PERONIA CLINIC PROTOCOL

This section outlines the policies and procedures for the clinic. 
If you have any questions prior to your trip, contact
Mike Johnson,
OWF Board Member & Clinic Committee Chairman 
480-980-2828 or e-mail to michaeljdds@cox.net

Meet the Guatemalan Clinic Staff: Peronia employs four full time Guatemalan staff members. They are proud of their clinic and are working hard to keep it running smoothly. Count on them to help with: language translation, patient flow, sterilization procedures, and locating supplies & instruments.

 

 

Clinic Manager, Dr. Hector Aguilar

Guatemalan dentist representing the Municipality of Villa Nueva Guatemala/Ciudad Peronia, Dr. Aguilar will be there to help with translation and to assist the Open Wide dentist as needed and provide dentistry during weeks when we do not have OWF teams in the clinic.

                        

Assistant Clinic Manager, Vivian Garcia

Vivian is in charge of inventory, ordering supplies and assisting volunteers with sterilization and maintenance procedures and helping with translation.

 

Front Desk Manager: Zaira

Zaira is in charge of managing the patient flow, receiving patients, making appointments, collecting fees etc. (Each patient pays the equivalent of $1.50 for each visit. Those fees are saved by the city of Peronia to fund the clinic when OWF moves on within five years.

 

Housekeeper: Angelica

Angelica cleans the clinic and helps with volunteer lunches.

 

 

 Security staff is on site 24/7.

 

Your Clinic Team

Your team is the group of volunteer dentists and assistants including your own assistants and family members who will work with you in the clinic. As a team you will stay in the same hotel in Antigua and travel to and from the clinic every day. We can assure you that you will make life-long friends with your fellow team members as you work side-by-side in the clinic and explore the culture and people of Guatemala.

 

Clinic Prep and Orientation

An orientation and prep session will be conducted at the clinic on Monday morning at 9am for about an hour . When you arrive in the clinic our Guatemalan staff will be there to greet you and your team.

 

 

Upon arrival at the clinic you will have adequate time to unpack your individual supplies and familiarize yourself with the clinic’s surroundings.

Take time to familiarize yourself with the clinic, arrange your supplies and instruments and prepare your trays. As you work in the clinic, please respect the fact that Vivian’s job is to keep the clinic organized and she has been instructed by OWF to keep supplies and instruments in assigned places. It is very important that you resist the urge to “reorganize” things”.  Doing so will wreck havoc with the inventory system already set in place.

It is important to understand that these staff members have been instructed by OWF to follow specific protocols in the clinic.  Please do not confuse them by changing their systems. We welcome feedback at the end of week debrief Thursday with Charity Crawford, or upon your return about how the clinic can run more efficiently.

 Thanks to the generous donations of our partner dental companies and Open Wide dentist volunteers, the clinic is set up with a complete inventory of instruments and supplies for your use. However, we know that each doctor may prefer to work with some of his/her own supplies and that OWF cannot possibly supply the individual needs of each doctor. For this reason, you may want to bring from home any preferred materials and instruments.  This will ensure that you will be able to work at an enjoyable and efficient pace, as you would in your own practice.

Some suggested items:

  • 100 pk of slow speed saliva ejectors per team
  • Own bonding materials, burs and composites
  • Any specialty instruments and supplies you care to use
  • Isolite mouthpieces if you want to use the Isolite on site
  • You may also prefer to bring a box of your own gloves

 

Clinic Days – Monday through Thursday

Support is Available

Your team leader is there to support you and to ensure that the clinic days are productive and enjoyable. He/she will also be doing dentistry as a team member. He/she will help manage the patient flow and consult with clinic staff on issues that may arise throughout the clinic workdays. If you have questions while you are seeing patients, your team leader will help to get the answers or refer the questions to the clinic staff.

 

Standard of Care

A Different standard of care exists in Guatemala.  Although you will always deliver the best care possible, the standard of care will be different. Recognize that you will not be able to sterilize according to the OSHA standards to which you are accustomed. (OSHA or any such standards do not exist in Guatemala) Don’t autoclave hand pieces.  All instruments and surgical instruments and burrs should be sterilized.  If autoclave breaks down, wipe down everything and do the best you can.  Remember that many dental offices in Guatemala do not have an autoclave.  Remember that even with these limitations you will still be practicing above the standard of care for Guatemala. Your team leader will assign one volunteer to do sterilization and one to do routine maintenance of the equipment. The clinical assistant will guide the process.

 

Triage System

We recommend using a Triage system to maximize the efficiency of patient flow.  A doctor or hygienist can perform triage services in operatory #1. Restorative doctors will work in operatories 2-5.

 

The triage doctor/hygienist will:

  1. Diagnose the patient
  2. Chart all decay, (no probing). Chart red line on occlusal surface for decay
  3. Numb up area that needs attention
  4. Re-seat patient in triage waiting area
  5. See next patient from front waiting area. The front desk receptionist will put charts for waiting patients in a wall file at the entrance to the clinic. They will be in sequential order so the dentist or assistant will know to take the chart of the patient with the next appointed time.

