The Timor-Leste Dental Program has played a profoundly significant role in my life. I first encountered Dr. Sandra Meihubers, one of TLDP’s founders, while working for Justice Health in NSW. Upon expressing my interest in volunteering, she met me in Glebe, Sydney, where she assessed my suitability for joining the program. Evidently, I passed muster, as 17 years have swiftly passed by. That evening, I gleaned a valuable lesson—the TLDP is meticulous about the values, cultural sensitivities, and clinical, emotional, and psychological capabilities of its volunteers, a commitment that persists to this day.
In 2006, the young program employed a single Timorese dental therapist, had less than 12 volunteers in its ranks, and the teams took a very simple set-up on outreach clinics, with very few instruments, and hand-mixed, chemical-set filling materials. There was one portable chair, and very little equipment that required electricity. The teams were small and visited many different villages in central and western parts of TL. During those early years, access to electricity and running water was a luxury. Evenings spent with the Carmelite sisters, our partners, dining by candlelight, remain among my fondest memories. Mobile service was virtually non-existent, rendering a trip to TL akin to disappearing into a black hole for the outside world. It was two weeks of being fully present, long before ‘mindfulness’ entered popular consciousness. There were no tourists – just the UN, armed forces from many countries, and many other non-government organisations (NGOs) like us.
On my second trip to TL, Sandra also invited along one of her uni friends, Dr Wayne Pearson, and his dental assistant, Melanie Murray. This serendipitous decision birthed two enduring friendships. Wayne and I spent 10 years heading to TL in a team together, and Mel would have also carried on past the 3 years that she was with us, but for the frightening and dangerous episode of dengue fever that she contracted in Maubara one year. Thanks to Wayne, for a decade I equated a trip to TL with the consumption of a huge amount of pistachios and a beer at end of a day’s work. I was fortunate to have him on all those trips. I attribute my skills in field maintenance and my amassing of random facts about heavy machinery, road building, and farming to the countless hours I spent in his company.
I became Program Coordinator, seemingly by accident, in 2012, taking over from Sandra. The then still small committee of co-founder Dr David Sheen, Dr David Digges, Wayne, and I steered the TLDP towards where it is today – a much larger, focussed entity. Now in its 20th year, the TLDP has had scores of volunteers, many making it a regular event in their calendar. To foster continuity, our teams now return annually to work in the same subdistricts, hoping to compound our impact. Striving for sustainability and local ownership, we have employed two Timorese dental therapists full-time in the Maubara Clinic since 2017, supported several Timorese in their dental studies and provided clinical supervision and mentoring for countless Timorese clinicians who often present themselves to our teams on outreach. Most are employed by the Ministry of Health; some are newly graduated; all come to learn. It has been a privilege and a joy to work beside these capable and enthusiastic people.
Much has changed in TL over that time. Mobile phones with multiple SIMS are now ubiquitous, so communication with our Timorese partners has become simultaneously easier and more complex, with multiple platforms and languages in use. Our teams are much larger, and the Timorese members often outnumber the Aussies, which is wonderful! The teams also carry around a lot more gear – about three times as much as we did on my first trip – and can treat huge numbers of people each trip. Electricity and water are much more reliable, at least in the larger centres, but as the teams operate mostly in remote villages, we always carry water and generators. Sadly, those candleit dinners with the Sisters are a distant memory.
Timor-Leste continues to change at a dizzying rate, and not always in a manner that could be defined as progress. The exit of the UN and other foreign military after 2012 prompted a collapse of hospitality services for a few years; now with the increase in tourism, our teams are increasingly able to enjoy meals in cafes with mountain views or by the beach. Roads have improved on some of the major routes, and the trip from Dili to our base in Maubara has reduced from the once 3-hour odyssey to less than an hour’s journey; nonetheless, driving in TL continues to be a challenge in most of the country. In the ever-evolving political landscape, navigating TL’s governmental structures and its rules and regulations is a bamboozling exercise.
The need for dental care in TL remains high, with need far outstripping available services. t has been my honour to collaborate with everyone involved in the program, and I am pleased to entrust its capable leadership to Dr. Mary Tuituinnik and Dr. Henry Gilkes. I wish them fair winds and smooth sailing!
Team 4 was the smallest team in 2023 after a member pulled out at the very last minute and proved too difficult to replace. The Australian contingent of Team 4 consisted of Dr Mary Tiutiunnik and Kayleen Alexopoulos, a very experienced dental assistant from Adelaide.
Mary had the additional administrative tasks which fall to the last team leader of the year, and also happened to be the first team leader in TL after the triennial changeover of the Carmelite leadership, so had ambassadorial duties as well. Hence, she arrived in TL one week early to meet with the Carmelite Sisters’ new regional superior, Sr Odette, and second-in-charge, Sr Joaninha, who previously managed the Maubara Clinic. She was fortunate to be able to touch base with our beloved founder, Sr Filomena, who now works in the TB clinic, and she also visited Sr Feliciana who the TLDP is currently sponsoring . Sr Feliciana seems to be enjoying her studies to be a dental therapist and is passing her course requirements.
Sr Joaninha, Dr Mary and Sr Odette
The following day, Mary and Ana Paula met with Father Bong, the head of the Jesuit Mission in Railaco. He graciously took time from his busy schedule to show them around his clinic and give them afternoon tea. They then travelled up the road a bit further to Gleno to visit Tino, our longest-standing mentee, who is a very skilled and popular government dental therapist. As always, Tino was extremely busy at his clinic, with a line of patients waiting to see him but unfortunately, there was no power. Despite his busy schedule, Tino often takes leave to travel with the TLDP teams. After a quick look around Tino’s clinic, Mary and Ana-Paula travelled to Kasait to look at the Jesuit clinic next to a large Jesuit school and college where Team 2 often works.
The extra time in Dili was well needed to hunt for missing clinic supplies, some of which had failed to arrive despite being ordered over two months in advance. Mario, our friend from Rotarians Helping TImor, proved invaluable as he rang friends to find the best place to purchase the large number of gloves needed for the trip and for the clinic until a team returns in 2024. Dili had no small gloves to be found, and hand sanitiser proved very difficult to source since many people in TL thought Covid no longer existed and that hand sanitiser was now unnecessary.
