A Humanitarian Dental Elective in Trujillo, Peru.

Transcription

McNulty, Richard and Allan, Martin and McKinnon, Gordon and
MacLeod, Alan (2008) A humanitarian dental elective in Trujllo, Peru.
BDS Elective Report.
http://hdl.handle.net/1905/797
20th November 2008
Enlighten
http://www.gla.ac.uk/enlighten
A HUMANITARIAN DENTAL ELECTIVE
IN TRUJILLO, PERU.
JUNE 2008
0403729, 0403809, 0403890, 0403737
WORD COUNT: 4537
1
Index
Page
Summary
3
Introduction / Literature Review
4
Background
4
The Charity
4
Oral Health
5
Prevention
6
Techniques
6
Aims
9
Planning and Materials
9
Method
12
ALTO TRUJILLO
13
MILAGRO
15
PRESS DAY
18
EN ALTO HUCHO – MIRAMAR
19
PALMERAS
19
Discussion
22
Reflection
24
Sources
26
Bibliography
26
Appendix 1 - Email Correspondence with Bruce Peru
27
Appendix 2 - Letter of application for support to companies
30
Appendix 3 - Inventory of supplies and who donated them
31
Appendix 4 - Oral hygiene and diet advice sheet (in Spanish)
32
Appendix 5 - Record Card example
33
Appendix 7 – Email correspondence regarding Fed Ex shipping
34
2
Summary
In June 2008, a group of 4 dental students from Glasgow Dental Hospital and School
conducted a humanitarian dental project in the barrios of Trujillo, Peru. The students provided
basic dental care such as extractions and basic restorations using the ART technique. They
provided this care in four clinics for a period of two weeks working from 9am to 3pm. Further
to this, the group established a preventative programme in these communities and in the
charity itself. This programme was based on the highly successful Scottish programme –
Childsmile. Their aims, amongst others were to gain valuable experience in basic dental
procedures, assist Bruce Peru in achieving their mission to improve the general health and
wellbeing of the poorest children in South America, provide dental care for communities that
have limited access to dental treatment and to establish an oral health promotion campaign in
the community and give advice to local workers on health promotion. Overall, the students felt
that they were successful in achieving their key aims and also they felt that they were
extremely privileged to have gained an insight into providing dental care in a developing
country.
3
Introduction / Literature Review
In June 2008, we conducted a humanitarian dental project in the barrios of Trujillo, Peru. This
report details the planning and execution of this project.
Background
We all had a longstanding desire to carry out a humanitarian type dental elective. They felt it
would be a very valuable and meaningful experience as it would help the lives of some of the
most impoverished people in the world. Further to this the group felt it would be very
challenging, having to apply their dental knowledge to a foreign environment where there
would be communication difficulties and limited resources.
We began researching different charities that had previously accommodated dental students.
Many charities were found but one stood out in particular – The Bruce Peru Organisation.
This was because the group felt this charity was very valuable and helped many people in the
impoverished communities in Peru, especially children and pregnant women.
The Charity
The primary objective of Bruce Peru is to integrate the poorest children of Peru into the
education system. It achieves this by establishing schools in the “barrios” or suburbs of
Trujillo. The barrios are areas of extreme poverty often with no running water, electricity or
1
sewage systems.
4
While educating children at their centres Bruce Peru also provides many other services to the
children and their families to which they would never gain access. To name but a few of the
volunteers the charity has in its numbers: social workers, community leaders, doctors,
dentists, midwives, psychologists and business consultants.
As we researched the charity we became more and more enthusiastic about it and decided
that we wanted to carry out our elective with them and thankfully the charity was able to
accommodate this.
Oral Health
Many of Peru’s indigenous children suffer from untreated dental disease and limited
knowledge of good dental hygiene habits. The absence of affordable help and knowledge
contributes to the suffering of these marginalized and under served people.
According to Peru's Vice-Minister of Health, Jose Calderon Yberico, oral health problems are
the second leading cause of health care visits in the country, with the majority of patients
2
3
being children . It is astonishing to think that according to the Orthodontist College of Lima
95% of Peruvian children aged 4 through 12 suffer from some types of oral infection.
Preventative dental education and water fluoridation is non-existent in most areas in Peru.
Because of a fear of dentists and the cost of dental care, treatment is sought primarily for
emergency extractions, most of which are usually done without the use of anaesthesia,
further compounding the fear of the dentist. As a result, gross untreated caries is often
evident in these children, contributing to malnutrition, constant dental infection and loss of
education due to school absenteeism.
5
Prevention
Oral diseases are a world wide problem. They can affect anyone and yet most are entirely
preventable. The oral health in Peru is no exception. Figures from the Pan-American Health
Organisation (PAHO) indicate that the prevalence of dental caries was 84% and the DMFT
index 5.6 for children 12 years of age in 2000; the prevalence of periodontal disease was 85%
4
and that of malocclusion 70% .
In order to tackle this problem, a vast effort is required to overcome the massive inequalities
and barriers that exist in healthcare.
5
In 1986 The World Health organisation (WHO) designed the Ottawa charter , a basis for
which health promotion strategies should be structured in the future.
Many Scottish
preventative programmes are based on these principles including the very successful
Childsmile programme. As a result we decided to try to introduce the key concepts of the
Childsmile programme in the communities in Peru. As part of this we aimed to educate local
health care workers in delivering oral heath promotion advice to continue when we have left
the area and establish a degree of longevity.
Techniques
The ART Technique (Atraumatic Restorative Technique)
The ART technique was developed by the World Health Organisation in association with
manufacturers of glass ionomer materials and was pioneered in the mid-1980s in Tanzania
5
and further developed in Thailand in 1991 and in Zimbabwe in 1993 . The ART technique is a
procedure that involves the removal of carious tooth tissue using only hand instruments
6
followed by the placement of an adhesive, Glass Ionomer restoration.
6
The technique was first developed to provide restorative dental care to people who came from
‘less-industrialised countries and certain special groups such as refugees and people living in
6
deprived communities’ . These groups would otherwise not be able to receive restorative
dental care and allow caries to progress to the point where extraction is necessary. Thus the
ART technique was developed to provide restorative treatment to populations were there is
either no electricity, or in the case of the barrios in Peru, where there is electricity but the
6
communities cannot afford expensive dental equipment or materials and therefore would be
ideally suited for our work in the barrios of Trujillo.
Picture A
Picture B
These pictures demonstrate the ART
technique as preformed in the clinics.
Picture A – shows the initial cavity into
dentine. Picture B- Demonstrates the
removal of carious tooth tissue with an
excavator. Picture C – demonstrates the
final Glass Ionemer restoration.
Picture C
7
The Hall Technique
This technique, developed in Scotland, is used to treat caries in primary teeth in a very
conservative – atraumatic manner.
Current British Society of Paediatric Dentistry Guidelines State that the best type of
restorations to place on a carious primary molar tooth which involves two or more surfaces, is
7
a preformed metal crown .
