Health Outreach

Field Report: HEALTH OUTREACH

A report written by Project Leaders Timothy Lee and Sylvia Guerron

 “Guatemala 2009”

Health Outreach

Field Report

Field Report

Field Report

Field Report

Field Report


Objectives

•1)     Provide Dental Emergency services in general

•2)     Service the communities surrounding Montericco and Panajachel  in

Guatemala .                                     

•3)     Carry out a preventative program including dental sealants and flouride for children

 

Services Offered

Dental Evaluation and Radiology

Dental Emergency/Urgent Care

Dental Preventative Care

 

Donations

Oral hygiene aids

 

Services Offered

Oral examination, radiology, endodontics, oral surgery (extraction), restorative, preventative including dental sealants and fluoride, individual dental health education.

 

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.

Locations: Week One was in the classroom in El Rosario. 

Week Two was in Municipalidad de Panajachel, department de Solola in a clinic (casa Oasis) operated by “Asociacion ASIS of Panajachel”

 

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

For Preventative care:

1. Children <= age 12

For Sealant care:

1. Children <= age 18

Entire schools and communities were given priorities on specific days.   Priorities also depended on patient demand and dentist availability.

 

Staffing

All staff were volunteers except there were paid positions for the equipment (heavy) staff. Our Country Director was present for the week in Monterrico.    Professional volunteers had to provide licenses which were copied in our files.

 

Volunteer Tasks

Primary or Secondary role

Team Leader  #

Project home (H) or                    On site (G)

# Per Week

WEEK 1                                      

WEEK 2                              

1

Triage dentist

P

3

G

1

Dragana Medjedovic

Richard Parrott

2

Dentist

P

3

G

4

Pravir Patel

Dennis Moren

 

 

 

 

 

 

Rajiv Arya

Trang Nguyen

 

 

 

 

 

 

Gerard Magne

Dragana Medjedovic

 

 

 

 

 

 

Tom Varden

N/A

3

Assistant

P

3

G

4

Cynthia Sprott

Cynthia Sprott

 

 

 

 

 

 

Janice Zalewski

Janelle Parrott

 

 

 

 

 

 

Tracy Shuttleworth

Janice Zalewski

 

 

 

 

 

 

Yvonne Joseph

N/A

4

Hygienist

P

3

G

2

Joanne Machin

Lucie Nadeau

 

 

 

 

 

 

Paula Benbow

N/A

5

Patient Coord.

P

1

G

1

Elizabeth Galarza

Sylvia Guerron

6

Xray tech*

P

2

G

2

Melissa Holst

Yvonne Joseph

7

Sterilization Tech*

P

2

G

1

Paul Zapletal

Guatemalan RN

8

Stats Admin

P

1

G

1

Jo-Anne Magne

N/A

9

Public Health

P

3

G

1

N/A

N/A

10

Translator

P

1

G

1

Fabiola Reyes

Sara Nadeau

11

Equipment

P

2

G

1

Vicente Garcia

Guatemalan RN

Patient Fees

All dental services and products were free.

 

Record Keeping

Health history, consent, and instructional documents were in Spanish.  Personal and clinical data was entered on a laptop computer.

 

Medications

Attending dentists prescribed medications as indicated.  Medication including antibiotics and analgesics were also dispensed by Health Outreach dentists. Medications included ibuprofen, acetaminophen, penicillin, clindamycin, Naproxen, Toradol, and acetaminophen compound with codeine.  An emergency kit was also available with medicine for emergencies.  One dentist prepared the meds for easy dispensing by other dentists.

 

Patient Education

Oral Hygiene lessons were conducted on a one-to-one basis only at El Rosario and

Hawaii.

OPERATIONS

 

Guatemala 2009

Twenty-four North American team members formed “Guatemala 2009” from January 24th to February 6th, 2008.  Week One volunteers operated in the schoolyard of El Rosario and Week Two volunteers operated at a clinic in Panajachel.  Seven volunteer arrived after the first week to participate in the second week only.  Three volunteers worked for two weeks in total.

Prior to Health Outreach’s arrival, notices were posted announcing dental treatment for “children as a priority”.  Our Country Director, Real Desrosiers, arranged for this.

Health Outreach members arrived in

Guatemala Cityand proceeded directly to Monterrico on the Saturday in three vehicles.

