Friday 26 June 2015

Finis (finished)

Wow - what an incredible two weeks.

I'm writing this blog from bed and savouring the feeling of not having to get up too early!

Yesterday was our last day of dentistry in Vanuatu. We spent it visiting a village in the north of Efate, Paunangisu. It was such a beautiful location for our last day and really felt like the epitome of Vanuatu. The whole community came together, chickens roamed around and on our lunch break we saw some pristine untouched beaches, with scatterings of islands on the horizon. We had the dental van and a makeshift dental chair (similar to a lay down physio bed) set up for treatment whilst we rotated between screening the children of the village. Not many children could have treatment yesterday but if they needed it they will make an appointment at the PCV clinic in Port Vila, possibly with Bob or the dental therapist visiting in July. The children in Paunangisu did have decay but it seemed less than in Port Vila, perhaps this is because they have a more natural diet in the village of things they can grow, rather than a more Western processed diet.

We had tallied the totals on Thursday night and realised if we did a further 46 extractions that would take our total to 500! At the start of week 1 we joked out target was 500 and suddenly this was a reality. We did it! 508 teeth extracted in two weeks. Don't worry - I know how sick this sounds and it reinforces the stereotypical dentist for a patient with dental anxiety but that's 508 areas of people's mouths that will no longer be in pain or subject to infection. The extractions have taken their toll on my body though, last night it was a struggle to lift my arms straight up. Yesterday morning after my first extraction my shoulder muscles felt as though they wouldn't survive the day. I'm looking forward to some slow yoga when I'm back to realign everything. After screening was complete in the afternoon I even took a few teeth up in a fairly upright camping chair (in a separate room). Visibility in less than ideal lighting (a camping headlamp) and patient positioning had me wondering what I'd gotten myself into but somehow, like everything else in the last two weeks, I coped. I'm expecting Monday back at work in private practice feels like a breeze - with great lighting, sharp and functioning instruments (and my instruments of choice no less) and no qualms of infection control.

Our statistics for the total two weeks of 10 working days of dentistry are:

- we saw 290 adults (102 male, 178 female)
- we saw 441 children (203 boys, 238 girls)

- screened 502 patients
- completed 422 fluoride treatments
- 508 extractions
- 159 restorations
- 26 scale and cleans
- 8 fissure sealants
- 3 endodontic instrumentations (first stage of root canal)
- 8 fissure sealants
- 1 pulpotomy

With love and fatigue from Vanuatu
Susan

Thursday 25 June 2015

Coming to an end

Today marked our last day in the PCV Clinic and dental van.

Michelle and Agnetha went to the Freshwota School to screen the kindy kids. They achieved an amazing 115 exams with fluoride treatments, and noted treatment to be continued for the upcoming dental therapist in July.




Viv tackled the chronic influx of patients with Gloria and Bob working two rooms in the clinic with Susan and I managing as many patients as possible in the van. Most of the afternoon today we dedicated to preparing the dental van for its voyage tomorrow to the remote village of Paungnisu, where we will be screening and treating children and adults.

All in all a very busy day but one of reflection on the many people we have helped so far. Tomorrow if we have 47 teeth to remove we will reach a landmark 500 extractions in 2 weeks!

An early departure of 7am to get to where we need to be requires an early night - so good night all and we shall report tomorrow!

Alicia

Wednesday 24 June 2015

Laplap... and teeth

The sun is rising on another beautiful morning and I'm going to take the time to reflect before the day starts. The roosters and been crowing and the birds chirping for what seems like hours but there are sleepy little heads all around.

We are 4 days into our second week of clinic and the work is taking its toll on our bodies and heads. Together our team totaled over 90 extractions yesterday on around 60 patients in addition to numerous fillings, fluorides and oral health instruction. The patients range from 3 up to 75 years of age.

We have all been working on-site at the PMC clinic with the mobile clinic parked out front. When we arrive at work just before 8am the waiting room is full with 15-20 patients waiting to be seen and the numbers stay pretty steady throughout the day.

We have opened up a new surgery...a bed similar to what you would see in a Dr's rooms with an ok but fairly inadequate light. Some supplies, and that is all. Bar a few minutes that we might manage to sit we have been on our feet for days.

