Brushing in the Bush
Possessing a strong physique and sporting wooden pegs through each earlobe, the elderly chief of the Xavante Indian tribe in Brazil strikes a commanding figure -- until he opens his mouth.
Several top teeth are missing. Many others are rotted beyond rescue. The chief, who goes by the single name of Serebura and is somewhere in his 80s -- he doesn't know his exact birth date -- didn't use a toothbrush and toothpaste until he was about 70 years old.
These days, Colgate-Palmolive Co. is trying to spare Serebura's 30-odd grandchildren and great-grandchildren (the polygamous chief can't keep track of his descendents) the same fate. The multinational company, working with Brazilian dentist Rui Arantes, is arming the onetime warrior tribe -- which still uses bows and arrows -- with weapons of modern oral hygiene.
For generations, dental care for the Xavante and other tribes consisted of twigs to scrape between the teeth and straw to wipe the tongue clean. That was all that was needed, given that their diet consisted of what they hunted or collected: tapirs, deer, fish, fruits and edible roots. The fare had a fortifying and cleansing effect on their teeth, dentists say. And though all the hard chewing eroded the Indians' choppers over time, cavities were rare.
Then came the "white man" -- offering gifts of tobacco, refined sugar and processed foods in exchange for mining privileges and other moneymaking activities. The Brazilian government inadvertently contributed to tooth decay by introducing rice -- the sticky starch causes cavities -- to Indians to encourage farming.
"We tried white man's food, and we liked it. Now we have toothaches," declares Chief Serebura, who says his problems stem from his acquired taste for sugar, cookies and coffee.
Between 1961 and 1991, the incidence of tooth decay quadrupled among six- to 12-year-old Xavante and rose more than fivefold among 13- to 19-year-olds. Overall, Brazil boasts developed-world standards of oral hygiene, with toothpaste consumption on a par with the U.S., at about 600 grams per capita annually -- 65% more than France, according to Colgate. But most Indians weren't using toothpaste as recently as five years ago. By the time Dr. Arantes studied the Xavante in 1997 as part of graduate work in public health, "immediate action was necessary to preserve the teeth of future generations," says the 38-year-old dentist.
So Dr. Arantes decided to take the Xavante's plight to a potentially powerful ally: Colgate. The company agreed in 1999 to sponsor a prevention, education and treatment program focused on five-to-14-year-olds.
In Brazil, Latin America's largest country and Colgate's fifth-biggest market, Indians account for just 280,000 in a total population of 175 million and generally don't have individual income. "I wouldn't call this a classic business-building process," says Roger Pratt, president of Colgate in Brazil. "We're not expecting to sell a lot of dental cream to Indians." Instead, Colgate considers the Xavante project, whose budget it won't disclose, as a socially responsible investment.
Next month, the project will extend to five other Xavante villages, with a total population of 10,000, as well to the Xingu National Park, home to about 4,000 Indians. Dr. Arantes will oversee two other dentists, and the goal is to slash tooth decay by 40% in five years.
For the past four years, Dr. Arantes has been visiting Pimentel Barbosa every four months for about 45 days at a time. To reach the village, he makes a backbreaking 24-hour journey from Sao Paulo by plane, bus and jeep. Each time, he lugs 500 Colgate toothpaste tubes and 500 toothbrushes (a pair for each villager), dental instruments, a 12-volt car battery to power a drill and a tent that he sleeps in.
Before starting his work, Dr. Arantes pays his respects to Chief Serebura and attends the Wara, a tribal council that convenes in the center of the horseshoe-shaped village each day for communal decisions. Through a translator, Dr. Arantes communicates his mission to the men assembled. Word quickly spreads that the dentist will be available for consultations.
The Xavante, who are recognizable by their square-cut shoulder-length hair with long bangs, were a nomadic tribe until about 30 years ago. Now settled, their living conditions have hardly changed: Extended families inhabit large palm-thatched huts. There is no running water, electricity or other modern conveniences.
Not a single Xavante woman in Pimentel Barbosa speaks Portuguese, and just a handful of Xavante men speak it. Especially in the early days, Dr. Arantes found little need to talk to his patients, once they opened their mouths. "They came in droves to get teeth pulled," he recalls. (He is now proficient in the Xavante dialect, Je.)
"Our priority is education and prevention," says Dr. Arantes, who teaches Portuguese-speaking tribesmen the ABCs of dental malaises -- plaque, gum disease and cavities -- which they pass on to the community. The dentist and the Indians also develop educational games, based on Xavante culture and customs.
One recent morning, after lunch at the Xavante schoolhouse, a tall Indian named Prepe gathered 15 students. Using a set of dentures and an oversize toothbrush to make his point, the Indian began: "Why are teeth important?" Several frisky children responded in unison that "we need them to chew, talk and have good health." Afterwards, Prepe handed every child a toothbrush with toothpaste, and four by four, they bent over a troughlike basin with four faucets and began brushing vigorously.
Dr. Arantes is confident that most youngsters here now brush their teeth regularly. One sign of improvement is that tribe members aren't just coming to see the dentist about toothaches. The other day, Monica , a Xavante carrying a newborn in a handwoven basket suspended by the handle across her forehead, asked for a checkup. Says Dr. Arantes: "The message about oral hygiene is getting across."