Kayleen, Mary and Mario take a break from The Search
On Sunday, the team travelled to the Maubara clinic, collecting Timorese team members Ana Tilman, Ana Martins and Tino on the way. After a brief stop to pack the vehicles, they were off to Maubisse with a welcome lunch break in Laulara at Ana Tilman’s home. After a night in Maubisse, Monday morning saw two more Timorese health workers join the team, Imelda from the Carmelite clinic in Maubisse and Ricardo, one of the dental therapists from Maubisse Hospital, both of whom had previously joined one of our teams several times.
The team then travelled another 2 hours to Hatobuilico at the base of TL’s highest mountain, Mt Ramelau. The countryside was extremely dry, with fires burning in all directions, which made for a very smoky and dusty experience. However, we were warmly welcomed by the parish priest and set up our clinic in the large church hall. The next four days saw a steady stream of patients who mostly attended with toothaches.
Hatobuilico
Friday and Saturday were spent back at the Carmelite clinic in Maubisse where the team mostly saw adult patients needing fillings, as the local hospital clinic had no working handpieces or any means of mixing filling materials. We met up with Dion the dental nurse from another NGO, Solar Smiles, who happened to be Imelda’s brother and a local from Maubisse. Dion kindly took Mary and Tino to their Aladdin’s cave of dental materials, where we were able to replace some of the stock that did not turn up in Darwin. Tino was also given a wonderful supply of materials for his government clinic in Gleno.
Even our smallest of teams become large with local health workers flocking to lend a hand
On Saturday evening, the team bid Kayleen goodbye at the Timor Plaza where she was staying for a well-deserved rest before flying back to Darwin on Sunday. Sunday saw Ana Paula, Ana Martins, Tino, and two young nursing students from Dili having treatment at the Maubara clinic. The two young nursing students required 3 extractions, and restorative work and one had quite poor periodontal health for a 22-year-old something rarely seen in Australia these days. As Monday had been declared a holiday for a second round of local government elections for some districts, Nico and Ana Tilman were required to travel to their homes in Baucau and Ailieu to vote so the rest of the team did a stocktake and general tidy-up of the clinic.
On Tuesday the team set up at the nearby Catholic primary and junior high school, St John Paul 11 at Paurubo. Mary noticed a general improvement in the school since 2018 with renovations and the building of new classrooms; however, about 60 % of the children had decayed teeth. Sadly, the team was unable to finish the treatment at this school and it was hoped that the children would come to the clinic or the school could be revisited early in 2024.
In total, Team 4 examined 396 patients; extracted 278 teeth, placed 172 fillings and did 76 preventative treatments.
Team 3 returned quite a while ago….in fact Team 4 is now in TL. Even the ‘easiest’ trips are exhausting, especially for the Team Leaders, who go from being flat chat in TL to being flat chat on their return to work… here are a few notes on the trip from Team Leader, Dr Peter Shakes
Compared to post COVID 2022, 2023 team 3 trip was pretty easy. Smooth travels. No cancelled flights. No MEETINGS!
The Australian contingent consisted of Drs Peter Shakes, Ed Montgomery and Will Hariman – all dentists. The three met for the first time in Darwin International Departures with Will playing the “who looks like a dentist” game and winning!
We arrived quite refreshed in Dili, did the customs and visa thing, hastened by the highly esteemed Mario from Dili Rotary and met Ed’s soon-to-be-highly-esteemed son, Jack, who is living and working in Dili.
Timor Plaza, Leader Supermarket, local sim cards – this is starting to feel familiar…
We overnighted in Timor Lodge in preference to the Maubara Klinic and managed to see the Matildas beat France in the women’s world cup at an Aussie expat bar – great atmospherics even for someone who believes football of any worth can’t be played with a spherical ball !
Days 2-11…
Began with the now familiar long haul Dili-Maubara-Atsabe which takes pretty much a full day with 10+ hrs Timor Leste Driving!
Ed fell into the role of car 2 driver like an old hand, with Will doing a great job of GPS route checking.
We collected all 3 Annas (Ana Paula, Ana Tilman, Ana Martins) after a little confusion and some stressful u-turns and made our way to Maubara Klinic where Nico Pires was waiting with all gear fully packed and ready to load (of course!)!
Arrived in Atsabe after a quick lunch in Gleno just in time to see our first Atsabe sunset!
If we were cursing the state of the road being as bad as always, it was more than balanced by the place being as beautiful as always!
New parish priest, Fr Fidelis was now in charge; a young vital fella with a real enthusiasm for the Timorese people he serves and a pretty fine musician as well.
So the pattern emerges from day 3 with clinic set up on the front verandah of the priests’ house and a dentist or two with an Ana or two off to drum up business in the surrounding schools.
Timor being Timor, a funeral and a commemoration ceremony meant that most of the schoolchildren and teachers were either enroute to, in, or returning from said ceremonies in Gleno for the first few days.
We still managed to get a good solid flow of work despite this and we rotated screening trips between Ed and Will with the rest of the team keeping busy on our verandah clinic.
A 4 pm finish allowed most of the team to join Fr Fidelis on a village tour higher up the mountain where an enterprising individual has built the Timor Leste Eiffel Tower. Not sure how or why, but you have to award him points for enthusiasm!
Day 6 saw a priest meet at Atsabe with the priests from surrounding parishes in attendance. Many of them have supported our teams in the past but for the few that were new to us it was a good networking opportunity most ably pursued by our marketing team of Anas.
Ana Tilma, in particular, was in her element and now has direct phone access to most of the parish priests in Ermera.
