188.8.131.52 Work Experience The work experience varied across the five sites. 9 The therapist assigned to a hospital clinic in Site A worked alongside full-time dentists. Patients were scheduled for him on a regular, 1-hour basis. 10 The clinic operated from 9 a.m. to 5 p.m., 5 days a week. The therapist who was assigned full time to a subregional village also had patients assigned at 1-hour intervals, but the volume was considerably less, primarily because of broken appointments, which approached 50% according to her supervisory dentist. In the two sites where we observed therapists working on an itinerant basis, the therapists typically arrived on Monday morning and worked all week, from 8 a.m. to 8 p.m. There were broken appointments, but not nearly as many as in the other clinics we observed. All of the therapists were available for after hours emergency care, but this was a very infrequent occurrence. The problem of broken appointments is not specific to the DHAT program; it is a systemwide issue and has multiple causes. Often a patient would schedule an appointment with one of the itinerant therapists (or a dentist) because of a toothache. When the itinerant therapist arrived the following week, the patientâ€™s tooth no longer hurt, so he did not see the need to keep his appointment. In the villages where the therapist was stationed full time, the therapists reported that this availability appeared to make the patients complacent about keeping their appointments. Another factor that influenced clinic volume was the length of time each therapist had been practicing in the village. When one therapist first started going to a village 1 week per month 3 years ago, there were 16 pages of patients who needed treatment; by the time of our site visit, the number of pages had been reduced to four. One of the therapists did not have a chairside assistant and had to perform these functions as well. This therapist, located in a small village, could not find a local resident who was interested in the job, nor could the regional clinic support her. As a result, care was provided for emergency walk-ins only. Lastly, several dentists complained that in many sites there had been inadequate development of a system for identifying other patients available to be seen when appointments are missed or cancelled. All of the therapists interviewed had positive feelings about their job experiences. They felt gratified that they could provide needed services for their villages. Several said that they liked having the opportunity to serve their people.
We observed clinic operations in four the five sites; in the fifth, the DHAT was on medical leave and not working. The standard across all sites was 1-hour per DHAT appointment.