Save Their Smiles December 2014 Trip
The goals of this trip were the following:
- Check in with the leaders of the villages about how the program is working.
- Touch base with the Ministry of Health (MINSA) to see how they view the program and find out if they would support our program by providing transportation and some medicines (Amoxicillin, Diclofenac, Acetominiphen, and Lidocaine ampules)
- Speak with the promoters one on one to assess program efficacy and hear any concerns they might have.
- Construct a secure location to store equipment and move the inventory from the Bilwas hospital to our dental clinic. This was necessary because Partners in Health needed the space for programs of their own, and it made sense to consolidate the inventory.
- Train promoters in correct use of the new equipment-an ultrasonic scaler and high-speed, low-speed dental unit.
- Provide additional training about the pharmacology of medications used in dentistry.
- Hold dental clinics to practice new skills.
- Set a fixed schedule for “Dental Brigades” for 2015.
- Complete set-up of our clinic in Bilwaskarma and hold two days of free dental care for villagers, young and old.
- Take a trip “down-river” to the territory of Andres to hold dental clinics and touch base with the communities there.
Trip Summary:
All in all, this was a very productive trip. We accomplished all our goals with the exception of visiting Andres. We were unable to travel because of financial issues-the bank would not give us the money I had sent down, so we were unable to pay for the gas for the trip.
Highlights of the trip:
Friday Dec 12th-After arriving mid-day, I spent much of the afternoon at the dental supply store arranging the purchase of a second ultrasonic scaler for use in el Rio Abajo. In the evening, I met with our lawyer, Miquel Ramirez, to discuss the formation of our ONG. The papers have been submitted and we are currently just waiting for them to be finalized. To do’s for me include hiring a Nicaragua accountant, writing minutes of meetings held, and keeping accurate books and receipts.
Saturday Dec 13th-Much of the day was spent in travel, first 6 hours at the airport/flying, then towards the end of the day, 5 hours by car to Bilwaskarma from Puerto Cabezas. Mid-day was spent purchasing supplies for the upcoming trip.
Sunday Dec 14th-Sunday was spent talking with employees (Promoters), going through supplies, and planning the week.
Monday Dec 15th-Monday was a yucky day full of logistics. First, we rode a transport truck in to Wespam and all went well. Then, we spent several hours were arranging (or, more accurately, trying to arrange) to have internet and phone service at the clinic through Claro’s program, Casa Claro. With this service, the clinic would have internet (Wi-Fi) and phone service (200 minutes/month) for approximately 40$/month. I also discussed possibly trying to find a donor to help pay for internet service for the community-it would be hugely helpful for education of the local children. If I cannot find a donor, I may pay myself and try to work a deal with Claro because I am signing up for 2 accounts. In addition, I purchased a small two-burner stove and gas for the clinic so that volunteers could be a bit more comfortable and less dependent on the family providing food for us. I also spent quite a bit of time “fighting” with the local “bank” to try to obtain our funds. Unfortunately, I was unable to convince the bank to release the funds, so needed to cancel the trip down-river and will have to return to Port 1 day early to deal with setting up a BanPro account. Finally, we spent 11,000 cords at the local hardware store to purchase construction materials for the “bodega.” We rented a delivery truck to transport the materials (1/2 ton) back to the clinic and, terrifyingly, were witness to a terrible accident with another of the transport trucks, which was directly in front of us. The heavily loaded truck seemed to slip out of gear and roll backwards down the hill towards us. Our driver tried to back up, as it was going to hit us, but before he could move the other truck actually went off the road and tipped over, flinging almost 25 people, including women with infants, out into the bush. Unbelievably, no one died. There were multiple injuries, and the passengers were stranded for 2 hours without help. This accident terrified me, and I have decided that no volunteers will travel with this type of transport. Trucks are always piled high with people hanging off the sides and top, and it is simply too dangerous.
