August Atsabe and Atauro Adventures

Friday, August 1

The team gathered in Dili — Alison and I travelling from Darwin, and Yvonne from Denpasar. We spent the afternoon preparing for the coming weeks. The various checklists and inventory lists the TLDP provided were very useful here.

It was a strong team: myself with significant experience with the program, and Alison and Yvonne with a wealth of experience to draw on to mentor our Timorese colleagues. Yvonne and Alison speak Indonesian and Portuguese respectively.

Fun fact: about 15 years ago Alison taught at the University of Adelaide — and taught me how to hold dental instruments and do my first examination on another dental student. Small world.

The Atsabe Team (top back to bottom front):

Dr William Hariman, Paulo “Paul” Salsinha Martins, Yvonne Bass, Alison Taylor, Ana Paula D.S.T. Salgado, Angelo Moniz Amaral, Diamantino “Tino” Correir Morais, Ana José Martins

Saturday, August 2……….to Atsabe

Sunday, August 3

The mountain views were stunning.

Father Fidelius, the parish priest, was impressively organised. Instead of travelling to schools for screenings, he arranged transport for students and teachers to come to our clinic.

We set up in the morning and began treating patients after Mass. Ana Paula, whose organisational skills are exemplary, spoke with all patients initially and allowed for a structured pathway to receive their treatment.

One highlight was doing a surgical extraction with Tino, pushing the usual scope but going smoothly thanks to our combined experience.

We saw about 40 patients. Tino and Ana Martins worked well. Paul Martins was noticeably less experienced than the others, which underlined how important CPD and postgraduate education are in getting a new graduate up to the level of more experienced clinicians. Which isn’t just about hours but also requires deliberate practice and an expert eye. 

He especially needs practice with inferior alveolar nerve blocks, using a luxator, and caries removal.

39 patients seen. Procedure	Exam	Tooth Extraction	Filling	Scaling	FS AgF
Total	39	45	14	3	12 2

Monday, August 4

A demanding day. I focused on coaching Paul, our new graduate colleague, through extractions. My vocabulary was enough to guide him through extractions, I left restorative teaching to Ana Martins and Tino.

We couldn’t do school screenings as planned — it would have meant closing one of our three dental chairs. 

We saw about 35 patients in the morning and 28 in the afternoon — close to our limit.

One notable procedure: was a sectional extraction of a lower left 6 with Tino.

That evening we visited the local hospital, about the size of a large suburban medical centre. The director said he’d send their therapist and hygienist to join us.The dental room attached to the hospital is very small and clearly has limited supplies. The hospital director reports shortages of anaesthetic, gauze and needles. Their dental chair is a mobile hand-crank model, donated by Tino. 

Father Fidelius’ advance coordination meant we didn’t need to travel between sites, unlike past visits.

Procedure	Exam	Tooth Extraction	Filling	Scaling	FS AgF
Total	62	63	19	11	6 37

I noticed many patients had hard black arrested decay in self-cleansing areas — likely a result of our work here a few years ago. 62 patients seen.

Tuesday, August 5

We walked through the weekly market in the morning — busy stalls of clothes, household goods and produce. A pig was going for $350 USD.

Views of the market with the Priest’s residence (and our clinic) a top the hill

Maria, the local dental therapist, joined us today. She usually avoids firm extractions due to limited tools and mostly only removes mobile teeth. Her infiltration technique could improve — important given their limited supply of anaesthetic.

Tino and Tison each see about 20 patients daily and are known for handling complex cases. Maria usually sees 1–2 patients a day. Some even travel from Atsabe to Gleno to see Tino.

One notable case today was a failed three-month-old filling placed without proper surface preparation or drills.

Paul is steadily building skills. Maria would also benefit from coaching, especially in using luxators properly.

Hand scaling and curetting could be developed here — low-cost and preventive.

Paul treated 13 patients today (11 extractions, 7 GIC fillings, several cleans) under close supervision. Over the next few days, he worked with increasing autonomy — a very short, high-intensity period of mentoring.

Procedure	Exam	Tooth Extraction	Filling	Scaling	FS	AgF
Total	56	55	19	16	0	19

56 patients seen.

Photos of the clinic in action. Notably Tino and Ana Martins are working independently while Paul benefits from closer mentorship

We fed a stray dog who took to guarding our clinic

Wednesday, August 6

Final Day in Atsabe

I took a lighter role while Tino and Ana worked steadily.

We limited treatment to extractions and GIC fillings, capped at 20 afternoon cases.

