The rural village of San Martin Jilotepeque in the Mayan Highlands of Guatemala, where a Howard County dentist and his daughter volunteered in a pediatric dental clinic, is stricken by extreme poverty.
Of the 783 children served over six days by four dentists, three hygienists and 13 nonmedical volunteers, most had never had their teeth examined before.
"The line of kids wrapped around the building," said Anjali Shroff, an 18-year-old freshman at James Madison University who worked in the clinic alongside her father, Dr. Deven Shroff.
"None of them were scared," she said. "They were laughing and happy to see us."
"Us" refers to volunteers with Global Dental Relief, a Denver-based nonprofit founded in 2001 to deliver free care to children ages 6 to 18 in schools, orphanages and remote villages.
Shroff, 47, a dentist at Smiles 4 Children in Ellicott City, had previously volunteered with the Frederick-based Mission of Mercy, which provides health and dental care to adults in need in Maryland and southern Pennsylvania.
"My skills afford me a certain lifestyle," said the Columbia resident, who served as a dentist in the Army before going into private practice. "But to be able to give back in this way is a reward that you can't place a value on."
He and his daughter had started talking about going abroad on a mission trip when she was in middle school.
"When the time finally came this summer I was counting down the days," Anjali said.
While some might not think of dental health as a global priority, Shroff points to the much-publicized death of a 12-year-old boy in Prince George's County in 2007 from a brain infection — which resulted from an abscessed tooth that went untreated — as an example of what a neglected mouth can lead to even here in the United States.
"It's agonizing to think of a child dying due to something preventable," he said. "Many parents in poor countries can't afford to take their kids to a dentist, especially if they're not complaining" of a toothache.
Working in teams, volunteers from around the world provide exams, cleanings, fluoride treatments, sealants, amalgam fillings and extractions. They also teach oral health care skills to the children and the adults in their lives.
"We are trying to make connections, trying to get entrenched so we can hook up with schools and follow up with the same kids when we return every 18 months to two years," said Shroff, whose practice also has offices in Catonsville and Eldersburg.
Global Dental Relief has donated $23 million in U.S.-equivalent dental care to serve 109,000 patients and plans to arrange 17 mission trips in 2016, said Will Mateo, the organization's country coordinator.
Aside from Guatemala, volunteers travel to Cambodia, India, Kenya and Nepal.
Of the nearly 1,600 volunteers who have served the organization through 2014, 850 had no dentistry background and underwent training to assist the 510 dentists and 180 hygienists who have taken part in missions, he said.
Anjali, who was the youngest volunteer in their group, described the village as clusters of brightly colored stucco buildings with clay roofs. In the impoverished sections, many homes had broken windows and doors.
"In the building where the clinic was held, we could hear dogs barking and roosters crowing while we worked," she said.
The setting was "very minimalistic," Shroff said. There was no running water or electric hookups in the gym-like community center where the clinic was held in July, so volunteers relied on bottled water and generators.
"It definitely takes you out of your comfort zone," he said.
Portable dental chairs resembling lawn furniture filled the open space, which was not meant to be sterile, Shroff said. Instead, the instruments are sterilized and volunteers wear masks to reduce patients' exposure to germs.
There was an upside, though.
"Kids could see what their peers were doing and that other kids weren't flinching. That reduced any anxiety and helped overcome the language barrier," he said.
Many of the children had multiple dental problems that can lead to chronic pain and other systemic health issues.
"We fixed the patient's worst problem first," said Anjali, who has not yet decided on a major, but is considering dental and medical school. "Some kids came back while we were there."
Shroff said his daughter's calling is to work with children, noting that she also serves as a volunteer swim instructor and coach with the Howard County Special Olympics.
"My favorite part of each day was talking with the kids," said Anjali, who can speak conversational Spanish. "They told me about their lives."
She especially enjoyed chatting with a 6-year-old girl who was excited to be at the clinic with her two younger brothers while their father sold goods at an open market nearby.
"I asked her, 'Why aren't you in school?' and she said, 'I don't go to school because I'm a girl, but my brothers will go.' She said that like she couldn't understand why I would ask such a question."
According to the GDR website, children in Guatemala attend school for an average of four years and only three in 10 finish sixth grade.
The Shroffs said their trip was an eye-opening experience and that they intend to go on another mission next year.
At the end of each long day, the volunteers celebrated with local beer and potato chips while watching the sun set, Shroff said.
"Our experience was incredible, thanks to the caring and compassionate group we were a part of, and we both got way more then we gave in the end," he said.
"There is clearly no shortage of need, just a shortage of good people willing to donate their time and services to help."