Strive-the Student View
January, 2006 edition

Service-Learning in Las Pintas, Mexico

By Prisella J. Adams

Our trip to Mexico began with several dozen mismatched suitcases. We had been collecting them for a year in our closets and garages. Now they filled our college dental hygiene clinic as we packed them with all the clinic supplies and portable equipment we anticipated needing for a week. Each member of our 20-person team would have two suitcases to check for our flight from Kansas City to Houston to Guadalajara. One carry-on item was our limit for personal belongings.

"When we get to customs, try not to look like we know each other," our team leader told us, explaining that if Mexican customs agents knew we were a group, we were more likely to be stopped. Last year's team had met such difficulty, and while nothing in their baggage was questionable, they had to pay a baseless "fee" that agents demanded after hours of searching.

Try not to look like we know each other? How could we pull that off--20 people on the same flight, carrying odd suitcases, some constrained by duct tape and elastic cord? But somehow we got through and waiting for us was Carmen Rodriguez, MD, the physician who runs Centro Integral Comunitario (CIC), where we would be working for a week.

CIC is a medical clinic and community development program in Las Pintas, Mexico, an impoverished community on the outskirts of Guadalajara. For eight years, teams of dental hygiene, early childhood, nursing and Spanish language students from Johnson County Community College (JCCC), my school in Overland Park, Kan., have traveled to Las Pintas. Our dental team in May 2004 consisted of four dental hygiene students, two alumni, a faculty member and two dentists. Early childhood students and faculty and translators made up the rest of our team. Our nursing counterparts had made the trip a few months earlier.

Rodriguez is the only doctor in Las Pintas, the only doctor for 130,000 people. There is no dentist, so for most residents, our annual trips are their only access to dental care. They could go to Guadalajara to see the dentist, but that would take several hours by bus, which would mean paying the bus fare as well as the dentist's bill. The ordeal would take a whole day, and for many families, the expense is too great.

Las Pintas residents had anticipated our arrival for a month. News that we were seeing patients spread by word of mouth. Community leaders opened their homes in the mornings to serve as screening sites. Anyone wishing to be seen at the clinic needed to be screened first, and they needed money for the fee Ð 100 pesos or about $10 U.S. The per-person fee was lower if two or more people in a family came to the clinic. That may seem like a bargain, but the average monthly income for a Las Pintas family is about 500 pesos.

The fee may have deterred some patients, but we couldn't tell it from the number of people gathered each morning waiting for us to open. We began seeing patients at 9 a.m., and while we intended to break for siesta at 1 p.m. , it was usually more like 2:30. We started again at 4 p.m. and worked until the light from our makeshift dental lamps couldn't compete with the darkness. Patients waited outside in the street. They sat on benches lining the CIC courtyard, lucky ones in the shade but most in the unforgiving Jaliscan sun. They went home for siesta and came back in the afternoon. They went home at night and came back in the morning.

We set up lawn chairs and ran extension cords from a gasoline-powered generator. New to us were three dental chairs donated to CIC when JCCC's dental hygiene clinic purchased new equipment. It had taken Rodriguez three years of paperwork to get the chairs to Las Pintas. A long drive to Ciudad Juarez had almost been for naught because officials refused to allow the chairs, then in El Paso, Texas, to enter Mexico. Not knowing the chairs' true purpose, the officials consented only after being told they were for massage and were not medical equipment.

Water was always a concern. All water sources were contaminated except for what was treated by an ultraviolet light at the clinic. We kept our showers short because, as Rodriguez explained, when we turned a tap, the water that came out was from a cistern buried under the CIC courtyard. The city of Guadalajara releases water intermittently to outlying communities, and homes that had cisterns would take the chance to fill them. Sometimes the water flowed twice a week, sometimes once.

Preventive oral health care, such as dental hygiene, is difficult to instill in people who have so many demands on their lives. That hit me every time I spoke with a patient about dental floss. On the first day, I would ask each patient, "Do you use dental floss?" That question became "Do you know what dental floss is?" The small groceries that pepper Las Pintas don't stock floss; if people want to buy it, they have to travel. We brought cases of floss, toothbrushes and toothpaste to give out along with self-care education. With my patients at school, the floss conversation always centered on making it a habit. At Las Pintas, I taught children and adults about floss, and I never had to explain the importance of flossing.

Measuring the success of a community dental health program is difficult when you can't track patients, but I felt that we did get a glimpse of long-term progress that week. One of our program priorities is sealant placement, and we observed a number of teenage patients who had had sealants placed on newly erupted molars years earlier at our clinic and were now back for cleaning caries-free mouths. In contrast were patients the same age who were new to our clinic, didn't have sealants, and were now suffering decay.

My responsibilities to patients were to provide prophylactic cleanings and sealants. As a team member, I shared responsibility for sterilizing the several hundred instruments we had brought along, keeping our supply table stocked and relieving fellow team members. It was easy to feel obligated to keep working when the line of patients was never-ending, when your skills were so badly needed and so richly appreciated. But for every patient we finished, five more joined the line, and we had to budget our strength.

We educated all patients to the extent possible and by midweek, I could give short explanations of sealants and fluoride. My fragile Spanish frustrated me as patients wanted to converse once they realized I knew some of their language. I grasped at the most simple vocabulary. I calmed a frightened four-year-old girl named Abigail by saying, "Tengo una hermana Abigail." What I meant to say was that I have a friend named Abigail, not a sister, but the trust in little Abigail's face was worth the error.

Another patient, a beautiful woman named Caroline who was probably not yet 35 years old, had advanced periodontal disease and had already lost almost half her teeth. She came for a cleaning, and the first thing she asked was if we were going to pull any teeth. Extraction had become regular dental treatment for so many patients that they expected it. Fortunately for Caroline, her time with us involved only an extensive cleaning, but for many other patients that week, extraction was the treatment. All totaled, our team provided 126 extractions, 333 cleanings, 296 sealants and 39 fillings.

Our week ended with an awards ceremony recognizing 56 Las Pintas students who had the highest scores in a competitive math exam. Because many families cannot afford to send their children to school for more than a few years, the JCCC International Education Office coordinates an educational stipend program. The 56 children received stipends to allow them to attend school for another year, an amount of about $100 U.S. per student.

The partnership between JCCC and CIC has changed the lives of many people in the few years that it has existed. Personally, the chance to do the type of work I did in Mexico was a big reason I chose to become a dental hygienist. I left a career in journalism to go back to school. My last job, at a major university, was stable and would have seen me to retirement, but it had become unfulfilling. I wanted a job that makes a difference in people's lives. I feel fortunate to have skills that allow me to contribute to other people's well-being. My Las Pintas trip is the first of many international dental missions I plan to make.

Prisella J. Adams is in her final year of dental hygiene studies at Johnson County Community College, in Overland Park, Kansas. She will join fellow classmates and alumni this June when the JCCC Dental Hygiene Program travels to Las Pintas, Mexico, to participate in the eighth year of the Las Pintas International Service Learning Program.