2018 KIDS Guatemala Dental Mission

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2018 KIDS Guatemala Team

This blog is an attempt to articulate some of the experiences that took place during the 2018 trip of 23 incredible Kids International Dental Services’ volunteers to the Mayan Highlands of Guatemala, where we educated, examined, treated almost 1600 children over 6 days.  What is so impressive is that each volunteer worked tirelessly sun-up to sun-down over the entire trip to provide dental services to the bright children of Guatemala, rewarded only with smiles and friendship.   It is true, you receive much more than you give, and the things we bring home are lessons learned in Guatemala — that it doesn’t take much to be happy, that people are pretty much the same everywhere, and that there is still a lot of unnecessary suffering in the world if you get out and look around.  And, that we can do a little something about it.

The anticipation and planning that go into planning a KIDS volunteer dental trip can be complex – and it often starts a year ahead of time.  There are so many variables that can come into play:  local festivals (we won’t schedule during the Mayan festival again as we got no sleep several years ago), volcanic eruptions (luckily the volcano Fuego was quiet after its deadly eruption the previous month), local politics, weather (torrential rains can wash out roads), so it’s a relief just to land in Guatemala and realize that everything is going to workout well.  Back on the busy streets of Guatemala always place me in a sense of a contentment, and as I gazed out the window of our van, and it felt like I’ve arrived back to a very familiar place and happy state of mind.  This is my 6th year back to Guatemala with KIDS, and I have developed a love for the country, culture and people here.  Photo Jul 28, 8 14 14 AM

Cobble-stone streets of Antigua

Our flight to Guatemala was easy – an overnight flight, and we woke up in a new country.  A handful of volunteers met in LA, and it was wonderful to see new and familiar faces. Upon landing,  we all met at San Jorge hotel in Antigua. Antigua was beautiful as always – and surprisingly, many tourists were there.  Orientation went well – we spent several hours getting to know each other going over basics for the trip.  We met up with our Guatemalan volunteer, Jairo, and we learned his wife Diana would be unable to join us on the trip. Jairo is an amazing person who I admire and is really working hard to change the world — he advocates for land reform for the people of Guatemala, often working against dangerous and corrupt government forces.  He has grown to be a good friend and has even visited me in my hometown of Napa.  His wife, Diana, is an award winning journalist, who is also working to expose government corruption, is an active feminist, and risks her life to tell the stories that often go left untold in Guatemala.  She recently did some work for the New York Times and Radio Europe.  I was also excited to have three mother daughter teams this year – which would prove to add a really fun dynamic to the week.

Our three 4th year dental students were Jessica, Jennifer, and Courtney.  Jessica, from Stony Brook dental school in NY, had already joined a KIDS mission in Cambodia, and plans to be a pediatric dentist.  She was a natural with children, and clearly loved the interaction with the young ones.  Jennifer, from Columbia dental school, is headed towards orthodontics, was continually positive and was skilled, and was always smiling ready to do whatever was asked of her.  Courtney, also from Columbia, is headed for 4 years in the Navy, and then orthodontics, and eagerly tackled any task given to her, from sterilization to post-op, to difficult extractions.  One of the greatest joys as a dentist of this trip is teaching what we’ve learned to the student dentists, and also in learning from them, and in absorbing their enthusiasm for learning all aspects of dentistry.   The student dentists add a youthful, optimistic and academic dynamic to our trip.

As mentioned, we were lucky to have three mother-daughter duos on this trip.  Purvi, a pediatric dentist from the San Francisco area, and her 15 year-old daughter Sanaa, were on their first dental mission trip together.  Purvi’s sense of humor and Sanaa’s attitude were infectious and at the end of the trip, on Instagram, Sanaa stated “this was the most wonderful experience of my life”.  That was incredible to read, and Sanaa is already signed up for next year, although Mom might have some other travel plans, so we’ll cross our fingers they return soon.    Michelle and Amanda were also on their first dental mission trip together, although Michelle has been on many trips to Cambodia.  This was Amanda’s first trip with KIDS.  Its so great to see the mother-child dynamic in action, and it brought back good memories of when my mom would do these mission trips with me (she’s joined me three times in Guatemala).  Michelle works as a dental assistant/office manager and more, from the NYC area, and Amanda was great at keeping it real, and their mother daughter banter was always entertaining.  Bozena and Hanna have been on multiple trips together, but this is their first time in the Mayan Highlands.  They come from the Chicago area where Bozena is a super dentist, and Hanna is a pre-dental college student in Florida.  Hanna was the serious student turned witty card shark once you got to know her.  Everyone commented on how much Hanna had grown since she was a shy 15 year-old volunteer to now, as a confident, funny and hardworking college student.

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KIDS mother-daughter team!

As for dentists, we have Kim, Roberto, Yung, Sean, Adena, Bozena, Purvi, and myself.   Berto, a pediatric dentist from Austin, is a staple on these trips.  His humor, insight, patience and friendship are valued by everyone.  Yung, also a pediatric dentist, also has a magic touch with any difficult children, and is a regular on our trips.  He has a very serious an intimidating side but is really gentle and thoughtful with children – he often sings to children while he delicately extracts their teeth.  He helps to lead inside the clinic and is always a tireless hardworker.  Adena, a pediatric dentist and mother of four children from Minnesota, is on her second tour.  At home she practices with her husband, an orthodontist, who we hope will join us on the trip one day.  She has been taking regular Spanish classes since last year, and her Spanish had progressed incredibly.  Sean, a periodontist and friend from Napa, has been on other mission trips with other groups to Haiti and Africa – he would serve as our group comedian as well as a great exodontist (aka tooth remover guy).  His fiancé, Sarah, would be joining us as well, and her tireless energy, smile, and enthusiasm would be put to good use. Kim is our rock star work-horse, who will tirelessly numb children all day, with seldom a peep heard from her or the child.  If you say something really inappropriate or shocking, you’ll get a good laugh out of her though.

Our other nondental volunteers included Sarah, Sean’s fiance, who has a background in teaching, marketing, and biology; Jeff, our career Army volunteer and the dog-lover of the trip; Sandra, our dental assistant from Dr. Kim’s office who quickly became the clinic manager — just do what she says and everything will go much more smoothly; Rajiv, an engineer from the Bay Area who stayed in Guatemala for an extra month to do homestays to learn more Spanish; Warren, our returning food scientist and almost fluent Spanish speaker (we don’t ask him to approve of our meals, and he seems to look the other way when things get a little sketchy); Abel, our leader and superhero — he does everything, all the time; Travis, a returning pre-dental college student, card shark, game host, Spanish speaker, and social chair.

Early Saturday morning we left for Nebaj…on the chicken bus, which are known locally as “Camionetas” (little buses).  These are usually old school buses from the US that are purchased at school district auctions, driven through Mexico, painted and “pimped out” with chrome and painting in Guatemala, blessed, and usually named for a sister or wife.  Our bus was named La Gabrielita, Lester’s sister.  The pride with which these are decorated and maintained are inspiring, and the buses are hardly recognizable as once being bland yellow school buses.  Senor Lestor and his ayudante (aka helper) showed up right on time, and we were off to the Mayan Highlands.   We took a chance on a little adventure and experienced the Mayan Temples at Iximche (“Corn Tree” literally).  The 4 large sets of temples here were astounding.  Each set of temples always has a duality – the sun and the moon temple, life and death, good and evil, wind, the skies, the earth, a ball court (with an 8 pound rubber ball), sacrificing stones (yes, we thought Trump might like one of these), intricate water passage ways and more.  The site is sacred to Mayans, who were actually having a religious ceremony during our visit.  Each structure had a special number of inside and outside corners (rincons and esquinas) as these numbers are important, and usually have a sum or a product of 20, which has special meaning to Mayans.  Our guide, Antonio, gave us many fascinating facts about the Mayans.  Their ingenuity, hard work, love of duality, humility tend to leave a profound impact.

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Admiring a temple at Iximche

Back on the bus – another 6 hours until Nebaj. The road is terrible, the government does not keep it up, and it gets worse every year.  It is difficult to tell what the government does here – everything seems to be getting more run down and corruption is increasing.  We arrived Saturday night in Nebaj, and reunited with Angelica at the Hotel Santa Maria.  We have stayed with her 5 years in a row now.  She is good and her team of sweet staff were happy to see us – and they made an amazing dinner.

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Abel loading up our trusty chicken bus, The “Gabrielita”  (100% Gabrielita!)

