The Timor-Leste Dental Project expanded the horizons of my dental career. It was the first opportunity I have had to synthesise my passions for dentistry and travel alike – and found the experience to be deeply fulfilling. As our neighbours and a nation that has suffered tremendously in recent decades, the culture is profoundly welcoming and kind. Dental care is very low hanging fruit to pick in the pursuit to better the lives of people in Timor Leste – so your involvement is impactful. This is a reassuring feeling when working in an environment without any perks or luxuries that I am accustomed to in Australia! I loved the team and thoroughly enjoyed my time participating with the project. Moreso, my nurse even says I am more laidback after returning!
The TLDP’s volunteering year has come to an end after Team 5’s return last week. The team was big even by TLDP standards. The Australian contingent consisted of Team Leader, Dr Blanche Tsetong, returnee Dr Mary Tuituinnik and newbies, Dr Kim Hartley and Dr Lesley Leong, with Mr Keith Mentiplay arriving for Week 2. The Timorese division comprised the usual suspects – Mr Nico Pires, Ms Ana Tilman and Ms Ana Paula Salgado – with the addition of Mr Tino Morais for Week 2 – plus Dr Inda Dias rocked up for a couple of days during the first week and Mr Savio Moreira snuck in for a day and a bit . The ring-ins come to learn – we welcome all-comers!
Week 1 was spent in the Maubisse Subdistrict. After the quickest trip to Maubisse EVER – 2.5 hrs up the new, yet still unsealed road, the team was delighted to find that they could stay with the Carmelite community. In the preceding couple of years, our longtime partners had increasing difficulties fitting a team into their accommodation, and so TLDP teams were forced to try their luck elsewhere, with variable results. This time, the team arrived to a newly constructed building, which even had hot running water at times! As usual, it was an absolute delight to take their meals with the Sisters and the team was thoroughly spoiled with big breakfasts, feasts for lunch, scrumptious afternoon teas and multi-course dinners.
The team spent their first 2 days at Gruto School, which is down a steep, rough, dirt road. The views were fabulous. On the second day, as it was just down the hill from Gruto, Blanche, Ana Paula and Ana Tilman went down to see if there were any kids that had pain and wanted treatment. At first it seemed like it was going to be a bust – although plenty of kids dobbed in their mates, there were no volunteers. It just needed one brave child to break the ice…and then there was a full car!
The next 2 days were spent at Fleixa School, another school with a spectacular view, but with no electricity or running water. This was a large school on the main road to Same, and the team was flat out trying to get through all the kids, as well as see some of the adult members of the community. The difference between the more remote Gruto and Samoro, and Fleixa was stark – Fleixa’s kids had much more decay than the other two schools, probably because of easier access to junk food.
Day 2 in Fleixa fairly flew by, and it seemed like the team was going to finish work at a reasonable hour for a change. All the equipment was working, the sterilisation was finished and they were starting to pack up. Then Inda let in a ‘last-minute-easy-patient’. It took the combined efforts of one dental therapist and 3 dentists, plus an extra hour to extract that ‘easy’ wisdom tooth!
After an abortive attempt to work at the not-famous-Balibo School, the team’s final day in Maubisse was spent in the Sisters’ Clinic. Despite letters and multiple phone calls to the Principal, the team arrived after a gnarly drive up a goat track to find another spectacular view…. and the school deserted. At least the drive was interesting! The roads in the subdistricts are challenging and Leslie found this out on the job. In Sisters’ car, he had a near miss with a horse, got stuck in a rut on the steep track out of Gruto and fell into another ditch on the drive down from Balibo. It’s a good thing that he is blessed with unshakable aplomb!
The suction broke down on Day 1, necessitating hours of repair work; mysterious water leaks sprung from the dental units that were ‘fixed’ with gaffa tape and plastic cups; and there was a bunch of other niggly faults in the equipment that had plagued everyone for the whole year. Like all the teams before them, Team 5 treated this as par for the course, all the while counting down the days and hours to when our equipment guru, Keith Mentiplay, would arrive and make it all better. What made these little annoyances easier to bear was the team had managed to borrow 2 extra dental chairs from Solar Smiles while they were in Maubisse, and so the work still flew. Having 5 purpose-built chairs going at once made it easier to mentor clinicians without significantly slowing down the pace at which they saw patients. It was great! Thanks Solar Smiles!
