Nicaragua: Mission Trip

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Disclaimer: all names have been changed, and all stories have been modified to be able to provide accounts of our mission, in order to protect the identities of our patients in Nicaragua. ALL images were captured with verbal consent.

During my senior year of college, I went on a dental service mission trip to provide dental, medical, and pharmaceutical care to people living in severe poverty in Managua, Nicaragua. This is the journal I wrote while I was on the trip. The program is called International Service Learning; it is a great program that runs through many colleges in order to safely send kids abroad to travel, learn more about their pre-professional career choice, and gain clinical volunteer hours. This trip was life changing and is the reason why I feel absolutely compelled to make charity work the purpose of my future career.

3/05/2016: Nicaragua Day 1.

It’s time! After having a relaxing day/night in Miami with my older cousin who lives there, I headed to Nicaragua. I got an empanada at the airport and boarded my flight. The plane right was smooth; we were delayed because of bad weather over Cuba. When we finally got into the air, I studied a little for my microbiology exam and watched some Jimmy Fallon. As we were getting close, we flew over an active volcano! Finally landing, I turned on my phone and saw that it was 95 degrees. Going through customs was quick and easy.

As I exited the airport I found the leader of my program, Sandra, waiting for me with a sign. The first thing I noticed on the way to our hotel was the blatant poverty. Metal screens were being used as the walls and doorways of most structures. People walking along the street were clearly very poor. More observations: traffic is crazy, and no one uses lane markers. They drive on the same side of the road as us. People sell fruit right in the middle of the busy streets. There are huge tree shaped colorful statues that line the streets and they are lit up; apparently guards have to watch them because people tend to steal the lights. Posters, banners and gigantic head statues of the Venezuelan president line the streets. I wondered why, and I was told that the Nicaraguan president loves him because he does a lot to help the poverty situation of this country, and he helped the Nicaraguans get back on their feet. People worship him. Its amazing to see that level of worship… they treat him like their savior. Sandra told us about how Americans seem “loud” to them because of our freedom of speech; we can say anything we want, and we say it loud and proud and no one can do anything about it. This up-coming election is a prime example. Nicaraguans are here worshiping a political figure in a way that I don’t understand or have ever felt toward a leader. Very interesting.

As we got to the hotel I met my wonderful room mate. We are both very personable and already have gotten along great. We are the only two here yet, and the others weren’t coming until late tonight. We unloaded the bus and headed to the grocery store. Before we got there, we had to exchange money. A sketchy guy got into our van and pulled out a wad of cash to do the exchange. We were assured that this was safe, and that the under- the-table deal was being done for our benefit because we got a lower exchange rate. Still, it was crazy. Next, the grocery store! I love roaming around foreign grocery stores, its always so interesting. I got Kinder, Cookies and Cream oreos, local granola bars, and tried some of Sandra’s  fried chicken (which was awesome) and ice cream (which was eh). When we came back to the pool we had some conversations with some locals. They told us about the country’s crime and poverty rate, about the beautiful Nicaraguan beaches and cities like Grenada, and about the high crime situation in Guatemala. We shared pictures of our lives and laughed. Next came dinner: the 4 of us here were served salad, chicken, rice, and veggies.

Now we have some downtime: The hotel is pretty nice, open to the outside with a courtyard, pool, and hot tub. Everyone here has seemed very nice so far. We even met some guy from Panama at the grocery store that spoke perfect english; he gave us his number in case we needed help. I am super excited for this week and what its going to bring. I already am in love and so happy. Going to end it here because it’s bed time soon! Till tomorrow.

Side note: I wish I knew more spanish. I love the language, the music, the culture, and the barrier is really killing me.

Our hotel to the left and the view of a Nicaraguan volcano to the right.

Nicaragua: Day 2

Woke up at 7 am to get ready for breakfast at 8. The room was pretty cold this morning; we turned the fan and AC on – we’re pretty lucky we have accommodations like this. Breakfast was beans and rice, shredded chicken in a chili sauce with chips, fried plantains, and eggs with ham!

