Paulo's first experience of an outdoor dental clinic

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Having wanted to provide some volunteer dental care for quite some time, I could not refuse when I received an email from Equal Health earlier in the year asking for dentists to go to East Timor to work with the clinics operated by Co-operativa Café Timor (CCT).

Our team consisted of Jacob, dental assistant and interpreter, Joaquina, a Dili-based dental therapist, and Moses, our driver and dental assistant also. In Dili at the CCT head office, we would pack the car with all the supplies we needed before stopping off to buy food supplies and then setting off for the villages. Among the items packed was a very large bag of gauze. It caught me by surprise, but I was advised by Jacob, who was also the project officer, that the gauze was very much required. My upcoming experiences would confirm this.

Driving towards the villages, it was evident how under-developed this country was. Roads were often little more than 4WD tracks, often one lane wide and on the side of the mountain. Yet despite this, Moses skillfully negotiated past trucks and motorbikes travelling in both directions. Where we had to pass a truck or van with little space available, both vehicles would slow down and using some friendly hand gestures and eye contact, an amicable solution would be found. Something you'd be hard pressed to find on a Brisbane street!

I was based at the towns of Lauana in the first week and Malabe in the second week. In both towns we travelled to the local schools to screen school children, many of whom were very excited to see us (a stark contrast to home!). We would follow this by returning to the CCT clinics, where we treated children from the school and adults. Most patients required extractions, in many cases several at a time. Many extracted teeth were little more than root stumps. Extraction patients were issued with paracetemol, antibiotics and vitamins. Restorations were provided with a spoon excavator and hand-mixed GIC. Saliva control required some improvisation with gauze and plain cotton. A headlight mounted on my loupes provided illumination with no power available in the treatment room.

One day was also spent at another town, Atara, involving a mobile set up on the verandah of a small building adjacent to a town basketball court. It was the first time that I had ever worked outdoors and as breeze blew through our 'surgery', I realised why it was not done often. During the day at Atara, a young man had fallen over and lacerated the skin above his right eye. With no other clinicians in the area, I became a surgeon and sutured the skin using dental suturing material, issuing a good amount of antibiotics. A large audience of children assembled to watch the 'action'. Three days later we 'bumped' into the young man as we were leaving the area, and he had healed quite well!

It was amazing to provide local anaesthetic and extract teeth on many children who were totally cooperative and barely made a sound!

One problem was that I kept confusing the Tetum words for open (loke) and close (taka), often telling patients by mistake to open their mouths after placing the gauze in, only for Jacob to have to bail me out! It was clear that many of the adult patients had suffered with carious teeth for many weeks and months.

Accommodation at the CCT clinics was basic but adequate. Electricity was only available at night with a diesel generator which sometimes required servicing by torchlight. It is hoped that the CCT Malabe Clinic will soon be connected to the power grid with some homes in the town already connected. Jacob, Joaquina and Moses along with the local staff at Lauana and Malabe did everything possible to make me comfortable, including the provision of water boiled in a kettle so I could have some warmth while undertaking my nightly bucket bath!

No refrigeration meant meat had to be consumed almost immediately, while a gas-powered vaccine fridge was used to store long-life milk after it had been opened. Some meals were purely rice and vegetables.

East Timor is still a very poor country and very dependent on overseas aid. However, it does appear that the Timorese are quite motivated to build their nation and I was advised that a dental school has started in Dili. It is hoped that in years to come, trips like mine will no longer be necessary. For now however, I would recommend people consider giving their time to this wonderful country and its people, a mere one hour flight from Darwin.

Paulo de Figueiredo, Dentist, Northgate, Queensland
East Timor volunteer - August 2013