As we near the end of our field school, we bring home with us great memories of San Pancho, the little community that could. These are just some random images of our time here.
Friday, May 20, 2011
I feel grateful to have worked in the San Pancho hospital, but not for the reasons I thought I would. I had thought it would be a relief to once again have the office equipment I needed at hand. I soon discovered that the antique equipment unfolded a whole new set of challenges - ones which I adapted to more naturally though than during our first week in Entre Amigo’s makeshift clinic. Instead I was grateful for two other things: to be able to provide more comfortable care for my patients by administering local anesthetic (as it is a very difficult thing to debride someone’s teeth knowing they are in agony with every stroke you make), and to be able to collaborate with dentists here who are eager to share their knowledge, skills and limited resources to benefit a patient’s oral health. Two of my patients now have appointments with the dentists next Monday for restorative needs. What a satisfying feeling it is when team work is centered on advocacy and a common goal.
We heavily relied on our translators in the hospital, both in communicating with hospital staff as well as with our patients. When providing professional oral healthcare it is critical to include information about the daily follow-up at home the patient can do to maximize the potential of the healing process. Without the dedication of our translators, our work would be a band-aid solution and would have little long-term benefits for our clients. Through working in the hospital, I have more perspective and empathy of what it might be like for an immigrant to Canada who is in need of healthcare but is not able to communicate this need.
Our last day of clinic was a long but satisfying one; we completed all our clients and finished at 7pm. Afterwards I ran the length of the San Pancho beach which was difficult, but not as difficult as knowing that there are many more people here we did not have time to provide dental hygiene services for. From this experience I take away the bitter-sweet knowledge that what I can do will never be enough, but what I can do is something.
Collaborating with the dentist at the hospital, Dr. Pa-ul, was an exciting experience. He is very interested in what we were doing and stayed around for a few days to complete some consults on some of our patients who presented with decay and periodontal problems. The dental clinic is furnished with two very old dental chairs, a portable x-ray unit from the 70's, a manual x-ray developer, a refrigerator to house some restorative materials, and little else. The amount of dental supplies were sorely lacking. Dr. Pa-ul mentioned that it is frustrating when a client is in need of treatment that he cannot provide because the materials are not available. In this environment, all anyone can do is provide the best oral health care possible, with limited resources. I have now come to fully realize the need for complete dental care in this community, and I feel that in the month that we were here, we have contributed to a portion of this goal.
Approximately 40 hours later, we finished our commitment at the hospital dental clinic at the San Francisco Regional Hospital. The following images are of our last two days there. I was privileged to meet the director of the hospital on the 3rd day in interesting circumstances. He walked over to the dental clinic looking for the two resident dentists. He said, "there's been an accident and I'd like them to have a look." When he couldn't find them, he suggested that I come with him. With no hesitation, I went but my heart raced with anticipation. What was I to find in the emergency ward? As we rounded the corner and walked another 50 feet to a cordoned off area, I see at least 7 emergency personnel over a hospital bed trying to subdue the accident victim. As I walked closer to the bed, I noticed blood on the floor and the sound of a man who was in obvious pain. He already had a neckbrace placed on him, showed visible signs of broken arms, broken legs, swollen lips, and face. As I looked over the man, I was prepared to be asked about broken teeth, possibly avulsed teeth but instead the hospital director moved the man's teeth forward and his entire maxillo facial bones moved and collapsed. I was looking at a man with a fractured skull and there was not much I can do. I looked at the doctors and raised my shoulders to clearly send this message..."sorry, guys this is out of my scope of practice." The doctor extended his arm to give me a handshake, and sent me on my way. I was of no use to them. I felt helpless. Later that day, I was told that he was sent to a Tepic hospital (2 hours north of SF) to get more appropriate care.
The beginning of another day.
Dr. Pa-ul and Shannon discussing patient's caries status.
Krista's turn to do 'stand-up dentistry'
The loupes were used and appreciated, even in this ergonomically challenging conditions.
Two office chairs = 1 dental chair
The operator chair was wobbly and not adjustable. Shannon making do while accessing sextant 6.
The only dental x-ray unit in the hospital...circa 1970's?