Conventional technique for the placement of a preformed metal crown(PFM) requires local
anaesthetic and tooth-preparation with handpieces, which would not be practical with the
limited resources available in the barrios of Trujillo.
The “Hall technique” is a simplified version of the above technique involving placement of an
appropriately sized PFM over a carious molar tooth, without local anaesthetic, carious
removal or tooth preparation. The crown was simply cemented into place with glass ionomer
8
cement . The theory behind the technique is that the placement of a PFM prevents the
substrate reaching the micro-organisms involved in the carious process preventing its
progression.
A recent investigation published in the BDJ concluded that the Hall Technique had similar
8
outcomes to more conventional methods of restoring carious primary teeth. Thus as it is a
simple and easy technique to perform with no need for electricity or dental handpieces this
technique could also be adopted in deprived areas such as the barrios in Trujillo, Peru.
8
Aims
The group wanted to:-
•
Gain valuable experience in basic dental procedures.
•
Assist Bruce Peru in achieving their mission to improve the general health and well
being of the poorest children in South America.
•
Provide dental care for communities that have limited access to dental treatment.
•
Describe the oral health promotion strategies in Peru, how effective they are and how
they compare to those in Scotland.
•
Assess the different barriers to care that exist.
•
Establish an oral health promotion campaign in the community and give advice to
local workers on health promotion.
Planning and Materials
Communication via email was established with the president of the charity in January 2008
(Appendix 1). She was interested in the proposal of carrying out a dental elective with the
charity for two weeks in Trujillo in June 2008. The president was very helpful as in 2007
another group of dental students from Glasgow University had volunteered and as a result
she knew the types of clinics that would not only benefit the students but also the
communities of Peru. The charity organised four clinics for the students to visit two days each
and they organised a supervising dentist in each clinic.
Further to this, the charity supplied accommodation, food and transport for the price of £210
for each student. They also provided a translator for each clinic to help with the language
9
barrier. However, the charity also provided Spanish lessons twice a week in order to allow the
students to learn the basics of the language and become more independent.
The charity informed the students that resources in the clinics were limited and that, if
possible, the group should have brought there own equipment. Following this the group wrote
letters to all the major dental companies in Britain asking for donations. (Appendix 2). The
materials that were required were:
•
Glass Ionomer. (Conventional)
•
Bur kits. (Basic)
•
Gloves (Medium and Large).
•
Scrubs
•
Visors and masks
•
Stainless steel crowns
•
Wooden wedges
•
Local Anaesthetic
Many companies donated very generously and the inventory of supplies and who donated
them can be found in appendix 2. Due to the large amount of supplies and their nature i.e.
medical, it was decided that they would be best sent to Peru via a courier, rather than attempt
to take it through in the luggage. As a result a company called Alba Bioscience agreed to
cover the cost of this and sent a box of supplies via FedEx for the cost of £280.
However, there was a major problem with this. Peruvian Customs refused to import the
package, eventually claiming that they required a price for each item present and a sanitation
certificate. FedEx had not informed any party of these requirements, which could not have
been honoured as many of the items were donations and therefore did not possess a resale
value. The charity informed us that the system in Peru is corrupt and that this has happened
before to them. Unfortunately, despite the best efforts of Bruce Peru and Alba Bioscience the
equipment was refused and returned to Britain.
10
Thankfully, the charity managed to obtain some materials for us from local dentists, this
included;-
•
Conventional Glass Ionomer
•
Gloves
•
Masks
•
Access to instruments, i.e. forceps, hand instruments, burs and hand pieces.
•
Topical fluoride gel
As a result of this the only techniques that could be preformed were the ART technique and
extractions. The group had to accept that they could not use the Hall technique.
This was not a large problem as prevention is key to all treatment plans and therefore the
most important aspect of our visit was to establish a preventative programme. As a result the
group purchased toothbrushes and toothpaste containing fluoride (at least 1000ppm) and
created an oral hygiene/diet instruction sheet in Spanish (appendix 3). These were put
together in a pack and given to all patients seen by the group.
Pictures showing the toothbrushes and toothpastes purchased and distributed in the
communities.
Records of each patient were kept using pro-forma sheets (appendix 5) provided by the
11
charity. They wanted to keep them as they had other dental students coming to volunteer in
the future.
Method
As mentioned above the barrios are areas of extreme poverty and as a result we were invited
to attend the local schools with the other volunteers on our first day. This was to highlight the
work the charity does and to acclimatise us to the kind of conditions in which we would be
working.
The charity only runs the schools in the mornings because it becomes too dangerous in the
afternoons. In this time the volunteers, both from Peru and abroad, teach the children the
basic educational requirement to enter public schools, play games with the children and
provide them with lunch (which may be their only meal of the day).
This introduction to the children was a valuable experience as it highlighted the extreme level
of poverty in the area – children often shared a toothbrush with the entire family and only
brushed with water. It also highlighted the difficulty in communication with the children on
even basic conversation.
The charity had organised a timetable for us to visit the different barrios associated with the
schools run by Bruce Peru. The timetable allowed us to spend 2 days at each clinic in order to
treat the children from the local school and some of the local community. Our presence was
advertised outside the local health centre with a poster, as shown, prior to our arrival, which
guaranteed sufficient patients.
In order to have some effect on the long-term oral health of the area, we knew we would have
to educate not only the patients, but also some of the other volunteers, to continue the oral
health promotion once we had departed. Obviously we had to reduce some of the barriers to
12
oral health, namely poverty, by providing each patient with a toothbrush and toothpaste, and
knowledge by providing an information sheet containing oral hygiene instructions and dietary
advice.
ALTO TRUJILLO
This is the largest barrio in Trujillo and Bruce Peru had a large presence there, with its largest
school in the area. The school was basically one class room, usually containing between 2030 pupils, who were divided into different tables according to their educational level.
In the morning of day 1 we arrived at the local health centre in Alto Trujillo, where we would
be working with the local dentist who would also be supervising us. The facilities were basic
as expected and comprised 2 neglected dental chairs, only one of which had a working drill, a
steriliser and a desk.
There was also the volunteer from the school to act as translator.
Day 1
On the first day we operated the policy of 2 operating and 2 assisting, however, after a period
it became clear that this was not efficient enough. Considering only one of the chairs had a
working high speed drill, patients had to switch between chairs and operators causing delays
in this very busy clinic. The types of treatment provided included extraction, restorations with
conventional GI (ART and high speed) and topical fluoridation.
13
Pictures demonstrating a typical paediatric patient in the clinics. These pictures demonstrate
a child with gross caries.
Day 2
As a result of the hectic nature of the previous days in the clinic, we decided to go to the
school in Alto Trujillo to screen the children before they were due to arrive at the clinic in order
to maximise our available time. We managed to set up a basic screening area in a separate
room in the school and decided to work in 2 groups, each consisting of an operator an
assistant and a translator. Each group saw 1 child from the school at a time, they took a
history and examination, gave topical fluoride, toothbrush, toothpaste and instruction sheet
with toothbrushing and dietary advice. Those children requiring treatment were invited to
attend the health centre for treatment.
