Dental Health International Nederland
Op deze pagina houden we u op de hoogte van de stand van zaken op dit moment.

Het laatste bezoek van Walter Mautsch aan Apurímac vond plaats van 3 oktober 2005 tot 25 oktober 2005
Het verslag is de moeite van het lezen waard en u treft het aan op een separate pagina, samen met een groot aantal foto's.

Walter Mautsch is in juli en augustus 2005 weer in Peru, na een vorig bezoek in oktober 2004.
Bij het eerste bezoek heeft hij een twintigtal ART sets meegenomen, die geschonken zijn door DHIN.
De huidige reis wordt besteed aan onderzoek van de tandheelkundige situatie op het platteland en tevens worden de voorbereidingen getroffen voor de ART cursus in oktober 2005. Bovendien worden de contacten met de autoriteiten opnieuw aangehaald en afspraken bevestigd.

De ervaring die DHIN heeft met de douane in Verweggistan wordt wederom bevestigd. De eerste 20 ART sets, meegenomen in de handbagage in oktober 2004, zijn probleemloos het ingeklaard.  De materialen die in juli naar Peru zijn verzonden (voor de ART cursus in oktober)  worden helaas nog steeds niet vrijgegeven door de douane. Het wordt weer een kwestie van lange adem. Afijn, lees de verslagen maar.

Hier is het verslag van Walter Mautsch:
-

 15 july 2005
We have returned yesterday evening from our second tour to the province of Grau.
Now we have finished with the exams in our pilot school centres of Grau, we examined 358 children.
We left Abancay rather late at 15:30 although it was planned to leave at 13:00.
This is one of the things you have to get acquainted to: time is something very flexible in Peru.
One nearly never gets the right hours when you ask how long a procedure will take or when we will leave or start an event.
Although already knowing this fact, it costs me sometimes a lot of energy not to lose my patience.
In this case I knew that the journey would take about 8 to 9 hours to get to the village of Huayllati where we wanted to start the survey on Monday morning. The roads are bad and dangerous, so you can imagine that I was not very keen to travel the whole night.
We arrived at the hospital of Chuquibambilla at 19:00 (120 km!) where Dr. Dean Cerrazo, my colleague was already waiting since several hours.
There was a discussion with the acting head of the hospital, as she was not prepared to give us a comfortable car to continue the journey.
We discussed the issue and finally we took this car.
Later on, I was informed about the reasons of her denial: the car should be property of the district of Progreso, but the hospital of Chuquibambilla has taken it by themselves. They feared that the people of Progreso would annect the car as soon as it enters the limits of the district!
Again something you have to experience: why do they not inform me at once about this problem?
We would have found a different solution.
We started our trip through the night, at 24:30 we arrived the town of Curasco
and I decided that we would not continue the journey, as we and particularly the driver was tired.
We slept in the health centre for three hours, at 4:00 we continued the journey.
We arrived Progreso at 6:00 and our driver returned as quickly as possible to avoid any confronting situation with the people of Progreso.
We continued our journey with the ambulance of Progreso. Finally we arrived at Huayllati at 8:00 in the morning.
The examinations in Huayllati were very successful, particularly as the teachers were very motivated and helpful.
The school was well organized and the pupils were very educated and with an excellent discipline.
It was the best experience throughout all our visits up to now.

On Tuesday we returned to Curasco (3-4 hours drive), leaving Huayllati at 4:00.
We took a family with their sick child with us to leave them in the health centre of Progreso where there is a medical doctor.
Unfortunately the baby (9 months) died during the journey and we had to leave the family with their grief in Progreso.
When you experience such problems you become aware how little important is a disease such as caries to the people!!
We should be moderate in our demands and be aware that dental disease is priority No. 155!