Bintang, the stray dog, followed us around the clinic, begging for leftovers and, even attending church — smelly but very cute.

We finalised payments: accommodation had been quoted at $20/night including food, but this time they wanted to charge $40. After a sensitive discussion, made culturally appropriate with Ana Paula’s help, we negotiated food down to $9/day. This matters because costs come from Rotary Dili’s account, and higher costs mean fewer communities reached.

Paul showed strong growth under the guidance of Ana, Tino, Yvonne and Alison. Maria improved too and could use donated anaesthetics if she consolidates her skills.

One lesson reinforced: even if someone is inexperienced, close supervision works — starting with the simplest tasks and progressing gradually builds competence.

Father Fideliez said locals prefer our clinic to the public one, even though the public clinic has scaling instruments. In a conversation with Alison, he suggested that the locals only receive medications for pain at the clinic, rather than having any required treatment. 

.Procedure	Exam	Tooth Extraction	Filling	Scaling	FS	AgF
Total	55	64	14	13	0	17

55 patients were seen

Thursday, August 7

The drive back was long but smoother than the mountain roads.

The Atsabe parish’s high accommodation fees left the team feeling our work wasn’t appreciated. For now, we’ve agreed not to return soon.

We stopped to buy Timorese coffee and gifts. The local team spent the weekend in Dili with family.

Ana Paula, Tino, Angelo, Ana Martins and Paul gave Alison a heartfelt farewell — Paul even teared up when she said how proud she was of his progress.

Tino and Paul wishing farewell to Alison. Paul and Yvonne

Friday, August 8 ……a rest day in Dili

Saturday, August 9……onward to Atauro

Yvonne got us good seats on the ferry. Boarding was chaotic with livestock being herded aboard.

The priest said their church offices were recently broken into, so boys will guard our gear overnight. The beaches are lovely, seafood plentiful, and hygiene careful.

Making up for Alison’s absence Yvonne spent the evening teaching Ana Martins Uno, igniting her competitive spark.

We met the local hospital priest, who said the hospital has two OHTs and a dentist. Supplies seem fine. The Ministry of Health visits occasionally but mostly for general care.

Dive resort prices: $60USD scuba, $30USD snorkelling — very tempting.

Sunday, August 10…..a day of rest

A simple rest day — beach walks, swims, catching up on sleep and writing home

Monday, August 11…….into the Clinic

We set up in a hall near the hospital and met local OHTs Benjamin and Victor, and dentist Carmelita (from Dili, trained in Indonesia).

I watched Victor extract a 46. He used three carpules of lidocaine, showing this anaesthetic technique could use some improvement. He worked efficiently, using an elevator well and maintaining forceps control.

They lack restorative materials, root extraction tools, and have only enough instruments for one upper and one lower extraction before reprocessing. No chair or drills.

The Atauro Team left to right:Benjamin, Tino, Victor, William, Ana Paula, Yvonne, Ana Martins, Paul, Tison, Angelo, Carmelita

Procedure	Exam	Tooth Extraction	Filling	Scaling	FS	AgF
Total	22	26	8	1	0	5

22 patients seen.

We took brief dental histories and found many patients had waited 5–10 years for treatment, often due to fear or low trust. The new team only started in May — previously a GP acted as dentist, doing what he could- mostly prescriptions.

Currently the Atuaro Hosptial Dental Clinic sees 1–3 patients a day. This shows how much reputation matters: experienced clinicians like Tino and Tison are literally 10x busier because they’ve built trust and a reputation in their community and surrounding areas. Having observed the skill of Ben, Victor and Carmelita, I would say that skill isn’t that much of a limiting factor. The delay in the free healthcare utilisation on the island is probably due to limited awareness and marketing- letting people know that there is a new dental team and they are more capable than the GP who was trying his best 3 months ago.

Some locals hesitant to see the hospital team were happy to see us — perhaps due to seeing friends treated successfully.

Tuesday, August 12

One notable case: 30-year-old had persistent bleeding after extractions of 36–38. We used tranexamic acid–soaked gauze (500 mg crushed in water), which stopped the bleeding after suturing alone failed.

Victor, Benjamin and Carmelita were initially absent in the morning as they needed the hospital director’s approval to join us.

I mostly sat and coached alongside Carmelita as she did restorations. Which she rarely does due to limited equipment as this location but, feels she needs to maintain so her skills don’t rust before such equipment arrives in the indeterminate future. 

