Making a difference


Australian volunteers open a dental clinic in East Timor to help undo decades of damage. By Andy Kollmorgen

The critical shortage of dentists in East Timor may seem like a side issue. After all, the country is still recovering from a gruelling war for independence from Indonesia that lasted nearly 25 years and which, according to some estimates, took up to 200,000 local lives.

East Timor suffers from all kinds of shortages, but if oral health is a general measure of human health—and there is plenty of evidence that it is—the current dental crisis cuts into every corner of society. When your teeth aren’t right, lots of other things aren’t right either.

This is certainly the case in East Timor (or Timor-Leste) at present, where too much of the food that is shipped in is junk food and malnutrition is endemic.

According to Oxfam Australia, 47 per cent of East Timorese children under age five suffer chronic malnutrition. In addition, there are more underweight kids than there are in similarly deprived Ethiopia and Malawi.

Poor nutrition is a factor that is inextricably linked to the sorry state of oral health among much of the population, but lack of access to dental care has also taken a toll.

At last count, there were just five local practitioners serving the oral-health needs of 1.2 million East Timorese, and four of them work in Dili.

The 54 dental nurses at work in the country help fill the void, but their duties extend only so far; they are generally not qualified to perform procedures that prevent latent oral-health issues from becoming critical where extraction is the only option.

Bloody backstory

Dr Jose Ramos-Horta—former President of East Timor with Dr David Bladen

Dr Jose Ramos-Horta—former President of East Timor with Dr David Bladen

Enter the recently opened Balibó Dental Clinic. It is an altruistically driven start-up that aims to stem the tide of oral decay one patient at a time. That is the first order of business, but the overarching mission is to help the East Timorese help themselves.

The project is sponsored by the Balibó House Trust, whose roots are distinctly Australian. The trust was set up by the Victorian government in 2002 as a memorial to the five Australia-based broadcast journalists—Greg Shackleton, Gary Cunningham, Tony Stewart, Malcolm Rennie and Brian Peters—who were targeted and killed by Indonesian special forces in 1975 at the start of the Indonesian occupation. They became known as the Balibó Five.

Another reporter, Roger East, was killed seven weeks later while investigating the killings. The Balibó House itself was the final refuge for the journalists. They painted an Australian flag on the outside wall to show their neutrality in the conflict, but it was not enough to save them.

The dental clinic, which sits on the Balibó House premises, is part of a long-running effort to piece together a hopeful future out of a dark past. The trust is also dedicated to promoting childhood education, building skills and creating employment for the local population. Balibó House has served as a community learning centre since 2003.

Getting the clinic up and running has been a team effort. Among others, the Rotary Clubs of Keilor, Port Melbourne, Packenham, Carlton and Berwick have all pitched in.

Getting up to speed

According to firsthand accounts by Dr David Bladen, a Victoria-based practitioner who ran the first clinic in August this year, the unmet dental needs in East Timor are pretty much off the charts.

“It took two or three days to get the clinic set up, and then it went fantastically well as far as turnout goes,” Bladen says. “I saw about 180 patients and did more extractions than I’ve ever done before. There were very serious decay and gum problems, which we expected to some extent. But we didn’t have any concept of just how bad the problem would be, especially with children. I saw six to nine-year-olds with decay from ear to ear. We got a very sobering sense of what we’re up against.”

Former East Timor president and Nobel laureate Dr José Ramos-Horta was Bladen’s first patient, a very effective promotional coup orchestrated by Balibó House Trust chief executive Terry Hicks.

“Changing people’s lives who have had no access to dentistry struck us as one way to have significant impact.”—John Milkins, secretary, Balibó House Trust

In 1975, Dr Ramos-Horta travelled from Balibó to Dili with footage of the Indonesian military build-up the Balibó Five had shot to be sent to TV channels 7 and 9. These were among the last reports the journalists managed to get out of the country.

