Tag Archives: ana tilman

Ana Paula in Fiji Uni's Library

While we are being quiet…

It’s been a pretty strange year for everyone, including the TLDP. Usually at this time of the year, two teams would have already completed their trips to TL. There would have been equipment breakdowns, vehicle troubles and severe depletion of consumables.  Hundreds of people would have had their toothaches relieved and broken teeth fixed. And back at home, we would be flat out trying to get ready for the following three teams – begging for and buying equipment and materials, arranging customs documentation for said equipment and materials, Timorese registration of dentists, and millions of WhatsApp texts, emails and Messenger texts flying back and forth trying to organise clinics in the ever-changing landscape of TL.

Instead, this year we have been very quiet. But we haven’t been holidaying  –  the work has not stopped behind the scenes.

In February this year, our long-time employee, Ana Paula Dos Santos Tavares Salgado, commenced a Dental Degree at Fiji National University in Suva. Ana Paula is progressing well – she passed her first lot of exams, YAY! WOOHOO!-  but it has been extremely challenging for her. She has had to adapt to a new country. Covid-19 has increased her social isolation, as well as educational isolation, as tuition has been solely online, and collaboration between classmates disallowed. Luckily, a number of our volunteers have been able to support Ana Paula during these stressful months. Dr Stephanie Shields, Dr Geoff Knight, Dr David Sheen and Mr John Tweedie have been a Godsend for her.

Thankfully, the University recommenced face-to-face teaching in Semester 2.  Fiji has had only a small number of Covid cases to date. Ana Paula is a determined and hardworking individual, which is why the TLDP is supporting her during her studies. Ana Paula’s education is a five year commitment for the TLDP, assuming she is successful, and will cost the program $25000 annually.

Meanwhile, back in TL, our full-time dental therapists, Nico Pires and Ana Tilman, were forced to close the Maubara clinic for 2 months, as the Timorese government called a State of Emergency. Like everywhere else, gloves and masks were in extremely short supply. The pandemic caused increased disruptions in shipping, and the TLDP and our friends spent significant effort trying to get supplies to Nico, Ana and our partners, the Carmelite sisters, who continue to run primary health clinics. Thank you to Rod Flavell from the Bendigo Maubisse Friendship Committee for helping us get our gear to Darwin. And thank you to Dr Yvonne Huijser Van Reenen (one of our volunteers) and Dr Jeff Swann from the ABSO Cleft Lip and Palate Program for getting the gear to TL.  However, the Timorese government chose this time to implement new rules about importing medical supplies, making a task that is always difficult into an impossibility. At time of writing our gear is still sitting in Dili airport awaiting ‘customs clearance’.

Timor-Leste emerged relatively unscathed from the pandemic. They had only 24 cases of Covid-19 and no deaths. What a relief! Ana and Nico have reopened the clinic and are back to treating patients. At the start of the pandemic, they set up a hand washing station  outside for their patients to wash their hands before and after treatment, and they continue to maintain this practice. Well done to both of them!

Lastly, the TLDP can finally, FINALLY, do away with all the exercise books in which we currently keep patient records! We now have our own fully functional digital clinical record which has been constructed specifically for our program. Anyone who has been to TL remarks upon the huge numbers of school children. They are usually seen in the streets in the afternoons – vast hordes of kids in immaculate school uniforms. It is a recipe for writer’s cramp filling out all those names – vast hordes of school kids in the streets means vast schools. Increased accuracy and speed of recording details will make for a better service. Unfortunately, Ana and Nico will have to wait until next year to launch it – we still can’t get over there!

A little request – as with all charities, we rely on people’s goodwill to continue our mission to improve the lives of Timorese people. With wages, and now university fees, constituting the largest part of our expenditure, we need help more than ever. Every dollar that is donated (minus 3% for Rotary admin fees) goes towards helping the Timorese people. All our volunteers self-fund and many of our materials are donations. We truly appreciate any contribution towards our program and we thank you in advance. To donate – hit the button up at the top!

 

 

Nico and Ana giving oral hygiene instruction to school kids

TWO’S COMPANY, NINE’S A PARTY – LAST TEAM FOR 2019

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!

