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

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

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

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

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

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