King’s College London

1. King’s College London King’s College London Dental Brigade Report Community: Narkwa Dates: 17th - 27th August 2012

2. OVERVIEW INFORMATION General Brigade Information University: King’s College London Number of Medical brigaders: 14 Number of Dental Brigaders: 26 Healthcare Professionals: 3 Initiatives: Community Description Narkwa is a very friendly and welcoming community. The whole community threw a welcome party for the brigade and at the end threw a farewell party to express their gratitude. Members of the community of all ages came to greet us. By visiting families in their houses and talking to the community at a personal level we could gain an understanding about their lifestyle and issues that they are concerned about. They were resourceful people, the sea being a large resource for them. Many men of the community were fishermen and farmers and fish was a key part of their diet alongside cassava, yam, bread and beans. there was a divide between the wealthy and the poor among the community and the houses were built from mud to stone and bricks for the wealthier families. As a whole the living conditions were not as bad as expected however in some houses there was poor hygiene with animals walking in and out of the house freely near preparation of food. There was a large proportion of children in each family and the main faiths that the community followed was Christianity and Islam. The main language was Fante although many spoke English. Community Profile (to be completed using the community profile)

3. PROJECT INFORMATION Mobile Clinic Description Objective of the brigade The dental brigades will work alongside medical brigades, in-country doctors, dentists and other staff such as interpreters. We will travel to a village to set-up temporary primary care clinics in a local school to diagnose and treat patients at no cost. We will deliver public health messages and assessing this new community to plan future brigades Describe the different components of the Brigade and what was accomplished. Intake: register patient details Medical triage: blood pressure, weight and glucose tests (persons aged over 40 and known diabetics) Medical treatment: medical assessment Dental triage: assessment, diagnosis, treatment plan and consent Dental treatment: students observed and assisted the qualified dentists carry out dental treatment Public health/Oral Hygiene Instruction: educating the community Pharmacy: checking prescriptions and dispensing medication Compound: decontamination of instruments How was each station set up? How many students worked at each station? Intake: The interpreters worked at the front of the school to register patient details Medical triage: 4 pairs of medical students and 1 pair of dental students. Each pair of students worked with an interpreter on a desk and chairs. Medical treatment: Ghanaian doctors carried out assessments, diagnoses and prescriptions were written up. On most days there were 4 tables, with one doctor and one medical student (assisting and observing) on each. Dental triage: 2 tables with two dental students per table; one student recorded information and one student carried out the clinical examination. There was also 1 interpreter for each pair of students. A qualified dentist oversaw the clinical examinations, diagnoses, treatment plan and consent. Dental treatment: 6 pairs of dental students observed and assisted the qualified dentists with treatment. The most effective and common procedure that was undertaken were extractions. Public health/Oral Hygiene Instruction: We separated the children from the adults. The adults were taken into a classroom with interpreters to discuss common health problems people are facing in the community. The children were taken outside where we taught them a songs and played interactive games which helped teach them the technique of brushing and the children thoroughly enjoyed this. Pharmacy: It consisted of a room with medications in boxes and suitcases clearly labelled all around the room. One pair of students calculated the number of tablets required to the dosage prescribed. Medications were checked by the Ghanaian pharmacists to ensure the dosage was correct and to explain the intake dosage to the patients. Compound: 3 people; one person washing, one bleaching and rinsing the instruments and one transporting to their relevant areas. Washing basins were laid out. One assigned and clearly labelled for each of the following: washing, bleaching, rinsing and drying.

