Navigate / search

Open Wide

Laura and I at an earlier time in our Honduran experience used to frequently walk by a dental clinic. The dentist there was very friendly and would wave and say hello as we walked by. We’d sometimes see patients going in or coming out. We thought it a bit surreal, however, as many of these patients had very few teeth, and the ones they still had didn’t appear very healthy. One day, the dentist invited us into his clinic. There weren’t any instruments or materials, save for a torturous looking instrument that was obviously designed to yank teeth out. The “dentist,” of course, was not really a dentist, and the “clinic” was not really a clinic. Were we appalled? Well, yes and no.

 

According to developed world sensitivities, having had professional dental care all our lives, and having been well-trained since youth in the importance of regular brushing and flossing, we would look upon this “dentist” and his “clinic” as archaic and barbaric. Our first reaction might be to call the ADA and have this man’s opportunistic practice closed down. But, this is not a developed world we live in, and perhaps we need to look closer at the context. There is no real dental care here, no programs to teach dental hygiene, and the term ‘dental health’ is an oxymoron. Yet, there are dental issues. People have toothaches. Given such limited resources and options, given a societal consciousness of dental care as pre-professional by developed world standards, what choices really exist? Extractions are the best, if not only, response to bringing relief. There are few voices to cry out against it. In fact there are all sorts of dental brigades that come to Honduras. They’re generally not here to raise the societal consciousness of what constitutes dental health and hygiene. Nor are they here to equip Honduras with the tools and skills to institute systems of periodontal professional care. They are here to pull teeth. So how are these US dentists any better than our friendly “dentist” at his “clinic?” Who is mimicking who? And how would one really go about making dental health a legitimate, sustainable reality in Honduras?

 

The answer is simple really. All you need is a generation of time and patience, a gargantuan amount of money and resources, professional and technical expertise readily available and disposed to assist, and Hondurans generously taking on an onerous mission that runs opposed to societal structures and practices. Am I being facetious? Well, yes and no.

Jan and Larry Tepe have dedicated themselves to making dental health a legitimate, sustainable reality in Honduras, particularly in the Frontera, for decades. They have garnered and directed the time, money, resources, and professional and technical expertise necessary to reshape the societal consciousness of what dental health is in Honduras. They have given it all away to Hondurans in whom they can do no more than trust will carry on an onerous mission. What a tremendous investment! Has it made a difference?

I suspect when Jan and Larry first started coming to Santa Lucia and Concepción, they did a lot of extractions. Through the decades, they have developed teams of dentists, dental students, dental assistants and hygienists, and other professionals to share in their mission. They also invested in Honduran professionals and dentists to slowly come to an appreciation and sharing of their vision and mission, working shoulder to shoulder. Jan and Larry were recently here again with Beth Deyhle, dental assistant in August. I suspect their time here now was qualitatively different than was their first experiences.

Today, when they come they work alongside two professional competent dentists, Dr. Idalia Ramos in Concepción and Dr. Flor Amaya in Santa Lucia, who run private dental clinics offering care that parallels quality care in the US. For all the years of Jan and Larry’s commitment, Dr. Idalia and Dr. Flor worked as employees of Shoulder to Shoulder. This year, Shoulder to Shoulder enabled the transformation of US subsidized clinics to private, Honduran enterprises. Jan, Larry, and Beth were here to support their work and not to impose their superiority. They are assisting them in obtaining the resources and the competence to manage their practices, and offering them training in promoting their practices as viable and sustainable. Dr. Flor and Dr. Idalia are in turn changing the societal consciousness relative to what constitutes dental health and making it possible for all persons to gain access to quality dental care. The work is not done. Decades have already been committed and further decades will be necessary, but substantial change has already taken place and the foundation is laid for continuing the revolution.