A full day (Sunday, January 22) was designated for product stocking, sorting out expired goods, medication packaging, meetings and equipment testing.  The supplies, our cargo and heavy equipment stored in

Antigua, were brought to our base at the Hotel Dulce y Salado.  There was an emphasis on training and planning.  The three generators, two autoclaves, a chemiclave, and four compressors and seven portable dental (ADEC) units were tested.  Project Meeting #3 was a final opportunity to prepare team members for the following week.  It covered topics such as accommodations, personal safety, transportation, and food safety.

The amount of equipment we had required two trucks to transport.  On Sunday, the male volunteers brought all the equipment to El Rosario for secure lock-up in the classroom. 

 

El Rosario – The

village of El Rosariowas the main clinic site this year.  .

We operated Monday to Friday with four dental operatories and two hygiene chairs.  Four dental units were working.  The community nurse, Ingrid, her sister Sara and another teacher, Doris, assisted with the instrument collection and washing.  Vicente, a local Guatemalan, and his son Luis took care of the generators and compressors.

Ramiro, the President of the community once again, was invaluable in his support.

Again this year, HO also donated US$100 to help cover some electricity costs.

 

Panajachel

On Friday January 30th, the entire team except for one member travelled to Pana.  This included the people staying for two weeks and those spending extra time before leaving the country on the Sunday. 

Our driver Real, decided to take the equipment to

Antiguaand return it the following day instead.   He wanted to rest a night at his home.  The following day, one of his drivers arrived at 11Am at our hotel to pick up three team members.  We were greeted by Olga Castellanos. All items were removed and placed in the clinic.  A back room was used for safe-keeping of the valuable items. On the following day, Sunday,  Project Leaders for Week one and two arrived again at 7:30 AM to test the compressors and electrical in the building.  Assisting us in this matter was Andre, a technician, whom we hired for Week Two.  He  reported that the compressors and generators needed maintenance, and that the electricity was not grounded making it unsafe to operate all the equipment without the generators.

On Friday February 6th, Health Outreach supplies and equipment used in Panajachel were transported to

Antiguaand unloaded at Real’s residence.  

Contacts

Isela Vega
Adventure Travel Center
5ta. Avenida Norte #25 B, El Arco,Antigua Guatemala
Phone : (502) 7832-0162
Fax : (502) 7832-1540
Emergency (502) 55733996
E-Mail :
viareal@guate.net.gt

Olga Castellanos

Asociacion ASIS de Panajachel

Cel: 5775-2338

Home: 7762-2760

E-Mail: olgaolralu@yahoo.com

 

ANALYSIS & RECOMMENDATIONS

“Guatemala 2009” was a success as our objective to see as many children as possible achieved once again.  This holds true for both weeks.  The following communities were seen in Montericco - Las Mañanitas, Cebollita, El Rosario, El Dormido and El

Hawaii.  In Panajachel, children were seen from various surrounding Mayan villages (Santa Cruz La Laguna, San Andre) and from Panajachel itself.

Regarding Cargo, we did not lose any items this year with TACA airlines.  There were problems with the generators which almost jeopardized the trip.  Both generators were not allowed on board, with the reason given that gas had been used in them making it against regulations.  We had not encountered this before with two generators brought in previous years.  There was no argument with the used generator, but we argued our point with the new Honda 2000W model.  After having the agent open the generator tank and smelling it, it was allowed to pass.  The response was “ that it did not have as much fumes from testing as some other types”.  The remaining pre-owned 3000W generator was left in a vehicle in the airport parking garage. Our sterilizer was over the weight limit and we were charged $60 for it to pass.

 

MONTERRICO

Dulce and

Salado, our base/hotel, was again ideal for our field trips, accommodating all but two of the volunteers. Two other volunteers stayed at a neighbouring hotel named Dos Mundos.

Transportation included a 4X4 double cab pick-up, a KIA 4X4 and passenger van (Adventure Travel).

Our heavy equipment had some minor problems.  Prior to the project, Real serviced the new DeWalt  compressor and the Yamaha generator.   Like last year, the new DeWalt 55131 would not start. Only later in the week, when a separate power cord was used from the outlet, did it function.  The extension cord was a higher grade.   The old DeWalt 55131 was working fine all week.  The second Dewalt 55151 did not work at all.

