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My travels through rural Honduras with forceps, scalpels, and friends.

May 10, 2014

As the realization has set in that this blog will never be viewed by more than a handful of visitors each month, I have begun to view it as a place where I can write mainly to memorialize thoughts and events I don’t want to forget. The relative obscurity of this site is more liberating than disappointing. It is with this in mind that I have taken the liberty to write about my trip to Honduras.


 

On Saturday, July 16, 1994 the first bits of Comet Shoemaker-Levy began to pepper the surface of Jupiter. The impacts continued through July 22nd. Also on that Saturday, I boarded a flight to Honduras to spend a week in the mountains providing basic dental care to the impoverished residents. The impact of that trip still lingers with me some 20 years later. I’m not sure what catalyst caused me to want to do the trip. I had maintained my dental license but had not practiced actively for several years so it wasn’t like the trip would be an extension of my daily activities. In retrospect, even if I had a busy practice it still would not have been an extension of anything dentists typically do in the United States.

I don’t remember how I heard of the group MEDICO, an acronym for Medical, Eye, and Dental International Care Organization. It was probably in 1993. It’s hard to believe how much access to information has changed since then. According to a study by Matthew K Gray of MIT, at the end of 1993 there were 623 websites on the World Wide Web; In December 2012 there were more than 650 million. Although I can’t remember how I found MEDICO, one of the things that resonated with me is that it was a fully non-secular group. I wanted to do something with my dental skills but not as a quid pro quo for anything, especially for an expression of religious devotion. There are many Christian based medical missions to developing countries and they undeniably do an immense amount of good. But for me, I’d rather deliver the care people need without requiring prayer. Well, to each their own but it seems transparent to me that a parent would say any prayer you want to hear if in return you help their sick child. I know I would.

All of this is by way of introduction to some notes I took during the trip. I’ve transcribed them from the long hand notes without any edits. Many of the comments are wont for editing but I’ve transcribed them as accurately as possible – grammar errors, hyperbole and all. Original content from the journal is italicized while current commentary is non-italicized.

7/16/1994

Left for the Indianapolis Airport at 5:30 AM. Check in was uneventful but it was very helpful that Jan had arranged for the Continental Airlines supervisor to help check the instruments through.

I brought my own oral surgical instruments as carry-on items. There is no way that could take place today!

I had  hoped for some quiet time to assemble my thoughts for the trip and maybe practice some Spanish phrases. It didn’t happen. Two youngsters were seated beside me and were travelling alone. Willie was 7 and his sister was turning 10 tomorrow. They had lots of questions. Willie especially needed some assurance when we hit some turbulence. I would have rather spent the two hour trip thinking or reading but I kept thinking of Jon and Ben and how I hoped that if they were in the same situation someone would “adopt” them. So I did.

I knew things would be tight time wise in Houston. I was right. The gate attendant didn’t know what I was talking about when I asked about a “group check in.” He sent me to the departure gate. It’s quite a walk. All the way I kept thinking about my unclaimed baggage. It couldn’t be checked through to Honduras because I didn’t have a ticket.

After meeting a few MEDICO people at the gate, I located my bag and went to the group check in counter. The flight left in 30 minutes. I guessed only a 50-50 chance of the bag making it. I didn’t realize at the time that my chances were about the same. I arrived at the gate as they were calling my row number for boarding. While standing in the jet way I heard an attendant behind me mention “Barefoot.” I answered, “That’s me.” “You don’t have a seat go see the counter agent.”

It didn’t look good. The flight was over booked and there were 7 unhappy passengers at the counter complaining in Spanish. “¿Donde le duele?” wasn’t going to help me.

I explained I had patients to see tomorrow and made sure my MEDICO shirt was visible.

One of the attendants said that another MEDICO person was going to trade places with me so we quietly walked away from the 7 and to the plane. As it turned out there was an extra seat available so the exchange wasn’t necessary. I still don’t know if the other 7 all made it. Not an unsurprising display of organization on Continental’s part. Anyway on to Honduras.

I sat next to a 15 year old that was with a church group from Georgia that was going to set up a clinic in Honduras. He wasn’t a bad kid – just full of the confidence that comes from having answers to everything. I didn’t realize that medical trips to Honduras were so popular.

As it turned out, this young Christian confirmed that at least for their clinic there was a one for one relationship between professing Christ as your savior and receiving penicillin. He didn’t see any issues with that.

We stopped first at Tegucigalpa. It was quite the landing. The pilot said “We are going to follow the contour of the mountain for the landing. When we break through the cloud cover we’ll be closer to the mountain than you’re comfortable with.” Damn straight! It was a very close-up view of the terrain. You could see the bananas on the trees. When we landed there was spontaneous applause. The pilot heard it and responded “Thank you, thank you.”