Tuesday Dec 16th was, more or less, our Grand Opening. Space was tight, as we had 3 people pulling teeth (The Nicaraguan dentist, Dr. Winsell, Nereyda Jackson, and Polancio Dinking). I trained both Alberto Dinking and Nereyda how to use the ultrasonic scaler. Moncho Velasque was responsible for cleaning instruments, but sadly, there were no extra hands to actually notate names, ages, teeth pulled, teeth cleaned and medicines administered. Nonetheless, the community was delighted with the clinic-indeed, our porch was so packed it was hard to get in and out of the clinic.
Wednesday Dec 17th was wrestling with the dry compressor, which was to power the dental units. After several hours of bruxism, we finally ascertained that the power in this village, which is far from any larger city, is simply too low voltage to run the compressor. We decided to abandon teaching how to fill teeth for this trip, but the dentist will return in January to help get. Today was the first of two days at the dental clinic in Bilwaskarma. It was another day packed with patients. I spent much of the day everything correctly set up and running efficiently and correctly. Total patients attended Tuesday and Wednesday: 50, Teeth pulled-81
Thursday Dec 18th, contemplating volunteering, I sleep on the floor in the clinic-it is actually fairly comfortable, and really nice to have some private space instead in of living right in the middle of a family with no available extra space. The “shower” is a little pad of concrete outside with walls of wood, a bucket of water, and a bowl to pour it over your head. Although it sounds pretty basic, it is actually delightful. At night, if you put your flashlight on the top beam of wood, it shines up on the coconut tree (and attracts all the bugs away from your body!). I do admit that I miss American bathrooms. The outhouse is a bit odiferous, and the bugs really seem to attack your legs when your pants are dropped, but on the other hand, it is part of the experience, and it surely makes one appreciate what one has at home. On this particular day, I left the clinic at about 7 am to travel to Wespam, this time to speak with Minsa about our project and ask if they would be willing to help with costs for meds dispensed. With Clara by my side (Clara Mueller Gomez, who supervises the project for me when I am in the states), we are able to get an appointment with the Director and the Sub-director of the local ministry of health. It was a very successful meeting! I had come to the meeting loaded with our library of books, the children’s book I wrote (then had translated to Miskito) about how to keep your body healthy and strong, our project documents. Both the director and sub-director were very supportive (and excited) about our program and granted us permission to use the ambulance for community outreach as well as agreed to give us dental meds, as long as we deliver a list of patients we are treating on a monthly basis.
After the meeting, we went to a radio station and were allowed to make an announcement about upcoming clinics (all free of charge). This may have been a mistake, as when I returned to Saupuka where our team was pulling teeth I found a fairly chaotic situation. We had hoped not only to pull teeth, but also to clean teeth. Unfortunately, the health clinic was locked and the nurse was gone, so we could not get into the clinic and had to work in a partially built house without electricity. Honestly, the day was a bit overwhelming. There are over 4,000 people living in Saupuka, and every single of them wanted to be seen. Obviously, we could not manage such crowds, and many people became fairly demanding (actually trying to push the door open to get in!) When I arrived, the situation was almost out of control, with our promoters on one side of the door trying to shut it with the villagers in a mass on the outside trying to push in, all while we were seeing patients and pulling teeth. It was ridiculous.
After assessing the situation, I went outside and stamped my feet and directed every single person to get off the porch. I tied a band across the stairway and said if anyone went past it without permission, we were leaving. I promised that we were going to be available moving forward at the dental clinic, and in the end, it all worked out okay. We did learn a few important lesions, the most critical of which was to tell towns people the “RULES” before starting (we made them up on our walk home at 6 pm in the rainy, dark night) and also, early in the day, to limit the list of people so that people are not angry when you run out of daylight (and strength). The second lesson was medical in nature. Towards the end of the day, a young woman was half-carried, half dragged into the clinic. She appeared to be having some kind of adverse reaction to her extractions earlier in the day. I took her heart rate, respiration rate, assaulted her lungs, assessed her pulse, and took her blood pressure. Everything was completely normal, but she was limp and fairly unresponsive. Her extractions had been routine, and she had received adequate pain meds. As the program director, I was, frankly, fairly terrified. There is almost no medical help available, and this was the first serious adverse reaction we had ever seen. I was not sure how to transport the patient to the closest doctor with only a bicycle to hands, and was considering what to do when, luckily, Clara arrived. I was never so happy to see her face (and I am always happy to see her face). She examined the patient, then asked a question I had not thought of–has she acted like this before? When the woman’s mother answered yes, Clara took her hand, made a fist with her knuckle pointing out, and rubbed it briskly on the patient’s sternum. It only took a few seconds until the woman opened her eyes and became verbally responsive…remarkable, and unbelievably relieving.