After our survey in Curasco we continued our journey to Vilcabamba where we stayed overnight in the newly built health centre.
Vilcabamba has a mild climate, it lies about 2700 meters high and there is eternal spring.
The survey showed that here we had a different picture of caries prevalence.
While in most other schools we had a high percentage of arrested initial caries,
we had the impression that in Vilcabamba there was much more cavitated caries.
One explanation might be the excellent access to the provincial capital (30 minutes , good road), more public transport and shops.
Well, we have to see what the statistical analysis will demonstrate.
We returned to Chuquibambilla where we took farewell from Dr. Dean.
During these two weeks I got the impression that he will be an excellent partner in our project.
He is eager to learn new things and to do more than only extractions in the hospital.  
Today I have prepared the filled survey forms to be put in an Excel table to transfer the data later in a statistical programme.
I do not want to take all the paper with me.
Unfortunately we had to change plans today. We actually wanted to go to the province of Antabamba to continue the survey.
But there is a national strike today and this causes problems on the roads.
Very often people close the roads blocking them for the traffic, in addition it is very probable that the teachers have left their schools to go back to Abancay to demonstrate.
We were not able to contact us with the health centres where we wanted to go.
For all these insecurities we had to postpone our journey to Sunday.
I will use the time in Abancay to prepare the ART course in October and to control the entry of data in the computer.
On Sunday we will leave for Antabamba and we will do the survey on Monday and Tuesday.
Then we have to stop the survey till mid of August, as there are other school activities and preparations for the national holidays and the school holidays will be from July 25th to August 15th.

 10 juli 2005
As I already have written, I arrived in Lima on june 16th, at the same day I
had a meeting with a representative of the Ministry of Health (MINSA) and we
discussed possibilities of cooperation in the project. MINSA (ministerio de Saude) seems to be
very much interested in the promotion of ART in the different Regions of
Peru. On friday, 17th june I was able to assist in the final day of a ART
mastercourse given by the above mentioned dentist. So MINSA has trained 24
dentists of the different Regions in a Mastercourse and the dentists should
be able to transfer their knowledge to their colleagues in the various
Regions.
We have started the calibration course for three dentists and 5
healthworkers in Abancay on june 21st. We had the theoretical introduction in
practical exercises in schools of Abancay examinig just the three ages 6, 9
and 12. The final practices demonstrated a vey high coincidence of the three
dentists in examinig the children. we had a Kappa coefficient of 95% which
is a very good result.
On june 27th we started our tour to do the survey. First we visited the
province of Cotabambas. Only to give you an imagination of the difficulties
to get to the different places. It took us 3 hours to go from Abancay to the
place where the unpaved road to Cotambas started (150 kilometers on asfalted
road). from there it took us 5 hours to cover 100 kilometers! So we had an
average of about 20 kilometers per hour, and this average remained the same
througout our journey. In Cotabambas, the capital of the province of
Cotabambas we met the local dentist and the next morning at 6 o´clock we
started to visit the first school in Pfaco, about two hours and half drive.
What do we do in the survey? We look for DMF-S, initial carious lesions,
Fluorosis, OHI-S, CPI, Hypoplasias and traumas, as well as signs of general
hygiene. In addition we do a questionnaire concerning oral health behaviour,
experience of dental pain, gum bleeding and lost hours in sleep or school
visits due to dental pain. We weigh the children and measure their height.
This is in coordination with the department of Nutrition of the regional
health Authority. As the examination is rather complex, we only are able to
examine about 40 to 60 children per schoolday. if there are more children we
do a selection by chance, as we do not have the chance to return to the
schools within  the next weeks.

So we did examinations in three schools from june 28th to 30th. It was
interesting that although there was a holiday (29th) the schoolchildren came
to be examined. We noticed in these communities which are far away that
caries is not very frequent, but oral hygiene is low. Many of the children do
not know toothbrushes and even less toothpaste. Toothpaste is sold in the
local shops and in the market, but only few toothpastes are sold per year.
One vendor told me that she sells about 15 toothpastes a year! There is also
fluoridated salt in the shops, but people buy salt without fluoride because
they think it is cheaper. But it is only a matter of weight!! The fluoridated
salt of 1 kg costs double of unfluoridated salt of 500 g! It is the same
price, but people are not able to consider the different weight. So there is
a lot of promotion to be done in the near future.
Later we left Cotabambas to go to the province of Grau. It took us one day to
go by car to the next schoolcentre, which was about 140 kilometers away. the
roads are extremely bad and dangerous and many crosses show how many deadly
accidents have happened. We recovered a little bit on sunday 3rd of july. On
Monday, 4th, the dentist of the province of Grau joined us in the morning.
he had left the provincial capital Chuquibambilla by a four-wheel driven car
at 4:30 to arrive in Totora Oropesa at 8 o´clock. We examined another
three schools in Totora Oropesa, Turpay and Virundo. Interesting to see that
in these schools, the project already had started thanks to the initiative
of this dentist. He had managed to get toothbrushes from Caritas for all
pupils of the schools which are integrated in our project. So we already
could see the children with their toothbrushes and according to the
information of the schoolteachers in Totora Oropesa, they have started to do
daily toothbrushing. Well, we have to see how it goes on and we need to find
some ways how to verify the reality...
On wednesday, 6th we examined in Virundo. Only to give you an example of the
cooperation of the schools. This day is the national "Day of the School
teacher" and it is a day free for teachers and children. Nevertheless, some
teachers and nearly all children have arrived at the school to undergo the
examination. It demonstrates that there is a big interest of the children
and the teachers to start a oral health school programme.
We returned to Chuquibambilla (2.5 hours)and from there in a 5-hour drive
back to Abancay. On the way we took a hospitalized person from one health
centre to the regional hospital in Abancay, because there was no ambulance
to tranfer him to the hospital. We arrived late at night.
The last two days i used to get clean again and to do all communication by
email, as there was no communication neither by phone nor by email during
the last ten days. I started to coordinate the trainig course in ART in
october and to check the filled survey forms to make them prepared for
entering them in the computer.
Our next trip will start on Sunday morning. We go back to Chuquibambilla and
from there in a 8 hour drive to the next school centres. We will be in three
schools, then return to Abancay (13th july) and leave for the next province
on july 14th till july 19th. then we should have covered about 60% of the
schools.
From july 22nd to august 15th, no examinations will be possible, as there
are school holidays. Therefore, the Peruvian dentists will continue the
survey after the holidays by their own. But I have the impression that they
will do it quite well.