21 children were seen and it was decided that 8 required immediate treatment
Pictures of the screening session.
14
Day 3
Due to the inefficiencies of the previous day we decided to adopt a slightly different approach
to treating the patients. Still maintaining the 2 operators and 2 assistant technique we decided
to use the chair with the faulty hand piece to screen the patients and treat patients not
requiring intervention with the handpiece, namely extractions and the ART technique. This
session comprised primarily adult patients, many of whom were pregnant.
During our time in Alto Trujillo we managed to treat a wide variety of patients, ranging from
age 3 months to 64 years, often requiring a large amount of treatment. Unfortunately, due to
time constraints and lack of materials, we decided to limit treatment to 1 unit per person or to
relieve pain. Patients worth noting included a 21 year old female with an untreated cleft
palate and a 5 year-old boy with gross nursing-bottle caries.
DAY
TOTAL NUMBER OF
NUMBER
OF
NUMBER
PATIENTS
EXTRACTIONS
RESTORATIONS
1
20
11
7
2
21
NA
NA
3
17
1
15
OF
MILAGRO
In this barrio to the west of Trujillo we were located in the local “centro de salud” and the
children from the local charity run school came to receive treatment. This school is smaller
than that of Alto Trujillo with only around 12 pupils.
15
Day 4
We arrived at this busy health centre where the school children and other individuals from the
community were already waiting for us. The dental surgery in this centre was the most
modern and well equipped of all the clinics visited. It contained one dental chair, a sterilisation
area, sinks with running water and an x-ray machine. Unfortunately, the dental chair had a
rather temperamental electricity supply, meaning the handpiece was mostly off limits. Due to
the fact that there was only one dental chair in the clinic we elected to create a screening area
and a treatment area in the surgery. Two of us were screening the children while the other
two were performing the treatment. We also had two translators present which was a great
help in terms of the efficiency of the entire process.
We found that this system was the most efficient in terms of time and quality of care. On the
screening section a history and examination would be taken followed by topical fluoridation
and the provision of toothbrushes, toothpaste and instruction sheet. If a patient required
treatment they would be transferred to the chair. The primary treatment was extractions due
to the large number of untreated, grossly carious teeth.
Left – Picture in the clinic
with some children who
were treated.
Bellow, Left – One of many
untreated cleft palates
observed in the clinics.
Bellow, Right – Picture
showing the hand hygiene
measures used in the clinic.
We used alcohol gel
between patients and
washed our hands every 56 patients.
16
Day 5
We rotated the groups each day to ensure that each group received equal treatment time.
The same system as the previous day was used as it was the most efficient and productive.
On the previous day treatment priority was given to the children from the schools; however on
this day treatment was solely for the community, which resulted in a very busy clinic.
A particularly challenging patient included a young blind boy with learning difficulties, who
would not let go of his mother to allow examination. This was obviously a challenge in terms
of simple communication but also in patient management. After some reassurance and
behaviour management techniques, the boy allowed a basic examination and the application
of topical fluoride. Thankfully, his teeth were in good condition and did not require treatment.
DAY
TOTAL NUMBER OF
TOTAL NUMBER OF
TOTAL NUMBER OF
PATIENTS
RESTORATIONS
EXTRACTIONS
4
15
1
10
5
43
14
6
17
Picture showing oral hygiene instruction
being given to a patient.
PRESS DAY
Day 6
At the start of our second week Bruce Peru charity had organised a press conference in order
to publicise our project and work in the area and the other work that the charity was involved
in. The press conference attracted quite a large number of journalists not only from the local
newspapers but also the national television and radio channels. Later we discovered that we
had appeared in the local newspapers, radio and even had a brief section on the nation
television channel!
Pictures showing the press who interviewed us
EN ALTO HUCHO – MIRAMAR
18
This clinic again had quite basic equipment. The facilities included one dental chair, which
incidentally had a working handpiece with water spray. We divided the surgery into two
sections by a curtain screen to segregate the operating and screening areas. We utilised the
same system as mentioned previously to screen and treat patients, however, there was only
one translator present, which did provide some communication issues despite our vast
improvement in Spanish.
DAY
TOTAL NUMBER OF
TOTAL NUMBER OF
TOTAL NUMBER OF
PATIENTS
RESTORATIONS
EXTRACTIONS
7
21
13
4
8
24
12
6
TOTAL
45
25
10
Picture showing the setup of the Mirimar clinic.
PALMERAS
This clinic again was situated in the local health centre. The facilities included a rather
experienced dental chair and instrument kits. The clinic also had a separate sterilisation room
for processing dirty instruments. The dental chair, as seen in the picture, was quite old,
however, was in excellent working order and actually the most reliable chair we had used. As
usual we adopted the same system of two screening the patients outside, giving oral hygiene
and dietary advice, topical fluoridation and handing out the toothbrush, toothpaste and
19
instructions kits. Meanwhile the other group of two would provide treatment for those requiring
it.
Left Picture demonstrating the old dental chair in the surgery.
Right Picture shows the screening queue of school children on the first day.
Day 9
It was arranged that the local school in the area would be arriving for treatment that morning,
which meant a limit on the amount of patients to see. The school was relatively large and had
14 pupils ranging from 6 to 13 years old. The clinic operated very smoothly and for the first
time we actually finished on schedule before 1 o’clock. Patients of particular interest were a
mesiodens on a 6 year old boy, which the supervising dentist wanted to extract, however, the
boy was not cooperative enough for treatment to commence.
Picture showing the patient with a mesiodens.
20
Day 10
The clinic on this day was opened to the public and several schools turned up, which meant
that there was a large volume of patients requiring treatment. This combined with fact that
one student was unwell, increased our workload dramatically. In this session we often treated
the child and their parents, which meant a variation of treatment and patient management
challenges.
One of the reasons for the increased patient load was that a teacher from a more affluent
school had noticed the poster and decided to bring the entire school down for treatment;
fortunately, these children had a higher standard of oral health. All patients were screened,
given topical fluoride, oral hygiene and dietary advice, oral hygiene kits and sent for treatment
if required. However, due to the sheer volume of patients and the use of only 1 dental chair, it
was decided that restorations would be provided on the dental chair and extractions would be
provided on the waiting chairs in the surgery. Furthermore, the supervising clinician opted to
help us with the patient load, which in turn meant that there were 3 areas for treatment within
the rather cramped surgery.
Picture showing school children following the provision of toothbrushes and toothpaste on the
final day.
21
DAY
TOTAL NUMBER OF
TOTAL NUMBER OF
TOTAL NUMBER OF
PATIENTS
RESTORATIONS
EXTRACTIONS
9
14
8
5
10
131
57
13
Discussion
Having completed the elective and now looking back on the project as a whole, we believe
that it went very well, thanks in part to the organisation of the charity and our planning and
foresight. We encountered several problems during our trip and did our best to resolve them,
usually with excellent results.
