Training Log Archive: 'Bent

Guatemala Health Outreach Dental Mission 2019 Rio Dulce.
This is my 5th dental mission, and second time in the Rio Dulce.



I met the team in the airport at 6 a.m., and we had a decent flight to Guatemala via Mexico. Unfortunately, three of us didn’t get our luggage, and mine included my personal clothing and gear as well as some special dental supplies and equipment.

We got a ride up the mountain to Antigua, the former national capital and a UNESCO World Heritage Site, surrounded by volcanic mountains. This town was destroyed when Agua erupted centuries ago and has only been partially rebuilt. We arrived late and grabbed a quick meal before bed. We stayed in a nice hotel built among some older ruins with several lush courtyards.



The next day we had some logistics meetings as we met Team 1 who were finishing their week and handing over the equipment to us.



We were fortunate to have a full day in Antigua, as it gave us time to look around a bit and have a nice lunch up the mountain while our bags were in transit from Mexico. Our luggage arrived in the evening during our full team dinner and presentations. Whew!







We had a dinner to recognize team 1, and to award Tracy her 10-mission pin. So many hard-working folks have been on this project for many years.

Thanks to the generosity of my sponsors, especially Palgrave Rotary, I was recognized as the top fundraiser on either team. All the support I received is very much appreciated.





Early start tomorrow with a 7 hour bus ride and a boat ride down the Rio Dulce into the jungle. Then we need to set up the clinic.
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Day 2- We got an early start and drove off the lush mountain in time to miss the crazy rush hour in Guatemala City.







Tim and Nasha arranging medical outreach via Guatemala conference call.





We made good time down to the flatter terrain by the Rio, then had lunch and transferred the entire clinic from bus to boat.












We got to Ak-Tenamit, (the rural vocational school and our base for the week) by going down the kilometre-wide Rio Dulce and up the side Tatine Creek, deep in the jungle.









We arrived nice and early with lots of time to set up the clinic boat. Unfortunately, there was a bit of miscommunication, and the boat was missing! It had been hauled to a different location than planned, so there was no set-up today. Off to our mosquito-netted bunk beds in our cabins early.





Day 3- We woke to duelling roosters, and headed up the Rio to an island community.
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These kids hadn't been seen since Health Outreach came here a few years ago.



We were able to set up 3 chairs on the boat, and run umbilical air lines to 3 more chairs under a palm roof on land where Pravir did Triage, and Steve and I did restorative dentistry with Erin and Baljot.







Ramzi is a British trained oral surgeon, and he took my former place on the deck



while Rob and Gerard worked inside the boat as they did last time with Crystal and Tracy.


Rob and Crystal had the best communication skills as Crystal speaks fluent Spanish and Rob spoke Spitalian to the kids.



Gerard was mistaken for me a few times. He and Tracy are the veterans, and the backbone of the trip as far as getting teeth fixed for kids.

Yvonne has done 11 years so far, including some double weeks! She keeps things sterile aboard.


It took a while to do the initial set-up and sort all the gear but soon we were able to get into the swing of things.



My assistant Baljot is a quick study, and we saw lots of kids. Our first one was a screamer but we had lots of good kids after that.



Steve and Erin worked the other chair on land, and we shared equipment and supplies.







We also got one kid who had run off from Triage as she refused treatment, but her Mom marched her back and it was a real challenge to get her numb for a filling by me and an extraction by Ramzi.

Our site was actually quite nice with a breeze and a view across the river, if a bit noisy with the generator.



Excellent fish and shrimp for lunch was brought by the Ak-temanit crew.



Then the next load of school kids arrived by boat. We ended up seeing everyone, and had time to relax a bit while waiting for Tim and Nasha to return from their medical outreach.















We actually found a hole-in-the-wall bar with cold drinks.







Here’s the clinic being towed off to tomorrow’s site:


Nice family-style dinner at Finca Tatine.


Day 4- We woke to dumping rain and duelling roosters with dogs as backup singers. The rain let up in time for our open boat ride to the clinic, this time at the girl’s school at Ak-tenamit.



The medical team (Tim, Nasha and Dennis) was heading up into the mountains on horseback for an overnight trip deep in the backcountry to a very poor village.

Gerard and Rob got right to work on board, while it took a while to set up chairs with umbilical air lines and extension cords on land for me and Baljot and Steve and Erin.












Pravir was on Triage, diagnosing and numbing kids up.



We saw a lot of very young kids from the local villages. It was a bit sad to see tiny kids with 10-15 cavities, many beyond saving. We did what we could for them.






One little 3 year old girl was amazingly stoic for several big fillings and extractions, while another screamed, yelled and fought over some tiny work so much that we could only apply our special Silver Diamine Fluoride to avoid the risk of losing a finger or two.



Some of the kids got right in there with me.









It was a tiring day.


Ramzi did quite a few extractions.

After an emotionally draining morning, the afternoon was a lot calmer as we started seeing the mothers and other adults, and we got some decent looking work on front teeth for some of these women.



Baljot was able to do some hands-on work under my supervision too. She assisted me very ably and is also licensed for dentistry in India.





