All posts by tsetongb

Living it LARGE in TL

 

Team 4 has returned from an immensely productive, fun-filled trip to TL. The team had Dr Peter Shakes (team leader) and Malita McCabe for the entire fortnight, with the addition of Dr David Digges for the first week, and Dr Mengzhu Wang for the second week.

Unfortunately the team had to endure a similar registration rigmarole to Team 3; however, as the TLDP has done some  scrambling to adjust to the new regulations, this team didn’t have to spend entire days in Dili cooling their heals. Instead they had a mere wait of 4 hours on the day of arrival for the Ministry of Health to advise them that they were unable to be seen that day, followed by a relatively succinct meeting with the Director of Health and Quality Assurance a week later. Progress!

After an overnight pitstop in Maubara to check in with fabulous Sr Filomena, gather the gear and collect Nico (our hardworking dental therapist), the team headed off to Maliana district for its first week. Lunch was taken enroute in the infamous town of Balibo, which now has an Australian-funded dental clinic of its own, and is staffed periodically by Timorese auxiliary staff  and Australian volunteer dentists.  On arrival into Maliana, the team was met by Isabella – Bony’s cousin – who had the job of fixer and translator for the week. Isabella quickly became an indispensable member of the team – the team has dubbed her “The Terrific Iza”. (Pic: Malita, David & Terrific Iza)Malita, David & Iza

The first 2 1/2 days  were spent working in Maliana Hospital. At first, both Peter and David were not running on all cylinders (Peter had a lingering respiratory illness and David was recovering from a recent operation) but they still plugged through the work with dedication. I’m sure that their ‘soldiering on’ was aided significantly by the distinctly unusual, über-plush working environment of Maliana. Not only did the hospital have air-conditioning, electricity, a fully-functional sterilisation room with sterilisation nurses, and hospital staff eager to assist our team; but the team were also housed in brand-new accomodation, which also had air-conditioning, electricity AND hot showers!! With lunch delivered everyday by Alberto, the Über Eats of Maliana, they were set!

Bony and Iza had organised the program in Maliana well in advance; this ensured a steady stream of patients, and the team had to work at pace to keep up with the numbers as well as provide quality clinical supervision and training for both Nico and the resident dental therapist, José, who was simply happy to have local anaesthetic to work with.

In the afternoon of the Day 3, the team packed up and headed up the hill to Bobonaro – a 10km, 1 hour drive. The TLDP has yet to see any improvement in this road since we started coming here over a decade ago.

The team had the usual warm welcome  by the Carmelite sisters and Malita was finally able to have the unique experience that accompanies all our trips – living with servants of God. In Bobonaro, the accomodation is simple and clean, the company is fabulous, the food plentiful and the cool mountain air delightful. The team set up in the Sisters’ clinic, a short walk away from the convent and church. The following 2 days were spent treating the local community, with the first morning dedicated to treating children. Now in a more typical Timorese clinical situation – no running water, no electricity – and with instruction from Nico, Malita was soon a dab hand at sterilising outreach style – with a pressure cooker on a gas ring. Malita is a qualified dental hygienist – so she was an exceedingly busy member of the team; she was sterilising instruments, assisting the 3 other clinicians, AND cleaning the teeth of her own patients. What a woman! Nico wowed the Aussies with his extraction skills – he has come a long way since we first employed him in April this year.

Before the long commute back to Maubara, the female members of the team (plus Nico) lightened their wallets at the local markets and they all had a lounge in the Bobonaro Hotsprings. Sheer luxury! (Pic: Bobonaro Hot Springs)Bobonaro Hot Springs

Sunday, always a slower day in a Catholic country, was spent in Dili – David and Meng did a tag team swap at the airport, and the team had the all important meeting with the MoH before heading back to Maubara ready for the second innings.

Week 2 was a week of movement for the team. The first two days were spent at Maubara High School and Maubara Primary School, where Meng was rapidly inducted into the cut and thrust of dentistry in TL. This was swiftly followed by a day in Paurubu Primary School, a day in Kaikaça Primary School and a final stint at our base clinic in Maubara. Phew!

