Mats worked very well on Wednesday and Thursday - and fixed all the problems that I have discussed with you over the last month. I am extremely pleased that the clinic is working well - and can be taken over by Lena next week in much better condition.
Here is a list of the work done, followed by my view / suggestions about management and maintenance.
I must be honest and say that regarding issues 4 and 5, the problems were basically due to lack of local management and maintenance - sad to say, but true.
1. High speed coupling and air-rotor turbine hand piece is fitted - and is working very well.
2. Low speed motor and hand piece is fitted - and is working very well.
3. Maintainance of hand pieces - was discussed with Dorn and Karen. They should be oiled with Kavo Spay daily, before autoclaving - and Karen was instructed.
4. The Scaler had no water spray. It is now fixed and working with water spray.
This was a very simple fix - ie. to turn on one on/off switch hidden on the water bottle on a far wall. Karen said did not know about this, and Dorn was not here to discuss. It seems that when the new cart was installed, the old scaler system was joined up, using water from the bottle on the far wall, rather than the water bottle in the cart (which supplies the drills). This is all very confusing Karin - sorry! - but it now works.
Dorn should have being able to fix this all along - as he was present when the cart was installed.
The solution was simple - one switch!
All the email comments from DentMed in Nairobi about blockages were nonsense.
I think it is quite ridiculous really that nobody knew about the switch, and I have struggled for a month without water in the scaler.
5. Suction is fixed.
The reason that the suction had been working so poorly is that the drainage tank was totally full (the tank is between the dental unit suction and the suction motor). It had never been emptied. The tank was full with an accumulation of water, blood, saliva, bits of amalgam and infected material - quite disgusting!
The overfilling of the tank could cause material to flow back to the sucker, with serious cross-infection risks - and also flow over into the suction motor.
The tank was emptied - and the suction now works well.
On Thursday we discussed the need to empty the tank - weekly. We suggested that Dorn should take responsibility for this - but he replied “I will be leaving soon”.
(Dorn does seem to lack interest in taking responsibility for the clinic - and has said several times that he is looking for work in Nairobi - which may explain his regular trips to Nairobi).
I emphasised the need for maintenance of the equipment, by clinic staff, otherwise things will deteriorate again, and visiting Rotary Dentists will have to get involved with fixing equipment, rather than fixing teeth.
It was agreed that Dorn will take responsibility for emptying the tank one a week - at the end of the Friday session.
Later on Friday, found clear instructions taped to a wall, from Human Bridge about emptying the tank daily. This had been totally ignored by Dorn (see under general comments) - sad - all this problem could have been prevented!
6. Both 3 in 1 syringes (dentist & assistant)- had problems - and are now fixed.
7. General electrical situation is much improved. There were many cables across the floor - which are now reduced. Therewere water leaks, which Mats has fixed.
8. Mobile unit with slow drill - was moved from the surgery to the second room. It was intended to use the mobile for simple procedures in the second room, but unfortunately Mats found that the mobile compressor is broken, and it’s not feasible to repair. So the mobile is now scrapped - including the old slow drill - a pity!
9. Second room - much rubbish has been removed, and now has a functioning chair and light only.
As such - It can still be very useful for simple procedures - including exams, injections and extractions. To use this extra room will improve the efficiency of the clinic - more patients can be seen by Dorn and the Rotary Dentist working side by side.
The second room still has an the old dental unit, which is not functional, takes up much space, is very messy and looks awful. Mats suggested removing this and the hospital technicians agreed to do this. However, the problem is that the old unit however holds the light. Mats suggested that a wall mounted light could possibly be provided - possibly from Sweden. If this could be provided, the room would be much better.
If a functioning reconditioned mobile unit and mobile suction could be found - it could be used in the second room to enable filings to be done. These mobile units could also be very useful in outlying schools, to do basic work for kids who cannot get to Migori. I will search for cheap mobiles in UK.
General comments:
I am very happy that the clinic is now working much better that when I came. I am very grateful to Mats for all his good work, and to Rotary Doctors for sending him to Migori.
However, in my opinion, there is a need for better local management and maintenance of this clinic - if equipment is to function well in the long term.
Dorn was in Nairobi on Mat’s first day (Wednesday). This was very disappointing. He should have been in the clinic - as he knows what technical work has been done previously, and he was well aware that Mats was due in Migori on Wednedsay. I had told him many times that Mats was coming, but he chose to avoid the opportunity to work with Mats. This shows his lack of interest in developing the clinic - sad!
I phoned him in Nairobi on Tuesday, and asked him to come back to Migori for Wednesday to help Mats, but he didn’t come. He came to the clinic on Thursday - when all the maintenance issues were discussed and the equipment was tested.
There is a real need for better management of the clinic at St Joseph’s - by somebody who is based here all the time. Equipment must be maintained correctly, and somebody in the hospital should have responsibility for maintainance. Otherwise visiting Rotary Dentists will always have ongoing problems and frustrations when equipment fails. Visiting dentists should be able to do the dental work they came here to do - with tools that work.
I am not sure what the role of the Oral Health Offficer is. Dorn does not seem really interested in managing maintenance of equipment - which I find disappointing. I am not happy to say this - but for the sake of the clinic, I feel I must be honest.
On Friday Mats discovered a protocol in the clinic, written by Human Bridge when the suction was fitted, which gives clear instructions that the suction tank should be emptied daily. This instruction has been totally ignored by staff in the clinic, resulting in failure of the suction. This is awful!
In my view - Rotary Doctors should discuss these issues of management and maintenance of the dental clinic with St Joseph’s Hospital administration - to develop clear lines of responsibility. This would be of great help to visiting Rotary Dentists.
Note - The new hand-pieces brought by Mats were recorded by VidiahaSalim - Procurement Manger, St Joseph’s.