One person at a time
He was brave, and he was scared, and still he was brave.
First the needle in one spot on the dark pink seam inside his front lip where it meets his gums, and then in another nearby spot above his black-rimmed baby teeth. Tears gathered in his chocolate brown eyes, spilling alongside his nose before veering down his peach-fuzzed cheeks.
Still he was quiet and brave, breathing in sharply through his nose, unmoving except for the tiny, jerking tightening of his grip inside his cousin’s larger hand. Another slow shot of anesthetic in a different spot and the shallow, sharp breaths became more rapid, his little chest fluttering with hummingbird swiftness.
He gazed unblinkingly at “The Jungle Book” playing in Spanish on a TV screen 4 feet above his eyes, the headphones over his ears letting him know about the simple bare necessities of life. Dancing bears, evil snakes — not so amusing just then.
More gradual anesthetic, minutes and minutes of it, a growing tremble spreading through his whole small body, and finally Christopher Ruiz, three days away from his sixth birthday, let out a high, keening wail.
“Está bien,” Dr. Glen Dean told him gently. It’s OK. Eight fillings later and it basically would be, but not before the wail turned to a scream and cousin Manuel had to hold down writhing, thrashing legs.
Maybe it was after this case, or the girl with 12 cavities, or the 12-year-old boy with an open palette who needed two extractions, or the young mother in the dental chair for almost five hours — it could have been after any one of these that Dean observed, “You kind of have to approach it that they may never see a dentist again.”
But still, usually twice a year, with varying teams of volunteers, they return to a simple, temporary dental clinic set up inside Hospitalito Atitlán in Santiago Atitlán, Guatemala. One tooth, one mouth, one person at a time.
There is no fixing all the problems. In a world full of need, the seeming tide against solutions is crushing and wide. But still.
“If I can do some good for even one child’s teeth, then that’s enough,” said Branton Richter, a Lehi, Utah, pediatric dentist who, with his wife, Becky, accompanied Dean, a Grand Junction pediatric dentist on a dental trip Aug. 15–25 to Santiago Atitlán.
Also part of the team, which was supported by the Hirsche Smiles Foundation (hirschesmiles.org) was Grand Junction periodontist Duane Weenig and his son, Jordan, a student at Brigham Young University; Dean’s office manager at Oral Health Partners, Mary White, and her daughter, Shiloh, marketing director at Oral Health Partners; and Cimmy Starr, a dental hygienist in Dean’s office, her husband, Bob, and their two teenage children.
‘WE’RE HAPPY TO DO THE WORK HERE’
Dean anticipates the questions: Why go all the way to Guatemala when there’s need right here? When tooth decay leads to health crises in this very region? When the expense of getting there is significant and there’s no way of knowing if, once you leave, the work done during that week will be followed up with good habits?
“This is a place where we can do some good work,” he explained. “We can help, we have the resources and the ability. It’s just one town, I know, but it means a lot to the people we work on.”
As a missionary for The Church of Jesus Christ of Latter-day Saints in Guatemala and El Salvador in the late 1960s, he said he grew to love the people and culture of Guatemala. Returning there in 2005 with his nephew on a dental trip to Santiago Atitlán, ideas stirred.
Almost two years before, Dean learned, a board of volunteers began meeting with community leaders to discuss the lack of 24-hour and quality, affordable care in town and what could be done about it. There was an abandoned stone clinic on the outskirts of town, built by priests from the Archdiocese of Oklahoma City, and 18 months later, in early 2005, it had been rehabilitated into Hospitalito Atitlán (hospitalito atitlan.org). Dean committed to regular, weeklong trips there to do dental work in a temporary clinic for which he brought the equipment and materials.
Six months after opening, though, in October 2005, Tropical Storm Stan devastated Guatemala and Santiago Atitlán especially. A torrent of mud washed down from the slopes of Tolimán volcano looming above the hospital, killing almost 200 in the neighborhood and burying the hospital 4 feet deep.
“And we thought, well, that’s it,” recalled Lyn Dickey, a Hospitalito founder and its development director. “But the board and especially the town leaders decided it was essential we rebuild.”