“Open wide!” That’s a loaded phrase, isn’t it? We’ve all heard it, reclining somewhat stiffly back in that odd shaped chair, a bright light blinding us, a bib alligator clipped around our neck, with the masked, white-coated person hovering over us. And we are anxious to what will be found when we open wide and expose ourselves to sharp, probing instruments. But if we do not open wide, if someone doesn’t insist upon it, we see only the surface of things and our remedies for improvement are limited by what is never really looked at or examined. So, perhaps it is best to probe deeper, under the surface and into the cavities where the forces that shape and define us dwell. That does in fact seem to be the work of a dentist.  Jan, Larry, and Beth visited our bilingual school while they were with us. Our bilingual school children have benefited from free dental care subsidized by Shoulder to Shoulder for years now. The children smiled for them when they visited; bright beaming smiles of health, well-being, and confidence. All this now because Jan and Larry were not willing to simply look upon the surface. Rather, as the good dentists that they are, they voiced their demand. Open wide!

Noble

Laura and I love living in Honduras; we couldn’t be happier. Still, the differences between us and Hondurans, culturally, linguistically, and even physically, are sometimes highlighted. They are mostly simple things to note and they don’t present challenges, but sometimes they can remind you that you are the odd person out in this society. The sense of time and efficiency in systems often sets me reeling, and sometimes railing, as no one ever meets my standard for punctuality. Similarly, my sense of personal space and privacy is frequently undermined as others barge in on my protected territories. High school and grade school students who we pass everyday huddled in groups of five to ten try out their limited English on us. They always wait until we pass when we’ll hear the brave one among them voice a “Gud Mowning.” We’ll turn and smile and respond, “Good Morning, How are you?” They all giggle and a few others will join in with more comically enunciated good mornings. This will continue back and forth four or five times dispersed with the adolescent giggles. It’s a recognition of our differences under a certain amount of insecurity, but also a transcendence that the differences are not insurmountable. There are so many other things that betray our difference. We dress different, eat different, stand and walk different. The cadence of our speech, the way we act and react, and the way we think all define us as the ones who come from some other world. We change as we live among the differences, sometimes adapting to new ways and sometimes not, but we will always be recognized as outside looking in.

MAHEC brigade members at the bilingual school
MAHEC brigade members at the bilingual school

I was observing the medical service team MAHEC (Mountain Area Health Education Center, Asheville, North Carolina) a few weeks ago as they arrived in our little town of Camasca. They came as a twenty-three person team, working hard, visiting distant smaller communities every day, offering health care, delivering workshops in adolescent wellness at the High School, and sharing with the younger children at our bilingual school. Such a strong presence in such a small community like Camasca is hard to miss. Because Laura and I were particularly busy during the time they were here, we didn’t so much involve ourselves with their activities as watched them from a distance. I noticed them perhaps as a Honduran would. I saw them walking down the street from our street-side porch, dressed in their blue scrubs, walking very fast and purposely, presenting a different aura than I was accustomed to seeing on the street. They visited our porch most mornings as they could share our WiFi, check email, and post pictures on Facebook. I chuckled to myself to think of them as a herd of cattle of an unknown species that had wandered into our meadow. Still they were all well welcomed, honored by a sense of gratitude by their hosts. This, however, seemed somehow more than simply the thankfulness for their service. There was something noble about their presence that I could not define. I found myself thinking about this, trying to figure out exactly what it was, while they were here among us.

At the Camasca Health Center
At the Camasca Health Center

On one of their days, they were visiting a small community called San Juan de Dios.  The mayor of our town, Julio, had lent a few of his pick-up trucks to the brigade, and on this particular day, he himself had driven them to the clinic site. Laura and I weren’t with them, but it happened we were in the same area visiting families benefiting from our nutrition program, MANI. Driving on the main rock/dirt road, we saw a man in a dress shirt, cell phone to his ear, and shovel in his hand. As we approached him, we recognized him. It was Julio, the mayor. We stopped and talked. He was filling in the ruts on the road, channeled out by the hard driving rains. He was doing this in preparation for the return trip with the brigade members who would ride in the bed of his truck. It was a humble gesture of gratitude, commendable in and of itself, but again I felt there was something more profound in that visage. Again, I felt there was something of great value in these acts, in this interchange. It was elusive, but again the word “noble” came to my mind.