This area has had little access to dental treatment since we were here pre-COVID despite having a dental nurse in the community clinic in Atsabe. In a familiar story, he has a clinic but pretty well no equipment or materials and no local anaesthetic. Fr Fidelis asked if we could set up and work for a time in a remote village in his parish known as Laçao. So after the Sunday morning off for those who mass to attend Mass we packed up and made our way to Laçao. The trip was slow, as we have come to expect, but a couple of the bridges were a point and pray moment that neither of us drivers enjoyed. It was not the bridges that caused the most concern but what appeared to be a clear stretch of road. It was here that I demonstrated for the benefit of the team that even 4WD doesn’t help if you have diagonally opposite wheels in the air.
The locals were as always helpful and got us back on the road without further incident.
Day 12-14….
We left Atsabe with a positive report from Fr Fidelis “you can stay for a month if you like” and an invitation to return next year.
The road to Gleno is pretty much the same going the other way – I spent the first hour on the way to Letofoho in first gear! I have passed here a number of times but it was the first time I had stopped here at the invitation of the priest who spoke very highly of the efforts of team 1. We stopped at Gleno Hospital on the way to Maubara and replenished Tino’s near exhausted local anaesthetic supplies and passed on some other restorative goodies he can’t get. [Tino is regarded by many of us in the TLDP as our biggest mentoring success story. He continues to join our teams every year to help out and gain experience, even though he now runs a busy hospital dental clinic – Ed.]. Back in the vehicles after a quick lunch and back to Maubara, with Nico and Peter making a detour to Dili to refill gas bottles while the rest of the team ate pizza in Liquiça!
Accommodation in clinic in Maubara with meals provided! Two days work at a school in Siamodo with about a 90 min drive each way. Normal flat out school with a great, friendly and curious group of kids with no water at all on school grounds. A very dry and dusty venue.
Last day was a half day – the team had worked every day for the last 12 days and was showing some sign of weariness. No complaints though. Back to Maubara to stocktake and clean and stow gear for the last team of 2023. Drop off and goodbyes as we returned to Dili for a last night at Timor lodge.
It seems that I’d only just finished taking my antimalarials from my last visit to TL, when it was time to visit the Doctor to get a new prescription and update my shots.
Of course, there had been a preamble for months. Organising our new team members, a flurry of emails from Blanche, the program coordinator, various docs for various bureaucrats, the logistics around stock and equipment and then who will transport what from where.
Team 2 consisted of the old guard Henry Gilkes, David Digges, Ana Tilman, Ana Martins, and Nico Pires, with the new faces of Rupa Mannan in the first week and Niamh Grant and Ben Abbott in the second.
Henry and David arrived into Dili on Friday, June 23 to be met by Mario, our Rotary man on the ground. Troopy delivered into our hands, we set off for the Timor Plaza Hotel to negotiate an upgrade to our budget single room. Fortunately, success was on our side. We also had the pleasure of catching up with Isa, a long-time helper of the TLDP, and meeting her very partner Levi. Isa regaled us with tales of her busy life, juggling work and studies.
Next morning it was an early start in the Troopy, picking up Ana Tilman (AT) and Ana Martins (AM) on our way to Maubara to collect the Sisters’ car and load both with our equipment. We’re met by Nico and in his usual efficient manner both cars are loaded with everything but the surgery kitchen sink and we set off back toward Dili. With a little time to kill, we visit the Carmelite stronghold at Fatuhada to fly the flag and chat with the Sisters and some of the young adults who live there whilst studying.
As ever, David managed to pull a crowd!
We split into two – Sisters’ car departed for the airport, raiding the Leader supermarket on route before collecting Rupa with her cargo of stock, whilst the Troopy headed up the mountain to get a head start on our portable surgery setup at the Jesuit stronghold in Railaco.
Reunited somewhat later, we completed the finishing touches, testing the equipment to find that the much travelled refurbished triple syringe was still misbehaving. Rupa was acquainted with the bathroom facilities and relived school camp by bunking with AT and AM in the dorm. We suspect there was a lot of talking after lights out!
Catching up with Father Bong and the other Jesuit priests for the evening meal before an early night to ready ourselves for the next day.
Somehow the news of our dental caravan is woven into Sunday mass and we hit the tools as soon as people left the church and wandered across to our clinic. No rest for the wicked – we had a full day of patients in their finest church attire.
Our working days start typically around 8am, usually rolling in to a group of locals who gather patiently at the clinic awaiting our arrival.
Our primary objective in Railaco was to work our way through the school students at the nearby Jesuit boarding school, finishing the job that we started last year.
With 6 operators we sent three of us on the 5 minute walk through the cemetery to the school. AT marshalled the children, they fill in brief details on a chit and then filed past two of us to be examined by headlight and loupes using a no-touch technique.
Having now created 2 groups, the “neehan diak” (good teeth) group wandered back to the classroom whilst we escorted those selected for treatment back to the clinic.
There is much nervous chatter discussing whether their paper says “solda” (filling) or “fokit” (extraction). The children face the dental unknowns ahead with stoicism, you can’t help but wonder how this would be going down in Australia.
We see many instances of children who have had chronic pain for months, unable to eat properly and surely affecting their academic performance.
The days settled into a similar clinical pattern, 4 chairs working generally flat out until we ran out of patients around 5.30. We rotated operators as needed, particularly when there was something interesting happening where we could observe and offer guidance to our local colleagues. We can see an improvement in their clinical skills from last year, Nico proving to be a master of extractions and AT revelled in rebuilding smiles!
After our last patient, floors are mopped, benches tidied and we hit the bathroom to wash off the daily grime. Dinner with our hosts with wide ranging discussions and then sometimes a quick tutorial about something pertinent such as nerve blocks and filling techniques.
One evening a guitar was procured and Rupa and AT regaled us all with their lovely voices and impressive musical prowess.
An equally noteworthy event took place during our time in Railaco, when an Australian couple, who had sponsored AM throughout her three-year dental hygiene course in Kupang, paid us a visit. Emotions ran high as AM, who had limited contact with her sponsors over the years, finally had the opportunity to showcase the skills her benefactors’ gift had bestowed upon her as a young woman from the Maubara orphanage.