The main team
The core crew – Ana Paula, Leslie, Kim, Blanche, Ana Tilman, Mary and Nico

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 View from Gruto School
The View from Gruto School

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!

Our senior dental therapist, Nico, is a quiet achiever. After 3 years of mentoring, his skills are formidable.

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!

Blanche and Nico fixing suction
Fixing the suction unit

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!

It’s always a blast with the Sisters

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 crazy kids in Faulara

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.

Beers and tyres
Keith the equipment whisperer
Keith the equipment whisperer and his newest acolyte

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.

 

Keith and Tino on a road trip
Keith and Tino on a road trip

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!

Mary mentoring Tino

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.

Kim demonstrating with Leslie assisting

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 Fast and the Furious

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 delightful Team 3 – Ashley, Steph, Evelyne, Jordan, Ana Tilman and Ana Paula – Nico is behind the camera

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.

The Silver Fluoride Arrives

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!

No OH & S people here – getting Sisters’ car onto the ferry
We get spoilt when we are at Barry’s Place

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!

Beautiful Atauro

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!

5 clinicians at work

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.

Ana Paula is invaluable in explaining treatment to worried parents.

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. 

Jordan eagerly awaits his mid-morning coconut.

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.

Ana Tilman gives oral health education with some digital assistance

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!

The team back in Dili

 

Welcome to the team Ana Tilman!

We have had an auspicious start to 2019. Just this week, we have hired a new staff member, Miss Ana de Jesus Barreto Tilman. Ana is a qualified Timorese dental therapist, a University of Dili (UNDIL) graduate. She will be working in the Maubara clinic and in our School dental program with Nico, our full-time dental therapist. She will be assisting with treatment, infection control, sterilisation and record-keeping – tasks that are very hard to do well when working by oneself. Ana Tilman also works for the Kose Nehan toothbrushing program in Aileu, so we are very lucky to have her onboard in her downtime. A warm welcome to the TLDP team, Ana!

The Sublime Grace of Good Friends

Team 1 has returned from a fortnight of fun, food and friendship with our Timorese friends in Maubara and Maubisse. On this trip, our 3-person contingent from Australia (Dr Mary Tuituinnik, Dr Blanche Tsetong and Mrs Yvette Young), was happily far-outnumbered by the Timorese part of the team. (Pic above: Gentle Tino; below: The beautiful Sisters in Maubisse: Sr Eva, Sr Rosa, Sr Inacia, Sr Loudres, Sr Helena – with Yvette, Blanche and Mary)

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Amongst our team members in Maubisse, were Dr Inda Zulmira Dias, the new dentist in Maubisse Hospital, as well as Armando da Costa Martins and Ricardo Mendonça, the Maubisse Hospital dental therapists. In addition to our usual tasks, the TLDP is currently assisting the Bendigo-Maubisse Friendship Group, who has been asked by the Maubisse Hospital Director to help improve dental services in Maubisse District. Hence, this trip we worked with the Maubisse dental team to develop a plan about how this could be achieved.  Dr Inda is a young and enthusiastic dentist, educated in the Phillipines and full of great ideas and a passion for promoting good oral health. (Pic: Clinical supervision in Maubisse Hospital)

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In Maubisse, we were also joined for a day by the bubbly, Ana Tilman, a dental therapist who works with the Kose Nehan group out of Aileu. She was super-fun and a joy to work with. Team 1 also had the task of ‘road testing’ a Timorese dental therapist, Nicolau Tolentino Faria Pires (aka Nico), that we hoped to employ for the TLDP. Nico has a couple of years’ experience, has worked for a couple of other NGOs previously, and has been recommended to us by our mate, Dili dentist, Dr Fernando. Our last team member in Maubisse was our driver, Dionisius Gonsalves (Dion). (Pic: Ana and Nico)

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We were so fortunate to have the opportunity to mentor so many clinicians at the same time!  We had three days of treatment and clinical supervision in Maubisse, peppered with lots of treats – joyful, delicious and noisy dinners with the Sisters, a soujourn at the Maubisse branch of AHHA helping young Timorese learn English, listening to the haunting notes of the Sisters’ singing early in the mornings, Mary and Dion’s afternoon jaunt with Sr Lourdes to deliver meals (on wheels) – and an oral health workshop for the community thrown in at the end! (Pic above: Dr Inda presenting at the Oral Health workshop; below: Ricardo welcomes the community at our workshop)

