Sarah Lyons
SCC DENHY Special Topics 293
We arrived in Cochabamba, Bolivia exhausted and excited to begin our journey in this country. Prepared with bags full of floss and toothpaste, Cheyanne Osborne and myself had the opportunity to accompany seven other women on a summer study abroad trip that would change our lives.
Our first day in Cochabamba, Bolivia greeted us with the challenge of educating the Smiles Forever students about basic oral hygiene, extra oral and intra oral cancer screening exams, patient positioning, and use of the mouth mirror. It was a great exercise for me to reinforce what I have spent many months learning and perfecting. I felt like I had so much experience in comparison to these girls and it made me think of how silly we must have looked in our first weeks of clinic. We were able to do hands on work and use the show, tell, do method with the students. Cheyanne demonstrated the use of the mirror on me and had her student partner do the same. The students were so hesitant to put their hands in our oral cavity, as it was one of their first experiences doing this. We assured them it was safe and we were willing, and eventually we started to make headway in clinic. We spent much of this time learning how to communicate with the Smiles Forever students and using broken Spanish and English to do so. I was amazed by the eagerness of the students to learn, even though it was difficult to understand. This language barrier followed us through out Bolivia, but we got better, and more resourceful as time progressed.
My biggest challenge in Bolivia was feeling overwhelmed. I have been on mission trips before. I have built many houses for faceless people. Here, I was delivering care to actual people. I was serving humans with feelings and fears. I was completely overwhelmed by my first patient. She was an indigenous woman, who had never been to the dentist, not even one time. She reached out to Smiles Forever for care because members of her family had done so. She got into my chair and I attempted to start scaling with their dull, old instruments. I felt like I wasn’t making any progress and it was over my head. I had never seen a calculus bridge like this before, not even in pictures. I had never seen inflammation to this extent. I attempted as well as I could for about thirty minutes and eventually sought out help. Rosie Bellert, the director of our program took over for me. She began working, slowly removing huge chunks of calculus and doing what I could not for this patient. Clinic time expired and we rescheduled the patient for that afternoon, but only a small portion of need was met with this patient. There was a lot more to accomplish. This is the moment that I will carry with me throughout school, throughout practice, and throughout life. I instantly felt a desire and a need to be in service. I was so affected by her eyes, her fear, and her need. Rosie told me that this feeling would happen. I shrugged it off…I had been on missions. I had traveled the world. I didn’t realize the difference in service when you directly deliver care to a patient. This is the moment that changed my life.
We spent time in several different locations in Bolivia. We worked at an orphanage, a burn unit, and a rural village in Morochata, Bolivia. We did the same procedures in each location, but each location affected us in a different way. Cheyanne and I actually had the opportunity to go to the orphanage together, and I am so glad we went together because we needed each other this day.
Madre de Dios is a home for girls between the ages of 8 and 18 that are in unfortunate circumstances and do not have a home anywhere else. 
They also have daycare on site for younger children. Here, they are fortunate enough to have a dental clinic that is overseen by Doctora Patty. There is a lot of need at this site. During our time there Cheyanne and I placed sealants and scaled on four young girls. We hardly scratched the surface of what needed to be done. Although I felt this way, Doctora Patty was so thankful for our help. She expressed how overwhelmed she gets and how little funding and help they get. At one point, Cheyanne was working on debriding her patient and her lips were cracking and bleeding, when she asked for lip lubricant, Doctora told us that it was not something they could afford in this clinic, and they do without it. It reminded me that the little thing that we expect to have and take for granted, are not common amenities there.
Working in the burn center in Cochabamba was a fragile and delicate craft. These children have been through a great deal of pain due to their burns and have had terrible experiences with doctors. We came to work at the burn center with our masks and gloves, and the children that were once loving and sweet were afraid and timid. Smiles Forever is working hard to create a positive presence there so that the children will be more willing to receive care in the future. The clinic we set up in the center was small and archaic, but is served its purpose. By the end of the clinic we were taking photos with the children, and letting them try on our masks and gloves. It seemed as if their fear had subsided for the moment, and that is what we wanted to achieve. In the rural town of Morochata fear of dentistry is also prevalent, but the pain these children were feeling overpowered their fear of dentists.
We drove to Morochata in the wee hours of the morning in September eager to start work in the village. When we arrived we set up clinic in the school in the center of town. Here, a handful of dental providers supplied care to 398 students. We had a silver fluoride application clinic, as well as an extraction unit. This school provided a center for multiple schools to meet so they could be provided care. All day we worked, educating, applying, extracting. It was an exhausting day. My mind and heart was tired by the end of our clinic. The Smiles Forever students took each class, one at a time, and talked about the importance of brushing and flossing, and nutrition. From here, the students went into the school restrooms to practice their newly learned brushing skills and to debride their surfaces for silver fluoride application. Here, silver fluoride was applied and if extractions were needed, they were sent on to the extraction unit. Most students had at least 2 extractions to be done that day, some up to seven. Some children were eager to get into the chair and have their teeth removed, some were terrified, but in pain. Reluctantly, they watched others 
go through extractions and come out with puffy cheeks. Eventually, we had compliance and were able to help those in pain. Our last extraction of the day is the one that stands out most in my mind. It was for a young girl that had watched all day. She stood back with her papers, but did not come forward for care. While we were cleaning up at the days end she finally asked for her extractions to be done. The Bolivian doctors were done, but Dr. Fred from Seattle gloved up. She sat in the chair with tears already running down her face, but she also complained of “duele,” or pain. After delivering an injection of Lidocaine, Dr. Fred began working on the two extractions needed. She was in tears. Cheyanne held her hand and comforted her, however, it was still a traumatic experience for her. Eventually, we completed the procedure, and she was given pain medication due to the level of discomfort she exhibited. We left with saddened hearts. We ate lunch at our hostel talked over our experiences and trying to discuss ideas for improving dental health in this area. We all felt overwhelmed by the need. This experience made the impression on me that we had made a large impact in a small area, but the reality is that there is so much more to do. That is why I feel a great loyalty to this area now.
There is a great need is Seattle, Yakima, and all over the United States. I do feel a commitment to my home, however the poorest people in the United States have a greater access to care than the people in these areas of Bolivia. The experience of giving a child their first toothbrush changed my perspective about health care. It alleviated my worries about finances and my future. It gave me an understanding that providing for the underserved is where my passion in dentistry lies. This study abroad experience was greater and more powerful than I could have hoped for. The three weeks that we spent in Bolivia only gave me a desire to spend more time in this country, and a dedication to community service. Dental hygiene school has prepared me with didactic and clinical skills, but this course has given me more knowledge about life and love than I could have read about in a book.
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