2005 Dental Adventures in México   
by Joe Bulger DDS

In 2005, Rotary International celebrated 100 years of giving. Our own Etobicoke Rotary Club (located in in the West End of Toronto, Canada), celebrated our 75th year.

On the 12th of February 2005, my 19-year old son David and I flew down to Huatulco to join Ara Run, a fellow Rotarian from Toronto. We had no idea what to expect, and my son had no experience in dental assistant.

Welcome to Mexico – what's in the box? At Ara's request, we brought along two large containers of clothing with us – to be distributed amongst the villagers we were to be visiting. Sure enough, airport security took an interest in these large containers. Seems they wanted to make sure we weren't smuggling something into Mexico – which somehow seemed funny at the time.

Rule #1: Find shade! Once airport security decided we were harmless enough, we stepped outside into the light of day. Still dressed in clothing more appropriate for the Canadian winter we had left behind, we quickly realized we would soon melt like snowmen in the afternoon heat. So, we did the smart thing and stuck to whatever shade we could find as we worked our way towards the parking lot.

Toonies won't fly... Before I had left Canada , I had asked Ara about money, and if Canadian dollars were OK. He told me, “Don't worry, Canadian, American, they'll take everything.”

Well, the airport employee who helped us with our large collection of luggage took a long, puzzled look at the pair of Toonies I handed to him. I could see that my Canadian money wasn't going to be getting me very far.

Our gracious host. We immediately felt at home at Ara's lovely winter residence. Clean, spacious and equipped with much-needed cooling fans in each room. Ara was a terrific host, keeping us well fed and well rested the entire time.

My concerns of unsafe drinking water were quickly put to rest. The Coca Cola Company supplied drinking water everywhere we went (unfortunately for the Mexican people's teeth, they also supplied Coca Cola).

The left half is Ara's place. The rooftop patio included lush gardens and a fountain.

The hope of the handpieces. While we were taking stock of dental supplies, Ara presented me a small box containing a brand new set of German-made Kavo dental handpieces (many consider as the best available).

“Wow,” I thought, “this will be just like home.” Needless to say, I would be in for some surprises.

Our adventure begins!The next morning we were off delivering the dental trailer and our supplies to our destination – Barra de la Cruz– a modest village about 30 km. South of Huatulco. This community had a population of about 700, many whom had rarely, if ever, seen a dentist before.

The highway was a well paved, tortuous, winding pathway through hills and valleys. I discovered “tope” meant bump, and there were plenty of speed bumps along the way. Stop signs didn't work, but speed bumps always did. Fortunately, Ara seemed to have intimate familiarity with most of the bumps, and we were rarely caught by surprise.

Fashionable or not, I wore my seat belt and insisted my son do the same. Eventually I even had Ara buckling up.

The grand arrival. Rolling into town, we were surprised to see many of the townspeople there in the town square, which doubled as a basketball and volleyball court. The people seemed rather curious, thought a little uncertain of us – as we were of them at this point.

Where's the catch? These people were not all that trusting of outsiders. We were told of a few incidents where organizations had offered needed services to the community but only in exchange for something precious – such as beachside land.

The elders protect the community from what they perceive as the corruption of modernization. They weren't too sure about this whole Rotary operation.

Fortunately Ara had worked long hours behind the scenes prior to our arrival.

The first key decision. Where to put the trailer? We had a choice of the Town Square or inside the adjacent Town Hall. I stepped inside the building and found it considerably cooler than the stifling hot, completely exposed concrete Square. I made the easy decision and chose the Hall.

The only trouble was, we would have to get the trailer up a set of stairs. Ara, well versed in Spanish, spoke our intent to the curios onlookers and we instantly had many hands lifting the trailer up the stairs and into the Hall. There was no plan, no words spoken – at least that I could understand – we just did it. I felt the initial inkling of being a participant in this community. Not exactly raising a barn, but a spirit of cooperation none the less.

The veil lifts. Once we had the cover off the trailer, organized the supplies, placed the doctor's stool and assembled the dental unit, I sat down to develop a sense as to what would be my working conditions. It was readily apparent that I was going to spend the next five days working out of a shoebox– crammed into the back corner of the trailer with almost no mobility. On top of that, I couldn't speak a word of Spanish. “How were we ever going to pull this off?” I thought quietly to myself.

Step into our office... not all the comforts of home! (notice Ara's Ribfest cap on the table)

The dream team. The only way we could make this work was by working together as a team...

Ara drove, directed operations, and served as backup interpreter.

David was the setup guy handling dental materials and disinfection duties (sterilization wasn't an option).

