PVC 1990 Delegation – Part Ten: The Dental Clinic

The following notes have been edited to correct errors and to add explanations and updates. Parenthetical notes and remarks from the original are enclosed in parentheses. Present day [2022] updates are italicized and enclosed in square brackets.

5 October 1990, 8:30 AM - The Dental Clinic

We are seated in a circle on folding chairs in a corner of a large garage or warehouse, talking with two of the leaders who direct the dental clinic. They begin with a history of the project.

- "Brazilian doctor Nathan Kamilot came here to develop a health project. As he worked among the people, he determined that there was a major problem with dental care, and that many health problems could be traced to dental problems. For instance, a lack of teeth can cause secondary malnutrition. Dental promotion was a new concept here. Dr. Kamilot studied to learn dental work himself, then started teaching others. The project took off. A proposal for funding was made to SHARE and to the Public Welfare Foundation, a U.S. organization which awards grants for health work. The funding is ongoing, because the project by its nature cannot be self-supporting. The PWF grant was about $50,000.00 and is still being given out.

"We train community members to do cleaning, extractions, and fillings, and to make and fit false teeth. This is a constant educational program, and it is spreading like wildfire all over the country. The main problem is getting supplies through to where they are needed. Our community clinics need generators and compressors, but anything bigger than a toothbrush is considered subversive. The doctor who started this work has since been captured and deported.

"We have a laboratory here and have just started to do braces. There is a kind of insurance system. A community pays a set amount, and then anyone from that community can come to the clinic for dental care. The clients do not pay anything themselves for the services.

"This project arose from a grave crisis in our country. In Chalatenango there is just one dentist, also just one in Morazan. Our project has shortcomings and has made some mistakes, but it has the confidence of the people and is doing very needed work.

"In San Salvador we function with three clinics and one laboratory. Patients come to the parish clinics. We also work with cooperatives and communities, especially the repopulated communities. They send some of their members here to work. This project is not just assistance, or welfare. It is based on the organizational ability of the people, and as such is a victory at the grassroots level. We have meetings with the directorates of communities, and on the basis of these we launch preventive campaigns. We teach children good dental care, how to make their own toothbrushes out of native plants, and how to make an effective toothpaste from 50% bicarbonate of soda and 50% salt. Before patients are treated, we give them an educational lecture.

"The work began by teaching extractions and cleanings to community members here in the city. When the return took place, the repopulations came with organizations already in place. That gave space for us to work with communities outside the city. We took a tour of three departments, meeting with the repopulated communities, and made plans for the spread of the work.

"Based on this trip, five or six persons from each community came to the clinic to learn the basics of dental care. A total of thirty to fifty promoters were trained on the first level. When they were trained, we began the second level to amplify their abilities. It was a tremendous challenge, for of the thirty in the initial course, many were illiterate or close to it. But after four months they were ready to go back to their communities and practice what they had learned.

"We found that we were doing a lot of extractions, so we developed the work of making prostheses. We had to develop our own modules and equipment. If sophisticated equipment is taken into remote areas, and if it fails, it is impossible to repair. So we had to simplify and develop our own systems.

Question: Do you have problems with the government?

"The basic problem that we face is oppression. The clinics are in war zones, so they are constantly watched. Last year twelve workers from this clinic were captured. Another basic problem is the transfer of material. In Chalatenango we had people trained and ready to do the work, but it took a full year to get the generator through. Other equipment has simply been denied. Still another problem is the purchase of materials. It is very difficult to find what we need in El Salvador."

Question: How old is the project?

"The project is four years old."

Question: What is your relationship to the churches?

"Our relationship with the Catholic churches is very positive. The Archdiocese offices have helped with the transfer of material. Diakonia, an organization of Baptist, Episcopal, Lutheran, and Roman Catholic churches, gave us some of the initial funding for the project."

Question: How many clinics do you run?

"There are three clinics in San Salvador: one in Madre Maria de los Pobres, one in San Roque, and this one in the parish of Santa Ursula.

Question: Will you please tell us about your own stories and training?

- Male worker: "I was working in the communities in the city. After the 1986 earthquake, I went out into the countryside to work as a health promoter with several international doctors. We found that many health problems stemmed from dental problems. So the idea came up for us to train people to deal directly with the dental problems."

Female worker: "From the countryside I came to the city because of the war. I began to work as a health promoter. Perhaps the earthquake gave us more space to work in the marginalized areas."

Question: Are you dentists?

"That is a matter of definition. A dentist spends many years at the university and gets a piece of paper. We prefer to say that we work at the dental craft."

Question: What do you need to continue your work?

"There are problems both in finding materials and in the rising costs. We do have a working relationship with the Bishop of Chalatenango. Things can be sent to him and they do get through. We need probes, mirrors, dental amalgam, mercury, hand instruments, also portable stoves and electrical generators. It would be wonderful to have a dental X-ray machine."

Question: How did you learn this craft?

"We originally thought that dentistry was very complicated. But experience has shown us that it is a very practical thing. Persons who learn a little bit more teach others. The original workers learned from Dr. Nathan. In each clinic we have one person in charge, the most experienced person. There is also one person in charge of each chair. At each module, there is one person with more experience and one person with less experience. Extracted teeth are saved and used for practice. We are constantly both learning and teaching others. We have no professors here. What we do have is shared experience."

Question: How many have you trained in total?

"There are approximately two hundred dental promoters out in the countryside."

Question: What is your patient volume?

"We average about sixteen patients per day per clinic. We also sometimes do extractions in mass sittings, when we can do up to 150 in one day. Often people will walk five or six hours to get to a place where we are doing extractions."

Question: Has either of you been captured?

Male worker, indicating an affirmative: "But it wasn't because of an accusation against the work of the clinic. They said we were helping the guerrillas. I was accused of working in the clinic during the day, then going out and blowing up electric towers at night!"

Question: What percentage of your dental promoters are women?

"Sixty per cent.

"There are now clinics in Chalatenango, Usulutan, La Libertad, and San Salvador. We want to establish two more in Chalatenango, two more in Usulutan, one in Morazan, another in the area of Aguilares. We are also promoting work in Guatemala and Nicaragua. Basically, we make projections, but we have to see if the work takes root. If people can learn the basics, then we can move on."

Copyright © 2022 Marian L. Shatto