We’ve been in orientation all morning. We are learning about the medical situation in Nicaragua and the health care structure. There is a high child mortality rate, and high rates of diabetes, cerebrovascular disease, and heart problems. We learned a little bit of Spanish as well. At the end of the morning orientation session, I brought down all of the donations I had brought from home. I had a three-day fundraiser to collect toothbrushes and medical supplies to bring down with me. I was shocked and so so thankful that so many wonderful people saw my posts and donated to help my cause. I ended up bringing over 200 toothbrushes, toothpastes, packets of ibuprofen, vitamins for malnourished kids, folic acid, and more.

Now we are on a lunch break- for a half hour Jennifer and I laid out by the pool and tanned; the sun was scorching but I was so happy to be under it.I can’t stress enough how much I wish I knew Spanish. The language I’ve noticed is very soft, as if they don’t enunciate but every word flows into the next making it a very smooth, fast, and trill language. It’s beautiful. No wonder why its one of the three romantic languages. The kids playing in the pool would swim towards me and say hola! And I would laugh and go hola! And they would swim away and come back and do it again. Adorable. For lunch I had steak dressed with garlic and pesto, potatoes, grilled plantain, sausage, chips, and rice and beans.

After sitting by the pool and getting to know a few of the other dental kids, we headed into the second part of our orientation. This time a local dentist is giving the lecture. The first hour of the orientation was like dentistry 101. WE LEARNED SO MUCH. For example, we learned about the teeth counting system that Nicaragua uses which honestly is much simpler than the USA! And then we went through topics such as perio, deciduous teeth, caries, how to mark exams and triage, extractions, what different fillings look like and consist of, and much more. Dr. Soto is doing amazing explaining all of this. It’s funny because I can tell just how much this profession is the fit for me just by how a simple presentation like this gets me so thrilled. There really is so much technique and precision in dentistry! No wonder why they text perceptual ability before even being admitted. Your hands (manual dexterity) are everything in this career.

After the seminar we came up to our room and collapsed in the AC for an hour. I felt bad for not enjoying the outside, but a kid’s birthday party took up the whole courtyard and pool area and I was exhausted. We got ready to go to dinner and all went to this restaurant where the owner was from the states! I got enchiladas, a margarita, and passion fruit cheesecake! It was unreal. So far the food here has been awesome and I have been eating so much.

We are back at the hotel and I’m actually a little queezy right now, I don’t know why. The only thing I may have done was eat the local fruit. I just hope I don’t get sick. Tomorrow we are going on home visits to the impoverished neighborhood where we will be setting up the clinic. I don’t know what to expect but I am very excited to get in the game now.  Buenos noches!

Nicaragua: Day 3

We get to go to our neighborhood today to do the house visits! It’s called Los Martinez.

The neighborhood visits consist of doing the following:

A group of 4 students, one guide, and one translator. We went door to door (even though they didn’t have doors sometimes) and told them we were having a medical and dental clinic set up for the next three days. We asked them questions in Spanish such as, name, age, level of education, chronic illnesses, vaccinations, etc. and wrote all the info down for every member of the family. We then asked if we could look in the home to see the condition, cleanliness, source of water and if they boil it, type of bathroom, etc.

This is the poorest area I’ve ever seen. The dentist on the trip with us said she did trips to Panama and Peru and thought she had seen poverty, but Nicaragua was severe poverty on another level. The houses were partial structures being held up with things like metal sheets to serve as doors and roofs. I can’t explain it like the pictures can. I asked before I could take a picture and they all said yes, but even so I felt bad when I was doing it, so I decided not to. It feels like exploitation. These people are so humble, they are dirt poor and suffering and don’t have anything and yet invite us in and even tried to find places for us to sit. Before we went on the home visits we stopped at a church where the guides did a prayer to thank god for sending us to them… and I was in tears. The babies had no shoes, little clothing (it was 100 degrees) and the roads were all made of dirt. The houses were one, maybe two rooms separated by sheets, and people either cooked inside or outside with broken metal pots and silverware. They had pictures put up of family and God. These people are so so so humble I can’t stress that enough. No person we surveyed drank or smoked. I assumed this was because of not being able to afford it (ignorantly linking poverty to crime and drugs and bad habits), but when we asked, the villagers would be like “no! I’m a Christian woman/man!”  – that was really amazing. Many women my age or younger are with children (some multiple children) already. Very low levels of education but we did get a few that had a few years of high school. One man invited us in and when leaving he was like, thank you so much and I am sorry if I offended you in any way, and we were like what?! Of course not. I can’t stress the level of humility in these people. The children playing were precious and it was heart breaking to see their conditions.