It’s not exactly clear to me how we went from the Tegucigalpa landing to San Pedro Sula airport but the approach to the airport is an indelible memory. As the pilot said in this YouTube video after landing, “That’s not fun, I don’t like this one.”

It was unfortunate that three planes had landed at San Pedro Sula at roughly the same time. Immigration took approximately 1½ hours and it was HOT. Once through immigration, Lynda Peters had collected our bags, mine made it, and found an agent that would essentially “wave us through.”

Once outside the first assault was from money changers. It was a favorable rater so I exchanged $100. The next assault came from many people that wanted to carry my luggage. However, not as bad as in other places. Lots of kids 4-5 years old were learning the trade.

One woman tracked us down asking for money for her daughter to have an operation – a brain tumor. Sounds trite? She had a letter signed by a social worker and a 2 year old with a protuberance on her head. Too bad Reggie wasn’t here. It was a good enough story to cause all of us to chip in a few bucks.

Reggie was a pediatric oncologist at Riley children hospital in Indianapolis.

About a dozen of us went in one van from the airport to the hotel. A lot of cardboard houses shacks along the road. Also shelters made of black plastic bags. San Pedro Sula is a major Honduran industrial city. We stayed in the Gran Hotel Sula. Pretty nice by Central American standards. Swimming pool, bar, AC and cable TV.

I am rooming with Jesus Cerda. This is his 3rd trip with MEDICO. A real nice person. He’s an 18 year veteran of the Post office in Austin, Texas.

July 17, 1994

We had dinner last night at Pat’s Steakhouse. Very urban and nice. I had the steak Charrusico – very good. I thought of Deb – she’s such a carnivore. It was good to get to know the people.

At one point yesterday, Bill Stavinoha, a family practice practioner from Texas said, “You dentists are the ones that really work hard”

“Oh, yeah?”

“Yeah. We just sit in the shade, talk to patients and pass out pills.” Later in the day someone else said something similar.

I hadn’t thought too much about the physical nature of the work being a limiting factor. Hmmm

Our plan is to leave the hotel at 7:30 and drive to the first village. However, the road we would take may be closed. Someone is coming from the other direction will let us know if it is passable. One way or another I’ll be extracting teeth this afternoon. A scary thought in some ways.

July 21, 1994

Four days since my last writing. An unbelievable experience in many, many ways. I had hoped to keep a daily record but I was just too tired to write at the end of each day. I’ll try to reconstruct what happened.

Sunday afternoon we drove to the village of Trinidad to meet the sponsoring organization of CCD (Christian Commission for Development) I was impressed along the way with the beauty of Honduras. Bill Jones, a professor of Latin American history and a translator on the trip said it’s the most mountainous country n Central America. We were to find out first hand after leaving Trinidad for our first destination – Tule.

We followed the CCD truck to Tule in two four wheel drive Toyota trucks and the 15 passenger van. The first interesting obstacle was s suspension bridge crossing a river – name unknown to me. We could easily see through the boards to the river below. The road deteriorated to the point where we had to remove some passengers from the van to get it up a section of road. It was pretty exciting – especially since the brake light kept coming on in the van.

Eventually it became too rough for the van so we loaded everything into the small trucks (pick ups) for the rest of the trip.

It was the bumpiest ride I’ve ever had. I was sitting in the bed of the truck and felt every bump and rock for the 30 minute ride.

The video below was made using Google Earth to show the route from Tule to Trinidad.

The village was right in the mountains and as impoverished as one might expect. Shoes were a luxury as were clothes for some of the smaller children. We set up shop quickly in a three room school. Medical in one room, eye in one and dental in the other.

The operatories consisted of two school desks pushed against a wall. There was a dental chair constructed of PVC pipe that Shelly started using once the height was increased.

I remember being anxious to get started. It had been 12 years since I had extracted any teeth. A big pregunta in my mind had been could I do it. No choice. I don’t remember my first case. In fact, I don’t remember many. It’s already becoming a blur. I got through the first afternoon and wondered how I could do it for four more days.

The teeth I saw in general were rotted shells of teeth. Nearly all of them would have been referrals to an oral surgeon back in Indy. I learned a lot about extracting teeth and some interesting ways of extracting teeth from Shelly. He is a veteran of a lot of international dental aid work and got his dental start in a “volume” practice in NYC. He could extract faster than anyone I’ve been around. There was more trauma involved with his method but on a trip like this it was more important to get the tooth/root out. I never quite mastered his technique but came a long way toward removing hard teeth. I never kept accurate records but suspect I extracted between 120-150 teeth in 4½ days. Far more than I’d done before. After the clinic closed at 6:45 P M, I was too tired to eat. We stayed in a “guest” house at the top of a hill. A moderately challenging walk. The plan was for all of us (17) to stay in one room. Actually 2 rooms. There were only two. The house was block and corrugated steel roof construction.