The team left their beer in Maubisse. DISASTER. Luckily, this was mitigated by the arrival of two old friends – miracle-working equipment-whisperer, Keith, and long-time mentee, Tino – so Week 2 was off to a great start! Although the entire team stayed at Maubara this week there were so many people that they had to split into 2 locations to sleep. Dinners were raucous feasts with the Sisters at the Orphanage, which kept everyone super happy.
The second week was characterised by long commutes, dust-choked air and crowded cars. The TLDP’s School Dental Program includes 17 schools. Some of these are impossible for Nico and Ana Tilman to get to by motorbike – they are too far away and the roads are too rough – so a team is needed to help them out.
The team spent the first 2 days at Faulara, which is on the farthest edge of Maubara subdistrict. The drive took 1.5-2 hours each way and resulted in some extremely long days. There were lots of waterway crossings, and then a drive UP a waterway to the school. The first return trip shredded one of the tyres on our precious Troopie.
The teeth in Faulara were not too bad – again, probably due to the remote nature of the village. And there was electricity! Over those 2 days, the team managed to check all the kids, Ana Tilman performing her by-now-familiar toothbrushing pitch to all the classes, and everybody pitched in with treatment and mentoring. And in the meantime, Keith fixed and tested everything! The team was now working like a well-oiled machine, so they managed to finish early at Faulara, break down the clinic, and drive to nearby-ish Guiçu School to set up the clinic for the next day.
It was a huge relief to the team that Guiçu is closer to Maubara – only 1 hour each way on bad roads for the next 2 days! While most of the team was tasked to see the school under Mary’s watchful eye, Blanche and Keith were absent for most of the next 2 days. Blanche headed into Dili for meetings (and to buy tyres). Keith accompanied a grateful Tino on a 4-hour return motorbike adventure to Gleno Hospital in order to check out Tino’s non-functioning chair. He was able to get the drills, light and triplex working, but was unable to get the chair moving again – luckily, it is stuck in a good position! Keith also serviced all the equipment in our Maubara clinic and ran his eye over the clinic’s big generator, as well as the solar panels at the orphanage – the Sisters were so happy to have him there!
Working in TL requires adaptability, and our teams are characterised by a fluidity of roles. Team 5 was no different. All the dentists shared all the tasks, from mentoring of Timorese clinicians to accompanying Ana Paula to do a share of the examinations; Ana Tilman and Nico delivered oral health education either en masse or class-by-class; Kim, Nico, Ana Tilman, Mary, Tino and Leslie were at different times the work horses of the crew; and everyone functioned as steri-nurse and dental assistant.
It was a very busy 2 weeks and so the last day spent in Maubara clinic, winding down and taking stock was much-needed. Kim did a vital skill demonstration for our mentees, a few patients were treated, there was a bit of tidying up and the team had important personnel and team meetings, but essentially the day was for closure, and farewelling the Sisters for the year. Later that night the extended team, including translators Bony and Isa, reconvened for a rowdy end-of-trip-end-of-year dinner in Dili. After being kicked out of a cafe at the end of the night, the team lingered in the carpark – it is always difficult to say ‘Goodbye’ to our Timorese family.
Team 5 examined a total of 836 patients, extracted 348 teeth, filled 368 teeth, did 383 preventive treatments and 2 root canal treatments. YAAY team! We will see you all next year!
The fabulous Dr Steph Shields met Team 4 at an ungodly hour at Darwin Airport to deliver much-needed supplies. The first wave of the Australian volunteers consisted of team leader, Dr Peter Shakes, and team members, Dr Jeremy Lung, Dr Martin Ramlah and Ms Malita McCabe. They were joined for the whole trip by our Timorese team members – dental therapists, Mr Nico Pires and Ms Ana Tilman, Ms Ana Paula Salgado, our translator and admin extraordinaire and Mr Tino Morais, our long time mentee dental therapist, who is in charge of the Gleno Hospital dental clinic.