The “RULES” are as follow:
Friday Dec 19th, the pharmacy, Alberto cleaned teeth, Polancio and I pulled teeth, Jose (Clara’s son). Friday was awesome. Clara was able to accompany us so she managed was awesome in supporting us by holding lights and anticipating needs (more gauze, extra lidocaine), and the village provided 2 volunteers that helped as well. When I had to go through the list of over 50 people waiting to be seen and limit it to children 18 or younger, pregnant woman, and adults over 65 years of age, the rest of the population acceded gracefully, which was lovely. We actually did have another “fainter,” but this time I knew what to do, and it worked perfectly. Phew!
Total patients attended Friday: 36, Teeth pulled-48
Saturday Dec 20th, altogether, we spent almost 8 hours in “class,” some of which was educational (pharmacology, use of excel to collect and manage data), and some organizational. It turns out that sitting still and thinking is almost as taxing as pulling teeth! All in all, though, it was a very productive day. We also calculated back pay and construction costs, and found that STS owed almost $1500 (included construction costs, November, December and “Christmas” pay-which is standard practice), and realized we needed to return to Port early to take out money from the ATM both Sunday and Monday (withdrawal limited to 300$ per day per account). I simply must get a BanPro account so it is easier to send money to Nicaraguan employees.
Sunday Dec 21st, off Polancio’s porch and into the dental clinic so it would be safe until the bodega is finished. Since the building is just wood (not concrete block), one of the members of the construction crew will sleep on the porch until Polancio returns home and the inventory can be stored safely in the new bodega. left for Puerto Cabeza and spent the rest of the day doing errands (banking, planning the supply list for the annex we are going to build for the clinic to use as a sleeping area, practicing how to use Facebook and email). We left for Port about 11:30 am and arrived, overheated and stiff, 4 1⁄2 hours later. Since all the stores were closed, Polancio and I spent time working on setting up a Facebook account so he can post photos of people treated at the clinic.
Monday Dec 22nd included purchasing a generator and various other construction and clinic supplies, opening a bank account, and pulling out the money I had previously sent to Polancio and Clara. Of course, though, all our availble time got eaten up dealing with bank business (UGH-the Nicaraguan banking system needs some upgrading). When I boarded my flight, I sent Clara and Polancio back to Bilwaskarma with a list of things to buy before returning to Bilwas, the most important of which was the generator to run the compressor. I also sent money to cover all back pay and a bit more to cover upcoming construction costs for the “bodega.” We will wait to build the annex until I have a better feel for what payroll will be this year. We have planned to have the first week of every month be a “Dental Brigade” to outlying villages. Other weeks will have some kind of set dental schedule. Extractions for children will always be free. For adults, it will cost 20 cords/tooth. We have yet to determine the was a day devoted to organizing inventory and educating promoters. The day started early at 5:30 am, as all the inventory had to be moved we rushed around trying to accomplish our final “to-dos” which cost for fillings, but definitely want to encourage prevention over extraction, so we will make it as low as possible. We do need to look into possible donations of glass ionomer and amalgam.
Top priorities now are to:
I hope to have my next trip be in 4 to 6 months. Please contact me if you are interested. It is a great opportunity for anyone who wants to help and doesn’t mind sweating, outhouses, and long days. Really… it is fun!
