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TLDP Team 3, June 2024

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/        TLDP Team 3 Visits Railaco,  Kasait, Maubara and  Maliana 

June 2024

It was a case of getting the band back together for Team 3 with Dr David joining Dr Henry and old friends Ana Tilman, Ana Martins, Ana Paula and Tino, together with our new travelling colleague, Tison. 

For the first time, we ran two teams back to back which was something new for our Timorese colleagues. This would involve meeting Dr Mary and her Team 2 colleagues in Dili, taking possession of the cars and equipment, dropping them to the airport and we would be on our way. Our rough plan was to travel up to hilltop Railaco to stay with our Jesuit friends, back down to the Kasait medical clinic and then pass through Maubara to visit far flung Maliana close to the Indonesian border.

 Dr Henry arrived first with some concerns as to how the airport customs officers would view his stash of anaesthetic and new equipment. Getting a chalk cross on his suitcase and told to go unpack everything over there didn’t sound great. However, pointing to the Rotary logo on my polo whilst mumbling the words “Carmelite Sisters, Mario and Rotary” seemed to do the trick and I was pointed to the door. 

Dr David who arrived on the next flight took the opposite tack, taking his chalk cross as a tick of approval he disregarded instructions, assumed an imperious air and strode for the exit unhindered.

It was good to catch up with Dr Mary and her new volunteers over lunch, exchange news, hear about their travels and any problems that may have arisen. One of which was the Sisters car needing some mechanical love before it could proceed, which involved running around rush hour Dili to find some expertise.

The next morning saw us depart Dili, picking up our local team members along the way for the trip up to Railaco.

Met by Father Bong, he allowed us to appropriate his small medical facility and we transformed it into a squeezy 4 chair dental clinic. We saw a trickle of patients that afternoon which became a flood after our presence was advertised at mass the next morning.

 

In parallel, we continued our screening and treatment of the children at the secondary boarding school next door. It was gratifying to see that the classes that we saw last year were generally dentally healthy, allowing us to do some less invasive treatments such as scaling and cleaning teeth. However the new (to us) incoming Year 9 class had plenty of problems to attend to with these students coming from a range of socioeconomic backgrounds over a large regional area.    

Father Bong and his Jesuit compatriots are great hosts, understanding that our team brings much needed dental help to their community and we all enjoyed their stash of altar wine and lively after dinner conversations. 

After 5 days we packed our portable gear away and travelled down through the hills to the medical clinic at Kasait, adjacent to two schools and a small University. A mix of academic staff and community were seen on the first day with the next day devoted to students and their self diagnosed issues. There were some clever ones who could get into Ana Paulas queue with a pain issue only to have it disappear in the chair but “could you clean my teeth while I’m here”. 

It can be a problem allocating resources, generally an abscessed tooth trumps teeth cleaning but it’s not easy to keep everyone happy. 

As always, Dr David would wander through the waiting area, triaging the throng, those needing a simple extraction would have their anaesthetic administered sitting on a semi private stool and would be nicely numb when a dental chair became available.

 

Friday afternoon saw us packing up our stock and equipment into the two cars, with all hands on deck we can get this process down to just over an hour with no nook and cranny left unfilled.

An hours drive down the road saw us at our Maubara clinic, a quick wash and a change of clothes and up to the Carmelite orphanage for dinner.

Visiting the children is something of an institution for us, familiar faces to say hello to and then the much awaited presentation of our gifts. T shirts, balls, hair ties and bubble blowers are dispensed with much laughter and general chaos. 

Of course the most famous ex student of the orphanage is our very own Ana Martins, making the jump from being Dr Davids 15 year old dental nurse to studying dental therapy in Kupang and now accompanying us on tour.

The next morning with the cars already fully loaded, we had some time to check the orphanage kids teeth (to be treated in the near future by Ana Tilman) before setting off on the 4 hour drive to Maliana. 

