How to set up your rural dental clinic in Guatemala.

1. When you arrive at your location look around the site and find a location with light and if possible good air circulation. Plan for good patient flow in and out too. You also need access to electricity for your headlight.
2. When you decide on your area, ask the local translators or officials to find you at least 1 table, 2-3 benches, 1 chair for you to sit on and two concrete blocks. I will explain these later, but this is for real. Trust me I’m a doctor!
3. On the table spread out the picnic plastic tablecloth you have brought. Find the two plastic tubs. Fill one with the cold sterile solution you brought and the other with plain rinse water. Find the scrub brush to use to brush the instruments. You will clean the instruments in the cold sterile solution, let them soak as long as feasible, and then rinse them off in the water.
4. Lay out your instruments, gauze, anesthetic and needles on the table. Teach someone how to load the syringes for you. Keep the sharps and bring them back with you for disposal at the clinic. Empty vitamin bottles from your pharmacy work well as sharps containers.
5. You also need 1-2 boxes, buckets, pails, etc. to use for trash. Line them with a plastic trash bag.
6. Set up your headlight next to your chair. Stack the two concrete blocks in front of you and cover with a towel or something. The patient will sit down with their back to you, and then you can lean them back, resting their neck, head on your knee. Keep their head out toward the knee, not in close to your stomach so you have the correct angle (especially if you have MY type of stomach.) That way you can sit and work all day without breaking your back. No, I am not kidding. TRY IT.  It works. It’s my invention to the humanitarian aid dental world.
7. I like to anesthetize 5-6 people, marking on their papers what teeth will be extracted. Then go back and do the extractions. Place 2-3 folded gauze in place and instruct them to hold pressure for an hour then discard the gauze. I have had few problems with bleeding. The people seem to know how to take care of it.
8. Throw out the excess bloody gauze and teeth into the trashcan with the plastic bag liner you have sitting next to you. Every one gets something for pain. Have your pharmacy make up packets of Tylenol or Ibuprofen, 10-12 per pack. Instructions are 1-2 every 6 hours for pain. They are not used to taking meds here so lower doses work well.
9. I personally do not give out a lot of antibiotics in the dental clinic. I feel once you remove the source of infection, the body heals quickly. You do what you feel is right. I give them out when there is acute pus present.
10. Then repeat, repeat, REPEAT, until exhausted or through for the day. Do take breaks as needed.
11. You will need to decide how many patients you want to see at the BEGINNING of the day. Be sure and see all that are given out numbers. Keep an eye out for how many patients you have left in the afternoon and you can gauge how many extractions to do for each one so you get finished. You can do only single extractions if you begin to run out of time.
12. Most of the extractions are simple and routine because the people’s nutrition is not good. The bone is softer, and most of the extractions are chronic abscesses so there is already bone breakdown.
13. If you do break off a root, you can try to retrieve it, but don’t try to be super Doc. If you can’t get it, don’t worry. Give them medications and have your translator explain to them they need to come to the clinic in Camanchaj on Mon or Tues. I will take care of it there with the proper equipment. The patients understand. Much of the dentistry done here is terrible, and root tips are a common occurrence.
14. When you have finished for the day, clean all the instruments up and repack. Please be sure they all get back. I keep losing instruments and forceps for some reason. Next time you may not have the forceps you need.
15. Pour the cold sterile back into its bottle. You can filter it through some folded gauze. You need to use that solution for the entire week you work.
16. Remember to bring back the needles and sharps for disposal.
17. Pack up all the other trash and gauze into plastic trash bags. The village will dispose of it. (Don’t ask.)
18. Sit down and drink some water, you probably need it.
19. Feel really, really good about what you have done for the people. You have eliminated many many sources of pain and infection that would still be there if it were not for you.
20. Load up the suitcases and head for home.
21. Let God’s grace fill you and take away your tension and fatigue. Feel the presence.
22. Get ready for the next day.  God bless you.

God grant you health and peace (salud y paz,)

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