We have given up on the delightful 2 hour lunch break instead opting for a quick lunch and breath of fresh air before jumping back in. But despite the exhaustion we are all doing what we love and feel that our contribution is really appreciated. I arrived back from lunch yesterday to find 2 patients waiting for me. The mum gave us with 2 delicious homemade banana loaves and a bag of vanuatu flags to share with the team.mThe little boy presented me with a great magnet with a picture of Vanuatu to take home. Agnetha was kindly given a huge cucumber fresh from her patients garden. Lovely, touching little gestures.

We managed to fit in a visit to a stunning waterfront dental practice owned by Felipe... Felipe is a Brazilian who moved from Sydney around 5 years ago and runs the practice with his wife. Novo Dental  services the wider Vila area treating some of the 6000 expats in Vanuatu but also treats Ni-Van patients at a hugely reduced rate of $80 a procedure. He is a lovely guy and they run a fantastic state of the art practice overlooking the ocean in the Pacific.

The significant moments continued at dinner. Richard and his lovely wife Rosie invited us to have dinner with their family and we were treated to an amazing local feast. Abu, (Richard's Mum) spent hours grating a bucket full of Maniok to make the Laplap. This was baked in the ground with coconut milk and local cabbage and wrapped in banana leafs. Yum yum! After cooking for around 3 hours we lifted this onto a flax mat, unwrapped it and Abu chopped it into generous pieces with a huge, well used knife. We ate this with a yummy BBQ meats, salads and a chicken curry.

Michelle

Tuesday 23 June 2015

Tag teaming in the clinic

Today Michelle, Susan and I worked in the clinic with Gloria, Bob, Jess and Seraphina, while Mum and Alicia were in the Van, which was stationed at the clinic, treating children from the Vila Central school. With only two rooms set up for dental treatment, and only one with a bracket tray, handpieces and suction, we set up a third room borrowed from the eye specialist team as a third examination room. So two rooms were for exams, extractions, oral hygiene instruction and fluoride treatment, while the other room was for general treatment. Word has definitely spread around the island about us and our free dental service, as this week we have been inundated with patients, some with appointments, others walk-ins, all requiring extensive treatment, and a large percentage having never seen a dentist. Many were patients we had screened at Freshwota park on Friday. We worked efficiently as a team to sift through the over-flowing waiting room, to get through the patients. Today between us, we did 89 extractions! 


Patients waiting to be seen before we have begun work

In the van, Mum and Alicia saw the children previously screened for requiring treatment at the Vila Central school for restorative treatment, extractions, oral hygiene instruction and fluoride. We have discovered during our time here, that the dental decay rate in children we have been screening, aged 3-7 years, is very high, with many needing extractions or extensive restorations. Consumption of sweets in this age group is high, including fruits, and brushing is not done as often as recommended, sometimes without toothpaste. A 3 year old patient I examined today, for example, had 6 decayed upper front baby teeth, due to a diet high in fruits, and no brushing because his mother said he does not like toothpaste. This is not that uncommon to child patients in Australia. We have been focusing on education in schools for children to understand the importance of brushing teeth, and a healthier diet. 


Mum and Alicia hard at work in the Van

The weather is Port Vila has cooled down, with heavy rain last night, and cool winds today. We are hoping for some sunnier days before we return to wintery Australia this Sunday! 


View of the road from our accommodation 


Agnetha

Monday 22 June 2015

Pace

Today I had my first day of 'screening' with Bob. Rather than doing the traditional dental treatment of drilling and filling (or as it is in Vanuatu - pullem tooth) I went out to a school and did 79 check ups and fluoride treatments on kinder and Year 1 students (equivalent to kindergarten/reception/Year 1 in South Australia). The teachers were great at helping us get the kids in order. I felt a bit shy as other students and parents crowded around the big UNICEF tent we were screening in but I guess they're more scared of me than I am of them! Generally the kids are smiley with us, some are a bit shy but one little girl bawled the entire time she was in the tent so I wasn't able to check her mouth, despite my attempts at bribes of stickers. Unfortunately almost every child had decay which made me feel a bit sad - these children are so young they will struggle to have so much treatment (if they can get it) and their dental fear will be perpetuated, not to mention the pain and embarrassment their decay will cause them. Dental decay is the most prevalent preventable chronic disease in the world.