Up early for our first day of work – which was in the local Mayan co-op in Nebaj.  Catarina, who goes by “Cata”, is the Mayan leader who is the head of the co-op, and a strong advocate for the local Mayan people.  Through the co-op teaches people how to eat healthy, organic diets, and they also advocate for the poor in other areas, such as medical and dental care, political power, and education. She is very warm and strong, and leaves a lasting impression.  It was good to see her again – last year she had a few of us over for delicious dinner with her family.  Her daughter was running around today and she had grown so much since last year.  We started the day with a Mayan ceremony, to bless us, and to summon the dead to help us.  The sign of today on the Mayan calendar is death – they are not afraid of death and they seek power from their ancestors who have died.  They feel strongly that death is just the passing to another life.  They do not fear it.  Perhaps this is why they are so resilient and can endure pain and suffering.  Ana, a Mayan spiritual woman, lead the ceremony.  She has told us that during the ceremonies, they watch how the fire and smoke respond to each person – and hopefully the fire likes you.  Later she told us that the fire really liked Sean and we took that as a good sign. He’s our periodontist, and we need him strong for the week.  We wafted our own faces with smoke from burning branches, and it was a mystical experience in the forest near the site.  We also had our faces and bodies rubbed with leaves and branches.  With that behind us, there was a strong team vibe and we started the day.   For a first day of a trip, it was very impressive.  We worked from 8am to 6:30, and we were all worn out.    The children were very poor and often had dirt on their face and hands, had visible warts, lesions on their hands and faces, but were very handsome, proud, and photogenic.  They had a very high caries rate due to the gaseosas they drink (sodas) and the dulces they suck on.  The day was long and hot, and many parents were adamant that they wanted certain teeth extracted or that they didn’t want certain teeth extracted. It is hard to explain to them our concerns when they have their own strong convictions.  However, ultimately we respect the parents’ wishes, as building local trust is always first and foremost – we cannot take care of their children in the future if they do not trust us today. There were a lot of extractions (over 170 teeth extracted).  Our team worked so well together – you had to force people to take breaks.  The children were kind and well behaved, although the extractions in the quiet room were still sometimes necessary.  Abel had great ideas for the layout of the clinic, and things went as smooth as they could have.  There was a sad incident at the end of the day in which a 14 year-old girl named Catarina needed some permanent molars extracted due to pain, abscesses and decay.  After two of the extractions she lost consciousness briefly.  We tended to her, gave her fruit drinks, cold compress on forehead, and she gradually recovered. The fear, heat and dehydration from waiting in the sun, and lack of food today contributed to her condition.  The team left on the chicken bus but a few of the dentists stayed behind with the child until she felt better, at which point she took a local tuktuk home to some relatives with her father.  He told us they live over 3 hours away, and they walked here, and they are staying with relatives  They wouldn’t take our money for the tuk-tuk ride, and the appreciation he had for our care was touching.  As Yung said, “they only take what they need, and that is care”.  We sometimes forget about the person connected to the teeth—and this was a great reminder that in this type of setting, our clinic has many limitations, and ultimately we must realize we cannot treat every child and extract every problematic tooth.  What struck me today was the extreme poverty, the team work, the limits of our system (we ultimately provide only limited emergency dental care to these patients in less than ideal settings, with no xrays and handpieces or suction).  This is the reality.  There are many teeth we pulled that would have been savable back home with a root canal and crown, and many teeth we couldn’t treat due to other constraints. But hopefully we made a small difference in this community, and many children can eat, play, sleep, study, attend school and help their parents without being in discomfort.

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Abel receiving his Mayan blessing from the spiritual leader, Ana

Also there are noticeable political tensions here in Nebaj, and a local Mayan female leader was assassinated over the weekend when we arrived.  Jairo says it will not even make the news.  And there will likely never be justice for her.  The government here is very oppressive and has no problem killing rivals from other political parties, and it seems to be getting worse.  It does not give me hope for the future of the Mayan and Guatemalan people at this time.  And the vibe with Cata was a little bit more intense today, and Jairo feared that she too, may be at risk.

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Children hanging at the Nebaj Cooperative.  This place is an amazing community center for Mayans.
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Berto didn’t know he was going to be on babysitting duty, but he happy accepted the task
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Sean and Purvi doing their craft

Day 2, Monday, was a really fun day – the team got to work together in Xix (pronounced “Sheesh”), a mountain village at about 8000 feet elevation, and about an hour straight up a dirt road, where we pass many horses, men working with machetes, motor bikes, dogs, pigs, puppies and kittens, and vans packed liked sardine cans with cargo stacked high on the roof.  The director and the teachers here are very helpful, although the children tend to cry often during treatment—this usually varies village to village.  This is our fourth year at Xix, our second at their new school.  It has a view of a beautiful mountain range.  We reunited with our friend Pedro, who lost his parents and grandparents in the war, and lived for many years in the mountains.  He is always there to look out for us and to help his people, and shows up on his motor cycle with his leather jacket and pony tail whenever we work in this area.  He works mostly on his farm now growing vegetables and raising beef.  We treated about 100 kids this day and saw about 70 in the dental clinic.  It went very smooth, although for some reason not many children turned out.  We will probably skip this school next year and return in 2 years.  We are not sure why the children did not turn out as well as in years past – it often has to do with what the director tells the students and families –we need good promoting from the directors, and they need to tell all of the students that its mandatory. Often, the children only go if they have pain, and we miss many other kids who may have infections with no pain.

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Breaktime at Xix – everyone gets “atol” – a type of corn-based hot cereal
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Open big Sanaa! Now that’s a toothbrush
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Adena screening a nino
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local woman and her child enjoying the view and patiently waiting at Xix

We made the most of the short day, and decided to hike to a sacred hill, recommended by some locals.  The hike was supposed to take 20 minutes each way, but true to Guatemalan form, it took about 45 each way and was really muddy and steep through the jungle and cow pastures, but the view was amazing.  It was a rocky mountain peak, and we passed a Mayan cemetery on the way up.  It is said that you can hear horses running down the mountain, or you will hear strange calls from different animals – the place is very sacred and mystical.  We took some great pictures, had a few falls on the slippery muddy trail, and everyone seemed to love the team building experience.  Our guide for the hike was Gehovanny, who was from Xix, and whose family had lived there for many years.  He told us about the war in the 1980s, and how the guerillas fought hard here.   What is interesting in this area is that the Mayan language is Quiche, even though its in the Ixil region. Apparently when the villagers resettled after the war, they were distributed outside of their historical homelands, and as such, they don’t follow the language norms of the area.  It was another unforgettable cultural experience.  We wrapped the day up with another great dinner by Angelica, and sang happy birthday to Angelica and Purvi, who shared a birthday today.

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hiking up the mountain, hoping the cows and mud don’t take us down.
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photo-op!
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million dollar view

Up early on day three to head to the Ixil pueblo of Chajul.   It’s a 45 minute scenic bus ride, and I always enjoy the views of the greenery, mountains, pines, rivers, and people along the way.  Chajul is a mountain top pueblo, and the market is twice per week there, Tuesday and Friday. Today was market day, but luckily it did not interfere with our route.  We did see many trucks loaded with produce and other goods heading to the market.  Once in Chajul, we set up our clinic in the top story of the two story Chajul Central School.  It’s a large school, with two different sets of students – a morning class and an afternoon class. Today, we treated the morning class.  We arrived at 7am, and the Director was already waiting with keys.  He is the most organized and appreciative Director of any of our schools – his name is Jose.  We call him Jefe or Jose, and he helped us turn the top floor into a makeshift dental clinic.  The team set up quickly and we were screening our patients by 8am.  There are many parts to our system – first we have an education station, where we educate parents and children on what we will do, diet, brushing, sugar, and more.  Next, we do exams on every child, and then they go to the fluoride station where they each get a toothbrush and a fluoride treatment.  If they have no dental treatment needed, they are finished with the clinic — but if they need dental treatment, they go into the waiting room where we play games with them and keep them distracted.  Next we have our operatories, where the dental treatment occurs.  Here we use the desks from the teachers as dental beds (the kids lie down on these), and we either perform extractions or fillings.  We also have our sterilization team set up here to quickly turnover and clean all of the dental instruments. We usually have about 6-10 dental tables set up here, and things happen quickly there.  There is often crying, loud music to distract kids, and people singing or dancing – we have a good time in the clinic and everyone has fun and tries to distract the kids. For the children that are uncooperative and need extractions, we usually have a quiet room where the children can cry and not upset the other calm children – crying and screaming can spread like wildfire if you are not careful.  After their treatment in the dental clinic, they go to post-op where they are tended to by our volunteers until the bleeding has stopped and they are ready to return to their families.  I treated some very strong and dignified young children here – one standout was a 10 year old girl named Maria who was very brave, and her aunt Sonia was a teacher in the school and helped to calm her – I took a picture of the two of them afterwards.   The girl was so trusting, never shed a tear, and just looked into my eyes during the entire process.

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Sonia, and her brave niece, Maria

These children were mostly very brave, and we did see a lot of improvements in the state of their dental health over the last 4 years.  Here, our team of 23 people worked hard to treat 404 children overall, and 160 of those in our dental clinic for extractions or fillings.  One of our amazing volunteers named Jeff, who is in the Army, said that even after 8 years in the Army, he has never seen teamwork like he saw today.  That was moving, and we were all feeling the good vibe.  At the end of the day, Director Jose gathered us all for a thank you ceremony, and he said he thinks we were sent from god to care for his children at the school.  He stated that the government of Guatemala does not even provide these services and he feels very lucky that we return to the school year after year to tend to their future —  their children.  It was very touching and brought tears to the eyes—we don’t often receive appreciation for what we do, and it is nice to have such great cooperation and friendship with this amazing Mayan community.

