1. Educate each child, approximately 600 in total, in the four schools that we will serve in oral and hand hygiene and ensure that each child has a toothbrush, toothpaste and soap. 2. Provide general health and oral health screening, anti-parasite medication and fluoride varnish application to all children in the four school community. For our intervention, each child will have a medical screening examination, dental screening examination and fluoride varnish application by a PA. The students and teachers will then be educated and the children will be provided with toothbrushes and toothpaste. In addition to the oral health screenings and education, each child will be given a dose of anti-worming medication, albendazole and a daily multivitamin. Through the treatment of parasites, this intervention will help to decrease the level of anemia and malnutrition within this community. These improvements in health have the potential for long term enhancements in the cognitive and physical development of the school children. 3. Deepen our relationship with several local and international organizations that serve the Santiago Atitlan community and continue a train-the-trainer program in which we recruited and trained a local member of the community to become a school health educator. As part of this intervention, we plan to train her regarding oral and hand hygiene best practices so that this education is reinforced throughout the school year. This health education trainer will travel among the four schools throughout the school year to reinforce a health curriculum using engaging educational sessions and age appropriate health related books. In addition to the services Mayanza will provide, this reinforcement of the important educational content will provide a measurable impact in the long term health of this community. In order to successfully engage this community, we have relied on the partnerships with several other organizations with a presence in this community, including La Escuelita Puerta Abierta, The Sparks Foundation, BEAMS, and PEG Partners as well as local stakeholders within the schools. 4. Develop and implement an electronic record to track data for analysis of trends in the growth of school children and incidence of dental disease over time. The last piece of this project is the data collection and analysis to track long term outcomes in this community. The long term goals of this electronic record is to track health outcomes over time as part of our project evaluation which will shape our future goals and projects.

In 2018, Mayanza provided the supplies and trained personnel to continue an educational and health screening program focused on oral health screening and hygiene education. The team traveled to Santiago Atitlan in February and July, 2018. For our intervention, each child received a full screening physical exam including measurements of growth and vision screening as well as a dose of anti-parasite medication. In addition, each child had a dental screening examination and fluoride varnish application by a physician assistant, medical or dental student. Then, the school children were each given a personal toothbrush, toothpaste and soap. In addition, Mayanza supports a school health educator position so that the important concepts related to oral health and hand hygiene will continue to be reinforced throughout the school year. The schools were also provided with multivitamins to be dispensed daily by the teachers. Data was collected to measure growth, prevalence of anemia and the impact of oral health screening, education and prevention. This Program has built on the success of similar interventions in February 2016 and 2017 that were supported by the NCCPA Foundation Oral Health Grant. On the initial trip, the group surpassed initial goals and provided oral health screening, fluoride varnish application and education to 113 students. In 2017, the group saw over 300 children and in 2018 we almost 500 children in February and again in July. In addition, we provided anti-parasite medication to all children that are were screened. This intervention, in addition to hand hygiene education will decrease the rate of diarrheal illness and increase school attendance as well as overall health of this community. Mayanza will travel to Santiago Atitlan again every six months in February and summer of each year. The health educator will continue to work in the schools and her work will be reevaluated upon a return trips. Mayanza will continue to make semi-annual trips for the foreseeable future. The time before then will be utilized to gather and organize both donated and purchased supplies, and ensure providers have completed all necessary pre-departure education.

Mayanza is lead by a 3 female team of physician assistants with experience in clinical medicine and public health. We have capabilities in both human capital and financial resources. Mayanza has had a very successful record of recruiting highly qualified health care professionals and students as volunteers for our 2 week long in-country interventions. These volunteers have included physician assistants and students, medical students, dental students, nurses and public health students. Although we are a young not-for-profit organization, we have successfully applied for a received a number of grants, 4 in total resulting in over $20,250 in funding since our inception. Our interventions of fluoride varnish application, anti-parasite medications and vitamins are evidence based upon current medical literature and we use the results of the interventions to direct future endeavors.

Following this intervention, we expect the following short term outcomes: dental screening and fluoride varnish application to approximately 700 children, increased knowledge and confidence in proper tech-niques of tooth brushing in the children, implementation of twice daily oral hygiene measures and frequent hand hygiene. Our long term expected outcomes for the community that we impact includes decreased incidence of dental caries and infectious disease and the formation of partnerships to provide for expand-ed health services. This project will provide employment for a member of the local community who will provide long term reinforcement of the education that we will initially provide. We will continue to track the growth patterns, extent of dental disease and knowledge and confidence in oral hygiene in these children to understand the long term impact of our intervention.

Our greatest success this year has been a substantial increase in the number of children Mayanza was able to screen and treat. This is due to our efforts in working to gain the trust of the community over the past three years. To be able to increase the number of students we see to 500 is a sign that the families and teachers of this community trust our group to provide culturally competent, high quality care. This year we saw 200 more students in both February and July, than in 2017. The team was able to see most of the children again six months later to re-apply varnish and monitor the extent of dental disease with the dental screening. Our total number of interventions that were performed on school children by Mayanza in February and July 2018 was 997. Another success was the willingness of the children to have a point of care hemoglobin test. Many of the children do not routinely receive medical care and our team was unsure what the level of participation would be. Almost 78% of children screened were willing to have this test which surpassed our expectations and again was a testament to our level of trust in the community. Rates of anemia ranged from 40-47% across the schools which confirmed the need for anti-parasite medication and daily multivitamins. In terms of impact on the provider community, the seven clinicians were able to experience the personal and professional growth of working in a low resource environment, outside of their comfort zone with a patient population of friendly, appreciative, beautiful children. Many of the providers made comments about the positive impact these trips have made on them. A few examples are: “this trip helped me to remember why I chose medicine as a career” and “I did this trip to remember that I bring value in the service to others, that I have resources to share, and I can be a role model of positive behavior and attitude.” The full impact on the 6 students cannot be measured, however all of the students described an appreciation for the experience and a desire to continue to provide care in low resource environment when they complete their training. Having an experience such as this during the formative training years can potentially impact the future practice of these clinicians. Moving forward, we will continue the current project and have received two grants to enable a partnership with a local dentist and support supplies for all children to receive restorative dental care. We are also piloting a diabetes educational initiative with indigenous Maya women to prevent and treat the high risk of diabetes endemic to this population.