Despite our incredibly hectic dental schedules we are struggling to adjust to the relaxed island pace. In Australia our patients are booked in tight schedules to maximise our productivity and sometimes we may even miss a lunch break but in Vanuatu the standard lunch break is 2 hours. Great for lifestyle but not when you want to treat as many people as possible! Poor Richard Tatwin, PCV Coordinator, has been very caring and encouraging us to take longer breaks when we would sometimes rather work through lunch. The Ni-Vans are very relaxed and don't seem too fussed by much (even cyclones) which seems to be in contrast to my life at home where I can cram things in to the point of stress and exhaustion. I can never imagine an Australian wedding with 9 couples (imagine the bridezillas together) but the Ni-Vans seemed very happy to celebrate as a community. I hope that I bring back a bit of Vanuatu to Australia by slowing down my life to a bit of more of a island pace and appreciating the simple important things more.

Susan

Sunday 21 June 2015

Statistics from our first week

The numbers have been crunched!

Last week, between the two dental chairs at the Presbyterian Church of Vanuatu dental clinic and the Rotary dental van, which visited schools and communities:

We saw:
- 142 adult patients (52 male, 88 female)
- 158 child patients (65 boys, 93 girls)

We did check ups for all these patients.

Treatment we performed included:
- 161 fluoride treatments (this will help prevent decay and remineralise early lesions)
- 151 extractions
- 93 fillings
- 22 scale and cleans
- 4 fissure sealants
- Prepared 3 teeth for the first stage of root canal (generally we aren't performing root canal as it will be awhile for another dentist to finish it but these were front teeth on young patients and the teeth were strong enough to last a long time after root canal treatment so we made an exception in this case)

Thank you for reading, we'd love your comments!

Susan

Wedding bliss

Today we were so lucky to witness 9 beautiful brides and handsome grooms say "I do". Richard (PCV coordinator) with his wife Rosie and their children (Valerie and baby Ronald), along with Debra (PCV coordinator) travelled to the island of Lelepa via water taxi.




Starting at 2 o'clock we made our way to the church and witnessed the procession of bridesmaids, groomsman, flower girls and ring boys flow into the church followed by the 9 blushing brides and their husbands to be. 
Finishing at 4 o'clock we congratulated the couples with the 200+ wedding guests from surrounding islands. After 30 minutes of uncertainty on water taxis from Lelepa we finally made our way home. It was such a privilege to take part in such a special day. 



Alicia 

Saturday 20 June 2015

Weekend in paradise

We had big plans for our first day off and happily achieved them all!

My day started with a canoe around the lagoon followed by a lovely breakfast.

After a lazy morning we were off for 2 hours of relaxation at Lotus Spa where the lovely Ni-Van girls worked their magic on our tired shoulders, necks and arms...a week of multiple extractions had left the dentists physically strained! Staff at local shops have noticed our Rotary VTT t-shirts during the week and we have picked up loads of new patients for the clinic. The owner of the spa was really impressed with the work we have been doing and presented us with a voucher for another half hour massage to use next week. It's little things that make us realise how much our being here means to people.


Our bus driver Eddie and his mate Pascall picked us up and shipped us off to the Mele waterfalls about 15 minutes out of Vila. We walked 20 minutes uphill to the start of the waterfall then followed a track upstream to the base of the falls. The scenery was breathtaking and we jumped in for an amazing swim. A little fresh but perfectly invigorating.

Mele Cascades

Numbawan (Bislama for number one!) team

We then headed back to Mele township where we caught a little water taxi over to Hideaway Island. The sun was going down but we snuck in for a quick snorkel and even managed to post a few cards off in the underwater post box. To all of you awaiting these I think we might arrive home before they do! We were in time for the ever important happy hour and indulged in a Mango daiquiri before a beachside BBQ.

Alicia looking pretty in the sunset at Hideaway Island

The days have been long, the work hard but moments like these come but once in a lifetime and make us feel so lucky to be here.