As usual, the first night consisted of packing and tidying at our base clinic in Maubara, then dinner with our partners, the Carmelite Sisters. Martin kept the Sisters entertained (and possibly scandalised) with Australian sayings, some of which may have not been entirely appropriate for the Servants of God!
The next morning the Team was off for 2 weeks in Atsabe, a 6 hour drive from Maubara. The first 5 days were spent in what is arguably the most scenic dental clinic that the TLDP gets to work in – the verandah of the Priests’ Residence. It is also one of the windiest locations – the Timorese shiver when they talk about Atsabe. However, the view more than makes up for the sporadic electricity and the icy morning baths!
Over the first 5 days, the team took care of the children from the local government and parish schools, as well as members of the general community. This is our second trip to Atsabe and like most places in TL, is desperate for dental care- the community was lining up for treatment before the team had even had breakfast! The week was punctuated by Nico’s 27th Birthday (he had cake for breakfast) and the local market day, where Malita did her civic duty contributing to the local economy.
Martin and Jeremy graduated relatively recently – almost 2 years ago – and these young sparks approached the transfer of knowledge and skills with great enthusiasm. Both worked closely with Nico, Tino and Ana Tilman to produce some very pleasing results – a number of the fillings on the front teeth would be at home at any high standard Australian practices and are testimony to the mentoring of the TLDP teams. Good work, guys! Some of these fillings were needed because of a local recent fashion trend of filing or deliberately chipping the front teeth – something we sought to discourage.
Having a dental hygienist on this team proved to be an excellent advertising tactic. On the third day, Malita got going with her cleaning and from that time on attracted a following of handsome young boys with shiny white teeth and typically TL wide smiles. These young boys recruited friends and family to attend for the remainder of the team’s stay. Great work, Malita!
Day 6 was changeover day and a very tired team had a day of relative rest. Peter and Nico did the 8 hour round trip to Dili to swap dentists. The trip started off a little shakily but at least they got the wrong turn out of the way early in journey! Jeremy was delivered to Dili and returning veteran, Dr Hans Raets, collected without problems.
Hans’ journey to TL had already been eventful. He had been flagged as a terrorist in Darwin, attempting to load a bomb (our new autoclave) on the Darwin-Dili flight. Personally, we would choose a less conspicuous individual if we were recruiting for a terrorist organisation – Hans is over 6 ft tall and is very distinctive. Luckily for us, Hans was eventually let on the plane after partial disassembly of ‘the bomb’.
The team worked one last day on their verandah before shifting to a new location. The village of Atara is only 10km by road, but it is a 1 hour drive as the ‘road’ closely resembles a goat track. The team arrived to find market day in full-swing, which necessitated a lot of shuffling of trucks and market stallholders before the team was installed in the open-air meeting area. Three pluses kept the team happy over the next 3 days – the old chief and his wife kept them well-fed and caffeinated, there was the luxury of electricity so no need to use the generators, and they were allowed to store the equipment onsite, so no need to set up and break down the clinic everyday!
The community had never had a dental service here before, which showed up in the large amounts of advanced dental disease in the adults. The children, however – screened at the local primary school by Martin and Ana Paula – had pretty good teeth, which is generally the case in the remote areas of TL – no access to junk food! With the dentists forming mentoring teams with the therapists, Malita manning the assisting and the sterilisation, and Ana Paula whipping them all along, the team worked through the patients with no problems.
On the penultimate morning, the team took their leave of Atsabe and headed back to Maubara for admin and housekeeping; stopping briefly at Gleno Hospital to drop Tino off so he could start his afternoon clinic. Tino is a great asset to the TLDP and demonstrates enormous enthusiasm for high quality, gentle dentistry. We have been mentoring Tino for 7 years now- he works voluntarily with as many teams as possible every year, simply to improve his skills. Nico has been employed and mentored by the TLDP for 3 years. In that time, both their skills have improved out-of-sight. For clinicians with limited resources, they have become excellent diagnosticians and they do some beautiful work. We are humbled by their dedication to their work.
