Dr. Joel Berg's Trip to Peru

Back in Seattle

2009-08-31T09:43:00.000-07:00

Having now returned to the sea level oxygenation of Puget Sound, I can reflect with clarity upon the incredible week we had in what is called “Amazing Peru”. I would strongly support this characterization – and I didn’t even get to go to the pretty beaches (I’ll save that for my next trip). As I’ve said throughout my blog, there is much opportunity for us to collaborate between our Early Childhood Oral Health (ECOH) program and programs such as the First Lady of Peru’s incredible Project Sembrando. Dental disease in children is one of the few conditions that is just as severe, if not more severe, in developed parts of the world as in developing parts of the world. This fact enables the ECOH program to study and create solutions locally, and assist in their delivery both locally and internationally. We have already begun correspondence with Project Sembrando and will first learn how we can accurately assess the extent of dental disease in the children in high altitude regions of the Andes. Only then will we determine how we might work together to create prevention and treatment programs.

Had we not hired two talented faculty from Peru to work with us at the University of Washington (UW), none of this would have happened. Had I not met Lucho in years past (a UW alumnus now practicing there), this might not have happened. Yet, with all of us aligned in our thinking we can do what is most important in prevention of the most common chronic disease in children – tooth decay. What is most important is raising awareness of this essentially preventable but often devastating disease. We have only begun to truly document the morbidity of tooth decay. It is clearly much worse than we know, both in the suffering of the child and in funds spent by healthcare systems around the world. This is even more significant when one includes the medical management costs if the disease spreads beyond the tooth to the face, as it too often does when there is little access to care.

I have attached a few selected final photos as reminders of the trip, but we will update with more as this story gets told.

Final Pictures

2009-08-31T09:26:00.001-07:00

Photo 1 – Drs. Seminario, Berg and Horruitiner discuss trip to Andes

Photo 2 – Beautiful courtyard at my hotel in Cusco

Photo 3 – Road in Cusco showing several types of materials, brick, stone, clay – some old, some new, but never cement.

Photo 4 – Child examined in Andes showing “chronic hyperplastic pulpitis” (pulp polyp) in lower left permanent first molar – evidence of chronic disease, and more commonly found in primary molars. Other teeth also badly decayed – this was a typical finding. (Taken without an intra-oral camera)

Photo 5 – Children gathered ready to learn about toothbrushing

Pictures from Day #6

2009-08-26T09:45:00.000-07:00

Photo #1 - First Lady of Peru, Pilar Nores, and myself

Photo #2 - Pilar Nores explains Project Sembrando to Drs. Berg and Ana Lucia Seminario

Photo #3 - Examination of children in the village

Day 6: Traveling with the First Lady of Peru

2009-08-26T09:42:00.000-07:00

This will be a day to remember. Woke up at 2:30 AM to catch a 5:00 AM flight to Trujillo. We met the First Lady of Peru, Pilar Nores, at the airport. We traveled several hours east into the Andes ascending curved, yet paved roads for the first 45 minutes, then extremely rugged and single-laned unpaved roads for the remainder of the ascent. At one stopping point, we were at 4,700 meters, higher than Mount Rainer in Washington. We eventually descended downward into a village center with an altitude of 3,800 meters, where we witnessed the incredible not-for-profit program that First Lady Pilar Nores is responsible for creating and maintaining.

Project Sembrando aims to offer a better quality of life to folks living high in the Andes who don’t have even the basic necessities of life. The program offers food, medical care, education in self-care and self-esteem, builds hygienic facilities and teaches how to prepare and cultivate food hygienically. It also brings together communities by requiring a certain presence at community meetings in order to receive the sustenance and important information. Today, we saw four communities, with a total of approximately 200 families gathered together, each proudly standing behind their community flag, waiting to learn what was to be presented to them this day. Pilar Nores gave an impassioned, articulate speech, explaining what was to happen today and the logistics of how it would happen. Families lined up to receive packages of powdered milk with supplements, many home care products, vitamins, and each family member took a pill for intestinal parasites. Liuva Horruitiner, a pediatric dentist from Lima who accompanied us, explained the importance of toothbrushing to the children. With Pilar Nores standing next to her animating, Dr. Horruitiner demonstrated the proper toothbrushing method.

I had the chance to examine the mouths and teeth of many children and quickly realized the high prevalence of dental caries in this population. One could be nothing but awe-inspired by the passion, the organization and the results achieved by all aspects of this incredible program, which is growing all around the high altitude regions of the Andes. We have already had preliminary discussions of how our Early Childhood Oral Health (ECOH) program might lead to significant oral health solutions within Project Sembrando, by utilizing its mission of developing local solutions and delivering them to distant sites. This amazing day is not over; there will be a lot more to this story, I am sure.

Day #5: Dinner in Lima

2009-08-26T08:51:00.000-07:00

We toured Cusco in the morning and I realized just how much I want to return to this beautiful city and all of its architecture, culture and people. I flew back to Lima in the afternoon where I was met at the airport by Ana Lucia and her mother, who was visiting from the north. Went to visit the practice of Jorge Castillo (Lucho), my host and University of Washington (UW) Orthodontics alumnus – he trained in Pediatric Dentistry at Connecticut – our own Dr. Mariella Garcia practiced in his beautiful office with him prior to coming to her position at UW. We then went to dinner at Jorge’s home. He and his wife prepared a lovely traditional Peruvian meal, preceded by traditional snacks, and, of course, a pisco sour. Everything was offered with a “salsa huancaina”. It was a wonderful evening.