Michelle

Life in the van

17-18th June 2015

Mum, Gloria, Richard, Bob, Neville and I went to the Seaside Community school on the 17th, with the van, while the girls were at the PCV clinic. Mum and I attended the school assembly and enjoyed the beautiful singing by the students. We then addressed the whole school, giving oral hygiene and dietary advice before the children went off to class. Mum then set up in a classroom, assisted by Bob, and did oral screening and recording for the junior class students, who would then come to the van to see Gloria and myself for their treatment. While Mum was able to screen all the children, we were unable to keep up with completing all treatment needed for the children, before the school day ended at 11.30am. The children were a bit apprehensive about visiting a dentist for the first time, understandably! But with their teacher's help, we were able to get through the treatment required for the children we did see. In the afternoon we saw the kindergarten students, who were more excited to see us (always a pleasant change to what we normally get!) for screening and as much treatment as time would allow. Despite language barriers, we were able to get the kids a bit more excited about brushing with our models, and the importance of a healthy diet. 


We attended our first Rotary meeting on the 17th, which happens on the lunch hour for the Rotarians in the club. We enjoyed a nice lunch with the club, listened in on various club activities and projects, and heard a presentation from a group from Victoria, Australia, who are in Vanuatu to organise a Cricket team for over 60 year olds. The club primarily consists of expats from all over the world, including Australia, New Zealand, France, Canada, and Korea. Our own presentation was very well received, as we each gave our own stories of where we come from, our work histories and some background about Australian culture. Mum and Susan presented the President, and our accommodation host, Richard Purdie, with banners from the Elizabeth and Clare clubs, respectively, and were each presented with a banner for the Port Vila club. We distributed our brochures, cards and badges to our new alliances, and exchanged contact details, so we can keep them informed of our time in Vanuatu.

On the 18th, the van stayed close by to the clinic, due to it being a school public holiday, we saw a mix of adult and child patients in the van. Despite several hiccups with the van, equipment, chair etc, we have managed to get everything working, (more or less!) and patient flow went much more efficiently today. We saw a group of children in the afternoon, brought to us by Ruth, a friend we made at the Rotary meeting the day before. She was very keen to get as many of the children in her school seen by a dentist as she is aware treatment is much needed for them. We have discovered that wearing our VTT shirts around the Main Street in Port Vila, attracts the Ni-Vans we meet at the shops, supermarkets, cafes, and they are all very interested in coming to see us.

Gloria and me in the dental van

One of my most rewarding moments, was a patient I saw on Monday at the clinic, who was so grateful for whatever treatment she could get, and for it being free, that she must have said 'thank you' a hundred times! Then by chance, Alicia and I walked into a shop on our lunch break, and it happened to be the same store where she worked. She was so excited to see me again, she hugged me and had been telling all her co-workers about us, encouraging them to come too. I saw her again today for some further treatment, helping to restore her beautiful smile, she was so happy with the result she bought me a lovely dress and some earrings! I was so happy to have been able to make her so happy, and to have added another lovely friend to the list of people I hope to return to Vanuatu to meet again. 

Agnetha

Friday 19 June 2015

Every day is busy but this was REALLY busy!

Feeling awesome!

Stats for Friday: Viv, Michelle and Agnetha with Gloria the local dental assistant achieved an amazing 73 patient exams, 5 fillings and 24 extractions!! Susan, Bob (the Ni-Van dental assistant) and I tackled 2 endodontic preparations (the first stage of root canal), 3 fillings and 53 extractions!! What a day for us!! Today felt like we really made a difference.


Bob sterilising 


Susan working her magic hands 


Bob and I!

Alicia




(added note from Susan): we did a lot of extractions in the morning (20) and I joked that we should aim for 50. When we counted from our records at the end of the day I was so surprised that we actually took out 53 teeth! Wow, I don't think I will ever work that hard again in my life. Richard, a Ni-Van optician who set up the dental and eye clinic asked me what my previous record was - I think it was around 15! We're having a great day of relaxation now, more on that later. Thanks for reading!
Susan

Tuesday 16 June 2015

Visiting the school

Today we had our first day of visiting a school. We took the dental van just around the corner to Vila Central, a primary school. Gloria (dental assistant from New Zealand who will has committed her life to volunteering here for the next few years with her wonderful husband Neville - godsends!) and I were in the dental van performing treatment after our team leader Viv and Bob (our Ni-Van) dental assistant/therapist) screened the students and assessed their need for further treatment. Agnetha, Alicia and Michelle treated adults and other children at the clinic today and we will all rotate this way for the next two weeks.