This trip was exceptional in that everything worked – the team even had a functioning suction unit, unlike last year! And nothing broke down! The team itself was a fabulous blend of ‘old-er’ and younger dentists, a veteran dental hygienist, plus the enthusiastic, uncomplaining and capable Timorese. Together, they brought to fruition our shared mission to make a difference to the Timorese communities we serve.
This trip the team treated 710 patients, extracted 623 teeth, filled 162 fillings, did 69 preventive treatments and 43 cleans. Well done team 4!
It’s only a week after Team 4’s return to Oz – just enough time for then to pass the baton to our final team for this year. Team 5 hits Timor’s shores today and will be bringing with them enough materials to sustain our Maubara crew (and all our mentees) on the ground for the next 6 months – we won’t be sending anyone over until March next year. Fingers crossed we got the numbers right!
Team 5 consists of the TLDP Program Coordinator, Dr Blanche Tsetong, TLDP veteran, Dr Mary Tuituinnik, and two new volunteers, Dr Kim Hartley and Dr Leslie Leong. The team heads to Maubisse for a week and then will be finishing off the work in 5 schools in the Maubara and Loes regions. Have fun team!
Team 4 arrives early today in Timor-Leste. The volunteers consist of Dr Peter Shakes, Dr Martin Ramlah, Dr Jeremy Lung, Dr Hans Raets and Ms Malita McCabe. They will be spending the entire 2 weeks in Atsabe. Have fun team! See you when you get back!
It’s a rapid-fire dental service this year! A mere 3 weeks after Team 2’s return, Team 3 has now completed a lightning trip to TL, leaving scores of happier people in their wake.
The Australian contingent of the team all hail from Darwin – Team Leader, Dr Ashley Freeman, returnee, Dr Stephanie Shields and newcomers, Dr Jordan Kolsky and Dr Evelyne Cheng (a medical doctor). They were joined by our permanent Timorese team, Ana DJB Tilman, Nico TF Pires and Ana Paula DST Salgado.
The team eagerly arrived with 15 boxes of supplies on the Friday morning, but spent the majority of the day cooling their heels in Dili as they waited for the outgoing TLDP Lions team which was late coming in from the districts. The two arms of the TLDP (Rotary and Lions) share the Troopie between them, but rarely meet. Once the handover was complete, the team hightailed it to Maubara to pack – the team was spending one week in the neighbouring island of Atauro.
It was at this point the team realised that no Silver Fluoride had made it over from Australia! A disaster! This preventive treatment is a key component in our program and it allows us to save many more teeth than we would without it. So – the Silver Fluoride needed to be begged and borrowed from somewhere back in Oz, then sent internationally to TL, then picked up and sent to another island – all within 2 days. Was this team stymied? Not this team. They put their cool, problem-solving heads together, liaised with 3 dental surgeries in Darwin, arranged for a pickup and drop off to the airport, convinced Airnorth to bring the gear over with their crew, organised our Timorese friends to collect the material and drop it off to a boat which would then take it to Atauro; it was in the team’s hands for their first clinic on Monday. A BIG THANK YOU to BUPA Dental in Casuarina, Palmerston Dental and Smith Street Dental; to Dr Johnny Chen in Darwin, Airnorth, Isabel Noronha Pereira de Lima Maia in Dili, and Barry Hinton in Atauro for performing this logistical miracle!
Back to Saturday. The team had to arrive in Dili super-early in order to make sure that the 2 vehicles (and all our stuff) got loaded onto the ferry. A previous team had learned that having a ticket did not guarantee getting on the boat. Getting on and off the ferry is extremely stressful – there are people, livestock and vehicles everywhere and the ramps are steep and unstable. We have almost lost a car to the ocean during one of these manoeuvres previously. Apart from a stressful start, the team had an uneventful journey over to Atauro and were soon ensconced in the laidback simplicity of Barry’s Place – their home for the week – where they were well and truly spoilt by Barry and his team. The remainder of the weekend was spent relaxing, setting up, and organising the week ahead.