I wasn’t feeling well during the morning home visits so for the last 20 minutes I sat in the bus. Then we had lunch.

We got through almost all of the afternoon visits when I started to have really bad tunnel vision and felt like I was going to pass out. Our guide said to wait two minutes but I shook my head and ran out and and started to cough up and throw up by a tree. The dentist on the trip rushed over and poured some water on me and held me up as I began to topple over and black out. After I stopped throwing up I didn’t have enough energy to go on so I went back to our bus where a few people were taking care of me. We went to the doctor and got medicine and it was inexpensive, thank god. When I came home I laid in bed and called my family to update them on my trip.

More observations: the food they eat is healthy. They can’t afford junk food but they eat lots of fruits and veggies and rice and beans and there are chickens running around everywhere so I’m assuming they have a lot of eggs. Many of them had the knowledge of basic dental hygiene but there were quite a few that didn’t. I apologize that these accounts of my days are not written eloquently. They are in the moment or soon after, and I am just writing in a raw fashion to be able to document every detail I can think of.

Next we had an injection seminar. I felt okay to go, a little tired and still not 100% but I wanted to truck through. It was very interesting and I actually knew a bunch of things already. It was SUPER cool to learn the anatomical details of the injection sites and we got to learn how to prepare a syringe.

We are waiting to head to dinner soon and relaxing by the pool. The weather is perfect. A very light breeze and a comfortable temp.

We are coming back from dinner now! We had authentic Nicaraguan food and I’m really glad I was up to eating. My stomach is still doing flips but I was hungry. I got a quesillo, an empanada with spinach and cheese, and crispy chicken fajitas with fries! I ate about half and then couldn’t go on. It was only $10! I’m glad to be back home now. I’m ready to take my meds and pass out. Gnight!

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Nicaragua day four.

First clinic day! In a small, empty, one-room building , we set up two dental chairs, a table for all the dental instruments and supplies, a table for medications, and an area for patients to be medically examined. We had extension cords scattered everywhere in order to plug in things like the amalgam mixer and the sonic scaler. We had no suction, limited supplies, no autoclave, no sink, no running water.

Each chair had one dentist, a translator, and three to four students who were assisting. My team was doing extractions, and the other team was doing restorations. We had no suction so the patient was told (in Spanish) to spit into a cup. We have scalers and explorers, gauze, local anesthesia, and lots of donations to give away. We have gloves and masks, and head light lamps to use as lights. We are being as infection control minded as possible, but in a place like this it feels like you can only do so much. We wash the instruments with a clean brush and bleach, and put them in a cleaner for 30 minutes before we use them again. It’s hot. 100 degrees and we have fans blowing hot air around. I’m ignoring my stomach but the sharp pains have started again.

We are ready. This is not a private American practice. This is not just observing. This is fast. In three hours we managed to see 10 patients for extractions. We take medical histories, prepare syringes, hand off supplies, apply the topical gel to the injection site, and pinch the gauze at the extraction site. We are very hands on with what we are ethically allowed to do as students, and we are an incredible team. One thing I forgot to mention is that we triage. If a person is asking for an extraction but we would rather do a filling to save the tooth, we will do that because extractions are sometimes included in the Nicaraguan public health care. If a person has a toothache in one tooth but we see something that needs more attention and will give he or she a greater problem down the line, we address that first.

