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Field Report: HEALTH OUTREACHA report written by Project Leader Ramzi Haddad and Timothy Lee May 9, 2015 “Guatemala 2015 – Rio Dulce”Health OutreachField ReportField ReportField ReportField ReportField ReportG2015 ObjectivesProvide Dental Emergency services in general for children<=age 18;Service the communities surrounding Quesada and the Rio Dulce region, Guatemala, seeing as many children as possible;Carry out a Preventative Program including dental sealants and fluoride for children<=age 18;Leadership Training for HO Projects;Develop a medical program in Partnership with Associason Ak’ TenamitVisit villages in the Rio Dulce to provide emergency care and promote Health Outreach services.“Guatemala 2015 - Rio Dulce” Partner (Joint Venture Participant) Week #2:? ?Asociación Ak ‘ Tenamit?? ?An indigenous community development organization that promotes long-term solutions to poverty through education, health care, income generation, and cultural programs. The Ak' Tenamit community has a boarding school that supports 523 students from 100 villages, including 224 girls; a 24-hour clinic that serves more than 25,000 people; a floating dental-care boat; a restaurant for vocational training and seven women’s cooperatives.Founder Asociación Ak’ Tenamit: Steve Dudenhoefer . ,? duden@, duden1@ phone 22541560, 22543346, cell. 56056991, 54601535Director: Guillermo Pérez De La Cruz, 4128-2205. : gperez@ContactsMr. Real DesrosiersCountry Director, Health OutreachAsociation Ak Tenamit staff and executive:Onofrie: translator and guideRolando: manager of restaurant Café TatinEduardo: boat driver and maintenance, Board memberMirza : restaurant manager and , Board memberJuan Shol : basic mechanic and?electrician. Miguel Rax: has over 8 years training as a dental technicianA note on Onofrie:Guillermo hired Onofrie as a guide and translator to ‘take care of us” during our stay. It was the first time we had a full-time guide and translator. Onofrie was an experienced missionary once in the Philippines. He had served almost 7 years. He also hosted other groups visiting Ak’Tenamit. He slept on the grounds and was available 24/7. For example, he was at the cabins in the morning before some of us woke up.Team Rio DulceThirteen Canadian team members formed “Guatemala 2015- Rio Dulce”, in the second week of Guatemala 2015. Week One volunteers (Team Quesada) operated in a medical clinic in Quesada. Most week two volunteers arrived at Guatemala City airport on January 31st. Some volunteers from Quebec arrived up to a week earlier. All volunteers carried on them an official letter with our names and cargo contents endorsed by the Guatemalan Consulate in Canada. It was distributed to all volunteers by e-mail. Prior to Health Outreach’s arrival, our partners announced our project dates to communities surrounding the clinic and made some appointments for patients. Our partners were Quesada Solidaria for Week One and Asociación Ak’ Tenamit for Week Two.Volunteer TasksROLE# Per WeekVolunteerTriage dentistP R I M A R Y (P)1Pravir PatelDentist3Claude Leduc??Gerard Magne??Francois Blondeau?? Ramzi Haddad??Assistant3Anita Lassak??Tracy Shuttleworth??Lorena Ramirez??Nasha Zaheer?Physician?Inés ErrandoneaAssistant Hygenist1Hygienist2Vicki Parolin??Patient Coord. 1X-ray tech*2?Sterilization Tech*1Jan Zalewski???Stats Admin1Nasha Public Health1?Translator1???Equipment 1Tim Lee????Social Activities **S E C O N D A R Y (S)1?Inventory1Anita.Donor Gifts1Lorena.Cargo1Pravir.Evaluation completion 1Tracy.Beverages/lunch1LorenaFirst Aid1Gerard.Relief Supplies2Local Driver1Accommodation1Lorena.Travel1Ramzi.Pharmacy1Francois.Toys/School supplies1Role /task coach1TimTransportation Mgr?Project LeaderP1Ramzi HaddadAdministration MgrS1RamziEquipment MgrS1TimClinical Team LeaderS1RamziOPERATIONSDay 1 (Saturday)On Saturday January 31.2015 the Team Rio Dulce arrived from Toronto on time in Guatemala airport. There were no luggage issues. Health Outreach volunteers from both teams met in Antigua in the evening. Some debriefing occurred and a transfer of information between volunteers and Team Leaders, about their primary and secondary duties.The Project leaders, Dan and Ramzi, also met as planned and reviewed several issues such as illness, injury, money, inventory, and equipment needs. The following was discussed:Illness: NoneInjury: NoneMoney: Transferred all the petty cash Transportation: Insubordination: None Meds: Transferred all the emergency meds with no issues.Dan Lee discussed Equipment issues with Tim, Equipment Manager for Week 2. All members from both teams stayed at Hotel Casa Del Parque.Day 2 (Sunday)Tim and Pravir and Ramzi supervised the transfer of HO equipment and supplies from Eloisa and Diego’s hotel to the bus designated to take Team Rio Dulce the following day. All was packed on the bus with plenty of room for passengers. The bus this year was bigger than last year’s bus.All the members had breakfast at the Hotel at 7 AM. It was not offered any earlier. Our vehicle arrived on time just before 7:15 AM and personal luggage was loaded in 15 minutes. Volunteers were punctual and the vehicle left at 8:00 right on time. There was a lot of personal baggage, Pravir, Cargo manager supervised the loading, in spite of his injury The road to Rio Dulce town was clear with very little traffic. One stop along the way was all that was necessary. At this time, more refreshments were purchased for the team since Rio Dulce offered very few opportunities to stock up on refreshments.We arrived at Rio Dulce town at about 1 PM. The dock for the transfer was at Brunos Marina, where we had lunch at the restaurant. There were two boats waiting for us. We used one boat for the clinic set up luggage and the other for personal luggage only. Loading was very efficient. We had numerous phone calls on the way with Guillermo to decide on the how and where we should set up. It was decided that we go to the site directly to set up for the next day. Therefore we headed straight to the village Aldea Puntarenas. We set up two clinics:3 Boat operatories 2 operatories and 1 triage chair on the deck A final run through of the equipment was not done. It was decided that this would be done the next morning. Went back to the cabins and set up our cabins. We used our generator for electricity at the cabins, but there were no bulbs at the cabins and there was no water. This was not expected and inconvenient for all. Official Meeting #3 was held after dinner at Ak’ Tenamit. The planned agenda was discussed. Ramzi selected the initial staff for the next day.Day 3, 4, 5, 6 and 7 (Monday to Friday)Monday 2nd Feb (Aldea Puntarenas)We had breakfast at Café Tatin. The boat was ready to take us to the site on time, and the trip was smooth.Once we got there we had a little bit of a problem with the connections, as the plug for the compressor was not compatible with the compressor cable. Alternate compressor was used The teams were set up as such:1 Triage:Pravir and Innes acted as the administrator and medical history translator.2 Ground/ Mini Clinic: Ramzi and Anita, Vicki as restorative hygienist, Pravir as triage3 Boat Clinic:Gerard and Tracy, Claude and Lorena, Francois and NashaStudents arrived, girls and boys, as arranged by the school. There were line-ups right from the start. Vicki was used as a restorative hygienist, which proved very effective in treating more patients, Tim and Ramzi were the clinical operators working with her. We took a break at 1:00 where we had lunch and took some official pictures. We finished work at 3:30. We packed up all the equipment from the ground clinic and stored them on the boat ready to set up for the next day.The Monday was ideal for both teams because it gave them time to become used to their instrument set-up and equipment, and to decide on how teams will work for the rest of the week. We went back to the cabins and there was water and bulbs available.Between the two clinics, 79 patients were seen- 84 restorations, 66 extractions, 16 hygiene, Tuesday 4th Feb. (Ak’Tenamit 2)The clinic was to be set up at Ak’Tenamit . After walking to Ak’Tenamit , and after breakfast at Café Tatin, the area was studied well to see where the ground clinic would be set up. It was decided to set up in the covered area under the restaurant, as well as the boat, which gave us close proximity of both clinics.This was set up very quickly after breakfast. The boat was set up in the same way as the day before.Ines set up a medical clinic in the same area, and had two rooms to work with. She also had a volunteer nurse. The teams were set up as such:1 Triage:Pravir2 Ground Clinic: Ramzi and Anita, Vicki as restorative hygienist, 3 Boat Clinic:Gerard and Tracy, Claude and Lorena, Francois and NashaMedical clinic: Innes and Julia (volunteer)Both clinics operated very smoothly with no issues. The patients were an older group mostly 13 years and up. This made the work quicker as the patients were more cooperative. 