The main problem that truly affected our elective project was the prevention of our dental
equipment from entering the country. Many dental companies from across the UK had kindly
donated a variety of equipment including instruments, safety glasses, gloves, local
anaesthetic and restorative material. As a result we had a vast amount of equipment that we
felt would be very useful for our elective project and when considering the restrictions on
baggage allowances for flights we believed sending the equipment by courier was the best
option. The company Alba Bioscience very generously offered to ship the two boxes,
collectively weighing over 40kg, to Lima via their courier FedEx. However, upon arrival at
Lima, it was clear that there were certain issues relating to the import of the selected
equipment, none of which had previously by made aware to us by FedEx. After a number of
days of dialogue between us, Bruce Peru and Alba bioscience with FedEx and the Peruvian
customs authorities it became clear the package would not be allowed through. This was
obviously a source of some distress for the group as we understood that most of the clinics
were poorly equipped and had been advised to bring some of our own equipment.
Fortunately, we had decided to bring a selection of forceps, burs and tunics in our personal
22
baggage allowance, which meant we had some equipment. Thankfully, the Bruce Peru charity
managed to source some dental equipment for our use; otherwise our elective could have
been ruined.
Obviously, in hindsight, perhaps being selective in our choice of equipment and taking it in our
personal luggage would have been preferable. However, as mentioned previously FedEx did
not make us aware at any point any restrictions in place regarding the import of goods into the
country, which could have prevented this issue entirely.
In relation to the actual day to day operation and setup of the clinic, we were given
administrative freedom. As mentioned in the method on our first number of days we lacked
efficiency in our practice. This was perhaps due to the vast difference in terms of equipment,
materials and sheer patient volume in comparison to work in the dental school. In addition to
this the organisation of the clinic was entirely up to us and having never operated our own
clinic prior to this, perhaps we were not entirely ready. However, after a couple of days we
managed to find a system of operating that was much more effective and every member of
the team understood their roles and acted to the best of their ability in order to maximise
efficiency.
Another point which would have greatly benefited our practice would have been a better
grasp of the Spanish language. Bruce Peru thankfully provided us with at least one translator
per group, otherwise treatment would have been impossible; however, there were still
occasions when we had to pause mid-treatment as the translator was busy with the other
section. Towards the end of our elective our Spanish had greatly improved and we were less
reliant on the translators, which helped make treatment much more efficient.
In terms of the treatment we provided, obviously with our own equipment we would have been
able to place stainless steel crowns, using the Hall technique for a large number of patients,
which would have been preferable. Clearly due to the limited equipment available in the clinic
the ART technique was the technique of choice and literature suggests that it has only slightly
23
poorer outcomes than when conventional restorative techniques are used i.e. caries removal
9
with rotary instruments and use of amalgam . We were informed by one of the supervising
dentists in Peru that the Peruvian government only provides extractions for patients and
restorations required private treatment, which most could not afford. As a result most of the
patients were so appreciative of the restorations we were providing despite there doubtful
longevity.
Reflection
On reflection the elective project was a very positive experience which we thoroughly
enjoyed. We feel that we were successful in achieving our aims which were to supply dental
care to those communities that have limited access to treatment and in doing so we feel that
we helped to improve the general health and wellbeing of the poorest children in South
America. Furthermore, each of us now feel a lot more confident at basic dental procedures,
including caries diagnosis, treatment planning and pain relief, giving preventative advice,
extractions and basic restorations. We also feel that we improved other key skills such as
communication, due to the language barrier, and behaviour and practice management. This
was due to the fact that although in each clinic we had a supervising dentist, they did not
intervene at every stage of a procedure; their role was more of an advisory one. We were left
to organise the clinic for the day; we decided how many patients we saw, how we would
organise them and we also decided what treatment was best and provided that treatment.
Thus the experience has made us all more responsible and independent clinicians.
We also feel that we have become more reflective practitioners. This is because at each clinic
we would have to assess how successful and productive it was and if there were any
problems make changes to the way we provided care for the next clinic. Thus we enhanced
our time management skills and our ability to organise patients. As a result we became more
and more efficient over the two week period. A good example of this was the fact that on the
first day we felt poorly organised, slow and inefficient. After evaluating how we could improve
efficiency we decided that screening of the children first would be very valuable and as the
24
days went on this proved to be the case.
Furthermore, we felt that the patients that we treated were very appreciative; almost every
patient thanked us and were thrilled with the treatment they received. This gave the group a
great feeling of satisfaction and made us realise that we were making a difference to these
people, especially because they had no other means of receiving dental care, even if they
were in pain.
Overall the group feels extremely privileged to have gained this opportunity to provide dental
care in some of the most deprived communities in the world. This experience has made us
judge our own lives and has made us realise how privileged we are. People from Britain do
not realise the huge benefits the NHS brings and we now realise how lucky we are to live and
work in Britain.
25
Sources
1. Bruce Peru website www.bruceperu.org. Last visited 21/08/08
2. Jose Calderon Yberico, Vice-Minister of Health, Peru.
3. http://www.livinginperu.com/news-3774-health-95-perus-children-have-oral-healthproblems. Last visited 21/08/08
4. http://www.paho.org/English/DD/AIS/cp_604.htm. Last visited 21/08/08
5. Ottawa Charter for Health Promotion. First International Conference on Health
Promotion. Ottawa, 21 November 1986 - WHO/HPR/HEP/95.1.
http://www.who.int/hpr/NPH/docs/ottawa_charter_hp.pdf
6. F J T Burke, S McHugh, L Shaw, M -T Hosey, L Macpherson, S Delargy & B
Dopheide UK dentists' attitudes and behaviour towards Atraumatic Restorative
Treatment for primary teeth. Br Dent J 2005;199, 365 - 369
7. Frencken J, Phantumvanit P, Pilot T, Songpaisan Y, van Amerongen E.Manual for
Atraumatic Restorative treatment. Chapter 1. 1997, WHO Collaborating Centre for
Oral Health Services research, Groningen.
8. Fayle SA. UK National Clinical Guidelines in Paediatric Dentistry. Stainless steel
preformed crowns for primary molars. Int J Paediatr Dent 1999;9:311–314.
9. N P T Innes, D R Stirrups, D J P Evans, N Hall, M Leggate. A novel technique using
preformed metal crowns for managing carious primary molars in general practice. A
retrospective analysis. Br Dent J 2006;200(8);451-4
Bibliography
1. Bruce Peru website www.bruceperu.org. Last visited 21/08/08
2. http://www.livinginperu.com/news-3774-health-95-perus-children-have-oral-healthproblems. Last visited 21/08/08
3. http://www.scotland.gov.uk/library/documents/oral02.htm. Last visited 21/08/08
4. http://www.paho.org/English/DD/AIS/cp_604.htm. Last visited 21/08/08
26
5. F J T Burke, S McHugh, L Shaw, M -T Hosey, L Macpherson, S Delargy & B Dopheide
UK dentists' attitudes and behaviour towards Atraumatic Restorative Treatment for
primary teeth. Br Dent J 199, 365 - 369 (2005)
6. Frencken J, Phantumvanit P, Pilot T, Songpaisan Y, van Amerongen E.Manual for
Atraumatic Restorative treatment. 1997, WHO Collaborating Centre for Oral Health
Services research, Groningen.
