Extracting Pain vs. Inserting Wellbeing

Long before our arrival at Shoulder to Shoulder when Laura and I were contemplating living and working in Honduras, we took a few exploratory trips to discern where we might find a site. We attended a conference in Copan Ruinas for NGOs serving in Honduras. At this conference there were a number of folks who regularly came to Honduras on dental brigades. The dentists were bragging about the large number of extractions they had accomplished. The braggadocio with which they expressed their accomplishments gave me the sense of a gunslinger carving notches in the ivory handle of his pistol. It didn’t seem to us as if ripping teeth out of peoples’ mouths would be something that most dentists would celebrate. Yet, we were in the proverbial Rome, and we would do as the Romans.

Dental Brigade Team Selfie
Dental Brigade Team Selfie

Now having lived in Honduras for some time we can easily understand why the practice of extractions, particularly in rural areas among people of extreme poverty, is so common. Dental care is either nonexistent in remote areas or inaccessible for poor people. For most suffering with chronic pain from infections and other dental complications, extractions are the only option. The dentists that come on brigades to pull teeth are offering a service that is greatly appreciated. Yet, this approach has some terrible, tragic consequences. The more these extractions become available, the more dental care becomes identified with extractions. The notion that dental care is about prevention, hygiene, and regular professional attention is completely lost. Among poor people and in extremely remote areas of Honduras, ongoing, professional, dental care is considered unnecessary.
Dental Brigade in Full Swing
Dental Brigade in Full Swing

Whereas extractions might be graciously appreciated and absolutely necessary to relieve chronic pain, this is certainly not development. Actually, it is its opposite: stifling the opportunity for an understanding of the need for good, dental hygiene and ongoing professional service. It standardizes a substandard praxis that will never promote development. It is disrespectful, basically yielding to a belief that poor people do not deserve anything better than a compromised response. Why does this inequity exist? Why are we willing to relegate dental care to the pulling of teeth? Why is there little emphasis on dental hygiene and professional dental care? Why would we acquiesce to a notion of dental hygiene and care that would never be accepted in the developed United States? The answer to these questions is not challenging. It’s because it is the easy response.
Dental Brigade Visiting Family
Dental Brigade Visiting Family

Charity, commitment in service, and development are never easy, though perhaps we would want them to be. They require engagement and investment. They require partnering. They require appreciation and respect for the potentials among the people served. They requires years, lifetimes really, of time, talent, and energy. Shoulder to Shoulder, particularly under the leadership of Jan and Larry Tepe, envisioned something more meaningful and sustainable in terms of oral hygiene and care among the people of Southern Intibucá. Shoulder to Shoulder established dental clinics with professional full time Honduran dentist in order to create and sustain the development of a culture of wellness. The simple response would have simply been to yank out pain where it was found. The just response is to eradicate the insidious systemic conditions that create the pain in the first place. The simple response takes a brigade of limited time, involvement, and relationship. The just response takes a sustained commitment of years and decades, an investment in the dignity and potential for a people’s development.
Smiles All Around
Smiles All Around

Dr. Larry Tepe, Dr. Elizabeth Mueller, Emily Mason, dental hygienist, and Cathy Doughman, dental assistant, were recently here on a one week dental brigade. They saw a great many patients. I’m certain they did a few extractions. But more important was their attention given to our Honduran dental staff. Dr. Larry spent a good deal of time repairing and maintaining our dental equipment, critical to the ongoing care at both clinics. There were long conversations in professional sharing such that the ongoing dental services continue to advance the sustainable development already achieved. There was no bragging about how many extractions had been accomplished, no notches carved into the dentists’ pliers and clamps. The success of the brigade is subtle. It is not easily identified. The celebration of the success is not to be found in the swelling of a dentist’s ego. Rather it is present in the advance of a people.
Dentist Becomes Patient
Dentist Becomes Patient

A particularly ironic occurrence on the brigade should be noted. Dr. Larry came on the brigade realizing he was actually in need of an extraction of one of his wisdom teeth. He, like most of us, would have liked to put this off. But the pain and discomfort became intolerable on one particular morning. So many US dentists have come to Honduras and extracted so many teeth. It somehow seems poetically appropriate that Dr. Larry would solicit Dr. Idalia Marilez Ramos to extract his tooth and relieve him of his pain. She did it with grace and expertise and Dr. Larry was the one who was grateful. The competence and professionalism of Shoulder to Shoulder’s dental mission is a source of tremendous pride. Shoulder to shoulder, the development of sustainable systems of well-being, make possible that which was considered impossible.

