Rotations in Guatemala: Students Making A Big Difference in a Small Country
Gabi Revis, from Rockford IL, is one of several dental students at UIC who have expanded their horizons through international rotations offered at UIC. She and two other students recently returned from a rotation serving patients in the rural highlands of Guatemala.
“As someone who is going into public health practice in the US, I found the international rotation experience invaluable for managing the complex, underserved patient, said Revis. “I got the opportunity to treat children and adults who have never even seen a dentist before. I now have a new sense of pride and faith in our profession and in our power as clinicians to heal.”
Gabi is a recent DMD graduate of the College of Dentistry and is also pursuing a Masters of Public Health in the UIC School of Public Health. Revis was also a fellow in the Chicago Area Albert Schweitzer Fellowship Program, which provides yearlong fellowships to graduate health students pursuing public service passion projects.
UIC College of Dentistry D4 Rotations, Guatemala 2018
Video by Gabi Revis
Dental Student International Rotations
Through partnerships with various community health centers in the US and international locations including China, Tanzania and Guatemala, UIC's Division of Prevention and Public Health Services in the College of Dentistry sends dental students to treat patients in far off locales who lack access to even the most basic dental care most people here take for granted. The specialized curriculum includes up to 16 weeks spent in an extramural rotation serving a diverse breadth of patients, young and old. Students may opt for the 4 week rotation in Guatemala or one of the other sites outside the US.
Since 2008, UIC has sent 24 students to Guatemala, who have collectively treated over 1,600 patients - mostly children – while also screening hundreds more for care needs.
“Each of these rotations offers different experiences for engagement in communities, and provides opportunities for students to deliver culturally-competent care to diverse and underserved populations,” said Dr. Caswell Evans, Associate Dean for Prevention and Public Health Sciences, at the UIC College of Dentistry. "The course specifically prepares these future health professionals to address the still prevalant issues of access to care, health disparities and social justice," add Dr. Evans. "These are topics not often considered in dentistry," he adds, "yet, in Guatemala, the students get an intense and unfiltered exposure to these factors."
During their time in Guatemala, students work along-side dentists and other providers in the Salud y Paz Clinic in Camanchaj, Quiché, Guatemala. Project Salud y Paz began in 2001 with one dentist working out of a small clinic in Camanchaj. Today, Salud y Paz operates three clinics on a regular basis, spread approximately four hours apart from the far northern reaches of El Quiche to the western highlands of Sololá. Since opening, the small clinic has provided comprehensive dental care, including cleanings, extractions and fillings to the people in the rural highlands around the region.
These international rotations can be life changing experiences for some students, beyond just enhancing their training. For DMD student, Denise Clare, the Guatemala rotation was personally meaningful. "Growing up as a first generation American, so many of my early memories involve me speaking for my parents who had no voice when it came to health care, " said Clare. "As a doctor, one of my personal goals is to be an example for other Latin American children so that they can see that doctors look like them too and that they are just as capable of becoming whatever they want."
DMD Class of 2018 students Matt Bernard, Denise Clare, Gabi Revis in Guatemala at Salud Y Paz Clinic
Students Providing Dental Care In Guatemala
Students who choose the Guatemala rotation experience a very different world of healthcare and particularly dental care within a culture strongly influenced by Mayan traditions.
Although small geographically, Guatemala is actually a blend of numerous cultures. Spanish is the official language, yet much of the rural population speak Ki’che, a traditional Mayan dialect, wear traditional Mayan clothing, and practice Mayan traditions.
Guatemala is a predominantly poor country that struggles in several areas of health and development, including infant, child, and maternal mortality, malnutrition, literacy, and contraceptive awareness and use.
Despite the hardships, the people of Guatemala are incredibly strong and brave. “Our patients walked miles to receive treatment,” said Revis. “Many of the children who came in because of numerous abscessed teeth, endured multiple teeth extractions without general anesthesia, without much complaint.”
Hardship and pain are daily occurrences in the lives of these poor children and their mothers. Domestic violence is incredibly common in Guatemala, particularly in poor and rural areas. In Mayan culture, women are often thought of as second-class citizens without rights of their own. For example, if a woman wants to go to the dentist, she must ask for her husband’s permission first.
“I learned first-hand how the people of Guatemala are resilient and make the most out of very little,” said Matt Bernard, DMD Class of 2018, who also rotated at the Salud Y Paz dental clinic this year. “They love their children and value their communities and want to see them succeed to the greatest potential. Despite the adversity, they have maintained a beautiful community that is on the rise.”
Healthcare Challenges in Guatemala
The Guatemalan health care system is extremely limited. Although high-quality care is available in Guatemala City, that care is limited to those who can afford it. Millions of people in the country lack adequate access to care and health education. Non-profit, religious mission-driven organizations such as Salud Y Paz fill an important void in rural Guatemalan care, but still cannot provide consistent regular care to all who need it.
"Salud y Paz is such a special organization because it provides both care and knowledge to a community of people who are so eager to learn," said DMD student Denise Clare. "It gives the community back their voice, it empowers people to live healthier lives and continue learning and I am so grateful to have been apart of it, even for just a little while."
Oral health care knowledge is also extremely limited among medical professionals in the area. This can lead to all sorts of problems for patients. “One of my patients was advised by his local pharmacist to keep putting aspirin directly on his gums, which caused severe burns to the gums and no real pain relief,” said Revis. The patient was subsequently relieved after students performed a routine filling procedure to resolve the cavity and reduce the pain.
In Guatemala, like in the US, the oral health system is largely separate from the medical health care system. Dental insurance is virtually non-existent in most rural areas. Dentists are trained and largely work separately from doctors, nurses, and pharmacists. Limited knowledge is shared between the fields. Outside of the mission clinics such as Salud Y Paz, many dentists have to travel to their patient’s homes without the benefit of a proper dental clinic. This unfortunately is the primary source of dental care in much of the country.
Another obstacle to good oral health is the local perception that teeth are temporary vs. permanent. So pulling bad teeth is seen as part of the normal course of living. For that reason, fillings are not a very common treatment choice of patients. "They would rather have a problem tooth taken out rather than saving it," said Revis.
The College of Dentistry receives financial support from the International College of Dentists (ICD) to support students’ travel expenses during their rotations at Salud y Paz in Guatemala, as well as the Muhimbili University of Health and Allied Sciences in Dar es Salaam, Tanzania.
This article was inspired by essays written by Gabi Revis, Denise Clare and Matt Bernard, DMD Class of 2018.