There are stark differences between villages in Timor, the most obvious arising from differentials in the availability of water, electricity and food; they are often noticed most by newcomers to TL. Meng and Malita, this team’s rookies, were struck by the differences between Paurubu and Kaikaça , which are only 5km apart. The well-being of the children in Kaikaça, which has had a significant amount of help from NGOs, was significantly better than that of Paurubu’s kids, who lack running water, adequate food, and sanitation.

Governed by school hours, the team generally finished earlier than usual. The additional time was spent carrying out necessary maintenance and inventory tasks, washing the cars (probably the first team EVER to do so – these people were keen!), having a dip in the ocean, and “getting their shop on” at the Maubara women’s cooperative where, according to reports, Meng alone bought half the village’s merchandise .

The team had relatively few problems with equipment – a dodgy power cord was ‘repaired’ by Nico, they coped with the ongoing problems with one of our portable dental chairs (the new part was ordered after Team 3 and will be coming up to TL with Team 5), and were unfazed by a dodgy water spray and hand piece.

Altogether, the team examined 490 people; they extracted 409 teeth, placed 63 fillings, and cleaned 41 people’s teeth. A fabulous effort from a well-oiled team!

Well done Team 4!

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Penultimate Team Returns

Team 4 returned from TL earlier this week. This team consisted of Dr Peter Shakes and Malita McCabe, who hail from South Australia, Dr David Digges, from New South Wales, and Dr Mengzhu Wang, who is fortunate to live in the beautiful Sunny Coast in Queensland. From initial reports, the team had a very successful, trouble-free-ish trip. Watch this space for updates. WELCOME HOME TEAM! Our last team for 2017 heads out on September 24 – they are busily gearing up for it now.

That which does not kill us…..

Team 3 has returned from a difficult trip to Timor Leste this month. The team leader, Dr Wayne Pearson, says that he found it difficult to write a positive report; hence, the tardiness of this update. In addition to Wayne, the Australian contingent of Team 3 consisted of Dr Karen Sloan, Sally Stephens and newbies, Dr Marius Mocke and Abbey Notley. The Timorese component of the team consisted of Nico Pires (our in-residence dental therapist, Bony Cardoso Martins (friend, translator, fixer) and the redoubtable Sr Filomena.

The team ran into their first problems with the airline, Airnorth before even leaving Australian soil. Airnorth’s system refused to recognise the TLDP’s current NGO status and so there were issues with the materials and equipment heading over. The team eventually sorted that out – money will fix almost anything. They arrived in Dili and were met by Judite and Mario, the Rotary Liaison team who handles much of the minutiae for many of the Rotary programs in TL. They liaise with customs to ensure that our dental gear gets through, pay bills for us, and deliver our car to the airport for us, which they keep safe when we were not in town. They are indispensable.

The team then met with Bony, who advised them of the new registration required for foreign dentists volunteering in TL. As mentioned in the previous report, this involved a great deal of documentation – two statutory declarations in Tetum and Portuguese, a copy of the passport, two passport photos, a copy of the dental registration, a copy of the degree certificate, a curriculum vitae in Tetum and, of course, a fee of USD 25. This was to be presented in person to the Ministry of Health and then there would be a wait of two weeks for it to be processed, after which the dentist could carry out their volunteer duties. Logistical difficulties were immediately apparent to the team – our teams are only in TL for two weeks! Having arrived earlier in the week, Sally had already bought the team’s general supplies and they finally got to Maubara in time for dinner with Sr Filomena.IMG_3204

(Pic: TL from afar – seemingly peaceful and pristine)
The next day, instead of starting work, the whole team, plus Sr Filomena and Bony, trooped back to Dili for an interview with the Ministry of Health (MoH). As the team were already in TL and had their AHPRHA registration, Dr Jaõa Manuel, who is in charge of professional registration, gave the team a once-off permission to work in TL. However, the following teams would have to comply with the new rules. As a concession to our short visits, he said that documents could be sent over in advance, but Wayne pointed out that this would be difficult when there is no postal service to TL; in addition, having to translate the documents into 2 different languages might prove to be a big deterrent to volunteers. Dr Manuel agreed, but this was the will of the political arm of the MoH, so it must be complied with. It was decided that the documents would be sent over to Bony by Blanche via email; Bony would do the necessary translations and then deliver the documents to the MoH. The team seemed to have arrived at a workable solution that the MoH was happy with. Disaster averted, the team had a well-earned lunch at Black Rock in Cameo Beach, Liquiça.

