Screams pierced the sultry tropic air.
They came from a 5-year-old boy who had four rotted teeth pulled. He was now biting down on some gauze to stanch the flow of blood.
The dentist, Maj. Andy Lind, said that 10 more of his teeth would likely need removal soon if the boy didn't change his eating and dental hygiene habits.
It was only 9 a.m., and in just two hours, Lind and another U.S. Army dentist had extracted 50 teeth from children and adults in the Salvadorian town of Olocuilta.
What's up with so many kids waiting in line to get teeth pulled? Lind had identified a likely culprit: a child's plastic bag filled with an assortment of candy. All that candy gets washed down with bottles of cola or orange soda, he said.
And while Lind said surgery treats are amply available, toothpaste, dental floss and toothbrushes are in short supply.
The two dentists were part of a medical readiness exercise team of 40 that included Peruvian and Salvadoran doctors and nurses. Of the 40, 32 were U.S. Army medical personnel from Combined Joint Task Force Hope participating in the Beyond the Horizon exercise. The larger scope of the humanitarian exercise included construction of clinics and schools.
The dental MEDRETE in Olocuilta, one of five that will be conducted during the exercise, started June 25 and concluded June 29.
Dr. Gustavo Angel, a non-governmental organization volunteer with Operation Blessing out of San Salvador, the capital, said many people can't afford to see a dentist. And when those people do eventually get in the chair, they're usually in a lot of pain and need teeth pulled.
Unfortunately, anesthetics are expensive and in short supply, so a primary tool is a pair of pliers to extract the teeth -- without numbing them. Once the teeth are pulled, they often need to bite down on pieces of cloth to stop the bleeding, since gauze is also in short supply, he said.
This is the second time in Angel's life that the 30-year-old has interacted with U.S. military personnel. Three years ago, the Navy hospital ship USS Comfort, docked in Acajutla, El Salvador, and set up a MEDRETE.
Angel said he was especially impressed with how well the current MEDRETE is organized. He added that the locals are grateful for the help from the U.S. and they consider it a blessing.
Capt. Jewell Hemmings, a Reserve public health nurse with the 801st Combat Support Hospital, out of Fort Sheridan, Illinois, said this is her second MEDRETE, the first was with Joint Task Force Bravo in Honduras in 2014.
She said dengue fever, malaria, chikungunya, zika virus, hepatitis A and typhoid are all prevalent in this part of El Salvador.
The emphasis here should be on prevention rather than cure, she said, since the American doctors won't always be around to respond, it's better to prevent the occurrence of disease.
For example, she said she educates people about getting standing water removed from tires and buckets which can harbor mosquitoes that carry zika and chikungunya.
Hemmings said she can totally relate to Salvadorans because she herself grew up poor in Jamaica. She joined the U.S. Army in 1991 and is proud to serve, especially as part of a humanitarian effort.
1st Lt. Claudia Aparcana, a Reserve medical surgical nurse with the 328th CSH out of Fort Douglas, Utah, said she too was poor, growing up in rural Peru. Her civilian job is a trauma nurse, so she said she is used to seeing patients who are in dire straits.
Staff Sgt. Leslie Felder, also from the 328th CSH, was in charge of organizing the entire MEDRETE, a huge responsibility for a non-commissioned officer.
She took charge on June 24, a day before the MEDRETE began, designated areas of the makeshift hospital for triage, dental, pediatrics, gynecology, pharmacy, optometry and other specialties.
A number of the U.S. personnel like Aparcana speak Spanish, Felder said, which is really a help. But for those who don't, volunteer students from El Salvador's Universidad Gerardo Barrios and Universidad Technology are ever-present to translate.
Victor Contreras, 28, and Oscar Cortez, 19, both from Universidad Gerardo Barrios, said that it can be tricky translating medical terms from Spanish to English, as it's a very technical skill. Nonetheless, they said they're happy to be a part of a humanitarian effort and they hope their effort will benefit many people.
Felder, whose civilian job is a lactation consultant, said about 600 patients were seen June 25, the first day where patients came in. She said she expects about 800 on the second day of the exercise, and believes the numbers will continue to increase daily as word spreads through the community.
Not all who visit the clinic are ill or need teeth pulled.
Reina Chavez, 43, has had great difficulty in reading. The strain on her eyes, she said, resulted in burning and itching.
At the MEDRETE clinic, she was seen by an optometrist and received her first-ever pair of eyeglasses, which corrected her vision problem and allowed her to see correctly.
"It was a blessing of God from the Americans," she said, through Cortez, her translator. She began to cry because she was so happy.