EL SALVADOR - DAY FIVE: SAN AGUSTIN SUCCESS

Well, sometimes things just don't work out the way you planned. Some logistical challenges on the ground here in El Salvador meant we didn't make it to Verapaz today but instead set up shop in San Agustin.

We didn't "get the memo" until we were on the bus at 7:30 this morning, thus the misinformation on the blog last night (sorry about that!). Like Joya Grande, the site of our second clinic on Tuesday, San Agustin is another struggling village on the shores of Lake Ilopango. But it took longer to get there, over more treacherous, winding mountain roads with near vertical 500 foot drops just inches from the bus.

We were once again in a school with Distribution, the Pharmacy and Dental set up in one classroom each, while Medical operated out of two classrooms - all connected by a central open corridor that quickly became congested with local villagers within minutes of our arrival.

Fascinating and heartbreaking stories surfaced in every room and we did all we could to ease their pain and lift their spirits. And, as usual, we found that the people we served lifted ours as well.

Just four weeks ago, 21 year old Yaneth suffered third degree burns over her arms and back from an electrical fire that burned her house to the ground in minutes. Amazingly, she had received no treatment at the time. Dr. Channy provided her with Opsite dressings, saline and other cleansing products as well as antibiotics and Polysporin.

Dr. Tony visited with 4 year old Genesis who's lighter hair colour, empty, lifeless eyes and listless behaviour indicated malnutrition. After a trip to the Pharmacy, the family was taken directly to Distribution to receive food supplies. And so it continued...

The Dental unit is always busy with long line-ups throughout the day... and for good reason. The drink of choice of every village family is pop - it's the cheapest drinkable fluid available. To make matters worse, most can't afford toothpaste. Kids drink Coke and orange pop from morning to night. The majority of children have rotted teeth by the age of six. It's a heartbreaking tragedy that recurs with every generation - and there's no end in sight.


Our team of four dentists and their dental assistants leave the hotel an hour earlier than the others as their sophisticated portable equipment requires an hour of set-up time. They're up and running by the time the rest of the team arrives - and they don't stop until they've seen every patient. Their "nobody goes without care" commitment means they don't stop for lunch and they don't take breaks, working right through until everyone's been seen.

There are five chairs for four dentists yet that fifth chair is always occupied. Dentist, Dr. Jack, a veteran of FTC Central American Medical-Dental Teams, says, "Local anesthetic takes time to work, so we minimize downtime by jumping to another patient while we wait. It's all about efficiency - we owe it to these people to really deliver on our primary care promise."


Dr. Mark confirmed that fillings, extractions and root canals are the most common procedures performed. And these dentists are fast and efficient while not compromising the quality of care. Fillings and extractions are performed in minutes while root canals take longer. Today, at San Agustin, the Dental unit treated over 100 patients. One of them was 17 year-old Luis, who had never been to a dentist in his life.

Luis top front teeth had decayed to the point that he was embarrassed and self-conscious. Dr. Mark weaved his magic and, in no time, Luis had new white fillings and a million dollar smile.


Meanwhile, Dr. Domenic, our root canal specialist blew a bulb in his overhead light and had to resort to a headlamp but still didn't miss a beat. Dr. Mimi, a local dentist, worked quietly in her corner seeing patient after patient all day long. Critical support from dental assistants, Odalmis, Iris, Melissa and Michelle (two of whom speak Spanish) mean patients receive care quickly and efficiently. This team really performs.

Here is one final story that effectively sums up the quality and character of this critical unit. A young girl was in the chair, ready for several fillings. On the surface, she looked comfortable and unafraid, but Dr. Jack could see in her eyes that she was nervous and needed a little reassurance.

Dr. Jack grabbed a cotton swab and reached for the topical anesthetic which is used to numb the gums. Instead of proceeding, he put the swab in the young patient's hand, had her dip it in the topical anesthetic, gently took her hand in his and, together, they applied it to the appropriate areas. Engaging the patient and having her play a role in the procedure put her at ease and built trust between two people who had never met and won't likely meet again.


We've provided care to over 2,500 patients in three days. As often happens in high-stress situations, we've really bonded as a team. Dinners have been a great release after the pressure of a chaotic clinic. There's lots of storytelling and lots of laughter. We've got the day off tomorrow to recharge and prepare for our final two clinics including our Saturday visit to Somalia, the massive slum in the middle of downtown San Salvador. May we do some good there too.