Director s Report-Dentistry in Honduras

Transcription

1 Director s Report-Dentistry in Honduras Name of Program: IU School of Dentistry Service Learning Dental Program In Honduras Dates of Program: March 13-20, 2010 Location of Program: Comayagua, Honduras Director of Program: Steven B. Blanchard, DDS, MS Participants Number: 7 4 th Year Dental Students, 2 School of Dentistry Faculty (Periodontics) Majors represented: Dental Class standing: 4th Year Dental. Campuses/ Institutions represented: IUPUI/IU School of Dentistry Pre-Departure Orientation Provided to Participants: IUSD ISL faculty presented orientation and training sessions on three different topics. Dr. Blanchard directed orientation through three additional sessions required of all Honduras participants. The classes included student presentations of topics to prepare for the trip, such as Honduras history, politics, geography, culture, economics, health care, and working in a field clinic environment in a developing country. One of the students, Matthew Rowe presented a PowerPoint presentation on Honduras culture, currency, and an overview of the Comayagua Lions Club facility and the layout of the dental clinic. There was no prerequisite language requirement, although a working understanding of Spanish was helpful. Information packets on dental Spanish language instruction were provided to all participants. Other orientation topics included fundraising and soliciting dental supplies. Academic Program: Description of course offered: This program is a one-week experience for students of IUSD during IUPUI spring break, providing clinical dental treatment for underserved patients in a developing country. This satisfies the required 1 credit hour IUSD Intramural Elective module for senior dental students. This elective course is "International Dental Service-Learning" and is a module in the required 19 credit hour clinical course T850 "Clinical Sciences IV Part II". Students enrolled in this elective receive credit for 80 clock hours of experience in community dentistry. Students from the Indiana University School of Dentistry were involved in providing direct and supportive dental health care to underserved children and adults in the Comayagua area. There is a large underserved population in Honduras. Most of the patients treated on this trip were children below the age of 12 with significant dental decay problems. This course is heavily oriented toward providing direct dental services. In four and a half clinic days, our team treated 414 patients, providing 169 dental restorations, 48 dental sealants, 301 dental extractions and 203 fluoride applications for patients in three different clinic settings. Any distinctive features: This program is unique in that it offers the opportunity to provide dental services for underserved patients in a developing country. This experience allows IUSD students to

2 observe and treat dental conditions that they would not see in this great concentration in the US, and allows them to understand living conditions and oral health conditions in a remote area of a developing country. Strengths/weaknesses of academic program: The program has enthusiastic faculty and students, and a well organized and experienced in-country sponsor and faculty mentors. This was the second ISL trip to Honduras and followed the format developed last year during our inaugural ISL trip last year. The faculty director and the in-country sponsor further refined the program based on last year s experience and plans have been made with the Comayagua Lions Club to return in future years. Dr. Blanchard and the students were pleased that we were able to provide a significant amount of restorative dentistry to preserve dentitions rather than largely providing extractions for this young population. The program allowed some time to appreciate the culture and beauty of the country and people. Time is our main limitation in providing a significant clinical and cultural experience in the time available. There are recommendations for future years as noted below. A strength of the program this year was that one of the students, Matthew Rowe was granted an IUPUI SLA award. He was vital in helping plan and to coordinate the trip with the in-country sponsor. Additionally, because of flight delays for some participants (described below), he was able to set-up the clinic before the arrival of the faculty director. 4 team members were involuntarily bumped on the flight to Atlanta due to flight cancellations and re-booking of flights from the day prior. These team members arrived one day late because of these flight issues. All of the students stayed in a weekend house owned by a member of the Comayagua Lions Club. This can be viewed as both a strength and a weakness. It was a strength as it allowed significant bonding of team members outside of the working environment. It was a weakness as it did not allow the same cultural interactions with host families. I think overall that the strengths outweighed the drawbacks. Impact/ influence of overseas setting on academic experience: The overseas setting is invaluable to the impact of this program. This program is designed to provide dental services to children, youth and adults who otherwise have little or no access to dental care, in a developing country. The dental students treated dental conditions that were much more severe and concentrated than the routine seen in the US, even among underserved patients here. Serving this Honduran population was very eye opening to the students, as this population expresses an unusual degree of cooperation and gratitude that is rarely seen in the typical American dental population of any economic background. Another big advantage of the overseas setting is in the team building and camaraderie developed among the team members. The concentrated time of working in clinics together under difficult conditions, problem solving and sharing meals together on a daily basis increased a strong feeling of interdependence among the team members and faculty that might never develop in a traditional US based clinic activity. Summary of Grade Distribution Credit is given in the elective course in International Dental Service-Learning. There are no letter grades given, all students who participate fully in all phases of the course including campus and international portions receive pass evaluations. All students were successful this year.