[Since then, the Ministry of Health has changed its mind. It wants originals of the CV, in a particular format, and originals of the statutory declarations, not scans. It has now added that it wants a criminal check as well. The TLDP is still trying to work out how we are going to do this in advance of our teams’ arrivals] (Pic: A fuzzy of most of the team: From Left bottom, Bony, Abbey, Sally, Karen and Marius)crew esplanada

The remainder of the week was taken up by a clinic in Guiço, and a couple of days in Klinik Maubara. Karen, Marius and Abbey spent a lot of time with Nico, honing his diagnostic skills; this is of prime importance, as most of the time he has no one else to seek advice. Sally spent a great deal of time sorting out the stores – the MoH has also developed stricter protocols on materials. On top of his clinical tasks, Wayne attended to maintenance, reconstructing the suction unit with the reconditioned motor which Blanche dismantled earlier this year. Wayne and Sr Filomena were summoned to the MoH again, this time to meet with the official who’s jurisdiction includes Atauro. This official told Wayne that he needed to provide her with an official letter so she could inform the people that they were coming. Despite assurance that, in fact, our visit had been planned a year ago with the local Atauro health authority, that Sr Filomena had been in close communication with the Director of the Hospital in Atauro, and that the people already knew the team was coming, a letter was demanded by close of business the next day. This necessitated a return to Maubara, where Sr Filomena produced a very official letter, with lots of stamps and signatures, and a quick return to Dili by motorcycle by Nico by 1pm on Friday.

The week was rounded off by dinner at the orphanage where, like so many of us before, the team was charmed and entertained by the Sisters’ young charges. All of us are no stranger to the upwelling of maternal feelings during these visits, but apparently, Abbey was particularly affected by the experience.IMG_3003

(Pic: The Nakroma – unloading at the Atauro end)

Saturday saw the team off to Atauro. In true Timorese fashion, boarding the vessel was colourful chaos. Although passenger tickets are available the day before, vehicle tickets are only purchasable on the day of departure – and even with a ticket, there is no guarantee of getting on board. The team had to hustle to fit both vehicles with all the gear onto the boat – Sister’s car was the second last car on! At least one other vehicle was turned away. The trip over was otherwise uneventful and the team arrived, unscathed, at Barry’s Place which, as always, was simultaneously a hive of activity and an oasis of peace. This time they were hosting a TEDX talk in the dining area! After meeting the local administrator, Mr Lucas, and hammering out a few details, the team was then free to soak off the frustrations of the previous week over the remainder of the weekend.IMG_3082

The team set up in the Vila hospital for the first 3 days and they were kept busy as usual. They had few problems with the equipment – only a dicky chair with a threaded screw, which they jury-rigged with a  strap. They even had lights and a fan from Day 2 after paying for some fuel for the hospital generator on Day 1. The final two days they went up the hill to Biquelli for 2 days. Here there was a lot more work, as these people have never had a dental service. They were ably assisted by Mr Lucas and a young German volunteer, Fransiska, who both helped with translation and reassuring patients. Timor is amazing in that way – one gets random help from everywhere.Franciska and Mr Lucas

In total, the team  treated 213 patients, extracting 371 teeth, placing 162 fillings, cleaned 21 people’s teeth and placed 17 fissure sealants. They were disappointed that their trip was not more productive. However, judging their trip by figures undervalues the peace building and diplomatic work that they carried out, which cannot be measured by numbers. In meeting with the MoH, working with Sr Filomena, Bony and Nico, and continuing Nico’s training, the team’s efforts were not only valuable, but vital for the continued growth and evolution of the program. On a personal level, dealing with difficult situations and difficult people inevitably delivers insight into oneself and encourages personal growth. As far as the TLDP is concerned this trip was not only a success, but a big win for all involved. Well done Team 3!! (Pic: Mr Lucas and Fransiska)

THANKYOU. An especially BIG thank you to Bony for his continued trips to above and beyond for this program. We would be a dead duck in the water if not for him. Thank you to Nico for his excellent work ethic and his willingness to learn from us and to take on the responsibility of the clinic. Thank you to Karen and Sal for the hard slog in the storeroom and to Karen for taking Nico under her wing. Thank you to Marius and Abbey for throwing your effort into the team – it’s a hard place to work. Thank you to Barry for his organisational skills and support for our teams in Atauro. Last, but not least, thank you to Henry Schein Halas for continuing to support out work with much needed materials. We appreciate it. No pics at the moment, folks – its slow going!