4 root canal treatments on two different patients were performed by Ramzi, after discussing the cases with Tim. This takes up a lot of time with limited medication but the teeth were the central incisors on 13 year old girls where the alternative would have been extractions. We had lunch at 1:00 at the restaurant and finished work at 4:30.Between the two clinics, 94 patients were seen- 122 restorations, 27 extractions, 50 hygiene Wednesday 5th Feb. (Cayo Quemado and Langostura)The clinics were to be set up at a close by island, where there were two communities Cayo Quemado and Langostura. The boat was ready on time and we left at 7:30 to get there at 8:00.WE chose the area for the ground clinic, which is just off the deckThe boat was set up in the same way and we used the same generator for both clinics.Innes set up a medical clinic in close proximity and had the same nurse as she had the day before.The teams were set up as such:1 Triage:Pravir2 Ground Clinic:Ramzi and Anita, Vicki as restorative hygienist, 3 Boat Clinic:Gerard and Tracy, Claude and Lorena, Francoise and NashaMedical Clinic: Innes and JuliaThe patients were of all ages and we served both communities, as all the students arrived from both areas.Lunch was very late as it was ordered from the restaurant Finka Tatin the day before. However it did arrive and we continued working till 3:30.Between the two clinics, 89 patients were seen- 80 restorations, 68 extractions, and 15 hygieneThursday 5th Feb. (Aldea Plan Grande Quehueche-Tatin-Guyara)A different site in the mountains had been chosen by Guillermo, where we had to travel to by truck which was due to leave from Livingstone. Therefore we had to pack equipment and chairs on the boat and on the truck it was decided to set up 4 chairs. Innes was to work at Ak’Tenamit 1 area. After having breakfast at 7:30, we travelled by boat to Livingstone that had already been packed. We dropped Innes and Nasha at Ak’Tenamit 1. They were to work at the medical clinic which was a permanent set up there. We continued to Livingstone and downloaded the boat on to two trucks, one for the equipment and one for the passengers. We travelled 45 minutes to the mountains. As it had been raining the road was very muddy and rough. The ride was very bumpy and we stood up all the way except for a couple of seats.Pravir’s condition was getting worse and he had to take a seat As soon as we arrived we scouted the area to find the right place for a set up. It was decided to set up 3 restorative chairs, one surgical chair and 1 triage chair.The set up was as follows:3 Restorative Clinics:Ramzi and Anita, Gerard and Tracy, Claude and Lorena, 1 Surgical Chair:Francoise and Vicki 1 Triage chair:PravirBetween the two clinics, 94 patients were seen- 36 restorations, 153 extractions, and 4 hygieneFriday 6th Feb. (Ak’Tenamit 1)The day was to be spent at Ak’Tenamit 1 site. We decided to start early to see the younger children After breakfast at 6:30. We waited for the boat which was very late as the driver was irresponsible. A different driver was allocated and drove us to Ak’Tenamit . 4 operatories were set only as follows:1 Triage: Pravir1 Ground Clinic: Ramzi and Anita, 3 Boat Clinic:Gerard and Tracy, Claude and Lorena, Francois and VickiMedical clinic: Innes and NashaThe patients were few and Ramzi completed the root canal treatments that had been started a few days ago. WE worked all the way without lunch and finished work at 11:30. We packed everything back on the boat, went back to the cabins and picked up all our luggage We had lunch at Café Tatin and presented all the awards and appreciation certificates. We left at 3:15 and travelled to Livingstone. We arrived there at 3:30 which was good timing for a relaxed afternoon.Between the two clinics, 49 patients were seen- 59 restorations, 35 extractions, 14 hygieneDay 8Volunteers’ day offDay 9Travel back to CanadaDESCRIPTION, ANALYSIS & RECOMMENDATIONSI CLINICS: DESCRIPTIONCLINICIt was decided that this year we would keep the main clinic on the boat and the “Mini” Field Clinic close to each other. Three operatories on the boat and two on land were within 100 meters to each other on three days. There was little time in moving staff around during the day between clinics.Equipment set-up and clinic set-up was much improved over last year. We were picked up on time in Rio Dulce town at Bruno’s Marina. As a result, we arrived early enough