7. Phantumvanit P, Songpaisan Y, Pilot T, Frencken JE. Atruamatic Restorative
Treatment (ART): a three-year community field trial in Thailand – survival of one
surface restorations in the permanent dentition. J Public Health Dent1996; 56: 141–
145.
8. Frencken JE, Makoni F, Sitholen D. ART restorations and glass ionomer sealants in
Zimbabwe:survival after 3 years. Community Dent Oral Epidemiol 1998; 26: 372–381.
9. Fayle SA. UK National Clinical Guidelines in Paediatric Dentistry. Stainless steel
preformed crowns for primary molars. Int J Paediatr Dent 1999;9:311–314.
10. Roberts JF, Sherriff M, The fate and Survival of Amalgam and pre-formed crown molar
restorations placed in a specialist paediatric dental practice. Br Dental J 1990; 169:
237-244
11. N P T Innes, D R Stirrups, D J P Evans, N Hall, M Leggate. A novel technique using
preformed metal crowns for managing carious primary molars in general practice. A
retrospective analysis. A retrospective analysis. Br Dent J 2006;200(8);451-4
12. Frencken JE, Mankoni F; A treatment technique for tooth decay in deprived
communities; World Health 1994 47: 15–17
13. Innes NP, Evans DJP, Stirrups DR; The Hall Technique: a randomized controlled
clinical trial of a novel method of managing carious primary molars in general dental
practice; acceptability of the technique and outcomes at 23 months; BMC Oral Health
2007, 7:18
14. ECM Lo, CJ Holmgren (2001); Provision of Atraumatic Restorative Treatment (ART)
restorations to Chinese pre-school children - a 30-month evaluation; Int J Paediatr
Dent 11 (1), 3–10
15. JE. Frencken, Taco Pilot, Yupin Songpaisan, Prathip Phantumvanit (1996); Atraumatic
27
Restorative Treatment (ART): Rationale, Technique, and Development ; Jl of Public
Health Den 56 (3), 135–140.
16. Honkala E, Behbehani J, Ibricevic H et al. The atraumatic restorative treatment (ART)
approach to restoring primary teeth in a standard dental clinic; Int J Paediat Dent 2003
13: 172-179.
17. Louw AJ, Sarvan I, Chikte UME et al; One-year evaluation of atraumatic restorative
treatment and minimal intervention techniques on primary teeth; S Afr Dent J 2002 57:
366-371
18. Frencken JE, Makoni F, Sithole WD et al; Three-year survival of one-surface ART
restorations and glass-ionomer sealants in a school oral health programme in
Zimbabwe; Caries Res 1998 32: 119-126.
19. Scottish Intercollegiate Guidelines Network; Preventing Dental Caries in Children at
High Caries Risk; SIGN publication number 47; December 2000.
20. Scottish Intercollegiate Guidelines Network; Prevention and Management of Dental
Decay in Pre-school Children; SIGN publication number 83; November 2005.
21. http://www.unison-scotland.org.uk/response/oralhealth.html. Last visited 21/08/08.
28
APPENDIX 1
--Forwarded Message Attachment-Date: Sun, 9 Dec 2007 10:23:21 -0800
From: [email protected]
Subject: Re: Alan, Probabl�y Dental Volunteer in
Trujillo, Peru
To: [email protected]
Dear Alan, (and your Dental School friends from
Glasgow)
We will be delighted to receive you. Can provide
official report from supervising/reporting authority practicing dentists to accompany - use of clinical
facilities and equipment - lots and lots of extremely
poor people to treat. If you can just bring some of the
needed materials.
The site will be in Trujillo, northern Peru
(http://volunteertrujillo.com ), and - once we have
communicated enough for you to be certain this is
your chosen destination - you will need to get in
reservations pretty quickly, because it will take some
arranging to receive all of you
at once - and we will block that many beds, etc, and
not accept other volunteers during this time.
Also, once you are decided, we will need fixed dates
right away, and before long, completer application
forms such as Gordon has already filled up below.
We will be delighted to have you with us, and so will
our children and mothers.
Once we have heard from you again, we will put
together a small compilation of previous dental
elective visits - to give you an idea of how they have
gone.
Our best wishes,
Ana Tere and the Bruce team
From: Alan MacLeod
<[email protected]>
Date: Nov 27, 2007 9:30 AM
Subject:
Hello my name is alan Macleod I am a fourth year
dental student at Glasgow university. There is a
period of time in which we carry out an elective study
(june 2008) in which there are four students including
myself who are interested in humanitarian work in
relation to dentistry in peru or surrounding countries.
I was wondering if there any opportunities within your
organisation or if you know off any other
organisation. Thank you
Agenda SOS International
[A registered Charity, active since 1976]
501(C)3 - Tax exempt/deductible status
Bruce Organisation is part of Agenda SOS
--Forwarded Message Attachment-Date: Sun, 9 Dec 2007 17:53:28 -0800
Subject: Some Progress toward getting you to Peru
next summer
Dear Alan- dental Friend at Glasgow,
We can accommodate your desire to participate in a
dental project in Trujillo, Peru - and by doing so you
will fulfill our need to help our extremely poor children
and their mothers with dental service.
1 - Come see some of the dental projects we have
conducted in the past.
http://peruproject.org/dental2007/ [Glasgow Dental
Elective July 2007]
http://sosmall.net/arribaya/dental.html
http://volunteers4u.org/cajamarca/dentists07.01.05.ht
ml
http://bruceperu.org/diadental3.jpg
2 - Consider carefully our volunteer programme.
http://bruceperu.org/bpovolunteer.html
3 - Make your applications to come
volunteer.
http://volunteers4u.org/emailform.html
Upon receipt of your applications we will get back to
you within 3/4 days.
Our best to you for this coming year,
Nicole, Ana Tere and the Bruce team
See our new video:
http://bruceperu.org
--Forwarded Message Attachment-Date: Thu, 13 Dec 2007 20:24:45 -0800
Subject: Dental Elective from GLASGOW - Alan
MacLeod, Martin Allan, Gordon McKinnon and
Richard McNulty
To: [email protected];
[email protected];
[email protected];
[email protected]
Dear Alan MacLeod, Martin Allan, Gordon McKinnon
and Richard McNulty,
Thank you all for your interest in helping poor
children and people in Peru! Your reasons for
wanting
to come help, your dental training and skills, plus
the fact you will join with us in providing dental
services to
some of the very poor people in our programmes,
make
you good candidate to volunteer with Bruce
Organisation.
