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Faculty-Led Humanitarian Outreach in Brazil

Caldana, Magali de Lourdes PhD; Bastos, José Roberto de Magalhães PhD; Santo, Samir Paiva do Espirito; Leite, Leticia de Azevedo; Alvarenga, Bianca Gonçalves; Rodrigues, Tayná Maiara Pilla; Santo, Cristina do Espirito PhD

doi: 10.1097/01.HJ.0000616128.47995.4a
Audiology Without Borders
Free

Dr. Caldana is a speech pathologist, an associate professor, and the head of the department of audiology and speech pathology at the University of São Paulo (USP). She is the coordinator of Project FOB USP in Rondônia. Dr. de Magalhães Bastos is a dental surgeon and professor in the department of public health at USP. He is the vice-coordinator of Project FOB USP in Rondônia. Mr. do Espírito Santo is an architect and a graduate student of public health at USP. Ms. de Azevedo Leite is a speech pathologist and a graduate student of public health at USP. Ms. Alvarenga is a speech pathologist and a graduate student in hearing and speech pathology at USP. Ms. Rodrigues is a psychologist and a graduate student in hearing and speech pathology at USP. Dr. do Espirito Santo is a speech pathologist at USP's department of hearing and speech pathology.

Since 2002, professors of dentistry and speech-language pathology at the University of Sao Paulo, Bauru, have been leading students to provide dental, speech, and audiology services to residents of the Amazonian state of Rondônia in Brazil. The expeditions are direct responses to the National Policy of Education (PNE2001-2010) initiative, the main purposes of which are to train health professionals and provide preventive, educational, and rehabilitative services in Rondônia. The expeditions aim to provide underserved communities with access to oral and speech-language health services, as well as to create holistic training opportunities for students to enhance their technical and social skills and expose them to diverse social, cultural, and economic settings, particularly the socioeconomic realities and health care needs of the populations served. These expeditions also aim to encourage collaboration with local municipal health managers in addressing the residents’ health care needs, including disease prevention, diagnosis, treatment, and rehabilitation.

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DENTAL & HEARING CARE FOR AMAZONIAN COMMUNITIES

Dental, speech, and hearing health care services are extremely limited in this region of Brazil. We serve two locations during our two-week trips: Monte Negro and Calama.

Monte Negro is a small city south of Rondônia's capital, Porto Velho, with a population of 14,000. About half of the residents live in an urban setting, and the rest stay in rural areas. In 2002, we chose Monte Negro for our first expedition because our university has a research center for tropical diseases, ICB-5, in the city. The mission of ICB-5 is to develop activities and studies related to population health and biodiversity. The center provides us with housing and clinical space so that we can serve the people in Monte Negro and the surrounding communities. The campus has four dental offices and three rooms for speech and language evaluations and therapy. Our last trip in July 2019 was the 39th trip to Monte Negro. We usually spend two weeks in Monte Negro in January and one week there in July.

In 2012, we expanded our outreach services to Calama, an Amazonian riverine village north of Porto Velho. It has fewer than 3,000 inhabitants, and is only accessible by boat. There are no oral, speech-language, or hearing health care services in the community, and it recently lost its primary care doctor to the withdrawal of Cuban doctors hired through the Mais Medicos program. Each one-way trip to Calama takes about 12 hours. During the dry season, we usually travel up the Madeira River on a Saturday night with all of our clinical equipment (e.g., dental chairs and tools for clinical testing and earmold making). From Port Velho, the transfer is a challenging process since the tools and equipment need to be brought down the port (about four to five stories high) to get to the boat, and, upon arrival at Calama, carried up to the river bank, then to the clinic in the village. Our work starts on Monday morning, and the boat becomes our home for the week. In July 2019, we completed our seventh expedition to Calama.

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VALUABLE STUDENT TRAINING

Student training is an important component of the expeditions. Faculty members supervise students from the university's dentistry, audiology, and speech-language therapy programs. Of note in Brazil, graduates of audiology and speech-language therapy get dual certifications. The students collect case history information, and perform speech, language, and hearing screening and evaluations. They also provide speech and language therapy, fitting of new hearing aids, and follow-up services to those who already have hearing aids. One of our team members is an earmold technician who makes custom earmolds for patients on site. Additionally, we provide counseling to family members and training for community health workers. We also refer patients who need long-term or more comprehensive services to tertiary hospitals in nearby states. We see an average of 400 patients during each trip.

In addition, we provide dental services—general dentistry, periodontics, endodontics, and dental surgeries—with a focus on preservation of the teeth instead of extraction. We educate patients on preventive measures and daily dental care practices. The dental faculty and students see approximately 600 patients during each expedition. Since 2010, joining the expedition has become an elective course for undergraduate and graduate students in the university's school of dentistry and the speech and hearing department. The students selected for the expeditions participate in pre-trip preparatory activities that address different aspects of providing services in rural settings, biosafety standards, and set their expectations for the trip. As of July 2019, 630 undergraduate and 220 graduate students in dental, speech, and hearing disciplines have participated in the expeditions.

In 2018, a medical school was added to the University of Sao Paulo, Bauru, campus. Faculty members and undergraduate students from the medical school will be joining our expeditions in 2020. With this wider collaboration, we look forward to providing integrated and interdisciplinary dental, medical, speech, and hearing health care services to the residents of Rondônia.

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