4. PROJECT INFORMATION Community Impact Each student saw on average around 12 patients a day. Pain management was the priority in all cases. There was a high number of patients presenting with dental pain and in order to get the patients out of pain, remove the source of infection and due to time constraints and a lack of resources, extractions were the main treatment for patients. We did no aesthetic treatments and we did not provide any removable or fixed prosthesis. We were not able to carry out any periodontal treatments either. We delivered public health information to groups of adults and children throughout every day. Needs of the Community • Based on the cases you saw, what do you believe are the highest needs of the community? • There was good water access in the Narkwa community however education was required regarding water hygiene for example ways to store water in the house. The common medical problems were malaria, diabetes and back pain and targeted health advice to the community (mosquito nets, healthy diet, exercises) would be very beneficial regarding these problems. Upon interaction with the children and families we found education was highly valued and the community were eager to learn what we have to teach them for example about oral heath, eating healthily and balanced diets. • How can GB programs help this community? • This was the first visit by a volunteer programme to the Narkwacommunity. Regular visits by dental and medical brigades will allow the people of the Narkwa community to see regular health professionals and will be able to address their problems sooner. We were told that the nearest hospital was 2 hours away in Accra. People had to pay 4 Cedi to have a card in order to get access to a doctor. • Global Brigades can: • Encourage children to attend school and perform to their full potential. • Encouraging people to get health insurance which cost 4 Cedi • Educating the community about preventable health problems. • Birth control advice. • Provide oral hygiene instruction • Provide resources such as toothbrushes, toothpastes • Providing relief of acute dental pain • Providing medicines • Build good relationships between community and Global Brigades and health professionals

5. FOLLOW-UP Dental Oral Hygiene Instruction What was presented in the Dental Public health station? How did the community respond? We separated adults and chidren and took he adults to a classroom and the children were taken outside in the playgrounds. In the classroom, together with the interpreters, we established the common health problems people were suffering from and tried to give targeted advice for these. Common problems that came up were waist and back pain. We taught simple and easy stretches and exercises that can be done daily and showed them the correct way of bending when lifting things. We went through oral hygiene education and gave a member of every family a toothbrush and toothpaste and taught them why we brush our teeth, when and how and what foods are good and bad for our teeth. We used posters and blackboards to share information. The children were taken outside where we taught them a song about brushing their teeth in Fante. The song would help them remember the principles and pass the message to more people. We also played interactive games using toothbrush and teeth models which helped teach them the technique of brushing and the children thoroughly enjoyed this. Both adults and children really enjoyed this part of the day and we were always very busy. We felt that they genuinely wanted to learn more. The interactive games we played with the children were very effective in teaching all the children the technique about brushing their teeth. Student Reflection What did you learn about health care/dental care in Ghana? There is free healthcare for children and elderly but the cost of transport and the lack of resources prevents people from going. Healthcare is widely needed and is not available in local villages. People felt that the public health education is inadequate, especially within the gynaecology field. They did not know about many diseases and infections even if they had them. Dental care is available but there is a lack of services and resources to support the population. There are only 180 dentists for the population of 26 million, which is a barrier to access care. Many people were frightened of dentists as the did not have good memories of when they were younger. We observed that it was socially acceptable for the local dentist to physically constrain children when undertaking treatment. In terms of oral health, caries is less of a problem than periodontal disease. The community generally did not snack regularly on fermentable carbohydrates and had a relatively low sugar diet. People did not have knowledge on how to bush effectively, why we brush and how we can prevent gum disease. In general, the knowledge of health and dental care in Ghana was poor. There was also limited knowledge on sanitation and disease prevention. There was a desperate need for healthcare and the community responded very appreciatively.

6. FOLLOW-UP Lessons Learned What are some best practices your group learned on the brigade in terms of setting up the clinic, patient care, education, etc? We learned that good teamwork made the brigade run smoothly and effectively. Good organisation and planning before hand made everyone clear of their delegated roles and coping with the large amounts of patients daily was achievable. Everyone in the team equally should be flexible and willing to change roles for example if more people were needed at a particular station one day due to large numbers of patients then people should be happy to help to get the job done. What would you do the same for the next brigade and what would you do differently? Using the school to set up the mobile clinics was a great location as the whole community know where it was, and there was plenty of space and separate classrooms to set up each clinic. We arranged the clinics so it was easy for the patients to move through and not have lots of congestion. It would have been better to have more medical brigades to help in pharmacy which on most days was just as busy as the dental treatment clinic but had less students working there. The more samples and medications we took with us the better. Have you set goals for the next brigade? What are they? To see more patients, help more families and continue the care to the people we have already treated. How did this experience effect the brigaders’ personal growth or understanding? On a personal level, this experience was extremely eye-opening and a complete contrast to the setting in which we deliver oral health in the UK. We came across many challenges and had to learn new skills in order to overcome them. It was a lot of hard work in a high pressure situation however I took away an experience of a life time, being the most rewarding thing I have done so far. www.globalbrigades.org