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Schoolyard at Chajul
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Courtney assisting Purvi
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Hmm, so many choices!
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Courtney on her own
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Dr. Yung serenading his patient “hola amiga, como estas…”

After we finished at the clinic, a local foundation, the Ixil Foundation, which provides education and employment opportunities for Mayan women, gave us a tour of their center where Mayan women hand make beautiful weaved colorful wool tapestries with back strap looms.  We learned that a typical bag you may buy takes over 1-2 weeks of work, and some with intricate patterns take even more, often over a month    We were all impressed, and were touched they chose to give us a tour. I saw some familiar faces – Eloisa and Abraham, who have always helped us in years past.  Eloisa is a scholarship recipient and is the director of the Ixil Foundation now, and recently married, she is contemplating quitting the Foundation to raise children.  Many local men do not like their wives to work, and that is what the scholarship is trying to change.  Abraham is in law school in Santa Cruz del Quiche, and he also happens to be “Mr. Quiche”, and he is all over the social media scene.  He is also a strong advocate for his people and the Foundation.

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Local girl in Chajul
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Lesson in weaving
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streets of Chajul
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Ixil Foundation weaving

Chajul is one of the most Mayan pueblos I have seen – there are almost no ladinos (ladinos tend to have lighter skin color, are non-indigenous, and whose ancestors came from the Spanish Peninsula), and Mayans walk the cobble-stone streets in small groups, and there is only very light traffic here, mostly consisting of three wheeled tuk-tuks.  The local people seem more rural, more proud, and more resistant to outside influences.   I feel we are very lucky to work in this bustling pueblo as outsiders are uncommon – and perhaps that is why it has taken us several years to earn the trust of some of the schools in this area.  Upon returning home to the US, I came across an article in the LA Times about the Mayan people of this area, which helped explain the resilience and shyness of the people here — “Guatemalan troops, using aerial assaults and other scorched-earth tactics, razed as many as 90% of all Ixil villages and bombed fleeing civilians”.  The United Nations Commission on human rights found that the Guatemalan government committed acts of genocide here between 1981 and 1983.  Considering that the government was backed by the US, it is astounding that we are welcome back here at all.  And when the history of the Ixil area is considered along with the current corrupt and self-serving government, it becomes apparent why this area continues to exist without basic services, such as medical and dental care, running water, regular electricity, better roads, and sewer.

That night, we had a great dinner and debriefing in which we all discuss the good and bad of the day.  It’s a tradition at KIDS, and it is always touching to hear the stories of the day from the other volunteers.  It brings us all closer together and is like a big family dinner.  My notes from this night:  “I am very proud of this team – everyone seems to be learning their station very quickly, taking ownership, staying very alert – I only have to make eye contact with people and they know what to do!  Every person took their roles very seriously.  Great attitudes all around. The clinic flow was really quick, everyone had their head down and we established a really efficient system – 100 patients by noon!  The work we did was amazing – 404 children treated by 23 people in under 8 hours.  Wow.   We also saw lots of children that did not need any dental care – they already had some extractions and fillings from previous years and we didn’t see a lot of new decay.”

After dinner, I visited Jairo’s house nearby, and we went in a traditional Mayan sauna, in which a small brick room is heated with a fire, which then heats the water.  After sweating out the days work in the smoky sauna, you bathe yourself with the hot water from the fire.  It is very cleansing and relaxing, and there are herbs and candles in the sauna.  After the sauna, Jairo made some tea from fresh picked leaves of many types of trees and plants (including fig leaves and lemongrass), and local honey.  It was some of the best tea I’ve ever had, and was made simply by boiling water with fresh leaves.  I have a real appreciation for the Mayan knowledge and use of local medicinal plants.  This culture is incredible, and every day I learn more and more about it.   When we walked back to our hotel through the pouring rain, the power to the hotel had been restored, and several of the younger volunteers – Travis, Sana, and Hanna, were all up playing cards.   So, we played a couple of rounds of Asshole with them, and sure enough, first round I was the asshole!  But I came back the second round and went to bed.  Gotta quit while you’re ahead!  Tomorrow off to Chajul again.

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Chajul Day 2, post Volleyball with directors and teachers
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Card room antics

Day 4 had us working back in Chajul for the afternoon school – typically this group, which shares the same campus, has been much less cooperative and the director has had a really poor attitude towards us – but still worked with us.  This year, our fourth there, saw a radical change – the director and all of the teachers were really helpful and the director said very kind words at the end of the day.  This day, we saw almost 300 children, and about 160 of them received dental treatment. Our days are long – we are up at 5, on the bus around 6, at the school by 7, and working by 8.  We often don’t get home until 5 or 6 at night, at which point we stock up our supplies for the next day and do it all over again.  By day 4, our team was getting tired, although no-one showed it, except for Bozena who had taken a Benadryl, and slept part of the day away in a classroom.  We didn’t mind, as everyone needs a break now and then.  Again, we saw a dramatic improvement in the oral health of these children.  They did not have nearly as much the level of decay and pain as in previous years. This felt great, and also the improved relationship with the school and the community itself.

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Abel keeping them lined up
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Brush this way
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Bozena and our amazing interpreter, a nurse, looking at some teeth
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Adena and Bozena waiting for the next batch
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Jeff rocking sterilization
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Dientes limpias!
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Michelle and a happy customer
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Captain America (aka Berto) working his magic
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Thumbs up from Yung and his little buddy
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Sanaa ALWAYS smiles
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Yes, Berto plays trumpet too, and played happy birthday to Purvi

Chajul is my favorite community here – it is very traditional, on a mountain top, and has cobblestone streets, many small food stands, and overall is very sleepy but has people everywhere.  It serves as a center for the people in the surrounding mountains.   I had some great moments during the day, working on my Ixil (hahatse, hoopatse, and de donde chony (very bad span-ixil!) :  open big, close hard, and pain?) are the extent of my Ixil. Bozena, Adena and I were the exam team – and as the children would back up in waiting, we would then rotate back to the clinic.  As a tradition, we also played volleyball with the director and the teachers – they set the net up to play with us and were waiting for us.  That was a lot of fun, and I got spiked on twice by a short Mayan teacher.  They got a big kick out of that, as did my KIDS team.  If it hadn’t been for my knee injury…that would have been a different story!

Waking up early again for Day 5, this time 5:00 with a wonderful breakfast from Angelica’s staff of eggs, sausage, pancakes, sautéed plaintains, avena (oatmeal), and of course, coffee.  Everyone in this group is on time and professional – and not one person has missed a day of clinic due from food borne illness – perhaps it is because we only eat at the hotel now.  We have a very special group of people.  Today was a day I witnessed teamwork that I didn’t know was possible.  We spent the day at a new school – the Cotzal Central School – which was about a 45-minute drive from our hotel in Nebaj.  It’s a large school, and there were hundreds of women and children waiting for us when we walked in at 7:30!    We never know how new schools will react to us – sometimes they do not trust us, sometimes they do not cooperate with us, but this school was incredible.  Cooperative and trusting, and they had over 500 children that wanted to see us!  No dentists have been to this community, and we did not see one filling or sign of any previous treatment on these children.  Using a PA system, the director, Jairo, and Abel communicated with all of the people in the auditorium, and gave instructions, education, and some entertainment too.  We set up the clinics on the upper level of the school, and laid out the school quickly.  The teachers helped to track down all tables in the school and we used those for our clinics.  Today was very successful – 443 children were evaluated and given education, fluoride treatments, and toothbrushes. And 218 of these received extractions and fillings.  A huge day for our team!!  We could not have done it without the amazing nondental volunteers!  Abel and Jairo worked the crowd.  The people of Cotzal are traditionally more difficult according to local folklore.  If you ask them to move to the other side of the hallway, they move an inch!  Abel had prescreened the waiting children, and we quickly got some children with pain into education.  There, Warren and Rajiv practiced their Spanish reading them Dr. Roberto’s children’s book about proper oral hygiene and diet.  From there, they lined up for exams with Adena and Bozena, who would speak their best Ixil and find out if the children have oral pain, and if so, where, how much, for how long, etc. and do a quick exam. These exams can be tough, as some children say they have pain so that you will work on them, and some don’t’ tell you they have pain so you won’t work on them. And this is often done with a translator on top of this.  This makes exams very tricky and exhausting, and to give the dentists in the clinic clear information, you often have to become a bit of a detective, working with three languages. However, we often have a great interpreter who leans quickly and helps us figure out the history of each child’s pain.  Once children have a treatment plan, they would proceed to Michelle and Jeff in fluoride, where at one point, they fluoridated over 120 children at once – a new record!  From here, the children would go see Amanda and Sanaa in waiting, where they would play with and entertain the children.  The children then get selected to go to the dental clinic (ops) where they are numbed by Kim, the “number”.  She will anesthetize each child, and then the child waits on another table for their treatment, which is usually an extraction due to abscess, decay, or infection.  Many children get multiple extractions of both permanent and primary teeth.  The children today were incredible – they were trusting, brave, and happy children.  They rarely cried, and one young boy even went so far as to stand up and say “gracias” to me after I just took out his tooth!  We took a selfie together, he was a definite highlight for me.  I also had a translator helping me who would ask the children if they would ever again eat dulces, gaseosas, or bonbons again while I was taking out their tooth.  I must say it was a very effective approach, and the children swore they would never tough those evil foods again!  The synergy of the team was incredible today – we didn’t even use verbal communication often, we just knew what to do.  In Ops, we have sterilization set up, where Sarah and Hanna cleaned and scrubbed all of our instruments so quickly and turned them over to be used again.  They even did quality control on each others work – this is a thankless job, but they took it so seriously and it showed.  They would even say thank you and smile when you brought them dirty tray!  We usually have two Ops room – one is a “quiet” room for the screamers and criers. Often our pediatric dentists use these for the challenging kids.  Berto and Yung work magic in this room and can calm even the toughest customer. However, sometimes the children can’t be calmed but the tooth needs to come out anyway due to infection or pain, and when this happens, they manage the child and always find a way to get the tooth out.  In the main Ops room, Purvi, Sean, me, and our three students worked together to take out all of the teeth that Kim had numbed.  Sandra, a Spanish speaking dental assistant from Washington DC, never stopped bringing us children, calming children, taking us instruments, telling us where to go next, escorted children to post op, and was in 10 places at once.  I have never seen someone as efficient and fast as her.  Some extractions can be difficult, especially without xrays, suction, or assistants.  After the extractions, we lead the children to the post op area, which Courtney and Travis managed over 20 children at once!  Several patients did not stop bleeding and we had to delay our return to the hotel in order to put some sutures in the extraction sites.

