Tag Archives: Atsabe

Team 4, August 2025

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August Atsabe and Atauro Adventures

Team 4:

William Hariman

Yvonne Bass

Alison Taylor

Paulo Salsinha Martins

Ana José Martins

Zaino Tison Martins

Diamantino Correir Morais

Ana Paula D.S.T. Salgado

Angelo Moniz Amaral

Friday, August 1

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

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

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

The Atsabe Team (top back to bottom front):

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

Saturday, August 2……….to Atsabe

Most of our Timorese colleagues met us at Timor Lodge, and we drove to Maubara to pack the troopie. Packing took time, but considering we were setting up three dental chairs, it’s impressive how compact our inventory is.

It was a tough day of travel on rough roads — leaving at 8 am and arriving at 6 pm. Dinner at the priest’s residence was very welcome. The mountain air and scenery were a pleasant change from the coastal heat and insects, though the worsening roads were tiring.

Last time one of our vehicles went off the road, and this trip was no exception.

Fun fact: Yvonne donated some of her Canadian scalers and curettes to TLDP when she retired. They’re still in use here in Timor-Leste, though a bit worn down and resharpened.

Sunday, August 3

The mountain views were stunning.

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

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

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

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

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

39 patients seen.
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Monday, August 4

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

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

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

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

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

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

ProcedureExamTooth ExtractionFillingScalingFS AgF 
Total626319116 37

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

Tuesday, August 5

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

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

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

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

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

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

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

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

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56 patients seen.

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

We fed a stray dog who took to guarding our clinic

Wednesday, August 6

Final Day in Atsabe

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

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

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

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

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

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

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

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55 patients were seen

Thursday, August 7

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

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

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

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

Tino and Paul wishing farewell to Alison. Paul and Yvonne

Friday, August 8 ……a rest day in Dili

Alison Yvonne and I visited Cristo Rei. The stairs were breezy and pleasant, we enjoyed the murals and, I even practised manual driving with Yvonne.

We bid farewell to Alison at the airport with more warmth than the usual handshakes. Yvonne jokingly tried to convince her to stay another week.

A very intense week — this rest is much needed.

Saturday, August 9……onward to Atauro

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

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

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

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

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

Sunday, August 10…..a day of rest

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

Anyone for Uno?

Monday, August 11…….into the Clinic

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

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

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

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

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Total22268105

22 patients seen.

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

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

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

Literally every single dental instrument they have at the hospital. This means that they can only extract teeth and, can’t do some complex extractions. And every second patient has to wait for the instruments to be sterilised before being treated.

Tuesday, August 12

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

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

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

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

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

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Total189133011

18 patients seen

Wednesday, August 13

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

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

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

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Total292226

29 patients seen.

Thursday, August 14

Another busy clinical day.

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

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

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

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

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Total4254197220

42 patients seen.

Friday, August 15…….our final day

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

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

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

ProcedureExamTooth ExtractionFillingScalingFSAgF
Total2440

24 patients seen.

Reflections

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Total347378135572012

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

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

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

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

It was tiring but, rewarding.

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

Business As Usual (Well Almost)

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Team 3 returned quite a while ago….in fact Team 4 is now in TL. Even the ‘easiest’ trips are exhausting, especially for the Team Leaders, who go from being flat chat in TL to being flat chat on their return to work… here are a few notes on the trip from Team Leader, Dr Peter Shakes

Compared to post COVID 2022, 2023 team 3 trip was pretty easy. Smooth travels. No cancelled flights. No MEETINGS!

The Australian contingent consisted of Drs Peter Shakes, Ed Montgomery and Will Hariman – all dentists. The three met for the first time in Darwin International Departures with Will playing the “who looks like a dentist” game and winning!

We arrived quite refreshed in Dili, did the customs and visa thing, hastened by the highly esteemed Mario from Dili Rotary and met Ed’s soon-to-be-highly-esteemed son, Jack, who is living and working in Dili.

Timor Plaza, Leader Supermarket, local sim cards – this is starting to feel familiar…

We overnighted in Timor Lodge in preference to the Maubara Klinic and managed to see the Matildas beat France in the women’s world cup at an Aussie expat bar – great atmospherics even for someone who believes football of any worth can’t be played with a spherical ball !

Days 2-11…

Began with the now familiar long haul Dili-Maubara-Atsabe which takes pretty much a full day with 10+ hrs Timor Leste Driving!

Ed fell into the role of car 2 driver like an old hand, with Will doing a great job of GPS route checking.

We collected all 3 Annas (Ana Paula, Ana Tilman, Ana Martins) after a little confusion and some stressful u-turns and made our way to Maubara Klinic where Nico Pires was waiting with all gear fully packed and ready to load (of course!)!

