Humanitarian Dentistry Amid the Pandemic - the Open Wide Foundation in GuatemalaBy Jim Merriman on November 23, 2020 | comments
The last week of February marked my fifth trip to Guatemala as a volunteer with the Open Wide Foundation. I traveled with my colleagues, Spear dentists Dr. Everett Heringer and Dr. Rick Timm, along with our families and staff from our practices. It was inconceivable at the time that the trip would mark the last week of volunteers in the Open Wide clinic for the reminder of 2020 due to the global emergence of COVID-19. When I returned home to Atlanta, I presented a photo slideshow of our trip to my staff and listened to the office buzz ... “Dr. Merriman just returned from Guatemala ...” It became clear to me that my patient community wanted to know what I do beyond this practice. Sharing my contribution to the story of Open Wide makes my staff and patients proud to incorporate “How we give back” into our office culture.
During one of my initial trips, I brought my daughter to experience a week in the Open Wide clinic in Peronia. It was shortly after the clinic was built by the local community in collaboration with the Open Wide Foundation and it was open year-round and staffed by the local municipal dental team. At this early point, it was only practical to focus on basic dentistry. One morning, I had a 14-year-old girl sit in my chair who had an abscess and caries exposure on an upper molar. I will never forget it. As I do in my practice in Atlanta, I told her and her mom, through the translator, that she needed a root canal. “We must get her sent over to get this done,” I said. Her mom without hesitation replied, “That's not going to work. We can't afford a root canal. Please, just extract it.” That was not something that I wanted to do; she had beautiful teeth except for this one. But I also could not leave her in immense pain. Reluctantly, I extracted the tooth. It just left me in an emotional moment, thinking, “That's not what I feel good about.” I knew extractions were necessary on most outreach trips where the resources are unavailable to save a tooth. Still that time, I'll never forget, I was at lunch and I could feel my daughter watching me talk about it with such emotion. That interaction really led me to see how we might be able to do more here. I realized it could be possible to provide quality restorative work in the Open Wide dental clinics.
An extraction, in most developing countries, is usually the only reason for visiting a dentist. Ten years ago, Open Wide Foundation set out to change that with a vision that would redefine humanitarian dentistry. Since it began its mission in 2011 to bring long-term oral health solutions to the most vulnerable communities in Guatemala, Open Wide volunteers, donors and industry partners have provided start-up support to eight public dental clinics, served over 250,000 patients, supported over 1,100 volunteer trips and mentored over 500 Guatemalan students.
Supporting the development of permanent clinics in underserved areas that would eventually be adopted by the local communities was exactly what the founders had in mind when envisioning the foundation. At Spear Summit 2011, I remember myself and many other Faculty Club members deciding to say “yes” to the initial call by Glen Wysel and Imtiaz Manji to invest in the development of the Open Wide Foundation – before the actual clinic in Peronia was even built. The mantra was “Open Minds, Open Hearts.” It was a heart tug that made me say “yes.” I could just hear my daughter's voice and I knew she would go if I asked her. To step out into an experience like this, in a developing country, I needed to be able to trust it was going to be safe to bring my family and it was going to be set up where I could use my skills to truly serve the people. I trusted that Spear leaders would put things together in a quality way because Spear had such a network for success.
From the beginning we recognized in Guatemala similar needs that many of us had witnessed while doing mission dentistry in other remote areas across the globe. Dentistry is not often a priority in communities where good health care is unaffordable and families struggle to feed their families. In most impoverished areas there are no trained dentists or established clinics. Guatemala has the highest rate of caries in the Western Hemisphere. Those were reasons enough to start there.
Peronia, Guatemala – a city of 80,000 with no trained dentists at the time – became the site of the foundation's first clinic. Led by Open Wide Foundation co-founders Imtiaz Manji and Glen and Lisa Wysel, Open Wide worked hand in hand with the local community and government leaders to build and equip the five-operatory facility, which opened in January 2012. Open Wide donated the operatories and equipment, thanks to the generosity of A-dec, Patterson and Dentsply Sirona. The local clinic staff provided year-round basic dentistry while Open Wide volunteer teams mentored and trained them in new techniques and materials. Volunteers also had the opportunity to work with dental students from local dental schools. Working closely with Open Wide, the local government sponsored pediatrics weeks, special needs outreach, advanced restorative care weeks, and recently an silver diamine fluoride pilot program.
Empowering Guatemalan communities with restorative dentistry
This groundwork of permanent clinics with ongoing care really made it possible for the advanced restorative program to get a foothold. Our volunteer group was collectively moving in that direction, to the point that it evolved to program committee planning where we now can review patient cases as a team, months in advance of a trip. To support us, the local staff selects patients and sends photographs, X-rays and the patient charts so that we can prepare our materials. (Our corporate representatives from Brassler, Cosmedent, Ultradent and Patterson are so generous in their support of donated materials that we often have leftover supplies to leave at the clinic.) This allows us to be prepared when we arrive, so we can focus on complex cases. Many who have missing front teeth or badly decayed front teeth are made whole again. With a restored smile, the patients we serve will have access to more opportunities in life … it is clear they value their smiles just as much as we do
What I will say about Open Wide – is that the foundation has such a network for success; it is always being improved. The organization's vision stays focused on the concept of sustainability. The teaching we do with local Guatemalan dental students and dentists during our advanced restorative weeks, gives them the tools and training to be able to do it themselves after we've returned to the U.S. It is such a unique experience to share your skillset, time and money in a sustainable model and watch it resonate in the community for years to come. What we are accomplishing in our advanced restorative week is lasting. We are teaching the dental students and staff, who come up and watch us work at the chair, how to do the best clinical work possible. Over the years, I have seen the local team become more engaged and inspired to apply what they are learning. The staff and students are now following standard operating procedures and protocols developed and written by Open Wide's team of dentists. Most recently, newly written COVID-19 protocols developed with guidance from Open Wide dentists and health experts in the field of infection control have guided the process of reopening when the time comes.
