Dr Vaibhav Garg—delivering oral healthcare to Australia’s remote communities

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Dr Vaibhav Garg
Dr Vaibhav Garg and the RFDS team visits some of the most remote locations in Australia where they are the only dental service available.

Using cutting-edge technology, Dr Vaibhav Garg delivers oral healthcare to the most remote outback communities in the country. By Kerryn Ramsey

Providing health and oral care to remote communities in Australia has its own set of challenges. There are vast distances to cover, often a lack of facilities and it can be hot and difficult work. At the same time, there is no excuse that a sub-standard quality of care should be acceptable.

“One of the critical things about working in remote areas is to ask yourself, ‘Is there a reason why I can’t provide the level of care in this location that I provide in private practice?’” says Dr Vaibhav Garg, senior dentist for the Royal Flying Doctor Service South Australia & Northern Territory (RFDS). “We live in Australia and everyone should have the same access to care. At the RFDS, we’ve partnered with the communities and industry leaders. By bringing everyone together, we’ve created a program that’s designed around how communities actually want to receive care.”

The result is a portable two-chair pop-up dental clinic. Around 350 to 400 kilos of dental equipment is packed into the back of a plane and then installed in a medical centre at a remote location. When the clinic opens its doors on Monday morning, the team works until Friday afternoon, dealing with around 60 appointments during that week.

“We’ve partnered with a lot of Aboriginal health services; the reception and uptake has been phenomenal,” says Dr Garg. “A critical request that all the communities made is that they want prevention, not just dentists flying in and extracting teeth. They want options for their children, adults and older people to access preventive care. That led us to include a hygienist chair and a dentist chair with every clinic we provide.”

Expectation versus reality

Often the expectation of what it’s like working in remote communities is very different to the reality. This can cause some dentists to refrain from being involved with the experience. When they do choose to take part, however, it can be the start of a long relationship.

“Clinicians who participate in a program soon discover we are exploring ways to deliver as many treatment modalities as possible,” says Dr Garg. “They will be working with a hygienist, visiting schools and going into aged care facilities. Each dentist is expected to come up with innovative solutions to unique problems. All their learning has to be moulded into a different setting and their skill set will be challenged.”

This commitment to quality care has helped the RFDS improve its clinician recruitment, particularly as word of mouth about the program has spread. They utilise a model where each clinician is able to give an amount of time that’s feasible for them, making the whole experience much more manageable.

“Working in remote communities is a unique experience and a little addictive,” says Dr Garg. “I often have dentists contact me saying it’s been too long since they went out on a trip. They miss it and can’t wait to be involved with an outback clinic.”

More than dentistry

The RFDS provides contemporary and innovative services to outback communities. It has a special needs consultant, a paediatric specialist and even a forensic odontologist on board. It holds annual CPD days with a culture of continuous learning. Additionally, clinicians get paid for going out on an RFDS clinic making it more feasible for many professionals.

“Each visit is different and has many beautiful aspects,” says Dr Garg. “In the opal mining town of Andamooka [in South Australia], they invited the team to learn how to mine opals because it’s an integral part of the community. 

One of the critical things about working in remote areas is to ask yourself, ‘Is there a reason why I can’t provide the level of care in this location that I provide in private practice?’

Dr Vaibhav Garg, senior dentist, Royal Flying Doctor Service (SA & NT)

“Kintore [in the Northern Territory] and Kiwirrkurra [in Western Australia] are in the Pintupi Homelands. The people here are the last known Aboriginal people to make contact with non-Aboriginal people. These people have an unbroken link with their culture that goes back tens of thousands of years. It’s a living tradition with the culture passed from person to person through song, ceremony, story and communing with the land.”

During their last visit, the team was invited to join a yarning circle and go goanna hunting. They sat on the land around a fireplace and shared their stories.

“These types of encounters really have an impact on you,” says Dr Garg. “It’s an experience that cannot be replicated elsewhere.”

Improving outcomes

While government and non-government bodies have been striving for decades to improve the quality of medical and dental health in remote communities, there’s still a way to go. The RFDS program, engaging with the community and with the dental industry, is a positive step forward.

“To achieve improved health outcomes, there are many structural challenges to overcome,” says Dr Garg. “One of the most important aspects is the recognition of the culture that exists in remote communities. Whether that’s an Aboriginal or Torres Strait Islander community, a mining town or a pastoral community, inherent culture is being recognised as a part of overall health outcomes. Once we recognise the importance and the richness of that, then patients engage more positively with the health service.”

The RFDS team visits some of the most remote locations in Australia where there are no government or private dental services available. Many of the patients travel up to five hours each way to attend their dental appointment. The pop-up clinics are fully accredited through the National Safety and Quality Health Service Standards, a further commitment the RFDS has undertaken to supply high-quality care comparable to anywhere else in Australia.

A large part of the RFDS success is partnering with dental manufacturers such as NSK Dental, SDI and Envista. “Our industry partners have literally sat down with us, looked at our clinic and looked at their product range,” says Dr Garg. “They understand how and where we work and have come up with some creative solutions. In a clinical setting, I have a digital X-ray, intraoral camera, rotary endo, and all my other equipment. I’m able to deliver dental work that is to the best of my abilities.”

Home and away

When not in the outback, Dr Garg works as a dentist at Better Dental in the Adelaide suburb of Seacombe Gardens. Like all clinicians who work with the RFDS, the first step is negotiating time away from the practice. The RFDS model is very flexible, ensuring that remote work is feasible and available to private practitioners.

“I give full credit to the owner of Better Dental, Dr Lena Regier,” says Dr Garg. “The work of the RFDS completely aligns with the ethos at our practice. We are about giving back to community and ensuring people who might find it challenging to access care have the opportunity. When I broached the idea of joining the RFDS to assist remote communities, Lena agreed without hesitation. Our patients know all our clinicians and they’re understanding when I go away. When I return, I talk to them about what we’ve done and they’re very much behind the concept.”

Job opportunities

Currently, Dr Garg is also the president of the Australian Dental Association South Australia branch. Here, he actively engages in improving and creating systems for change. The branch recently set up the ADA’s Council Working Group on Aboriginal and Torres Strait Islander Inclusion, led by Aboriginal and Torres Strait Island dentists. 

“Our branch is very forward thinking,” says Dr Garg. “We’re engaging with TAFE to make oral health a profession that people in remote areas consider as a career. Whether it’s dental assisting, being a hygienist, obtaining a Bachelor of Oral Health or a Bachelor of Dentistry, we want our young rural and remote people to know that oral health could be a profession for them. If we’re going to have big change in remote communities, it’s people within those communities that are going to drive that change.” 

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