“He’s highly revered in the country. He said ‘everybody go to the dentist’, and everybody did,” Bladen says.

It didn’t take long for Bladen to figure out that poor nutrition is the root cause of the oral health problem. “They’ll eat whatever is cheap and put in front of them, and that means sugary foods.”

It is a particular problem in a country that has the fastest growing population in Asia, with 43 per cent of its inhabitants under age 14.

For many of the older East Timorese patients, most of whom are heavy smokers, the options are few at the clinic. “All we can do is to get them out of pain through extraction,”Bladen says.

The country has much to offer in the way of natural beauty and resources, but the mix of modernity and deprivation is striking. Facebook and mobile phones are everywhere, but healthy foods are hard to come by.

The untapped oil and gas riches in the Timor Sea close to East Timor, which could potentially lift the country out of poverty, are a longstanding point of contention between the East Timorese and Australian governments, with Australia claiming the lion’s share. The Greater Sunrise oil and gas field is said to be worth about $40 billion. The first exploration permits were issued to Woodside Petroleum, an Australian company, in 1963. Woodside discovered the Sunrise field in 1974.

Politics were not at play in Balibó, but one of the biggest stumbling points at the clinic was communication: Bladen doesn’t speak Tetun-Prasa, the native language. Fortunately, he found a local who spoke that as well as English, and an East Timorese became central to the clinic’s inaugural success.

Setting priorities

John Milkins, secretary of the Balibó House Trust and the son of one of the slain journalists, says the idea of a dental clinic emerged from a number ideas about how best to help the country with the resources at hand.

“The genesis of this project goes back to when we began looking at the basic health needs of the population, and dental health really stood out as something where we felt we could make a difference. The question was, ‘What can we do to lift the basic standards of living?’ Changing people’s lives who have had no access to dentistry struck us as one way to have significant impact.”

Crucially, the idea was also born out of close consultation with local East Timorese.

Dr Bladen providing dental treatment to Dr Ramos-Horta

Dr Bladen providing dental treatment to Dr Ramos-Horta

Since the Balibó House Trust was set up nearly 15 years ago, Milkins has watched the country inch its way forward. It used to take five or six hours to navigate the rough roads between Dili and Balibó, for instance; now it takes two or three.

Better infrastructure will make getting equipment to the clinic that much easier, but for now the facility is restricted to basic care. It will also be a part-time undertaking to start off, operating for roughly two-week stints four times a year.

The hope is that a continual supply of volunteer dentists from Australia will allow the clinic to run more frequently. Ideally, there will be enough volunteers on hand going forward to mount a prevention program in local schools.

Prevention is by far and away the main game, says Milkins, and dental professionals from Australia have a critical role to play.

“It’s an opportunity for dentists to stay in a fantastic place and do great work,” Milkins says. “The ongoing success of this project depends on a steady supply of volunteers with a global vision of oral health and health in general. It’s an opportunity to live out the reasons you became a health professional in the first place.”

And it won’t be all work and no play, Milkins stresses. “It’s a fantastic country with a warm and welcoming people. Dentists can come over and apply their skills where they’re needed most and have a pretty amazing adventure at the same time.”

In the meantime, says Balibó House Trust executive officer Terry Hacks, the clinic is looking to hire a Timorese dental therapist or nurse to deliver basic treatments, educate the local population on the importance of oral health and manage preventative programs.

“We are currently working with a number of organisations to ensure that the clinic is staffed by volunteers as often as possible,” Hacks says.

There have been other missions of mercy to East Timor on the part of dentists. In 2012, Ballina-based dentist Steve Shelton set up shop in the remote, mountainous districts of Lauana and Malabe. And in 2003, the Timor Leste Dental Program was founded by Rotary Australia with the aim of training and mentoring local dentists, donating much-needed equipment, and providing treatment.

With the establishment of the dental clinic at Balibó House, the collective compassion that has long been a force in Australian dentistry extends its reach across the Timor Sea.

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