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!
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 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.
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!
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!
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!
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.
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.
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.
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!
Our first team arrives in TL this Sunday. Dr John Moran, Dr John Whyte, Bella Miller and Rebecca Bushell are headed for a stint in the communities of Railaco and Kasait. As usual, the team will also include the TLDP’s full-time dental therapists, Nico Pires and Ana Tilman, as well as dental assistant and interpreter, Ana Paula Salgado. Tino Correia, a dental therapist who we have mentored for many years, and who works in Gleno Hospital clinic, also intends to join the team for more training. A big busy team!! Have fun and good luck!
Our volunteering year is now ended with Team 5 returning a couple of weeks ago from TL. It has been a very busy year, and so we are quite happy to be able to draw a quick breath or two before we start to prepare for the year ahead. (Pic: Isa, Nico, Tino, Bony, David and Ana Paula)
Team 5 was led by Dr David Sheen, one of this program’s founders, and an excellent dentist, teacher and mentor. David has decided that this will be his last clinical trip, so we imagine that this trip tasted bittersweet. David will be sorely missed. He is a gracious, good-humoured and considerate person and a skilled team leader. However, there is no rest for the wicked – David will continue to be involved in the TLDP management committee, and he has taken on the responsibility for getting a Timorese person into and through a dental degree! We haven’t seen the last of him yet!
The remainder of the Australian contingent of Team 5 consisted of returnee, Dr Geoff Knight (Week 1), and newcomers, John Darby (Week 1 and2) and Gaye Dumont (Week 2).
We are proud to say that the Timorese portion of Team 5 was considerably larger than the Australian part, something that is now typical of all our teams, and an ideal that we have been steadily working towards over the past 15 years. We believe that a program is only sustainable if it has local ownership and it can only be locally-owned if there is a preponderance of local participation. The timorese contingent consisted of TLDP dental therapist, Nicolau Tolentino Faria Pires (Nico), TLDP dental assistant and translator, Ana Paula Dos Santos Tavares Salgado, Ministry of Health (MoH) dental therapist, Diamantino Correia Morais (Tino), translator, Bonifacio Cardoso Martins (Bony), translator and organiser, Isabel Noronha Pereira De Lima Maia (Isa), MoH dentist, Dr Inda Zulmira Dias, MoH dental therapists, Armando Da Costa Martins and Ricardo Mendonça, and Carmelite sister, Sr Delfina Soares. With the exception of Sr Delfina, all the Timorese in this team have worked with the TLDP for many years.
The lucky team spent the first week in Oecusse, an East Timorese enclave within West Timor, Indonesia. They were lucky not only because Oecusse is a beautiful area with coral reefs off the beach, but also because they got to spend time with our beloved Sr Filomena da Costa, our old Timorese program coordinator who was uprooted from Maubara to take over the new Oecusse Carmelite community. (Pic: Sr Carmelita, Sr Filomena and Ana Paula)
This team journeyed by ferry, a quite expensive and time-consuming exercise involving putting the 2 packed vehicles on the ferry in the morning, waiting around Dili all day, then boarding at 5pm, before finally arriving at 5am the next morning. Luckily, the team scored the only 2 cabins onboard and were able to sleep! Thanks to Isa for booking the tickets in advance! (Pic: Dedicated Nico and Tino)
The team worked for 3 ½ days within the Carmelite Health Centre, São Domico Clinic, mostly treating the children from the neighbouring high school and the local community. Sr Filomena, Bony and Nico did all the oral health education and screening of the school kids. After that, the team broke up into two teams, each comprising a Timorese clinician with a mentor; Geoff teamed with Tino and Ana Paula to do all the fillings and preventive treatments, while David and Nico did all the extractions. John Darby, a dental prosthetist in Oz, became the team’s super-efficient sterilising nurse and infection control manager. It was a very busy few days! It was a real treat for the team to be able to spend time with Sr Filomena, who is also one of the founders of our program and a delightful lady with a loving and ebullient nature. (Pic: Geoff, Sr Carmelita and Tino)
Another 12-hour boat ride and the team returned to Dili on the Saturday for restocking and team changeover. The team farewelled Tino, Bony and Geoff and welcomed Gaye and Sr Delfina into the fold. Sr Delfina is keen to study dentistry and the TLDP has agreed to support her studies if she gets into a training program. In a meeting with the Carmelite head honchos on the weekend, David suggested that Sr Delfina gain some work experience, so she also joined Team 5 for round 2! Off to the hills of Maubisse! (Pic: John and Gaye atop the Christo Rei)