 8 juli 2005
Things are going, the Ministry of Health in Lima wants to support us with
material and instruments in the ART course in october, we are coordinating
now, I will ask the panamerican Health Organisation if they can support us
to invite Osvaldo Ruiz from Ecuador who works closely with Christopher
Holmgren to do the course. Apparently his cost would be about 2000 Dollars,
which should be cheaper than invite Christopher Holmgren who in addition
does not speak Spanish.
The instruments and material are still in the customs in Lima, there is
always quarrels between the institutions. It is a pity; now the regional
health Authority has published a resolution to demand the material without
paying customs.

 27 juni 2005
As you know, I arrived thursday june 16th in the evening. On friday I got
into contact with a person who should help us to get the material out of the
customs. He already was in contact with Mario and we were very optimistic.
The same day I had the opportunity to visit the last day of a mastercourse
in ART in Lima, organised by the Ministry of Health. One of my dentists from
Abancay, the former coordinator of the oral health programme participated in
this event.  I got to know the responsable person of the Ministry and we
agreed in coordinating our course in Apurimac in october with her. We
might have some support from the Ministry of Health which is very important.
On saturday I went to Cusco, on Sunday I drove to Abancay. From tuesday 21st
to friday 24th we had a good calibration course with three Peruvian dentists
and 5 health workers.

I was very strict with the participation of the
people, as there is always the custom that dnetists come only for some
hours, arrive late, go earlier and so on. I made quite clear that only
dentists who will participate the whole curse will be able to participate in
the epidemiological study. Thus, two of the dentists of Abancay who I wanted
to have with me cannot participate. I think they were surprised that I would
be so strict. But why do we do a calibration exercise when the participants
are not here? I think the team we have now will be able to do the survey and
they are very interested in it.

There are a lot of difficulties to do the survey in the time period I had
planned, as there are some strikes and holidays we did not know. But all
dentists want to organise their communities and tomorrow I will go to
Cotabambas to start the survey with the responsable dentist of this
province. It will take me about 12 hours to go there, first i have to go
back to Cusco where a car of the health centre of Cotabambas will pick me
up. We will arrive in the night and will meet the other team members. Then
we go to a community which is about 2 hours drive from Cotabambas and will
do the survey. We will need three days to visit four schools together, then
the rest of the control schools the dentist will do with his team by his
own.
What the material is concerned, we got information that the customs
authority does not want to release it without  paying high customs.
Apparently Customs does not cooperate well with Ministry of Health. Now we
have put the issue to the regional Government which will send the
corresponding official resolution that the material is a donation and will
be free of taxes.