The electricity at El Rosario was available at all times.  Initially however, our high electricity usage drew so much power that the breakers cut off the power.  We deemed it necessary to turn off the lights to conserve electricity.

The dental ADEC units were superb all week.  There were seven units in total with two placed in service and five operational. Three units were brought back to

Canada . One unit is still unaccountable.

Regarding Patient Care, the professional staff suited the size of the project.  The two hygienists made for an effective preventative and sealant and varnish program.  One hygienist carried out prophylactic appointments and the other used the unit for sealants and varnish applications.  The hygienists were not given an assistant.  Only when the radiographs were not available did that volunteer help the hygienists. We concluded that this was the only effective way of having two hygienists work.

Regarding Volunteer safety, there was one incident of needle stick injury.  Bleach was used disinfect.

Health Outreach Staffing on this project was ideal, except for designating an assistant for the two hygienists.   Two Guatemalan technical persons were hired for Week One which may have been excessive.

They were invaluable initially when the compressors were problematic.  They did need a lot of direction however and tended to forget things. They were paid $100 each for the week. There was no formal group Public Health effort because we were missing a Public Health Officer.

Illness was not a major issue this year.  As usual there were several incidences of illness creating diarrhea in the morning.  Not one volunteer missed a day.

Health Outreach produces a budget for the project which is approved by our Board for action.  The project did not go over–budget.

The Digital x-ray was functional after two days.  It was discovered on preparation Day one that the software for it’s operation was missing.  Ultimately, software was sent by e-mail form the manufacturer. A cord was also missing but was found in another suitcase.  The printer was also not working because the software was not installed in the laptop. This is an example of inadequate preparation.  Had the unit been set-up prior to arriving and images at least printed, these problems would have been discovered. hat holding the X-ray head was easier than moving the patient into position in relation to the head.  The new 4X6 printer operated well.  The Lithium battery was not used.  No protective bibs were used on providers or staff despite recommendations. A lightweight provider bib should be purchased for next year.

As recommended after last year, the x-ray area was placed in an area far from other activities.

Lighting was better this year from two donated medical Welch Allen halogen lights on stands.  The fibro-optic light was not popular because operators felt tethered.

The sundry supply was good.  Last year sealant material and etch were the two products in short supply.  This year, a lot was purchased just prior to the trip. One material missing was dental liner.  It was not overlooked in the inventory.  The material was present but it was simply not setting.

Sterilization was adequate.  There were three sterilizers.  The one repaired by Real had difficulty holding water and was put aside. It is speculated that it leaked only because it was tilted.  It was not tested again.  The Chemiclave was tested and working.  It was use as a back-up only.  The chemiclave was donated.  It was small allowing us to bring it without difficulty.  In previous weeks, it was serviced and tested.

Last year there was a perceived urgency for items because items could not be readily found amongst all our supply totes and suitcases.  This year, that problem was rare.  It is attributed to the organizational skills of our volunteers, especially on the preparation Sunday.  Unlike last year, volunteers made sure that they had everything they needed for Monday.  The team in general functioned very well and on time.

All the dental hand pieces were retrieved to be stored in

Canada .

On the last day, some items were overlooked at the clinic.   One was the ice chest loaned by the Hotel.  It was retrieved by Vicente and Luis while we were preparing to leave Montericco.  The sharps containers were forgotten at the clinic.  Traditionally, they were taken to a hospital in

Antiguafor disposal.

PANAJACHEL (written by Sylvia Guerron)

Dos Mundos was our base/hotel which accommodated all of the volunteers. We were about a 20 minute walk to the clinic which made the location ideal. On the first day to the clinic, Andres our equipment manager, drove entire team and some equipment to the clinic and then back again. We used the services of his truck only in other occasion. On the evening that we met with the members of the Asociacion ASIS de Panajachel, we all took taxis to the restaurant they chosen.

