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Wednesday
Sep182013

« DR. RAY DAMAZO: WSDA'S 2013 CITIZEN OF THE YEAR »

 

“Things were looking up. I felt a touch of cockiness for defeating our first black hole. Then Gail, who was standing near the trailer, shouted an alarm, “Buffalo!” A male Cape Buffalo had appeared out of nowhere and was heading in our direction at a fast pace, hostilely shaking his massive curved horns back and forth.”
­­— From Safari Dentist, by Dr. Ray Damazo

For nearly 20 years, Dr. Raymond Damazo and his wife Gail traveled to Africa twice a year, delivering humanitarian dental care to the African people while marveling at the vast reaches of Kenya and the bounty of its wildlife. In his book, Safari Dentist, Damazo details scores of stories like the one above — putting the reader face-to-horn with all manner of wild things — using keen humor to detail near-misses by charging elephants, the demands of an oft-married Masaai Warrior, and the skills required to keep their rolling operatory rolling. The specially-outfitted Range Rover towed a massive two-axle trailer — and both were constantly losing their battle with the elements, “We’d be going along and the visors would fall off in our laps,” Gail says, “Ray would drive and I would be screwing or duct taping things back together.” Even in Africa, it seems, duct tape is essential.

But it’s not just the roads that are wild, dentistry in Africa can be equally hair-raising — “I’ve worked on patients with an AK-47s in their lap,” says Ray, with a huge laugh, “You don’t want to hurt a guy like that.” Nearly all the Masaai are armed in some fashion, though — with pangas (knives) and rongas (a weapon fashioned from wood), both easily capable of inflicting mortal wounds. And while Damazo clearly had the pluck to at least appear unfazed in the face of such danger, finding a partner equally possessed might have been difficult. But Gail is comparably adventurous, having spent many years exploring third world countries prior to meeting Ray. In fact, Africa was on her “bucket list” long before the pair became a couple. Part hygienist, part assistant, part MacGuyver (“I’m very mechanical, I read manuals, and I can fix just about anything”), she’s always at his side, and is often the voice of reason. With a degree in psychology and years of experience running businesses, Gail has been able to soldier through difficult circumstances and gruesome medical situations with aplomb. “So much of what we did in Kenya was creative – like making artificial teeth in the bush, which really appealed to me because I’m artistic,” she says, “I’m not a fearful person, so I’m perfect in a crisis. We work really well as a team.” 

“We’re soul mates,” Damazo says, and seeing them together, you believe it. They share an undeniable electricity and humor. To prepare for their journey together, Gail studied with a hygienist and did a lot of training out in the field with Ray. She even completed a year of hygiene school before dropping out — but not because she couldn’t handle the work load, “I was getting really bored because I knew I didn’t want to polish teeth in the U.S., “ she explains. “I needed the skills that I could use in Africa, and they weren’t teaching me anything I hadn’t already learned.”

Through a relationship with first-class lodges catering to tourists, the couple criss-crossed Kenya and Tanzania, traveling from lodge to lodge, delivering free dental care to thousands of lodge employees and indigenous Africans who would likely have had to live in pain or worse, see a bush dentist. The Damazos spent 3-5 months a year in Africa, seeing as many as 75 patients a day, setting up their operatory in lodges and tents all over Kenya. In all their years in Africa, the couple has paid for everything themselves, with the exception of their housing and food at the lodges. Ray says “The inner satisfaction of helping without any strings or fee, making someone’s life a little more bearable is sufficient pay. I have never received money from any corporation, and have funded the mobile clinic myself. What we do receive from the lodges is lots of love, friendship, cooperation, and the best hospitality in Africa.” Of course, they’re not counting the time that Hemingway’s Resort made them a gift of goats, but that’s another story. Regardless, the Damazo’s are careful to plan their trips in the off-season, when the resorts have many rooms available, so they’re not depriving their hosts of an opportunity to make a living. Plus, it leaves more time to share a glass or two of wine with friends at the end of a busy day of dentistry.