Team 3 safely home

(Pic: Bony, Karen, Abbey, Marius, Sally, Wayne – on arrival)

The last members of Team 3 have landed safely in Oz last week, after their 2 weeks in the heat, dust and humidity of TL. According to brief reports, this trip had was a tad more challenging than a ‘run-of-the-mill’ Timor trip; the Ministry of Health in Timor Leste has just introduced a new regulation for volunteer dentists – they must provide a bunch of documentation, two statutory declarations in Tetum and Portuguese, passport photos and a fee of USD25 for the privilege of volunteering their services in Timor Leste. Unknowing Team 3 had none of the above, resulting in a number of trips to the Ministry of Health in Dili, and a lot of talking to officials. This frittered away some of the team’s precious treatment time, but their skills in compassion, patience and diplomacy were well-exercised! Glad you are home, Team 3; we look forward to your full report.

 

GO TEAM 3!

This Monday marks the arrival of our third team in TL this year. The team comprises team leader, Dr Wayne Pearson, boomerang volunteers – Dr Karen Sloan and the hardcore supernurse, Mrs Sally Stephens; as well as new blood, Dr Marius Mocke and Ms Abbey Notley; the eastern states of Australia are well-represented here – Victoria, New South Wales and Queensland! Along with Nico, it’s a BIG team! They will be spending their outreach week in the offshore island of Atauro – and braving the big boat – the ‘Nakroma’ – which we have previously used to get to/from Oecusse. The team will be taking 2 vehicles over to Atauro, and the Nakroma is the only boat big enough to carry them. We are a little apprehensive – the last time we put a car onto THAT boat, it nearly fell into the sea! Have fun Team 3! Hope you have red skies at night…..

The Inestimable Value of Service

john john nico Sr F and JApologies to our supporters for the tardy update, but there has been significant busy-ness this month for the TLDP team. Team 2 returned mid-June after a highly productive trip, which is only to be expected from the well-oiled team of Dr John Moran, Dr John Whyte and Ms Bella Miller. The last member of the team was, of course, Nico (Nicolau Tolentino Faria Pires), our recently contracted, hard working dental therapist, who has been chipping away at the work in Maubara. (Pic: Nico, John Whyte, Sr Filomena, John Moran, Sr Joaninha)

All teams carry a great deal of dental materials and equipment back and forth from TL and we rely heavily upon the goodwill of the airlines. It is not uncommon for each team member to carry 30 kg of goods into TL, without which we could not treat patients, or support all our mentored Timorese clinicians! Thank you Airnorth and jmjwbmSriwijaya airlines – we appreciate your support!

A trip to TL is never without a few hiccups, and this team proved to be no exception to the rule. The team battled enormous queues to catch their flight from Bali, were stymied by Citilink airline officialdom, which made them pay excess baggage fees for their 9 kg extra, and when they arrived in Dili, there was no one to meet them – our Rotary liaison had forgotten about them! By the time the team finally arrived at their Liquiça accommodation, they were exhausted! Thank God for Black Rock at Caimeo Beach – there’s nothing like a bit of good food and glamping to the sound of lapping waves to soothe away one’s travel woes. (Pic: Bella Miller, JM and JW at Black Rock)JW in Railaco secondary

Fully refreshed the next morning, there was a drop in to Maubara to gear up, say “Hi” to Sisters Filomena and Joaninha, and collect Nico, then the team was off to Railaco for the next 5 days. For this team, Railaco is like their second home – the indefatigable Father Bong and his merry men and women always provide a warm welcome. (Pic below: Old and new at Railaco, pic left: JW in his mini-surgery at Railaco secondary school)