 

Doctors and assistants in operatories 2-5 will:

 

  1. Get their next patient from the triage waiting area or when there are no patients waiting in triage, from the front waiting area. If patients are not coming from the triage waiting area they will need an exam and an plan for treatment. Understand that the purpose of triage is to move the process of treating patients along in the most efficient way, however there will be times in the day when there will not be patients waiting in triage so all dentists can bring in their next patient from the waiting room as they are ready.
  2. When finished treating a patient, the doctor/assistant will chart what was done, make notes on what needs to be done at next appointment and when (ideally) that appointment should be.  Doctor/assistant will do their best to communicate post treatment care and daily oral care instructions and will bring in Vivian or Hector to translate when needed.  It is very important that the patient understands the instructions so use your translators! When the patients leave the clinic, Zaida at the front desk will check in with them to make sure that if a follow-up visit is necessary it is appointed. 
  3. Communicate with your team leader and other doctors throughout the day. Adjust appropriately to ensure that the flow is working well for you and the patients. Each doctor will see an average of 8-10 patients per day.  We promise that you will be both very tired and very exhilarated at the end of each day!

Beginning and End of Day/Week Procedures:

 

  • Your team will be in the clinic Monday through Thursday.  Your van driver will take you to the clinic from Antigua in the morning and back to Antigua in the afternoon. You will leave from Antigua at 8:00 AM in the morning and depart for home at 3:30 or 4pm at the latest.

 

  • At the end of each day, leave the clinic clean and ready for the next day. Do sterilization and equipment maintenance procedures as specified by your team leader. See “Sterilization and Equipment Maintenance Procedures”

 

  • Report clinic numbers (extractions, fillings, etc) at the end of each day.  A form will be provided to keep track of patients seen throughout the day.  Give forms to Vivian or Zaira at the end of each day.

 

  • At the end of your week, please return supplies to the appropriate cabinets. If you note that something is in short supply please inform the full time staff immediately.
  • Share with your team leader your ideas on how the clinic can run more efficiently.  Following your week of service, your team leader will have a detailed debrief session with Charity Crawford and will be able to make suggestions at that time.  You can also email Dr. Johnson at michaeljdds@cox.net. All of us have a vested interest in making the clinic run as smoothly as possible so we appreciate your feedback. 

 

Photos:

 

  • Take time to take clinical photos.  Take photos of yourself and your assistants with your patients. There will be lots of happy smiles to photograph!  Share your favorites in your dental office, on the Spear and OWF Face book pages and on your own Face book page.  The clinic has a bulletin board to display photos as well.

 

  • A Nikon camera is provided at the clinic for team use. It must remain in the clinic at all times. The camera may need to be charged daily with a lot of use. 

 

Spanish in the Clinic:

It can be challenging to treat patients when you cannot speak their language!  Understand that the

patients appreciate the fact that you are there and are very patient when language differences

create barriers to communication. Be patient with yourself and the process and remember that

actions speak louder than words.  A kind look or pat on the back speaks volumes.  Practice the

phrases at the end of this document and if you can, practice with someone who knows a little

Spanish.

 

TIP - If you have an iPhone, get the “app” Dental Spanish by Mavro Inc. or from “Lonely Planet” It will become your best friend in the clinic!  We also have a dental Spanish book to use as a  resource in the clinic.

 

TIP - Rely on the Guatemalan staff, especially Hector and Vivian to help you with translation.

 

TIP – Although it is very important that you do your best to communicate the treatment options to your patient, you will find that the patients trust you and will let you complete treatment without extensive explanations. Your best is enough!

 

TIP – Small children cry, they are scared. As long as the parent is there and understands that you are not hurting the child they will expect you to do treatment regardless of the crying.

Clinic Layout:

                                                 

Each chair side table has a cotton roll dispenser, a bottle of disinfecting wipes, Needle container and cotton tip applicators. Each team has a team basket on the shelf.  Team members are to fill the team baskets with the products they need from the supply cabinets.

 

Restorative Supplies:

Lower Cabinets

  • Burs
  • Handpiece Maintenance 
  • Misc. Supplies…

Open Shelves – Upper Left

  • Etch/Desensitizer
  • S.S. Crown
  • Micro Brush Applicators

    Middle Upper Cabinets: Restorative Cabinets

  • Composites
  • Articulating Paper
  • Amalgam
  • Wedges
  • Tofflemire, Myar Stripes, Floss, Retraction Cord
  • Astrigident
  • Finishing Strips
  • Isolation, Rubber Damn
  • Dapen Dishes
  • Various Cements, Mixing Pads, Spatulas, IRM, Zinc Oxide, Bonding Agents

 

 Counter top:

Composite Compules /Various Tips Box

  • Curing Lights
  • RotoMix

Open Shelves – Upper Right

  • Misc Supplies
  • Office Supplies (Scissors, Tape, Stapler)
  • Empty Team Baskets

