day Three: Free Day in Antigua

Having shut down the medical and dental clinic in El Hato yesterday, today was a free day for the team members to explore the city of Antigua.

Antigua was the former capitol of Guatemala, until the late 1700's; nestled in a valley, the city is surrounded by three volcanoes and was nearly destroyed by a series of earthquakes. Throughout the town lie ruins from ancient buildings demolished in the earthquakes, such as the original Cathedral built in 1545. Behind the cathedral that dominates one side of the city's Central Park sits the skeleton of the old cathedral; for under $0.50 anyone can climb around the remains.

While most of the team members spend the day wandering the streets and sites of Antigua, four did return to El Hato. Leroy, Mike, Dr. Allen and Verity all seized the down time to seriously organize the dental equipment. By separating out the tools into separate, labelled containers and packing everything into clearly marked boxes the set-up time for future uses -- such as tomorrow, when the team moves to another village -- should be drastically reduced.

Saturday, March 18, 2006

2006 Day Two: Wrapping Up El Hato


Today was the team's second and final day in the little village of El Hato. In an effort to reach more people the project has expanded to do clinics in two villages, as well as a local charity group that has worked closely with the Newberg Noon Rotary in its organization of this trip.

While the majority of the team members climb into two vans and head up the hill, organizers Leroy Benham and Mike Caruso stay in Antigua for a supplies run before joining the others.

This year Leroy has rented a car, a Kia Rio. It's his sixth visit to Antigua -- Mike's fifth -- and both agree that it's getting ever more comfortable to maneuver the city's maze.

"Getting down the the hardware area is getting pretty easy," said Leroy.

The decision to rent a car came as an effort to cut the trip's cost. Like so many projects, the clinics are regularly finding they need something, be it paper towels or Tylenol. In past years the team has simply kept two hired drivers on hand the whole day to manage the errands to town; by simply renting a car, the fee for the drivers, who now simply escort the team to and from the village, is considerably less.

"I believe we can save $400 to $500 by having our own car" for emergencies and errands, Leroy said.

On the way up the rough road Leroy slows for one of many deep ruts.

"Mike," he cued.

"Be careful here," Mike warned, looking out the window.

Up at the school in El Hato, the site of the clinics, the team is busy uncovering the tables of tools and chairs. With the clinics already set up -- tools arranged, chairs standing, water pumping -- the doctors are able to get in and start pulling teeth by ten in the morning.

One of the first dental patients of the day is 5 year old Gustavo. Gustavo needs extractions or fillings for most of his teeth; he came yesterday but panicked after receiving the numbing medication. He returned today, but even the promise of his own soccer ball couldn't keep him from falling apart again once numb. His were the only sobs the clinic saw.

The line for the dental clinic was a long one and children pressed into the cement-block building, watching their comrades and eyeing the goody bags that are handed out to everyone who receives treatment.

The children seem bolder this year than the last. They creep ever closer to the goings-on, occasionally having to be shooed back to keep from getting underfoot. A few of the children boldly ask questions of the team members, such as names and home states, and a few others reach out to touch the skin so much paler than their own; some tease playfully and giggle at the reciprocated attention. A couple can even be coaxed into demonstrating the English they're learning in school.

This boldness suggests a growing trust on the behalf of the villagers, as well as increasing familiarity.

Flor is a member of the Antigua Rotary who has been very instrumental in the success of the team's work in the villages. She helps with screening the patients seeking care and acting as liaison between the Americans and Guatemalans.

"My impression is that a lot of the people who came last year came back," she said of the trust growing among the villagers.

She also noted the appreciation for the medical clinic, which saw an un-ending stream of visitors.
"They feel that there is someone out there for them," she said. She credited much of the medical clinic's success to the presence of the Dr. Jan Paquette, a female doctor; sometimes the women's husbands "won't let them come to see a male doctor."

One of the clinic's many patients today was Jolon, a two and a half year old boy whose had a rash on his cheeks for the past eight days. The boy sat silently on his mother's lap as his mother responds to intake questions posed by Alia Paquette. Dr. Jan interjected occasionally, asking additional questions, and Auggie Gonzales translated.

The rash, Dr. Jan concluded, is simply a result of over-exposure to the sun, possibly residual from a second-degree burn. But during the exam something else was revealed. The boy has a heart murmur.

Heart murmurs result from leaky valves and are not infrequent, nor are they always serious. Many children grow out of them.

"(Jolon's) is a little bit exuberant," Dr. Jan said. In the U.S. they'd run further tests to exclude the possibility of it indication of more serious causes. Here, however, she told Jolon's mother to simply keep an eye on how he does physically. If, as he ages, he seems to have frequent shortness of breath or struggles to keep up with his friends, he should be brought to the city to the specialist.