 

The main coast road is much improved with Chinese road building companies in evidence, but the goat track from Batugarde up to Balibo certainly needs a little love. The reward for making the bumpy ascent is to visit the Balibo Fort for pizza and refreshments, always a hit with the Team. 

Then onward to Maliana for our planned rondevoux with the empty Covid ward in the big regional hospital. 

A small fly in the ointment was that they weren’t expecting us, with the security guard suggesting we should make an appointment to see the Director on Monday. But wait…there was the Director making a random weekend visit to his office…….corralling him we explained the situation, blaming the lack of warning of our visit on beaurocratic bungling in Dili and with much nodding and shaking of hands we were given the keys to the  salubrious Covid wing of the hospital. Air conditioning, tiled floors, flushing toilets and plenty of power sockets…….what more does an itinerant dental team need?

News of our arrival spreads fast and for the next 5 days we are kept busy seeing hospital staff, other community, local clergy and many students from a large Catholic boarding school 3 kms away. Not one to look a gift horse in the mouth, their mercurial headmaster sorted out any staff and children with dental issues and drove them to us for treatment.

We even were able to co-opt some of the students as dental nurses, the 10 minute rapid training module proving adequate to hold a dental sucker or the hand of one of their colleagues.

Our evenings included time for discussion about issues that may have arisen through the day, ranging from endodontic treatment, bleeding control through to how to treat a dislocated jaw.  

One situation we needed to give consideration to is what to do when a very young child presents with multiple abscessed teeth that would be best treated using a general anaesthetic. We are placed in a difficult situation, wanting to help those in pain but facing the reality of dealing with unwilling patients and not wanting to traumatise them if it all goes pear shaped.

Finally on Friday, our time at Maliana comes to an end, the full executive of the hospital meets with us to thank us for our efforts and we are presented with traditional Tais as a parting gift. 

Back on the road again we pass through Balibo too early for pizza and drive right through to Maubara with just a quick stop at a nascent beach bar for the obligatory selfies.

Unloading our equipment, a stocktake to make sure our next team has the neccessary materials, goodbye to Tison who lives near the clinic, handing the Sisters car back to the Sisters and then packing the 3 Ana’s into the back of the Troopy we roll back into Dili.

Goodbyes said, data collated, promises to write, the Troopy delivered to Rotary Mario and suddenly a busy two weeks with our team is over.

Having gleaned an impromptu invitation to a garden party being attended by the President and other officials, Dr’s David and Henry set off to the presidential palace where we were able to buttonhole the Deputy Health Minister to appraise him of our work and of the great need for dental education and services, particularly in the rural districts of Timor Leste.

Debriefing with refreshments back at the Timor Plaza Skybar we were able to reflect on a busy and successful trip.

Patient Statistics

Total Patients Examined: 702

Extractions: 565 teeth

Fillings: 479 teeth

Fissure Sealants: 79 teeth

Silver Fluoride treatments: 338 teeth

Scaling: 120 patients

Endodontic treatment: 3 patients 

TLDP Team 2 June 2024

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Visiting Maubara, Don Bosco and Maubisse from June 2nd to June 16.

Team Leader: Dr Mary Tiutiunnik

Australian Team Members: Kayleen Alexopoulos – Dental Assistant (Week 1)

                                            Dr Geordie Meekin – Dentist (Week 2)

                                            Dr Shane Fernando – Dentist (Week 2)

Timorese Team Members: Ana de Jesus Barreto Tilman (AT) Dental Nurse

                                           Ana Paula dos Santos Tavares Salgado (AP)

                                           Ana Jose Martins (AM) Dental Nurse

                                           Zaino Tison Martins (Tison) Dental Nurse

Timorese Dental Nurses (Solar Smiles): Deonisio Anyonio Mendonca 

                                                                Lucas Mendonca Rodrigues

Timorese  Helpers: Diamantin0 Correia Morais (Tino) (Don Bosco)