Dr David and Ana Martin, her two benefactors, and Father Bong
Halfway through the first week, we received disconcerting news about our planned access to the Maliana Hospital in our second week. A high-ranking bureaucrat at the Ministry of Health (MoH) had taken it upon himself to disregard all previous correspondence regarding our legitimacy and insisted on additional documentation. It appeared that the change in government had brought everything to a grinding halt. Determined to resolve the matter, we procured necessary numbers, made calls, and engaged in back-and-forth discussions with the Carmelite Sisters. Finally, a vague promise was made that a decision would be reached by the end of the week.
By Wednesday afternoon we had finished in Railaco, so the next morning, we trundled down the mountain stopping for some photos in a traditional village, to the expansive Jesuit institution at Kasait.
Ensconced in the medical clinic, we unpacked and saw a trickle of patients who magically appeared. Treating ourselves to a pizza dinner at the nearby Lauhota Beach Bar in the late afternoon we found daylight fading early with a swiftly appearing thunderstorm. Note to self: driving at night is not much fun with other traffic sometimes having no lights and the Sisters’ car headlights powered by votive candles.
Friday saw a full day of children, arriving with their very organised signed parental consent forms.
Still, the decision from the MoH remained elusive. In a stroke of genius, we reached out to the Director of the Maliana Hospital, Dr. Monez. A call was made to the MoH, and later that day, we received the long-awaited good news: we would be welcomed with open arms.
Saturday morning saw the team arrive back at our “home base” in Maubara clinic. Our plan was to only see the orphanage kids and any Sisters that might require some dental attention. We are trying to teach the local community that our two Timorese colleagues are more than competent to treat them and not to wait until the foreigners come before seeking treatment.
Rupa enjoyed looking after her cute little patients before it was time to whizz her into Dili for her flight back to Darwin. In a seamless transition we also picked up Niamh and Ben from the airport with their much needed cargo of gauze. Then back to Maubara we went – it’s becoming a familiar trip with us now knowing the potholes on a first name basis.
We retired up to the peaceful surroundings at the Carmelite stronghold of Fatubese. Perched up on the ridge with lovely views over the ocean, its a pleasant introduction to life on tour for our new crew.
Back to the orphanage for dinner with the highlight being the distribution of presents to the assembled children. There is much excitement as balls are thrown, bubbles blown and T shirts tried on. Good luck getting them to bed early that night!
Sunday morning saw us on the long and adventurous drive to Maliana. It’s quite a picturesque journey, initially following the coast south toward the border with expansive views toward offshore islands and then passing large swathes of rice paddies. Coastal villages whizz by with their slowly drying fish dangling in bunches and newly minted bags of salt set neatly in rows. Children line the road in their Sunday best clothes, returning from church, often walking barefoot and carrying their high heel shoes.
At Batugade the road turns away from the coast and ascends the mountain toward Balibo. Memories of bitumen with a white line are soon forgotten and it’s slow driving with the road no more than a rutted gravel track with some forlorn strips of old tar.
The reward is a lunch of pizza and beer at the Fort Hotel in Balibo, an unlikely oasis in this rural part of Timor Leste. It’s also an opportunity for our new team members to visit “Australia House” and read the history of the 5 journalists who lost their lives here in 1975. A poignant place that has a small dental surgery attached, supported by dentists and donations from Victoria.
Then it’s back down the other side of the mountain, across the long bridge over the wide pebbled river, skirting the Indonesian border and we arrive into Maliana. With much low rise housing and plenty of trees, it is hard to see how this is Timor-Leste’s third biggest city.
Met at the hospital by Mia, our friend and local organiser, we were shown to our new clinical home for the next week – the hospital’s new Covid annex, purpose built a couple of years ago it sits unused, full of fancy hospital beds, flushing toilets and air-conditioned. Laying out our instruments and consumables, setting up our portable chairs in this perfect situation it seemed strange that until a couple of days ago the MoH was making our life very difficult.
Accommodation was up the hill at Bethania, a partially used seminary and not a hardship posting. A wide bed, air-con and mozzie screens left Niamh and Ben wondering what I was on about with my pre-team missives about the challenges of life on the road. To Niamh’s relief, we were yet to meet a crocodile, although it was early days.
Our brief for the next 5 days was to screen and treat the children in a local middle school, see the community who invariably arrives after hearing of us on the bush telegraph and minister to the young hospital staff.
Starting early, the team splits into those who start on already-formed queue we encounter as we arrived and those who head to the school in the Troopy.
At school, Ana Tilman works her magic, taking names and ages whilst those with loupes and lights pass down the row of desks, the children standing and opening wide to expose their teeth. Once we had a suitable number for the Troopy ( a number not found in the Toyota manual but we suspect close to 20) they were shepherded outside and transported back to our makeshift clinic. Clasping their small chits inscribed with their fate, they cluster in the hallway under Mia’s watchful eye.
Tuesday saw Dr David leave in a thunderstorm for the long trip back to Dili, an unenviable journey in wet and gloomy conditions. Thankfully, he survived!
By the end of the week we were a well-oiled machine, our favourable working conditions enabling a lot of dentistry to be performed.
Just as Rupa had shown our local colleagues some tips and tricks, Niamh’s oral surgery skills and knowledge provided valuable insights for us all. One lucky banana skin is still in ICU after being put back together in our evening tutorial.
Finishing our school project in the nick of time on the Friday afternoon, we carefully packed up after the last patient, took the obligatory photos with the local dignitaries and got ready to hit the town for a big night out in Maliana.
For the two Ana’s, this involved a mysterious ritual known as “preperating” that involved hair washing, a selfie, clothes trying on and selection, more selfies, makeup application, a final selfie for the road and then appearing fashionably late!
An early start on the Saturday for our trip back to Dili enabled us to call into a small orphanage in the Loes area to remove any painful teeth and perform some basic silver fluoride treatments.
We continued on to Maubara to unload the cars, stocktake and sterilise our recently used instruments. Delivering the Sisters’ car back to the Sisters, we farewelled Nico to bike it back to his family in Dili, while we continue on in the Troopy. Those sitting on the rear bench seats discover that leaf springs and potholes make sports bra wearing mandatory. And that was just the for the guys!
