Health Outreach

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project 2005 overview

Guatemala 2005

Services Offered Oral examination, endodontics, oral surgery (extraction), and restorative were all offered. Some dental health education was offered. As usual, care was taken to match a specific volunteer dentist with the appropriate patient such as difficult extractions with skilled providers.

Scheduling Clinics, Days and Hours Day one was for meetings, orientation, inventory control and the set-up and testing of equipment. Day 2 to 6 were clinic days consisting of 6 hours of dentistry including set-up and clean-up. Day 2 was at the school at El Cebollito. Day 3 & 4 was at the Health Clinic in Hawaii. Days 5&6 were at the school at El Rosario.

 

Eligibility Determination Patients were prioritized in the following order: 1. Children in pain and/or who have infection 2. Children with urgent needs (discomfort or likelihood of pain or infection) 3. Adults having pain or infection As usual, priorities were modified as the week progressed to ensure that patients who were promised treatment did indeed receive it.

Staffing The staff were all volunteers. There were five dentists, one senior dental student, two dental assistants, a translator/manager, a translator, one guide, and a technician. Community representatives included a person to do sterilization at each site, and administrative support personnel. There were no paid positions. All volunteers had to hold appropriate licenses. Current licenses were copied in our files.

 

Patient Fees

All dental services and products were free.

Record Keeping & Cultural Issues

Translation was always available. Surveys and forms on health history, consent, and instructional documents were in Spanish.

Medications Attending dentists prescribed medications as indicated. Medication including antibiotics and analgesics were also dispensed by Health Outreach dentists.

Patient Education

One lesson in Oral Hygiene was conducted on the last day of the project at Las Mananitas. Oral Health Manuals were distributed. Staff also distributed toothbrushes and floss with instructions on their use. top

Operations Health Outreach members arrived in Antigua, Guatemala on Saturday January 22ndand drove to Monterrico immediately. Fifteen team members formed "Guatemala 2005 from January 23rd to January 29th 2005. One team operated in the field which traveled to local schools at remote villages, namely, El Cebollito, Hawaii and El Rosario. The population of these communities and the surrounding rural areas is 5751 people.

 

This was the first time we had assigned a full day (Sunday) for product and equipment organization. In the morning of January 23rd, the "Puesto de Salud" - (the health clinic) - in Monterrico was visited to sort, clean, and collect Health Outreach supplies. Fortunately the supplies were intact, however some supplies were covered with dust spoiling much of the goods. There was an emphasis on disposal of expired goods. Our task was quickly done with help of 13 volunteers.

In the afternoon, the supplies, our cargo and heavy equipment stored in Antigua, were brought to our base at the Hotel Dulce y Salado.

The generator, chemiclave, and compressor and three portable dental (ADEC) units were tested. Two restorative carriers and one surgery carrier were stocked by the dentist/assistant to whom they were assigned. The clinical team was trained to set up the dental units. Project Meeting #3 was a final opportunity to prepare team members for the following week. It covered topics such as transportation, infection control and food safety…essential knowledge for our volunteers. top

El Cebollito The team started breakfast at 7am in preparation for our pick-up at 7:30am. Real picked up four of us and the equipment with the 4x4 to set-up. The school was spacious but required major re-arrangement to accommodate our needs. 20 chairs were arranged outside to organize the arriving children and 10 school tables were arranged to place equipment and supplies. Local members of the community assisted with the set up. Electrical outlets were in short supply so some members were asked to bring extensions from their homes. One strong supporter of the project was a trained nurse named Gladys. top

Hawaii The team operated in Hawaii on Tuesday and Wednesday. The Puesto de Salud in Hawaii was a medical clinic, but to our dismay, on Tuesday there was no water or electricity and it took an hour to get the water running for sterilization. The two rooms were set up for restorative: a surgery operatory was set up in the main floor and another dental chair was placed outside for surgery.

