Setting up community-based dental care projects in remote Australian communities and overseas has been a career-long calling for Dr Sandra Meihubers. By Kerryn Ramsey
Dr Sandra Meihubers has worked in community-based dental programs since graduating in the ’70s, but she admits that she’s still learning all the time. “We’re constantly refining our processes and programs,” she explains. “While we don’t have a lot of resources or money, we do have the greatest asset in any community or any country—people.”
Dr Meihubers’ community work takes place in the Australian outback, the Nepalese mountains and Bangladesh countryside. “We actively invest and train local people so they develop the confidence and skills to provide the care that’s needed in those communities,” says Dr Meihubers, who recently received the Order of Australia.
While she’s based in Sydney’s northern beaches, Dr Meihubers is involved in overseas projects on a voluntary basis and also works as a dental consultant and advisor to rural and remote area dental services. These are the Nganampa Health Council (SA), Walgett Aboriginal Medical Service (NSW), Maari Ma Health Aboriginal Corporation (NSW), Bila Muuji Aboriginal Health Service (NSW) and NT’s Groote Eylandt and Bickerton Island Enterprises.
Working mainly in Walgett, Broken Hill and Central Australia, she’s also working with local dental teams to implement school-based brushing programs, where teachers supervise kids brushing their teeth once a day at school.
As well as coordinating these programs, Dr Meihubers is committed to the improvement of conditions in marginalised communities, particularly in Nepal and Bangladesh.
Her passion for community-based projects began when she was in her final year at the University of Sydney. She spent three weeks in Darwin on a placement organised by public dental health professor, Dr Peter Barnard. “It just opened my eyes,” says Dr Meihubers. “Within a couple of days, I was on a small aeroplane heading out to a remote community on the border of the Northern Territory and Western Australia with a senior dentist. We were doing very basic dental work on the verandah of the community health centre. There was an overwhelming need for the care that we could provide.”
After completing her dentistry degree, Dr Meihubers moved to Darwin before travelling overseas for two years with her husband. When she returned to Australia, she started working at the Aboriginal Medical Service in the inner-city Sydney suburb of Redfern, along with outreach services in regional NSW in a mobile dental van in the early ’80s.
During this time, Dr Meihubers found great satisfaction in the work that she provided. “You’re delivering a service that’s needed and the people really appreciate it. You also get to learn so much about our beautiful country,” says the dentist.
In 1986, Dr Meihubers started setting up dental services in remote communities, and currently acts as a dental advisor to a range of organisations. She has been instrumental in establishing programs where none previously existed, and is proud of the way the communities have developed.
“Sometimes people get carried away with the idea of going to a remote area. They have romantic notions and when they get there, they realise there isn’t a Coles supermarket down the road.”
Dr Meihubers is trying to address many of the challenges facing people living in remote communities, those ranging from poor dental health to a lack of affordable fresh food. “Advice is quite often dispensed by someone with a fairly comfortable, middle-class, well-resourced background—in that they have a bathroom with a toilet, working shower, sinks and taps where toothbrushing can be easily achieved. Sadly, because of the poor housing programs in a lot of communities, houses aren’t built properly, with inadequate and inappropriate health hardware, causing failures in basic sanitation,” says the dentist who’s well aware of the financial issues for people in remote communities.
The three more southern organisations—Nganampa Health Council, Walgett Aboriginal Medical Service and Maari Ma Health Aboriginal Corporation—are Aboriginal community-controlled health organisations. “So they’re run by the Aboriginal community for the Aboriginal community.”
Meanwhile, in Groote Eylandt in NT, the Aboriginal Land Council is putting money into the dental program, using funds from the mining royalties.
Dr Meihubers set this up six years ago and it is still running smoothly. “We’re partnering with Northern Territory Health Services because it has the clinics in position up there.”
By working with a range of stakeholders and funders, she has improved the system so that extra dental teams can now provide longer-visit dental services. “We have at least four to five teams per year, so the community’s getting a more consistent, grounded service,” she says.