 

Medications & Emergency Drugs:

    Antibiotics (Spanish Instructions)

    1 Tableta cada 8 horas, Por 7 dias.

    Liquid Acetaminofen

    Klaricid: Powder Antibiotics 125mg (Spanish Instructions)

    1 Cucharadita (5ml) cada 8 horas, Por 7 dias

     Pain: (Zetwin/Piroxicam) (Spanish Instructions)

     1-2 tableta’s cada 4-6 horas, Cuando es necesario

 

 

 

   

Masks & Gloves:    

  • Masks & Clear Disposable Shields
  • Gloves (all sizes)
  • Wipes
  •  Saliva Ejectors
  • Misc. Donations…

Bibs & Disposables:

  • 2X2’s – 4X4’s
  • Cotton Tip Applicators
  • Cotton Rolls
  • Bibs
  • Disposable Dapen dishes

 

 

    

 

 

    

Medications & Emergency Drugs: Prescription medications are in the medicine cabinet and bottles and labels have been provided. The clinic staff is there to answer any questions.

  • Pharmaceutical supplies 
  •  Misc. Medications 
  •  Anesthetic
  • Needles

 

The medication cabinet contains various medications left behind by each team. Please feel free to use what is needed for your team and also please leave behind anything that you might think others can use.

Dr. Hector Aguilar Guatemala Dentist

 **Please see Dr. Aguilar for questions about prescription medications.

 

Tray Set up:

 

  • Realizing that the permanent staff cannot possibly learn individual doctor’s needs, we provide a basic tray         setup. Please do not confuse the permanent staff by changing this setup.

 

  • If you bring some of your own instruments from home, please keep them chair-side so they don’t get mixed up with the clinic ones.

 

  • Please do not put cotton rolls on the tray.

  

Basic setup includes 2 Mirrors-Explorer-SH6/76 Scaler-PFIHF2 Plugger-CIGFT3 Plastic Ins.-BB2/29 Burnisher-Cotton Plier

 *All specialty supplies are kept in team baskets ie: Matrix, Tofflemires, Etch, Wedges, Burs. 

 Sterilization Protocol:

 Disposables are not a luxury that the environment of Peronia can afford.

Garbage disposal is an issue in Peronia so we are trying not to contribute to the problem by using too many disposables.  However, you can be assured that everything is cleaned and sterilized and placed in a clean environment. This standard of care is above the typical standards for the region.

Non-surgical Instruments:

  • Place all Instruments and burs in the front ultrasonic
  • Rinse all Instruments and burs after ultrasonic cycle
  • Place Instruments and burs on towel to dry
  • Place dry instruments un-bagged in Statim
  • Brush and place burs/bur blocks in metal trough sterilize as needed
  • After Statim cycle place sterilized instruments in drawer
  • Hand pieces and Air/water syringes are sterilized at the end of the day

 Top Center Drawer of the Sterilization area

 Surgical Instruments:

  • Hand pieces are sterilized after surgical procedures
  • Place all surgical instruments and surgical burs in the back ultrasonic
  • Rinse all surgical Instruments and surgical burs after ultrasonic cycle
  • Place surgical Instruments and surgical burs on towel to dry
  • Bag dry surgical Instruments do not bag surgical burs
  • Place dry surgical Instruments and burs in sterilizer
  • After sterilization place bagged surgical Instruments in drawers
  • Place surgical burs in the surgical bur container

 Maintenance and cleaning protocol:

 

A-dec, AirTechniques, Hu-Friedy, Kerr, Patterson Dental, PhotoMed, Schick, Sirona

And Spear Education have so generously donated great equipment for the Peronia Clinic.

 

Checklist:

 Daily:   At the end of the day

  • Clean and sterilize hand pieces and syringe tips.
  • Wipe all surfaces of the chair and base.              
  • Flush Vacuum lines                                                  
  • Refill water bottles with distilled water.            
  • Lube hand pieces                         
  • Lock all cabinets                                               

     Weekly:  Thursday before the team leaves

  • Clean the entire chair and base.                      
  • Flush Vacuum lines.
  • Clean traps on chair.                                  
  • Drain and refill statim.
  • Leave tray table clean w/ wipes,cotton roll disp. Anes.
  • Place all supplies back into their cabinets
  • Place team baskets back on shelf.
                                                              




enjoy the experience!

 

If you have any questions or ideas on how to improve the efficiency or experience in the clinic,  feel free to communicate by email with OWF Board Member:

Dr. Michael Johnson  michaeljdds@cox.net  Clinic Program Director

Cheri Walker  cheriwalker@cableone.net  OWF clinical coordinator

Charity Crawford  ccrawford@speareducation.com  Executive Director

 

Message / Picture Board

 The Goal of your week is certainly to treat patients…But also remember to have fun, enjoy the clinic and the great service you are providing…Enjoy it enough to return and bring friends!!

 

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