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Bubbles never ceased to amaze
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Get it!
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Mother daughter dreamteam
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“Education is the best inheritance that parents can give to their children”
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Mas bubble

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Jeff became a fluoride specialist.  And Hanna thanks for letting me know its fluororo, not florido.

Some other favorite moments today were seeing the children smile after the tooth was taken out, or having Berto blow bubbles over the children, which immediately stops the crying and causes them to smile and catch bubbles. Berto is continually positive, smiling, helpful and kind.  He is an amazing individual.  He goes on at least 6 mission trips per year, and plans his life around volunteering.  He has a gift with children, and he says his goal is to  “change” them when he treats them – they always leave happy and seem to suddenly like the dentist, and he can get even the toughest adult tooth out.  All around star.  Everyone had a great day today and over dinner back at the hotel, we heard some really funny stories about everyone’s experiences.  No one had anything negative to say today.  Some highlights were when Sanaa told a story of how a local woman scolded her that she will never make a good wife because she does not speak correctly (Kim thought of this as a compliment – “ darn, no marriage for you Sanaa!”).  And also, Courtney profoundly quoted Charles Dickens summing up her gory post-op experience: “It was the best of times, and it was the worst of times”. The delicious tortilla soup was enjoyed by all – it was some of the best I have ever had.  Angelica is sweet and always goes out of her way to check on me and make sure we are happy.  Tomorrow is our last day, and we are off to a new school, Rio Azul, where we expect about 500 children.  I am so tired at this point, I cannot wait to be on the plane headed home, but at the same time, I realize why this is always the best week of my entire year – the richness of the experiences I have here are unlike anything else I have ever experienced – the friendships, the beauty of the Mayan culture, the high mountains of Guatemala, the unreal team work, the children, the dentistry, the escape from the worries of every-day life.

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Screening superstars Adena and Bozena, with a great translator
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This guy jumped up and said “gracias” with a mouthful of gauze.  Amazing child.
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They were lined clear around this pavilion at Cotzal

Day 6, last day!  Today, we are at Rio Azul, a new school for us on the main road heading from Nebaj to Chajul.  We have driven by this school for 5 years now and thought it would be a great school for us to visit – it is large enough where it could be a worthwhile place to treat many kids.  After showing up at this school at 7:30, we had the familiar feeling of being there before the director and the teachers.  The kids showed up with backpacks and we wondered if they were even expecting us.  However, the director and teachers starting to filter in and eventually we were let onto the school grounds and got to take a look around.  The school is fairly large with probably 20 classrooms – and after taking a look around, we decided to make the clinic in the lower part of the school to keep the other kids from hearing the cries and clinic excitement we often create.  This school was fairly dirty, with mud paths connecting sections of the school, although they did have a great set of bathrooms, freshly mopped by the children, just for us.  The children started mopping the entire school, and even helped us to move tables and chairs.  At one point, one table was carried across the school park by at least 8 children!  These kids have teamwork figured out, you can tell they are use to being put to work and know how to get things done.  While setting up, Travis and some other volunteers played soccer with the kids. This is always one of the most fun parts of our experience – the kids are great sportsmen, and they often tap the ball to you so you can score the goal.  I had a special moment waiting with these kids – while waiting for the clinic to start, I spent some time chatting with the kids – they wanted to know all about my magnification glasses (loupes), and wanted to tickle me too (I think Travis started this!).  The kids then run away and come back with little bags of frozen juice they called helado (ice cream).  It was not even 9am, and these kids were eating ice cream. One boy then gave me his bag of ice cream, and would not take it back!  These kids were so curious, mature and cool that I could not believe it.  We posed for a picture, and the little girls even put their arms around me, and had no fear of me at all, only showing kindness.  I was very touched.

As soon as the majority of kids started to arrive this morning, we quickly realized it would be a quieter day than expected—less then 200 children were at the school.  The director and Abel organized the children, and we started exams and education.  We ended up seeing about 150 kids in all, and about 80 received either fillings extractions.  We were perplexed as to why these kids were not showing up as we expected, and after some questioning, we found out a dental volunteer group had just visited this school last week!  We saw some children with stainless steel crowns and other small fillings. We were happy to see these kids were pretty much taken care of, and decided that next year we would try to visit schools further off of the beaten path that need our services more than places like Rio Azul. Nevertheless, it was a great day, and a nice way to end our trip – as we all were happy to finish early and head back to the hotel by 2.  Many people went out to the street market in Nebaj today, but I took a nap.  So tired, but it also gave us time pack for the bus ride home tomorrow, organize our dental supplies – we take some home for other trips and leave some supplies at hotels in Guatemala.  I was just relieved that we had 6 productive days, everyone seemed to have a great experience, and no one was hurt, injured, abandoned, and all seemed to be embracing the experience!

Tonight we all headed to a celebratory feast at Acul, where the Mil Amores ranch hosted us for our final meal together.  This ranch makes famous goat and cow cheese in a lush serene valley surrounded by rugged, green peaks.  The feel is almost like something in the swiss alps, and the old ranch home has classic white adobe with wood trim and tile floors.  There are great, hairy dogs, thousands of plants, which they even sell, and several little cottages available for stays.  Its about an hour bus ride (which included singing to many songs from the back of the bus), and it also has a hiking trail that takes full day hike to get here from Nebaj.  This ranch was burned down and destroyed in the war in the 80’s, and then rebuilt completely in the early 90’s.  It has a special feeling around it.  Everyone on our team enjoyed taking some great photos together – silly and serious, and some wine may have even been drunk.

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Just a couple of locals
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Amazing setting at Mil Amores
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Jeff making a new friend
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The serene valley of Acul
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Deliciosa!
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The most photogenic couple ever
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Good friends Abel and Michelle

During our final evening debriefing, tears were shed as everyone told the group about their experience.  It is the most touching part of the trip for me – hearing the different perspectives and journeys that people have had this week.  It is truly a transformative experience, and deep bonds are formed.  As Gandi had said, “the best way to find yourself is to lose yourself in the service of others”.  People found themselves this week —  I know I did.  It happens every year in a different way.  There is a deep satisfaction to doing what we did – bonding as a team, immersing ourselves in another culture, sharing a singular mission to help children, and spending morning noon and night together.  It’s a high that takes a little while to come down from, and this evening is the epitome of our experience together.  I wish I had a recording of the talks that were given, as my memory tends to blur them all together.   But they were good!  After a delicious dinner of truly locally produced everything – cheese, meat, corn, milk, dessert, coffee and more, we all went back home, tired and sleepy and happy.

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Our new family in front of our favorite chicken bus

Only 7 days ago, we were mostly strangers, and have now become good friends.  The friendships that form on these trips are difficult to explain to people back home.  Perhaps its because everyone is here sacrificing something for others.  Or perhaps its because you see the best and worst of each other, and experience a true adventure together.  These are great human beings.  As Deon Leonard, an ultramarathon runner said about his races “one of the things I love most about these races is that as you push yourself to the absolute limits of physical endurance, you make some of the deepest friendships of your life”.  We may not have been running an ultramarathon, but we were pushing ourselves physically and emotionally to our limits, and formed some lifelong bonds in the process.

Up early for breakfast and then on the bus by 6am, we were heading back to Antigua!  Most people passed out, played games, talked, listened to music, sung music loudly, and shared food.  We stopped for a few bathroom breaks, including one restaurant where they make us coffee and sell local salt and homemade clothes.  We saw an armadillo here several years ago, and the same lady always comes out of the kitchen to greet us when our busload of 23 people pulls up to her empty kitchen at 7am.  They disappear and then reappear with 15 watery coffees, but we don’t complain, at least its hot and caffeinated. They still taste good somehow.

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The poker room in the back of La Gabrielita (Is Jeff looking at Travis’ cards?!- busted!)