Although Dr Meihubers’ management skills have been outstanding, she admits that she often has to deal with unexpected problems. “Sometimes people get carried away with the idea of going to a remote area. They have romantic notions and when they get there, they realise there isn’t a Coles supermarket down the road. In the remote communities, there’s no alcohol, so that affects the recreational capacity for some people. It doesn’t happen often but it does make us very careful when we take on people who want to work in the community.”
Apart from managing remote Aboriginal communities, Dr Meihubers has also embraced a global approach. She has established volunteer programs through the Rotary Australia World Community Service, and has herself become a Rotarian.
Her first international project was in the “very smashed post-conflict Timor-Leste” in 1999 when she travelled with her colleague, Dr David Sheen. “It was a shock to see what humanity can do to itself,” she says. “It was a pretty awful situation so we just set up basic care during that first visit. A couple of years later, David and I returned to set up an ongoing volunteer-based dental program in a clinic 50km from Dili. I had been a part of an AusAID team in 2000, working to provide the framework for the re-growth of a national public dental system.
“However, when it seemed the importance was more on the quantity of documentation provided rather than the quality of work necessary, I was determined to get closer to the ground again, and work directly with communities.”
“Our job is to support these people with relevant skills development, by working on real jobs, and building on our networks and relationships.”
The dentists set up a partnership with a local Catholic-run health centre, from which the dental program runs local and outreach programs. Currently, four Australian voluntary dental teams per year are working closely with local East Timorese dental staff.
While she values and enjoys her work, Dr Meihubers is well aware of potential dangers. This was apparent when she started volunteering in Nepal during the 1996-2006 civil war. “I had to be smuggled in ambulances to move around and get past the checkpoints,” she recalls. “We were driving through villages where people were shot because they broke curfew when they were trying to get home. During that decade, around 15,000 Nepalese people were killed. It was a terrible time.”
Working as part of a Rotary volunteer team, Dr Meihubers joined forces with ADRA Nepal, a large international NGO. However, during the civil war in 2002, the Rotary team was concerned about security risks so Dr Meihubers had to go solo.
“At that point, I’d made enough local connections so I decided to stay. I wasn’t doing any sort of heroic stunts—locals warned me whenever things were getting dangerous. We were trying to do dentistry and train the local people so they could carry on. At the same time, we were ducking down our heads for cover all the time.”
After starting Teeth & Toilets (www.teethandtoilets.com.au) 10 years ago, she now visits Nepal twice each year. Her goal is to embed school-based dental programs in poor village schools, and provide dental outreach care with local Nepali dental teams.
While Dr Meihubers works with many dentists from around the world, she found an instant bond with a Bangladeshi-born dentist who now lives in Australia. Dr Nahid Sayma was the first dentist from Bangladesh to be accredited and registered in Australia. When the two dentists met in 2013, they established a volunteer-based dental training and outreach program for slum areas and rural villages in Bangladesh.
“We now have a monthly dental outreach camp in slum areas of Dhaka and once a year we bring a volunteer team from Australia who combine forces with the local Bangladeshi team and local Rotarians. This team consists mainly of young enthusiastic dentists working with their professor, Dr Sunny, with the implementing agency being a local NGO specialising in national sanitation programs. When we’re there, we go to rural areas and provide relief of pain work and dental care for school kids.”
Dr Meihubers was well equipped to run this project after spending the past 17 years volunteering in Nepal. During these years, she worked with other Australian teams to improve sanitation in remote villages by training local people to construct toilets, as well as assisting the villagers to rebuild their destroyed houses after the earthquakes in 2015.
The dentist believes the key to success in any project is to find a local ‘champion’—or several ‘champions’—who are committed to improving the welfare of their communities. “Our job is to support these people with relevant skills development, by working on real jobs, and building on our networks and relationships.”