 

Laura and I were present at MAHEC’s going away celebration. There was cultural music and dance, a festive spirit. There were speeches in gratitude of MAHEC’s generosity and service. Then our mayor, Julio, got up to offer his words. He recalled some of the time he had spent with the MAHEC team while they were visiting the outlining communities and offering medical care. He began to recount a particular house visit and became emotionally choked up. They visited an older couple, very poor and very frail. They were most certainly coming to the end of life’s journey. There was nothing that the team could do for this couple, medically, but they shared their time with them, sat with them in their house by their bedside. It was this that moved Julio to tears, and he noted that next year when MAHEC would return, this old couple would likely not be with them. But for Julio this visit was of exceptional, incalculable, ineffable value.

 

Listening to Julio, I then knew what it was that I had been struggling to understand and define while MAHEC was visiting Camasca. Indeed, it was their presence that was noble. At first glance, this group of medical missioners from the US presented as so foreign. And so they are. But we can all get beyond that in deference to the reason they had come. In the second instance then, we can give them credit and gratitude, for the great and generous service that they offer. This, perhaps, would be enough. Yet Julio was moved by something else at a moment when no service was even possible. This is a moment when differences are neither noted nor have any meaning. This is a moment in which service —  who is the giver and who is required to be grateful —  is also of no import. This is a moment when all judgment is discarded, and what remains is the value of human caring. This is noble.

Witness

Writers are dependent on muses who are often fickle and unreliable. Sometimes, after a medical mission trip, I suffer through the anxiety of not finding inspiration. On other occasions, I simply find myself too busy to dedicate the time to writing up an article. Both problems haunted me after the Brown/Wingate medical mission trip that recently took place in Guachipilincito. August presents as one of those months were the stars align in such a peculiar manner that everyone wants to be in Honduras. Another brigade followed on the heels of Brown/Wingate. The funder for our very extensive and ambitious nutrition program, Mathile Institute with its representative, Greg Rheinhart and his wife Becky, came to the Frontera to visit the families and children benefiting from the program. We are investing in a major expansion of our education program among area schools. And finally, the Board members of our organization came to Honduras for a meeting. With all of this happening at the same time, Laura and I were caught up in the whirlwind.

Dr. Emily Harrison and Moises Vallecillo, Brigade Coordinator
Dr. Emily Harrison and Moises Vallecillo, Brigade Coordinator

Meanwhile, I was feeling great anxiety over not publishing a blog on Brown/Wingate. Additionally, one brigade participant, David, a talented pre-med student, had extended his stay in Guachipilincito to complete additional service among the community. Laura and I had no time to look in on him, or to wish him happy birthday as it had passed during his time there. But this Wednesday, we were transporting yet another brigade from the Frontera back to the airport in Tegucigalpa. We stopped in Concepcion to pick David up along the way to bring him back to the airport as well. He had been in Guachipilincito over a month so we figured he had a lot of luggage. Our brigade coordinator, Moises, and I jumped from the bus figuring we would need to assist him with his baggage. What an amazing site! David walked towards us, a light backpack strapped to his back and a water bottle and hat in his hand. He looked as if he were going to the corner store, rather than taking an intercontinental journey. The sight of him froze me in my tracks, and I knew there was something of tremendous value in this visage upon which I would need to reflect.

“Take nothing for your journey, no staff, nor bag, nor bread, nor money; and do not have two tunics. And whatever house you enter, stay there, and from there depart. (Luke 9.1)” Fear not, I do not intend to preach, at least not in any religious sense, though I used to do that for a living. I might have just as easily said, “I have always depended on the kindness of strangers (Scarlett O’Hara in Gone With the Wind).” David’s confidence, his willingness to shed the false security of things for a conviction in the goodness of relationship, is a witness of which I and the world have great need. Here I am running around for the past three weeks, investing in the complexities of negotiations and intense communications, carrying a ton of baggage both literally and figuratively, and this young man walks lightly and lithely among the humble people of Guachipilincito. Whose journey has more meaning? Who has touched upon the beauty of humanity? Who has witnessed the miracle of compassion and generosity?

