Dental Outreach Work In Zimbabwe

How to proceed step by step

Quentin Voellinger, 1998

Secours Dentaire International

INDEX

Introduction

First Step: First inquiring

Second Step: Establishment of a provisional ORW program

Third Step: Contact with the local authorities

Forth Step: Contact with the Rural Health Centres and Schools

Fifth Step: Definitive program

Sixth Step: Materials

Seventh Step: Organization

Eighth Step: Going out into the bush

Ninth Step: Coming back to the base

Tenth Step: Adapt your system in function of the local needs

Eleventh Step: Importance of the maintenance of the materials

Twelfth Step: Evaluation of the costs of your outreach work program

Last words

Introduction

Zimbabwe is a landlocked in south-central Africa shaped roughly like a water droplet falling from the Caprivi Strip of Namibia. It is situated entirely within the tropics -between 15 degrees south and 22 degrees south latitude - but most Zimbabwe consists of a highveld plateau lying between 900 and 1700 metres over sea level. The country enjoys a remarkably temperate climate. The rainy season is between November and February. Zimbabwe is bound on the north-west by Zambia, on the east and north-east by Mozambique, on the south - west by Botswana, and on the south by the Republic of South Africa. Four countries (Zambia, Zimbabwe, Botswana and Namibia) meet at a single point at the country’s westernmost extreme. Zimbabwe’s maximum width is 725 km, while north to south it stretches 835 km. The total area is 390’580 sq km, roughly about 9,5 times Switzerland’s size.

The capital of Zimbabwe is Harare and the whole country is divided into 8 provinces. English is the official language, Shona the first national language and Ndebele the second national language. Besides these 2 indigenous languages, about 15 dialects are spoken in Zimbabwe, depending on which tribe is concerned. The population grows at a rate of 3.5% and in 1991 (last official census), Zimbabwe had approximately around 11million inhabitants. The currency used is the Zimbabwe dollar (Z$) and the exchange rate in 1996 was CHF 1.- to Z$ 7.7.-.

Zimbabwe’s infrastructure is already on level which permits easy travelling, construction, introduction of institutions, industrial and health establishments. Despite of this, Zimbabwe’s economy is very low, but most of the inhabitants have access to school and health care facilities. Progress has been made in supplying arid regions with water in the development of irrigation projects for farming and agriculture.

In all African countries, it has been established that in the domain of dentistry, the situation has deteriorated dramatically over the past thirty years. According to the World Health Organization, we are witnessing a devastating increase in the number of cavities and gum disease in this area of the world. Various factors such as the unfortunate modification of eating habits which include excessive sugar intake, the lack of knowledge of the mouth and dental diseases and of their prevention, the shortage of health services available including qualified staff and management and lack of equipment, the overall poor health of the general population can often mask or worsen a dental problem. Not to mention the harsh environment with its demographic problems both socio-economic and geographic, can all be attributed to this decline in oral health.

Efforts have been made to set up clinics and “help Africans help themselves” in treating dental and mouth pathologies, but it has become quite evident, that it is utopic to wait for impressive results in oral health on a long term. "Dental-Aid International" has introduced dental health education in schools and has invested time and money in such prophylaxis programs. A coherent and credible prophylaxis program will be the only way to lastingly improve the situation created by teeth and mouth diseases in Africa.

Chikombedzi Mission Hospital is located in the south-east region (Chiredzi South) of Zimbabwe and belongs to the province of Masvingo. It is 96 km east of Rutenga, it is 128 km south of Chiredzi and 244 km from Masvingo. The population area served by this hospital is 30’000 for Chikombedzi, plus rural areas for a total of 100’000.

Chikombedzi Mission Hospital is owned and operated by the Free Methodist Church of Zimbabwe. The responsible authority is the board of directors appointed by the said church (Actual president Mr N. Zanamwe). The Medical Superintendant is the person in charge of the whole hospital, he is a licensed medical doctor and lives at the hospital complex (actual MSI is Dr Sibanda). The Dental Department is an integral part of the 160 bed hospital and has been fully equipped by the Swiss Foundation called “Secours Dentaire International” (SDI) since November 1993 (also called Dental-Aid International). The clinic includes a fixed dental unit plus a mobile dental unit (MDU), which is used for the outreach work in the Chiredzi South area. Most of the materials of the dental clinic have been financed through the regional Swiss Rotary Clubs and the Swiss Association of Albert Schweitzer.