Welcome!
[
http://agendasos.com/bruceorganisation/index.html ]
There are lots of needs in the poor communities we
serve, and what
29
Bruce Organisation attempts to
address is their education, and
all their basic needs to accomplish a relative normal
life as students including dental and medical treatment.
We work with a mix of foreign and Peruvian
volunteers.
Our children are usually the poorest in the poorest
community.
Under the umbrella of "education": we also look after
their
nutritional, clothes, Psychological needs (within our
limitations).
Our program provides a very necessary support for
the
child by way of education, building self-esteem and
instilling discipline in the classroom. We also
support the families through our social workers and
help pay some of the school fees to ensure that the
child does not drop out - and we provide alternative
education for those too old or too far behind to enter
regular school at or near to their grade.
In addition to teaching, feeding,
medicating and providing
challenging projects for poor children, we are working
with
at-risk pregnant adolescents, in the north of Peru.
We also have term projects involving poverty
eradication and
working with orphans.
We offer free Spanish lessons to our volunteers while
you are
with us (two afternoons per week).
Please have a thorough read of the volunteer page to
make certain you understand everything:
http://agendasos.com/bruceorganisation/bpovoluntee
r.html
You also might want to have a look at the useful
information
in an
E-mail from one of our first volunteers:
http://agendasos.com/bruceorganisation/emailsandra
1.html
You have applied to come at a time when we will
soon have more applicants
than we have available places With this in mind, we
highly recommend that
you confirm your places at the earliest opportunity:
http://agendasos.com/bruceorganisation/reservation.
html or
http://agendasos.com/bruceorganisation/prepayment.
html
And do let us know your exact arrival date as soon as
you have your tickets so we can be prepared to
receive you. We are delighted to do the extra
preparations required to help
make it possible for you to realse your elective
project.
All best wishes,
Nicole, Ana Tere and the Bruce team
From: Agenda SOS Int.NGO
<[email protected]>
Subject: Information pertinent to your Peru Dental
Elective 2008
To: "Alan MacLeod" <[email protected]>
Date: Tuesday, March 25, 2008, 9:55 AM
Dear Alan, - [please pass this along to
the members of your dental elective]
Here is information pertinent
to your approaching Dental Elective at Bruce
Organisation,
Trujillo, Peru.
1 - The licensed Dentist who will work with you during
the elective - urban and field clinic facilities - direct
supervision:
http://peruproject.org/dental2007/index2008.html
2 - Getting from Lima airport to Bruce Peru in Trujillo:
http://agendasos.com/bruceorganisation/lima2brucep
eru.html
3 - Amount of payment due now ($260); please go
here when ready:
http://agendasos.com/bruceorganisation/prepayment
02.03.08.html
4 - Please click here to receive our Welcome folder
for Volunteers http://agendasos.com/WELCOME/
5 - Please click here for all the information we can
think of to give you before coming:
http://bruceperu.com/peruinfo.html
6 - If one is thinking of bringing something for the
children.
http://bruceorg.org/2bring4kids.jpg
--Forwarded Message Attachment-Date: Sat, 26 Apr 2008 11:56:47 -0700
Subject: Confirmation of payment Alan MacLeod and
30
all in Dental Elective
Dear Alan,
You and (we presume) all your team are now paid up
through your PayPal payment.
Now all we and the local dentists and thousands of
Peruvian teeth await is your arrival.
Best wishes,
Nicole, for the Bruce team
31
APPENDIX 2
Glasgow Dental Hospital and
School
378 Sauchiehall Street,
Glasgow,
Scotland,
G2 3JZ
Dear Sir/Madam:
Application for Support
We are a group of four, fourth year dental students from Glasgow Dental Hospital and
School. This summer (June 2008) we will be carrying out our elective study. We have
decided to do a humanitarian project to a town called Trujillo in northern Peru. Our
study has led us to a charity called Bruce Peru, which has set up clinics for us to carry
out basic dental treatment on children and pregnant women. The children we shall be
treating will be some of the poorest in the country who do not normally have the
opportunity to access dental care. We are aiming to help the charity by providing our
services through treatment and promoting oral health in the community.
Although the charity has established the clinics, we understand they are quite poorly
equipped and are writing to you to ask if it would be possible for your company to
donate any of the following to help us provide dental care to an impoverished society.
The materials that we require are
• Glass Ionomer.
• Bur kits. (Basic)
• Gloves (Medium and Large).
• Scrubs
• Visors and masks
• Universal forceps
• Stainless steel crowns
• Wooden wedges
Any help that you could provide would be very much appreciated.
A copy of our elective protocol is enclosed to provide you some more detailed
information of our objectives.
Yours Sincerely,
Richard McNulty
For and on behalf of Martin Allan, Gordon McKinnon and Alan Ma
32
APPENDIX 3
•
•
•
•
•
•
•
The Paediatric Department of Glasgow Dental School
o £200 award
Perfection Plus Ltd / Surrey Precision Dental
o GI
o Gloves
DENTSPLY
o Hand instruments
o Dental Syringes
o Forceps
o Scalpels/Surgical kits
GC International
o GI
o ART instrument Kit
o Mixing Pads
o Spatulas
David Swinfen B.D.S.
o Cartridges of Local Anaesthetic
o Visors
o Gloves
o Alcohol Hand Gel
o GI
Gordon McKinnon B.D.S.
o Dental needles
o High speed burs
o Slow Speed Burs
o Forceps
Alba Bio-Science
o Postage and packaging of materials via FedEx
o The following pages lists the inventory of items sent. They are in
the form of an invoice.
We would like to thank all the companies and parties who kindly made
donations towards our elective. They were much appreciated.
Unfortunately, due to unforeseen circumstances we were unable to use the
majority of the above materials. However, we will donate all of these
instruments to subsequent elective projects that are carrying out humanitarian
work.