The staff we have worked with over the last 10 years will keep striving to improve and they will continue to have our support when they need it. Support not just from Spear dentists, but from the partnership with manufacturers such as A-dec and Dentsply Sirona who have provided critical equipment that has led to the Peronia clinic being known as the most technically advanced public dental clinic in Central America.
Open Wide has been told by the community leaders that because of the dental clinic being built and invested in over the years in Peronia, more good things are happening in the city itself; simply by virtue of the fact that Peronia is on the map and government leaders are putting more resources in the city. We have watched year after year, a community that many would describe as a refugee camp after the civil war, put up streetlights, distribute cleaner water, increase access to medical care, and provide more support to the elderly, young women, youth and other marginalized populations. A new jobs center went up right next to the clinic and the ripple effects go on. These are amazing achievements. But as a foundation we know that we are not the authors of this transformation but rather the catalysts empowering the communities.
Advanced Restorative Week in Guatemala
There are so many patients that have impacted me over the years. These patients are incredible. Patients travel many hours overnight across the country in buses in preparation for an appointment during advanced restorative week. Access to these services are very rare in the public health setting around the world and the patients selected know that. They are so appreciative, grateful and you know that it is a pure situation that is rewarding to see. When we hand a mirror to the patients – and that could be any of the eight that we saw that week – as you see them looking at themselves, you just see the look on their face and it's an amazing expression to see. You just can't believe how they react, and nothing is taken for granted.
One of my colleagues, Open Wide Foundation Clinical Director Dr. Mike Johnson, shared one of his unforgettable memories about when one of his team members had completed eight upper anterior composite veneers on the teeth of a young lady in her 20s whose mouth was riddled with tooth decay. After three hours of tedious work, they gave her a mirror. She was speechless at first and then burst into tears. She told them, “I am one of nine children from a very poor family and this is the nicest thing anyone has ever done for me.” Being able to use our skills to give patients such a life-changing experience is a feeling difficult to put into words.
There is no amount of money that could substitute for those experiences. The local staff call us the “crying dentists,” and we hope that patients know that we're crying because we are touched to see patients look in the mirror with their new smiles, not because we are tired after working at the dental chair for four hours. Those experiences are just too numerous to name them all. It is just every time you work on these people, they are so grateful.
Dentistry might be the excuse, the reason to go, but once there, in the village, surrounded by the beauty and spirit of the country, inside and out, the purpose changes. In this environment, distinctions between the served and service begin to blur. Dentistry is no longer an end unto itself but a means, a beginning both for the community and the volunteer.
COVID-19 in Guatemala – not just numbers on a chart
Since the pandemic has forced the closures of Open Wide clinics and borders, volunteers have had to postpone their trips and find new ways to support the work in Guatemala.
The COVID-19 numbers we see on the charts or hear in the news about Guatemala aren't just data to us. They are real people, many of them friends. In response to the immediate needs since the onset of the pandemic in March 2020, Open Wide was able to donate its clinic inventory of 1,300 masks and 4,200 gloves to be used in “The Market,” which is the public health service complex for the Municipality of Villa Nueva that includes Peronia. The local team in Guatemala continued to support their municipality, working as public health responders during the shelter in place order issued by the government. Open Wide worked with the team throughout the summer to develop COVID-19 protocols to prepare them to present them to the Municipal Directors of Health, as required.
We are not there and can't be there right now, but we still want to make sure that all the effort that has been put forth to make Open Wide's mission a success continues. We want to sustain this work. That's the whole point of sustainability – meaning we support start-up clinics in underserved communities with equipment and supplies, and then we mentor, train and teach local dentists so that they can continue when we go home. But we still need to get over the hurdle that COVID-19 has created for us. Open Wide's program funding comes from donations given by each volunteer team that works in the clinics, so when volunteers can't go, the funding stops. So, I think we must recognize that we must step up to ensure that we, keep it viable.
Personally, I can't wait to get back to Guatemala again. Hopefully restrictions will be lifted by February 2022, when my next trip is scheduled. But if I had to say to anybody who's thinking about doing this trip to the clinic or volunteering – I wish I hadn't waited so long to have done something like this. But I'm glad when I did, that I did. If you are thinking about volunteering, you could go by yourself or with someone. If I had a preference, it would be to share this experience with someone as I do with my family, staff and colleagues.
Jim Merriman, D.M.D., F.A.G.D., is a Spear Faculty Club and Visiting Faculty member in private practice in Atlanta.
How to support Open Wide's efforts in Guatemala
- Learn more: openwidefoundation.org
- Access Open Wide's “Redefining Humanitarian Dentistry” photobook
- Connect on social media: Facebook, Instagram and YouTube
As 2021 dawns, there's a line of teams waiting to go. Open Wide still doesn't know for sure when that will be as it cannot know when COVID-19 advisories will be lifted. But until then, the foundation continues to move forward with gratitude for all the volunteers and donors who have been steadfast in their commitment to the work they set out to do 10 years ago. During this COVID-19 pause, Open Wide leaders spent some time looking back at thousands of photos shared by volunteers and hundreds of stories told, like Dr. Merriman's. They are inspired by friendships across borders, camaraderie among volunteer teams, adventure and fun, and of helping others and, in doing so, returning home with life-changing memories to share, as Jim does, with staff and patients.
Open Wide is about more than words a dentist speaks to a patient. It is an opening of the mind, the heart, the spirit. It is about opening a door to a better way of life. It means to give generously and in doing so receive far more than you could have hoped for.
OPEN MOUTHS. OPEN HEARTS. OPEN MINDS.