Dental Hygiene Issues in Guatemala Centro Educativo y De Salud Patanatic Patanatic, Solola, Guatemala January 7th-21st 2017 Ciana Albarelli, School of Nursing

Objectives Use evidence-based practices, health care technology, and effective communication strategies to guide the essential public health interventions across the lifespan. Use data from population assessments to identify the influences of the determinants of health (environmental, social, political, legal-ethical, economic, behavioral, and cultural) on delivery of care to diverse populations. Assess the health status, health care access, and emergency preparedness needs of the defined population. Participate with healthcare providers and community leaders in the planning, implementation, and evaluation of health interventions. Collaborate with healthcare providers and community partners to promote clinical prevention and population-focused health. Apply knowledge from nursing and related arts and sciences to the care of selected community based aggregates.

Background Information Patanatic is located approximately 10 minutes by car/bus from Panajachel, Guatemala overlooking Lake Atitlan. The average life expectancy in Guatemala is 69.8 years for men and 75.2 for women in 2014 Guatemala is among the lowest in all Latin American and Caribbean countries. 59.3% of Guatemala’s population (9.3 million people) lives below the poverty line Making less that 30 Quetzales or 4 USD a day. Infant Mortaility in the state of Solola was 20.5% of all births in 2014

Clinical Site Community based clinic that cares for residents of Patanatic and surrounding areas. Approximately 300 families living among the 4 sectors of the community. Run by 2 nurses, Sonia and Ana Provide most patient care and community health activities. Close connection with elementary school (checkups) Services are free Reliant on donations and volunteers from outside organizations (Woodland Public Charities) Follows children born each year with annual health screenings

Future for the Clinic Medical student from the community of Patanatic, David, will be finished in 2 years Plans to return to the community to work Community chose to send David to medical school with the hope that he will return to Patanatic and be the first doctor in the community. Renovations will begin on the clinic to include surgical suites where David can operate as a surgeon on those needing surgery.

Health Indicator During health assessments and checkups with families and children in Patanatic we began to notice very poor dental health. A common complaint from community members was tooth pain. Missing teeth, severe dental caries, chipped/cracked teeth in very young children. When further asked about their oral hygiene it was clear that many children did not have a toothbrush and toothpaste at home nor did they know how many times to properly brush their teeth. Children would often say “Yes, I brush my teeth” but when asked how many times a day they would say 6 or 7, so the information was somewhat unreliable. Many interventions consisted of proper education on brushing teeth, dental referrals or providing families with toothbrushes and toothpaste. Clean water is another issue in the area, which may act as a barrier to proper teeth brushing.

Interventions for Dental Hygiene Individual Interventions Education provided to child and family present at check up on proper brushing (number of times per day, duration) Students have toothbrushes at school to utilize throughout the day Community Interventions School in Patantic is involved with educating children on importance of brushing teeth Donations of toothbrushes and toothpaste are distributed at the clinic to families Systemic Interventions Government funding for dentists and access to dental care Water sanitation efforts and fluoride added to water supply to promote dental health

Most Profound Academic Experience The clinic visits were where I learned and grew the most. I felt a strong sense of autonomy that I hadn’t experienced in career as a nursing student before. I was able to strengthen my assessment and communication skills as well as educate and diagnose patients. It also pushed me outside of my comfort zone and allow me to utilize my spanish and intercultural communication skills

Most Profound Cultural Experience The experience that had the biggest impact on me personally was being apart of the kid’s first day of school ceremony. There was so much excitement and joy as they started a new school year. I also felt a strong sense of national pride as they sang their anthem and the flag was presented by the children. After, we were able to present to them about our initiative Agua Limpia, Manos Limpias, Calles Limpias.

Lessons Learned Lack of resources can make providing care a huge challenge in underdeveloped countries It is important to understand the cultural aspects and barriers you may be facing when providing care Patients may respond to home remedies to relieve pain more often than turning to medications Remaining flexible and understanding is incredibly important in stressful and frustrating medical situations

References Guatemala Political Map. (n.d.). Retrieved March 27, 2017, from http://www.emapsworld.com/guatemala-political-map.html Institute for Health Metrics and Evaluation. (2015). Retrieved January 30, 2017, from http://www.healthdata.org/guatemala Orozco, A. (2016, August 01). Pobreza se incrementó en el país, según informe del PNUD. Retrieved February 01, 2017, from http://www.prensalibre.com/guatemala/politica/estudio-detalla-que-en-guatemala-hay-mas-pobreza The World Bank Group. (2016). Retrieved February 01, 2017, from http://www.worldbank.org/