at Ak’tenamit on the Sunday afternoon to set up on the boat clinic. Electricity:Between the 8000 Watt Ak’Tenamit generator and our Honda 3000W generator, we had more than enough power to run our compressors. The Honda generator ran rough at one time but the problem was that air was not allowed to enter the gas cap. The oil was changed mid –week using the last ? L 10W-30 we had.Most of our power needs were served by the 8000 W Generator. The rip cord was still damaged from last year. It was a problem for everyone to use except the Health Promoter Miguel, who was accustomed to using the broken cord.A 2000 W generator was available to serve other HO equipment requiring electricity. It was used primarily to run the lights in the cabins. It was left in the cabins during the day because we did not need it for the pressors:The Ak’Tenamit gas-powered compressor and our De Walt compressor were adequate for running up to 5 ADEC units. An extra old compressor on the boat shaped like a cylinder was not used. Hose and Cabling:The set-up varied for all five days. The hoses performed well. The set-up was restricted primarily by the length of pressure hose from the boat to the compressor on land. This hose determined how far the boat could be moored f rom land. In the week, two couplings on hoses had to be changed. The electrical cables functioned well. One power bar burned out.Sterilization:Our workhorse Prestige sterilizer served flawlessly for the week. A second extra one was not needed since the team worked close to each other unlike last year.ADEC unitsGenerally all 5 units performed well except one where water was not consistently flowing in the highspeed handpiece. The Equipment Manager tried to fix it with no result. That unit was not returned to Toronto for repair. Another unit was brought to Canada the previous week.ADEC unitsGenerally good performance but water was a problem in two units:- water stopped intermittently to the high speed handpiece– water leakage into the unit Notes were taken identifying the units needing repair.Dental ChairsAs expected the some of the lights and the dental chairs did not function. One portable I-TEC dental chair had a leg with we could not lock into place. It remains to be repaired. An extra piece was ordered in March 2015.I(ii) CLINICS: ANALYSIS CLINICS: The number of patients booked for the teams on each day was nearly perfect. On each of the five days we were able to see all the children booked for us. An exception was on the Tuesday, at Site 1 at Ak’Tenamit’ - a handful of students were examined but not treated. Typically on each day, when there was time, parents were examined in the morning and asked to return at 2 pm. Most clinics finished on time before 4 pm.There were different challenges at each location at each site:Monday - Punta ArenasThis village was only a 20 minute boat ride from Ak’Tenamit. The dental boat had already been moored at their dock by the river. As we approached through the mangroves the children were already waiting on the docks. There was a long dock extending approximately 100 metres from the school yard We didn’t have an opportunity to visit the site beforehand, so the set up was slower than usual. The two extra operatories were set up on a wooden deck at a level higher than the boat. This made it tricky for our staff to carry heavy items to those two operatories.An early delay was caused by an incorrect connector to connect the electricity from the generator to the boat. Miguel sent for the new connector which took a half day to arrive. In the meantime, we used the extra red HO generator. We managed even though the two compressors driven by this generator had trouble getting to full pressure at times.The generator and compressor were set up on wet ground beside the river, 1.5 metres below the dock. There was very little cover and it was tough to access the equipment from the high dock. However, there wasn’t any other option. The electrical cable was long enough to avoid this route. It was woven through the dock planks so to avoid the water and children who walked down the middle of the dock .The waiting children had very little shelter from the sun so they crowded our workspace somewhat.The patient population was perfect. We saw a lot of children between ages 4 and 14 , and finished the children early. At 2 pm we took care of about 10 adults.Tuesday - Ak’Tenamit Site 2This site was convenient because it was situated beneath restaurant Café Tatin and was close