Steph and Ana Tilman shared a birthday on Sunday – Happy Birthday to them both!!!! What a special place to have a birthday!
The first three days were spent working in the Vila Maumeta Health Clinic. Atauro has a total population of 11500 people, and approximately 1900 live in the administrative centre of Vila Maumeta. The population is largely Protestant, in contrast to the Catholic-dominated TL mainland.
Atauro has no electrical supply between 2pm and 6pm, so during the bulk of the day, the team ran on a generator – not unusual for our clinics. There are also no petrol stations on Atauro, so thankfully Barry came to the rescue again when they ran out of fuel!
As well as the general community, the team was able to treat some of the local schoolchildren. Steph and Ana Paula screened all of Grades 1-6, but were less successful with Grades 7-9 as there was overlap with the school feeding program. Nevertheless, even with a public holiday to celebrate the 20th anniversary of the independence referendum, the team was extremely busy, with Jordan, Steph, Ash, Nico and Ana Tilman all treating patients, whilst Ana Paula translated, maintained the records, and assisted the clinicians. Evelyne functioned as sole steri-nurse, dental assistant and medical back-up for the team.
Most patients required multiple extractions and fillings. Atauro is an island whose population leads a largely subsistence existence. Many of its communities are remote and there is a high level of disease and few resources. Barry told the team that a number of villagers had died over the preceding year as a result of dental infections. Although the Ministry of Health says that they attend this island regularly; in fact, there has been no dental team here since the TLDP visited 2 years ago.
So when the people of Atauro have an acute dental infection, they have only two choices – to take repeated antibiotics (if they are available) or to travel to Dili where they can make arrangements for extractions. However, many locals are unable to afford even the cost of the ferry to the mainland. It is a sobering thought that this is commonplace across much of TL.
The team spent the last 2 days in the village of Beloi, a rough trip across mountainous terrain. Beloi has the largest population on the island – around 2500 people. Here, many of the locals only speak a local dialect, so it was really lucky that Senhor Lucas, the clinical director in Maumeta stayed to support the team throughout their entire trip. He helped with translating, crowd management, distributing pain killers and fresh coconuts for morning tea. Ana Tilman delivered oral health education to the Beloi kids, in true 21st century style – with a smartphone. Again, the team was busy here and they left after dark on their last day.
After breaking down the clinic in the dark, repacking the cars, catching the ferry back to the mainland, driving back to our Maubara base, then unpacking the cars and repacking the stockroom, then discovering a flat tyre on one car and changing the tyre, I am sure that the team was super-relieved to fall into the welcoming arms of the Sisters at the end of their trip.
All our trips are taxing, but due to the restricted days and remote location, this one was particularly intense. The team in total saw 371 patients. They extracted 657 teeth, placed 294 fillings, and carried out 40 preventive treatments. Good job Team 3!
Team 2 has returned home safe and sound. In the past couple of years, our teams seem to have become quite large as a general rule, as our Australian volunteers are matched in numbers by Timorese employees. This team consisted of Australian volunteers, Dr David Digges (Team Leader), Dr Henry Gilkes, Ms Liz Eberl, and the tag teamers – Dr Geoff Knight and newcomer, Dr William Hariman. The Timorese contingent consisted of Ana de Jesus Barreto Tilman (AT), Ana Paula Dos Santos Tavares Salgado (AT), Nicolau Tolentino Faria Pires (Nico), Isabel Noronha Pereira De Lima Maia (Isa), Bonifacio Cardoso Martins (Bony), and Diamantino Correia Morais (Tino). Hence, at any given moment, this team had 3 dentists, 2 or 3 dental therapists, a dental assistant/steri nurse and 2 translators/dental assistants/admin officers. A massive team!