Dentsply Ultrasonic....DeVilBliss Portable Evacuation Unit
One of our patient's way of saving his back! ;-(
Marcelino and the women of Camosun! He came back for a second appointment so that Sam can complete his treatment!
Shannon showing Celia how to floss. She was most keen.
Ada and Shannon working together. The clock was ticking and it was getting close to 6pm....way past our scheduled closing time.
Nice technique, Sam.
Getting close to the end of the day on our last day at the hospital...with two severe periodontally-involved patients still to complete, we weren't going anywhere fast.
Shannon starting to clean-up while Krista was busy-ly working away.
A great relationship was formed between Celia and Shannon. Big hugs were exchanged by all after treatment was completed. Celia was most happy to have been anesthesized for the procedure.
We had just enough time to catch the sunset after our 7pm closing time at the hospital. While sitting on the beach, one of our patients came over to gift us with handmade necklaces for all the ladies and a bracelet for me. Very sweet.
Giving thanks to Jinaro.
Awww...he's putting it on for me.
Luigi, a local surfer indulged us with this photo.
The waves were particularly high that evening. This is San Pancho @ post sunset.
Wednesday, May 18, 2011
The following are images are from the last two days at the San Francisco Regional Hospital where a two chair dental unit is available for the public. Currently, there are two 'field dentists' who are here during the weekdays and one dentist who works in the weekends. The field dentists are new graduates, and are sent to different hospitals around the country to do a year's worth of 'social work' and dentistry before they begin private practice, continue with further schooling, or other things. They were most helpful to us and stayed around in the very cramped dental area to observe, to assist, and to collaborate.
In preparation to receiving clients on our first day, Glades found a palm branch to sweep off some of the debris laying on floor by the front door.
Very cramped quarters for three dental hygienists. We had to create a makeshift dental chair with office chairs for the third person. It was the best that we can do.
Another view of our layout.
The door on the left leads to the hospital back hallway and the door to the right of it, leads to the outside where patients wait for their turn.
Our interpreter/helper, Rio helping shine a light on Krista's client.
This dental light emits a strange light that shines on the client's entire face.
This dental cart does not work and as you can see, it is very old.
Sam and Krista briefly worked together on a patient who has severely periodontally-involved dentition, and also has cancer and very compromised health history. Very interesting for all of us.
Shannon gathering health history data in Spanish. ;-)
One of Shannon's clients on the first day who provided excellent learning for her, particularly with debridement and health history issues.
A happy patient who brought all of us homemade crocheted purses as gifts. One other patient later stopped by the clinic to drop off a bag full of fresh fruits!
An area near one of the dental units, featuring Dentsply ultrasonic and Devilbliss Portable Suction.
My Mexico office/patio. Breakfast of hot cereal and soy milk before work.
A good view of one of the dental units. The stool is supporting the ultrasonic unit. We did not use the spitoon (don't think it works that well). The dental chair has to be manually reclined. Sam diligently sharpening her instruments before seating her first patient of the second day.
Krista gets the "office chair" today as her unit. She is sharpening and still smiling!
Just completed two of the three clients this morning, Bola and Regina.
Lunch of quesadilla and pork tacos at a nearby taqueria by the hospital.
Sam and Marcelino. He has never had dental hygiene treatment before. We were very happy to see him and he was most appreciative and patient and interested in what we were doing. We were only able to complete a couple of sextants this afternoon but we had an opening two days later. He seemed eager to return. Cross our fingers!
It was stand-up dentistry for the entire day for this "unit".
We consulted with Dr. Paul (Pa-ool) on Krista's patient who presented with severely mobile teeth, exudate, and abscess on the maxillary anteriors. He suggested that he take an x-ray of the area. The x-ray machine was at least 30 years old. He held the film in place while he took the x-ray. There was not a lead apron to be found. Shannon and her client left the room for a brief moment while he took the x-rays. He manually developed it. The film showed that the roots were encased with calculus and was barely supported by bone. We talked about splinting the two teeth together but there were no materials available to do the work. In the end, debridement/curretage with LA was the best treatment that we can offer.
More pictures to come of our remaining days at the hospital.