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.
Monday, 14 October 1991 - 1:00 PM - The Dental Clinic
We are back in familiar territory for several of us, having visited this clinic last year, and we are eager to learn what advances they have made since we were here before. There is also the pleasure of having Sally, who works as a dental technician, with us this time, since she had not been able to make the visit last year. We are seated on wooden benches in an open garage area, talking with O., who had been one of our guides the previous time and who recognizes us as repeat visitors.
"Welcome to our country. Thank you for coming to see the reality that we have. Our project specifically is the formation of dental promoters. Here we train people in how to extract teeth, cleaning, denture making and fitting; and we build the equipment needed to do these things.
"Owing to the situation in our country, 90% of our projects are installed in the countryside where there is no electricity, so we need to buy generators. This means that our dental promoters must also be trained in generator maintenance. Our project is now about five years old. It came out of the need of the people, as there was no government program around. Before we started, campesinos had to walk nearly all day to get to a clinic for one extraction. This meant a whole day lost, with the danger of leaving a conflicted area, spending money for transportation and food, and of course losing the day's wages.
"We first experimented with five campesinos in San Miguel. We ran five seminars, each two days long, in which the participants learned to extract teeth. Later we had further experience in the western part of the country. (Note: San Miguel is in the east.) By these experiments we demonstrated that peasants could and would do this work. So we decided to visit the repopulation sites, where we trained an initial group of thirty peasants. During this experience we found that there were many teeth which could be saved, but people were not trained to do fillings. So we developed a second round of seminars and brought in thirty more trainees from the repopulated villages. The course lasted four months, full time study from June through September. At the end these people knew how to do fillings. They returned and opened the first three clinics in the countryside, which were all located in Chalatenango province.
"In the following months we trained more in Cuscatlan, Usulutan, San Miguel, La Libertad, and Chalatenango, so that now we are operating clinics in eight of the fourteen departments. After the training these people could do extractions and fillings, but still there was the question of what could be done about the empty space in the mouth where the teeth had come out. So we developed dentures.
"One of our primary objectives is to offer dental service to people at the least possible cost. We have had to develop materials which are cheap but are of the same quality as what could be bought at a dental supply store. We build our own dental examining tables. We have adapted a lighting fixture so that it is as flexible as possible. At this time 70% of all the materials that the promoters use we make ourselves. This reduces the cost of the project. We are also concerned to control the quality of the work. We may not use the most sophisticated materials, but that doesn't mean that the work cannot be of high quality.
"Presently we have three clinics in La Libertad, three in San Salvador, five in Chalatenango, two in Cuscatlan. Four of the five in Chalatenango are in repopulated centers. We have trained about 300 promoters, 60% of whom are women. Now our experience has spread to Guatemala, and to one province in Nicaragua."
Question: Do you receive outside funding?
"Yes, from institutions like SHARE, which has funded several clinics. We also get support from the archdiocese of San Salvador. We develop proposals each year and the institutions make commitments as they can." [SHARE El Salvador provided delegation leaders, logistical support, and training for early PVC delegations. Their Mission Statement reads “SHARE strengthens solidarity with and among the Salvadoran people in El Salvador and the United States in the struggle for economic sustainability, justice, and human and civil rights.”]
Question: What are your charges?
"Some examples would be two colones for an extraction ($0.25); four colones for a full cleaning ($0.50); 7.5 for a filling ($0.88); 150 for a full set of false teeth ($18.75); 50 for a crown ($6.25)."
Question: Can you do X-rays?
"Yes, we have one x-ray machine for thirteen clinics, which is upstairs in this building. Some of the promoters are trained to use it, thanks to a dentist who came from the United States to train us."
Question: Do you have problems with the military?
"Here in our country anyone who works with the poor is suspected of being collaborators or FMLN. In September 1988 the military came in at 3:00 AM and captured twelve promoters. They charged that this was a clandestine clinic and that only guerrillas were being treated. The promoters were held for a week, during which time they were beaten, and the soldiers threatened to decapitate them if they came back here to work.
"Parents of the captured promoters came here and declared a hunger strike until their children were released. Two months before this happened the doctor who had started the project, Nathan Cambrio, had been captured and expelled from the country.
"As we move about the country, there is the danger that our young men will be abducted into the military. They detain our equipment and materials. For instance, when we set up the clinic in Copapayo, they detained the truck and stole half of what was in it. There are always two guards out front of this clinic. All of our work is seen as suspicious work."
Question: Do you foresee any difficulties in the short run as the national guard is phased out?
"We believe that yes, there will be problems. Everything that has been signed has been done, not out of the will of the government, but as a result of twenty-five years of struggle by our people. To the extent that the accords are followed, and if Bush [U.S. President George H. W. Bush] doesn't send more money for arms, there should be more space for us to work."
Question: Are you seeing more or fewer human rights violations?
"We are seeing somewhat fewer, but they are being very selective. The goal is to eliminate the heads of the popular organizations so that these are very weak by the time that the military is reduced."
Question: Do you do any follow-up on the three hundred trained promoters?
"Our program begins with four months of initial training. Then the promoters go out and set up a clinic. Someone from this clinic goes out once a month to review the quality of their work, to give them news, and to meet with the directorate of the community where the clinic is located. We want to know how many people are being served, and possibilities of branching to neighboring communities. Every two months there is a meeting here in San Salvador with the promoters and members of the community directorates."
Question: Do you teach people to clean their own teeth?
"Yes, we teach the proper way to brush teeth and how to make toothpaste from natural materials. The promoters work with children in school programs, teaching them how to brush their teeth. We also distribute toothbrushes to the children and examine their teeth to see if fillings or extractions are needed.
"Our next project, now being planned, is to sample the water in the communities for natural fluorine content, and to start a fluoridation project if necessary. We now have a computer on which we are logging in all our projects, to keep track of what we are doing."
After the talk we are taken on a tour of the clinic. They had scheduled us during a time when they expected to have patients, but the rotating power outage had been extended to the afternoon, so they were unable to serve the patients who had come. There are several promoters working on making dentures, and two assembling the basic examining equipment that they would be taking back to their village. Each promoter is required to participate in the building process so that she or he can repair any part of the equipment which might break down once it is taken out to the countryside.
O. explains to us how they have experimented with various substitute components to make the equipment. A refrigerator compressor serves to drive the basic cleaning and drilling unit, which they can now fabricate for about one third of the cost of a unit from a dental supply store. They are now working on an improved design for a reflector lamp on an articulated stand, which can be swung around and directed at the area of the mouth on which the promoter is working. Their enthusiasm for their work is contagious; we leave the clinic convinced that this group of young people can devise a way to do just about any dental technique for which they see a need.
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