I was the tooth carpenter who barked strange orders to the others – at least from the perspective of our Spanish speaking patients.

The key to it all was Henriette Claeys, our translator. She handled interpreting and served as my chairside assistant. She had previous experience working on projects such as offering cataract surgery to the blind. Even with almost no dental experience, she was a vital aspect of our team.

The show begins. Working out of a cramped trailer in a small Mexican town inside their Town Hall seemed strange and surreal to us. To the townspeople, this was pure theatre, and many gathered about to watch the show. People of all ages sitting around us and children peeking through the barred, unglassed windows. Some came for the care, some just for the show! There was a constant buzz of chatter, none of which I could understand. It was strangely exhilarating, though I felt somewhat like a circus sideshow propped up on a stage, performing tricks in front of an ogling crowd. Yet, this was their town, and we were rather strange to their world.

Test of the elders. The first patients eager to get started on Monday morning were a group of village elders. I had a sense we were being tested and I didn't want to blow the opportunity to make a good first impression.

An older gentleman climbed into the dental chair and I eagerly began asking dentally oriented questions while Henriette translated. The older gentleman soon warmed up to the idea that he had a willing audience and began telling long tales about his personal adventures with teeth.

Henriette was quick to realize that this wasn't going to work very well. So, I changed tactics – picked up my mouth mirror, had him open up, and took a look for myself. My first of many lessons – keep it simple.

Unexpected surprise. Turns out that first elder gentleman needed an extraction. Ok, that looked easy enough. I gave him some local anaesthetic and had him hop out of the trailer so I could see someone else while the anaesthetic took hold. Soon I had two others joining him, waiting for the anaesthetic to kick in.

I got the first señor back up in the chair and Harriet asked him about the state of his lower lip. Seems the freezing didn't take. “No problems, I'll give him another shot,” I said. Unfortunately that didn't make a difference, and the other two weren't numb either.

What was going on? Xylocaine with or without epinephrine – no dice on either. Expiry date still not lapsed. What could it be?

I realized the culprit had to be the hot climate. Ara had been storing the anaesthetic in his garage and the heat had gradually inactivated it.

The bad news. We had to tell the group of three to go home and we would try again the next day. Not an impressive start to our first day. I was worried we had lost much credibility with the elders and hoped they would give us another chance.

Turns out they were more worried about losing their place in line for treatment.

The hard decision. The rest of the first day we spent diagnosing and taking care of small problems that didn't require local anaesthetic. People often asked to have their teeth cleaned. They certainly needed extensive hygiene therapy, but we didn't have a single curette or scaler amongst our supplies. Ara and Henriette urged me to just polish teeth to keep the villagers happy.

I couldn't do it. These people needed real help, not an illusion of dental service. I made the decision to only offer examinations, basic restorative procedures, and extractions.

Local rules for dental care. This wasn't Toronto-style dental care. I had to make up some guidelines on the fly...

I had to rely on my clinical judgment to determine appropriate treatment. No X-rays, minimal symptom evaluation - simply take a look and make a plan. Fortunately, most people's needs were rather obvious.

Credibility restored. The next day we got back to work with a fresh batch of local anaesthetic. Lo and behold, the people's lips numbed as they should, teeth were removed, cavities were filled and we were up to full speed. We continued working out the kinks – adapting to our surroundings and making the best of what we had. At times we needed to get rather creative…

96% solution. We needed a quick effective surface and handpiece disinfectant. We picked up some 96% ethanol from a pharmacy in Hualtulco. The trouble was this was the beverage of choice for one of the locals who hung around us all week. We were always concerned our disinfectant could go missing.

The brushing lesson. We brought along some boxes of toothbrushes. They came in very handy as it seems many locals didn't own one. At one point, with school having just finished, a horde of children came in to see us. The first few children had rather unclean teeth so I figured it was a good time for a brushing demonstration.

I stood with my young “volunteer” on the front of the trailer and did a brushing demonstration for the crowd as Henriette translated. The children were very excited about their new toothbrushes.

A quick group lesson in oral hygiene – Henriette translating.

The community cup. I cringed when one of the local leaders insisted that we didn't need to change the rinse cup between patients – only refill it. It seems no one minded sharing the same cup. Harriet and I were somewhat appalled, but the show needed to keep going and the shared cup routine helped things along.

The universal instrument. Seems the local dentists in town liked a particular multi-headed instrument that served as an all purpose amalgam plugger, carver, and resin instrument. We had only one of those so it was kept in instant circulation through our rudimentary disinfection cycle.