The dental van was a first dental visit for almost all our patients. In each school all kinder and Year 1 students (4-6 years old) are being screened by us. In Australia we try to encourage children to have their first dental visit a few years earlier so they are familiar with the dentist, hopefully haven't experienced any disease so can focus on preventing decay and if there is any evidence of disease there is still an opportunity for early intervention.

Viv conducted 80 examinations today! Incredible! In addition every patient had a fluoride treatment of duraphat varnish by Viv, Bob or I. The fluoride treatment will help to prevent decay by strengthening their enamel, or in cases that already had decay (most) it will help remineralise early decays. If a child was assessed to need treatment (the majority) they would line up at the dental van. 30 children came through the van today, around half of those were just for fluoride treatments which are very quick and the other half were for restorative treatment (fillings - all in glass ionomer cement and without local anaesthesia, which is much quicker working in a little child's mouth) or extractions. The children cope very well without local anaesthetic for restorations but still don't like it much when they have it for an extraction! The children really are just the same as Aussie kids in so many other ways also. A little girl said to me 'you gonna stick me?!' and I tried not to laugh because it sounded so funny. The children have quite good English, as Bislama is based 95% on English and 5% French. I'm trying to pick up some Bislama and today I used a lot of 'bigfela openem' which roughly (hopefully) translates to 'open your mouth wide'.

Unfortunately we identified many children with grossly decayed teeth that needed treatment that wasn't able to be completed today but we are looking to try get these children into the clinic another time in the next two weeks. Another difficulty is completing so much treatment on such a young child, as they become fearful and upset in such a new environment. In Australia many of these children would meet the criteria to have all their treatment performed under a general anaesthetic but unfortunately that isn't an option here.

I think we are all feeling a bit tired and overwhelmed after a big few days but are also feeling really energised knowing that we are contributing to making an improvement. It does feel a little like our small bit of treatment is just a drop in the ocean of what needs to be done but it's encouraging to think of the positive aspects that could come from it - like knowing that even if we don't get all the treatment that these children need done that we have hopefully identified an area of need so that volunteers and resources might be dedicated further to these school children.

Gloria kindly took these photos (we couldn't unlock the door after lunchtime so the teacher put a child through the window to open it for us!):

In case you think we're working too hard here is our view from dinner:


Tata
Susan

Monday 15 June 2015

First day in the clinic

Today was the team's first day in the Presbyterian Church of Vanuatu Dental Clinic and Rotary-donated dental van. Off to an early start by "Island time", we arrived at the clinic at 8:30am, greeted at the surgery by Gloria (dental assistant), Debra (operations), Jessie (receptionist), Richard (operations manager) and Bob (Ni-van dental assistant). 

The first job of the day was to unload the 50kg of donated dental materials into the PCV Clinic. Donations from dental companies, surgeries and Rotary consisted of much needed gloves, filling materials, bonds, masks, mirrors, gauze just to name a few! 

After sorting out who was working in the clinic or the van, we were off to a shaky start but finally found our groove by lunch. Susan, Viv, Gloria and Bob were to start the day in the mobile van visiting the local schools, however due to technical issues the van served as a third treatment room. 



Susan and Bob in the Dental Van

The dental clinic consists of two dental chairs, Michelle occupied room 1 with Agnetha and I in room 2. Michelle's treatment consisted of oral hygiene instruction, applying fluoride, cleaning teeth with scalers and diet instruction. After seeing today's patients, Michelle noted that patients had a very good standard of oral care, however due to lack of dental resources gum issues (periodontal disease) was quite a common issue. 



Michelle and Bob in room 1

Agnetha in room 2

My first time manually developing x-rays!

Next door saw Agnetha and I tackling a lot of extractions and fillings with adult patients. After sorting through foreign cupboards and finding our feet, Agnetha and I tackled up to 4 fillings and 1 extraction per patient within an hour appointment! Today marked my first day of manually processing x-rays with developer and fixer as in my day to day routine as a dental assistant in Alice Springs our radiographs are digitally processed! As they say you learn new things everyday! 



Off to dinner after our first day's work!

After finishing the day at 4:30pm, the team already felt a great sense of achievement and were looking forward to the coming week.


Alicia 

Sunday 14 June 2015

Starting out in Vanuatu

We woke this morning feeling refreshed and ready to go after a beautiful 8 hours sleep listening to the raindrops on our thatched roofs. Sounds dreamy, and it is rather!