At the Dental Department, the working staff is composed of:

A dental therapist with Zimbabwean diploma: Mr Manuel Chivavo (Upper-L)

An exodontist (aid-nurse trained by SDI): Mr Naison Lukas Chauke (Lower-L)

An exodontist (aid-nurse trained by SDI): Mr Clemens Sibanda (Lower-R)

An exodontist (aid-nurse trained by SDI): Mr Nelson Gonese (Upper-R)

Chikombedzi Mission Hospital is surrounded by 14 bush clinics (called RHC for “rural health centre”) which have been constructed by the Zimbabwe Ministry of Health. These clinics are located 25 to 100 km from the operation base which sits in Chikombedzi.

Each of the rural health centres (RHC's) are in the hands of a state certified nurse and at least one aid-nurse. Materials at their disposal in the bush clinics are essentially materials for emergency treatment (dressings, antibiotics … ). The major part of their work concerns the huge child welfare program and the local births. Two of the 14 RHC’s have a set of instruments for dental emergency treatments such as extractions and treatment of abscesses. The set is used by the state certified nurse in charge who has gone through an exodontist course of 3 months duration in Masvingo to become certified for applying such procedures.

After the dental clinic of Chikombedzi, the nearest dental clinic is to be found at Chiredzi Government Hospital (180 km) and the nearest maxillo-facial surgeon works at Bulawayo Government Hospital.

FIRST STEP: First inquiring

Before you start anything in any given country you must first inform yourself on the organization and local rules of the health system. In our case Zimbabwe, we did not inquire enough at the beginning and with passing time, we realized Zimbabwe had a very strict and complex health system. You should make a rough check of all such details to avoid future obstacles with government authorities.

The whole health system in Zimbabwe is supervised by the Ministry of Health which registers all health professionals and health activities. Once you are registered (and this is in itself a very long procedure), you must apply for a work permit. Without such a permit, all your activities will be considered as illegal.

The Acting Director of the Dental Health Services in Harare is responsible for all dental health activities and supervises the systems in the provinces. At the province level sits a Provincial Medical Director (PMD) who supervises his districts. On top of each district sits a District Medical Officer (DMO) who supervises all Medical Superintendants of the hospitals of the district. This last Officer (DMO) is also responsible for the local dental services. Further more, if you intend to go into schools for dental health education, you will need approval from the District Health Education Officer.

There are other aspects to be considered before setting up such a programme including:

· How many schools are to be visited and how far are they ? Problem of transportation, costs ?

· Is there already a similar program running somewhere nearby the place you’ve chosen ? And if yes, how does it work ? What is the attendance?

· What is the capacity of payment ? Treatments for free ? Do not forget costs of salaries, materials and maintenance ... must be covered

· In what conditions are the structures at disposal in the RHC's and are they O.K. to be used for installation of mobile dental unit (MDU). Is accommodation possible ? How are the roads and how is the accessibility during the rainy season?

· Did you want to introduce an outreach program or did the local population ask for such a program ? Give preference to the second case.

· How can the instructed population follow your education, accessibility of tooth brush and paste, costs ...?

Once you have thought over the above mentioned points, you must consider the question: “Are the factors inquired in your first evaluation more or less favourable to introduction of a dental prophylaxis program ? If the answer is yes, you may now begin with the local inquiries.

First you will get in touch with the Medical Superintendant of the hospital where the base of your activities sits. Together with the management of the hospital, you will localize the different rural health centres surrounding the area. In the case of Chikombedzi, the situation of the different rural health centres is as follows:

Masvingo Province, Chiredzi District

Outreach Work catchment area

SECOND STEP: Establishment of a provisional ORW program

Then, you will need to establish an outreach work program for the next 12 month period. Take into consideration the rainy season (roads passable) and the school holidays. During one ORW week, we usually drive to our next destination on Monday morning. Once arrived on the spot, the mobile dental unit (MDU) is equipped in the dental room of the RHC and then the dental staff meets the directors of the surrounding schools to organize the oral health instruction lessons. On Monday afternoon, the local children can return home with dental care information and inform their families of our stay at the RHC. Treatments can be delivered from Tuesday to Friday midday and on Friday afternoon, the MDU is packed and brought back to the base. For the year program, our first plan looked as follows:

Dental Department Chikombedzi Mission Hospital; Private Bag7075, Chiredzi, Zimbabwe

Outreach Work Programme For The Year 1996/1997

22 April - 25 April 1996 ; Malipati Clinic

6 May - 10 May 1996; Rutandare Clinic

20 May - 24 May 1996; Gezani Clinic

3 June - 7 June 1996; Samu Clinic

17 June - 21 June 1996; Dumisa Clinic

1 July - 5 July 1996; Davata Clinic

15 July - 19 July 1996; Muhlanguleni Clinic

29 July - 2 August 1996; Old Boli Clinic

16 September - 20 September 1996; Makambe Clinic

30 September - 4 October 1996; Chibwedziwa Clinic

14 October - 18 October 1996; Chilonga Clinic

28 October - 1 November 1996 ; Chambutta Clinic

11 November - 15 November 1996; Gezani Clinic

25 November - 29 November 1996; Rutandare Clinic

20 January - 24 January 1997; Malipati Clinic

3 February - 7 February 1997; Samu Clinic

17 February - 21 February 1997; Dumisa Clinic

3 March - 7 March 1997 ; Davata Clinic

17 March - 21 March1997; Muhlanguleni Clinic

31 March - 4 April 1997 ; Old Boli Clinic

First term: 16 January - 3 April 1996; Holiday: 4 April - 6 May 1996

Second term: 7 May - 8 August 1996; Holiday: 9 August - 9 September 1996

Third term: 10 Sept. - 5 December 1996; Holiday: 5 December - 7 January 1997

This program has been established on 12th of April 1996 in arrangement with the actual dental staff and the hospital management. This program has to be consulted and supported by the hospital management and the hospital administration. The dental staff members will plan their holidays during the periods of school holidays to provide the good running of outreach work.

The running of the program will be controlled and extended during the visits of SDI representatives.

Should the weather be inclement and/or roads impassable, the schedule will be adjusted to make the visit one week later. It maybe necessary to wait until road conditions improve (insert your new schedule on the regular schedule) In all cases the visits must be made up!

Signatures:___________ Date:___________

THIRD STEP: Contact with the local authorities

Before starting out, the District Medical Officer must be informed of your activities and must give you his approval for the program.

For the oral health education in the schools, you will meet the District Health Education Officer, who will need to give you his approval too and at the same time, he will be so enthused with your program and you might have the opportunity to receive all the addresses of the different schools in the district.