The team spent the first few days hosted by the Sisters in Bobonaro. The girls got to stay with the Sisters themselves, but the boys were housed in the Sisters’Tuberculosis clinic – we suspect that they will be looking for some new digs next year! The team spent the first 2 days operating in the meeting room of Gumer Primary School, with the nearby High School kids walking over. Gumer is an isolated valley between Bobonaro and Maliana and there are 800 children in these 2 schools, many of whom have very poor oral health. The team soon realised that on Day 1, but were able to broaden their scope on Day 2.
For the remainder of the week, the team shifted accommodation to Maliana – this is the Big Smoke in this area, and the team gets to enjoy a little luxury. Isa’s Mom runs Restaurant Maliana, so the team is well-fed when they live here. Day 3 and 4 saw the team working out of a very impoverished village called Memo, 30 minutes west of Maliana and within spitting distance of the Indonesian border. They found it a little unerving to be able to see an Indonesian Military checkpoint from the school where they set up. The villagers here had never seen a dentist.
Day 5 was changeover day – the team started working out of Maliana Hospital. Bony and Tino arrived together on what would have been a very long, dusty and bumpy tandem ride from Dili. Bony still managed to look immaculate coming off that bike – some people just have that knack! Geoff headed back to Dili – any team lucky enough to have Geoff with them benefits from his wealth of knowledge, especially with Silver Fluoride, which we use extensively in our work over in TL. William had been picked up from the airport by one of Isa’s friends and was put straight on the tools when he arrived in Maliana – no problem for William!
The team spent the next 2 days treating the community as well as students from the High School. This team is impressive with its logistics. They split into two teams, with screening and transportation of the students carried out by Bony, Willian, Tino and Liz, and treatment carried out in the hospital by Nico, Henry and David. Translation, sterilisation and patient marshalling were efficiently handled by AP, Isa and AT. After working late, the team had sunset drinks on the rooftop terrace – a last hurrah with Isa, who is now employed by Maluk Timor as the Oral Health Coordinator for all the dental charities that come to TL – we wish her well, but are very sad that she will no longer be spending so much time with us!
Week 2 was spent closer to our home base, Maubara. Three days were spent visiting Loes Orphanage, which we have never been before, Loes School (one of our regular schools) and Tapamanolu School (last seen in 2012 – very hard to get to). This involved a commute of 40 min along the crumbling coast road. The last 2 days were spent in Ediri School, one of the schools in our program.
What a hectic schedule!!! The team did a fabulous job – there was heaps of mentoring for Nico, Tino, Ana Tilman and Ana Paula, a whole stack of work got done, and they all had a great time! Henry did a super job of keeping us updated on social media. What more could we ask for?
The TLDP is exceedingly lucky to have so many dedicated volunteers who continue to come back year after year. We are even luckier that we are supported in our work by dental companies such as Henry Schein and SDI. And we are the luckiest to have so many enthusiastic, hardworking, talented Timorese people working with us. We are immensely grateful in particular, to our primary partners, The Carmelite Sisters, who smooth our way through the bureaucracy of TL. Our program has carried on unabated despite constant changes in the Ministry of Health over the past few years.
Nico and AT have become an excellent home team. They are in charge of the Maubara Clinic and our school dental program – Nico is an excellent operator and has the confidence of the Sisters – that is a HUGE endorsement! Although we initially employed Ana Tilman as a dental assistant, she too is trained as a dental therapist and so is now also benefitting from mentoring within the team environment. Her skills are on the up!
We are especially lucky to have an unofficial Timorese Committee of bright, young people – AP, AT, Nico, Tino, Bony and Isa – they are expert problem-solvers and can-do people. They are unstoppable!
Team 2 itself was pretty lucky – there were minimal repair issues, although they did get a flat tyre on the way home from Maliana – changing tyres in the dust and heat could not have been fun. They also were the first to try out our brand new custom-made portable hand washing unit – for all those places with no running water (it was a hit! Conceived in the Sunshine Coast, Made in Grafton), and they were the first team to wear our new spic uniforms!!
Overall, the team examined 1350 people, they extracted 467 teeth, placed 770 fillings, and carried out 722 preventive treatments. Well done Team!