Download 1 - 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
1
2
Triage dentist
Dentist
Primary or
Secondary
role
Team
Leader
#
Project
home
(H) or
On site
(G)
P
P
3
3
G
G
# Per
Week
1
4
WEEK 1
WEEK 2
Dragana Medjedovic
Pravir Patel
Rajiv Arya
Gerard Magne
Tom Varden
Richard Parrott
Dennis Moren
Trang Nguyen
Dragana Medjedovic
N/A
3
Assistant
P
3
G
4
4
Hygienist
P
3
G
2
Patient Coord.
Xray tech*
Sterilization Tech*
Stats Admin
Public Health
Translator
Equipment
P
P
P
P
P
P
P
1
2
2
1
3
1
2
G
G
G
G
G
G
G
1
2
1
1
1
1
1
5
6
7
8
9
10
11
Cynthia Sprott
Janice Zalewski
Tracy Shuttleworth
Yvonne Joseph
Joanne Machin
Paula Benbow
Elizabeth Galarza
Melissa Holst
Paul Zapletal
Jo-Anne Magne
N/A
Fabiola Reyes
Vicente Garcia
Cynthia Sprott
Janelle Parrott
Janice Zalewski
N/A
Lucie Nadeau
N/A
Sylvia Guerron
Yvonne Joseph
Guatemalan RN
N/A
N/A
Sara Nadeau
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 City and 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 Rosario was 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 Antigua and 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
Antigua and 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 : [email protected]
Olga Castellanos
Asociacion ASIS de Panajachel
Cel: 5775-2338
Home: 7762-2760
E-Mail: [email protected]
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 fibrooptic 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 Antigua for 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.