 2 november 2004
I just have finished a wonderful lunch with Mario Paniagua, my person of
confidence here in Abancay and his family. It is holiday, first of november
and all people are celebrating and go to the cementary to celebrate with
their family members who already have died. It is an very interesting
custom, they bring meals to the graveyards and eat and drink. They make
twelve dishes and leave the dishes for their passed families. This is
repeated for dinner and tomorrow also.
Tomorrow is my last day in Abancay. I used the last days to finish the
project protocol, which is in Spanish. I wills end it to you when I am back
in Germany. There was also a lot of documents to be finished, such as the
official handing over of the instruments and the material, I brought with me
copies of some literature on ART and Public Health which has to be handed
over officially. In the meantime I have contacted  PAHO office in Lima,
because I learned from PAHO officials that there is a spanish Version of the
ART manual for dentists and auxiliary personnel.
(PAHO = Pan American Health Organization - de Amerikaanse tak van de WHO)
I have also contacted a project of the European Community here in Abancay
and have handed in a solicitud for financing the courses of the dentists and
health personnel next year. Tomorro w I will have a meeting with
representatives of Caritas to explore whether there other possibilities of
financial support.
The meetings in Antabamba and Chuquibambilla were quite successful. The
people are eager to work with us and they already obliged themselves to
aupport, for example the municipality will provide us with gasoline to visit
the different school centres which are some hours away from the provincial
capital. The educatin sector wants to cooperate with us and wants to
multiplicate the manual for teachers which we want to develop. So there is
some enthusiasm going on and we already had some complaints from
schooldirectors of other schools why we have not included them in the
project. We had to explain them that we cannot cover the whole provinces in
the beginning and we want to start with few (17) schools and about 2300
pupils between 6 and 14 years. Better to start slowly and small and extend
gradually than to be too ambitious and not be able to implement the
activities either due to lack of funds or manpower.
Today I will make a list of activities to do in the next months with
responsibilities for me and my counterparts at the health authority. It is
important to remind me and particularly my Peruvian counterparts that there
is a lot of preparatory work still to be done. And it is very human, that
you will leave it when you think, that the next course is not before March
2005!! And at last you do not have time to prepare everything carefully and
in detail.
Tomorrow evening I will meet a group in Cusco called  "Dental Project Peru".
They apparently go from one community to the other for one day and extract
teeth and then dont appear again for months or even one year. Unfortunately
they went to the province of Chuquibambilla and did not contact neither el
responsible dentist of the Regional health authority nor the dentist of the
Hospital of Chuquibambilla. Of course, the dentists are not very amused
about this issue, it seems to me like the old-fashioned health colonialism
which I thought we already have overcome. In addition, they worked in
healthposts where we have trained auxiliary personnel!! Thus they will
undermine the authority of that trained health worker, people will only go
the these campaigns where they get treatment without any cost, although they
could get the same treatment (extractions) throughout the year. I want to
talk with them about this issue and ask them to keep out of the provinces of
Chuquibambilla and Antabamba where we waht to establish the project, because
it will interefere with our objectives and activities and it is not a
complementary activity.


 30 oktober 2004
I arrived on Tuesday 19th, after spending the whole monday in Lima to arrange my
flight to Cusco. The airline I wanted to take (and I had already the ticket)
was not able to fly due to lack of funds and therefore lack of gasoline!!
So I changed the airline, and then I had to wait for 3 hours to recover the
money for my ticket already paid. It was a typical situation, therefore I
always consider one day in Lima. It is not the first time that I had to stay
one day more in Lima.
From tuesday all went quite well. The responsible dentist was very engaged
and we worked hard to plan the project and write a project protocol. We
nearly have finished and will do the last touch tomorrow (saturday). Last
tusday and today we visited the two regions where we want to work and had
meetings with the local authorities (municipality, education sector,
headmasters of the schools, responsibles for health promotion, health
workers). We explained the project and the people agreed in supporting us
where they can. So we have promises from the municipality to give us
gasoline for the car, education sector will multiplicate the manuals for
teachers we will develop and the Church supports us in writing funding
proposals for Caritas.
contacted the organizers of that university to ask whether some of our
dentists can participate. I will have a meeting with her on november 6th
when I will return to Germany. Christopher would be prepared to come to
Abancay to give the course to the dentists here, which would be an excellent
solution as I would be able to let more dentists of the health authority
participate. We just have to get some funding for Christopher to come to
Abancay, give him accommodation and some per diems. He really is a nice guy
and does not charge any money for his course!
So you see, things are starting and I am quite hopeful and enthusiastic
about the project.
By the way, I had 40 kgs overweight in Maastricht, the woman was very nice
and she reduced the overweight to 13 kgs, but anyhow this were 250 Euros. In
addition, the Peruvian airline charged me 30 Dollars. The customs had a look
at the things but I could convince them that it is donation and they let me
go with all without any charge. So all went rather well.
I have handed over the instruments to the regional health authority and DHIN
will get an official letter of them thanking you for the donation.
There are also possibilities to buy some of the instruments directly with
 PAHO in their office in Lima and we should think about that to avoid another
excess weight charge.