Spying a large plot of flat land near the road, Dr Ben provided some driving instruction to Ana Tilman who is becoming more accomplished (or less dangerous) every year.
Foregoing mass, we took a Sunday drive to the Cristo Rei statue with its views over the bay toward Dili before heading back to the airport, delivering the Troopy to Mario, expressing fond farewells and suddenly it’s all over.
Team 2 examined 1126 patients in our two weeks, removed 592 teeth, filled 173 teeth, sealed 470 fissured teeth, silver fluorided at least 520 teeth, and provided a clean for 52 new friends.
In addition, we had Ana Tilman stand in front of various groups of children to provide oral hygiene instruction, whilst in the clinic we pleaded “decrease your sugar intake” and “could you please limit your betel nut chewing to one a day”.
Of course none of this would be possible without those that sponsor us, in particular Henry Schein and Southern Dental Industries ( providers of the wonderful silver fluoride/potassium iodide). Also we operate under the aegis of the Rotary Club of Chatswood / Roseville which provides insurance cover for the team and a mechanism for tax deductible donations to the TLDP.
To all those who have donated, your contributions have been instrumental in supporting education, salaries for our Timorese staff, and the procurement of essential anaesthetics and dental supplies.
Finally, a big shout out to our program coordinator, who finds time in her busy life to marshal the teams, deal with sponsors, herd the cats, grey her hair with bureaucratic dimwittery, point the Carmelites in the right direction, WhatsApp the local crew and occasionally stamp her foot when required. (Thanks Henry-B)
Team 1’s Aussie contingent returned home 2.5 weeks ago. Team 1 consisted of dentists – Dr Leslie Leong (LL) and Dr Tom Li (Tom); oral health therapists – Ana Tilman (AT), Ana Martins (AM), Nicolau Pires (NP) and Diamantino Morais (TM); and admin organiser, Ana Paula Salgado (AP). Following is an excerpt from the team leader’s (LL) trip report:
Dropping in on the Saturday afternoon, Tom and Leslie were greeted to beautifully cool Dili day. Dili was a ghost town – peaceful, but somewhat unnerving. So election day swept through Timor (almost everyone who lives in Dili isn’t ‘from’ Dili, and has to go back to their home town to vote), which left Tom and LL the luxury of a day’s holiday. This was well-spent on underwater exploration.
On Monday morning, coconut and caffeine hit taken in, we set sail for Maubara. There, we picked up the sister’s Landcruiser, which thankfully was looking in much better nick that 8 months ago. With the two Toyotas at hand, we loaded one Toyota up with dental equipment and the other up with Ana’s (three Ana’s!). With now AM, AP, AT, NP, Tom and LL together, we needed only to sweep up one more (TM) on the way past Gleno, and we were ready to rock and roll.
Image: Team 1 – Left clockwise – Tom, LL, NP, AM, AT, TM, AP)
Up in the mountains made for stunning viewing. We were spoilt with views of the clouds sweeping across the valley while we sat and ate our morning bread and afternoon rice. The sisters were tight on space so the girls stayed with the sisters and the boys stayed in the priest’s guesthouse.
We set up in the clinic beside the church and were treated to an enormous room. Here, the community steadily flowed in. Tom slotted into the Timor rhythm like a seasoned pro. His Tetun for under a week of exposure was impressive! He also got involved in another TLDP tradition: screening and transporting kids from local schools. Does anyone know the Troopie’s max capacity? Tom and AT fit 15 littlies at one point.
Letefoho was super busy. Starting each day at 9am, we frequently powered on to 5-6pm. Extractions were Letefoho’s favourite procedure. They loved it so much that by day 4, we were running out of gauze. A generous donation from the health centre was welcome, and we also boosted supplies by modifying paper towels with a knife and scissors.
AT, NP, Tom and LL shared the duties on the two chairs reserved for restorations. What AT can do with limited materials is absolutely amazing. Her passion to improve a person’s smile is infectious. (Image above: AT performing her magic)
On the third dental chair, AM and TM were tag teaming nicely, with TM providing excellent mentoring along the way. It’s been really noticeable how AM’s extraction skills have improved since the last outreach trip. (Image below: Our longest serving Timorese mentee and volunteer, Tino, now mentoring himself)
AP was our trusty gatekeeper. Although she has been in Fiji the past few years, it really feels like she never left. How did we manage without her? (Image below: AP, organiser extraordinaire)
Three days in Letefoho turned into five. Our final two days were planned for Dukurai (30 min drive from Letefoho), however the sisters organised the Durukai people to travel to Letefoho themselves, saving us the pain of packing up and setting up once more.
The priest’s place was extremely comfortable. Fit with a dining room with million dollar views, and a table tennis table, it was relative luxury. There was the infrequent visit of a rat in Tom’s room, keeping the newbie on his toes [I probably was visited by that rat’s grandmother – Ed].
Each night, the team had dinner at the priest’s place, and then Tom and LL took turns dropping the Ana’s back to the sister’s place in the Landcruiser. Only perhaps a 1.5 kilometre walk, it was treacherous stretch of road. LL found the hard way, going down the wrong stretch of road, and having to reverse back for 400+ metres in the dark with a cliff on one side. Tom however, found out the very hard way, ending up in a ditch. Pulling the Landcruiser out required many, many helpful locals, the cheapest looking rope, crazy good knots, the Troopie, and several hours. Amazingly, no Landcruisers were harmed.
Travel day Sunday and heading back on simply awful roads on the segment from Letefoho to Gleno. We said goodbye to the ever smiling TM (but not before he pinched extra gauze from his health clinic in Gleno for us-thanks Tino) and plowed on. As much as LL and Tom love driving, they were pretty over it by the time we reached Maubara.
Monday struck another surprise. A close family member of Tom’s had fallen ill and he had to fly out later that day to go and see them. Onwards and depleted, a 1.5 hour drive to Lisadilla from Maubara and another 45-60 minutes of setting up, we were feeling slow.