In all my clinical days, I will be writing about the cases that struck me the most:

Case one: A woman came in and felt pain in tooth number 19. She already had a filling but was feeling pain.

In this case, we saw that her upper left molars had terrible decay and decided that it would be better to fill those rather than extract number 19; the doctor concluded that what she is feeling isn’t pain, but sensitivity. Before sending her to the extraction chair we tried to get rid of all the calculus; since her gums were so swollen she bled a lot and was in a lot of pain. I was on the doctors right with gauze to clean her instrument and as soon as she started, the patient grabbed my hands and looked at me with this unexplainable fear in her eyes. I don’t blame her; there were 5 people looking over her with head lamps, not speaking Spanish, and she had no idea what was going on. There were tears running down her face; I kept saying bueno bueno it’s okay it’s okay but she was in a lot of pain. Even with the language barrier I jumped forward to try and calm her down. I shocked myself how ready I was to dive in. My shadowing experience really prepared me for this. After she was done i explained to her with a translator what exactly we did. We told her to come back tomorrow to get her filling.

Case 2: This woman had severe ANUG- Acute necrotizing ulcering gingivitis. This is also called Trench mouth because soldiers fighting in the trenches would develop this in World War 1. We had to attack her calculus first, and this woman was clearly in so much pain. She was holding on to the sides of the chair as if she had a sever phobia of heights, and was just about to go down the tallest roller coaster in the world. She was an incredibly brave patient.

Cases 3 and 4:

This case was a little girl, three years old, and her brother who was eight. She sat down in the chair and had a bright smile but we could tell she was scared. As soon as we started to look around her mouth, she started to cry. We all crouched down to work on her because I felt like we were scaring her by huddling over. We noticed that she needed two extractions. She was still crying so we prepared the needle away from her sight. She kept reaching up for her dad but he was also trying to calm her down. At this point we were ready to inject the local. I was at her head, the doctor on my right and her father on my left. Students on my team were holding down her arms and legs because she started to kick and scream and screech at the top of her lungs. I grabbed her head and held it firmly pressed down while prying open her mouth open with my thumb and index finger. I wasn’t told to do that but I just did it. She wasn’t biting me hard so I knew she was terrified, but not in pain. After one vile of local anesthesia, she calmed down a bit but was still crying. The extraction was simple, it was a baby tooth and she didn’t feel it at all. After her procedure I gave her toys and a kids toothbrush. She was so brave. I wish I could have stepped away because I was beginning to get really really teary and felt an intense gut emotion. After her I realized I really wanted to work with children. But there was no time to think about this now.

Now her brother sat in the chair and he was scared after watching what had happened to his sister. He had SO much decay. He needed four extractions on the top and more on the bottom. We decided to extract four on the top. He was a brave boy but was also very scared. I again, grabbed his head and a cup because he was salivating a lot and kept needing to spit. Fieldwork is gruesome and hard. My feet were going numb from crouching down so much and the heat started to hit me again but there was no time to think about that. I was so in the moment that I would be okay during procedures, probably due to adrenaline, and then after the patient left I would feel a hard wave of sickness. After four extractions I gave him a child’s toothbrush and told the parents he needed to come back tomorrow. He wasn’t too happy about that haha.

Case 5: Next came the children’s father! He was reluctant and very scared after seeing what happened to his children. His wife was laughing at him for being scared! But he had a difficult case. He had a third molar that needed to be extracted and he was in a lot of pain- the anesthesia situation was going to be really tough because an average person goes through 4-5 vials for a third molar and we had to ration. After about three, we decided to extract. The extraction was prepared to be complex but it ended up being easier than planned. We didn’t open him up by doing surgical flaps but used an excavator and cotton pliers. Dr. Neda extracted the tooth and his roots broke, but she looked around the extraction site and found them very easily. Thank goodness… this man was terrified and holding his wife’s hand. He didn’t get any toys like his children but now he will feel so much better!