Dr. Livingston, I presume?
But to tell Damazo’s story, we have to start in New Bedford, Mass., where he grew up with nine siblings to parents who had emigrated from the Azores. They instilled a boundless work ethic in their brood, and stimulated a quest for knowledge that Damazo and his siblings have to this day. But the family wasn’t wealthy, so they taught their children to be self-sufficient, too. “My mother and father had almost no education — and no money — so none of us relied on them for anything.” Ray continues, “They motivated us and let us figure it out for ourselves. When you’re loved and confident, no one can stop you.” It was there, in the New Bedford Library, that Damazo first read the works of renowned missionary and physician Dr. David Livingston, recounting his travels in the African continent in the late 19th century. “Though Livingston was a missionary and a physician, his biggest love was for travel, adventure, and exploration,” Damazo explains, “And that was what drew me to his writing. He ended up exploring much of Africa on foot — from places Gail and I have been to, to thousands of miles away — at a time when no one knew the tribes and what danger lay ahead.“

The road to Africa
In 1977, an opportunity arose for Ray to train a Brazilian physician in emergency dentistry. He’d been looking for a way to give back, and so, for four months he and the doc flew a Cessna 180 to remote areas of the San Francisco River Islands treating patients. Damazo trained him how to perform simple extractions, manage infections, control pain, and brought him up to date on dental anatomy and local anesthesia blocks. In 1986, Damazo was asked to develop a program to train a cadre of Clinical Officers (physician assistants) in emergency dentistry — they were responsible for providing primary care for millions in Kenya. The training all took place in Nairobi in hotel conference rooms rented by Ray, and gradually evolved to become the mobile dentistry model he would later use. While there, Damazo got to explore the country as a tourist, going to game parks, the Mombassa coast, and the Highlands, but he wasn’t exposed to the “real” Africa.

In 1991, Damazo’s retirement from his thriving dental practice in Bellevue was imminent. That, and success in another business venture had left him in a position to really make a difference in the world, and he began to research where he would spend his time. “I am basically a cheap guy – I want to get a lot for my money. I wanted to work someplace where a dollar was worth four dollars — so while I briefly considered Hawaii, I knew it would never work,” he says with a broad smile. With so much of the world in need, Damazo’s options were open, including Haiti and Guatemala, but neither had the sex appeal of Kenya. “I’m not this great altruistic, humanitarian person,” Damazo says, laughing, “I liked Kenya because it has the beautiful coast with gorgeous beaches, and it has the Masaai Mara, the biggest game attraction in Africa. I love the people, and there was a big need.” True, but in places like Somalia or Ethiopia the need was far greater, but Damazo wanted to be productive. “And,” he says, “I can be my most productive when I am comfortable. I don’t mind all the trouble and sacrifices you go through to do this type of work, and I don’t mind providing free dentistry to the people of Africa — working on hundreds of people in all kinds of crud — if I know at night I have a good place to sleep and a great glass of wine.” 

Kenya fit because there was a balance — it was possible to deliver free dentistry and be comfortable. The lodges that dotted the landscape would provide the perfect place for Damazo to recharge for the next day, while giving him a central location from which to perform dentistry for the African people. 

It was the start of what become a decades-long love affair with a country and its people. He relates, “I saw that the people were unique and good. For the most part they are very generous, sincere, and friendly. They are trusting, they want to believe in you, and if you help them they are appreciative.” But while the Masaai trust them now, that wasn’t always the case — Gail explains, “People came to Africa all the time with good intentions and stories about how they were going to help the people, only to never return.” Gaining the Masaai’s real trust took years — something the Damazos accomplished by returning as promised, year after year, making many lifelong friends along the way. 

But something else about the culture proved just as difficult for the Damazos. The Masaai and many of the other 53 tribes in Africa are nomadic people, even though that is beginning to change, and in their culture they live for today. The couple says, “There is no tomorrow to them, they don’t even keep track of the year they were born, so they’re not clear about their age. The concept of the future is meaningless to them— for instance, if their cows eat up all the grass in one place, the Masaai simply move to find more grass. If they really thought it through — the grass is dead, it’s 110 degrees, and there’s no rain in sight — they might be completely stressed. But because they don’t live for the future, they simply look for more grass.” 

And while the Masaai perspective has helped the Damazos to slow down and get more balance out of their lives, treatment planning with a population with no concept of the future was a problem. Ray explains, “For instance, when doing a serial extraction they would want more teeth removed than necessary, and I would say to them ‘If I extract these, then these other teeth will come down and rotate into place.’ But they didn’t understand the concept, and they didn’t trust my diagnosis.” 

Eventually some people took Ray’s advice, and when he returned six months later, they noted that what he had recommended had worked. “Now they believe in us, and they will let us do what is best for them,” Gail says, “But the shift in their thinking took years.”