Locations of Operation: Loes Vatuboro (Maubara Subdistrict) Yrs 1-6

                           Don Bosco Technical College Dili 

                           Fatubessi School (Maubisse Subdistrict)

                           Carmelite Sisters’ Clinic Maubisse

After some weeks of preparation, organising people, supplies and other logistics necessary for a successful trip, Mary and Kayleen arrived on the late flight from Darwin, delayed due to bags needing to be offloaded in Darwin due to weight restrictions. One of which was Mary’s, full of gloves and stock. The ever reliable Mario, on hand with the Troopie to pick up the Team, assured them that he would gather the bag tomorrow. Quickly shopping for consumables, we headed to Maubara to find a number of boxes from Rotary in Adelaide containing a dental potpourri of stock and equipment, including the much needed gloves.

We try and educate our Timorese colleagues about many aspects of dentistry and after dinner, Kayleen impressed upon AT and AM the importance of stock control and packing in an orderly manner so that things can be easily seen, collated and repacked for our road trips. Importantly, AP and Tino had recently sourced sharps boxes from the Maubara Health Clinic who will also dispose of them for us…..saving the less professional repurposing of water bottles.

This year we have implemented a more thorough oral health program with the nearby schools that seems to be going quite well. AT, AP, and AM have screened, treated, and given oral health education to the children at the three preschools in Maubara and are working their way through the 595 students at the primary school a few doors down the road.

We started the weeks outreach work in Loes, a community about 20 minutes down the road from Maubara. As most of the Maubara district schools are only open until 12, we left early for Loes with Tison, a dental nurse from Maubara who is presently volunteering at Liquicia Hospital and enjoying learning with our Team. After the Oecusse trip in May, Tison, a helpful and amiable young man, became very able at setting up our equipment. He speaks the local Maubara dialect which was great for oral hygiene instruction and patient communication. The mornings were filled with primary school students and then after school we saw the community, many who seemed to be related to Tison. 

These Loes patients all had large multi rooted teeth, perhaps the biggest we have seen in Timor, however AT was very competent at removing them, albeit needing to swap hands to relieve the strain. Mary was able to tutor Tison about doing simple fillings and the use of silver fluoride in arresting large carious cavities.

We extended our stay in Loes, it was important to not leave any school children still suffering infections. Nothing is written in stone with our trips and it is important to remain flexible with our scheduling to accomodate first hand information.

Finally, it was time to leave Maubara and head toward Dili and then on to Maubisse for the second half of our trip. This needed some careful planning as the cars would not return to Maubara before handing them over to the next Team, necessitating carrying extra stock. Kayleen’s instructions about recording and packing proved very useful in organising the cars.

Don Bosco Clinic

After the 1 hour trip back to Dili, we set up our clinic in the Don Bosco vocational training centre on the edge of Dili. Usually we try and look after regional communities but as many of the young people at the centre came from the country, with limited funds for dental treatment we felt that we should help look after them. 

Saying goodbye to Kayleen, we picked up our two new team members, Geordie and Shane who are working in rural Queensland. Joined by Tino and the many helpers at Don Bosco, the mobile clinic was quickly established and we were able to see many young people over the weekend. The brothers and priests were extremely grateful for our service, and we are hopeful we can come back in November to complete our tasks here.

The Sisters car suffered two broken windows overnight, a rare negative to our trips and Mary and the Don Bosco driver needed to tour the car repair workshops of Dili to find something that looked like the originals.

Sister Joaninha de Araujo, Sister Joaninha dos Reis, Dr Mary Tuituinnik and Sister Odette

Being in Dili afforded an opportunity to meet with the Carmelite Sisters who are integral to us efficiently doing our work. Unfortunately, the news wasn’t good as the felt they did not have the time to attend to our accreditation and customs clearance. As the Sisters are licensed to run health clinics, we can use their credentials to bring essentials such as anaesthetic into Timor Leste. We left for Maubisse wondering about the future and how we might need to restructure our arrangements.