to the dental boat. It was covered. We had ample time to plan our operatories and move furniture. We set up the “mini-clinic” which included two restorative operatories, and a triage station. The physician also set up in a quiet, secluded covered area.Triage was quick because the forms were easily understood by the patients, who were primarily 12 to 18 year olds who understood Spanish and some English. The students completed their own forms at a round table that fit many of them at once.Three other operatories including the surgical suite were set up in the Dental boat, situated at the docks about 50 metres away. Gerard, Francois and Claude were the dentists on the boat.One sterilization station manned by Jan was able to keep up with all the instruments so that our second sterilizer did not have to be used in the mini-clinic. Instrumental to the team was Miguel who walked between both clinics in order to bring Jan dirty instruments and restock Pravir with examination instruments.Wednesday- Cayo QuemadoThis village was only 15 minute away from Ak’Tenamit. It was a fishing village on an island. The site was good because there were houses and shelter very close the the docks. This gave shade for the dentists and patients . There was also stores closeby to purchase refreshments. The set-up of equipment took some time because of some confusion initially on whether we could use the electricity from one home. We did not take that chance ( that the electricity was not sufficient) and we set up the generator on higher ground on shore under the shade of trees.The set-up again was slow because we did not have the opportunity to plan the cables and hoses to the boat from ground. As a result we were slow in getting patients on board the boat. We did make upfor lost time . The patient coordinator found the tarp covering the boat reduced visibility of the pace of the dentists. As a result, getting patients to the dentists on the boat was slow.The physician set up in a private room . Dr. Errandonea saw many patients and reported that the need was great in this remote village . Thursday – Tatin, and Playa GrandThe village of Tatin was a 2 hour hike uphill from Ak’Tenamit. Because it rained, Guillermo decided not to hike but to take a boat and truck to the site. A boat picked us up from Site 1, close to the restaurant Café Tatin, and took 20 minutes to arrive at a gas station at Livingston. The truck transportation from Livingston t to Tatin took about 40 minutes. Two trucks were taken to accommodate the equipment as well as our team. One truck took equipment at the back and the other took passengers only. It was a rough ride on the back of the truck. Two seats were offered to those who had back problems.One error was the miscalculation of the fuel we needed to run the gas-powered compressor. It ran out at 12:45 pm and all the dentists had to stop working . We took the fuel from the extra red generator tto keep it running a bit more. There was about 45 minutes of downtime, before a truck arrived with fuel we ordered. Before that, we took the fuel from the red generator.Our clinic was set up in the large school. There was a sliding wall between to classrooms that we closed partially to keep the crowds away from the clinic. Desks were moved to clear some space. The open windows provided some breeze and allowed the cables and hoses to pass easily into the rooms. The floor was flat and clean.The operatories were close to one another making it a very efficient set-up. Instruments moved readily. That being said , being indoors and the crowding of the space with patients and onlookers, made it noisy and chaotic at times. These children had very bad teeth and many had to have extractions because they were too damaged to save and/or they had pain.The public toilets were locked making it uncomfortable for all the volunteers. We had to use private homes. A small store became a good source of refreshments including cold water.The return trip downhill was faster but we lost time at the gas station. It took time to photocopy more medical questionnaires.Friday –Ak’Tenamit Site 1There was an early start because we were asked to see kids in primary school. They started class at 7 pm. The ages ranged from 6 to 12. It was raining in the early morning. The clinic was delayed due to the uncertain electricity source we were to use at site 1, and after determining electricity would be drawn from Ak’Tenamit. Once that was decide, the boat was finally positioned