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The ride back takes between 7-8 hours on a bumpy chicken bus on rough roads, with speedbumps ever km it feels, and because today was Saturday, there were some more markets to navigate around.  Once back in Antigua, everyone roamed the town.  With beautiful cobblestone streets, 500 year-old stone buildings surrounded by volcanoes, any direction you go is enchanting in Antigua.  Today we were cooled by drenching downpours and warmed by bright sunbreaks.  Some people went to a farm, some went for coffee, but we all met for dinner at Frida’s, a great cantina in Antigua.  Hugs were shared and goodbyes were said, and future plans were made.  Although exhausted, its exhilarating to share this journey together, and I truly hope that each person on this mission makes it back for another round in the Mayan Highlands.   I always learn and grow in ways I didn’t expect in these missions, and this trip was no different. There were times where I just laid down in bed and had tears in my eyes at the end of the evening – often from the exhaustion and overwhelming emotion that I bottled up throughout the day – children suffering yet so strong, guilt, poverty, basic medical and dental needs being unmet, as well as the joy of being able to do a little something about it in the company of these wonderful human beings.

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The following were incredible essays from the three student dentists:

Courtney:

On the first day of the KIDS International mission to Nebaj, Guatemala, 23 dentists, students and non-dental volunteers arrived to a community center in a flamboyantly refurbished school bus. It was my first mission experience and I was nervous for what the day would bring. After unpacking the supplies from the bus that allowed us to transform a school or community center into a temporary clinic,  I was able to absorb my surroundings: many children patiently waiting for care along with their parents, all of whom are dressed in traditional Mayan garb. Although we do not speak a common language, eye contact and smiles provided the only communication that was necessary at the time. Before proceeding with patient care, the spiritual leader of the Mayan community blessed the group in ceremony, ensuring our energy was aligned with the Earth and that may we have a smooth and productive day. In six days with five different locations, we were able to accomplish more than I ever expected, seeing hundreds of patients a day and all the while exploring a foreign culture and making new friends.

With each day, I felt my that my operative and patient management skills continued to improve. During the first couple of days of the trip, student dentists like myself were paired with an experienced dentist in order to learn the flow of the clinical operation, assist and eventually perform selected procedures. By the third day, we were able to treat our own patients with supervision. The encouragement, guidance and patience of the dentists created an environment for the students to truly flourish and become more confident as providers. I was able to extract countless primary and some adult teeth and even performed restorative treatments, too. Not only did my technical skills progress, but while treating patients ranging from 5-20 years old, I was able to improve my pediatric patient management skills. After watching the dentists coax nervous children into a calm state, I learned a few tips and tricks that I can apply in the future such as voice control, non-verbal communication, singing and utilizing props. Needless to say, I am eager for my next pediatric rotation back at dental school.

The team worked tirelessly, starting with a 5:30 a.m. breakfast call to allow time for travel and set-up before the children arrived to the school. One of my favorite parts of the day was the morning bus ride to the school. Looking out the window, we were immersed in what could have been another world. Nebaj was largely un-penetrated by Western influence and its traditional charm was like nothing I have ever seen. After the nightly rainfall, mornings were cool and crisp, perfect condition for the fresh start of a productive day.  Driving by the lush landscape of the mountains with free range farm animals, I would look out the window and share smiles with the local people beginning their days work. This provided me with enough joy and gratitude to stay present and motivated throughout day.

All in all, the children of these Mayan communities do not have access to dental care or knowledge of oral hygiene and yet are exposed to processed foods. The need for care in this region was profound and I am proud to have been part of an organization that could mobilize and coordinate the man-power and supplies that made a significant difference in the region. Not only did we treat emergency conditions, but we instilled the value of oral hygiene and continuity of care through education and fluoride treatment to have a sustaining influence. During the process of treating these children, I was able to advance my ability as a dental provider, experience a new culture and lifestyle and make life-long friends. I can say, without hesitation, that I will definitely incorporate KIDS mission trips into my life in the future.”

Jennifer:

I just returned from an amazing week serving with KIDS in Guatemala, providing much needed dental care to children in the Mayan highlands. After a winding, 8 hour ride up into the mountains to our base in Nebaj, Guatemala, our team of 23 volunteers was excited to see the hundreds of smiling faces and to get to work. For 6 days, we rose early to travel to different schools in the area. Each day, we set up stations for education, fluoride treatments, examinations, the operatories, and post-op. Our team worked extremely well together and everyone pitched in to organize, set up supplies, and round up as many suitable tables as we could find, with the help of our host school staff and students.

 

On our first day, we were welcomed with a traditional Mayan blessing. It was such an intimate and unique experience and a great way to begin our week. We all found our rhythm working that first day, finding the best ways to keep the flow of patients running smoothly and helping each other out. Each successive day got busier and even smoother as our awesome team became a well-oiled machine, in tune with one another and in awe of and valuing everyone’s dedication and contributions.

 

As a dental student, I had the privilege of working alongside a group of very encouraging and caring dentists. Each one served as a mentor, assisting and giving tips and advice the whole way through. I learned a tremendous amount from them, not only of anesthesia, extraction techniques and patient management, but of the good in their hearts and the value of serving those in need. Treating these children was extremely rewarding, and though it was difficult at times to see them scared and crying, we reminded each other at the end of the day that it was for an important purpose, benefitting the children’s health and getting them out of pain.

 

The week was successful–we treated and educated hundreds of children–but this was not because of any extraordinary skill. It was because of our team, who worked together so wonderfully, everyone giving their all without expecting anything back. No one felt like they were better than any other and we got along so well that by the end of the first day we were like a family. And we didn’t do it alone either: we had an amazing driver and his assistant, who spent the week with us, getting us safely to each destination. We had great school administrations, who trusted us in their communities. And we had the sweetest, bravest children to treat, who laughed, hugged, and high-fived us, even after going through a rough day in the clinic. This trip will remain one of the best, most rewarding, and most memorable experiences of my professional education, and I am so grateful to have been allowed to be a part of it.

Jessica:

Guatemala is country of magnificent colors, breathe-taking volcano landscapes, unlimited streaming fresh tortillas, and pint sized children with the most genuine of sonrisa brilliantes. This past July, I ventured to Guatemala on my second KIDS trip as a rising 4th year dental student. As always, the experience was exhausting and challenging but, also so humbling and rewarding.

The team met in charming Antigua and had the most delicious Mexican food at Frieda’s for dinner. The next morning, we bussed for eight hours on a neon flame decorated “chicken bus” to Mayan ruins before reaching our base in Nebaj. Every morning, we woke to fresh coffee and traditional Guatemalan breakfast before journeying on narrow Guatemalan back roads to that day’s clinic site. We were met by lines of mothers, swarms of children, and once by a marching band. The communities of Nebaj, Cojul, and Cotzal were excited to see us and we were equally as excited to see them.

Weekly totals tallied 1579 patients, 454 varnish, 97 ARTs, and 1089 extractions. As a dental student who sees 4 patients on a good day, these numbers are unfathomable but, a testament to the dedication and hardwork of this team. Throughout the six clinic days, the flow was often non-stop and I know everyone worked tirelessly to see as many patients as possible. On our busiest day, however, we were unable to see all the children. And of all the good we did, I think about the child who stopped me on the way to the bathroom to beg to have his tooth extracted, and me having to turn him away.

Our work in Guatemala is not done however, I can see the progress and gradual acceptance of oral care in the community. The work that KIDS does has laid the groundwork for future growth in these communities, and is both necessary and important. I foresee myself returning soon.

 

 

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Guatemala with KIDS, 2016

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This is an attempt to put in writing the amazing experience I had volunteering with KIDS (Kids International Dental Services) in Nebaj, Guatemala this year.  This is my fourth year going to Guatemala with KIDS, and there was so much that was experienced this week, I thought it only appropriate to write it down, record it all.  So, here it is.

Our week started in Antigua with a bit of the usual chaos – delayed flights, cancelled flights, and last minute changes for some of the 23 volunteers.  Of the group, only Abel, me, Kim, Wani, Briana, and my mother Sheila have done previous KIDS trips.  This was my fourth year with KIDS in Guatemala, and I must say I was anxious to make sure the entire trip worked was successful for everyone involved–volunteers as well as children and their communities,  and especially because the KIDS founders, Dr. Bob and Purobi, had trusted us with the KIDS mission, and this was their first trip in which they did not come.  Abel and I have spoken weekly for months now, and there were many emails, phone calls and planning sessions made for this one week.  I was really excited at the prospect of this week – we had lots of local help this year, with our local friends Pedro and Jairo contacting the school directors for us and helping to create a great supporting team in communities around Nebaj, which we were hoping would result in a great turnout of children.  We would not be disappointed.  We definitely felt challenged with the task of assembling a great team this year – the scare from Zika was everywhere, and some soon to be parents elected not to attend.  However, there are no mosquitoes known to be where we go in Nebaj nor has there been any reports of zika– its above 7000 feet elevation in the mountains of Guatemala and mosquito-free.

