February 20, 2001

oft drinks and sugar are the bad boys to American dentistry. Imagine their effect on oral health if there was no dentistry. Along the Amazon River in northeastern Peru there isn't.

Despite the Third World location near Iquitos, 300 miles east of the lonely Pacific coast and mere miles from the headwaters of the Amazon, soft drinks are widely available and much sought after, and sugar cane - a staple crop and a constant oral companion - brings a smile to young and old alike. But both bring raging dental caries, along with dental discomfort and pain.

So when the dentists come, the local people put on their Sunday best and happily trek on down to the village where care is being dispensed.

Twenty-five third-year UConn School of Dental Medicine students and eight preceptors, including two full-time and three part-time dental school faculty members, will temporarily become dental care providers in Peru this year.

The annual trip, now in its sixth year, is one aspect of the dental school's many clinical outreach programs. It is a collaborative effort with the West Hartford-founded Association Promoting Education and Conservation in Amazonia.

This year's trip, with so many students participating, will be broken into two teams. The first leaves Feb. 23; the next March 2. Each team will have a week's worth of dentistry, boating down the river to a village and providing care. Most of the care consists of extracts, but hygiene plays a role too. The students will give care under the supervision of the preceptors.

"This is a wonderful opportunity," says Michael Goupil, assistant professor of oral and maxillofacial surgery, and an organizer of the expedition. "The patients win because they receive the care they need so badly. The students win because this is an eye-opening opportunity for them. They learn about dentistry but, even more importantly, they learn about life."

The party will deliver high quality care in a non-standard setting, he says.

Indeed. It's a far cry from the sterile, brightly lighted, fully equipped clinics of the Health Center. Roads are few; locomotion is by boat, and many of the boats are dugouts with an outboard motor attached. Clinics are outdoors in village squares. The light is natural.

Temperatures are usually in the 90s and sweltering, as you'd expect in the rain forest. Last year, however, during a hot spell, it was 105 degrees and totally enervating. The dental chair is a kitchen or dining room chair. Still, the care providers ensure good sanitation and technique.

"The students have to become ingenious in providing care," Goupil says. "These are austere conditions and the people are poor. It's an entirely different culture. It's such a different standard to what the students are used to at the Health Center, that it is truly an impossible-to-match educational experience."

The dental teams will overnight and eat at APECA's "El Fundo" base along the river. The daily menu will consist of locally produced foods - rice, fish, plantains - and western-type water: sterilized or bottled.

Usually the group is broken down into two or three teams and each day, they'll boat to a new village to provide care. Each clinic serves between three and five villages. The number of patients treated during the week usually runs between 800 and 1,000. But this year, because of the size of the two groups, Goupil expects between 1,200 and 1,500 patients to be served.

Getting to Iquitos isn't as easy as jumping on a commuter flight. The cost is $1,500 per person out-of-pocket that everyone pays. Although there is some support from the dental school for transportation, community dentists and practitioners contribute tools and money, and some philanthropically inclined manufacturers contribute goods, the majority of costs are borne by the individual participants.

The trip requires weeks of planning and preparation, including inoculations. David Hill's Health Center-based International Traveler's Medical Service has played a special role there, Goupil says, setting aside a night just to give the Peru-bound clinicians inoculations and health advice.

Each traveler is allowed one bag but they also have to drag along another bag crammed full of dental equipment - mostly hand tools - and supplies. Scrubs - lightweight yet durable - are the dress of the day once they reach Peru.

While there's no gainsaying the clinical and educational experience, for some, this year's Peru trip will be a family experience as well. Four of the eight preceptors have children making the trip.

Chad Kasperowski will be joining his father, Alan Kasperowski of Westfield, Mass. Chad says he is looking forward to spending some time with his father, particularly in the clinical setting.

"I've been thinking about going back and joining him in practice," he says, "and this will be a chance to see how we work together. I think he'll be a great mentor."

Jeffrey Bennett, assistant professor or oral and maxillofacial surgery, is leading the first group and Goupil the second. Part-time faculty making the trip include John Russo of Glastonbury; Thomas Galvin of East Hartford; and Ronald Albert of East Hartford. Other practitioners besides Kasperowski include Ronald Noseck of Arizona and Stephen Locke of Hull, Mass.

APECA, the organization collaborating on the Peru trip, seeks to promote the conservation of the rain forest and remote Amazon River villages of Loreto, a large area of northeastern Peru, by helping people develop their own sustainable methods of health care, nutrition, and sanitation.

Patrick Keefe