After diner the villagers cam to sing for us. Four string instruments and Honduran songs. It was nice for a while but better when they left so we could sleep.

MEDICO provided a thermarest and a blanket. We all found floor space and talked for a while. With good timing the generator ran out of gas around 10:30 to make “lights out.” The talking settled down in around 10 minutes. Bill Jones started what was to be a continuous night of snoring. No way Jose. After about 5 minutes of thinking what to do.

July 23 (On plane from SPS to Houston)

..I moved outside and found a level place to sleep. There were numerous animals running around all night but they didn’t bother me much. Mostly dogs and chickens. The chickens, or rather rooters, were very loud. Starting at about 3-4 AM they would start crowing. It was a real chorus – a cacophony of sounds. It was funny. One would start and the others throughout the mountains would respond until the sound was overwhelming.

I was relatively comfortable; until the rain started at about 4:30. I moved inside and struggled to find some empty floor space. There wasn’t much. I must have fallen asleep when it really started to pour down rain. Rain is pretty noisy on a corrugated metal roof.

Finally fell asleep to be awakened by an explosion. The villagers had exploded a small bomb to awaken us and celebrate our presence. Thanks! The snooze alarm explosion went of 5 minutes later.

Breakfast was prepared by a cook who was to cook for us throughout the trip. I don’t remember the specifics. Their idea of coffee was super strong and super sweet. It really gets you going. Maybe too much – I was pretty shaky during the first few patients.

There was a lot of trepidation on my part wanting to get started. We were on top of a hill, a common place to be in Honduras, and could see people lining up at the clinic.

I won’t forget walking down the hill. I was following Lillian when she slipped at the base of the hill. I heard the snap as she fell. Her words were “Oh No. I’ve broken my leg.” It turned out she was right. At first Bill and Brady thought it might be sprained but the next day it was obvious it was broken. She toughed it out for a day while arrangements were made to get her home. Bill made a cast and Jerry escorted her back to Houston. It must have been a very long ride down the mountain. Later we learned it was a break and she had surgery to correct it in Austin.

At this point, I can’t remember the specifics on day two in Tule. More patients, more broken down teeth. It was a patient to patient day. The feeling was one of being overwhelmed and wondering how it would be possible to male it thorough the week.

Honduras extraction

In this photo, Jesus holds a flashlight as I perform one of many extractions.

I do remember one very young patient. He was 5 years old and totally bombed out primary molars. He was so nervous and crying and clinging to his father. I got both sides blocked – I think – and tried to extract the left molar. He started crying. It was so hard to tell if he was afraid, feeling pressure or it hurt. He cried all through the injections but said his lip was “esta dormido.” I opted to just plow ahead and do the extractions through his cries. I was wiped out by that. His father said one was enough. I couldn’t have been happier. I was so choked up by that patient I had to go to the eye area and take a break. It would have been very easy for me to start crying – my eyes hurt. I kept thinking of that little guy being Jonathon. It’s painful even now. Poor guy.

Tuesday was a half day – true, but first Monday night.

Monday night was our last night in Tule. The villagers wanted to thank us for coming by performing a “blessing.” Obviously I’m not into religious ceremonies but this was pretty neat. I think all of the villagers walked up to our “house” by 7 PM.

They straggled in, in groups of 2 and 3 until we were surrounded. The musicians were there as was the priest’s representative. He was a former patient and a musician. After reading a verse from the bible he gave a speech. Some of the translated thoughts were:

“We know we are poor and appreciate your coming. Your coming is a miracle for us. God has sent each one of you for the purpose of helping us.” Songs were sung for us and they descended back to their homes. Even for me it was pretty moving.

Wednesday we worked until 2:30. I wasn’t really sure how appreciated the dentistas were until 2:30. There was an argument between two women when it was announced we could take only one more patient. Must have been pretty important for them.

We “broke camp”, packed and loaded the trucks and headed down the mountain – a much easier trip since I was in the front of a truck this time. Departure was almost too stereotypical to be real – kids running behind the trucks, people waving saying “adios.”

Our destination was the CCD office in Trinidad. We unloaded the boxes and headed for a hotel in Santa Barbara. (we were just warned that we should hit moderate to heavy turbulence in 7 minutes. I can’t wait and will finish this when things settle down.)

Well it hasn’t been bumpy yet so I’ll continue.