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For their last 2 days in the mountains, Dr Inda organised an outreach clinic in Hatubulico, a beautiful, extremely peaceful village at the foot of Mt Ramelau, Timor’s highest mountain. Like Mt Fuji, Mt Ramelau has a very particular shape and is instantly recognisable – over the years we have been lucky to view it from all sides. Hatubulico is a 2 hour, super rocky drive from Maubisse, with plenty of spectacular scenery, narrow roads and sharp drop offs to occupy passengers and drivers alike. (Pic: Mt Ramelau from Hatubulico)

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As is the case in many remote communities, the dental need is massive and we had a very busy couple of days – four clinicians working, two in ‘normal’ chairs (oh, our backs!!), one dentist supervising the therapists, Yvette assisting everyone, checking the post operative conditions of the patients and sterilising instruments, and Dion doing admin and a very relaxed kind of crowd control. (Pic: Our alfresco clinic – 2 chairs manned by Nico and Ricardo)

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We always love alfresco clinics! The team had fun in Hatubulico. We stayed in a pretty swish place (despite the need to share beds and a dearth of blankets, it had running hot water showers that mostly worked!), enjoyed the views and friendly locals whilst walking to work, and even attempted the gnarly track to the start of the Ramelau ascent path (we had to abort halfway because Sister’s car threw a hissy fit. (Pic: Inda and Blanche – impromptu checkups for the crowd)

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Week 2 saw the team descending from the cool mountain air into the miasma of the coast. The heat and humidity affected us all, but struck down Yvette one day and Mary the next. The sea, usually a welcome relief, was lukewarm and full of debris and sea-lice. Still, we soldiered on and the second week proved just as exciting as the first. Tino joined the team on the Tuesday and Bony rocked up on Wednesday night. It was lovely to see them both! During the week, the team worked in Maubara Clinic for 2 days, giving the two therapists (Tino and Nico) the benefit of working under Mary’s exacting eye, and Blanche, the opportunity to effect some repairs. (Pic: Yvette, Nico, Blanche, Dion and Mary)

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The team also spent a day in Lebotelo treating the primary school and the community and a day in Loes SMP School – both journeys took longer than before. Road degradation continues on apace in Timor! Lebotelo is now a 90 min journey via goat track, not a 30 min soireé up the hill from Maubara, and the road to Loes is literally falling into the sea!

The team fell into a natural rhythm: Sr Filomena and Tino screened the kids, Bony did admin duties and tag-teamed with Tino to give toothbrush instruction, and Nico (tag-teaming with Tino), Blanche, Mary and Yvette got the treatment done – a well-oiled machine!

20170504_100551 (2)The only thing that went slightly awry was in Loes when Yvette – driving Sister’s car – temporarily forgot the existence of those rather large drains. Nobody was hurt and there no damage to the car, but Yvette provided a whole bunch of entertainment for the locals at the cost of a slightly bruised street cred.

Although Bony and Tino are old mates, they soon took Nico under their wing and all three were soon carrying on like long lost brothers. Nico was a super hard worker and a careful clinician. We are sure that he will make a good addition to our program. From now on, he will be permanently employed by the program to work both in the clinic and the surrounding Loes/Maubara subdistricts, as well as to work with the teams when they are in Timor. For now, we have enrolled him in English classes in Dili. Hopefully, he will have picked up a word or two by the time John’s team rolls into town in 9 days! All he needs is “No worries!”

IMG_8658 (2)Many thanks to all our team members, and to their families, who support them, to our lovely Sr Filomena, Sr Joaninha, and to the Maubisse Sisters. Thankyou to Mario and Judite in the Rotary Liaison office in Dili – your help is essential to our work, and thank you to Henry Schein Halas, who continues to support our program. (Pic left: Novagenerian who fought with the Australians in WW2; right: Full of grace, Sr Filomena and everybody’s favorite dish, Brinzela).

A final note: In my excitement, I forgot the all important stats! Team 1 saw 540 patients, did 378 examinations, filled 94 teeth, extracted 234 teeth,  and carried out 21 preventive treatments.20170505_145409 (2)