There were some challenges in Antigua.  First, a friend and patient of mine, Cathy, had made plans to volunteer with us, along with her daughter Emma, who is 15 years old.  She had also made plans to volunteer the next consecutive week with her church, in an area outside of Guatemala City.    Cathy’s story is very moving.  In the last few months, she was diagnosed with breast cancer, and by the first week of August, she would be through 2 of her 3 surgeries and would also be in the midst of a difficult chemotherapy regimen.  She informed me about a month before the trip of her condition, and then quickly told me that there was NO WAY she was missing this opportunity, as it was on her bucket list, and she was putting off her last surgery so that she could come on the trip with her daughter.  She was adamant that everyone know about her condition in order to raise awareness of breast cancer, so that other women would know to get regular mammograms.  She impressed me very much with her perseverance and strength.  While I was in in Antigua, Cathy sent me an urgent message, stating that she would not be able to make the first part of our week as she was stuck in Dallas with flight delays, which meant she wouldn’t be able to work with us.  While disappointing, this situation seemed like a gift to Cathy and her daughter, as they got to spend a week in the Caribbean together.

Friday night we were visited by an earthquake, which our Guatemalan dentist, Julio, loved.  He said it felt like he was being welcomed home.  “Its so cool, did you feel that” was his text.  His enthusiasm for everything would not subside throughout the entire week.  Some of us were also lucky to witness a volcanic eruption, as well as another small trembler the next morning.  No one is ever bored in Antigua, with the many church ruins and picturesque views of volcanoes, and our time here always seems to be a great time for some fun, adventure and bonding with new teammates.  This year we found the best restaurant yet—a local place full of local food, thanks to Julio who was seeking out some stews like his mother used to make.

Once all 23 volunteers met during our orientation meeting, the enthusiasm in the air was palpable.  We had our three Columbia student dentists – Jodi, John, and Andrea;  our two pediatric dentists – Julio, a native Guatemalan who was returning after a 19 year stretch without visiting the country of his birth; and Roberto from Laredo, Texas;  Kim from outside of DC, whom Purobi labled a “superdentist” who changed weeks to join our team, Briana, a dentist currently living in Florida, who had joined KIDS as a student dentist; Sima, an enthusiastic first-time volunteer who practices in LA; Nancy, a pediatric dental resident at UC San Francisco; Charles, a prosthodontic resident at the VA system in LA; and Adam, a dental school classmate of mine who practices in Tennessee, and of course, me, a dentist who practices in Napa, California.

For the volunteers with a non-dental history (aka the nondentals), we had our amazing leader, Abel, who manages to run clinic after clinic in new settings that never cease to be run efficiently and smoothly; Adam’s wife Stephanie, a school teacher; Wani, a retired Optometrist from LA who usually does 2 trips with KIDS per year; Abel’s 20 year old nephew Efren; my mother, Sheila, who was on her third trip with KIDS to Guatemala; her good friend Marcy, a yoga teacher and retired educator from Napa and her son, Steve, a project manager with a large construction company;  Warren, a food scientist in Napa; Natalie, a nutritionist who works with Kim and whose Grandmother was born in Guatemala – this was a very important trip for Natalie, and; Margaret, a newly retired nurse, and her husband Issa, who live in Napa as well.

Sunday morning, our trusty chicken bus driver, Senor Lestor, and his assistant Jose Luis, showed up a just a touch late, as they were hassled by the cops in Antigua for driving a chicken bus in the city limits, and after loading the bags Guatemala-style on the roof, we were off!  The drive to Nebaj, in the Mayan Highlands, is about 7-8 hours by bus, depending on the the numerous markets, parades, marathons or road closures we may face.  It’s always an adventure, and this year we learned Senor Lestor took his newest bus (he owns and operates 5) and that this bus is a bit smaller than the ones we took in years past – that proved to be a wise move as we navigated tight turns much easier this year.    The drive to Nebaj is beautiful, and the mountains become steeper as we get closer to our destination.  Along the way, we get to see Lake Atitlan, which reminds me of years past when we would work based in the lakeside community of Panajachel.     There were many sleepy faces and bobbing heads on our bouncy journey, as well as interesting conversations about everything under the sun.  Road trips will do that to a group of people.

This is the third year our group returned to Nebaj, in the Ixil area of the Mayan Highlands.  The area is comprised of many mountainside pueblos, in which the community primarily raises corn and other limited agriculture for subsistence living.  A certain smoke hangs over every pueblo from the wood fires in every kitchen.  This area experienced some of the worst atrocities by the dictatorships of years past, and the people that live in this area are notoriously private.  We have learned about the war on the peasants and the Mayans by the government, and of the tenacious resistance by the Mayans.  The guerilla fighters would live in the forests, untouchable high above the pueblos, and the armies then decided to “take the water from the fish”.  Meaning, if the guerilla fighters couldn’t be beat, then the communities and families that supported them could be crushed.  Hence, the genocides and the atrocities that took place.  This area is still very poor, has no land rights, and is still subject to the whims of the ever changing and corrupt government.  This history is important to remember while working in this area—it helps explain the shyness, the durability, and the skepticism of these wonderful people.

We arrived in Nebaj and for those that know Senora Angelica, we were very happy to see her alive and well and waving to us in the front of her hotel, the Hotel Santa Maria.  The homey comforts of her place are something I look forward to.  Her wonderful breakfasts and her motherly touch are always welcome.  I was really hoping that this year my water heater unit would work and I could have hot showers, and maybe not even get an electric shock as in years past.  Got lucky—hot showers all week with no electricutions. In Nebaj, we settled in, went out for dinner at local backpackers bar, El Descanso, for some quesadillas and fajitas, but for me, mostly for the homemade corn tortillas.  Mmmm.  And a Gallo beer helps wash it down too.

Monday morning, we were up early, fueled by a wonderful “typico” breakfast consisting of scrambled eggs, salsa, tortillas, plantains, black beans, bread and more, made by Senora Angelica and her bustling staff, and we were off to Xolcuay in the community of Cotzal, about an hour drive from Nebaj.  We have been here for the two previous years and have had increasingly good support from the director and the maestros/teachers.    This school has a large “salon” or great room, that was wonderful for setting up the exams, education, and waiting areas.  Being that this was our first day, the easy communication between volunteers was appreciated.  We spent extra time going through the clinic flow with all volunteers, and after a formal meeting with all of the maestros, we began to operate.  Our team quickly came to life and it was great to see everyone working so well together.  Our week was finally underwayand overall it was a very smooth first day.  One memory that stood out was meeting a wonderful teacher named Celestina, who asked me to treat her two daughters.  Celestina, like the other teachers this day, were very helpful all day long.  It was a noticeable shift from years past, in which the director and the teachers seemed unprepared for us and were less than eager to open doors, move desks, and interpret.  We will come back here for at least another year.   After our bus ride home, we were ready for a dinner and an early night’s bedtime.  Upon arriving at the hotel, we had our traditional debriefing, where we each share our experience of the day, and offer any suggestions for improving our systems.  This is one of the greatest teambuilding moments—it brings everyone together and you learn what the day was like from other people and perspectives, and takes on the feel of a family meeting.  The Mayan dialect spoken at this village was Quiche, and some words that you heard very much of were “zapi achi” for open wide and “todo achi” for close!  These children were very respectful and obedient, and they do whatever their teachers tell them to.   The children learn to speak Spanish in grade school, and their first language is their Mayan dialect, so speaking in that language seems to be the most effective.

Day two had us at Xix, pronounced “sheesh”, where we had gone for the first time last year.  This school was way out of the way, about 30 minutes up a dirt road, through mountain tops and jungle, and dropping down into a small valley, you find several buildings, one of which is the school.  This school seems the poorest of the schools we go to, with trash on the school grounds, many children and parents barefoot, and generally children that seem unbathed and very wild.  The mothers and the children were less cooperative with our requests, and we had a challenging day with with crowd control.   It was overall one of the roughest days for the team since it was very tiring to work in an environment like this.  We had a similar experience here last year, but we did have one of many heartwarming stories.  One of our local interpreters who has helped us in years past went to this school as a child, and last year he returned from his medical training in Cuba and was now a physician.  He was very proud, and this school will always be known to the KIDS group as “Diego’s School”.  I couldn’t help but think about him while I was working with the children on this day.  The number of children is not huge at this school, primarily due to its remote location, but many of these children were uncooperative and difficult to treat.  We quickly realized that every child in the clinic was going to cry once they were in the dental clinic, and we tried to slow down and maintain a calm environment, albeit in vain.    All day, there were curious children peeking in the back windows of the classrooms, and after a while, everyone just ignored them.  Usually we don’t like the children to see what goes on – the crying and instruments may scare them, but there was nothing we could do to keep these curious children away.  The stations seemed to be working better today, and Wani ran a tight ship in the sterilization room.  We were happy to have power on this day to place some glass ionomer fillings. We finished early today, and wanted to reward the team with a visit to the famed Hacienda Mil Amores and its famous cheese.  We were not disappointed and had a wonderful dinner at a great, long table that was outside—the picturesque view of this lush valley was amazing, even in the rain.  The cheese and “quesadillas” did not disappoint—although the meals were much more than quesadillas, its just how Abel described them to us gringos.  This lush green valley and steep green mountains on either side felt as if were in in the alps.  Apparently an Italian family settled here nearly 100 years ago, and this place seemed unchanged throughout the wars and strife that plagued other parts of Guatemala.