During conversation learned that this year there has been two other dental teams visiting the island this year. A ministry of health team- which brought extra materials and equipment, proving mostly logistical and administrative support while Carmelita did most of the procedures herself. And a Brazilian dentist who focused on preventative and restorative work.

A long day but slept fairly well considering the sound of the mouse gnawing through the thatched walls of our accommodation- I hope he doesn’t chew through much else.

Procedure	Exam	Tooth Extraction	Filling	Scaling	FS	AgF
Total	18	9	13	3	0	11

18 patients seen

Wednesday, August 13

I work up early to watch the sunrise at the beach and when heading back noticed Victor gifting us his morning catch of fish. A very kind gesture to express appreciation for our help.

I worked with Carmelita on fillings and root extractions. We also continues to talk to patients about how long they have been in pain for and why are they seeing us now instead of Carmelita earlier. One interesting observation is that life isn’t easy here and they are tough- waiting a long time for healthcare to be temporarily available has been normal for a long time. This here is the first generation of young dentists. Which probably means that us encouraging the community to attend the dental clinic in the hospital is important.

In the afternoon, Yvonne went diving while I snorkelled — pristine reefs and teeming fish. It was very refreshing to do a little bit of touristy/fun activities while here.Our Timorese Colleagues were able to run the clinic independently and well. Not only seeing patients and maintaining workflows but, also Tino, Tison and Ana Martins very capably mentoring the newer grads as well. In the evening, we grilled Victor’s fish with Ana and Tison’s freshly made sambal.

Procedure	Exam	Tooth Extraction	Filling	Scaling	FS	AgF
Total	29	22	26

29 patients seen.

Thursday, August 14

Another busy clinical day.

Villa Gracia has been a pleasant base despite noisy neighbours and a mouse chewing our clothes. The shady common area has been perfect for Uno games and escaping from the heat.

Paul has improved greatly, now handling trickier procedures. My concern is consolidating these improved skills — I strongly recommended that he should join future trips.

The young dental team at Atauro have decent fundamentals, are motivated and show great promise. What we covered with them was generally the uncommon and tricky stuff, what I would target most here is equipment so patient don’t have to wait for the hospital central sterilisation to be done after every second patient. Carmelita said the week was busy and she learned a lot. 

Points of improvement next time, earlier on we should match our record formats to match theirs and possibly work inside the hospital to show integration, though their rooms are less well ventilated — which matters on this hot island.

Procedure	Exam	Tooth Extraction	Filling	Scaling	FS	AgF
Total	42	54	19	7	2	20

42 patients seen.

Friday, August 15…….our final day

More patients arrived than we could manage. Victor triaged those needing extractions to return to see him, Ben and, Carmelita next week at the hospital- which fit in nicely with the wider strategy of encouraging patient to attend the hospital. One last thing we did was dispose of our garbage according to local procedures… by dousing it in diesel and burning it.

Carmelita said she enjoyed working with us and learned a lot, especially about the procdures she gets less exposure to i.e. fillings, sutures and root extractions.

We left her an extra set of instruments, including root forceps, so she can now do three extractions per sterilisation cycle instead of two. An improvement of 50% throughput increase.

Procedure	Exam	Tooth Extraction	Filling	Scaling	FS	AgF
Total	24	40

24 patients seen.

Reflections

347 patients seen.Procedure	Exam	Tooth Extraction	Filling	Scaling	FS	AgF
Total	347	378	135	57	20	12

I think revisiting Atauro would be helpful but, what they really need is more extraction instruments so they can more reliably treat patients in a timely manner. These three young clinicians are very promising

Prior to Paul joining, Ana Martins was the newest regular member of the TLDP and mentoring Paul reminded me of watching David, Henry and Ana Tilman take turns teaching Ana Martins years ago. It’s repetitive and takes time, but Ana’s progress is clear — this trip I saw Ana teaching Paul more complex anaesthetic injection techniques the same way she learned from 5 years ago. 

This demonstrates that through the program’s mentorship there is a growing pool of knowledge that has been maintained and passed on multiple times from the slightly older to younger Timorese clinicians with Paul representing the newest generation in that line.

While initially unsure due to his lack of experience, Yvonne, Alison and, I are proud of Paul’s development and look forward to seeing how much of this improvement he consolidates on future TLDP trips. 

It was tiring but, rewarding.

I am grateful to the team for their skills, insight and most of all, company. We have made a small part of the world a slightly better place and that means a lot. –Dr William Hariman