Arrived in Atsabe after a quick lunch in Gleno just in time to see our first Atsabe sunset!

If we were cursing the state of the road being as bad as always, it was more than balanced by the place being as beautiful as always!

New parish priest, Fr Fidelis was now in charge; a young vital fella with a real enthusiasm for the Timorese people he serves and a pretty fine musician as well.

So the pattern emerges from day 3 with clinic set up on the front verandah of the priests’ house and a dentist or two with an Ana or two off to drum up business in the surrounding schools.

Timor being Timor, a funeral and a commemoration ceremony meant that most of the schoolchildren and teachers were either enroute to, in,  or returning from said ceremonies in Gleno for the first few days.

We still managed to get a good solid flow of work despite this and we rotated screening trips between Ed and Will with the rest of the team keeping busy on our verandah clinic.

A 4 pm finish allowed most of the team to join Fr Fidelis on a village tour higher up the mountain where an enterprising individual has built the Timor Leste Eiffel Tower. Not sure how or why, but you have to award him points for enthusiasm!

Day 6 saw a priest meet at Atsabe with the priests from surrounding parishes in attendance. Many of them have supported our teams in the past but for the few that were new to us it was a good networking opportunity most ably pursued by our marketing team of Anas.

Ana Tilma, in particular, was in her element and now has direct phone access to most of the parish priests in Ermera.

This area has had little access to dental treatment since we were here pre-COVID despite having a dental nurse in the community clinic in Atsabe. In a familiar story, he has a clinic but pretty well no equipment or materials and no local anaesthetic. Fr Fidelis asked if we could set up and work for a time in a remote village in his parish known as Laçao. So after the Sunday morning off for those who mass to attend Mass we packed up and made our way to Laçao. The trip was slow, as we have come to expect, but a couple of the bridges were a point and pray moment that neither of us drivers enjoyed. It was not the bridges that caused the most concern but what appeared to be a clear stretch of road. It was here that I demonstrated for the benefit of the team that even 4WD doesn’t help if you have diagonally opposite wheels in the air.

The locals were as always helpful and got us back on the road without further incident.

Day 12-14….

We left Atsabe with a positive report from Fr Fidelis “you can stay for a month if you like” and an invitation to return next year.

The road to Gleno is pretty much the same going the other way – I spent the first hour on the way to Letofoho in first gear! I have passed here a number of times but it was the first time I had stopped here at the invitation of the priest who spoke very highly of the efforts of team 1. We stopped at Gleno Hospital on the way to Maubara and replenished Tino’s near exhausted local anaesthetic supplies and passed on some other restorative goodies he can’t get. [Tino is regarded by many of us in the TLDP as our biggest mentoring success story. He continues to join our teams every year to help out and gain experience, even though he now runs a busy hospital dental clinic – Ed.]. Back in the vehicles after a quick lunch and back to Maubara, with Nico and Peter making a detour to Dili to refill gas bottles while the rest of the team ate pizza in Liquiça!

Accommodation in clinic in Maubara with meals provided! Two days work at a school in Siamodo with about a 90 min drive each way. Normal flat out school with a great, friendly and curious group of kids with no water at all on school grounds. A very dry and dusty venue.

Last day was a half day – the team had worked every day for the last 12 days and was showing some sign of weariness. No complaints though. Back to Maubara to stocktake and clean and stow gear for the last team of 2023. Drop off and goodbyes as we returned to Dili for a last night  at Timor lodge.

-Pete

Busy, no Catastrophes – notes from Team 4

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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.

Team 4
Team 4. minus Hans

Clinic with a view

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!

Happy Birthday Nico!

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.

Tino and Martin

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.

Malita giving oral health education

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’.

Jeremy and Peter on the tools

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!

Hans is too tall for the chair

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.

The fabulous Timorese

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!

Farewell Team 4

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Team 4 will farewell Australian shores next Saturday. Team Leader, Dr Peter Shakes will be joined by Dr Ashley Freeman and Dr Andrew Frame in the first week, who will then be replaced by the redoubtable Dr Mary Tuituinnik in Week 2.  The Timorese team members include Nico Pires, TLDP’s hard-working dental therapist and new Dad, and  Ana Paula Dos Santos Tavares Salgado, the team’s translator and dental assistant. Team 4 has already been plagued by misdirected supplies, team members dropping out, and confusion with scheduling;. Hopefully, all the wrinkles have been ironed out now and this team will have some smooth sailing once they get to TL. They are heading to Atsabe and Maubara. Good luck and have fun Team!