The Covid-19 pandemic continues to make its presence felt throughout the world. In Australia, although we have managed to “flatten the curve”, and we have had many less infections and deaths than many other unfortunate countries, we are not out of the woods yet. Timor remains in a partial lockdown, even though (thankfully) they have had only 24 cases as of last week.
Uncertainty remains the word that defines 2020. We are uncertain about the safety of our Timorese employees, especially with Timorese spitting practices, and we are uncertain about the safety of volunteers in-country. Dentistry is extremely high risk for Covid infection due to the amount of aerosols that are produced while treating patients, and the proximity of the dental team to the patient’s mouth. There is also uncertainty with regards to overseas travel, which is banned for Australians for the foreseeable future.
Hence, it is with great disappointment that the TLDP has decided to cancel the remainder of our trips to TL. We shall have to have a do-over in 2021!
In the meantime, there’s still heaps going on –
Ana Paula is slogging away in Fiji University. She is in her first year of dentistry and is finding it an extremely challenging task to deal with the new online delivery of coursework.
We are developing our electronic clinical record. It’s almost finished!
As PPE is almost non-existent in TL, we are trying to get PPE and dental supplies over to our Maubara team, as well as to the Sisters, who run a primary health clinic in Maubara….with shipping disruption, this is still a work in progress.
You know that feeling when you flop down onto a chair, tired and exhausted from a hard day’s work, yet feel strangely rejuvenated and fresh? Timor gives me that feeling in the bucketloads. You might think that’s from piling through patient after patient. Through lifting box after box from the Landcruiser to the classroom cum clinic, setting up and doing it all in reverse by the end of the day. And some days you’d be right. Other days, I get that feeling from chasing kids around the school with a broomstick and squeezy bottle of water.
I get such a sense of family and community being around these amazing individuals. I first met Nico (the dental therapist) while filtering through the dental supplies to bring to Maubisse. Complete with the cheeky smile, tooth gem on his lateral incisor and tough guy exterior, Nico is the best problem solver. Repairs to the suction unit with composite resin comes second nature, thus earning the title Nico ‘sempre diak’ (translate: Nico always good). Learning Tetum, there is a definite ‘go-to’ Ana to ask for advice. Ana ‘diak’ (Ana Paula) will give you sound translations that had me somewhat conversing with my patients. Ana ‘la-diak’ (Ana Tilman) might have you buying lollies when all I wanted was a bottle of water.
You have to be ready to get uber basic when it comes to lifestyle habits. Fortunately, I love putting my technology away and find a certain joy in living and eating simple. One trip to the Maubisse market yielded the tiniest, reddest strawberries and plump avocadoes. As not to offend the sisters, who were accommodating and feeding us, I gifted both of these items to them. I found that evening they already had mountains of strawberries ready for us to stuff our faces.
Those avocadoes though, I never saw those again. Count me moderately devastated. Safe to say then, I’m coming back for those avocados.
(The indefatigable Leslie will be joining another team this year – he really wants those avos! – Ed)
We are extremely pleased to announce that our long-time team member, Ana Paula Dos Santos Tavares Salgado, has had the official offer of a place in the Bachelor of Oral Health Program at the College of Medicine, Nursing and Health Sciences,in Fiji National University. Her first term starts in February and so she will be leaving TL in just over a week.
The TLDP is sponsoring Ana Paula’s studies, so we are very excited for her, although everyone will sorely miss her presence in the coming years. We all wish her the very best of luck and hope she enjoys her new home, with all the new experiences and challenges it brings with it.
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!