Sixteen days later, the hospital had relocated to a former backpackers’ hotel, where it remained for several years while Dickey and the rest of the hospital board raised funds. Donations came from around the world. Austin, Texas, hospital architect David Schele donated the plans. The Archdiocese of Oklahoma City donated a medical storage building and the Kendeda Fund provided a $750,000 matching challenge grant. In all, almost $2 million was raised and in October 2007 a new, 25,000-square-foot Hospitalito Atitlán opened.
One of the hospital’s focuses is serving those who live in poverty, a significant portion of Santiago Atitlán’s population. Hospital services aren’t free, Dickey explained, because the board decided that people have the right to be invested in their health care and it’s easier to value something that one pays for. Plus, patient fees — 15 quetzals, or about $1.90, for a clinic visit — cover about 60 percent of the hospital’s annual $350,000 operating budget.
“And some people can’t afford that,” Dickey said, “so our social worker gets together with them, does a home visit, works with them so they can get the care they need. That may mean a payment plan, or trading labor, maybe doing grounds work at the hospital. We’re not going to turn someone away because they can’t pay.”
So, when Dean and his teams set up the temporary clinic semi-annually, patients pay the hospital nominal fees for their services though they are volunteered. Dean smiles at the set-up; it’s essential to keeping a not-for-profit afloat “and we’re happy to do the work here,” he said.
‘HELPING WHERE WE CAN’
It’s a unique “here,” a special “here.” On the shores of Lake Atitlán at about 6,000 feet above sea level, rimmed by volcanoes, Santiago Atitlán is green. It’s blooming. In August, ripe avocados fall with a thud onto metal roofs and hibiscus plants pulse red and pink and yellow. It’s not unusual to see tarantulas scuttle across cobblestones.
In this town, women hitch their traditional Mayan textile skirts around their thighs to wash their laundry in the shallows of the lake, mostly ignoring the concrete laundry pool built nearby. As the sun sets, darkening the looming San Pedro volcano, a trail of people head down to the lake to fill water containers and women often carry them home on their heads. Children with grubby feet inside plastic sandals scamper around them.
On a Sunday night, with the glow from storefront Evangelical churches spilling golden onto the cobblestone streets, the town rises with variegated choruses of clapping praise. Women sell tortillas on folding tables at their doorsteps. Men in traditional, striped white knee pants carry machetes home from the fields or from fishing.
Up to 60 percent of the town’s residents don’t speak Spanish, but rather Tz’utujil, the Mayan dialect. So, though Dean, Branton Richter and Jordan Weenig speak Spanish, the help of local residents that Dean hoped to train as dental assistants was essential.
They came on Sunday afternoon, Aug. 18, while Mary White and Cimmy Starr oversaw creation of a temporary dental clinic on the hospital’s second floor. It’s happened more than a dozen times before, and so it happens with military precision. Over the years, Dean has brought more than $70,000 in dental equipment to the hospital, stored there for the semi-annual clinics.
While five dental stations were set up, Dolores Xicay Chojpen and Irma Xicay Chiuiliu made arrangements for the week’s work, which would begin at 8 a.m. the following day. Dickey said depending on the number of dentists and assistants coming, the hospital notifies area pastors of the clinic, posts fliers and sometimes advertises on the radio.
That’s how Wilmer Zimmerman with the Hands of Compassion orphanage in Tzanchaj heard about it, from a flier on a bulletin board. He brought Yuri Julajuj Cumes, 15, and Jeamy Armira, 14, and several other prospective patients.
Yuri was first. She lay on the red examination chair while Starr and her 18-year-old daughter, Ciara, laid a lead vest across Yuri’s chest in preparation for x-rays. She cringed through them, her dark hair spilling across her eyes where it wasn’t secured by three turquoise bobby pins. Jeamy crept into the large, open-air space to whisper to local dental assistant Concepcion Xicay Cali: Yuri was two months pregnant.
“Oh, boy,” Starr said. “Good thing we used the apron.”
And that’s how it goes every time, Dean said. The problem is the teeth, but the problem is also the poverty, and the socioeconomics, and the small-town traditionalism and the pregnant, 15-year-old orphan. These are situations that will not be solved by a weeklong dental clinic.