Maubisse is up in the hills and quite cold, especially for Tison who lives on the hot coast and appeared quite stunned with the change in climate. Our arrival coincided with a visit from the Cardinal and we enjoyed seeing the colourful celebrations with many dancing Timorese in native costumes. Our accomodation was within earshot of the church, loud music continuing until luckily there was a power outage which sent the noisy throng home.

Maubisse

School starts a little later because of the cold and so there was less need for an early start, just as well as the road was rough with the last 300 meters more suited to a mountain goat. Shaun, a keen 4 wheel driver enjoyed the challenge but baulked at the last decent thinking that losing the Troopy over the edge wouldn’t look good on his resume. Luckily a bevy of locals appeared and kindly carried our equipment down the hill to the small school.

Portage of our equipment down the hill

Lucas and Deon, the two Solar Smiles dental nurses met us up with us and joined the Team for the week. Solar Smiles is another Rotary backed group that concentrates on oral health in schools in the Maubisse region.  After a short ceremony from the teachers where we were presented with the local woven tais we set to work. As often is the case the power supply at the school was not quite enough requiring more helpers to climb the hill and fetch our generators.

We found that the children and community had quite poor oral health however their teeth were quite small and easy to remove, unlike those of the folk in Loes down by the coast.

The next day it was a late finish to our clinic as the local men who were to carry our gear up the hill wished to have their teeth cleaned before they would start.

We then worked for two days at the Carmelite Sisters clinic in Maubisse, unfortunately they did not have their government contract renewed and the once busy clinic was very quiet. The slower change of pace allowed for some quality mentoring, particularly in filling techniques of the Solar Smiles boys and Tison, Geordie and Shane were of a similar age to their new Timorese friends and enjoyed the chance to share their knowledge which was received with great interest.

The Solar Smiles boys had a treasure trove of materials and we were able to “borrow” tubes of hand sanitiser which was in short supply and donate other materials to Tino who never has enough in hid government run clinic.

Back down to Dili where Mary was knee deep in the documentation rigmarole for the next team. Nothing seems straightforward in Timor Leste, working out who to approach at the MoH for our accreditations and designating someone to get that job done.

Helping the children, relieving pain and infection sometimes seem the easy tasks to do.

More running around to get the essentials for the next Team, a trip to the airport to pick up newly arrived Henry, introductions, debrief and lunch, back to the airport for the Australian contingent and all of a sudden our trip was over.

For an impromptu trip, Team 2 was very busy , importantly helping the locals in need and also introducing new team members to our work in Timor Leste.

Second week Team 2 Team members

TLDP Team 1 2024

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TLDP Team 1 Visits Oecusse May 2024

Oecusse is somewhat of an anomaly, the site of some of the first Portuguese landings in Timor in the 1560’s, it sits landlocked within Indonesian West Timor.

The TLDP last visited Oecusse in 2018 with a team led by Dave Sheen.

Logistically, this was the most complex trip that we’ve undertaken in the last few years and plenty of planning was necessary to minimise the inevitable curve balls that get thrown at us. Should we take the ferry or travel overland…..the ferry schedule seems somewhat random, what documents do we need to get through 4 border posts……plenty of things to think about.

On top of all this, there was a wedding invitation in the mail from our old friend Bony…..and he wished for all the team to attend the celebrations to be held at the start of our visit.

 Team 1 consisted of Dr Henry, new recruit Dr Josie with our employees Ana Tilman and Ana Martins, fellow dental nurses Tino and Tison and Ana Paula, our super organiser.

Dr Henry arrived on Wednesday May 1 to be met by gout free Mario (our Rotary liaison in Dili) and AT. There followed much racing around to collect consumables (there was not one paper towel left in Dili) and dispense funds for various activities. This included money for tickets to get most of the team onto the nights ferry to Oecusse. The original plan was for the team and Troopy to take the Friday nights ferry however Bony’s wedding needed to be moved forward a day because the priests in Oecusse don’t do Saturday weddings. Apparently nobody turns up at mass the next day. So away they went on Wednesday night. 