A few patients we saw actually had pretty good teeth! Their diets were clean and they didn’t smoke or drink.

Lunch time. We cleaned up and sat in a circle and had rice, veggies, and steak. We also got plantain chips and Coke. We are just about to get started for our afternoon session and I feel like I’m going to vomit. I ate a little but can’t go on. I’m went outside for a little bit of fresh air.

Next hour and a half we saw 5 more patients.

Case 6: This was a little girl, 7 years old. She was complaining about general pain in her mouth; all her teeth were coming in but her jaw was too small, so there was a lot of crowding. She wouldn’t sit down, so I ran and got a child’s toothbrush and got her to sit on the chair. She was terrified. Her mom was standing over her, I was by her head and to the left of the doctor. She immediately started to scream and kick and thrash her head back and forth. I grabbed her head and her mom grabbed her body (her legs still weren’t restrained and none of the other students would take charge to just hold them down). The doctor and I tried and tried to pry her mouth open but she would not stop clenching and throwing her head back and forth. We got a good enough of a look to see that this was work for the orthodontist. This was very sad and we hesitated to tell the mother because there was no way this child was going to afford braces. We could have extracted a tooth to make room but with her crying and moving around there was no way we were going to be able to poke around with a needly in the back of her mouth. The little girl won. When we gave up she rested her head on my hand that was holding her cheek and stopped crying and fighting us. The mom seemed incredibly disappointed because we couldn’t do anything but we told her to try to come back tomorrow. It is awful seeing the look on their faces when we can’t do something they came for, but they are so thankful anyways.

Case 7: Tmj patient- 25. I felt her jaw click and it was the worst case of TMD I’ve ever seen. We told her she could get a night Guard but here they don’t sell them in drug stores, you can only get them in private practices. We couldn’t help her. This one hit me hard because I have TMJ/TMD as well, and I know just how painful it can become.

We packed up and headed back to the hotel for a seminar. The pharmacy seminar was short and interesting. We only prescribe for pain or infection and the medicines are pretty standard and simple. We went through the differences and side effects.

Getting ready for dinner!

We’re on the bus to go to the mall for dinner. I just remembered a case of a woman who had all her teeth filled. She had fillings in every single molar and got them while she was pregnant because healthcare is free when you are pregnant. It was obvious that all the teeth were very healthy, and the dentist must have filled them all just to make money from the government. It was so sad because she didn’t know any better and trusted him.

Dinner was in the city of Nicaragua at a huge mall- it was almost like stepping into a whole new world. Jennifer and I scarfed down our TORTAS! It was awesome. There were a lot of restaurants with outdoor patios and even some bars and clubs. Jennifer, Adonis, and I started to walk to the bus to drop some things off and we noticed a man was following us. It was pretty scary and I started to say “guys….. ” … suddenly we all just started to run as he was power walking behind us. We were kind of going into an ally where the bus was parked and as soon as we got on he turned around and walked out. I was super scared so I left all my stuff on the bus and we walked back to the mall area when we didn’t see him anymore. After another hour we came back to the hotel.

I really felt like a field medical professional today and it makes me think: I honestly love this work. I felt like we were doing gods work. It really was eye opening for me and how I see myself in my future career. 1937160_10208592357103655_5979425929685200422_n1394105_10208592359303710_4722780883637368966_n10336736_10208592359583717_4628541424487278742_n10389469_10208592360463739_8661448249502401745_n

Nicaragua Day 5:

Back to the clinics! Today I am assisting restorations.

Case 1: This woman was the mother of the two children, and the wife of the man we saw yesterday. She also needed an extraction. Dr. Soto showed us tooth by tooth that she had many cavities. She asked us to name the tooth and the surface of the cavities (mesial/buccal/occlusal) and what we learned in our seminar really kicked in. We sent this woman to the other chair for an extraction that needed more attention.

