Projekt Perureise
Peru - the diary of an exiting working trip – by Ilka-Constance Horlitz
Airport Frankfrut , 7:50 Thursday 19th March 98 My mother and me waiting for our flight to Lima\Peru. Suitcase overweight of more than 55kg full of impressionmaterials, serile tools and medications. A couple of weeks ago we met this lady Niki Muegge-Bruckert . She is the leader of the Assocassion Pacha Mama .founded in 1985. A caritative project based in Nasca that gives developing help to the population especially to children. Niki told us about the underdeveloped medical conditions and that any help is needed there. Especially prothetical care is in most cases bad and too expensive for the poor patients.
So we decided to make a twelve days trip to the Pacha Mama House in the middle of Nasca Desert to work there on patients with extra-oral or maxillo-faciale defects. Tired but full of expectation we arrived after 12 hours flight in Lima . There we had to stay for the night to continue on the bus 7 hours to Nasca the next day - quite an adventure. Here we collected the first impressions of Peruvian lifestyle: you need a lot of time and patience - waiting is normal.
Nasca , 21:30 Friday 20th March 98 Arrival in Pacha Mama House The hole crew was there to welcome us. We got introduced and showed arround. Assosation Pacha Mama is a big house which gives place for special social cases from the area. Exept from the crew- a teacher, a chef and two assistants - there were living two homeless children and two young mothers with their children. The women work also in the kitchen and the house and for this they stay and eat for free with their children. The whole place was very familiar to us and we directly felt comfortable in this environment.
It also became clear that for treating patients and laboratory works we would have to find some solutions but coming to Peru we knew that everything would walk in a littlebit different way than in Europe. Saturday, 21st March Chris was the first patient that I saw in Pacha Mama. Her mother heard in the town about our arrival and thought we could maybe help her daughter. Seven years old Chris had a defect of the left Bulbus after operation three years ago. All this was normal but the shocking element was the prosthesis that the girl had to wear : it was far too big so that it looked like a frog's eye .It was obvious that the little girl must have suffered from a lot of pain when she got the prosthesis. The lids where in the three years of wearing so unnaturally streched that it got clear a normal prosthesis would be far to small at the beginning and it would take some training to let the lid muscles restrict and get them working again. As the mother permitted she would not mind this I started the work on the eye by taking an impresion and defining the girl's the eye color.
Monday, 23rd March We drove to IPSS Hospital in Ica to see different patients and check up the situation in how far we can help with our brought materials. Arriving there we found a situation not comparable to any German standart. A totally overcrowded hospital with very low hygenic care and a technical standard of the early 80ies. The permantent lack of financial and medical means makes improvisation neccessary for everyone. Tools like oneway scalpels or gloves are rare and all the things that we brought were more than useful for the clinic. Because of this lack the medicals are only able to make simple surgeries.
The more complicated cases get transfered to Lima. We were guided by one of the only English speaking persons Dr.SotoMerino a plastic surgeon who was himself only temporarily working in this hospital. He was a member of a surgeons group from Lima who give helping work in hospitals in the poor areas of the country. He also informed us that our visit was something very special for this hospital in Ica because the most help activities happend in Lima and just very few medical teams find their way so far into the country. To see the patients then was a real adventure...
In a small room with a table and two chairs , a bed and a little medical table it became soon packed . exept from us and the patient there were several hospitants and a translator. there appeared situations that i had to use toilet paper because hygernic serviets are luxury. also cellulose tissues were not arround - things that at home nobody would work without. four patients came. The first patient was Yolanda . In a car accident she lost her left hand and the upper front teeth. I took an impression of the defect arm and the right hand . To make this hand prosthesis in Peru would be a too big effort so I decided to take these imprints with me to Germeny to finish . But as we also brought teeth with us it was no problem for my mother to get a prothsesis for Yolanda done.
Second patient was Edith a 23 years old dental student who has a defect in the left eye. When I asked her for the diagnosis she could just tell me that at the age of 1 1|2 her Bulbus started to be sore and then restricted more and more until it stopped at the age of 6. The doctors told her that it was an infection. Nower days there is just 10 % of her Bulbus left. Making an eye prosthesis for her during my stay was no problem so I started with the neccessary procedures like taking the impression and the eye color . Her further treatment I decided to do in the Pacha Mama House. Third patient was Gerardo. A 5 years old boy that at the age of 8 month exploded with a cerosine cooker. As seen on the photos he suffers from heaviest burnings on the hole corpus and especially in face and arm area. In first step he was a case for chirugic care. Dr.SotoMerino took over this part.