33
Alba Bioscience
Ellen’s Glen Road
Edinburgh
EH17 7QT
United Kingdom
Tel: +44 (0) 131 536 5907
Fax: +44 (0) 131 536 6799
VAT No. GB 916 5123 38
Despatch to:
Martin Allan
Bruce Organisation
Av. Larco 385
La Merced
Trujillo
Peru
Number of packages:
2
Type of packages:
Invoice no:
Invoice date:
BrucePeru280508 28th May 2008
Customer reference:
Dental supplies for charitable work
Despatch method: Despatch date:
Fedex
28th May 2008
Package identification marks:
Marked addressed to consignee
Weights and Dimensions of packages:
Dimensions: 1 @ 47cm x 36cm x 32cm & 1@
34cm x 33cm x 29cm
Standard cardboard airfreight cartons
Total weight: 24.72Kg
Product Description
Total
GBP
1. Schottlander, Latex examination gloves. 100 gloves – qty 10
2. GC Fuji IX glass ionomer cement. 50 capsules – qty 3
3. GC Fuji IX 1-1 PKG glass ionomer cement – qty 4
4. Dentsply, Chemfil superior, glass ionomer restorative powder, 10g – qty 3
5. Dentsply water dispensing bottle – qty 1
6. GC Fuji II LC power 15g – qty 1
7. GC Fuji II GP liquid 8g(6.4ml) – qty 1
8. GC Fuji ART kits – qty 4
9. Surgical face masks (boxed) 50 masks – qty 1
10. Surgical face masks (bagged) approx 50 – qty 1
11. Dental hand piece, high speed TCP450m, 4 hole – qty 1
12. Dental high speed air turbine hand piece, challenger SF1048 – qty 1
13. Perfection plus, Cotton rolls, 1000 cotton rolls – qty 1
14. GC mixing spatulas – qty 8
15. Kent dental, Lignokent. Lidocaine Hydrochloride 2% + adrenaline/epinephrine
1:80,000. Solution for injection. Art 957 925. 50 cartridges of 2.2ml – qty 5
16. Xylocaine 2% with adrenaline 1:80,000 DENTAL. Solution for dental injection
only. Lignocaine hydrochloride 2% with adrenaline 1:80,000. 100 1.8ml
cartridges – qty – 1
17. Dentsply 1.8ml imperial thread Aspirating syringe (2a), D SAK 887SGH – qty
12
18. Dentsply ASH periodontal kit – qty 1
34
CUSTOMS INVOICE
Goods covered by this customs invoice are for are not for re-sale
19. Perfection Plus, Temporary anatomical aluminium molar crowns – qty 1
20. Polydentia, Vista-tec, ultra-light protective shield – qty 1
21. Dentsply progress dental forceps – qty 2
22. Dentsply, Hand Instrument, stainless steel hand instrument (various) – qty 6
23. Pegasus, H-DENT, Dental Anaesthetic needles, 100 pcs – qty
24. Falcon Sugical Co LTD, SS – 200 mouth mirrors, 12 pcs – qty 1
25. Stainless steel dental mirror heads (bagged) – qty 11
26. 40 Dental Anaesthetic needles, long. (bagged) - qty 1
27. Dentsply, progress scissors, various – qty 5
28. Dentsply, Progress tweezer surgery – qty 7
29. Perfection Plus, stainless steel instruments, tweezers pack – qty 2
30. Perfection Plus stainless steel instruments, various packs – qty 6
31. Dentsply, Progress Elev Winters – qty 2
32. Perfection Plus, Stainless steel instruments, various extraction forceps and
elevators – qty 1
The above products are dental supplies for a humanitarian project (The
Bruce Peru charity). Goods are not for re-sale
Total value
for customs
purpose
only:
20.00GBP
For and on behalf of Alba Bioscience.
.
_______________________________________
35
Apendix 4
DIENTES SALUDABLES
•
Ten cuidado con tus dientes.
•
Sepía tus dientes dos veces cada día. Por la mañana y por la noche.
•
Usa pasta dental que contiene fluoruro.
•
Usa un cepillo de dientes con una pequeña cabeza
•
Limpia todos lados de tus dientas. Esto tiene que durar 3 minutos.
•
Escupe y no enjuaga con agua.
•
No come mucha comida que con azúcar como gaseosas y dulces.
•
Come azúcar solamente durante tus comidas.
•
Otros alimentos:
o Queso
o Fruta
o Papitas fritas
o
Agu
36
Appendix 5
Side 1
Side 2
37
Appendix 6
----- Forwarded Message ---From: Anne Murphy <[email protected]>
To: john allan <[email protected]>
Sent: Tuesday, 27 May, 2008 3:27:06 PM
Subject: RE: BRUCE PERU charity
John
We can send the goods by FedEx and have them held at Lima airport for
collection. They can be collected at:
Counter Faucett
Av. Elmer J Faucett 3350
Callao 1
Callao
Tel 517 166, Fax 575 1889
Opening hours: Monday to Friday 10-18 hours
Miss your Messenger buddies when on-the-go? Get Messenger on
your Mobile!
Date: Wed, 11 Jun 2008 16:16:50 -0500
Subject: Alan Martin URGENT
CC: [email protected]
Fwd: PARA LA ATENCIÓN DE MARTIN ALLAN - un estudiante
dental de Escocia, trabajo en la organización de bruce
We will provide the consignment number and a copy of the consignment slip ---------- Forwarded message ---------as soon as the goods have been shipped.
From: Nicola Thompson
<[email protected]>
We have been assured that these premises are at Jorge Chavez airport.
Date: Jun 11, 2008 3:26 AM
Alternative FedEx contact number in Lima is 00 511 517 1600 - just in case! Subject: PARA LA ATENCIÓN DE MARTIN ALLAN - un
estudiante dental de Escocia, trabajo en la organización de bruce
To: [email protected], [email protected]
The cost to ship the goods will be £280.00. We can have any duties and
Cc: John Allan <[email protected]>
taxes added to our bill - normally we would charge them forward to the
Dé por favor este mensaje a Martin Allan. Es urgente
consignee - this will remove the need to deal with customs and taxes on
collection in Lima. I don't know what the additional cost for these will be at
Martin
the moment but should not be too much. Goods will have a customs value
only invoice and all documentation will describe the goods as "not for
I have been trying to contact you regarding the clearance of the
resale"
shipment of dental equipment. Fedex called yesterday to request
that the goods are returned to the UK as they are not cleared.
We will put Martin's name as the consignee c/o the address below.
They are holding the shipment at the moment, however I am not
sure how long they will hold it for. Please can you contact me
We can arrange to have this shipped tomorrow if above acceptable. ETA is (telephone number 0044 131 536 5881/5907 or email:
Monday 2nd June.
[email protected]) to discuss.
Plse let me know if you want to proceed.
Thanks
Anne
From: john allan [mailto:[email protected]]
Sent: 27 May 2008 13:01
To: Anne Murphy
Subject: Fw: BRUCE PERU charity
Anne,
Here is the address in Peru.
Ideally, the boys would pick up the boxes in Lima, eg Fedex office.
thanks, John
----- Forwarded Message ---From: Martin Allan <[email protected]>
To: dad <[email protected]>; dad2
<[email protected]>
Sent: Tuesday, 27 May, 2008 12:38:26 PM
Subject: BRUCE PERU charity
this is the contact information from their website - there mailing address
appears to be
Bruce organisation, Av. Larco 385, La Merced, Trujillo, Peru
Thanks
Nicola
Nicola Thompson
Customer Services Officer
Alba Bioscience Limited
Ellen's Glen Road
Edinburgh, UK EH17 7QT
Tel: +44 (0) 131 536 5907
Fax: +44 (0) 131 536 6799
Direct Line: +44 (0) 131 536 5881
website: www.albabioscience.co.uk
-Bruce Organisation ngo is a registered charity
in Latin America, part of Agenda SOS International (1976) a
501(c)3.
www.bruceorg.org
there are other addresses also but says this is the mailing address. other
contact details are
+51 44949924445
[email protected]
Subject: RE: Peru shipment
Date: Wed, 11 Jun 2008 07:18:47 +0100
38
[email protected]
Hi Nicola,
I have had no luck contacting Martin either, but will let you know
when I do !
