When wandering here, do not pack curling iron

Charitable journeys to the earth`s far corners fulfill hygienist`s hunger to demonstrate good will.

Cathleen Terhune Alty, RDH

"I`m probably the least likely person you`d ever expect to see on a medical mission to Venezuela. Roughing it to me means no microwave. My luggage contains blush, mascara, a curling iron, and designer scrubs ... It was really difficult to pack because I wanted to be prepared for as many situations as possible."

So begins the first entry in an insightful travel journal belonging to Sue Biewer, RDH, of St. Clair, Mich. Although her first trip to a third world country found her packing several items that were not very practical, Biewer has now made three trips overseas to work as a dental liaison in short-term medical mission teams to Guatemala and Venezuela.

Other health care professionals take similar "vacations" every year, volunteering their time and talents as part of medical teams traveling to third world countries. It`s certainly not Club Med, but it could truly be the trip of a lifetime.

Biewer got involved with a medical mission team through her church. The 1979 graduate of the University of Michigan said, "It was the dream of one of the parishioners to do short-term medical missions in the more remote areas of Venezuela. They expanded the focus of medical missions to also include dentistry, so I got involved."

Biewer`s first mission trip to Venezuela was an eye-opening experience for her. In her detailed travel journal, the essence of her experiences are captured.

"I`m the only dental team member of the team. Basically, I`m going down there with no job description. My job will be whatever I can make of it ... Besides basic dental education, my goal is to assess the dental needs of these people ... I will probably do some calculus removal. We`re taking lots of toothbrushes. Many of these people may have never seen one before. Medical care is rare in these areas, but dental care is virtually non-existent."

Once Biewer realized that she would be the only dental professional going on the trip, she immediately began to seek out training to learn how to do more traditional dental services.

"I knew there would be some dental needs which weren`t exactly in the normal parameters of dental hygiene practice," she said. "So I asked a dentist who was a friend to teach me everything he could about oral surgery in the month before I went. He showed me what to do but I could not practice what I was watching. He gave me two universal forceps, needles, and anesthetic to take along with my dental hygiene instruments."

When the team arrived in Venezuela, they traveled over rugged terrain and by boat to reach the people, carrying their supplies with them.

"Our trip down the river ... was almost like what you would see in the movies ... There were families living along the banks of the river in bamboo huts or lean-to types with thatched roofs. Some people wore clothes but others had none. Most of the children had no clothes or only shirts. There were people in dug-out canoes collecting bananas from trees ... The village in which we arrived ... had a fairly large cement block building ... It would be inconceivable to American standards to even think of setting up a clinic in this building but we did. This was all the people had. They were in such a remote area that the chance of another medical team visiting in the near future was next to none."

Biewer said that they would set up a clinic for a day, screening and treating patient`s medical and dental problems as best they could. Then they would pack up and move to the next village.

"We traveled like a MASH unit, visiting small villages along the way. Some of the places looked just like the pages of National Geographic magazine! There was no electricity or running water, and we were often the first Americans allowed into some of the more remote areas."

"The bathroom was `almost` an outhouse. It had `almost` four walls and a hole in the floor that emptied directly into the river from which the people drink, bathe..."

There were no dental chairs or what some might consider basic equipment. The patients sat in a straight-backed chair while a member of the team held a flashlight. A metal bucket was the cuspidor. "I used a bulb-type syringe for water, and a foot pump used for blowing up air mattresses was the air syringe," she said.

Biewer expected to see people with some dental needs. But she was surprised at the amount of severe, untreated caries due to the natives chewing on raw sugar cane and even drinking the often available Pepsi-Cola.

"Decay is a major problem here due to chewing on raw sugar cane. Periodontal disease also seems to be a problem. The mortality rate for children here is 50 percent."

She said, "There were so many people in dental pain. There was no one coming behind us to help these people so I began to help them in any way I could. If that meant extracting teeth, I did it to the best of my limited ability. If you can picture doing something you`ve only been shown - and there was no one to ask if you`re doing it right."

"We arrived at the village about 8:30 a.m. and took a half hour to set up. There was a line of people waiting to see us ... after their medical work-up ... I finally got to see some people. At first I saw just a few children individually. I explained the caries process and the reason for a good diet low in sugar. Then I gave them toothbrush instruction. I did clean the teeth of a girl ... about 20 years old. She had a badly decayed maxillary anterior incisor that needed to be removed - she wanted me to do it - Oh no! My first extraction!"

Word of the medical team`s arrival traveled quickly from village to village. The people were so happy that someone was coming to help with their teeth that long lines began to form. The medical team`s work was often used as a sort of bait to get the people to hear the team`s evangelism message.

"At the next village, there were a lot of patients ... waiting for me. First I removed a first and second bicuspid on a woman. Both teeth had double roots and they were quite long. After I saw them I was amazed that I was able to get them out. After that I think I may have been a little too confident. The next extraction didn`t go as easily ... I`ve lost count of how many teeth I`ve extracted so far but I`d say it`s around 35. I had some children with abscessed teeth and some adults with very large cavities that were hurting them ... I can`t believe how wonderful these people are to work on - they tolerate anything. With all I`ve been through today I can see the futility of my curling iron and makeup but old habits die hard."