Fortunately, the students of Filadelphia school had surprisingly excellent teeth (apparently a team was there a few years ago) and our workload was kept to a minimum.
Rinse and repeat for the schools of Folara on Tuesday and Wednesday, and the combined 5 hours of driving and setting up/packing down each day had us far more drained than any of the dentistry. Folara’s school however had a curveball.
Walking into our designated room, we were met with a dusty, messy heap that they called a library. It looked like it hasn’t been used in awhile and we soon realised why. Bees were flying through the open wall and had set up 3 lovely bee homes. Nico was more than up for it. Armed with tiny artery forceps, he extracted 3 bee hives, later to find out there were another 3 hives, only bigger. Nico had 4 stings after the rehoming and half a can of Mortein later, we had a bee free working environment. (Image above: Nico, our saviour)
Here we learnt that Thursday is ‘youth day’ and all the kids have the day off school. Got to love Timor’s schedule of public holidays. The team welcomed a day off and celebrated with a hearty bowl of Bakso, sate and many coconuts.
Back in on Friday with a visit to the final Lisadilla school. Nico has been a powerhouse in setting up the clinic day to day. The physical efforts and the efficiency in getting the clinic from the back of the Troopie and functional 45 minutes later is mighty impressive.
Friday flew by and we said goodbye to Lisadilla and those roads. Those roads will not be missed.
Bintangs all round closed out our two weeks in Timor for Team 1. Super proud of the hustle from the team.
A mighty effort from Team 1 and superbly managed by our youngest team leader yet. Well done Leslie. Team 1 saw 756 people, carried out 432 extractions, filled 126 teeth and performed 199 preventive procedures. Well done Team!!
Our charity auction has ended and we are pleased to announce a clear winner! Congratulations to the highest bidder – Patrick Mattu!!! Like many other Indian nationals, Patrick is an extreme cricket enthusiast. He also happens to be a fantastic local dentist, who lives and works in the regional Victorian town of Bendigo. Patrick is now the proud owner of the cricket bat signed by Steve Smith. Thanks for your support, Patrick!!!!
Find the auction post. Handy Hint: It will be the one with the cricket bat picture and the title AUCTION
Go to comments and change the filtering from ‘most relevant’ to ‘newest’. Write your bid for Steve Smith’s bat in the comments.
Bid must be must be $20 more than the previous bid.
Bidding ends Thursday 23 March 1600 AEDT ( Sydney time).
The bat must be paid for by Monday 27th March 1700 AEDT or it will go to the next highest bidder.
Buyer pays for shipping. The bay is in Sydney, so a pick-up may be possible to organise. If you need a shipping estimate please send us an email timordentalprogram@gmail.com
Once you have won, I will comment on your winning bid to let you know you have won 🙌
The third post-Covid team has returned from TL. The last team for the year always has the tough job of winding things up for the year, and planning for the next. Team 3 was led by Dr Mary Tiutiunnik, who was joined by Dr Leslie Leong and Dr Ashul Kaul.
In what seems to be the theme for 2022, this team spent a lot of time in meetings, and they started on Day 1! Hindered by road closures for the Dili Marathon, the first meeting of the Australian and Timorese members of the TLDP with the Carmelite leadership was late in the day. This was the first of several meetings to discuss a new Memorandum of Understanding (MoU) between the TLDP, Rotary, the Carmelites, and the Timor-Leste Ministry of Health. Meetings in TL are never small affairs, and this one was a party of 9 – the 3 Australian dentists, 2 Timorese dental nurses, Ana Tilman and Nico Pires, the heads of the Carmelite order, Sister Santina and Sister Inacia, the head of the Carmelite clinic in Maubara, Sister Fatima, and translator, Isabel Pereira. After the meeting, the team then made their way to the Maubara where they spent the night in the air-conditioned comfort of the Retreat House before heading up to Maubisse.
Lunch with the gang
The next day, dental therapists, Nico Pires and Ana Tilman promptly managed the packing of all the dental gear into the cars. After picking up another of our mentees in Liquiça, Tino Morais, who runs the dental clinic in Gleno Hospital, they made their way via the “shortcut” road to Maubisse. They stopped for lunch at Aileu and all agreed that the “shortcut” road was terrible and they would go the long way home the following Saturday.
On their arrival in Maubisse, they discovered that their Carmelite hosts were not due back until after dinner as they were at a ceremony on Mt Ramelau. They also discovered that Dr Inda, the Maubisse hospital senior dentist who organised the clinics for the next week, was away in Dili visiting her sick mother. At 8 pm that evening when the clinic director, Sister Angelica, returned, she, and Sister Eva informed the team that the road to their first clinic at Manetu was in a bad condition and that they should reconsider going there. Sister Eva did a quick ring around and it was decided that the team’s first two days would be spent at the Franciscan school behind the Maubisse Hospital, the next two days at Maulau as planned, and their last day at the sisters’ Maubisse health clinic. With the sisters’ enthusiastic support and this new plan in place, they all breathed a sigh of relief and happily retired for the night.
Ana Tilman, Rino, a doctor, Armando, the Maubisse hospital co-director, Nico, Sr Angelica, Dr Leslie, Dr Mary, Tino and Imel
On the morning of day 3, Sister Angelica accompanied the team to meet with the Maubisse hospital director. An important part of the program is meeting with other Timorese health staff and building relationships. They met with the co-director of the hospital and discovered that not one, but both, the Maubisse hospital dentists were away. Luckily, the team had the support of the Carmelites to ensure the organisation of their week!
Sister Angelica, Imel, the Carmelite clinic administrator, and Rino the technician joined the team and they set up at the big Franciscan senior and junior high school, Escola Santu Inacio de Loyola and Saõ Paulo. They were extremely busy and managed to treat every class at this school in two days! Imel and Rino were on loan for the week, so the team was very spoilt with a sterilising person and someone to record all the treatment.
The team was so efficient that they even had time at the end of the day to explore the market and the Pousada on the hill. As usual, the sisters’ legendary cooking and the cool weather were highlights of a week in Maubisse.