“It’s difficult here because we wait for there to be pain,” Dickey explained. “There’s not a real culture of prevention, so by the time it hurts there can be big problems. We see that a lot on the medical side, too. That’s why this hospital is so important, because to go an hour across the lake to Sololá, sometimes people in crisis don’t have that kind of time. And some of our patients have never left Santiago in their lives; they’d rather die in their homes than leave to go across the lake, or even to the next town, to the hospital.”
And it’s into that culture that dental teams arrive: “We can fix the teeth,” said Mary White, “but it’s impossible to ignore everything else. All we can do is focus on helping where we can.”
For Jose Maruin Yaxon Ajpot, age 6, with his six top front teeth rotted black at the gum line, that meant approaching the pale green dental chair like a boy heading to the guillotine. Jordan Weenig was waiting for him with a smile and a hand up, while his mother and little sister sat on a folding chair nearby.
Duane Weenig gently pulled out the bad baby teeth and Jose wept for most of the two hours it required, sometimes drifting into fitful, exhausted sleep. Finally, he sat up groggy and spent, swollen-eyed with a wad of cotton protruding like a bone from his mouth. Dean advised Jose’s mother, in her traditional, green Mayan skirt and embroidered top, to give him ice cream.
Concepcion quietly pulled Dean aside: “Ella no puede permitirse a comprar helado.” She can’t afford to buy ice cream.
There’s no reconciling that with the first world, with the comforts of America, with the easy ignorance of life here. Dickey said it’s vital for medical volunteers — the hospital hosts not just dental volunteers, but teams from all areas of medical care — to approach their work in Guatemala with an attitude of humility and equality. Theirs is not to be the Great White Hope proclaiming what people “need,” but rather fellow human beings with the fortunate circumstances of birth and opportunity to be able to help.
‘WE’RE ON THE FRONTIER
OF DELTAL CARE HERE’
For five days at the clinic, and in five chairs, and with five sets of equipment that only occasionally conked out, more than 55 patients received fillings and root canals and extractions, and often the pain they came in with went away. Fathers held small hands and mothers reassured children hovering nearby that they were fine, it’s OK to go play with the stuffed animals that the Starr family brought from Delta.
Andrea Sojuel brought several students from ADISA (adisagt.com), the nearby special-needs school she and her family started. Several would need the general anesthetic of an operating room, procedures that Dean and Branton Richter would perform and train local dentist Bianca Bonatto to do.
Juan Mendoza, 69, sat straight on a folding chair while his 23-year-old daughter, Sandy, who has Down syndrome, received some fillings. He talked about her with love: When she was a baby, two different medical teams from the United States told him and his wife, Concepcion, that Sandy wouldn’t live to age 3. Her heart beat too fast. Let her go.
“Y ahora, diecinueve años más!” he said, beaming. And now, 19 years more. Later, he would hover worriedly over Concepcion while Weenig removed one of her last six teeth, and then he himself would lie stoically through two extractions.
Bonatto, who works three days per week at Hospitalito Atitlán’s new dental clinic, sponsored by donors and grants, worked alongside Dean and the other dentists when she wasn’t in the operating room. The pace ebbed and flowed, calm to frantically busy, while the local dental assistants translated and handed out toothbrushes with a little speech about the necessity of brushing.
“And hopefully it’ll take,” Dean said. Starr had been brushing as part of her exam, and a lot of gums bled. “In a lot of ways, we’re on the frontier of dental care here. So, we do what we can,” he said.
‘LOVED NOT MAN, BUT LIFE’
Maybe it’s like Loren Eisley’s short story “The Star Thrower,” often co-opted by motivational speakers, about a narrator who sees a man throwing starfish stranded on the beach back into the ocean. Though at first it seems a pointless exercise against the reality of the situation and the inevitability of death, the narrator comes to this:
“I picked and flung another star. I could feel the movement in my body. It was like a sowing — the sowing of life on an infinitely gigantic scale. I looked back over my shoulder, and small and dark against the receding rainbow, the star thrower stooped and flung one more. I never looked back again. The task we assumed was too immense for gazing. I flung and flung again while all about us roared the insatiable waters of death, the burning sun, for it was men as well as starfish that we sought to save, a thrower who loved not man, but life.”
In Santiago Atitlán, like in most towns in the world, the tide of problems may threaten to drown the raft of solutions.
But one at a time, Dean said. One at a time. One tooth filled, one pain alleviated, and we do what we can.
We do what we can.