While Jolon and his mother are typical of the clinic's patients, Alia, who handled intake, added that there were also some men who came by.

"Men actually got off work to come in," she said.

The men typically came in with more specific requests than the women and were less inclined to sit through establishing a medical history. One man, a 75 year old, had broken a rib a few months ago and wanted help so he could continue working.

"I told him to eat chicken cartilage and he looked at me like 'Are you nuts?'" said John Paquette, who as acted as medical assistant. The man then presented a pocket-full of pills he'd been given -- some of which were a form of cartilage, a common treatment for such an ailment -- but didn't what they were.

"We told him how to use those," said Alia, and gave him some Ibuprofen.

Overall the clinic was seeing "stuff we can actually help with," Alia noted, in contrast to yesterday wherein they mostly saw viruses that simply need to run their course.

At the end of the day the team started packing up the equipment in preparation for the move to the next village, Vuelta Grande. After dismantling the chairs equipment stands the team loaded back into a van and down to Antigua.

In the city many of the team members went to a local restaurant for dinner with John Bell and Flor. Both John and Flor work for the local charity Transitions, which largely provides wheelchair's to disabled children, as well as providing medical care. John frequently brings difficult medical cases to Portland, Ore., where they'll receive surgery or treatment at the Oregon Health Science University. John and Flor have also been valuable assets, as well as generous friends, to the whole dental and medical project.

While dinner marked the end of the day for most, a few, in honor of it's being St. Patrick's Day, headed to the local Irish pub, Reilly's. Yes, there really is an Irish pub in Antigua. Happy St. Patrick's Day, and "may your glass be ever full, may the roof over your head always be strong, ad may you reach the gates of heaven half an hour before the devil knows you're dead."

Friday, March 17, 2006

2006 Day One


The team was greeted with clear skies for the first morning in Guatemala. After leisurely breakfasts and gathering supplies, the team climbed into a tourist bus that carried them up the gravel road to El Hato.

Since beginning the dental project in El Hato three years ago the clinic has been set up in the village’s school. Last year two additional buildings were under construction to double the school’s size; this year those buildings are finished – wired with electricity, painted and even decorated with murals. Children gathered in the courtyard as the team tore into setting up a clinic.

It took over two hours to unpack supplies – everything from the patient chairs to suction tubes to gauze. By the time the first patients came in after noon there were four stations: three dentists who focused primarily on extractions and fillings and one hygienist to provide preventative cleanings.

Once the first patients took their seats the chairs hardly stayed empty. As soon as one patient was done another was ushered in to fill the space. The courtyard filled with women and children either waiting their turn or just there to check out the excitement.

Across the courtyard from the dental clinic, in the small room that serves as the principal’s office, Dr. Jan Paquette set up a make-shift medical clinic. A health record, containing height, weight, temperature, blood pressure and pulse was created for each of the 13 patients that came into the clinic, and a copy given to the patient in hopes of providing some history for future treatment.

Most of the medical patients came with complaints of coughs, low-grade fevers and other mild illnesses. The clinic did see a man with pneumonia and a woman with a urinary tract infection, easily treated with free samples of medication.

Working well past the designated departure time, the dental team saw over thirty patients ranging in age from 5 to 56 years. Twenty of those patients were asked to return the next day to receive either extensive treatment after just a brief exam or for more work that couldn’t be finished in one day.

Yet with this third year the impact of the project began to show itself. Dr. Allan Methven and Dr. Bob MacIlveen both noted that they did far more fillings on the first day of this trip than on the first day of the previous trips – a sign that the serious dental health problems, mostly treated with extractions, are diminishing.

The clinics were finally closed down as the sun started to set behind the surrounding mountains. The mood in the bus was light, albeit tired, as the team members rode back into the city.

It begins...

The day that's been in the works for months has finally arrived.

Team members amassed at the airport before dawn to begin the journey from the Northwest to Latin America. The first leg of the journey ended in Texas with a lay-over at the Dallas Fort-Worth airport. A long refreshing lunch and a short meeting for final preperational instructions, then back into the air.

Guatemala greeted the team members with air like a warm, humid hug. In the crowd outside the airport, amid the swarming cab drivers eager to offer a hand, emerged the familiar face of Eduardo. Eduardo is the chauffeur for the team; he has two vans that wisk the team out of the lights and bustle of Guatemala City into the dark hillsides beyond.

Twists and turns, up and down along a single one-way road for over half an hour before a sudden right turn brings the team into the enclosed town of Antigua. The cobblestone streets are lined with the walls of the buildings for the entire length of the block, turning the city into a colorful maze. The two vans weave seamlessly to the hotel and the team is, for now, home.