Patient Consultation at Guachipilincito
Patient Consultation at Guachipilincito

 David symbolizes the greatness of many of our brigade experience, and most especially that of Brown/Wingate. Our brigade groups arrive with loads of supplies at the Tegucigalpa airport, bins of medicines and supplies that make their way through customs and are packed into transport vehicles to journey into isolated territories where the people are resourced challenge. The groups have paid extra to move these items and it has cost them time and energy for planning and execution. We place great value on the things we tote, while we essentially ignore those who do the toting. But when these groups leave, they are unburdened, having used up or gifted the supplies. They are depleted, or seemingly so. Yet, I would contend that they are the ones who have been enriched as much if not more so than the ones who have benefitted from their service and generosity.

Nutrition Committee Meeting
Nutrition Committee Meeting

Brown/Wingate saw hundreds of patients, gave away hundreds of dollars of medications, trekked across step winding paths to visit the elderly and infirmed confined to their distant homes, fulfilling their well-planned mission of compassionate service. They unburdened themselves with the absolute joy realized in generosity. Giving presents as an exercise in addition and subtraction; something taken away from one to the corresponding gain of another. In fact it is an exercise in multiplication where value expands exponentially. I wonder sometimes who benefits more from generous compassion, the one receiving or the one giving? Then again, even that is my need to judge and quantify as if even compassion becomes a measured competition. Perhaps it is only the matter of walking joyfully unburdened.

In the Pharmacy
In the Pharmacy

Thank you David and thank you Brown/Wingate. Thank you Guachipilincito. All of you have given witness of the beauty of humanity. How enriched we are when we realize how little we need.

Happy Birthday, Estados Unidos

Feliz cumpleaños, Estados Unidos! On Monday, July 4th, the American volunteers (Matt, Kate, Ben and Mr. Yon) thought that a lesson on U.S. independence was in order. Accordingly, the four of us spent the day going from class to class offering special lessons on why the United States celebrates the Fourth of July.

The kids had a great time with the special activities. With the chiquitinos (youngsters) in Kindergarten, we had a special lesson on the American flag. The kids, who are very proud of their recently acquired familiarity with the English color spectrum, memorized that the flag is red, white and blue in a heartbeat. Next, they got to show off their artistic prowess and drew their best rendition of Old Glory.

Presentation of Flags
Presentation of Flags

Since the flag activity was such a hit, we did the same with the first graders. We also thought that we would test their arithmetic, as we challenged them to tell us how old the United States was this year (they were mind-blown when they figured out that the Fourth of July was the U.S.’s 240th birthday—que viejo!).

With the second and third graders, we pursued a different activity. We had them play the “Game of Georges,” in which half of the class got to pretend that they were Englishmen and the other half American colonists. The pseudo-Englishmen had (probably too much) fun bossing around their colonial counterparts, and the American colonists clearly felt some just satisfaction in declaring their independence at the end of the game. Throughout our lessons with the older kids, we were sure to draw upon the similarities between the Anglo/American divorce and that of Spain/Honduras.

It was a fun, educational Fourth of July, and the kids walked away with a good history lesson and some even better artwork.

Volunteers

We presently have five volunteers at our bilingual school. Thabi, Ben, John (Mr. Yon), Kate, and Matt are having a great time and an incredible, meaningful, life-changing experience. We are tremendously proud of them and grateful for the incalculable gift  they give to our students. Our children will remember them as friends for a lifetime and they will learn to converse in English. Our volunteers may never truly understand the significance and value of the time they have given.

Thabi and Kate will be with us through the end of the school year in November. Matt will soon complete his five weeks with us and we will dearly miss him. It has been all too short and we hope he can return. In mid August, Ben and John will complete their tour with us. On the day of their travel, Alex will be arriving to join Thabi and Kate for the remainder of the school year. We have had an incredible year with volunteers of all ages and backgrounds. What they have had in common is a generous heart open to enriching, life-changing experiences. We thank them!!

Volunteer Matt Tibbits
Volunteer Matt Tibbits

If you would like to read about Matt’s experience at the school, he posts a blog at Backpack Matt.