As valuable as the instrument was, it frustrated me to no end. Using it as a resin applicator was particularly confounding, as it stuck much better to the instrument than it did to the tooth. My gloved finger became my smear tool to force the material down into the grooves. Henriette was sure I would eventually toss that instrument across the room. She was almost right.

Pablo the surfer. Henriette wasn't available for Wednesday. We got word that a local named Pablo, renowned for his surfing prowess, could speak English and would serve as our interpreter. I felt a sense of panic – imagining some drugged-out, long-haired, irresponsible rebel. That couldn't have been further from the truth.

Yes, Pablo was a surfer, and a world-class one at that. He was also highly intelligent. His devotion to his community along with his love of surfing kept him in this small town. He was a local hero and one of the community's most influential leaders.

Having this local legend interpret for us helped win further approval from the villagers. We liked him and he liked us. Credibility and trust were now much stronger. That meant further acceptance of us simply as good people there to simply help serve their community.

Pablo was a strong, fit man, in his early 30's. He organized adventure tours and spoke of surfing, white water rafting, mountain climbing. Though apparently fearless, he wasn't keen on watching any dental procedures. I thought we were going to lose him during a few of the extractions.

Strong teeth, bad diets. I felt like an anthropologist studying the dental conditions of a remote tribe. This was a unique perspective as most of the villagers had received little or no dental care up until our arrival. I was really impressed with how strong their teeth were. Unfortunately, many children suffered from rampant dental decay – the influence of a modern diet.

Coca-Cola was widely available to these people. The water truck was there frequently – bottled and distributed by The Coca-Cola Company. The trouble was, Coke was less expensive than water and many of these people were drinking it daily.

The mystery of dissolving teeth. I saw many villagers with severely eroded teeth, some right down to the gumline. This was particularly evident with the elders – who hadn't been as affected by the impact of sugar and Coke. Something else was doing the damage.

Turns out these people really enjoy eating limes and green papayas (highly acidic when less ripened).

Restaurant Shayla. The first day we declined having the lunch offered to us by the town. That was a mistake, as it didn't help break the ice. The second day we joined Fernando, one of the key leaders in town and one of our few initial allies, for lunch at a local restaurant named after the daughter of the restaurant owners. We treated Shayla like she was famous, and she kindly helped serve us lunch for the remainder of our stay.

We ate fish caught fresh that day from the local lagoon. David's fish still had the bait inside its stomach – a big fat grub. Other than that, the food was excellent and the stories about the town were fascinating. The tide was turning on the community's acceptance of us.

David and Shayla, with slight difference in tans. (notice the cola bottle on the table to the right)

The gift of acceptance. One of the villagers gave us a batch of homemade cakes – somewhat like big cookies. Not only did we enjoy the cakes, we appreciated the symbolism that the villagers were now truly accepting us.

The real treasure. For us, the real treasure was the people of this village. Perhaps they weren't worldly and sophisticated by our standards, yet these simple, straightforward, and above all, gentle people were a great pleasure to work for. They were always well dressed and kept their village quite clean. They were deservedly proud of their small community.

I was astounded and truly felt honored by the complete trust they were willing to put into our hands.
As patients, cooperation was terrific, and that was remarkable considering most had never received any dental care before.

This young mother was our last of 84 patients. Like many, she had never been in a dental chair.

The missing generation. It wasn't difficult to see the gaps in the village population. We saw mostly elders, mothers and children up to the age of fifteen. Older teens, young adults, and most of the men of working age were noticeably absent. As could be expected, the lure of city life and paying jobs drew this segment away, perhaps not to return to the simple village life.

Nearby, Huatulco is blossoming and this puts pressure on small communities such as Barra de la Cruz. We could sense the village was in a state of transition. We also had faith, based on the terrific people we met, that whatever happens, this community will do just fine,

The windup.All good things must come to an end. After working long hours, we finished up on Thursday and gave David the afternoon off to go surf with some of the locals. He deserved a break – this being his reading week from university.

Once again some of the men helped us carry out the trailer as other villagers gathered to watch. We stopped to say brief goodbyes to our many newfound friends. We left to a final chorus of “Adios amigos!” as we pulled away.

Our team was left with a deep sense of satisfaction for having done some significant good for this community – we had truly made a difference.

Pablo gave us the ultimate compliment in that after seeing the camaraderie, compassion and contribution of our group, he mentioned he would like to join the Rotary organization.

International fellowship – isn't that what Rotary is all about!

The simple life in Barra de la Cruz.	We enjoyed the laughter of beautiful children.
The look on this young face says it all!	Our team celebrates a job well done!

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2006 Trip