Addresses Of The Rural Health Centres & The Schools
Place	Clinic / School	Nurse in charge / Headmaster	Address
CHILONGA	Chilonga RHC	Mr J. Bvindi	Chilonga RHC, P.O. Box 142, Chiredzi
	Chikovo P	Mr Mepula	Private Bag 7104, Chiredzi
	Chilonga P	Mr Mutangirwa	Private Bag 7049, Chiredzi
	Chilonga S	Mr Museva	Private Bag 7097, Chiredzi
	Gwaseche P	Mr ?	Private Bag 7069, Chiredzi
CHAMBUTTA	Chambutta RHC	Mrs R Chakauya	Chambutta RHC, P.O. Box 142, Chiredzi
	Makhosiya P	Mr ?	Private Bag 7071, Chiredzi
	Chambutta P	Mr ?	Private Bag 7064, Chiredzi
	Chipinda P	Mr ?	Private Bag 7029, Chiredzi
	Velemu P	Mr Chauke	Private Bag ? , Chiredzi
CHIBWEDZIVA	Chibwedziva RHC	Mrs S. Muzenda	Chibwedziva RHC, P.O. Box 142, Chiredzi
	Chibwedziva P	Mr Makumi	Private Bag 7008, Chiredzi
	Chibwedziva S	Mr Ticharwa	Private Bag 7096, Chiredzi
	Masivamele P	Mr ?	Private Bag 7007, Chiredzi
	Chingele P	Mr ?	Private Bag 7072, Chiredzi
	Chingele S	Mr ?	Private Bag 7095, Chiredzi
MAKAMBE	Makambe RHC	Mrs r. Mashayanya	Makambe RHC, P.O. Box 142, Chiredzi
	Makambe P	Mr Shuma	Private Bag 7047, Chiredzi
	Makambe S	Mr Rukuni	Private Bag 7108, Chiredzi
	Tichidya P	Mr Balloy	Private Bag 7079, Chiredzi
	Chompani P	Mr ?	Private Bag 7053, Chiredzi
MUHLANGULENI	Muhlanguleni RHC	Mr H. Nyika	Muhlanguleni RHC, P.O. Box 142, Chiredzi
	Muhlanguleni P	Mrs Muguewe	Private Bag 7033, Chiredzi
	Muhlanguleni S	Mr Machaya	Private Bag 7038, Chiredzi
	Machindu P	Mr Gwachara	Private Bag 7028, Chiredzi
OLD BOLI	Old Boli RHC	Mrs P. Dhewa	Old Boli RHC, P.O. Box 142, Chiredzi
	Boli P	Mr Moyo	Private Bag 7034, Chiredzi
	Malisanga P	Mr Mazuma	Private Bag 7052, Chiredzi
	Majijimba P	Mr Moyo	Private Bag 7031, Chiredzi
GEZANI	Gezani RHC	Mr C. Sithole	Gezani RHC, P.O. Box 142, Chiredzi
	Gezani P	Mr Maponde	Private Bag 7062, Chiredzi
	Gezani S	Mr Gumbo	Private Bag 7105, Chiredzi
	Chilugwi P	Mr Mubaiwa	Private Bag 7090, Chiredzi
	Bondela P	Mr Chauke	Private Bag 7087, Chiredzi
	Pukupela P	Mr Macheke	Private Bag 7066, Chiredzi
	Makhanani P	Mr Mavu	Private Bag 7050, Chiredzi
RUTANDARE	Rutandare RHC	Mr C. Mhango	Rutandare RHC, P.O. Box 142, Chiredzi
	Rutandare P	Mr Shumba	Private Bag 7039, Chiredzi
	Maose P	Mr Zindove	Private Bag 7055, Chiredzi
	Chigalo P	Mr Masetese	Private Bag 7068, Chiredzi
MALIPATI	Malipati RHC	Mrs G. Machicho	Malipati RHC, P.O. Box 142, Chiredzi
	Malipati P	Mr Baloyi	Private Bag 7059, Chiredzi
	Malipati S	Mr Ndevele	Private Bag 7086, Chiredzi
	Ngwenyeni P	Mr N'Dlovu	Private Bag 7077, Chiredzi
DAVATA	Davata RHC	Mrs S. Gweyi	Davata RHC, P.O. Box 142, Chiredzi
	Pusani P	Mr Murira	Private Bag 7056, Chiredzi
	Davata P	Mr Magumise	Private Bag 7048, Chiredzi
	Gwaivhi P	Mr Muthelisso	Private Bag 7076, Chiredzi
SAMU	Samu RHC	Mrs R.E. Mbiza	Samu RHC, P.O. Box 142, Chiredzi
	Chishinya P	Mr Chinondiwana	Private Bag 7083, Chiredzi
	Samu P	Mr Mhakeni	Private Bag 7080, Chiredzi
	Mugivisa P	Mr Mupa	Private Bag 7099, Chiredzi
DUMISA	Dumisa RHC	Mrs E. Mugova	Dumisa RHC, P.O. Box 142, Chiredzi
	Dumisa P	Mr Chauke	Private Bag 7081, Chiredzi
Addresses Of The Chiefs & Headmen
Chief Sengwe	Pusani School		Private Bag 7056, Chiredzi
Headman Ngwenieni	Care of the local administrator		P.O.Box 199, Chiredzi
Headman Samu	Care of the local administrator		P.O.Box 199, Chiredzi
Headman Gezani	Care of the local administrator		P.O.Box 199, Chiredzi
Headmen Mpapa	Care of the local administrator		P.O.Box 199, Chiredzi
Headman Chilonga	Care of the local administrator		P.O.Box 199, Chiredzi
Headman Masimavele	Care of the local administrator		P.O.Box 199, Chiredzi