We are in need of volunteers at our bilingual school for the 2017 academic year from February through November. Find out more about our volunteer opportunities at http://shouldertoshoulder.org/volunteer-opportunities. You can also write us at Paul and Laura with any and all inquiries.

Be Part of Something Revolutionary

The Unexpected

As I am writing this, Laura and I are on vacation in the US. We have, as always, an incredibly packed agenda. We started out in Denver, three days, in order to visit Laura’s son Gregory, my cousin Kevin and his wife Dolores, and their son Alex, who will be joining us for three months in August as a volunteer at the bilingual school. We also managed to tour the Rocky Mountain National Park at 13,000 feet. Breathtaking! Now we are in the greater Springfield, MA area to catch up with family and friends. So in four days we’ve traveled over 3000 miles. Everything has happened exactly as we planned it. Just this morning I realized that is what is putting me just a little on edge. There haven’t been any surprises. I’m not used to everything falling together as planned. I’m thinking something is wrong.

Brigade Members at Hotel in La Esperanza
Brigade Members at Hotel in La Esperanza

Efficiency is so highly valued in the US. But sometimes it is the unexpected, and the way we end up dealing with it, that identifies and marks us.

 

Virginia Commonwealth University, Fairfax Family Practice Centers, and the organization SAGE (Student and Global Community Engagement) that they have founded recently visited the clinic they built and sustain in Pinares, San Marcos de la Sierra, Honduras. They came with a thirty person team. Though that was a bit large for them and presented a challenge, they have done this so many times they have learned all the routines. They know what to pack. They know what to expect. In the week they were here, they managed to visit many of the outlining communities and assess the health needs of the children living there. They provided medical and dental consults, physical therapy, and a mission to maintain clean water in the small communities. They do incredible work with precise planning and expertise; a model of efficiency at its finest. Still, this is Honduras, so something will have to go wrong.

Brigade Member with Happy Kid at Portillo de Norte
Brigade Member with Happy Kid at Portillo de Norte

It was not a desperate phone call, but our brigade coordinator, Moises, had a hint of urgency in his voice when he told us the brigade was running out of meds only half way through their week. It wouldn’t be a problem, we planned on visiting anyway. We would pick up the meds they needed at one of our main clinics, and if we couldn’t find everything they needed, we could drive them to La Esperanza where they could purchase them. But before he hung up the phone he also told us a five year old had to be transported to the hospital in La Esperanza. He had a broken arm. Also not a problem, we could get him there.

None of that was expected, but still it was a relatively easy fix. We got most of the meds. Chris and Logan would travel with us to La Esperanza to pick up the remaining meds. Our doctor/translator Jose would accompany our young man with the broken arm and his mother to the hospital. The hospital is always busy, and I worried that it might be all day, if not until the next, before they actually treated the broken arm. But we dropped the three of them off at the hospital and asked for a telephone call to update us. We found the remaining meds, and to my surprise got the telephone call that the arm had been cast. Dr. Jose also realized they might be waiting forever. He simply asked them to show him where the plaster was and he cast the arm himself. Everything was done within a few hours and we were on our way back to Pinares, mother and son in the back seat of the pickup with Jose, Chris, and Logan riding in the bed. This might not have been the most conventional means for supplying meds or setting a broken arm, but all things considered, rather efficient for Honduran standards. But then we offered mother and son a ride back to their home.

They had walked in the morning to the clinic at Pinares. She said it had taken them two hours, which is more than the typical “one hour” pat answer to that question. In fact, it took me almost an hour to arrive at their home in the car. Admittedly the car is not that much faster than walking considering the terrain over which we travelled, but walking this could not have been less than three hours. Now think about this. A mother walking with her five-year-old son, walking for three hours up and down mountains and over rocky terrain, walking with her son whose broken arm is neither set nor cast, and now perhaps we can understand why efficiency is not necessarily a prized value here. Their response was nothing more than gratitude.

VCU, FFPCS, and SAGE have once again done tremendous work at the clinic in Pinares. They prepared themselves well and followed an ambitious schedule. But it was what they did on the fly, for which there are no plans, that exemplified their unique style of compassion.