Neighborhood Notes

People are full of surprises. Last week, I had lunch with Kaz Rafia, the bright smile behind Rafia Dental, to catch up on the latest. Like most folks, I adore Kaz. Sure, he's a great dentist, but he's also a wonderful person who happens to be one of the most hilarious people that I know. But, over lunch at On Deck, I found out something new about Kaz. It didn't make me laugh--okay, there were moments--but it did make me even more proud to be his friend. Here's what I found out...

Kaz is a member of Medical Teams International and 'Team Rafia' just returned from a medical mission to Honduras. He counts this, his third trip as part of MTI, as a "pretty good trip," because he was able to experience it with three of his staff members (Kim, Trista and Tasha).

So, before I go any further, here's a little info on how MTI works. That Hollywood-inspired notion of random doctors being assigned to teams, hacking their way through jungles into unsuspecting villages to perform MacGyver-style surgeries, well, it's just not true. Each medical team coordinates their trip with the organization, uses housing provided by the organization and has appointments pre-booked by a field coordinator.

Team Rafia stayed in rustic cabins nestled in the mountains about 2.5 hours from the airport (San Pedro Sula). The cabins had running water and electricity, but they also had bedbugs and tarantulas. "That was a joy," recalls Rafia, " but it was absolutely beautiful up in the mountains."

After a day of rest, the team was driven to a neighboring village--which Rafia describes as more of an intersection--where they found a two room health center made of cinder blocks. One room was used for women's health and the other was cleaned out for Team Rafia's use. "I'm not kidding," says Rafia, "they had a barber chair for us to use."

A compressor and generator were sent beforehand to provide electricity and suction power to the dental set up. The team brought in all of their equipment and prepared their work area, but soon discovered that the tap didn't work. "Oh, we don't have any running water here," someone explained.

They also found out that using the toilet required a bucket of water and a headlamp because there was no water or electric in the bathroom.

"This is part of an actual, active, functioning women's clinic. there's people coming in there getting their lady business taken care of," explains Rafia incredulously. "It's the village's health center."

The team brought 5-6 sets of surgical equipment, which they sterilized in buckets of bleach and water. There were two little tubs, one with bleach and one with a little less bleach and water. The instruments were scrubbed down in the bleach, placed in the bleach water, wiped down with a towel and then ready for use.

You may be surprised to learn that most of the appointments (25-30 each day) were for extractions. Rafia explains that when these patients go see the dentist, "it's for taking teeth out, not for veneers, teeth whitening or invisalign."

"This is hardcore, ground level, basic, basic, basic care. All you're trying to do," explains Rafia,"is put them out of their pain and misery and reduce the infection."

99% of the patients were there for extractions, as many as 3-4 teeth per patient. There were no x-rays or images. The team had to work with what they could see. They weren't equipped to fill cavities, but they did let their patients know that cavities are fixable. (They even gave some folks money to use at a local dentist office.) Patients were given gauze to put over the area where their teeth were taken out. Rinsing was not an option, so patients were asked to spit in a nearby garbage can.

According to Rafia, in this village, by your 30s, you're pretty much an edentialist. "It's pretty much the norm," he says, "We had 18-year-olds who had 6 upper teeth and 5 lower teeth."

Dental care is culturally ingrained. In our country, there is an expectation and an association that if you're missing teeth, something's not right, but in a poverty-stricken area such as this one, dental care simply isn't a priority.

"It's both socio-economic and cultural and all about the hierarchy of needs," explains Rafia, "Vaccination and dentistry, Really?"

The team brought 55 pounds of toothpaste, toothbrushes and floss for the patients. Because they were not taught basic dental care and floss was a new concept, The patients thought it was the funniest thing in the world. One of the patients even asked if he could go fishing with it!

Kim and Trista spent half a day at an elementary school, teaching kids how to brush and floss. Like the adults, the kids also thought floss was a hoot.

In total, the team was in Honduras for nine days. They spent the last 24 hours "chilling out" and taking in the sights of a nearby city.

The team brought home their sharps containers, because they couldn't trust they'd be disposed of properly. "There was garbage everywhere," recalls Rafia, "it blew my mind."

Now that the team has been back in Portland for a couple of weeks, they've had time to reflect on the experience. Rafia's team--two of which had never traveled out of this country--was shocked by the level of abject poverty as well as their working environment.

"One reason i love doing this trip is because I believe you reset your expectations in your daily life," offers Rafia. "It gives you a sense of what's really important and a macro, dead-center, right up nose-to-nose view of what 99.9% of the world might be going through. We need that."

His take home lesson: quit bitching.

"If you opened your tap this morning and warm water came out. if you didn't have bedbugs on your ankles, or your stomach wasn't in turns every time you used the facilities," he says, "Everything is great in your life."