close to the shore. The boat was moved closer to land but not quite enough to fit under the roof . It was however close enough for the hoses and cables to reach. Cables and hoses were lined along the cement dock to the boat deck. Unfortunately they crossed over the path that patients walked.Dr. Errandonea and Nasha the nursing student worked in the Ak’Tenamit medical clinic once again, located only about 100 metres from the dental team.Medical ProgramDr. Errandonea had the following comments about her experience:Patient population:Patients at villages were needy and appreciative of careStudents at Ak’Tenamit at the Site 1 tuesday clinic did not have serious medical issues ie, many simply wanted a note to skip class Support by Ak’Tenamit management was lacking. For example, the visit was not promoted well and more patients could have been pre-booked.Medical Clinic: The Head Nurse was a student and did not have enough skills to really help her. For example, she took too long to take a blood pressure Ideally the support staff including the nurse should be narrowing the diagnoses down with an accurate and comprehensive medical questionnaire. This was not done well.The equipment in not in good working order, or missing completely,Medicine - Pharmacy was stocked but not inventoried well. Staff did not seem to know about inventory and where to locate the medicine.Prevalent Conditions :GynecologyPregnancyMusculoskeletalParasitic infectionsTraumaGastro-intestinal diseasesRespiratory diseasesDr. Errandonea felt that she was more valuable working in the field at the villages. The patients participated more in the field clinic. There is still a problem with patients not taking their conditions seriously. A future medical service is still possible to carry out but more assistance would be required from Health Outreach and the Ak’Tenamit organization as a whole.II PATIENT POPULATION:DESCRIPTIONThe patient population was appropriate on this project. There were more younger children under ten years of age seen on this project compared to G2016. Of course at the Ak’Tenamit Site 2, there were a lot of older students from the nearby classrooms. The dentists were booked well with very little downtime. On some days, the children booked were all seen so adults were seen in the afternoon. This occurred on Monday and Wednesday . There was very little rain and no teacher strike to affect participation.II(ii) Patient Population: ANALYSISOver 80% of the patients seen were under age 18. Some adults are seen when the booked children were already seen.III COMMUNICATION:DESCRIPTION/ANALYSISTwo HO phones were used, and Dr. Pravir Patel used his phone for HO purposes. Reception was often poor and unreliable.IV TRANSLATION: DESCRIPTIONOnofrie was fantastic as a translator and on Thursday Guillermo was additional help. The students at Site 1 were good a completing the medical questionnaires.IV(ii) TRANSLATION: ANALYSISIt would also be good if the medical forms were in Que’chi as well as Spanish . Guillermo advised us that this would be very difficult so it wasn’t done. V ACCOMMODATION: DESCRIPTION &ANALYSISHotel del Parque Antigua:Some felt that this hotel was noisy and volunteers could hear music all night. It did however offer all the rooms that we needed in Antigua. Both teams were there on the second Saturday night.The Ak’Tenamit cabins were once again considered to too small to be comfortable according to some. Mosquito nets however were provided. Light was an initial problem. The small 2000W generator ran the lights all week. To our surprise however, there were no lightbulbs in the cabin for the first 24 hours.There were four beds (two bunks), new mattresses, mosquito nets, a table, cabinet and lock and key. One lock was broken. There was security at the cabins most of the time.The path that was covered with large rocks last year was clear of debris and safer to walk on.Hotel Villa Caribe, Livingston –comfortable but a long way to carry suitcases from the docks Hotel Nana Juana, Rio Dulce – convenient being close to the road home but spiders still remain a problemRooms closer to the reception were requested and granted.VI FOOD/BEVERAGES: DESCRIPTION/ANALYSISFiltered water was available most of the time. The poor lunch problem from last year was resolved somewhat by take out from certain restaurants nearby. ( Finca Tatin)VII BUDGET: DESCRIPTION& ANALYSISThe expenses were not tallied at the time of this writing. Our food bill was managed better