 

After clinic on Wednesday, the equipment was packed and readied for pick up on Thursday morning and transportation to the next community.top

El Rosario El Rosario was our last destination. Health Outreach operated there on Thursday and Friday. This village was located far beyond Hawaii, just inland from the beach and the canal. The site drew patients from two other communities further south of El Rosario - Las Mañanitas and El Dormido. The final communities were more remotely located south of Monterrico along the Pacific coast, accessible by 4x4 and by boat only. Transportation to the village was rigorous, taking 30 minutes over rough terrain.

Pick-up from the hotel was at 7:30 again. Without enough room to accommodate the equipment, everyone except three members was dropped off at the canal riverside for boat transportation. The three picked up Health Outreach equipment left the day before at Hawaii. Refreshments were purchased too. We continued on along the beach by 4X4 arriving at the school at the same time as the rest of the team. Set up was relatively quick since we were more experienced. The four chairs were arranged in a row facing the school. Because we were outside the light was good and there was cool breeze off the ocean, a refreshing relief after the previous locations. The team worked the longest here to 2:15pm because of a late start.top

Analysis The project was a great success, considering how logistically difficult it is to travel to our remote destinations. Our objectives were achieved with very little problems and our large, skilled team performed with enthusiasm and a commendable work ethic.

The location of our base/hotel was ideal for our field trips. We were able to travel to all three sites in less than 30 minutes. The hotel was also reasonably priced and convenient for meal meetings and organization of supplies. We even had storage space.

Transportation was ideal. A KIA 4X4 accommodated our heavy equipment and team as well. The vehicle managed the deep sand of the road and the soft sand of the beach.

Staffing on this project was great on our part but only fair on the part of the community. Our team had three bilingual staff including an assistant who spoke Spanish and English fluently. Not surprisingly, this gave patients confidence in us foreigners. Professional staff was skilled with five dentists and one senior dental student. Four pairs operated simultaneously using four dental chairs. The skill level of the team made for a very efficient operation where even difficult restorations and extractions were performed. Guatemalan assistance was fair. Our sterilization staff person fell ill with a serious facial infection unrelated to his job with us so he only worked one day. Community

help was poor. Most helpers lacked the aptitude to sterilize properly but we did get good help administratively in Hawaii. On a positive note, the Guatemalan dentist and her assistant were excellent in their roles as assistants.

Lack of illness among team members was also improved this year. Our solution to last years problems were Cipro and Dukoral, an oral vaccination for E.coli. Only one team member became ill causing her to lose a half a day's work. I filled in to keep that chair operational through the remainder of the day. Our accommodations which included healthy food were a positive factor.

Our dental equipment was suitable for our needs. The recently purchased third unit was invaluable. The carriers were convenient and sturdy. The sterilizer was slower than expected but still gave a 45 minute turn-around time. The fourth dental chair brought by the Guatemalan dentist was very bulky and heavy. Our new generator worked extremely well. It ran the compressor to drive three dental units. Luckily we did not need to depend on the electricity in Hawaii since there was none.

Sundry problems that we had last year did not materialize: certain items last year were in short supply and some were actually missing for the project. This year, a check-list was used for packing yet some of the dentists still found that the products to which they were accustomed were not available.top

Summary Our objective to outreach further to Guatemalans in need was achieved with Guatemala 2005. The five communities visited in July 2004 were serviced by this project. Over three field sites in El Cebollito, Hawaii and El Rosario. These communities have worse health than last years’ communities and had less access to dental care. Furthermore, our team had international representation and was more skilled and experienced than the previous year giving us the ability to perform more diverse procedures.

Written feedback from all members revealed a very positive experience. One member remarked that it was the "best experience of his life".

A special note must be made in regards to our Guatemalan dental team. They were superb as assistants. The dentist Dr. Maria Gonzalez left her three children and her office behind to join us. Further more, their presence gave our team credibility in the eyes of our Guatemalan patients and, being female, they also served as a role model for the young girls in the villages. top

Dr. Timothy Lee

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