 

old and new railacoThe team set up clinic in number of places during this time. They spent the first day in Father Bong’s clinic at the Jesuit Mission, the next two days in the Escola Secundária Católica Railaco, Nossa Senhora de Fátima – the local catholic high school in the sister parish to St. Canice’s in Elizabeth Bay in Sydney and two days in Fahite primary school. The team was kept busy all 5 days and they were most ably assisted by Brother Luis in the high school, and a local Fahite lady, Fátima, who has made it her life’s purpose to improve life for the Fahite community. Fátima originally intended to join the ranks of the catholic Sisters in Timor, who make such a difference to people in the villages; however, after 2 years as an aspirant, she decided she could do more good as lay person. The team found her invaluable as a translator and dental assistant. (Pic below: Fatima of Fahite and JM with the view from the village)fatima of fahite

The team noticed a stark difference between the Catholic high school and the government primary school; the environment in Fahite was significantly poorer, with no lights, and large crevasses forming in the floors of the classrooms. This state of disrepair is unfortunately unexceptional in village schools across TL. Fahite, at least, has electricity, even though it was delivered through a single power socket. As always, though, the charm and warmth of the Timorese people, and their extremely well-mannered children, transcends their difficult lives.JM and fractured incisors

In Fahite, the team were again faced with the unique Timorese myth that extracting an upper tooth leads to blindness. All of our teams have found that this belief is extremely difficult to dispel and it often leads to the patient declining treatment. Nonetheless, the busy team had plenty of work to do. John Whyte was the powerhouse of the team, John Moran switched between treating patients, triage and teaching Nico who, being a solid grafter, carried out treatment, assisted John and John, translated and reassured patients. Bella, as all our dental assistants do, attended to all of the clinicians at once, and so she probably worked harder than everyone else put together! At the end of their time in Fahite, the team was serenaded with the national anthem by the entire student body, and waved off by the happy and appreciative community! (Pic: JM restores a smile and extracts a promise from a happy customer!)fahite kids

The team spent the final 3 days in Kasait Clinic, down the hill from Railaco and not far from Liquiça district. The clinic is fairly new and clean, so it is a real treat for the team to live and work in. Super-organised and helpful, Sr Eliza and her assistant, Manuela, ensured a steady flow of patients from the school and community, without the usual crowd of onlookers (a feat bordering on impossibility!), and provided invaluable assistance with translating, reassuring patients and administration. The second last day was a Sunday, a quiet day in a Catholic country, so with few patients, this enabled Bella to give Nico a much-needed refresher in infection control and gave the team some much needed downtime at Black Rock. (Pic: Curious kids in Fahite)nico in training

Nico was a hit with the rest of the team. They found him to be a diligent and highly motivated clinician, who is compassionate and well-mannered, who develops excellent rapport with patients and puts a great deal of effort into every task. That is truly music to our ears! We count ourselves very lucky to have found him. We only have two real issues – we have to break him out of some bad clinical habits that he has picked up along the way, and we still have to improve our communication – but all Timorese seem to soak up different languages effortlessly. Since putting him through one term of English lessons, Nico’s English has already improved greatly! This team put a great deal of mentoring time in with Nico, which has increased his skills and his confidence. With each team’s effort, he just gets better! (Pic above: Nico in training. Pic below: The team in Kasait with Father EJ, JM, JW, BM, Nico, Sr Eliza and Manuela)

kasait teamThe team suffered through the usual equipment issues that make working in TL a challenge – this time the other suction unit played up (our main suction motor was being repaired in the Sunny Coast), our slow speed drill units went on a go-slow industrial action and our autoclave developed disco lights. In addtion, one of the portable chairs developed a fault in which the back suddenly drops – no chance of falling asleep for our already apprehensive patients! Never a dull moment. I see maintenance in the future of the following team. Thankfully, the team’s exit was smoother than their entry and they managed to get home without incidence.

esplanada viewAltogether Team 2 examined 282 patients, extracted 222 teeth, did 313 fillings and 233 preventative treatments. A fantastic effort from a dedicated team. Well done! (Pic: the view from the Esplanada)

Bye Team 2!

Team 2 heads off to TL this Saturday. Dr John Moran will be joined by his usual side-kick, Dr John Whyte, and super-dental assistant, Bella Miller, who is heading out for a second ride! John’s team will, once again, be the guests of Father Bong and his merry men in Railaco. They will be the second team to work with Nico. Have fun team!