The team at Maulau: Tino, Mr Martins, Nico, Dr Anshul, Rino, Antonio, Ana Tilman Dr Leslie, Dr Mary, Imel, Sr Miranda and Ana Martins.
On Day 5 the team made their way to Maulau with Sr Eva. They were greeted by one of TL’s best school directors, according to the Timorese – Mr Martins, Director of the Maulau primary school. He stayed with the team throughout their visit ensuring the attendance and good behaviour of the students. He even made sure that the team was fed well, plying them with lunch and snacks! Over the next 2 days, they screened the entire primary school and the high school, treating students, staff, and community members.
On Day 8, the team took the long road home to Maubara. Serendipitously, this allowed a detour to Hatmatek waterfall, and a surprise stop at Ana Tilman`s home to have lunch with her big family (she has 11 siblings). Ana`s family home is about 15 minutes from Dili in a pineapple-growing region, so the lucky team bought a good supply to have back at Maubara.
Previously, teams would visit Black Rock Hotel in Caimeo Beach on their day of rest, but sadly this establishment has now been reclaimed by the sea. Nevertheless, there has been continued investment into the area, which is great to see. Over the last 19 years, the TLDP has seen so much change! On their only day ‘off’ the team headed to the new favourite hangout, Lauhata Beach Escape, for lunch, before Mary met with the Carmelite leadership for another MoU meeting. No rest for the wicked, Mary.
Klinik Maubara
The team spent the next 4 days on the sweltering coast. The first very hot two days were spent at a nearby health centre in Ediri, treating the community. The second very hot two days were spent at our base, the Carmelite Maubara Dental clinic where Nico and Ana are based. They were kept very busy treating children from the school down the road, as well as the Carmelites and the community.
The Australian contingent team were flying out on Friday, and Mary had yet another meeting on Friday in Dili with the sisters about the MoU, so the clinical week ended on Thursday. At the end of their second week Team 3 had examined 673 patients, extracted 402 teeth, filled 206 teeth, and performed 184 preventative procedures in some very challenging conditions. Good work team!
After the administrative frustrations experienced by Team 1 and the continuing logistical uncertainties that the TLDP is navigating, Team 2 faced our second post-Covid trip to TL with not a small amount of trepidation. Nevertheless, off they went to Dili, buoyed by an ocean of phone calls, emails, messages and video conferences via Whatsapp and Messenger.
The Australian contingent of Team 2 comprised Team Leader, Dr David Digges, Dr Henry Gilkes and Dr William Hariman. As is quickly becoming a trend for 2022, Day 1 was taken up by meetings.
First, the team met with Dr Sanjay Mathew, who heads the oral health program for Maluk Timor, another NGO with which the TLDP collaborates. There was a lively discussion about the issues facing dental care in TL.
This was followed by another meeting with the Big Bosses at the Carmelite HQ in Fatuhada. The aim was to discuss the program’s challenges and to agree upon future directions. However, the meeting also came with a lovely surprise for the team; Sr Inacia and Sr Santina were accompanied by one of the TLDP’s founders, our beloved Sr Filomena, who is now in charge of the running of Fatuhada. After so many years, they were thrilled to be reunited with our dynamic friend.
Sr Filomena, Sr Santina, Dr David, Dr William, Ana Tilman, Sr Inacia
Administrative tasks complete, the team then collected Ana Tilman and Ana Martins, did the shopping, and headed to Maubara, where they had another joyful reunion – this time with Sr Fabiola, the former ‘Big Boss’ of the Carmelites in TL. She is now a member of their World Leadership Council, based in Spain. Anyone involved in our program over the years would remember her dynamic spirit and her supportive, can-do attitude, especially when it came to the TLDP.
Sr Fabiola and Dr David meet again!
By Day 2 – Sunday – the team was all together – the Timorese contingent comprised our full-time dental therapists, Nico Pires and Ana Tilman, as well as newbie, Ana Martins, who graduated as a dental therapist from Kupang last year. The team packed up and set off for Maliana near the West Timor border. They stopped for lunch in Balibo; a town that achieved notoriety after five Australian journalists were murdered by Indonesian troops during the Indonesian invasion in 1975.
Nico Pires, Dr William, Ana Martins, Ana Tilman and Dr David – tourists in Balibo
On arrival in Maliana, the team was met by Noemia Pereira Noronha, aka Mia, the younger sister of our much-loved Isa. Like her sister, she has exceptional translating and organising skills and made the team’s lives substantially easier. For the 3 days the team spent in Maliana, they were accommodated in the Seminary – the food was good and excellent lighting for Dr. Henry’s nightly tutorials for the crew, which covered everything from how to give injections to dental emergencies.
Nightly tutorials with Dr Henry
The team worked out of Maliana hospital for 2 days and were extremely busy seeing the community. They happily shared some preventive dental knowledge with the hospital doctors and also provided much-needed clinical supervision and support for the newly graduated local Timorese dentists, Drs Nelia and Maria. They then spent a day working in the nearby village of Cailaco – they found it was faster to follow the riverbed than to use the roads – it still took them over 2 hours to get there!
Dr William wth new graduate, Dr Maria
On Thursday the team headed slowly over the mountains up to Bobonaro where they worked in the Sister’s Clinic over the next 3 days. There were some concerns about the possible lack of patients due to the visit landing squarely in school holidays. They needn’t have worried; there were plenty of patients and the team’s young crew thrived and developed well during these few days. As always, the sisters spoiled them with excellent food and lively company.
Joy personified – AT, Dr Wiliam and Mia
On Sunday, the team farewelled Mia in Maliana – she was needed back at her mother’s restaurant. She was such a great addition to the team – she was sorely missed during the seond week. Dr William also headed back to Dili to catch a flight to Sydney the next day. Feeling short-staffed, the rest of the team dropped the gear in Loes on the way back home to Maubara.
During the second week, the team spent the first 3 days in Loes where they worked in an outdoor village clinic in very hot conditions. Loes is located inland at sea-level, so it doesn’t seem to get any sea breezes and hasn’t got any of the advantages of elevation. They treated children from a local orphanage, as well as the general community, which included members of water police force, who we have never come across before.
