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Sunday, August 1, 2010

The Haitian Dental School

On July 16th, 2010, the deans of the Haitian Dental School, Dr. Sam Prophete and Dr. Denis met with me at the school to discuss how our group might be of service to them and to assess what changes are already underway. I also had the opportunity to meet and spend time with some fifth and sixth year students. Dr. Prophete took me on a much more detailed tour of the facility than I had taken during my last visit to the school in the fall.

I must be clear from the outset that I make only observations, not to be taken as criticisms. I believe the fact that the school is up and running so well under these post-quake conditions is nothing short of miraculous. These are my findings:

Coordination and Transparency

These are two issues we discussed for some time, and we reached the following conclusions:

Coordination of efforts to improve and promote dental education in Haiti should be handled by The Oral Health of Haiti Coalition, formed by the Pan American Health and Education Foundation, for issues of a more global nature.

My thoughts were to create an internet portal or even a blog where the world community can come together and interact, exchanging information about what is being done specifically for the Haitian Dental School. This will avoid duplication, will prioritize efforts and will promote transparency and coordination.

Transparency seems to be the trend in relief funds management today. We discussed that issue, and the deans were more than happy to share their accounting methods as well as to generate any of their reports for analysis. It was thought that an accounting entity could be brought in to coordinate which computer accounting program would be best for the school, and to what standards would be used to ensure transparency in the distribution of funds.

We also discussed the creation of a completely separate fund, which would be accessed by the deans for emergency needs or very specific projects.

Educational Materials

The chief request has been and continues to be educational materials. The following is a list of needs that has yet to be satisfied in any appreciable way since my last report:

LCD Projectors – There is only one projector for the entire school.

Typodonts – Used to practice cavity preparations and root canals.

Practice blocks for endodontics.

Manikins – My assistant Debbie has procured donations of two dental manikins valued at $1,500 each. We have sent out inquiries to the University of Maryland School of Dentistry as to where the manikins and typodonts were disposed of from the old school facility.

Books – The library was locked and was without a librarian since the quake, as she is recovering from a leg amputation. The library has no computerized indexing and lacked sufficient up-to-date volumes, but the students nonetheless used it to its full potential. Here, one possible solution would be a book drive in the States, or better yet from a French speaking country, for a uniform set of textbooks that could be made available to the students.

Computers

I believe the more important and more easily attainable solution would be to connect the school up to the internet and provide student access to computers in addition to online dental libraries and journals. The school had this capability in the past. There was a dish on the roof with a security cage and a room dedicated to computers, all of which was out of date and nonfunctional.

With little effort and minimal cost, I believe the school could be fully WiFi’ed, preferably with Apple computer products, as computer viruses are a large problem in Haiti. This could be achieved if funds could be made available to maintain the internet connection service. This connectivity would bring immediate improvements to dental education in Haiti.

Power Point lectures and educational materials - (again, preferably in French) enough to teach all six years of dental education - could now be gathered and stored on a large thumb drive!

It is my firm belief that there is an abundance of unused dental education materials in the States that could be brought in to Haiti, to eliminate Haiti’s lack of such materials. The Association of Dental Education (ADEE) in Europe and/or The American Association of Dental Educators (AADE) would be logical places to start this appeal and to follow it through.





The Mechanical Room

The mechanical room was undergoing some compressor repairs. The staff had just finished changing out a large capacity compressor for what appeared to be a different one with insufficient capacity. There were two larger compressors, and one of those had been almost completely scavenged for spare parts. I believe the other was in need of a coolant pump. My best guess is that they need the capacity to run more than 30 dental units and 20-25 lab handpiece units. The school only has five air driven laboratory units with need of twenty more. New York University was to supply dental chairs to replace the aging ones.

As Tobias mentioned in his report, there is no central suction for any of the units. The one single unit suction appeared to be inoperable.

Possible solutions would be to have engineers or dental lab technicians make a thorough review of the school’s future and current needs, and determine if their larger compressors can be brought back online. The plumbing and compressor capacity needs to deliver adequate suction to each dental unit. Perhaps the UN or engineers from other countries could be brought in to repair or assess the situation. The dental schools in the Dominican Republic could also be asked to send technicians.

Supplies

The supply room seemed to suffer from lack of shelving in order to conduct a proper inventory. A problem that we have seen in many medical facilities throughout the developing world is the inability or knowledge of what to save and what to discard as either obsolete or unfixable, under the best of conditions.

From our warehouse in Jimani, Dominican Republic, I was able to bring in about 5,000 doses of antibiotics. From the States, I brought in approximately 2,500 doses of local anesthesia and needles, along with 150 pounds of assorted supplies and two ultrasonic scalers.

My assistant has been able to obtain a new donated emergency kit for the school and is working on acquiring accessories for the existing portable oxygen cart. We will need to know what type of oxygen bottles are used so we can find the correct connections for the hoses.

Some of these immediate needs could be purchased in the future with the institution of the aforementioned emergency fund. The limited supplies and funds that the International Medical Alliance (IMA) helped us deliver in February seemed to make a significant contribution toward the continued function just after the quake. It has been our goal to be flexible and to meet the requested supply needs of the school in a timely fashion.

Infection Control

One of the two sterilizers that we had shipped through MedShare in their first container after the quake was there, but appeared not to be in use. The school was still using dry heat sterilization. From the provisions brought with us from the States, we supplied some sterilization pouches with indicators on them. It would be beneficial to use these to determine if their current methods of sterilization are working.

Infection control improvement is an area of great importance, and would be a Herculean task for any one person. My thinking is that before any visiting faculty or student exchanges could take place, this issue needs to be addressed.

A possible solution is to appoint some member of the staff or faculty to take responsibility for overall infection control implementation and to educate the remaining faculty or staff. That person could then be paired with their counterpoint in one or more US dental schools.

The issue of infection control issues is closely linked to the lack of infection control materials, such as sterilization pouches, barriers, paper products, distilled water, more sterilizers, cold sterilants and surface disinfectants.





Things That Need Follow-Ups

New York University’s equipment donation or transport and installation.

Commitments from Sullivan Schein, the ADA and Health Volunteers Overseas – what are they doing to follow up on their promises of aid? The deans are very discouraged.

Dental laboratory involvement – The students I saw had no way to place dowel pins in crown and bridge models or to bake porcelain onto metal.

Students expressed desire to interact and exchange with other students internationally. I met with some of them, and I believe that every effort is being made on the school’s behalf to provide a quality dental education. The students should be included in the process. They, as children of the internet, Facebook and other social media, may be able to help us in ways we old-timers could ever begin to comprehend.

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