Breakfast was overlooking the lagoon and we were greeted with fresh local fruit, homemade bread and croissants just out of the oven and local coffee from Tanna Island. The coffee plantations on the island have been decimated by the recent devastating cyclone so may be a precious commodity in the months to come.

Our obliging and patient host Richard drove us into town where I luckily got to travel first class, in the boot! A fun start to the day! 



We picked up water and a few other essential supplies at the supermarket roaming around the aisles bumping into locals doing their weekly shop.

We had the maximum security jail pointed out to us which consisted of a reasonably low barbed wire fence, a concrete building and a series of shipping containers, and yes it does house true maximum security prisoners. Interesting.

After meandering our way through a few streets and up a few steps taking in the stunning seascape we met up with Gloria and Neville at the dental clinic where we had our first glance at our work base for the next 2 weeks, familiarizing ourselves with the equipment and materials.





The mobile dental van where will split our time between was parked on-site. The clinic and van were packed and ready for action and it is clear see how much work has gone on behind the scenes by a passionate and dedicated team, most of who volunteer their time to the project.


We have a list of patients pages long waiting for treatment and packed appointment book.

Luckily we have 3 great dentists, a very able, dynamic assistant and myself ready to get our teeth stuck into the challenge...no pun intended!

Michelle 

Farewell dinner and arrival to Vanuatu!

On Friday evening the Rotary Club of Elizabeth hosted our team, and our family and friends for a Farewell Dinner. We modelled our uniforms for the first time and gave our presentation to the club, that we will be giving while in Vanuatu, detailing our personal stories, including where we come from, where we work, our families and discussion about Australia's wildlife, culture, history, wineries and agriculture. Our presentation was well received by the VTT committee, the Elizabeth Club and a few of our family members, friends and workmates. We enjoyed a lovely meal with the club before heading home for some last minute packing and preparations.

Our flight was at 6am Saturday morning, to Vanuatu via Brisbane. We had our own bags plus two extra bags to check in filled with our dental supplies. We arrived in Port Vila at approximately 2.30pm, to gusty winds and rain causing our plane to circle the island several times before it could safely land. We were greeted upon arrival by Richard Purdie, Rotarian and owner of Vila Chaumieres, our accommodation for the next two weeks, and Bruce, also a Rotarian expat from Australia. We were taken to our accommodation for some R & R before meeting Richard Tatwin, a Rotarian youth worker studying ophthalmology, and Gloria and Neville Jones, missionaries from New Zealand now living in Vanuatu, who help run the clinic. We enjoyed our first meal at the accommodation on the lagoon, and then turned in early for a much needed good night's sleep!

Agnetha

View from the plane of Port Vila 

Welcome to Vanuatu!

Flying over Vanuatu on arrival from Australia

Friday 12 June 2015

We're about to head to Vanuatu!

Hi everyone (or 'halo' in Bislama - the language of Vanuatu)

This blog has been created to document our journey as we head to Vanuatu (at 6am tomorrow!) for a volunteer Dental Project. Rotary District 9500 (SA/NT in Australia) has coordinated a Vocational Training Team of three dentists, a dental hygienist/therapist and dental assistant to assist Vanuatu with their oral health. We are all very excited to be going after much hard work from the committee, especially Chair Jacqui Ateyo, and our Team Leader Dr Viv Valladares.

Tonight Viv's Rotary Club, the Rotary Club of Elizabeth, is hosting a Farewell Dinner for before we depart. We will present some information about ourselves to the guests. A lot of work has gone into getting to this point, including coordinating with the team in Vanuatu to bring equipment and materials and organising brochures, business cards and uniforms. Rotary District 9500 also hosted a lovely training weekend to help brief and prepare us for the weekend away.

Vanuatu has a high rate of dental decay and a lack of dental services. Australia has one dentist for every 1910 in the population, compared to Vanuatu which has 1:34900. Hopefully our trip can make a difference to some of the issues related to dental decay by getting people out of pain and improving their quality of life.


Here is our team:

From left: Dr Agnetha Valladares, Michelle Johnstone (hygienist/therapist), Dr Viv Valladares (team leader), Alicia Colombet (dental assistant), Dr Susan Clift


We look forward to sharing our experiences with you!

Tata (goodbye in Bislama)
Susan