Hanna Ekstrom CEO: Save Their Smiles
All in all, this was a very productive trip. We accomplished all our goals with the exception of visiting Andres. We were unable to travel because of financial issues-the bank would not give us the money I had sent down, so we were unable to pay for the gas for the trip.
Highlights of the trip:
Friday Dec 12th-After arriving mid-day, I spent much of the afternoon at the dental supply store arranging the purchase of a second ultrasonic scaler for use in el Rio Abajo. In the evening, I met with our lawyer, Miquel Ramirez, to discuss the formation of our ONG. The papers have been submitted and we are currently just waiting for them to be finalized. To do’s for me include hiring a Nicaragua accountant, writing minutes of meetings held, and keeping accurate books and receipts.
Saturday Dec 13th-Much of the day was spent in travel, first 6 hours at the airport/flying, then towards the end of the day, 5 hours by car to Bilwaskarma from Puerto Cabezas. Mid-day was spent purchasing supplies for the upcoming trip.
Sunday Dec 14th-Sunday was spent talking with employees (Promoters), going through supplies, and planning the week.
Monday Dec 15th-Monday was a yucky day full of logistics. First, we rode a transport truck in to Wespam and all went well. Then, we spent several hours were arranging (or, more accurately, trying to arrange) to have internet and phone service at the clinic through Claro’s program, Casa Claro. With this service, the clinic would have internet (Wi-Fi) and phone service (200 minutes/month) for approximately 40$/month. I also discussed possibly trying to find a donor to help pay for internet service for the community-it would be hugely helpful for education of the local children. If I cannot find a donor, I may pay myself and try to work a deal with Claro because I am signing up for 2 accounts. In addition, I purchased a small two-burner stove and gas for the clinic so that volunteers could be a bit more comfortable and less dependent on the family providing food for us. I also spent quite a bit of time “fighting” with the local “bank” to try to obtain our funds. Unfortunately, I was unable to convince the bank to release the funds, so needed to cancel the trip down-river and will have to return to Port 1 day early to deal with setting up a BanPro account. Finally, we spent 11,000 cords at the local hardware store to purchase construction materials for the “bodega.” We rented a delivery truck to transport the materials (1/2 ton) back to the clinic and, terrifyingly, were witness to a terrible accident with another of the transport trucks, which was directly in front of us. The heavily loaded truck seemed to slip out of gear and roll backwards down the hill towards us. Our driver tried to back up, as it was going to hit us, but before he could move the other truck actually went off the road and tipped over, flinging almost 25 people, including women with infants, out into the bush. Unbelievably, no one died. There were multiple injuries, and the passengers were stranded for 2 hours without help. This accident terrified me, and I have decided that no volunteers will travel with this type of transport. Trucks are always piled high with people hanging off the sides and top, and it is simply too dangerous.
Tuesday Dec 16th was, more or less, our Grand Opening. Space was tight, as we had 3 people pulling teeth (The Nicaraguan dentist, Dr. Winsell, Nereyda Jackson, and Polancio Dinking). I trained both Alberto Dinking and Nereyda how to use the ultrasonic scaler. Moncho Velasque was responsible for cleaning instruments, but sadly, there were no extra hands to actually notate names, ages, teeth pulled, teeth cleaned and medicines administered. Nonetheless, the community was delighted with the clinic-indeed, our porch was so packed it was hard to get in and out of the clinic.