After sleeping on the ground for two days the hotel was a real luxury – small rooms-some had a window air conditioner, some had a private shower and some just a fan. I had a room with AC on the first day but switched with Bob for day 2 and 3. I didn’t use the AC but he did. (Bob’s a good guy – more on that later)

The hotel was about a 30 minute ride from Trinidad. I was pretty tired after getting there but we decided to go out on the town. Since it hadn’t rained much in Honduras their reservoir that provided electoral power was low. This meant that there was no electricity in Santa Barbara from 7-11PM. We all had our flashlights and in our scrubs we headed for “el centro.” There wasn’t much action but we were able to find a place to serve us a few cervezas. Salva Vida was the best. There was a juke box that provided music for la Punta.

July 24 (Home in Zionsville)

David taught us how to “Punta” and all of us joined in. Regan was the show stopper when he danced with his daughter April. It was probably an unusual if not funny sight to see all those gringos in scrubs dancing.

We all crashed when we returned to the hotel.

The next morning we set up the clinic in the CCD office in Trinidad. It was before breakfast that diarrhea hit me. I was pissed. Fortunately it didn’t turn out to be full blown “turista.” Didn’t eat breakfast and wasn’t looking forward to working all day.

Again endless patients. Working conditions were really better in Tule. Trinidad had less space and more heat. It did have a toilet. Still had to pour in water by hand to flush it. Lots and lots of extractions.

One of the most rewarding experiences happened here. A very small boy, maybe 5, came in with his mother and sister age 7. He was very clingy crying even before the sat in the chair. The guy was terrified! We couldn’t even get him to open his mouth. Had to punt. Jesus explained to his mother that we couldn’t work on him. His sister was next. She was a squirmer that needed work in all four quadrants – especially the upper right. I would have done 5 extractions but only two were giving her pain and she would be losing the others to secondary teeth in a few months. My thought was to do a painless as possible procedure for he while her brother watched 8 inches away. I infiltrated the upper left quadrant and waited a solid 15 minutes (a luxury in Honduras) I did a pretty smooth extraction of 1st and 2nd primary molars. There were a few tears but not many. My hope was that I was setting both of them up for more complete future dental care. Lynda gave her a plastic necklace and everyone praised her a lot. Her brother watched the whole process.

The reward for me came the next day. The mother brought the boy back and insisted that we try again. Everyone had doubts – the kid was untouchable yesterday. He was a different kid on day 2, sat in Shelly’s chair, cried a bit but accepted the whole procedure. Everyone had assumed his mother had “worked” on him to somehow get him to come back in. I’m sure that’s true but I know that my plan with his sister had worked. It was good.

Another thought – with the kids I didn’t wear the mask so I wouldn’t look so intimidating.

It’s really a blur, the rest of the day. As I sit here in Zionsville, the details are already vanishing leaving only the feelings.

That night at the hotel I taught the team euchre. It was pretty funny trying to explain a “simple” game to someone who had never heard of it. The game caught on and will be a hallmark of the trip.

On Friday we (a subset of the group) went to the Mayan ruins at Copan. It was interesting but it was too far and I was too tired to get a lot out of it. I got a taste of Honduras driving on the way back. Our driver, Hector, would only pass on curves. Pretty scary.

We did almost have a serious accident. A bus passed us and cut us off – majorly. He had only gone half way past when he moved back in our lane. We were on a bridge with nowhere to go. Damn close. I’ve never been closer.

July 26

Returning to SPS was a relief that there would be good food and a warm shower – or 2. It felt very strange to be returning to the same hotel, same floor. It was the same, only different. It seemed like revisiting a place I had been in a long time before not just one week ago. I roomed with Jesus again.

It really was funny to walk around the lobby – a real time warp.

The food was excellent –everyone was just relaxing. We were to have gone out for our “formal” closing dinner but everyone gathered around the pool and ordered something from the hotel restaurant. Very friendly .I talked to Diane quite a bit and learned about what she did back in Austin, Texas- epidemiologist. A good conversation.

Saturday AM we walked to a local tourist market. Pretty much like the market in Guadalajara Mexico only smaller. I didn’t find much worth buying except for a small clay pot.

Since our flight back home was “way overbooked” we left the hotel early for the airport. Sitting in the waiting room it started to sink in that the trip was over. The group was disbanding.

The trip home was unremarkable. Routine flight. No one to meet me at the airport. What did I expect? Something.

I just talked to Lynda on the phone and got a report on everything. Lillian is doing fine and ready to go back next year.

In some ways it seems like yesterday that this group photo was taken; in other was it is a lifetime ago.

In some ways it seems like yesterday that this group photo was taken; in other was it seem a lifetime ago.

 

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