The trip to Maubisse takes 4-5 hours from Dili. The team was scheduled to work in one of its more remote regions, Manetu, for the next couple of days. The team arrived in the early afternoon in Maubisse town and collected Dr Inda, so they decided to push onto the Manetu-Lebululi Health Centre to set up for the next day. Unfortunately, they travelled via a suggested ‘short cut’, which turned out to be an extremely bad road, and when they finally arrived, the health centre was locked up with no one around, leaving the team to do a u-turn and head back to Maubisse. At least the return trip was on the longer, but much better, road and so the return journey only took 1 ½ hours! (Pic: Gaye and the Maubara sisters)
Manetu is a very poor area, which suffers from severe water shortages when the rain doesn’t come on time. As a result, the villagers have difficulties with personal and home hygiene, and the team saw many people with scabies and badly infected mouths. This is the first time the TLDP has travelled to this village (this was an agreement drawn up in April this year in a meeting with the local chiefs) and the first time this village has had any dental care at all, so it was unsurprising that most of the treatment was extractions. Dr Inda manned 2 extraction chairs all by herself, and David mentored Nico doing restorations.
The last couple of days were spent in the Horaiki High School, which had already been screened and given oral health education by the Maubisse Hospital team (Dr Inda, Armando and Ricardo). Team 5 was assisting the hospital team to follow up with treatment. David and Inda mentored the two Maubisse dental therapists, Armando and Ricardo, while Nico gave additional toothbrushing instruction in the classrooms. In both locations, Gaye, John and Ana Paula kept the team going. Support staff are essential for maintaining good infection control in TL! (Pic: Dr Inda and Ana Paula doing the admin)
Team 5 had brought over our new 34kg suction unit. It worked brilliantly, which meant happy clinicians and happy patients. Lucky for them, there were no equipment breakdowns. NONE! That must be a record! The team also got to spend time with 3 different sets of Carmelites – Sr Filomena, Sr Carmelita and Co. in Oecusse, Sr Joaninha, Sr Lindalva and Co. in Maubara, and Sr Domingas, Sr Rosa, Sr Eva, Sr Veronica and Sr Zeza in Maubisse. That’s a lot of cheeriness and good food right there! (Pic: the Maubisse Sisters)Overall the team saw 443 patients, carried out 318 check-ups, took out 460 teeth, placed 218 fillings and did 42 preventive treatments. Well done Team 5!
Thank you to everyone who continues to support our program! From our donors, to our team members in Darwin who collect supplies and bring them to the airport for the teams, to our biggest materials donors – Henry Schein Halas and SDI – and the Rotary Liaison Team in Dili who do so much running around for us, we are in your debt. Thank you for your generosity. We could not do this without you.
It’s coming to the end of our volunteering year. Phew! Team 4 arrived back safely 2 weeks ago, but we have been super-busy trying to address some of their problems, as well as sort out some tricky logistics for Team 5; so we have yet to update our friends and supporters on what Team 4 got up to! Sorry for the delay – the team leader’s report was just posted last night – we will update you as soon as possible.
Meanwhile, our last team for the year, headed by Dr David Sheen, arrives in TL tomorrow. Accompanying David, is long-time volunteer, Dr Geoff Knight, and Sydney prosthetist, Dr John Darby. Team 5 is working in the Oecusse and Maubisse areas. Oecusse is an East Timorese enclave within West Timor (Indonesia). It is Timor Leste’s East Berlin – difficult to get to, significantly poorer, and with less services than the rest of TL. With equipment and vehicles, one gets there via road or via sea. The road option takes a several hours visit to the Indonesian embassy, a whole day drive through 60km of West Timor, stopping at multiple military checkpoints, and multiple ‘extra’ payments. It was a total pain the last time we chose the road. So, this time, the team is trying to get their by boat; however, the last time a team took the sea-option, our vehicle almost went for a swim. So…Good Luck Team 5!
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…..
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)
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)
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)
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)
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)
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)
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)
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)
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!
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!”
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.