0 In Explore/ International Development/ Nicaragua


On our final Friday in the Bosawas, we took the boats downriver for a day trip to set up a clinic in the small community of Pamkawas. This community is home to Primitivo (Primo) Centeno, the President of the Government of Indigenous Territory. Primo is an advocate for indigenous territorial rights and has worked steadfastly, as well as collaboratively with Change for Children and Centro Humboldt, to increase indigenous capacity with respect to health, education, and agriculture.

A natural leader, he is not only our gracious host in the Bosawas, but also a patient in our dental clinic!

We arrive by boat and follow Omar who, as I learn through my new-found self-proclaimed conversational Spanish prowess, is Primo’s cousin and a local school teacher. Omar has lived here his whole life and from him I learn that Pamkawas is a community of about 75 houses, 125 families, and 750 people.

I follow him and we wind our way through the village to the site of the clinic (the first school ever built in the Bosawas by Change for Children).

I try not to take the message emblazoned on the back of Omar’s T-shirt personally.

Because, the more patients we see, the more I know that the work we are doing does matter. It could be a year or even more before the people of Pamkawas get an opportunity to receive dental care again. They are kind and patient and prideful as they wait their turn. Men come in from the fields with machetes in hand, women bring rags to cover their mouths and blankets to cover their legs, and, sadly, children reveal smiles of blackened teeth.

It is in Pamkawas that I become familiar with the term Clearance as we remove the last eight teeth from the mouth of a woman younger than myself. I know I sound like a broken record as I continually confirm (for my own peace of mind) with the dentists that having no teeth is in fact better than having rotten, decaying teeth. It is. I know it is. And though a ‘clearance’ eliminates all chances of ever achieving the Crest-white smile we are programmed to covet, when you live a remote existence, survival and functionality trumps vanity every time.

For this reason alone, education is so important. Wouldn’t it be great to return in a year or two and not have a line-up of patients? Wouldn’t it be great if there were too many dentists and not enough demand to keep them busy? Wouldn’t it be great if the generator never ran out of gas because the drill was barely used?

In that vein, Nahoun, a dental therapist local to the area who received training in Managua joins us and, with his purple grinning unicorn, reminds kids just how important it is to brush their teeth.

It is also in Pamkawas that I realize that in addition to having learned some new Miskito words, I have also increased my Spanish vocabulary. It is not until the words come out of my mouth that I am aware that over the course of the last week, I have somehow acquired the ability to communicate phrases like: You are going to feel a pinch. But, if for some reason you feel pain, raise your hand!

I surprised even myself.

There is something about removing ten adult teeth from a thirteen-year-old, extracting the front four teeth of a six-year-old, or even pulling out the last few not-so-pearly-whites from an eighty-year-old that makes me want to visit the dentist more often…or, having assumed a front row seat, makes me want to never visit the dentist again…

I am currently on the fence.

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