Case 2: Karla was 21 years old, and scared. She said she was in so much pain that she could not sleep at night. She sat down and I grabbed a mirror and explorer and started in the back of quadrant one. She had decay on the buccal surface of her first molar, but it was nothing serious. When I got to tooth #12 (#9 in the USA system), the back half of it was gone. It was broken, I saw in my mirror, and was clouded with black decay and the dentin was visibly mushy. Everything else looked fine. It was obvious that we were going to be restoring 12 (#9, USA). It was a class 3 and I was really proud of myself because every time Dr.Soto asked me the position of the decay I got it right! And the tooth number. As soon as we were ready to start Karla started to tear. She was laughing because she was embarrassed about it, but you could tell she was very very scared. The injection was scary and painful for her because it was on the palatial surface. We told her not to look but she was still scared. During the whole procedure I was assisting by wiping the instrument, holding a headlamp, and wiping her tears. After working on the tooth you could see that this case would have been a root canal. The pulp was exposed and you could see that by seeing red dots on the tooth. We don’t have the ability to take x-rays so we could not have known, but we still managed to save it the best we could. After she was done I ran and gave her a toothbrush and toothpaste and told her “Bueno” because that’s all I knew how to say. She got a wonderful restoration.

Case 3: A young boy came in who needed a filling. He was very scared and would not open his mouth wide enough. Dr. Soto is so incredible with talking to the patients. especially children. She speaks Spanish and they whole way through the procedures, (unless she is explaining something to us), she is talking to the patient. I was on the left side of the patient and to the right of Dr. Soto, facing her. We had no suction so every 10 seconds he needed to spit. It is literally like doing a filling under water. Once we cleared the decay, we started to do the amalgam filling. This was really interesting to see because I have only ever assisted composite. We used the amalgam applicator, compactor, and created the natural shape of the tooth. Dr. Soto’s technique is incredible. After grinding on the carbon paper and checking articulation, we sent him on his way.

The next case I had to sit down. It is really windy today and the church has barred windows. Dust was flying in and out of the church and someone started to burn something (it was probably garbage) and the smell was really strong. I sat in a corner because I couldn’t breathe and felt light headed again. Jennifer went home because she was feeling too sick. Restorations aren’t as fast paced but we are learning very good skill and technique. Even though I shadow and see fillings every day this is way different; the cases have been tougher and doing this work in our condition is crazy to see. Again, field work is so much different than practice.

Case 4: A young girl chipped her front tooth. She was about seven years old and was with her mom. She was also very scared. Dr. Soto sat by her side and had the most gentle conversation with her. She told her she pinky promises she will not get a shot or feel any pain, and told her she will look so beautiful after. She went on to say that she is just going to be playing with something that shines and cleans the tooth – she was gonna paint her a new tooth! Dr. Soto was like, do you trust me? And the girl said yes. Ah that was awesome. And so we begin. Every little thing we did we told the little girl beforehand, and showed her. We did a little, and asked if it hurt and she said no and opened really, really wide. She was really brave.

Lunch time. We got fried chicken pieces, white rice, and potatoes.

At lunch we exchange stories: the medical students had a patient who was 16 and just had a baby. The baby was running a high fever and had a parasitic infection that they prescribed meds for. Another patient they had: his blood sugar was at 279! Thank goodness he came to us for help.

We put out the food we didn’t eat and the mothers and children ran to it. That hurt my heart.

Cases 5 and 6 were two young children who came for a checkup and cleaning. We checked booth their teeth and they had good hygiene, no cavities, and did not cry at all! I got to do another clinical exam on the little boy. I grabbed the mirror and explorer; it’s strange having the instruments in my hands. I analyzed the patients mouth and had nothing to report. The doctor came and she said I was right. He was only 5, and his 6 year molars didn’t come in yet so we were looking at all baby teeth- this i also noted and was commended on for asking him his age and assessing. I gave him a Star Wars toy for his bravery!

His sister had the same great hygiene and also received a toy for being brave. We commended the mother for making sure to take such good care of the kids’ oral hygiene.

There’s a hole in my sock.

I’m rehydrating.