Wednesday Dec 17th was wrestling with the dry compressor, which was to power the dental units. After several hours of bruxism, we finally ascertained that the power in this village, which is far from any larger city, is simply too low voltage to run the compressor. We decided to abandon teaching how to fill teeth for this trip, but the dentist will return in January to help get. Today was the first of two days at the dental clinic in Bilwaskarma. It was another day packed with patients. I spent much of the day everything correctly set up and running efficiently and correctly. Total patients attended Tuesday and Wednesday: 50, Teeth pulled-81
Thursday Dec 18th, contemplating volunteering, I sleep on the floor in the clinic-it is actually fairly comfortable, and really nice to have some private space instead in of living right in the middle of a family with no available extra space. The “shower” is a little pad of concrete outside with walls of wood, a bucket of water, and a bowl to pour it over your head. Although it sounds pretty basic, it is actually delightful. At night, if you put your flashlight on the top beam of wood, it shines up on the coconut tree (and attracts all the bugs away from your body!). I do admit that I miss American bathrooms. The outhouse is a bit odiferous, and the bugs really seem to attack your legs when your pants are dropped, but on the other hand, it is part of the experience, and it surely makes one appreciate what one has at home. On this particular day, I left the clinic at about 7 am to travel to Wespam, this time to speak with Minsa about our project and ask if they would be willing to help with costs for meds dispensed. With Clara by my side (Clara Mueller Gomez, who supervises the project for me when I am in the states), we are able to get an appointment with the Director and the Sub-director of the local ministry of health. It was a very successful meeting! I had come to the meeting loaded with our library of books, the children’s book I wrote (then had translated to Miskito) about how to keep your body healthy and strong, our project documents. Both the director and sub-director were very supportive (and excited) about our program and granted us permission to use the ambulance for community outreach as well as agreed to give us dental meds, as long as we deliver a list of patients we are treating on a monthly basis.
After the meeting, we went to a radio station and were allowed to make an announcement about upcoming clinics (all free of charge). This may have been a mistake, as when I returned to Saupuka where our team was pulling teeth I found a fairly chaotic situation. We had hoped not only to pull teeth, but also to clean teeth. Unfortunately, the health clinic was locked and the nurse was gone, so we could not get into the clinic and had to work in a partially built house without electricity. Honestly, the day was a bit overwhelming. There are over 4,000 people living in Saupuka, and every single of them wanted to be seen. Obviously, we could not manage such crowds, and many people became fairly demanding (actually trying to push the door open to get in!) When I arrived, the situation was almost out of control, with our promoters on one side of the door trying to shut it with the villagers in a mass on the outside trying to push in, all while we were seeing patients and pulling teeth. It was ridiculous.
After assessing the situation, I went outside and stamped my feet and directed every single person to get off the porch. I tied a band across the stairway and said if anyone went past it without permission, we were leaving. I promised that we were going to be available moving forward at the dental clinic, and in the end, it all worked out okay. We did learn a few important lesions, the most critical of which was to tell towns people the “RULES” before starting (we made them up on our walk home at 6 pm in the rainy, dark night) and also, early in the day, to limit the list of people so that people are not angry when you run out of daylight (and strength). The second lesson was medical in nature. Towards the end of the day, a young woman was half-carried, half dragged into the clinic. She appeared to be having some kind of adverse reaction to her extractions earlier in the day. I took her heart rate, respiration rate, assaulted her lungs, assessed her pulse, and took her blood pressure. Everything was completely normal, but she was limp and fairly unresponsive. Her extractions had been routine, and she had received adequate pain meds. As the program director, I was, frankly, fairly terrified. There is almost no medical help available, and this was the first serious adverse reaction we had ever seen. I was not sure how to transport the patient to the closest doctor with only a bicycle to hands, and was considering what to do when, luckily, Clara arrived. I was never so happy to see her face (and I am always happy to see her face). She examined the patient, then asked a question I had not thought of–has she acted like this before? When the woman’s mother answered yes, Clara took her hand, made a fist with her knuckle pointing out, and rubbed it briskly on the patient’s sternum. It only took a few seconds until the woman opened her eyes and became verbally responsive…remarkable, and unbelievably relieving.
The “RULES” are as follow:
- Villages have to help us set up the clinic-fetch water, provide 4 chairs and 2 table or benches
- The village has to provide 2-4 volunteers (depending on patient load) to help. These people might provide crowd control, write down patient names and information, hold lights and children as needed.
- Villagers need to provide lunch (rice and beans) and clean water for the dental clinic workers, as there is no other simple way for us to get food and we can’t prepare it ourselves when we are busy with patients.