灌木林中的刷牙运动
强壮的体格，显眼的木制耳环，巴西印第安部落Xavante的年老酋长真是威风凛凛－－直到他开始张口说话。
口腔上排的几个牙齿已经没了，而其他许多牙齿也烂得无可救药。这位单名叫Serebura的酋长现在约有八十多岁（他记不得自己的具体生日了），直到七十岁左右才开始使用牙刷和牙膏。
目前，高露洁棕榄(Colgate-Palmolive Co.)正试图避免让相同的命运降临到Serebura的三十多个孙子和曾孙身上。这家跨国公司与巴西牙科医生鲁?埃伦特(Rui Arantes)携手合作，用现代口腔卫生学来武装Xavante这个昔日的武士部落─该部落的成员直到现在还使用弓箭。 世世代代以来，Xavante和其他部落的牙齿保健方式主要是用小树枝擦牙齿，用稻草刷舌头。由于他们的食物来自狩猎和采集品，如貘、鹿、鱼、水果和食用块根，这种清洁方式已经足够了。牙医们解释说，上述食品有清洁和加固牙齿的作用。虽然随著时间的推移，强力咀嚼会侵蚀印第安人的牙齿，但几乎没有蛀牙。
后来，"白人"进入印第安人的世界。他们带来了土豆、精制糖和加工食品，用这些作为礼物来获取采矿权，进行各种牟利活动。巴西政府还向印第安人引进稻谷，鼓励他们从事农耕，无意间起了推波助澜的作用，因为稻米中带有粘性的淀粉能引起蛀牙。
Serebura说："我们尝了白人的食物，并喜欢上了它们。如今，我们的牙开始疼了。"他说自己的牙病源于对糖、甜饼和咖啡的喜爱。
从1961年至1991年，在Xavante部落6到12岁的孩子中，龋齿的发病率翻了四倍，而在13到19岁的孩子中，发病率上升了五倍多。高露洁公司称，总体而言，巴西的口腔卫生程度达到了发达国家的水平，牙膏的消费量与美国持平，人均年消量约为600克─比法国高出65%。但大多数印第安人直到5年前才开始使用牙膏。1997年，作为攻读公众健康领域的研究生，埃伦特研究了Xavante部落的口腔卫生状况。这位现年38岁的医生说："当时必须马上采取行动来保护孩子们的牙齿。"
于是，埃轮特医生决定把Xavante部落的困境告诉潜在的强大盟友高露洁。该公司在1999年同意赞助一项针对5到14岁儿童的、把预防、教育和治疗结合起来的牙病防治活动。
巴西是拉丁美洲的第一大国，也是高露洁的第五大市场，总人口为1.75亿，其中印第安人只有28万，而且基本上没有个人收入。高露洁驻巴西的总裁罗杰?普莱特(Roger Pratt)说："这不是一般的商业活动，我们并不指望向印第安人出售大量的牙膏。"相反，该公司把这项活动作为一项社会公益活动，但它没有透露预算金额。
下个月，这项活动将扩展至Xavante的另外5个总人口为1万的村落，以及Xingu国家公园，那里居住著大约4,000名印第安人。埃伦特手下还有两名医生，他们的目标是在五年把龋齿的发病率降低40%。
在过去四年里，埃伦特医生每4个月就要在Pimentel Barbosa村呆上45天左右。为了到达这个村庄，他要艰苦跋涉24个小时，先从圣保罗(San Paulo)乘飞机，再转乘汽车和吉普车。他每次都要带500支高露洁牙膏和500支高露洁牙刷（每个村民将获得一支牙膏和牙刷），医疗设备、一个给牙钻供电的12伏车用蓄电池以及一个供他睡觉用的帐篷。
在开始工作之前，埃伦特要问候酋长Serebura，每天都参加Wara，即部落会议。这种会议在马蹄铁形的村庄的中心召开，商讨公共事务，并做决定。通过翻译，埃伦特把他的使命传达给在场的人。大家很快都知道可以向这位牙医请教。
三十年前，Xavante还是个游牧部落，部落成员都留著长及肩膀的头发，前面还有长长的刘海。目前虽已定居，但他们的生活水平几乎没有改变：成员众多的大家庭住在棕榈覆盖的茅屋里。村里没有自来水、没有通电，也没有其他现代生活设施。
在Pimentel Barbosa村里，没有一个Xavante妇女会说葡萄牙语，仅有少数几个男子会讲。起初，埃伦特发现几乎不必与病人交谈，只要他们张口，他就知道怎么回事。埃伦特会议说："他们成群结队地来拔牙。"（他现在已精通Xavante的方言Je了。）
埃伦特说："我们的主要任务是教育和预防牙病。"他向那些懂葡萄牙语的男子们传授关于牙病的基础知识，如牙斑、齿龈疾病以及蛀牙等，然后再由这些人传授给全村人。这位牙医还和懂葡萄牙语的印第安人根据Xavante的文化和风俗，开发具有教育意义的游戏。
最近的某天上午，在Xavante的校舍里吃完午饭后，一个个子高高的名叫Prepe的印第安人召集了15名学生。他用了一副假牙和特大型牙刷进行教学。Prepe首先问道："牙齿为什么很重要？"几个活泼的孩子齐声答道："我们需要牙齿来咀嚼，说话，保持身体健康。"随后，Prepe给每个孩子发了一支牙刷和牙膏，让孩子们以四个为单位，在带有四个龙头的槽形水盆前用力地刷牙。
埃伦特相信，大多数年轻人现在经常刷牙。一个可喜的迹象是，该部落的成员们如今找他不仅仅是为了看牙病。有一天，一个名叫Monica的Xavante妇女带著个放在手工编织篮里的新生儿来找他，要求进行检查。埃伦特说："口腔卫生的知识正在普及。"