Al fresco in Loes – Dr Henry supervising Ana Martins
Although Tuesday was a public holiday in TL (Independence Day), there was no rest for this Aussie-based team, who worked through to 4pm before taking a late lunch at the Lauhata Beach Resort. This proved to be serendipitous for the team because they then had the extraordinary privilege of meeting the President of Timor-Leste, Dr. Hose Ramos Horta! It was a great joy for both Ana’s not only to meet their President, but to also be allowed to have a photo with him. Dr Henry and Dr David took the opportunity to speak to him about the TLDP, and he expressed his thanks for our efforts and stressed the need for us to continue our program. He even suggested that if we continued having difficulties, he could make available space in the Presidential Palace!
AT and AM with the President
The following 2 days were spent in the TLDP base clinic in Maubara in sweltering heat. The effects of the pandemic were very much evident with more patients than ever before, queuing for hours to be seen. The Sisters were thrilled to see Ana Martins working with the team. Ana grew up in the Carmelite sisters’ orphanage in Maubara, and so she occupies a special place in their hearts. The pandemonium at the clinic increased even more when the other children from the orphanage arrived for their checkups! The team’s highlight that week was dinner with the kids at the orphanage – despite having taken out some of the kids’ teeth that day, they were still greeted with smiles.
Queues at Maubara
The last 2 days were spent in Railaco with the Jesuit mission, which functions like a well-oiled machine. After a spectacular drive up into the mountains, the rapidly tiring team were greeted with beers. The indefatigable Father Bong always knows how to make our job easier, and any team hosted by him can expect seamless support. The team was very happy to follow up Team 1’s trip, to continue working their way through the very large Covid backlog, before heading back to Maubara and then home.
This was a mammoth trip for Team 2, even by their own standards. It was longer than normal, and busier than normal, which in the heat is even more difficult physically and mentally. In total, Team 2 carried out 754 check-ups, extracted 528 teeth, placed 193 fillings, and did 240 preventive treatments. It was an enormous effort all round. Well done!
Deep in our hearts we knew that the first trip to TL in almost three years was always going to be an unknown quantity. A change in government with the accompanying change in administration meant that we had to renegotiate to be able to continue to provide the same services that we have provided for the past 20 years. And after over 6 fruitless months of texts/emails/calls to seemingly every official person in TL, we decided upon a new strategy:
Wing it.
So we sent in Team 1. The Australian contingent consisted of a single sacrificial victim – Dr Peter Shakes – who was to brave the sea of endless red tape for the rest of us. Luckily, he had the support of a hefty, indefatigable Timorese contingent, consisting of TLDP veteran dental therapists, Nico Pires and Ana Tilman, who have continued to run the Maubara clinic throughout the pandemic; our very able first mentee, and now head dental therapist in Gleno Hospital, Tino Morais, and new graduate, Ana Martins, who the TLDP supported through her studies. (Title image: From Left Nico Pires, Tino Morais, Ana Tilman. Image below: Ana Martins assists Tino Morais)
The trip was the typical mixture of trial and tribulation. After much paper shuffling prior to arrival, and expert shepherding by super-reliable Rotary Liaison Officer, Mario Jesus, Peter glided through customs. However, even Mario was unable to ensure that those pre-arranged meetings (that Peter had arrived early for) with the Departments of Registration, Pharmacy and Cooperation went ahead. The meetings were rescheduled for Monday and Team 1 lost a clinical day.
The weekend was spent prepping equipment for the week ahead and the boss of Maubara Clinic, Sister Fatima, ensured Peter received the full Carmelite spoiling. Peter and Mario returned to Dili on Monday morning for the big meetings – described by Peter as, “impacted third molar extraction without local anaesthetic would have been quicker, more productive and much more enjoyable”.
While the dealings with the government were unsurprisingly less-than-useful, the team’s woes continued, with the outreach plan being thrown into disarray by a mix-up with accommodation. There was no room for all of them in Maubara, so the team upped sticks and headed to west to Kasait.
Kasait was a treat for the team. The clinic staff were very helpful and the working conditions and digs were positively luxurious – three rooms with running water, power AND lights! The team worked in Kasait until the Saturday lunchtime, reluctantly declining another week’s hospitality.
Saturday afternoon saw a first in TLDP history.
The team made their way to an open flat area where Peter bravely conducted the Inaugural TLDP Driving Course. All Timorese members ‘had a go’ and all went well. Peter only had to employ the (emergency) handbrake once and although they only made it into second gear, considerable progress was made. Yet another step towards self-sufficiency! Well done Nico, Ana, Tino and Ana!
The second week was spent in Railaco, in the tender and efficient care of the redoubtable Father Bong. The team conducted clinics in Railaco Vila as well as Railaco Leten. As expected, Railaco was extremely busy and the team worked long hours. Luckily, with the exception of Ana Martins, everyone in Team 1 was a well-seasoned TLDP worker – Peter found that it was easier to just get out of the way of that well-honed team when there was any packing/unpacking/setting up/breaking down of the mountains of gear that we carry around. Indeed, the Timorese team members were at great pains to take good care of Dr Peter, affectionately calling him”Katuas” i.e. old Grandfather.
What was patently obvious to Peter this trip was that the TLDP’s Timorese mentee clinicians can now consistently provide high standard restorative treatment as well as competent extractions. They have highly-developed standards of professional competence, motivation and conduct – a testament to their efforts and those of the volunteers who have contributed to the TLDP.
Tino farewelled the team after the week at Railaco. The TLDP started mentoring him in 2011 and it is truly wonderful that he continues to take leave to help out the TLDP teams. He returned to his clinic in Gleno Hospital with the team’s excess local anaesthetic – a treasure in a place where supply is extremely limited. Meanwhile the rest of the team headed back to Maubara and thence to Dili and Oz.
The work with the government is ongoing. Team 2 is now in the zone.
Timor-Leste Dental Program 