- The last patient will be seen no later than 4 pm so we don’t have to return home in the dark.
- Villagers have to help with clean up, including returning all chairs and tables to their rightful owners and cleaning up and disposing of garbage. These rules were designed to get some buy-in and make the project more sustainable.
Friday Dec 19th, the pharmacy, Alberto cleaned teeth, Polancio and I pulled teeth, Jose (Clara’s son). Friday was awesome. Clara was able to accompany us so she managed was awesome in supporting us by holding lights and anticipating needs (more gauze, extra lidocaine), and the village provided 2 volunteers that helped as well. When I had to go through the list of over 50 people waiting to be seen and limit it to children 18 or younger, pregnant woman, and adults over 65 years of age, the rest of the population acceded gracefully, which was lovely. We actually did have another “fainter,” but this time I knew what to do, and it worked perfectly. Phew!
Total patients attended Friday: 36, Teeth pulled-48
Saturday Dec 20th, altogether, we spent almost 8 hours in “class,” some of which was educational (pharmacology, use of excel to collect and manage data), and some organizational. It turns out that sitting still and thinking is almost as taxing as pulling teeth! All in all, though, it was a very productive day. We also calculated back pay and construction costs, and found that STS owed almost $1500 (included construction costs, November, December and “Christmas” pay-which is standard practice), and realized we needed to return to Port early to take out money from the ATM both Sunday and Monday (withdrawal limited to 300$ per day per account). I simply must get a BanPro account so it is easier to send money to Nicaraguan employees.
Sunday Dec 21st, off Polancio’s porch and into the dental clinic so it would be safe until the bodega is finished. Since the building is just wood (not concrete block), one of the members of the construction crew will sleep on the porch until Polancio returns home and the inventory can be stored safely in the new bodega. left for Puerto Cabeza and spent the rest of the day doing errands (banking, planning the supply list for the annex we are going to build for the clinic to use as a sleeping area, practicing how to use Facebook and email). We left for Port about 11:30 am and arrived, overheated and stiff, 4 1⁄2 hours later. Since all the stores were closed, Polancio and I spent time working on setting up a Facebook account so he can post photos of people treated at the clinic.
Monday Dec 22nd included purchasing a generator and various other construction and clinic supplies, opening a bank account, and pulling out the money I had previously sent to Polancio and Clara. Of course, though, all our availble time got eaten up dealing with bank business (UGH-the Nicaraguan banking system needs some upgrading). When I boarded my flight, I sent Clara and Polancio back to Bilwaskarma with a list of things to buy before returning to Bilwas, the most important of which was the generator to run the compressor. I also sent money to cover all back pay and a bit more to cover upcoming construction costs for the “bodega.” We will wait to build the annex until I have a better feel for what payroll will be this year. We have planned to have the first week of every month be a “Dental Brigade” to outlying villages. Other weeks will have some kind of set dental schedule. Extractions for children will always be free. For adults, it will cost 20 cords/tooth. We have yet to determine the was a day devoted to organizing inventory and educating promoters. The day started early at 5:30 am, as all the inventory had to be moved we rushed around trying to accomplish our final “to-dos” which cost for fillings, but definitely want to encourage prevention over extraction, so we will make it as low as possible. We do need to look into possible donations of glass ionomer and amalgam.
Top priorities now are to:
- Find a dentist who is interested in this kind of work and willing to teach our dental techs the finer aspects of dental care. The Nicaraguan school of dentistry seems to be slightly less focused on patient comfort, and we want our patients to be as comfortable as possible.
- Find a donor for internet for the village
- Find extra funding for program growth. We are growing, and it is good growth. The program is actually working.
I hope to have my next trip be in 4 to 6 months. Please contact me if you are interested. It is a great opportunity for anyone who wants to help and doesn’t mind sweating, outhouses, and long days. Really… it is fun!
Hanna Ekstrom CEO: Save Their Smiles
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