3 Description of Student Housing and Transportation: The in-country sponsor arranged housing for students and faculty. Students stayed together in a house supplied by a member of the Comayagua Lions Club. The house was sufficiently large to accommodate the 7 students. The 2 faculty members stayed with another member of the Lions Club. All accommodations were more than adequate, with warm and cool running water and flush toilets. Members of the Lions Club arranged for 2 social get-togethers that expressed the warm Honduran hospitality from the in-country hosts. The Lions Club made arrangements for travel to and from the airport and to the various treatment locations. Transportation to and from the airport (in Tegucigalpa) was in a commercial van and transportation to and from the clinic facilities was provided by the hosting Lions Club members. The next to the last day was allotted for sightseeing opportunities and transportation was provided by the same company and commercial van that provided the transportation to and from the airport. Description of Meal Arrangements: The in-country sponsor helped arrange meals for students and faculty. Breakfast and lunch were provided by the in-country sponsor. Dinners were generally at local restaurants and the costs were paid from budgetary funds. Description of Any Health and Safety Incidents that Occurred on Program: One safety incidents occurred in country. One of the students received a percutaneous needlestick injury. The director had a rapid HIV test which was done on the patient which tested negative. The student was advised to follow-up according to IUSD policy for percutaneous injuries after his return to the US. Insect bites were a very small problem due to consistent use of insect repellents. One student was affected by GI upset, which was treated and resolved with local measures and antibiotics. Recommendations for Future Offerings of this Program: This trip was 8 days in length (Saturday to Saturday) with one day (Friday) set aside for sightseeing away from Comayagua. One student expressed a desire to have more time available in country, with additional time to visit the coastal areas. Another student suggestion was to improve the Spanish dental language training, and to review specific dental phrases immediately before the trip. Several students volunteered to help with plans for organizing clinic supplies more efficiently for future years. Most students gave high marks to all other aspects of this program but some students felt that the large group orientation sessions were not particularly helpful and more than half of the students commented that the briefings on ethical considerations made them question as to why IUSD was sponsoring these trips (the bottom line of the presentation according to the students is that service-learning trips/dental missions are inherently unethical). All students gave high marks to the clinical and cultural portions of the experience. The director gave the students the course/trip evaluation forms to fill out upon their return to the US; a recommendation for the future would be to distribute these forms on the plane home in order to get immediate responses and to have concentrated time to reflect and reply. Some students recommended including dental hygiene students for future trips but would need to coordinate for additional clinic space accommodations if hygiene students were included. All students will be graduating but expressed a desire to continue this type of work in the future.

4 From a director s point of view, the in-country program ran much better this year compared to our inaugural trip last year. We were better organized and more prepared, especially in regard to equipment and supplies this year. It would be nice to be able to take more students on this experience but clinic space (and housing) limitations would make it difficult to take more than 6 or 7 students. After 7 or 8 years of university education, dental students have accumulated a large debt, and the dental school has no available budget for these elective programs. It has been the goal of the four International Dental program directors to provide this volunteer opportunity at no direct cost to the school and at a reasonable cost to the students. The student participants were required to provide at least half of the total cost of their individual programs ($1100 for Honduras). It is likely that students will have to bear an increasing portion of the program costs, even as faculty directors either pay their own way, or raise funds, as this program receives no direct school funding. We have already been invited to return to Honduras by the Comayagua Lions Club as program sponsors, and we would be pleased to offer the program again in Hondurasr in the Spring of Program Will Next be Offered: IUPUI Spring Break 2011 (March 2011) Reflections on any concerns raised by Overseas Study Advisory Council during the program approval process: Overseas Studies and the administration of the School of Dentistry have been very supportive of our international service-learning trips, and have not raised concerns that needed to be addressed.

5 Appendix 2010 Participants from IUSD: Boller Ketti Fourth Year Dental Gotlib Joshua Fourth Year Dental Jackson Joseph Fourth Year Dental Ha Dan-Linh Fourth Year Dental Miller Maxwell Fourth Year dental Quinn Patrick Fourth Year Dental Rowe Matthew Fourth Year Dental Blanchard Steven Dentistry Assoc. Professor Blanchard Jane Dentistry Asst Clin. Professor

6 Treatment Statistics: IUSD/Honduras Comayagua Team Clinical Statistics 3/2010 Location Sunday Monday Tuesday Wednesday Thursday Total Week Screening Comayagua Lions Comayagua Clinic Club Lions Club El Citio School El Vocan School Totals Child Patients Adult Patients # Patients Ext Primary Ext Permanent Ext Total Sealant Resin GI/FujiIX Amalgam Temp/IRM Resto Total Prophy Rx Fluoride Varnish