We did two more fillings on adults and they went smoothly. Simple cases and only one under local anesthetic.  At this point my day is a blur. I stepped back and watched the others assist because my mind was just getting too fuzzy from the heat. Putting on rubber gloves made me aggressively nervous. Today was worse than yesterday condition wise because of the dusty wind making it even more humid and hot inside. Believe it or not, it felt better outside. Direct sunlight kills.

We finally packed up for the day and I’m on the bus. My feel hurt and I smell. At one point I thought I was dripping pee in my pants but it was just sweat running down my legs. Gross, I know. The AC feels nice. I see stray chickens. The radio is playing American mainstream songs from 2014. We came home and went straight to our suture seminar where we learned how to do simple and cross sutures on sponges! I was tired at first but then I really got into it, especially because I was really good at it!

We went to dinner at a great Italian restaurant.

Back at the hotel now and straight to bed. Buenos noches!

Nicaragura: Day 6

Last day of clinics! We see horses as we drive up. The community uses them along with makeshift wagons in order to carry things.

Children here get $100 a year to go to school. To compare, in Panama, the poor children receive 1,000$. Nicaragua’s poverty is very severe.

The walk to the clinic today to set up from the bus was a special one because I wouldn’t be doing it again. I tried to take everything in and look around at the details as I was walking. I was carrying a big fan. People wave to us and say bueno as we walk by.

Case 1: this patient was a young child who needed a restoration on #9. We did a composite and I assisted Dr. Soto perfectly. I was on her left side (if we were facing the same way) and handed her what she needed. I handed her an explorer and mirror first. I set up the hand piece and triple syringe and she started to drill into the tooth. Drill and spit, drill and spit. Once she was finished, I handed her the blue gel, counted for 20 seconds, and then prepared the next steps for her: bonding agent, spatula and composite(A2), the UV light, sandpaper or clear paper to recreate the anatomy of the tooth, articulating paper, and we finished.

Case 2: This patient had a restoration (class 3) on numbers 8 and 9. This case really hit me. He was terrified. And when I say terrified, I mean that the look in his eyes struck me so hard that I was clenching my teeth so I wouldn’t burst out into tears just by looking at him. His eyes were fixed on the ceiling the whole time and full of fright. His hands were by his side hovering over his thighs but trembling. Even his tongue looked like it was quivering. He was definitely trying to be strong and it’s like, even though he has been in situations way tougher than a filling, something so unfamiliar like this has to be unbelievably terrifying. Even remembering this patient now is giving me chills and making me teary. Some things are so unfair.

Case 3: Patient three was another restoration and she wasn’t scared at all. This was an amalgam case.

I had to stop. The community started to fumigate for dengue and I started to choke because of the smoke seeping through our windows.

The rest of the day went smoothly with extractions and restorations.

As we are cleaning up, I am stepping back and watching…  there is a line of people outside that we have to turn away. I’m trying to fight back the tears. People of the village are realizing they won’t be seen and are getting pushy and trying to come in. Some came up to me and called me “doctora, doctora!” They try to talk to me in Spanish or show me their kids mouth, and I feel so helpless. I go to the front door of the clinic and start to hand out toothpastes and brushes to the people outside. We packed up and took some pictures and I realized we had worked 2 hours overtime, but still I feel like it wasn’t enough. The little kids helped us carry things back to the bus! I can’t hold back the tears at this point.

Salsa, merengue, zumba, and national Nicaraguan dance class when we came back! WE ARE SO TIRED! But it was so much fun.

Popousa for dinner! Best meal yet.

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The last few days we got to spend playing with the children! We brought them gifts and donations.

We also spent a day in Grenada, Nicaragua, where we got to hike, go on an island tour, go shopping, see monkey’s, and go zip-lining! I cannot wait to come back to this country. Its people, its cuisine, its culture, is all so incredible. Not only do I hope to come back with more dental missions (which I will), but I also hope to travel to the beaches and sites that the locals just rave about here. See you again, Nicaragua!

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