Regards,
John
John Allan
CEO
Direct Dial:+44 (0) 0131 536 5979
Mobile: +44 (0) 7831 343468
Sent: Tue 10/06/2008 16:35
To: '[email protected]'; John Allan
Subject: FW: Peru shipment
Hi Martin
I've just spoken with the Chamber of Commerce to get some
advice on this.
There is a Product Standards Agency in Peru and all products
intended for import must be registered with them - this regardless
of whether they are for resale or humanitarian aid. This is a
lengthy procedure and not something that FedEx can sort out.
FedEx cannot clear the products without the necessary approval
from the authorities.
Given that the products have been donated and we have very
little information about them, the Chamber of Commerce
suggested that it might be best if someone from the charity
contacts the Peruvian Consul in London to see if they can help to
get this cleared.
Their details are:
52 Sloane Street
London
SW1X9SP
Tel 00 44 207 235 1917
Fax 00 44 207 823 2789
E-mail:[email protected]
Sorry, I can't provide more positive information.
Fedex have confirmed that they will hold this at the moment but
please let me know if you are making any progress as they have
not confirmed how long they will hold this for
Regards
Anne Murphy
Nicola
Sent: 10 June 2008 15:54
To: '[email protected]'
Cc: John Allan; Anne Murphy
Subject: Peru shipment
Importance: High
Hi Martin
I have been trying to call your mobile and keep getting voicemail
so I'm not sure if you can get calls were you are so have left a
message. I have just had Fedex UK on the telephone. As the
goods have not yet been cleared they have had notification from
Peru that they would like to return the goods to us. I have asked
them to request holding the shipment there to give you a bit more
time to clear them. I cannot guarantee this will happen until they
come back to me and confirm. Can you let me know if you have
had any progress with customs in Peru
Sent: 06 June 2008 16:11
To: John Allan
Cc: Anne Murphy; '[email protected]'
Hi John
Just to keep you in the loop. Fedex UK have called to let me know
that they have been in touch with the consignee and they need
them to supply a breakdown of the value of each item on the
invoice, technical specifications for each item and a sanitary
requisition (this must be something specific to the country that
they need the recipient to provide)
I have attached a copy of the original invoice in case they want to
just add the values to this and re-print it.
Nicola
Nicola
Nicola Thompson
Ellen's Glen Road
Tel: +44 (0) 131 536 5907
Fax: +44 (0) 131 536 6799
Nicola Thompson
Ellen's Glen Road
Tel: +44 (0) 131 536 5907
Fax: +44 (0) 131 536 6799
Direct Line: +44 (0) 131 536 5881
Direct Line: +44 (0) 131 536 5881
Subject: RE: Peru shipment
Date: Mon, 9 Jun 2008 11:14:04 +0100
[email protected]
Subject: RE: Guia 635481927636
Date: Sat, 7 Jun 2008 02:38:26 +0100
To: [email protected]; [email protected]
Hi Christian,
39
This is a selection of odd bits of dental equipment donated to my
son and 4 other students going to work in a dental clinic in Peru
for several weeks. It is intended for charitable/humanitarian work
and has no commerial value.
It would be impossible for these students to gather the 'technical
specifications' for these odd bits of equipment. The suppliers who
donated these items (see attached) will not provide this
information and the students are now in Peru and don't have
access any way of getting this information or getting approval
from the Peruvian Health Dept.
I have attached information on the project that my son and the
other students are involved in. Can you pass this onto the
customs authorities to try and get clearance for these goods,
invoice, technical specifications for each item and a sanitary
requisition (this must be something specific to the country that
they need the recipient to provide)
I have attached a copy of the original invoice in case they want to
just add the values to this and re-print it.
Nicola
Nicola Thompson
Ellen's Glen Road
Regards,
Tel: +44 (0) 131 536 5907
Fax: +44 (0) 131 536 6799
John
Direct Line: +44 (0) 131 536 5881
John Allan
CEO
Direct Dial:+44 (0) 0131 536 5979
Mobile: +44 (0) 7831 343468
From: Christian Sierra [mailto:[email protected]]
Sent: Fri 06/06/2008 17:29
To: John Allan; [email protected]
Cc: Anne Murphy
Subject: Guia 635481927636
Dear John,
To: [email protected]; [email protected]
Subject: Re: Attn Christian Sierra
Date: Thu, 5 Jun 2008 12:17:59 -0500
Dear Mr Murphy,
Thanks for your email.
Dear Mr Allan,
We are asking to Peruvian Health Department wheter this kind of
supplies need authorization or not to be cleared.
Peruvian Customs notifies for clearing this shipment is required:
I will let you know as soon as possible,
* Comercial Invoice, Unit value included.
* Technical Specifications.
* Authorization from Peruvian Health Department.
Saludos,
Let me know your answer please.
Christian Sierra Torres
Agente de Importaciones
Servicio al Cliente
Regards,
Christian Sierra Torres
Agente de Importaciones
Servicio al Cliente
Grupo Scharff - FedEx
Lima – Perú
Teléfono: (511) 517-1600
Fax: (511) 5751890 / 575-1889
Email: [email protected]
Web : www.scharff.com.pe
"Servicios sin límites, para el comercio sin fronteras"
Grupo Scharff - FedEx
Lima – Perú
Teléfono: (511) 517-1600
Fax: (511) 5751890 / 575-1889
Email: [email protected]
Web : www.scharff.com.pe
"Servicios sin límites, para el comercio sin fronteras"
----- Original Message ----From: Anne Murphy
Cc: John Allan
Sent: Thursday, June 05, 2008 11:19 AM
Subject: Attn Christian Sierra
Dear Christian
Date: Fri, 6 Jun 2008 16:11:04 +0100
CC: [email protected];
[email protected]
Hi John
Just to keep you in the loop. Fedex UK have called to let me know
that they have been in touch with the consignee and they need
them to supply a breakdown of the value of each item on the
This e-mail relates to consignment number 635481927636 which was
despatched from Edinburgh GB to Lima and is for the attention of
Martin Allan, Bruce Organisation, Av Larco 385 La merced Trujillo.
We understand that you need the attached documentation to clear this
consignment.
If you require further information from us to help clear these goods,
please do not hesitate to contact the undersigned.
Thanks and regards
40
Anne Murphy
Commercial Manager
Ellen's Glen Road
Tel: + 44 (0) 131 536 5907
Fax: + 44 (0) 131 536 6799
Direct Line: +44 (0) 131 536 5708
41
42

A Humanitarian Dental Elective in Trujillo, Peru.

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