Photographs courtesy of Emily Mason’s Facebook


February Not Quite Like You Remembered It

February Not Quite Like You Remembered It

For the majority of my life living in the States, I absolutely loathed February. This is indeed my personal bias, but I’ll state my arguments anyway. Being a New Englander, it is very cold and raw in February. It just makes the winter too long. March brings the possibility of an early round or two of golf, but February just has to be endured. For sports fans, February is also a complete wasteland. Oh yes, there is the Super Bowl, but that use to be at the end of January until they made it the first Sunday of February to allow for extended play-off games. Still, after the Super Bowl there is nothing of import (except perhaps badminton games) until college basketball’s March Madness. February is so far away from the beginning of the school year or graduations. And who would ever get married in February. They put Valentine’s Day in February to trick us into believing it has some worth. Besides all that, February is just strange as a month. It doesn’t have enough days, and then its days correspond to March’s days exactly, like Groundhog Day only extended. Then there’s leap year that messes everybody up. I guess the only thing February has going for it is primaries and caucuses for the political junkies in an election year like this one. I’ve never been much of a political junkie. February has just always been difficult to get over.


But here in Honduras, February is a completely different experience. It is the end of school vacation, school begins on February first. Because the Christmas season is overly extended here, it is also the end of the Christmas season (I don’t think they have yet taken down the crèche in the central plaza in La Esperanza). We are now already in the heart of the dry season and summer is beginning. Yes, summer! The days will get drier and hotter, much hotter. With school in session, sports get really serious, especially fútbol (sorry, soccer), kids in full force running up and down the fields. Here, February is anything but boring. It is an amusement park ride and everyone is jumping on.


Ever Bonilla and Angela McCaskill on the radio advertising the brigades

Many of those who are jumping on the February roller coaster are the Shoulder to Shoulder mission trip participants. Whether it is because February is such a grueling month in the States, or because February rocks in Honduras, we have seven brigades scheduled in this all too short of a month, even with the extra, leap year day. One-hundred-three otherwise unknown gringos will come and leave their mark upon the soil of Intibucá over the next 29 days. This is great! This is exciting! We are so much looking forward to it. But at the same time, it means an incredible amount of planning and work.
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  •  Brown/Wingate is once again going to their clinic in Guachipilincito. They have so many participants, twenty-six, that they have decided to do it in shifts over the course of three weeks. They are also planning on more patient educational days and more professional training days. Our Honduran medical professionals are really looking forward to sharing practice protocols with Brown/Wingate’s team.
  • Virginia Commonwealth University and Fairfield Family Practice Centers are once again housing themselves at their clinic in Pinares. They serve some of the poorest and most isolated people in the Frontera. We appreciate their long standing commitment.
  • For the first time ever, Shoulder to Shoulder is hosting Unidad Hospitalaria Móvil Latinoamerica or Latin America Mobile Hospital Unit. They will be providing general and proctologic surgeries for many of our people in the Frontera as well as from La Esperanza. They will be at the hospital in La Esperanza. We are incredibly proud of this new mission and hope that it will be the beginning of a very meaningful relationship.
  • Mountain Area Health Education Center will return to Camasca with a small contingent of travellers to complete a study and to offer some assistance at the health center there, as well as at our bilingual school.
  • Johns Hopkins is coming to Santa Lucia once again after a year’s hiatus. It will be a small brigade, but we are pleased and honored to receive them.
  • Larry Tepe and a small dental brigade will see patients at the clinic in Concepción.
  • We will complete the month with a mega brigade from Cleveland Clinic and Christ Church of thirty-three people descending upon the small town of Camasca. I’m certain they will be a force to reckon with.