Fourth and most special case was Olinda. Her huge facial defect was including the right eye, the nose, the upper jaw and parts of the cheek and the forehead. The remarkable thing was that also this patient did not know what she was suffering from. She just told us that she had once been in Lima for an examination. For us it was obvious from some scars that she must have had some surgery even though she denied this. To reconstruct the face we had to take an impression of the hole defect. Further some fotos of the patient ' s sister ande some samples of skin and eye color should help to rebuild the face for the prosthesis. But also this work I decided to continue in Germany where all the neccessary tools for such a specific work are given and than to come back again to finish the treatment on the patient.
Our biggest problem was the heat. Not that we were personally suffering but it was the impression materials that - on European standart - reacted in the heat enormously much faster so it was quite difficult to get acceptable results. After a long sweating day and another 2 1|2 hours drive we came back to the Pacha Mama House. Tuesday, 24th March Danyella - 5 years old - was the next patient I got. Because of a mycroty her left eye was missing and it appeared as no problem to have an prosthesis done for her .After the normal procedures I started out with the "laboratoy works " on the imprints.
In this my laboratory was a corner in the kitchen of the Pacha Mama House which I concored for my works. Maybe some people cannot understand how it is possible to work under such circumstances but to say the truth I found it quite exiting to work with that much improvisation. At that time I did not figure out with what kind of promblems more I would have to fight exept from the fact the the acrylic more or less dryed under my hands in this wether conditions. Wednesday, 25th March The works on the three eyes proceded quite good . The acrylic reacted well ,too and the colors came out how they were supposed to be. But then my grinder gave up. Because of the differnt Hertz frequency it got hot and it was not possible to use it more than 5 minutes in one turn. That started to be a big problem and the working got slower and slower. The patients that I had asked to come for the evening to compare the color and fitting had to be transferred to the next day.
Thursday, 26th March It took me ages to grind the eyes but for the polishing it was not possible anymore to use the grinder. We had to find a different option. After serious searches in the hospital of Nasca and in other dental offices finally we found a denal technichian who allowed me to work on his polishmashine. I was able to finish at least one eye.This trip though the clinics aswell gave an insight into the poorness of this area i.e. the denal section of the hospital in Nasca has one pair of grinders to traet all their patients.
The mashine that they have to work on was probably built before I was born. In one word : incredible ! Back in Pacha Mama Chris was there to recieve her eye ( photo ). She was very happy . I found it quite remarkable how fast the girl understood how to do the movements that we showed her to train her eyemuscles. In the early evening the father of one of the assistants came with a packet. What he unwraped looked like a cross between a sewingmashine and an old Black'nDecker and turned out to be a selfmade polisher . This was basically the safing tool. Quite old fashioned but doing it's job it seemed that I was able to finish the works then on the next day.
Friday, 27th March It took a half day but in the end the eyes were polished and ready to be fit in. First came Danyella. She was very exited so that it needed some time to calm her down but then we could try on the prosthesis. After all this circumstances I nearly could't believe when I saw that everything was fine. Nothing to change we all were very happy. Next was Edith. When we fitted in the eye she had some points in the eye which were not really comfortable so it was neccessary to work it over again. Normally this was a job of a few minutes but circumstances let me work deep into the night so that I had to fit in Edith's eye the next day. Saturday, 28th March Edith's prothesis fitted and she was more than happy.
All we could further do was taking some photoes and close our works. Danyella came arround once more and also with her everything was fine so that in the end of the last working day we could say that our work was successfully done. The next day was dedicated to relaxation for the trip back to Germany. Back homeI was quite shocked about the rushing speed of Europe and further more this trip to Peru showed me in what wellfare we live here . Help down there is needed so badly and if just some of us give a little bit of their time or money beautiful things can be done. To me it was a big experience and very rewarding to work there and I am looking forward to go back soon again to finish the started works and see how our little patients developed.