Dr Henry and AT took the Troopy to Maubara, and filled it full of the contents of the clinic. Thursday dawned and a local driver took the heavily loaded Troopy back to Dili whilst AT and Dr Henry followed in the requisitioned Sisters car, heading to the airport to pick up Dr Josie. 

She was in surprisingly good humour after lugging in 40 kilos of stock all the way from Newcastle. Introductions done, we decamped back into Dili to gather sim cards, final shopping and a collect couple of Bony’s friends, fellow travellers to the wedding who reputedly had crossed the borders previously and had the requisite knowledge. 

Back to Maubara for our merry band of travellers. Having completed Dr Josies induction into the vagaries of bathrooms, mosquito nets and most things Timor Leste, we took an early night to get ready for the overland adventure in the morning.

The 2 hour trip down the coast to the border town of Batugarde was uneventful, however vigilance was necessary with many children walking to school on the road and goats and chickens crossing the road (to get to the other side). Nervously we approached the Timorese border post, our passports and papers were in order but did we have 7 copies of the cars documents? Commandeering a motorbike, a search for a photocopier began and 7 copies later, the Timorese bureaucracy happy, we advanced 500 meters to the Indonesian officialdom.   

A well oiled machine at extracting money from unsuspecting travellers sprang into action. Yes, there possibly was transposition of a couple of numerals in our vehicles documents but it can be all fixed with a $70 facilitation fee, just see that man over there. 

Finally we emerged into Indonesia and set off in search of Oecusse. 

It was here that our fellow wedding guests with the intimate knowledge of roads, maps and local experience were able to apply their expertise. Suffice to say that the Sisters car has seen a lot more of West Timor than it needed to. 

Finally arriving at the next Indonesian passport control we were pleasantly surprised to be ushered through with a minimum of fuss. Only to be deposited into the clutches of the Timorese officials who insisted that our good for 30 days “Visa on Arrival” which we procured at some expense at Dili airport just a day or so ago needed to be renewed because we were entering Timor Leste. Go figure.   

Our sense of humour somewhat dented we arrive just in time to miss the wedding service, something the locals said was no bad thing. This lucky break left time for the team to “preperate” ( an ill defined term, but known to those of us who’ve seen the girls emerge radiant from the bathroom after throwing ladles of water at themselves ) for the evenings festivities. 

  They are possibly still talking about the wedding of Bony to Byca in Oecusse; a cast of thousands, it was a joyful celebration. Spare a thought for Dr Josie who found herself dropped into a huge Timorese wedding as a guest of honour, not knowing the protagonists and still finding her Timor Leste feet. 

Making our exit in the early morning, dropping a bunch of nuns home on the way, it was a very tired Dr Henry who arose to meet the ferry at 5am, retrieving the Troopy loaded with all our equipment and materials.

   Commandeering a church hall, we created our 3 chair portable dental surgery which was to be our home for the next 12 days. We were fortunate to have a new compressor and 2 new portable dental units which had been recently bought with funds donated in recognition of the long service that Dr Blanche had given the TLDP as Coordinator.

We settled into an easy routine of walking to work from our Carmelite accommodation, through a cow pat studded field, saying “Bondia” to the flock gathered to see us at the hall front door, prepping the surgery for the days endeavours, lighting mosquito coils and firing up the fans. 

The church hall enjoyed an ambient temperature of about 32 degrees C and if you weren’t in the range of a fan it became somewhat uncomfortable. 

Ana Paula marshalled the throng, numbered them off with requisite paper chit and set them to patiently wait watching their compatriots get treated. It was amazing to see that they all knew exactly where they were in the queue, often wanting to load themselves as a chair became empty. 

