January 11, 2019

ICD International Student Experience Program (ISE) Report

University of Colorado School of Dental Medicine Guatemala Smiles Program

Grant Amount: $3332.00

Date of project: March, May, July and December 2018

Project Budget: Funds were dedicated to support student travel in 2018.  The #1 reason students cannot participate in our Guatemala clinic is lack of extra funds and they are unable to afford it. The grant money was allocated equally to all 21 students who traveled with us in 2018 and each one received enough financial support ($158.66 each) to cover their in country local accommodations and transportation expenses. This was extremely helpful in allowing students to participate this year.  The four trips per year that we make are completely student driven and we rely on student participation for the success of our program.


Summary of Project

The University of Colorado School of Dental Medicine was one of the fortunate recipients of funding from the ICD International Student Experience Program. We were so grateful to receive $3332.00 to use for our program in 2018.  The CU Guatemala Smiles Program includes dental students, faculty and volunteer dentists who travel to rural Southwest Guatemala to a permanent community health center. The healthcare center, Fundacion Para la Salud Integral de los Guatemaltecos (FUNSALUD), is a unique collaboration between private and academic entities.  In 2014 faculty at the CU Center for Global Health entered into a partnership with Agro America, one of Guatemala’s leading agro company specializing in palm oil and banana exportation.  The clinic serves the workers of the local banana and palm tree plantation and the surrounding community of approximately 30,000 people living in poverty. The community health center was opened to provide a medical and dental home for this population but it is not a free clinic. Patients who access this clinic must pay something for services and it operates much like a community health center in the U.S.  Adults and children pay for all medical, pharmacy and lab services. The dental clinic treats children for free but adults are charged a minimal fee. The medical clinic is staffed by local Guatemalan doctors who are paid by grant funding and various medical residents from CU and Children’s Hospital Colorado who rotate there every month. There is always a pediatric medical resident at the clinic. The medical clinic services offered to the community are early childhood development activities, outpatient primary care for children and adults, emergency services and a birthing center. The clinic also houses a pharmacy and a laboratory providing basic outpatient lab testing.  The dental clinic is solely run by the CU School of Dental Medicine and travels there four times a year with dental students and faculty to operate.

The dental program includes prevention, oral health education, direct care and population caries research.  There is an elementary school on site and we provide dental education and dental screenings to the students there. Students with cavities are referred to the dental clinic for treatment.  Even on four trips per year, our clinic provides a dental home to many people in the region as we see both children and adults.  The students get an incredible experience in our clinic treating extreme dental disease and learning to treat the underserved community in an ethical and respectful way. We are hopeful that these students will return to the U.S. having developed empathy and desire to help the underserved populations in their own communities. 

The biggest barrier to students participating in our program is cost. Currently, the CU School of Dental Medicine generously funds the clinic with supplies, equipment and faculty travel but does not have enough funds to support 20-25 students per year to work in our clinic.   This is typical for international programs; students must pay for their own trip.  Unfortunately, the cost of dental education is high and the national average student debt for four years of dental education is $230,000.  While our Guatemala program has no additional program or tuition costs associated, students still must pay for airline travel, local transportation, local accommodations and necessary pre-trip vaccines. The trip costs our students approximately $1200 total for one week of experience.  While this may not seem like a staggeringly high number, most students do not have this extra funding available or hesitate to take out more loan money and incur more debt for this.  

We fill most of our trips to capacity but not all of them in a given year.   One of our primary goals is to always fill our program to capacity and increase the number of patients we can see on a given trip.   Our program relies completely on student volunteers, as they provide the care under the supervision of 1-2 faculty members.  Therefore, the ICD International Student Experience Program has kept our program running in 2018.  With the ICD funds, we were able to pay for all students’ local accommodations and local transportation while working in our clinic.  This was a huge saving for the 21 students who participated in 2018.   By continuing to have ICD funding helping our students, more students will commit and we should work on full capacity to continue our service in 2019.  Some photos from the program are included to illustrate our students providing excellent care to the local population.  Below is a table illustrating our program demographics and treatment rendered to the community in 2018.

 

RUNNING TOTAL TRIPS FOR
MARCH, MAY, JULY, DECEMBER
 
Number of patient visits
300
Number of dental cleanings
37
Number of sealants placed
23
Number of fillings placed
285
Number of pediatric crowns (SSCs) placed
36
Number of extractions
352
Number of teeth treated with Silver Diamine Fluoride (SDF)
76
Dental Students*
21
Pediatric Dental Residents from Children’s Hospital Colorado
2
Dental School Faculty
5
Dentists from the community and volunteers
9

*Received ICD grant funds


Mario

Special Case: 8-year-old male

Mario is a special case that illustrates how even with just 4 trips/year we can help save lives in Guatemala. In April 2018 a team of researchers went to Mario’s house to speak with his mom who was enrolled in a grant awarded to our medical director by the NIH to study Zika virus in this population.  The researchers were young Guatemalan psychologists and noticed Mario laying on a mattress in the corner. 

They took this photo in April 2018:

The researchers asked mom and she said he had been like this for 3 weeks and was missing school.  They acted quickly and brought back a Guatemalan doctor who was working in our medical clinic that day. The doctor contacted Dr. Shick by using What’s App and had a quick consultation. It was determined that Mario’s swelling was from his teeth. The doctor told his parents to take him to the local hospital immediately but they refused saying they had no money. The doctor gave him a free prescription of Amoxicillin and told the family to come in May when the next dental team would be working at the clinic.

Mario came in May to see the dental team, the following photo and radiographs were taken:

While improved from the antibiotics given in April, Mario still had cellulitis present. In addition to the radiographic diagnosis, a clinical diagnosis was made and teeth #3, A, B, S, T and 30 were extracted.  Mario was again placed on antibiotics due to the facial swelling still present. Radiographs on the left side revealed equally infected teeth but mom refused to do more treatment that week.  Mom was told to return in July when the next team would be working.

Mario did return in July and had infected teeth on his left side extracted. All cellulitis was gone at that visit and Mario was again healthy and happy. The July group forgot to bring back any pictures or radiographs for me. I will also add that waiver forms and photo release forms were obtained but were also left in our Guatemala clinic.

The students involved in Mario’s care were impacted by his case. Mario was seen by 2 dental teams so many students benefitted from his case.  They have never seen so much infection and cellulitis leading to facial swelling. If the Zika research team hadn’t found Mario he certainly would have died soon if untreated. The ICD grant helps funds student experiences like this.  This is also an excellent example of high functioning collaboration between the Guatemalan health care and research teams and our CU teams. Mario’s casee is interdisciplinary and involved the Guatemalan research team, the Guatemalan medical team and our CU dental team. We believe that our model is a high quality model for student experiential learning in Global Health. Thank you again for your kind and generous funding of our program in 2018.


Report Submitted by: Elizabeth Shick, DDS, MPH, Associate Professor and Director of Global Health at University of Colorado School of Dental Medicine

 

Make a Comment

Log in to post comments