FORTH STEP: Contact with the RHC’s and schools

At this point, you know if an outreach program can be set up and is (or not) approved by the local authorities. Further more, you will know exactly which of the surrounding clinics could benefit from such a program. The next step will be to make a visit to each of your listed RHC’s and inquire about the necessity of prophylaxis lessons at schools (inquiring has to be done by the directors of the schools), about the necessity of dental treatments and at the same time, you will find out if the motivation and the cooperation of those responsible for the RHC’s are sufficient support your program. For the first visit, the following check-list has been established:

Questions To Ask During Your First Visit Into An ORW Area

1. Introduce yourself and your activities, introduce the hospital and the dental department

2. Ask for a meeting of about 30 minutes duration

3. Introduce the Chikombedzi Mission Hospital Dental Department ORW program

4. Explanation about your system of

-treatment and referring

-prophylactic lessons at schools and screenings

-information for pregnant women

5. Inform about your working hours: 8 am to 6 pm

6.Give the program schedule of the week concerning the MDU and the school lessons

7. Inform about the fee system and the importance of this financial support (trips and materials)

8. Following up after your departure, give document “Indications for the responsible of the RHC”

9. Give posters and ask for diffusion of the information, when are we coming …

10. What kind of medicines are available at the RHC?

11. Ask practical questions:

-accommodation, dental room, showers, toilets, ...?

-rooms have to be locked, possibilities ?

-water: Where is the borehole, river water, ...?

-electricity, solar, ...?

QV, SDI, 08.08.98

Chikombedzi Mission Hospital / Dental Department

Indications For The Responsible Of The Rural Health Centre

A. Capacities of the dental team during outreach work with the mobile dental unit (MDU)

a) Dental hygiene instruction to the patients e) Extractions with local anesthesia

b) Cleaning and scaling f) Little surgery like abscess drainage or suture points

c) Deep scaling with local anesthesia g) Prophylactic lessons at schools (grade 1 to 7)

d) Temporary and definitive fillings with local anesthesia h) Screening of the children in all classes

B. Capacities of the Dental Department at Chikombedzi

a) All the treatments given by the MDU d) Composites (esthetical fillings)

b) Definitive root treatments for single root teeth e) Oral surgery (jaw fracture, tooth luxation, abscesses)

c) Dental X-Rays

C. Kind of problems which can appear after a treatment at the MDU

EXTRACTING a tooth is like a small operation. There will be bleeding and later on some pain and swelling. This is normal and should

be expected after an extraction. Inform the person about that fact. After extraction(s), two main problems can appear:

One day after the operation, the socket still bleeds. Explain to the patient that he should not spit nor rinse his mouth. When he rests,

he should keep his head up. He should not drink hot liquids like tea or coffee because they encourage bleeding. The patient has then

first to bite firmly on cotton gauze for an hour, and again later if blood still comes out of the socket. Eventually, the nurse can do a

suture point if that is possible. If the bleeding persists, refer the patient quickly to Chikombedzi Mission Hospital Dental department

with a compress on the socket. Notice that any bleeding can be stopped by direct compression.

Rarely, the development of a bone infection occurs (infected socket. The signs are pus, pain and bad smell. Clean the socket

with a Chlorhexidine syringe and give an antibiotic:

First choice: amoxicilline 250mg caps adults 2cap x 3/day during 7 days

children 25mg/kg x 3/day during 5 days

Second choice: co-trimoxazole 80+400mg adults 1cap x 2/day during 7 days

children 8mg+40mg/kg/d. during 5 days

or co-trimoxazole 20+100mg adults 4cap x 2/day during 7 days

children 8+40mg/kg/day during 5 days

Third choice: erythromycine 250mg adults 2cap x 3/day during 7 days

children 50mg/kg7day during 5 days

It is important to persist on the fact that an antibiotic has to be taken during the prescribed duration, even if the pain and the

infection have disappeared. If necessary, give also a painkiller.

It is possible that a patient complains about sensitivity or pain after having received a FILLING. Usually, the pain occurs

during a few days only, the sensitivity can persist longer. Give some painkillers if necessary, but if pain remains after 3 weeks,

refer the patient to Chikombedzi Mission Hospital Dental Department.