Wednesday morning we were off to Juil, the longest drive of the week – about 1 ½ hours from Nebaj, where we had been for the previous two years.  We were happy to see that there was a major addition going on in this school.  The director proudly reported that they were building a salon and several more classrooms.  The construction crew worked alongside us all day.  This school is known to us as the “green school” or the school where the child ran out of the clinic and Abel went into the community to bring him back to complete his treatment.  Can’t let word get out that you can run away from the KIDS team!  Of course, this team has the utmost respect for the children, and day after day I was blown away at the care and respect that was held for the beautiful Mayan children.  We had a great day here, with the team working so well together that I felt we have worked together for a very long time.   The walkie-talkies that Abel brought were a lifesaver and welcome addition to our system.  Our communication between buildings was now effortless, and the regular chaos was minimized due to this.  Wednesday evening we had a delicious dinner at Senor Angelica’s kitchen, where we then ate the next three nights since it was so good.  A home cooked meal.  As with the day before, some of our team members stayed behind due to the usual causes – traveler’s diarrhea.

Thursday and Friday we planned to be at the main school in the city of Chajul.  Chajul is one of the bustling Mayan city centers in the Ixil region.  There is a two story school in the center of town, and thanks to Purobi and Abel, who followed up on a hunch during our first year that this would be a good place to treat children, we are now here for our second year.  Last year we spent one day here, saw over 600 children, which wasn’t even half of the total children at this school.  This year we decided to spend two days here – and what long days they were.  This school is near a cooperative where the women of the Ixil Foundation sell their woven goods.   The Ixil Foundation has a fascinating story:   Funded by the coffee buyers in this area, the Foundation supports women and children and their communities with many different programs, including scholarships for young women (the recipients work with us yearly), services for women who have suffered from spousal abuse, and it also works with many of the local schools to support the children.  The Foundation and its previous executive director, Jairo, were our initial contact in this area.  Jairo has since moved on to another organization and he was dearly missed this year, however, we were all amazed by the new, and very young executive director, Eloisa, who worked with us over the course of the week.  The Foundation suffered greatly when the big coffee buyers, such as Green Mountain Coffee, started buying their coffee elsewhere due to the coffee rust disease that hit Guatemala, and in turn took their financial support with them.  Being that these farmers were organically growing coffee, the disease meant they needed to replant their crops, which would then be ready to harvest in 5 years when the plants reach maturity.  This is one of the many hardships this region has dealt with, and the Ixil Foundation is struggling due to a lack of funding at the moment.

Working in Chajul was the highlight of the trip for me.  Our team was firing on all cylinders, and the synergy and energy of the team was at a high.  Each day, we examined, educated, and fluoridated between 450-600 children, and our clinic treated about 230 children each day, in which children received fillings or extractions.   Our days were long – we started the clinics by about 8:30 and worked until almost 6pm both days.  Our team never once quit or expressed a desire to “call it a day”.  We tried our best to get to every child, and we didn’t turn away anyone, except for some older community members who had heard about the dentists at the school. We politely told them we are only “allowed” to treat children, and they begrudgingly accepted this explanation, although they wanted to know why only children received free dental care.  It did make me realize that there is no dental care whatsoever in this community, and it is something that is badly needed.  Many of the children examined had great teeth – these children seemed to come from isolated and rural communities away from the city center.   The closer to the city center or a tienda, the more “gasiosas” or sweets they would eat.  Many children only had decay on their lower teeth, and came into education with hard candies in their mouth — hence only decay on their lower teeth.   Some people asked me whether the education we provide makes a difference.  I do not know, but I do know the dental care made a clear difference – doing exams and seeing children with healthy mouths now, who had dental treatment the last year or two, was very gratifying.  No pain, no abscesses or problems for these children.  Other children had extensive decay in their mouths, and the limits of our KIDS system was evident:  we can’t treat every child, and we can’t do many types of fillings that we can do here in the US.  But, we do what we can, and it was quite a bit.

The last two days were very moving.  We had strong support from Pedro from the Ixil Foundation, and many teachers as well.  Pedro is one of the favorites of the group – he is a quiet, kind person always willing to share a smile or a greeting.  He shared his story with us last year – he lost his family in the war, including his parents and grandparents.  He was raised in the mountains, away from his pueblo, and he seems to have a heavy, but very kind heart to this day.  At the end of the last day, all of the KIDS volunteers gathered with the Ixil Foundation leaders and the Chajul school leaders.  Pedro spoke for them, and thanked us for the dental care we provided for their children.  They also thanked us for the way in which the children were so delicately and lovingly treated, as they had witnessed countless interactions of our volunteers with the children.    We thanked them for trusting us with their children and for sharing their culture and community with us.  It is indeed a beautiful culture, and I hope they can preserve in the future.  Many, many warm hugs and photos were taken after this ceremony, and I know we will have great support and friendships waiting for us when we return next year.   The Mayan Dialect spoken here is Ixil, and the most common words heard all day were “ha ha tse” for open wide and “hoopa tse” for close.  Their language is spoken very emphatically and is unlike any other I’ve ever heard.

A few stories really stand out and capture the spirit of our time in the Mayan Highlands.  One story involves Dr. Roberto, aka Berto, a pediatric dentist who would go the extra mile for each child, time and time again.  He wore his heart on his sleeve, and there were moments where you could see the sadness or the joy on his face.  Also, many children were crying or being difficult and uncooperative, and we decided as a group that we would not be able to treat children if they would not cooperate.  We wanted to set a precedent that their cooperation was needed.  Also, there were so many other children that needed treatment that we didn’t have the time to physically restrain any children, or spend the extra 5-10 minutes talking each child into treatment.  On the last day, Berto had one such girl, who must have been 7 years old.  I remember doing the exam, and seeing extensive decay and abscesses in almost every corner of her mouth.  She was clearly frightened, and it was shocking to see what was going on in her mouth.  She had said that she didn’t have pain, but I wonder if she even knew what pain was since she had lived with it for so long.  She was taken to Roberto, who showed a knack for successfully treating children who were fearful, and she kept saying “no quiero, no quiero”.  Roberto, who was dog tired at this point, decided he could not treat this girl if she would not cooperate.  I saw him immediately afterward, and asked how everything went.  The look on his face said it all.  He couldn’t treat her.  We were both very disappointed, and I thought about the long year ahead for this young lady.  An hour or two later, as we were getting ready to close the clinic, the little girl was brought back by her mother, who asked if we could treat her still.  The little girl looked much braver this time, and her older brother even stepped out of the waiting area to assist us in treating her.  Along with Charles and a couple of translators, Berto was able to do all of the treatment he needed to do on her.  Not only that, she gave him a big hug outside. The joy and relief on his face was amazing to see, and this seemed to summarize how we all felt about this trip.  As a sidenote, the clinic was almost closed, but Adam was adamant that we treat her brother, who was such a good dental assistant, and who also had profound pain in two areas.  He had 3 permanent molars extracted, and he would now be pain and infection free.    We ended the trip on a high, but there were many children we could not treat, and there were many stories like this one each day.

Back at the Hotel Santa Maria at our family dinner, we had our final debriefing.  Some tears were shared, many thanks were given to each other, and we all learned a little more about each other by sharing so much.   We were all going to miss each other, and I know many lifelong friendships were made.  This group was so positive, creative, helpful, intelligent, hard-working, kind, and fun, that I wouldn’t have believed it if I hadn’t lived it!  A few words on the great characters who joined us this year:  First, the three dental students.  Wow, how they grew during the week.  Jodi was our loud, jubilant New Yorker who was deathly afraid of heights, so anytime the bus was near a cliff, we all made sure we asked Jodi how she was doing.  She only jumped out of the bus once when she thought it was driving off the cliff.  It was really just making a regular turn in a the village.  She’s a future oral surgeon, and loves to have fun in clinic.  Her daily dance warmups in the clinic were a hit, and you could always hear her laugh during the workdays.  John, the second dental student, was a bit more on the quiet, serious side. He was always willing to help out, would literally run when asked to do something, and was the most efficient dental student I’ve ever seen in the clinic.  Some oral surgery program will be lucky to have this guy next year.  Andrea, the third student, a future pediatric dentist, always had a huge smile on her face and learned so much this week.  She was a joy to have on our team, and her care and skill with each child was notable, and her confidence grew tremendously throughout the week.  Having dental students along these trips is one of my favorite parts of KIDS – their enthusiasm and love for dentistry is contagious, and it’s a perfect environment for them to learn in the field.