this year. Ramzi settled the balance on a few occasions during the week. Unexpectedly , Guillermo asked us the pay for the light bulbs for the cabins, the window of the boat that we broke last year; and the latex gloves. Guillermo did keep the costs for accommodations (cabins) lower than last year, after concerns were expressed to him.VIII CARGO: DESCRIPTION/ANALYSISThe space on the bus from Antigua to Rio Dulce town was limited, but better than last year. Team Quesada packed less items for us as requested by us. Some time was wasted because we couldn’t locate Eloisa’s exact hotel. The door was closed so it could not be identified. All Equipment except the compressor and the 2 generators were packed on the roof.At Rio Dulce these same items were transferred to the boat. The boat also appeared over packed, despite reassurances from Guillermo and the captain.In the future, the cargo must be calculated more precisely and tAk’Tenamiting into consideration of the number of volunteer s and there personal luggage.IX ILLNESS: DESCRIPTIONThere were no incidences of illness brought to the attention of the Project Leader. An exception was Dr. Patel who had an undiagnosed neck problem. It was undiagnosed going into the project. Unfortunately it worsened as the week progressed, affecting his ability to walk and lift. He role of triage was not affected too much.IX(ii) ILLNESS: ANALYSISNo volunteers required a day off because of illness.X TIMING: DESCRIPTIONIt generally took some time to set up at each site and get patients into the operatories. The set up speed improved after each day. Patient flow was very good with the experienced dentists we had. The Oral surgeon Dr. Blondeau was not booked very tightly and there were many times when his chair was without a patient. The following is the timing on the very last work day (Friday):- Restaurant for breakfast at 630- Clinic finished at 1130 and packed by 12:15- Boat departure at 12:25- Cabin arrival at 1235- Volunteers ready at 1:10- Delay of boat arrival to cabin- Volunteers load at 1:45; boat covered- Arrival at Café Tatin at 2:15- Departure at 3:15 for Livingston- Arrival at Hotel in Livingston at 3:30X FLIGHTS: DESCRIPTIONThe flight through Miami was shorter but the stopover was longer this year. Also, the flight left earlier and arrived later in Guatemala. Southbound, our baggage was directed right through to Guatemala but on the way back, we had to recheck our luggage at Miami International airport . The security check was lengthy and it was tight getting to the return flight to Toronto. The reason may have been the storm that hit the East coast that day and travelers diverting through Miami.There was no separate 20Q airport tax in Guatemala.RECOMMENDATIONS:SUMMARYG2015- Rio Dulce was designed with two new initiatives:Medical program. Dr. Errandonea saw patients on every workday from diverse backgrounds. According to the physician, the support staff at the Ak’Tenamit Medical clinic needed more training and equipment. Any medical program in the future would require more support from Health Outreach and Ak’Tenamit.Village Visits. The small team that was meant to hike to villages never materialized. His was because of the lack of need and the poor hiking conditions due to overnight rain. When a village visit was necessary, the entire dental team went, transported by truck.405 patients, mostly children, were seen over two weeks in the rural and remote communities of Quesada and Rio Dulce. Our volunteers worked tirelessly and endured risks to see more patients than ever before in the 13-year history of Health Outreach. Options for G2016 RIO:Better flight optionsShorter trip - Consider returning Saturday.Have villagers transported to Ak’TenamitAccommodation other than cabins ___________________________________________Items brought back to Canada:One ADEC dental units, Portable HeadlampsDental hand piecesMedical /first aid kit.To Be Considered:Digital X-ray sensorsRepair ADEC units that leak New cases for storage of items ( suitcases were short)New dental carriers for restorative suppliesNew pressure hoses and connectorsEquipment and Sundry Needs:Handpiece LubricantDuct tapeGenerator oil 10 W30400 copies of QuestionnaireAmalgamator x1 One portable I-TEC dental chair locking mechanism for a legSee “Equipment and Sundry Needs List” at healthoutreach.caMedical equipment in good working orderIe. portable sonography ................
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