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Dental brigade smaller one 013

So for all of you that will be sitting around your house feeling sorry for yourselves as the month of February drags on and on, we invite you to think about coming to Honduras. It’s the place to be this February.

Dentists and Dinosaurs

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I can fairly well remember my first experience as a child visiting the dentist.  Like the experience for most kids, mine held the potential to be a traumatizing event.  He was an older, unfamiliar man who seemed way too anxious about becoming my friend.  He placed me in this strange, inclining, mechanical chair with straps on it.  How could a little kid think of anything other than Frankenstein?  Then this man I didn’t know who smiled at me way too widely, who now wore a bizarre green gown and a surgical mask, shown a tremendously bright light into my eyes, pried open my mouth and squinted oddly to peer profoundly into my oral cavity.  His peering had obviously not satisfied his curiosity because he continued to poke and prod in and out of every crevice with sharp metal instruments, relics of torturing tools from the Inquisition.  If anyone ever wished to publish a manual on how to traumatize a kid, they would simply accurately describe a first visit to a dentist.  Yet, I wasn’t traumatized.  In fact, I don’t even remember any of the business end of the visit to the dentist.  Still, I do remember it.  What did I remember?  Why wasn’t I traumatized?
Dinosaurs.  After the exam and perhaps a quick brushing (I didn’t have any cavities and thus was spared the true horror of a whizzing drill), the dentist lead me, my mother in tow, to a small supply room.  There, displayed on a counter at about my eye level, were herding, plastic (actually probably rubber since it was the 60’s), green, red, blue, and yellow dinosaurs.  They were only about one and a half inches tall, but they were mesmerizing.  Then the dentist said a truly magic word.  “Pick one.”  Whatever maniacal experiment this deranged man had performed on me had been worth it, because I had hit the mother lode of prizes, my own dinosaur.  Though I should have been traumatized by such a foreign, terrifying event, I wasn’t.  The principal part of the visit, picking out my personal dinosaur, far overshadowed the otherwise haunting, intrusive nature of having someone stare into your mouth.
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I remembered the dinosaurs, and the brilliance of my first dentist, just yesterday in a most unlikely, and yet again, foreign environment.  We followed the dental brigade to the small village of El Cerrón.  Though it is still vacation until February 2, the kids from the village met them at the small schoolhouse.  The school is already enrolled in Shoulder to Shoulder’s school dental program.  Most of them know the importance of brushing and the dangers of gluttonous consumption of sweets and junk food.  They also get fluoride treatments and trips to the dental clinic when they need work.  Even so, here in Honduras where dental disease from poor dental hygiene is an epidemic, the message can’t be repeated often enough.  In any case, the boys all had rings on their fingers; little plastic rings that I assumed were gifts from the dental brigade.  Then I noticed one boy playing with another boy, poking his ring at the other boy’s ring.  I focused to see the two plastic, ring dinosaurs engaged in mortal combat.  I laughed audibly.  Though you may think otherwise, things have not changed that much in forty-five years.  Closer scrutiny made me realize that some of the rings featured dolphins as well, and the girls had stick-on jewelry proudly attached to their bodies.  When it came time for the kids to line up for their exam, when these very tall, very foreign people with bright flashlights wanted to poke around inside their mouths, the children showed no hesitancy, but rather raced to be first in line.
It really is easy to help others.  It really is easy to communicate healthy habits to others.  It really is easy to reach out across culture divides, to overcome the fear derived by the response to what is foreign by celebrating the joy discovered in what is shared.  We do great things here at Shoulder to Shoulder, miraculous things, tear-jerking heroic things.  Our brigades come down because they want to be part of it, and they are.  They do miraculous things.  We are proud of our and their achievements as we should be.  Still it is sometimes the littlest things we do, the things most people wouldn’t notice or remember, that are the most powerful.  Someone thought enough to bring dinosaurs, dolphins, and stick-on costume jewelry.  Maybe even they didn’t think it would be that important, given all the heroic acts they would be involved in.  But forty-five years from now, one of those kids from the small schoolhouse in El Cerrón might remember the magic of a dinosaur.  Truly miraculous!!
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