Building a permanent clinic
Having made friends throughout Kenya, the Damazos began to look at ways to simplify the delivery of care to the people they had grown so fond of. Ray was 78, ready for his “second retirement,” and managing the mobile clinic and the hard slog across Kenya had just become too difficult. Shifting forward, the couple designed and built the Maasai Dental Clinic at Siana Springs in 2008, after acquiring a 33-year lease on a plot of land by the Masaai people. Additionally, Rotary International clubs from Washington and Nairobi contributed $53,000 to help equip three treatment rooms in the clinic and purchase cabinets. With a population between 50,000-100,000 and with the nearest dentist 87 kilometers away, the clinic was in a truly underserved community. “When I originally built and conceived the facility,” Ray explains, “It was with the hope that it would become a global teaching center with adjunct faculty there at all times, and there would be senior dental students circulating through the clinic.”

The three apartments house visiting dentists who come to the facility from around the world. Using the Peer Pal model, dentists agree to volunteer for two weeks and three days. For the first three days, they work with the outgoing volunteer, who is able to help the new dentist figure out the lay of the land. The time is essential, according to Ray, who says, “The model really works — in March, a successful dentist came to the clinic as a volunteer. The first morning he was there, I happened by the operatory and saw that his hand was shaking like a junior dental student. At lunchtime, he confided in me, saying, ‘You know Ray, I can’t believe how shook up I was at the first part of the day. When you don’t have your regular dental assistant, or your own equipment, and when you have patients with no shoes and big holes in their ears – everything is so different, I was really nervous.’ At the end of the three days, he was happy to get me out of there, but there is definitely a breaking in period. You go from a sophisticated suburban place to the middle of nowhere where absolutely everything is different. It scares the hell out of some people.”

At the clinic, patients are seen on a first come, first served basis, with no appointments, and on a typical day the staff sees between 12-14 people. The clinic has one volunteer dentist and six permanent staff members – two Masaai assistants, a clinic manager, and three Ascaris — or guards — who are assigned to control the crowds and assure that wild animals cannot get into the compound, even though it is completely fenced in. 

What lies ahead
After running the facility for nearly three years, Ray and Gail made the decision to gift the facility to Loma Linda University School of Dentistry, with the understanding that the university would continue to manage and staff the facility for the foreseeable future. The University recently reached out to the Damazos to resume running the clinic for another two years, health permitting, giving them time to put new systems in place to streamline its management, protect the clinic, and guarantee its place in the community going forward. In coming back to right the ship, the Damazo’s legacy in Africa is secure. 

The gift of the Masaai
Even with all he has done for the people of Africa over the decades, it is Damazo who says he has benefitted the most from the arrangement. “I could never give back to the Masaai what they have given me. I have learned trust from them, and I know how lucky I am because of them. Their ability to survive with very little and be happy and content is amazing. Kids have flies in their mouths and eyes, women give birth inside a mud hut and aren’t allowed to leave for a week, even for a bath. They have survived for centuries in this way. They’re happy for the most part, they roll with the punches, they’re easy keepers, and they suffer like dogs without ever complaining. Their expectations from life are much lower than ours. They are a nice, gentle people. My daughter lives in Mercer Island, and what she told me was that the Masaai women, who have nothing, seem more content than the women she knows in Washington who have so much.” 

Both he and Gail remember one of the people they helped in their travels, a handsome South African Ranger with a deplorable mouth — because of it, he never smiled. “We got him to come into the clinic, told him not to be ashamed, that not everyone had access to dentistry. We decided that we were going to totally restore his mouth in the week that we were there, which we did. By the time we left, he had a beautiful mouth – and he was a completely different person, with a much better attitude about life. He wrote us a letter and rubber banded it to our side view mirror so that we would see it as we were driving out. We cried as we read the letter, because it was so heart wrenching and heartfelt. At that point, we realized that it’s not just about fixing teeth, it’s fixing self esteem, it’s the unconditional acceptance of other people. It’s a whole combination of things that play into what we’re doing.”

Interested in volunteering in Africa?
The clinic needs trained dentists to volunteer year ‘round. If you’re interested in finding out more about volunteering in Kenya at Maasai Dental Clinic at Siana Springs, please contact Dr. Damazo at raymonddamazo@hotmail.com, and leave your information, including phone number, so that he may contact you personally. At this time, the clinic can only use those practicing general dentistry, and they do not typically need assistant or hygienist volunteers.

More about Safari Dentist
Dr. Damazo has written an engrossing account of his years traveling in Africa with his wife, Gail. In Safari Dentist, his imaginative, clear writing style brings the African bush to life. Like Livingston before him, his stories of their adventures in the wilds will keep you interested throughout. To get your own copy, contact Dr. Damazo at raymonddamazo@hotmail.com, or look online at amazon.com. 

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