Back to San Marcos

Norma was back to pick me up at the hotel lobby at 9 the following morning. We drove back to Toncontin airport and headed for the United desk, which was supposed to open at 9:30. Surprise! No one was actually there until almost 10:00, but I was able to finally get my bag, which had arrived unscathed.

Norma, her sister Susi, and I headed onto the highway in our rented SUV. Normally, the road to San Marcos takes about four hours , but on that Sunday morning with minimal traffic, we made it there in pretty good time, passing through Nacaome where the CapeCARES team had stayed the night before and then through Langue, the last major town before the road turned from pavement to rocky dirt. The last stretch of road that winds through the hills to San Marcos is so bumpy that I consider it a “sports bra road.”

Behind a truck on the highway

The town of Langue

It was a happy feeling to finally drive up through the gates of the complex in San Marcos where we would be spending the rest of the week. I saw lots of familiar faces: Maria, Vergilia, and Marle, the women who work in the kitchen cooking our meals every day; Juan Carlos, one of the jefes of the village; Tomasa, who launders our clothes and attends all of the Catholic celebrations in the chapel; and Maria Norma holding her cousin David, who still has my vote as the cutest baby in the world.

I got a warm reception from everyone on the team. Five of the team members had been there with me a year before: Randy and Gordon, both dentists; Warren, our physician; and Helena and Diane, who work as support staff in the pharmacy and dental clinic. We had a great team of nurses this year: Lauren, Teresa, and Heather, as well as Jen, a respiratory therapist. Bill and Bob also worked as support staff in the pharmacy and at triage. Two high school students from the Discovery School in Tegus, Nicole and Valerie, were our interpreters, along with their chaperone, Linda, who assisted me in dental. In addition, CapeCARES had hired three Honduran military guards, Carlos, Johnny, and Darwin, who would be accompanying us for safety all week. I had arrived just in time for lunch, and then it was time to get to work.

I’ve written an article about our setup in San Marcos, but for those of you who don’t happen to subscribe to a Cleveland-based Slovenian newspaper, I’ll give you the rundown. Our medical clinic and pharmacy are set up inside the main building, and the dental clinic operates on the porch. Just off that porch are the women’s dorm rooms, where we sleep in cots. The men’s dorm and the food storage room are on the opposite side of the building. For meals, the medical and pharmacy tables and chairs are pushed to the center of the main room and covered with tablecloths for dining. Within the gates of the complex are also a water tower, a set of connected stalls with latrines and two simple showers, a chapel, and an open-air kitchen.

Teresa in the women’s dorm

Jen organizing records

The main gate
/>
Bathrooms and showers

Breakfast time

Bill in the pharmacy

Wake-up time comes early in San Marcos, especially if you have been kept awake by any of the following:
1. Barking dogs
2. Fighting dogs
3. Crying babies
4. The bus to Langue blaring its horn from the road at 4am
5. Frequent rooster crowing. I am used to the normal crowing, but this year one rooster emitted the weirdest sound. I finally found a way to describe it: look up the song “Creep” by TLC. There’s a repetitive horn loop playing in the background: “buh-BAH!” Now imagine that horn dying a long and painful death: “buh-BAaaaaauuuhh.” Now imagine that over and over again between the hours of 2-5am. Bring earplugs. 🙂

“Office hours” are from 8am to about 12-12:30pm and then from 1 to about 5-5:30 pm (or whenever we finish with the last patient). In dental, we had three chairs set up this year: one for fillings and two for extractions. Lack of electricity changes how we do a lot of things: sterilization of instruments is done with pressure cookers twice a day, diagnosis has to be done without the use of xrays, and our “drill” runs on a gasoline-powered compressor (which this year also became popular as a charging station for cell phones. What a difference a year makes! Last year, no one used a phone. This year, all we had to do was turn the generator on, and within minutes 3-5 people would come running in the hope of claiming a spot on the power strip!)

Dental supply table

San Marcos restorative department

My “office”

Sterilization department

Sharps container

I did extractions all week. Because of poor dental health education, infrequent use of fluoride toothpaste (whether due to lack of access, finances, or interest), high consumption of sweet sodas and juices, and what seems to be absolutely no social stigma against loss of teeth, it was not uncommon for us to extract 3-5 teeth for one person. Many people walk for several hours to get to our clinic and appear to come with the mindset that they want to get as many teeth removed as they can. Many people, even including younger people in their teens and 20s, have full or partial dentures with gold teeth added, which are very popular. One day, I extracted the four front teeth of an 18-year-old boy because of rampant decay; at home, I would have treatment planned him for root canals and crowns on all those teeth, but that’s not an option here. It’s a very different way of practicing dentistry.

The clinic setting is a bit different, too. My patient chair was a reclining lawn chair, which was SO MUCH BETTER on my back compared to the upright plastic patio chair I used last year. We are on a porch, so in the late afternoon when the sun is on the other side of the building, we have to rely more on headlamps and flashlights. And (my favorite part), once every couple hours or so, you would hear this increasingly loud chorus of chirps. Sure enough, coming around the corner and through the clinic would be the local chicken and her twelve little chicks. I was so entertained by this that I would always run and get my camera to take pictures if I wasn’t with a patient (after several rounds of this, Gordon told me that I might have a problem!)

Dinner time is usually around 5:30 and for me was either preceded or accompanied by an end-of-the-day beer. I have come to really enjoy a local Salva Vida after a long day. After dinner, it is already dark, so other than finishing up some daily paperwork, the rest of the evening is free. However, given our early wake-up time and the heat of the day, I usually found myself in bed before 9pm (which never/ happens at home!)