The boys on the boat were amazingly productive until the generator went down. Our local guys managed to get plan B working briefly with a backup, then plan C with a self-contained compressor.

We actually finished all the afternoon patients a bit early and headed back. Sadly, tough-guy Dr Gerard was sick and had to miss a nice dinner across the river at the place with the chocolate lab concierge.



Day 5- The kitchen crew got our coffee maker dialed without my help today! We headed off downriver to another small village.


Gerard was back to his usual larger-than-life self.



We had to set up three of the chairs under the awning of the local primary school, as there was no shelter near the long dock with the clinic boat.







We had some loud, challenging kids to start, including some who watched intently as their loud little buddy got some extractions so they were stressed before we even started their dental work.



We got the work done, and the kids were happy to play around with us after their appointments.



There were some pretty cheeky kids today with devilish grins.





One tiny girl sought out Tracy and sat in her lap. She had seen her in 2017 when she was two, and she remembered her.



It was very hot and definitely an emotionally and physically tiring morning.





We saw older kids and adults in the afternoon and had some bigger jobs to do. Using our SMART (Silver Diamide Fluoride and Glass Ionomer base) technique, we were able to save a lot of teeth that would need extraction otherwise. Baljot got to help perform parts of procedures under my supervision, and I gave her a wider, more challenging range of things to do, which she took in stride. We got a lot more done and finished up all our patients.




Dinner was at the hot springs, where a cold drink and a hot soak was very much needed.



We reunited with Tim and Nash after their medical outreach up in the mountains on horseback. Now that was remote! The local seafood here was particularly excellent.

Day 6- We were back working at the boys' school right next to our restaurant at Ak-tenamit.





It was particularly hot and airless, and we got off to a slow start as both Baljot and Crystal (our only Spanish-speaking team member) were feeling sick and had to take some time off. I worked with Martine a bit. He’s the local health worker I worked with last time, a smart guy who speaks no English.



Poor Crystal had to go back to her cabin but Baljot revived a fair bit after a round of water coconuts I was able to procure for lunch. We saw older kids this time, with great cooperation and somewhat better teeth.





Steve and Erin did lots of great work despite the heat.





There were fewer extractions for us, and Baljot and I did more big anterior tooth fillings that are more aesthetically demanding and technically difficult in the field. Gerard was happily borrowing my Silver Diamide to save teeth we’d otherwise extract. He worked with Yvonne today, and Tracy worked with Rob.



Both have 10 missions+ but Yvonne is usually on sterilization duty. Steve and Erin worked along steadily with no problems, the only Rio first-timers to do so.

I did some bigger cases on front teeth. Rob did a fantastic job for this kid:





We had a long but scenic boat ride down the twisting canyon to Livingston for dinner at Bugamama’s restaurant. All the kitchen and serving staff are graduates of Ak-tenamit, no longer poor locals but skilled workers. There was a nice presentation from the president of Ak-tenamit to us all.



I got to be both shoemaker and electrician today after a sandal broke in mid-walk and our solar power went out.

Here's my brother from another mother, Gerard.



We had a late night and I found an interesting bed fellow. My bed net had a corner untucked, and a spider bigger than my palm was running around *inside* until I managed to steer it out.

Day 7 - We were back at the same location today. It was complicated by dumping rain, which turned our dirt floor into a sea of mud for those of us not working on the boat. We still saw a lot of high school kids, and Rob and Crystal did root canals. We packed up the entire clinic and had a nice lunch with presentations for all our local volunteers. We finally got to eat with Nurse Dennis.








Ramzi our leader said we’d seen 375 kids and probably did nearly 1500 procedures, mostly fillings and extractions.





I did techniques that involved more sealing and healing and less drilling, but the boys on the boat are incredible performers who did massive numbers of amalgam fillings, fast but gently, with kindness. Rob did a few big anterior cases that came out really well too. Working off the boat is a bit more challenging to set up, and you are always running for instruments or sterilization while tripping over spectators. Steve did an amazing amount of work in these conditions too.

We loaded up and headed back up the Rio to a hotel with hot showers and a pool.



Checking in with compressors, generators, dental kits....



Tomorrow we’re off to the airport dark and early.

All in all, an exhausting, crazy, hot, fulfilling, fun, meaningful trip with an outstanding bunch of caring doctors and health workers.

C • Guatemala Dental Mission 9

Gotta ditch this cold, and gotta head to the airport after work. Still hate missing a gorgeous bluebird powder ski commute.

Bah, forecast is too windy to ski home from work tonight, so I drove. And packed.

Woo hoo, trail breaking with Bazingadog in shin deep powder.
A little easier ski home in my tracks from this morning. About half the route wasn’t stomped.

Love my commute. Still have to take it easy due to my cold.

C • Sweet! 1

Easy ski to work. Brilliant sunshine, deal calm and -21C. Not much glide. No dog, but probably would have been OK.

Ski home in a full on blizzard. Needed goggles.
Progress was sluggish, but when I got home I found one grip skin was half off and one pole tip was missing. Still a great commute.

All fixed up now.

Too nice out not to ski with AD. Short and easy due to my cold, not because of the cold.

Rehab, core and easy workout 1.