Biewer did perform more than just extractions. She also was very involved with toothbrushing instructions in every village. She reports that some children owned nothing but their new toothbrush.

"I did some group instructions with the children. Giving individual toothbrush instruction seemed to be much less efficient. The kids loved doing it as a group! I spoke to a Spanish interpreter who spoke to a Waraw interpreter who spoke to the children - it took awhile. Then they were each given a toothbrush - they had never seen one before. I applied fluoride to the brushes and instructed the children to brush their teeth while ... I observed and assisted. Then the children all spit on the ground at the same time - they loved it! In no time we had more groups of children wanting toothbrush instruction - some didn`t even have clothes - but now they had a toothbrush!

"After lunch we went to the school in the village and gave toothbrush demonstrations to the fourth and fifth grades. We saw over 100 children today. Tomorrow we will see about 220 more."

Before leaving the country and ending the mission trip, the team was invited to visit a public hospital. Biewer`s journal best describes the appalling conditions they witnessed.

Materine, Venezuela: "Today we started out by taking a tour of the public hospital in Maturine. I didn`t think it would bother me as much as it did ... There were bugs crawling on the walls and window sills around the children in the pediatric ward. Bedding and eating utensils are not provided by the hospital. The family of the patient has to bring everything and stay to take care of their family member ... No medicine is provided for the patients - they must bring anything they need ... We saw some very sick children ... the filth in the hospital was almost incomprehensible to an American. The needless suffering is something you almost have to see for yourself to believe ... We`ve tried to help these people but we haven`t even made a small dent - yet. You have to start somewhere."

Safety was an issue that Biewer said she didn`t spend a lot of time thinking about on the trip. Although she left behind three young children and her husband, she found an inner peace and tranquility. The areas she visited were home to African "killer bees," piranhas, and sometimes hostile governments. "It is really hard to leave my children, and, if for some reason I don`t come back, I trust that God will take care of them," she said.

A safety issue that the team could control was limiting the risk of infection by wearing gloves, masks, and protective eyewear. These items were used extensively by the mission team.

Another challenge Biewer faced was cleaning instruments between patients. Because of the lack of electricity, an autoclave was out of the question. So the soiled instruments were rinsed and disinfected with a gluteraldehyde solution, then rinsed again with boiled water.

"It wasn`t a perfect procedure but compared to the conditions they live in, we did a pretty good job. We left gluteraldehyde with the local villager that we trained to do dental work. When he runs out, he was instructed to use bleach tablets, available from the larger cities, to disinfect the instruments."

Biewer recently returned from her third trip overseas where the mission team stayed for two weeks in very remote Las Pacayas, Guatemala. This rainy and cool village is home to about 850 people.

"This was, by far, my most exhausting trip," said Biewer. "A dentist accompanied us on this trip, and he performed the extractions and trained a person in the village how to perform extractions as well. The first time I went to Las Pacayas no one even knew what a cleaning was. This trip, they were lined up and I actually had to turn people away. I performed 112 prophies in seven clinic days. The last day my hands were swollen. But our equipment was better because we had a real dental chair, a generator, and other more modern conveniences. The best part was that I could see the changes from the last time I was there. People were taking better care of their teeth.O

All of this mission work makes Biewer determined to help the less fortunate in her hometown. Her goal is to have a dental hygiene clinic for the homeless of the county where she resides.

ODentists in my area will volunteer to do emergency care at reduced rates for the homeless, but there is no system like this for dental hygiene. A person could donate one day a month and really make a difference in her own corner of the world.O Legislation has been introduced in Michigan (and in other states) that may make a clinic like this a legal reality.

For now, Biewer is going where the opportunity is, even if that means overseas. She encourages fellow dental hygienists to join her.

OYou?ll see things you?d never see as a tourist,O she said. OTourists are despised. As a health professional, you are recognized as being there to help their people. They welcome you and even allow you into their home.O

OI used to feel guilty after being on a mission trip. Here I am with so much and there are these people who have so little. Now I feel thankful for what I have. These people don?t realize they have nothing. They want the same things we do ? the things money can?t really buy .. healthy children and a little higher standard of living. They don?t want a car or a house or any other of our things. We didn?t go to Americanize the people. We were just there to help. They don?t want to be like us.O

Cathleen Terhune Alty, RDH, is a contributing editor for RDH and is a member of the Office of Sterilization and Asepsis Procedures Research Foundation.

Travel Agents for Wandering Hygienists To Contact

If you long for something out of the ordinary, crave adventure, want the chance to see parts of the world few people have ever seen, and would like to help a small part of humanity all within a week or two-week vacation, you can join the growing ranks of dental professionals who choose to volunteer their time to help those with dental needs of every kind.

Christian Dental Society

P.O. Box 177

Sumner, IA 50674

(319) 578-5137

Christian Medical Dental Society

1616 Gateway Blvd.

P.O. Box 830689

Richardson, TX 75083-0689

(214) 783-8384

Health Teams International

7518 S. Evanston Ave.

Tulsa, OK 74136