The Clinic provided by the Asociacion ASIS was perhaps the best clinic to date that we have been able to use. The clinic was new so floors, walls, rooms were all new. First floor contained an area that served as a reception area, with bathroom for volunteers to use. Down the hall there was a larger bathroom that the children could use and a smaller room where various equipment, suitcases, supplies and food and cooler were kept. To the right of the reception area, the largest room in clinic was used for treatment and to set-up the 3 dental chairs. The surgical area was closest to the kitchen area that we used for sterilizing.  On the second floor, the first room atop of the stairs, was used for dental hygiene. The other large room was left empty with the exception of some equipment being put there. The generators were kept outside on the terrace of the second floor while they were being used. Everything was brought into the clinic and locked up in the evenings with a security guard sleeping there every night to guard the equipment.

In general we did not have problems with our equipment with the exception of the Chemiclave Sterilizer which broke down on the third day which caused us to loose about 40 minutes. Andres looked into it but was not able to fix it. The handle to shut the door completely was missing.  As we had no other sterilizer, we used a large pressure cooker that Edgar, the nurse/sterilization tech, advised us that it was used by the local hospital. Prior to the sterilizer breaking down, there was much concern about how well the instruments were being sterilized. This was carefully looked into by Dr. Dennis Moren and Dr. Richard Parrott and further steps were taken to ensure things were being carried out properly. When pressure cooker was put in place of sterilizer, Dr. Tran Nguyen also researched into this and some of these suggestions were considered to further ensure proper sterilization:

How to sterilize:

Pressure Cooker

•-          Heat degrees F / 121 degrees Celsius for 30 mins

•-          When sterilizing handpieces, lubricate before and after sterilization (must not be hot when lubricating)

3% Gluta-ralderhyde

•-          8 hours cold chemical sterilization

How to disinfect:

Sodium Hypochlorite/Bleach

•-          10 minute soak

Isopropyl alcohol

•-          10 minute soak

Electricity was available at all times with the exception of one day where we lost power but only for a couple of minutes as Andres was readily available and quick to fix electrical/equipment problems. Rooms were very airy and natural sunlight came in through the windows, despite the fact that we covered some of the windows so as the children outside would not see other children being treated.

Regarding Patient Care, everyone worked hard and efficiently while at the same time taking great care of each patient.  This was noted several times by the ASIS members and were very grateful for our genuine concern for each child. The assistance of the local volunteers from the Asociacion ASIS greatly helped everyday with patient flow and having pre-booked patients prior to our arrival. The only negative side to this was that it made it difficult for us to know where exactly all these patients were coming from and had to rely for the most part on the judgment of the members of ASIS.  Having said that,  ASIS members gave us no reason to doubt their credibility and good intentions.  

Regarding Volunteer safety, there was nothing of concern at the clinic. There were however a couple of  exhaustive episodes by two dental assistants who were on their second week – one felt overworked  and the other was concerned about the safety of our sterilizing methods. We could perhaps in future lessen the number of patients seen as there was no real down-time between patients for the dental team during clinic hours.

We did not have any major concerns with illnesses and everyone was able to work all 5 days.

We did not have an x-ray unit during the week but were able to cope without it but it would have been useful for a few cases.

On last day, all equipment was packed and loaded onto Real’s truck with the assistance of Oscar. Everything was brought back to be stored at Real’s in Antigua with the exception of handpieces and a broken curing light to be brought back to Canada by Dragana.

Also, on last day, money was paid out to:

Andres – use of truck; all spare parts bought, including gasoline; servicing of equipment

Edgar – work done as sterilizing tech during week – worked very hard between our clinic, ASIS other clinic and hospital

Gloria – cleaned, swept, moped and bought supplies as they were needed throughout the week such as toilet paper, drinks, bleach, fruit

Recognition and gifts were given to all local volunteers that helped throughout the week.

 

To Be Considered:

•-          Digital X-ray for 2nd week as well

•-          2 Chemiclaves for 2nd week in case one breaks down

•-          Carefully consider decision of volunteers wishing to go for 2 weeks

 

Other items required or suggested:

HO Banner

New high rated extension cords

Peroxide for needlestick injury

 

SUMMARY

Our objectives for “Guatemala 2009” were reached.  Five needy communities were serviced in Week One at the school in El Rosario.  A remarkable number of children were seen in six operatories and an examination area.  A full week was completed at our new site in Panajachel.  Our Preventative Program was very efficient delivering care continuously throughout the two weeks. Perhaps most importantly, a real difference is being noted in the severity of dental disease among our sponsored children.  Many observed dental sealants and restorations placed in previous years doing their job.

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