After a SCALING or a CLEANING, the patient may complain about sensitivities appearing essentially during cold drinking

and bleedings of the gums appearing during brushing of the teeth. Scaling or cleaning of the teeth induces a microtraumatism

on the gums. These lesions disappear after a few days if oral hygiene is correctly maintained. Tell to the patient to go on with

tooth cleaning 3 times a day, even if it hurts a little.

The patients treated in outreach work by the MDU for a ROOT TREATMENT usually have received a second and a third

appointment for Chikombedzi Dental Clinic. Pain can occur during a few days after the first intervention given by the MDU.

Give a painkiller if necessary. Remind the patient that the next appointments are 100% necessary for a definitive treatment

and for the conservation of the treated tooth.

QV, SDI, 22.07.98

FIFTH STEP: Definitive program

After your first visit to possible sites, you will make a proposal to the hospital management for a definitive program. This program takes into consideration the collaboration of the responsible you have met at the bush clinics. In our case, the provisional program became definitive.

SIXTH STEP: Materials

Your project is now beginning to take shape and you have the psychological support you need. At this time you need to think about the materials you will use for the ORW. We have made a list of all the materials needed. The mobile dental unit we have is completely collapsible and can be loaded on a 4 wheel drive Toyota truck.

Check-list Of The ORW Equipment
		SDI Code	n°			SDI Code	n°
	Loading Accessories				MDU File
1	Canvas Cover	ZW	1	17	Loading Check-list		1
2	Ropes	ZW	2	18	ORW Statistics		1
3	Red & Blue Rack (Wedge)	QV	2	19	Reduced Map Of The Region		1
4	White Board	QV	1	20	Check-list For ORW File		1
5	Little Water Tank	ZW	1	21	Certified Letter From Medical Superintendant		1
				22	ORW Program Of The Year		1
	Repair Materials			23	Daily Registration Patients MDU		10
6	Spare Valve Toyota	ZW	1	24	Agreement For Administration Of Anesthetics		15
7	Valve Key	ZW	1	25	Dental Clinic Of Chikombedzi Receipts		100
8	Bicycle Hand Pump	ZW	1	26	Oral Health Education Registration		20
9	Spare Tube	ZW	1	27	Check-list Forms & Medical-Aid Forms		1/10
10	Tyre Levers	ZW	2	28	Services & Rates		2
11	Crick & Handle Toyota	ZW	1	29	Memory-Aid For Teachers		20
12	Nut Spanner Toyota	ZW	1	30	Indications For Responsible Of The Clinics		20
13	Spare Wheel Toyota	ZW	1	31	Rate of ...		2
14	Tube Patch	ZW	1	32	Use Of The Dental Car		2
15	Glue For Tubes Repair	ZW	1	33	Costs Of ORW		2
16	Craft Knife (Cutter)	ZW	1	34	Monthly Accounts		2
				35	Reports Of ORW To The MSI
				36	Instruction For Use Of Generator		1
				37	Evaluation Of ORW		2
	Generator Trunk Blue
38	Robin Generator RGD 3300 os (3000W, 24A)	9700	1
39	Set Of Spare Fuses	9705	1*		Compressor Trunk Blue
40	Set Of Various Packing	9708	1*	45	DUERR Compressor 5211 With Dryer	9901	1
41	Air Filter Robin	9709	1*	46	5 m Air Tube With Connection	9915	1
42	Oil Filter Robin	9710	1*	47	DUERR Compressor Filter	6027	2*
43	Gazoil Filter Robin	9711	1*	48	DUERR Desiccation Filter	6027 a	1*
44	Starter With Cable	9706 a	1*	49	Pneumatic Connection	6029	1
	Little Black Trunk
50	Stäuble Suction Machine with Safety Bottle, Big Suction Bottle and End	9906	1
51	Suction Tube	9913	1
52	Plastic Glasses	ZW	5
53	Ink Bottle	ZW	1
54	Spare Philips Lamp 35 Watts	9904 a	1
55	Philips Lamp (chase) (see n° 308 for Tripod)	9904	1
56	ORW Money Box With 20Z$ In Coins	ZW	1
57	Dental Study Model "Nissin"	9000	1
58	Enlarged Toothbrush P3-TB	9001	1		Middle Black Trunk
59	Mupani & Mubhubhunu Green Branches	Bush	20	80	Gas Bottle	ZW	2
60	Tool Box With	ZW	1	81	Reserve Gas Valve	ZW	1
61	* Starter Cable Robin Generator	9706	1	82	Domino Camping Stove + Metal Cup	9510	1
62	* Tap for Supertank n° 57027	9503	2	83	Sensitive Paper Tape	Hosp	1
63	* Screw Spanner 10, 12-13, 14-17	9701/2	3	84	Steribags	Hosp	3
64	* Pliers	4513	1	85	Paraffin Bottle	Hosp	1
65	* Sharp Pliers	4512	1	86	Paraffin Lamp & Funnel	ZW	1
66	* Big & Little Screw Spanner	4598/9	2	87	Pressure Pot, Perforated Bottom, Save Valve, Lid	9908	1
67	* Dish Screwdriver Set	4504	1	88	Candles & Matches	Hosp	1
68	* Plastic Dams	4507	2	89	Hatchet White & Red	ZW	1
69	* Electrical Screwdriver	4515	1	90	Paraffin Cooker	ZW	1
70	* Teflon Tape	4517	1	91	Migros Working Gloves (Pair)	CH/ZW	1
71	* Flat Nose Pliers	4514	1
72	* Hose Clips	4516	2
73	* Insulating Tape + Scotch Tape	Hosp	2
74	*String (in meters)	Hosp	15
75	Mirror Box With	ZW	1		Mecadent Dentaport Suitcase M 101	9900	1
76	* Demo Looking Glasses	9004	8	92	Flexiflon Tube & Pedal (6 x 4)	9902	1
77	* Chalk Box for Blackboard	9006	1	93	Air Tube with Midwest Connection (to n° 46)	9915	1
78	* Displak Coloration Bottle	9005	1	94	Air-Water Pistol Faro With Tube	9911	1
79	* Cotton Balls For Displak Application	3007 b	10	95	Support for Pistol And Contra-angles & Screw	9911 a	1