Dr. Kim, whom many at KIDS know, is serious about hard work and will make any sacrifice for the team.  Skilled at surgeries and treating children, she volunteered to be our “number” and numb each child, and I can’t remember one child crying from her numbing.  Wow.  Quiet at first, she always has a witty comment to share, and her positive energy and hard work made all the difference.  She also worked on her Spanish, and she now knows the correct meaning of the word “caliente” after using it with children for so long.  She will no longer tell children they are being hot, and will instead tell them they are being brave (valiente).  Dr. Briana, who returned after volunteering as a dental student (another reason its great to have students along—they return as experienced doctors!), was our designated DJ in the clinic, and her tunes kept the clinic hopping.  Her warm demeanor and jovial personality kept the team upbeat as well.  Dr. Adam, a friend of mine from dental school, had been to Nebaj on another dental mission trip before and had even stayed at the same hotel.  He was the designated “Dr. Bob” for his ability to do hundreds of thoughtful exams on the children.  I think he introduced himself to every child as “Dr. Adam” and shook each of their hands.  One of the most colorful personalities of the group, his unique perspective and love of Gallo beer kept the group laughing.  He was willing to do whatever the team needed him to do, including fix any gadgets.  He also won the award for the best t-shirts and funniest comments.  Dr. Charles, a prosthodontic resident on his second KIDS trip, would stay up late with the gang telling story after story.  He’s quick to share a laugh or a travel story, and spent a lot of time doing exams with Adam. He had some humorous comments to share on the charts of the children that gave us a laugh in the clinic, and gave every child a full “prosthodontic” exam, as prosthodontists can’t do anything halfway.  Dr. Bob would be proud!   Dr. Sima, who was on her first KIDS trip, radiated joy and it was contagious.  I predict she will be KIDS devotee for years to come.  She’s been wanting to volunteer like this for a while, and thankfully she found us!  She restored so many teeth we lost count—she has the patience of a monk.   She has a huge heart, and her kindness affected everyone.  Her operatory (aka table) became the go to place for tooth saving.  She made many young Mayan women love their smile again.  Dr. Julio, returning to his native Guatemala for the first time in almost 20 years, as a pediatric dentist no less, will be designated the social chair on future trips.  He was always trying to get people to get together and do something fun after the clinic.  And during clinic, always asking if his teammates needed anything.  He would get down on his knee and look each patient in the eye and introduce himself.   The significance and emotion he was feeling about his return as a pediatric dentist to his native people was written all over his face, and he took care of those children as if he was born to do it.  Moreover, the way in which the young children looked at him spoke volumes of the trust they had for him—someone who looked and spoke like they did.  I am sure more than one Guatemalan child is wondering if he or she can too, grow up to be a pediatric dentist like Dr. Julio.  Dr. Roberto, a budding writer and illustrator, as well as a great pediatric dentist, was always willing to treat an uncooperative child in the quiet room.  He would calm them down, and had tremendous care with each child he treated.  His childrens’ book “Sugar Bugs” was a hit in education, and I will be buying copies for my friends and patients.  Always quick to lend a hand or share a smile, or a positive message on his shirt “Be the reason someone smiles today”, he, like Dr. Julio, will definitely be back on future KIDS trips.   Actually, Dr. Berto is already signed up for trips to Haiti and maybe even Cambodia.  Dr. Nancy is a pediatric dental resident at UCSF.  Her gentle demeanor and bright smile were on display every moment of every day.  She would be so kind to the children that they hardly ever cried–I think she always made them feel comfortable.  During the final debriefing, she said that this trip really made her feel that she had chosen the right specialty.  You could tell her heart was in it.

For the nondental volunteers, we sure got lucky with a talented group.  First, Natalie, a nutritionist who was experiencing her grandmothers birth country for the first time, was very outgoing and would problem solve daily and help us refine our system.  She also wasn’t shy about speaking up.  She would never complain if there was a problem, but would instead suggest a new way of doing things that was faster and more efficient than the old way.  It was her first volunteer trip, and you knew it wouldn’t be her last, even though it was clear she really missed her two boys.  Wani, a retired optometrist, who often does two KIDS trips per year, has sterilization down pat!  There are no cutting corners in her clinic, and though very serious, its easy to make her crack a grin.  Warren, a food scientist who lives in my hometown of Napa, really tried to practice his Spanish with the children.  He also asked the children to draw some sketches of him – and those very creative and different interpretations had me laughing hard.  He told me before the trip “I don’t know much about working in a dental clinic, and I am a food scientist, but I can clean a mean toilet”!  I knew immediately he would be an asset to the team with that attitude.  He was great at refining our systems.   Margaret and Issa are a married couple from Napa as well.  Margaret is a newly retired nurse and excelled in post op.  She was a great surgical assistant as well when one of my patients would not stop bleeding, and her quick wit and Irish humor were always welcomed.  She also had some creative ideas, such as educating the waiting mothers as well, and we even tried this and it seems like a brilliant idea.  We will incorporate this idea next year.  Issa was always curious about everything and his clever responses would often catch me off guard.  He seemed to always have an interesting thought to share.  He made a good team with Margaret.  And, Marcy.  Marcy was an amazing part of our team, and excelled in education.  A retired educator herself, she would have the students teach the class how to brush, and the response was instant.  She had many small ideas like these, and involving the students in their education quickly sparked their interest.  Her positive and supportive attributes made her a beacon of light on this trip.  Her son Steve, a project manager with a construction company, joined us last minute after his schedule opened up.  His analytic mind and excellent Spanish were an asset to our team, and we were blessed that he was able to join us.  Stephanie, Adam’s wife, was on her first volunteer trip and first trip to a place as poor as Guatemala.  Her eyes were wide and she absorbed everything when we traveled—always looking out the window and taking everything in.  A teacher by training, she is gifted at connecting with children.  She also loves Adam very much, and tolerated his bad jokes very well. Her big smile and easy laugh make her fun to be around in whatever station she is at.  My mother, Sheila, was on her third trip, and knows the system well.  She practices her Spanish with the children, and never cuts any corners!  She studies the places we go carefully, always thinking about how her understanding of the culture and place explain what she sees, as a historian would.  It made me very proud to see how well she looked after each child in the fluoride station or post op.  Efren, Abel’s 20 year old nephew, was the young guy of the trip.  His open heart and interest in learning from others is awesome.   He seemed to really appreciate connecting with children, and when he was reading to them in education, would get down on the ground to connect with them at their level.  The kids seemed to respond really well to him.  And last, but definitely not least, is the mighty Abel.  This guy has a heart as big as Texas, and the brain to go with it.  He runs a smooth operation, making sure every part of the engine is operating as it should, and makes constant adjustments to allow for a better flow.   He will call it like he sees it, and everyone has the greatest respect for him.  This is his vacation, and he never takes a moment off.    At only 31 years old, he runs the KIDS camp like a confident veteran.

I feel fortunate to be able to work with KIDS and this group – its such a unique experience.  Its intense and fulfilling on many levels, and I won’t soon forget the characters or the experiences of this trip.   Here are some of our photos that tell the rest of the story.

 

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Sima with another lucky patient
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Ha ha Tse!
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My mom and me
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This sweet girl came to watch us pack up and leave in Juil.  It was raining so she used this bucket to cover her head.  This image stuck with me, and still saddens me.

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Berto being awesome
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The teachers were very helpful with comforting the children
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Briana hard at work
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The school in Chajul, many mothers with children waiting below
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Briana with a nervous patient
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He looks calm and happy now – good job Briana!
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Berto taking a look
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Some of the wild boys of Xix, peeking through the back window

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Adam throwing our KIDS sign
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Adam and Julio discussing some treatment options
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Our fantastic dinner at Hacienda Mil Amores
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Briana and Julio sharing some thoughts
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Stephanie hard at work in sterilization
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Kim numbing another patient
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Stephanie smiling under all that PPE
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Sima and Jodi having some fun
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Now back to work

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My mom, Sheila, hard at work in Sterilization
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Berto working with some of the local teachers
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Landscape is lush and rugged
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Andrea and Kim getting ready to treat a child
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Nancy and Warren –teamwork!!

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The children waiting at the school in Xix
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Sisters?
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Abraham (a local law student), Stephanie and Issa sharing a laugh
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Hey, he’s happy!
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Steve and Natalie working the waiting room
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Steve when he’s not being a construction project manager
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One of the volcanoes of Antigua
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Beautiful smile and braces, of a local woman at a weekend festival
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Children waiting in Xix
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My friend at Xolcuay, Celestina.  Until next year my friend!
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Berto would introduce himself to every patient like this.
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The mothers of Chajul in Education with their children
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Poncho the alligator has really clean teeth now
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Brush the tongue!
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I managed to do a little work in the clinic as well.  We couldn’t do it without the help of teachers like these.
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Love riding in the chicken bus together.  Feels like a field trip.
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This photo means a lot to me.  Pedro is an outstanding human being, and I really admire him.  My third year visiting with him.
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Steve and Marcy (son and mother), with Eloisa on the right, the new Director of the Ixil Foundation.
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Best kids in the world!
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Margaret with one of our favorite teachers
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Jodi and her patient after some treatment.  All smiles!  Well, Jodi’s smiling at least.
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My Mom Sheila applying Fluoride to one of the cutest patients of the day.
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Every child has a chart signed by the parents
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The traditional dress of the Mayan people is beautiful and hand made. And the people are always so well dressed and composed.
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A favorite photo of my Mom from outside of the school
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Yes, my back began to hurt!
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Our morning team huddle on Day 1
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This photo of Dr. Kim reminds me of how the children look to our eyes for comfort.  They put so much trust in us.  Note how calm she is as Kim ever so gently numbs her.
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Wani, Steve and John in the clinic
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Efren reading to the students in education.
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Happy and curious children
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The school at Xolcuay with the salon on the left
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Senora Angelica waving goodbye!  Miss her already.