Pictures from Day #2-4

2009-08-24T09:14:00.001-07:00

Photo #1 – Left to Right – Dr. Giovanna Espejo Arteaga, President, Cusco Society of Pediatric Dentistry, myself, and Dr. Jacquelin Camacho Claros, Pediatric Dentist in Cusco.

Photo #2 - Machu Picchu

Photo #3 - Machu Picchu

Photo #4 – En route to dinner in Cusco

Day #4: Machu Picchu

2009-08-24T09:13:00.001-07:00

What can I say? If the Grand Canyon is one of Nature’s most incredible creations, then the ruins of the Incas at Machu Picchu must be one of man’s greatest achievements. Taking 100 years to build in the 11th century, the workmanship and results achieved are mind-boggling given the knowledge-base and technology available at that time. The photos I have attached certainly do no justice to the feel of being there. The only thing I forgot was sunscreen – at the high altitude and being close to the equator (and being surprisingly warm for 2,500 meters at 22 C), I developed a nice sunburn. It will serve as a great memory of an unbelievable day. The three hour train ride each way from Cusco crescendos with anticipation of what one is about to observe. My favorite technological observation of all the hundreds of amazing achievements was the way in which the Incas broke down stones weighing many tons eventually into small stones, some only a few kilograms in weight. They bored holes with special tools, jammed wood into the holes and allowed moistening of the wood to fracture the pieces. Their systematic and patient approach is one to be admired.

Day #3: Flight to Cusco

2009-08-24T09:11:00.000-07:00

I took a 5:30 AM flight to Cusco. After landing and transferring to the hotel, I immediately discovered the beauty immersed within and surrounding this magnificent city. I lectured to the Cusco Society of Pediatric Dentistry’s members – more than twenty, all of whom were women. They were an engaging audience and also understood the problem of dental caries in young children as we do – that we need to raise more public and parental awareness to solve this silent epidemic. During our three hour lunch, I toured the city square as we also did at night, which was even more beautiful, walking to and from a great Peruvian dinner. I have traveled to over 50 countries during the course of my career, and cannot recall many places with the beauty of Cusco. This is a must-see place if one is looking for a spot to relax and just enjoy the natural beauty. The people are proud of their beautiful city and are very pleased when visitors acknowledge their perceptions of same.

Day #2: Lecturing in Peru

2009-08-24T08:49:00.000-07:00

On this day I lectured in Lima to the Peruvian Academy of Pediatric Dentistry. More than 200 people were in attendance, and simultaneous translation was used. I estimate that 60% listened directly in English. The crowd was gracious, asked good questions, and engaged in the ideas we espouse at the Early Childhood Oral Health (ECOH) program in Seattle: Caries management via risk assessment at an early age of intervention. That evening we were treated to a tour of the Presidential Palace. We then went to Lima’s most exclusive private club, an absolutely spectacular place with various rooms featuring different décor and architecture. The balconies overlooked the city center which was magnificent at night. Then, we went on for an amazing Peruvian meal and entertainment.

Pictures from Day #1

2009-08-21T08:20:00.000-07:00

Photo #1: Dr. Berg and the officers of the Peruvian Academy of Pediatric Dentistry organization at lunch pre-congress; Dr. Ana Lucia Seminario (top left of photo), Acting Assistant Professor in our Department, and Dr. Travis Nelson (top right of photo), third-year fellow of our residency program, are also pictured here.

Photo #2 (L to R): Dr. Evelyn Alvarez, Dr. Berg and Dr. Liuva Horruitiner. Dr. Horruitiner is a pediatric dentist and will accompany him during his visit with the First Lady of Peru.

Day #1: Incredible Peru

2009-08-20T10:22:00.000-07:00

I am not big on being acknowledged on my birthday, but after that amazing video edited by Amanda which I just received, I was very happy. The room maid just knocked on my door to clean the room – I said “treinta minutos” (I will then go to lunch). She said, “Senor Joel (Yo-el),?” I said, “Si”. She said “feliz cumpleanos”. That was after receiving numerous deliveries of cakes and other items.

The staff and my hosts are incredibly kind. I arrived late last night to a very crowed Lima airport. Apparently, most of the US originating flights arrive between 11 PM and 1 AM. After about a 45 min wait to get through immigration, I was immediately confronted with the commercialism – including walking through the duty free shop to get to the baggage claim area after immigration. I was offered to buy everything from drivers to cell phones by dozens. The crowds were enormous.

It was great see Lucho (Jorge Castillo), my host, and my distinguished colleague Ana Lucia Seminario at the airport to greet me. It was very kind of them to come out so late. We arrived at the hotel around 1:00 AM and unpacked. Today I will go to lunch and tour with Lucho and others from the congress.

The schedule is compelling to say the least, but should be incredible. For example, after lecturing all day tomorrow, I will go to the Presidential Palace to meet with leadership. Then, we will have a full-fledged “Peruvian evening” with great food, entertainment, and dancing. After a late evening tomorrow, I will depart on a 5:30 AM flight to Cuzco the next day – altitude 11,000 ft. Will lecture a few hours later for several hours. My hosts there will take me around the city and to dinner. Will rise early Sunday for a 3 hour train ride to Machu Picchu. Can’t wait to see this. After returning late at night Sunday, will tour Cuzco Monday morning and return to Lima in the afternoon. The next morning (after a late dinner, of course, on Monday), will depart with the First Lady and entourage to Trujillo at 5:30 AM (is everything at 5:30 AM?). We will then take a 4 hour jeep ride to a remote village to observe oral health situation in the villages. We will return to Lima only at 11:30 PM that evening.

I will report with photos, videos, and voice notes as possible. I hope that ECOH and the local efforts here will connect in ways that will benefit many.

More soon.

Joel

Joel's Itinerary

2009-08-19T14:37:00.000-07:00

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