		SDI Code	n°			SDI Code	n°
	Big Black Trunk n° One				Big Black Trunk N° Two
96	Inox Steel Kitchen Utensil	9514	1	118	Silamat-Silver Mix 90 Amalgamator	9903	1
97	"Campina" Service (knife, fork, b & s spoon)	9513	2	119	Plate Drier Small/Big Or Kitchen Linen	9518	9
98	"Marco" Plate Aluminium 18 cm	9512	2	120	Red Basin For Sekusept	9515	1
99	Blue Basin With Lid (Sadza)	ZW	1	121	Green Basin For Vimbath	9516	1
100	Orange Basin With Lid (Vegetables, Soup, Meat)	ZW	1	123	"Marco" Glass In Aluminium	9511	2
101	Little Blue Lunchbox (sugar, rice, spices)	ZW	3	124	Sekusept Granulated Little	3127	1
102	Bottle Of Oil (Olivine)	Hosp	1	125	Orotol Granulated (Tin)	3005	1
103	Dish Soap Bottle (Sunlight)	Hosp	1	126	Hypochlorite Disinfection-Solution-Spray	1016	1
104	Shower Soap (FA Light)	Hosp	1	127	Styrolog 1 Drawer	1014 g	1
105	Toilet Paper Rolls	Hosp	2	128	Svedia Tray Cover 4030-00	2067 a	7
106	Pillow	Hosp	2	129	Duett Ana 2000 Amalgam Caps Set	3056	1
107	Big Cooking Pot	ZW	1	130	Decontamination Bath Brown With Cover	CH	1
108	Little Cooking Pot with Lid (=>pan)	ZW	1	131	Suction Tip Brushes Small 5mm	3132	10
109	Teapot With Lid	ZW	1	132	Suction Tip Brushes Wide 10mm	3131	10
110	Tea Plastic Cups	ZW	2	133	Metal Brush For Burrs	3100	1
111	M'Goti (Porridge Stick)	ZW-Art