In tandem, two of the team would be dispatched to the school next door to triage the students class by class and herd the chosen ones back to the hall. Then came the tricky part, with the students as our priority we needed to gently ask some of the community to come back in the afternoon or even tomorrow. For the first few days, our optimistic judgment of time had us trudging home in the dark.

Our hostesses, four Carmelite Sisters, a quartet of passion and activity, proved to be very good company. Nothing was too much trouble, from whistling up a driver, to setting off in a Tum-tum to do some shopping for us. In the evening, strumming a guitar and singing whist we enjoyed a well deserved beer and in the morning, woken to the sounds of “Alleluia” drifting through the wall from their small chapel.

Our association with the Carmelite Sisters helps navigate the sometime impenetrable pathways of bureaucracy that seem commonplace in Timor Leste. 

On our first day, the Sisters accompanied the Team to present our credentials to the local Minister of Health and with much nodding,  handshaking and with a small speech, he allowed us to do our work.

Sundays being a day of rest, we were discouraged from working, apparently dental pain can be assuaged by attending mass.

So we thought that we would get a bit of fresh air, see the great outdoors and tick off a number of local waterfalls. Our first choice was quickly discounted when we found that the local bad spirits preyed on unwary travellers who walked in an odd numbered group. Our team being seven.   

The next choice looked suitable and we set off with a jaunty gait, through the coconut grove and up the creek. Not hearing the sounds of falling water we employed some local children to guide us toward our aquatic destination. Yes, it’s just up this hill, around the corner and up and down a little bit. What started as a merry doddle turned into a team bonding session. Who would have thought that a waterfall would be at the top of a mountain! Just as we were wondering who to eat first, through the mist our waterfall appeared. There followed a frenzy of selfie taking with the photogenic backdrop ensuring friends and family scattered through Timor Leste could travel along with us and be suitably impressed.

The following Sunday we drove out to conquer our second waterfall, this one more conventionally situated at the bottom of the mountain. Reached by walking up a dried river bed and then through the stream itself for a kilometre or so, this waterfall was another scenic example of what the Oecusse landscape has to offer.

The dental treatment we were able to provide varied quite a bit. Of course, there was attention to “moras” (pain) for many patients with extraction of the offending tooth a quick remedy. One young man who had come off his motorbike a year ago and fractured his front teeth was able to be treated with multiple root canals and large resin restorations.  

We also saw many large anterior cavities where the team was able to provide tooth saving treatment.

Another important facet of our TLDP is to help provide clinical knowledge and  guidance to our Timorese colleagues. Dr Josie (who could still remember being at University) provided the intellectual heft whilst Dr Henry imparted some more practical advice.

The days ticked past and finally it was time to pack up, thankfully not needing to turn any patients away in the final hours. 

Team 1 for the TLDP provided treatment for over 660 patients, many of them secondary students, much of it relieving pain and infection or preventing future problems. It is so rewarding to be able to help young people and change the course of their life by saving their anterior teeth from future removal.

After having enough of border crossings we all returned to Dili on the overnight ferry to be deposited at the docks at 5am. There is not much open at that time so we decamped to the lobby of the best hotel in town, fought the night manager for the sofa and grabbed some much needed sleep. 

Later that morning we said goodbye to Dr Josie as she was to wing her way back to Australia, leaving behind some new best friends and taking with her the myriad experiences that volunteering in Timor Leste will provide.

However no rest for the wicked, the cars still needed to be driven the hours drive back to Maubara, unloaded, stocktake done and still time for an afternoon clinic with children from a local school.

Back to Dili the next day, leaving the Troopy in Mario’s capable hands, final goodbyes and another successful TLDP team visit was completed.

There are many people who contribute to our TLDP team success, from those who donate funds that allow us to operate, our self funded volunteer dentists who contribute their time and expertise, our Timorese collegues, the many Carmelite Sisters and our Rotary friends, Mario and Judite.

Special mention to Dr Mary and the TLDP Advisory Board who attend to everything that makes for a successful and fulfilling program.