Indigenous dental health and the Poche Centre

indigenous dental health

Helping improve indigenous dental health—students graduate at the Aboriginal and Torres Strait Islander Primary Health Care Practice Scholarship in 2017

Seeking to drive change in Aboriginal and Torres Strait Islander people’s health, the Poche Centre for Indigenous Health is helping to close the gap in Indigenous dental health disparities, writes Tracey Porter.

It’s not often a service organisation will willingly render itself obsolete within a tight four-year time frame. But that’s the aim of the Poche Centre for Indigenous Health as it strives to ensure a smooth skills and program handover to the communities in which it currently operates.

Set up in 2008, the Poche Centre was established and funded by philanthropists Greg Poche AO and Kay Van Norton Poche after the pair recognised an opportunity for universities, governments, research organisations and communities to work together to create permanent solutions to Aboriginal health problems.

In 2013 following a change in leadership, the centre set out a new strategic direction which prioritised three high-need areas it termed Healthy Kids, Healthy Hearts and Healthy Teeth —the latter of which incorporates oral health promotion, early intervention, treatment and rehabilitation.

In an interview with the ABC late last year, former centre director Dr Kylie Gwynne—who has over 30 years’ experience in the design, implementation and evaluation of human services for vulnerable Australians, noted this was an area of opportunity for the centre as Aboriginal people had much higher rates of dental disease than most other Australians.

This was particularly true of places such as far northern NSW where decades of decay had far-reaching consequences and many children did not even own a toothbrush. “We did a whole study, actually, of interviewing the kids across the community. Almost all of those children believed that dental pain was just normal,” Dr Gwynne noted.

Based out of the University of Sydney, the centre’s running costs equate to around $3 million per annum. However, the centre works off the interest of the original $10 million donation from Poches, as well as additional funds sourced from a combination of Commonwealth, State and philanthropic sources.

Since 2013, the centre’s dentistry arm has delivered more than 20,000 oral health services in nine rural and remote NSW communities.

Currently, the centre’s Healthy Teeth Strategy is responsible for the delivery of two major projects. The first is its Central Tablelands Dental Service, which is located in Boggabilla but includes the communities of Toomelah, Moree, Mungindi and Wee Waa. The second is its Dalang Project which is delivered across seven sites in NSW including La Perouse (South Sydney), Illawarra Aboriginal Medical Service (Wollongong), Biripi Aboriginal Medical Service (Taree), Armajun Aboriginal Medical Service (Inverell), Katungul Aboriginal Medical Service (Narooma), Durri Aboriginal Medical Service (Kempsey) and Albury Wodonga Aboriginal Health Service (Albury).

This has led to an assortment of unique initiatives to address the specific oral health needs of these isolated rural communities including a weekly tele-dentistry clinic introduced in late 2015 to support graduate clinicians and a purpose-built van fitted with a dental laboratory that travels through towns in far-north NSW fitting Aboriginal patients with dentures free of charge.

While previously a lack of public health dentists in these communities meant some patients were sent to Redfern in Sydney to see a dentist more than 550 kilometres away, the centre has been credited with revolutionising the way dental care is delivered.

In his report outlining the centre’s strategic plan 2016-2020, Professor Tom Calma AO, patron of the Poche Indigenous Health Network and board member for the Poche Centre at the University of Sydney, claimed that more and more communities are engaging with the centre.

“The positive effects we’re witnessing are illustrative of what can happen when consistency and focus is maintained; when Aboriginal culture and expertise is valued; and when Aboriginal people themselves are empowered to take a leading role in designing, developing and delivering programs.”—Professor Tom Calma, patron of the Poche Indigenous Health Network and board member for the Poche Centre at University of Sydney

As a result, the centre was seeing “encouraging” results across the full spectrum of health services, from prevention and early intervention to chronic disease management. “The positive effects we’re witnessing are illustrative of what can happen when consistency and focus is maintained; when Aboriginal culture and expertise is valued; and when Aboriginal people themselves are empowered to take a leading role in designing, developing and delivering programs,” he says.

However, Dr Gwynne argues that fundamental to all aspects of the centre’s strategy is building a local, skilled Aboriginal workforce—and through that workforce, maintaining sustainable, long-term services that the community needs.

Only too aware a fly-in, fly-out service is not an effective, efficient or sustainable model, three years ago the centre teamed up with the NSW Centre for Oral Health Strategy and Sydney Rotary to create a NSW Dental Assistant Scholarship, which enables Aboriginal people from across the state to gain their qualification, and provides them with the support of a mentor.

Last year alone, the Poche Centre supported 144 scholars in oral health, allied health, nursing, primary health care and research, with 54 per cent at the Certificate IV or Diploma level. In total, more than 200 Aboriginal scholars have completed qualifications with the support of the centre over the past two years, with 75 students graduating at Certificate IV or Diploma level.

Folau (Paul) Talbot is one such graduate. Now employed as a dental technician and project officer for the centre, the Boggabilla-born local initially did a stint at Queensland Health and was trained on the job.

In 2014 he heard about the scholarship the centre was offering to complete a Cert III and Cert IV in dental assisting and to study in Sydney over a six-month period. He successfully applied for the scholarship and completed his Cert III in dental assisting at the start of 2015. He was later accepted for one of two cadetships available through the centre to complete a diploma in dental technology (dental technician).

“I wanted to be a role model for the young children back home in my community—to help them believe that if they set their mind to something, they could achieve anything; the sky is the limit, and that there is a lot of help and support out there, you just have to keep trying.”

Talbot is now considering studying at the University of Sydney for a Bachelor of Oral Health.

The Poche Centre is aware that it remains a challenge for a lot of Aboriginal people to attend university, so considers that working with TAFE on creating pathways a critical part of its work. For a service that people need to access every week, and one that needs to be available every day, you have to have local skilled people delivering it, the centre argues.

The vocational training is also assisting in creating workforces within community, staffed by local people with a good understanding of the barriers for Aboriginal people when it comes to access and health care. It is these local culturally competent workforces that it expects to contribute to closing the gap.

Dr Gwynne, who resigned from her director position late last year but maintains an adjunct appointment leading the Poche Centre program of translational research, says the centre’s vision around the Healthy Teeth strategy is to “make ourselves largely redundant over the next three to four years in the communities that we are currently working with.

“Once the strategic goal of ensuring oral health services are owned and run locally is achieved, the centre’s role will then shift to focus on skills development, scholarships, research partnerships, and service design and development.”

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