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Pulling teeth in the Andes

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Give a man a fish; feed him for a day. Teach a man to fish; feed him for a lifetime.” One of the most widely recognized proverbs comes from the founder of Taoism. I had never really put much thought into those words until this past summer when I was given the unforgettable opportunity to be a part of a MEDLIFE mobile clinic in Cusco, Peru. To say it was eye-opening would be a great understatement.

Leaving for the trip, I didn’t know what to expect. I jumped from one scenario to the next, trying to envision how each clinic would look like or what I would be tasked with.

The setup of the clinics was simple enough. All of the students were split into three groups, and each day, we would load and board the buses by 7 a.m. One group would be taken to the development project ( such as building a bathroom for an elementary school in the small community of Ccaccaccollo), while the other two would each run a clinic in nearby mountainous communities, where access to medical care is not readily available. It took two hours to drive up treacherous dirt paths barely wide enough for a single bus. One could only imagine how long the people of the villages would have to walk just to get basic medical care.

At the dental stations in each community, I didn’t see a single person with less than ten cavities, and the number of children with cavities so large that the tooth was practically gone was heartbreaking. In assisting the dentist, I was able to witness seven complete tooth extractions under barely any anaesthesia. While the lidocaine was always injected generously, it was impossible not to notice the tears building up in the eyes of children hardly over the age of ten, as the dentist jammed a root elevator into their gums, loosening teeth that were still intact. The patients never made a sound, even when the dentist moved on to forceps and with pure force, pulled the tooth out. Many times, the teeth were rotten to their core and simply cracked in half when the dentist applied force. The dentist had to go in a second time and attempt another extraction in hopes that they would not further break into smaller pieces. Watching the blood flow freely from such an open wound was both mesmerizing and repulsing. I remember wanting to look away or cringe, but I was frozen in place by the unbelievable surgery in front of me. I kept trying to imagine my own trips to the dentist, but my experiences paled in comparison, and the most that I could do was to keep a solemn expression. The dentist would smile with words of encouragement to the patient, admire his own handiwork, and wave the next patient over.

Aside from dentistry, there were also doctor and OB/GYN stations at each clinic. Patients came through the door with varied ailments, and even with the language barrier between English and Spanish or Quechua (a native South American language), the doctors tried their best to explain every patient’s problems to the students. There were simple coughs, to full-body dermatitis caused by scabies, to various fungal infections, to parasitic worms. With every patient, the doctor would write a script for whatever medication they needed, and they would be able to pick it up at the pharmacy station.

While the patients waited to see a doctor or the dentist, they could sit in the education station and watch videos, which gave information on a wide range of health issues such as breast exams, further dental precautions, and general hygiene care.

As a developing country, Peru has faced political unrest and fiscal crises since gaining independence in 1821. Although the country is still classified as a less-developed country due to its Human Development Index, living standards, and undeveloped industrial base, there have still been periods of stability and strong economic upswing. One of the most telltale signs of a developing country that I noticed was that there was a big gap between the wealthy and the poor in Peru. It was almost as if the middle class did not exist. Peruvians seem to be either extremely affluent or impoverished, with the latter group left without access to basic healthcare. Unequal distribution of income is one of the main roadblocks in Peru’s current system, as it produces a large gap in education, which has proven to result in many other problems.

Because of this lack of quality education, poorer communities are not well-equipped with knowledge regarding preventative health practices such as tooth brushing and frequent mammary examinations. Unaware of health-related warning signs or symptoms, people will usually ignore minor problems until they become extremely serious, as was seen in the full-body scabies cases. Many of the patients I saw had issues that were either easily preventable or could have been easily cured when the early onset of symptoms were noticed.

An uneven income distribution also results in a lack of proper infrastructure, including roads, sanitation, and stairs for the mountainous communities. This means that they will not have easy access to hospitals until the city expands towards them. Without these fundamental backbones of development, the children of those communities will not have access to quality education and thus the cycle will continue.

In its focus on information, MEDLIFE is ensuring that, in addition to free and immediate medical aid, the rural communities are also aided through education and development so that, over time, these communities will gain access to a gamut of services and be able to thrive on their own.

Immediate care is important for any emerging community, but without a change in the structural causes of poverty and a development of infrastructure, health outcomes in the area are not likely to improve.