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Dental Clinic at Clinic Nepal in Meghauli - carried out by from July 22nd 2012 to July 27th 2012:

Equipment we would recommend on bringing:

  1. Clove oil
  2. Endomethozone
  3. Temporary cement e.g. Coltisol
  4. Small mobile drill network
  5. Mobile Aspirator (need to be sent over prior to the arrival)
  6. Sterile disposable tray sheets - 40 sheets per day
  7. Wire brush
  8. Tweezers
  9. Heavy duty scissors
  10. Fly swatter and any other heavy duty insect killer
  11. At least 24 mirrors and 24 probes
  12. Cryers elevators (right and left)
  13. Warwick James full set
  14. High quality LED laser headlight
  15. Small disposable matrix bands
  16. GIC that needs to be placed with accurate syringes (this needs to be researched)
  17. Butterfly sponges and Buccal saliva pads
  18. Large volume of floss packets to give away
  19. Self curing resin - 3rd or 4th generation
  20. Self curing composite in a syringe
  21. Heavy duty hand sanitising gel
  22. Hydrocortisone cream
  23. Photo and chart of dental disease and health
  24. Photo of oral cancer and prevention

Equipment already present at Clinic Nepal - Meghauli

  1. Steam steriliser
  2. Good record sheets/pads
  3. Good array of antibiotics
  4. 3 sets of an array of dental equipment - ranging from forceps to elevators (we did not use these)

Report

Although Inspire gave us a broad idea of the number of patients to be seen in one day, they we still unsure. This therefore made us unconfident of how much dental materials and equipment to bring.

Ram Krishna was superb with all his explanations of the set up and history of Clinic Nepal. He was friendly and also extremely helpful to us, especially on the first day where he acted as an interpreter.

During our week of volunteering at Clinic Nepal, we stayed in the ideally situated Cushion Cottage, which was indeed very spacious. It was a god-send to have the generators come on when the electricity cut out.Sahadev, is a fine cook as he was able to cater for all our needs during the week. He was very obliging and the volume of food provided was more than enough. The food he prepared was so tasty aspect especially the dhal.

During the week, Manesh, a local Megauli volunteer to assist us with the communications between the dentists and patients. He had a very funny and bubbly personality, and he helped to make the clinics fun. He spoke good english and was therefore very good at interpreting as well. Manesh helped to organise other activities for us in the evenings, after we had finished the clinic. He was able to organise an elephant safari in a forest near the edge of Chitwan National Park, together with a close acquaintance of his, called Prem. I would strongly recommend Manesh to assist any other volunteers. Sarswati was also a good nurse and was helpful with the communication problems.

On the first day we started working at 9.00 and it was initially a slow start, but by 10.00 we were in full flow. By the end of the day we had treated 30 patients. The treatments that Kalpana and I carried out ranged from simple fillings to complex extractions.

We saw many patients who didn't want their cariously exposed teeth to be extracted. We were also in a dilemma, because the local charge for a route canal was up to 700 rupees. We knew that he villagers couldn't afford this, but they still did not want extractions .In these cases, we made it clear to the patients as to what their situation was and, as an alternative, placed a crushed Endomethozone tablet mixed with Corsodyl in their mouths as a lining, then filled it up with a Gloss Ionomer Cement (GIC).

However it was frustrating when a patient came to us with anterior activities, as we were placing GIC in the front teeth, when composite would have been much better and more aesthetically pleasing.

We used a chair as the dental chair, and asked the nurse to support the head of the patient. I strongly recommend a high quality LED head light.

The main problem with GIC was that it set very very quickly, as the temperatures were reaching up to 40 degrees centigrade. This meant that we had to make the GIC extremely runny so placing it in the cavity was difficult.

Isolation and maintaining a dry field was also a challenge, so I would bring butterfly sponges and saliva cheek pads next time to resolve this. We could also research self bonding resin and self curing composites with matrices.

On the second day, we had to turn away approximately 20 patients due to the high volume of patients that were already waiting. As the week went on, we were finding that he volume of patients kept on increasing, as word had spread to other villages. We were also finding that more patients were presenting with multiple cavities and extractions. This took more time and as a result, we were not able to get through all of the patients.

After the first day, we did have to ban patients, friends and other people from coming into the operating room and gazing at the treatment in progress.

I organised a teaching session to all the staff on the last day.I taught them with the aid of diagrams and notes about dental diseases, signs and symptoms as well as simple non-intrusive treatment.

I also wanted to educate them about oral cancer - I wish I had brought photos of the early signs of cancer. I will sent them posters so they cam put these up on the walls on the clinic operating room .

The posters I want to send will cover the following topics:
  • Oral cancer
  • Toothbrushing and flossing technique
  • Dietary advice
  • Simple restorations -how they are carried out

On the 25.07.12 our last full both Kalpana and myself were prepared to work late into the night to help as many people as possible. The clinic gave us unconditional support throughout out final day.

Jayna and Riya have been teaching in a kindergarten and I know that they have thoroughly enjoyed this. In the afternoons they became our nurses and this help was invaluable as it allowed us to see more patients. They have really suffered in the 35 degree heat of the operating room but both have been so determined in the cause.

By the end of the last day, we had really worked hard and totally exhausted.

We started from 9am to 7pm with a 30 minutes break for lunch. Both Kalpana and I saw 71 patients between us on the last day. The system worked really well, but we still had to turn away 30 patients and more were ringing in. Most patients were waiting 1-3 hours, and most had travelled quite far to see us. Some patients had walked up to 2.5 hours to see us, or travelled on a local bus for up to 1 hour.

The support in the surgery from Manesh and Saraswati was excellent and invaluable. We had to say no to patients who requested teeth cleaning and stain removing.

We have left many disposable including gloves, masks and swabs.

We also left many new mirrors and probes. We gave out many free samples of toothpastes and tooth brushes.

Reflection

These people are poor yet so happy .Dental health to them is not a priority as just having food is more important.

Many people with missing teeth did not have dentures. There was a significant evidence that most is the adult patients showed significant tooth wear. Buccal abrasion cavities were also very prevalent.

Patients showed from very gross scale to no scale. In general there was systemic staining In the 3 and a half days we were there we saw 193 patients.

Carried out 121 fillings and 129 extractions.

Patients Reviews

  • Dr Minesh always takes into account the patient's age of current health, he is always respectable to elderly patients. The dental nurses, reception etc are professional in their approach, always good at their jobs and nice and considerate to the patients! - Pamela Davis