The Royal Flying Doctor Service received new funding in the Federal Budget to improve dental health in remote communities, but dentists in these mobile dental clinics say working this way is not for everyone. John Burfitt reports
When Dr Alice Gubbins started working for the Royal Flying Doctor Service (RFDS) in Victoria a year ago, there was one thing that really surprised her. “Our team drives all over the state; we don’t fly. Even our most remote areas are only a five-hour drive away, so it’s easier and cheaper than organising a plane,” explains the dentist.
“People are always asking, ‘where are you wings?’, and they get disappointed when I explain we drive. It’s just a better use of money, and we also have to take along so much gear.”
Dr Gubbins is one of the teams of dentists, oral health therapists and dental assistants employed in the Mobile Dental Care unit of the RFDS, attending to communities throughout Victoria. They usually have a schedule of one week away in rural and remote areas, and then one week back at their home base in and around Melbourne. In the space of one week in a remote community, a Mobile Dental Care unit can attend to as many as 30 patients.
“I’ve always believed it’s important for people in rural areas to have access to the same treatment people in metropolitan areas receive,” Dr Gubbins says. “Just because they’ve chosen to live on the land or in a remote region doesn’t mean they don’t deserve the best in health treatments.
“These are the people who provide us with pretty much everything we need to live in terms of the food they’re growing, so I feel we have to take care of them. Improving access to oral health care for people everywhere is so important.”
In the 2018-19 Budget announced in April, the Commonwealth Government committed $327 million to the RFDS for medical, nursing, dental, and mental health programs. This included $5.5m specifically for dental services.
In the 2016-17 year, the RFDS provided 10,832 episodes of dental care. The new federal funding will allow the RFDS to not only maintain its current level of service, but also expand upon it, says Lana Mitchell, director of communications, Royal Flying Doctor Service of Australia.
“The RFDS will continue to deliver mobile outreach services—fly-in fly-out, or drive-in drive-out—in areas beyond normal dental infrastructure and in most need following the recent Budget announcement,” Mitchell says.
“Through our fly-in fly-out and drive-in drive-out dental services, the RFDS is providing access to areas where dental services are not otherwise available, to improve the dental health of people living in these areas. These services are flexibly planned to best respond to the needs of individual communities.”
According to the RFDS 2016 ‘Filling the Gap’ report, Australians living in rural and remote areas have poorer dental health and access to dental services when compared to people living in metropolitan centres. The report revealed that childhood cavities are 55 per cent higher for children in remote areas, a third of people in remote areas are living with untreated tooth decay, one third have gum disease and only four in 10 adults visited a dentist in the previous 12 months. All these figures are significantly higher than for people living in metropolitan areas.
“Country people are just very different—they’re so appreciative of what you’re doing for them. It definitely makes us happy when we’re dealing with people who are so grateful that we’re there.”—Dr Alice Gubbins, RFDS Victoria
“Things are different in the oral health between the patients I see in a private practice in Geelong compared to what I am seeing in remote communities,” Dr Gubbins says. “It’s about issues like oral hygiene education and the lack of fluoride in water, and dietary choices are not necessarily there as ranges are small in local supermarkets. It’s a matter of working in with all of that.”
Thinking on your feet
The Victorian team visits a wide range of remote indigenous and farming communities, nursing homes and schools. Marli Ruhl has been a dental assistant with the RFDS for 15 months, alternating one week with the mobile clinic and one week at the RFDS office, based in Richmond. She calls the RFDS role her “dream job”.
“This is a phenomenal service to work for, and every week is different,” she says. “You have to be proactive and efficient in your decisions because you’re working out of a truck in the middle of a remote area, so it’s not like being in a regular clinic. If something breaks down, you have to troubleshoot it and learn to solve the problem. Here, you quickly learn how to figure things out and think on your feet very fast.”
The distinct difference between treating the patient demographic in remote communities and the people she sees in the city, Ruhl observes, is the level of appreciation.
“Country people are very different. They’re so appreciative of what you’re doing for them. It definitely makes us happy when we’re dealing with people who are so grateful that we’re there. Some of the patients have been in pain for a while before we arrive, so by the time we see them, they’re just glad to see us and want us to do what we do.”
According to Dr Alice Gubbins, who had been working in the private health sector before being involved with the RFDS, the experience has been an important eye-opener to the way the public health system operates.
“It’s a completely different experience, as once you have treated someone and as they leave, you say, ‘no charge’, and that’s actually a nice thing,” she says. “It’s a nice process to be a part of. There can be such a negative attitude toward dentistry because of how much it costs, along with many people being so frightened of dentists, so we try to provide a better service than the service they’ve ever had in the past.
“So when it’s not hurting them, not costing anything and they’re happy with the results, it feels like we are changing attitudes as well.”
The reality of a work schedule that involves one week of travel around the state and the next week back at home base is a juggling act that some dentists are better suited to than others, Dr Gubbins advises.
“Those of us who are doing it are the type of people who want to do it because we like the variety and the range of really interesting cases,” she says. “You need to think about which parts of your life are mobile, from your gym membership to tennis lessons to your partner and family commitments. All that needs to be factored in, along with travelling a lot and eating at restaurants and being regularly on the move.
“But all of that is exactly why I do it and is part of the reason why I think the job is so worth it.”