I fight through the gaps in traffic to cross the highway that runs past Urubamba. It's clinic time. Squatting on the far side of the road, the run-down Minsa clinic offers government subsidized medical attention in all flavors, from physiological counseling to childbirth: not a beautiful building, but an important one, and volunteering there has been both enjoyable and eye-opening.
Minsa's dental unit is a single white walled room with two big tables jammed with countless instruments of hygiene. The impressive collection of shiny dental paraphernalia sits out because there is no room for storage. It lends the room a daunting, slightly sinister atmosphere. Fortunately, any negative impression is soon swept away by the two cheery men in white coats. Javier is a pudgy middle aged man with subtle Santa-clause like tenancies. Reserved with adults, he's great with kids, and they usually leave his care smiling. Or at least not crying-- which is no small feat for a dentist. He also makes a mean latex glove balloon. Jaime is a young, passionate, fresh-out-of-school-er. Patients are always a bit surprised when they wade though the gray bureaucracy of a state medical program only to be greeted a energetic dentist with a radio blasting American pop. As usual, I'll spend most of my time today with Jaime. He's been fantastically welcoming to the strange gringo who showed up in his office. I get the impression that another pair of hands (even foreign, untrained, barely competent in Spanish hands) are always useful when there's a flood of patients.
And what do those hands do? Well, today they'll be holding the saliva vacuum. I'm sure the thing has an actual name, but my limited spanish vocabulary usually leaves me calling it “La aspiradora de saliva.” I think my Spanish buffoonery may actually ease tension in patients, and it certainly eliminates any status as intimidating foreigner. The suction device only works about 50% or the time, but I have job security through my roles as instrument rack, sink cleaner, pliers fetcher, and stitches holder (when we have to sew up gums, I help hold the thread so that Jamie can get a nice, secure knot). Dental work is unsurprisingly gruesome: today, we'll inject novacaine, pull teeth, and see a lot of blood. At first, I found it hard to watch any part of the work. I'd blindly hold the saliva vacuum and focus on not feeling nauseous. Now I've adapted; it helps to know that the patients really can't feel anything through the Novocaine. This afternoon, I'll only squirm during the actual injection of the numbing agent. The first minutes of our operations are nothing but needles, gums, and pure, tense discomfort, but things soon relax into light banter, saliva suction, and the yanking of molars. Peruvian dental work has become a normal part of my Wednesday-- just another routine. Arrive, wash up, chat, help, and wash up again. I have a good time goofing off with Jaime between patients or in slow periods, and I get to feel useful in the rushes. Above all, I get exposure to a basic, and revealing aspect of life in Peru.
In my clinic time, I've felt a gradual, growing understanding of poverty. I listen as Jaime explains the two options for filling: the free, mercury based filling or the ceramic filling, with a 3 dollar per tooth surcharge. People always opt for mercury. I listen as Jaime explains how the clinic doesn't have the technology to save a tooth-- we can pull it out, or the patient can go to a costlier, private dentist to repair it. People always opt to pull the tooth. I listen to Jaime explain the need for braces, and watch the patients cringe at the price. Minsa is a clinic for people without options. The clinic itself is stretched thin. Every day, I notice small wants, from the finicky, barely operational suction machine to the supply shortages to the lack of space that forces the exam room to double as storage. Minsa is built on good intentions and staffed with dedicated doctors-- but chronically underfunded and poorly equipped. I've asked myself why, but there is no good explanation: the government either can't or won't provide for the poor.
Together, the clinic and its patients tell a story. For me, they've shaped a new conception of poverty. Instead of a statistical description (x percent of people lack Y) or an emotional understanding (the shock of realizing that a friend lives with his entire family in one room), my time in Minsa is narrating poverty though an ugly process. Every day, for a flood of people, Minsa is the only choice. Every day, patients have no alternative but cheap mercury fillings and the removal of teeth that could be saved for a bit more cash. Watching this flow, I feel the human pain of poverty, but captured in a whole new scale. This is a pain bigger than individuals, or even villages. This is systematic, substandard health for people who have done nothing to deserve their lot in life, and I know that every day, the flow of patients continues. It's sobering and frustrating beyond belief.
The hours I spend in Minsa will stay with me for a long time, a sharp reminder of inequality-- and yet when I walk out the door, I will feel satisfied. Maybe thats because I'm reminded that the world is filled with Jaimes Javiers, wonderfully dedicated people. Or maybe it's because I feel like I've helped in some tiny way. Or maybe it's just hard to feel gloomy when watching a five year old play with a latex glove balloon. Whatever the reason, I'm always glad that I braved traffic and stares to go work with the dentists. There can be no better way to spend Wednesday afternoons.
