Fly-in dentists

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1986

Dr John and Jan Owen have established a fly-in clinic in the Kimberley where dentists can learn how to deal with some of the worst oral health problems they’re likely to face. By Mary Banfield

Jan and Dr John Owen, who established the Kimberley Dental Team that’s “very close to the middle of bloody nowhere”.
Jan and Dr John Owen, who established the Kimberley Dental Team that’s “very close to the middle of bloody nowhere”.

The Kimberley is a vast expanse of land, twice the size of Victoria yet it is home to just 35,000 people. This isolation brings many challenges, and in the three years to 2009, Halls Creek, the biggest town in the region, had rarely seen a visiting dentist and never had a permanent dentist. That’s the year that Jan and Dr John Owen wandered into the town and realised they were witnessing an oral health crisis.

No more shocking was finding that in Halls Creek 75 per cent of the primary school children showed signs of advanced decay.

“When we started 95 per cent of our work was emergency care … now we are down to about 45-50 per cent.” Dr John Owen

As an emergency response the couple set up the Kimberley Dental Team (KDT) and asked their peers to drop their cushy lifestyle, particularly their dinners at fancy restaurants, to dedicate time and skills to turn this crisis around.

It is a two-hour drive along the gravel road from Halls Creek to Ringers Soak, a tiny indigenous community of 200 residents. On arrival Dr Jilen Patel, one of the KDT volunteers, opens the door of his four-wheel drive causing thick red dust to fall off the window. He emerges fresh and very smart, ready to draw together from the most meagre of resources in a modern, though minimal, dental clinic.

One day this year was particularly memorable. A five-year old girl emerged with a swollen face, the pain in her eyes was excruciating. For months she had been too sick to play or go to school and now she was unable to eat. “By the look in her eye, then opening her mouth, it was clear that she had not had a day free from chronic pain for many months, possibly years,” says Dr Patel.

It was almost 40 degrees as sun pelted down onto the metal roofs in this town that is situated in the far northern regions of Western Australia. Yet against the odds a veranda was re-designed into a dental clinic, with one end being a dentist surgery, the other end were rows of old wooden chairs creating a waiting room.

Despite the challenges this tiny girl sat through the process as Dr Patel removed two rotting teeth.

“The next day I saw her playing with her friends around the community store so she showed me around the area. She was feeling fantastic; there was life in her face again. That was priceless,” says Dr Patel.

This was the third of Dr Patel’s visits to the Kimberley. His first was in 2009 when he was a final-year dental intern at the University of Western Australia. Since then he has developed a passion for leaving his comfortable, family practice in suburban Perth to enter a world that was described by the man who set up the KDT, Dr Owen, as “very close to the middle of bloody nowhere”.

The isolation is the problem and without the KDT service, residents of the Kimberley face having to travel for hundreds of kilometres to see a dentist. With most families in the area living on the pension, the cost of dental work, even if it is subsidised, is prohibitive.

That’s the problem that Dr Owen was determined to overcome after seeing for himself the consequences of a neglected dental service.

In the past, children would develop tooth decay that was left untreated until an infection developed. The only option for GPs was to prescribe repeated courses of antibiotics and painkillers until it became so bad the patient had to be transported to hospital, possibly in Perth.

Volunteers working with the Kimberley Dental Team have to learn to overcome the challenges of equipment and location.
Volunteers working with the Kimberley Dental Team have to learn to overcome the challenges of equipment and location.

In 2010, 56 per cent of Kimberley primary school children desperately need dental work, and 38 per cent of those required immediate attention, with abscesses and gross caries; the remaining ones needed work within six months.

The dental health problems in the Kimberley are not unique. As part of the Northern Territory Intervention, research on the state of indigenous children’s oral health was carried out and the results were astonishing.

“Fifty-two per cent of children who received a Child Health Check Initiative (Closing the Gap) program funded dental service were diagnosed with decay. Analysis of data on decayed, missing and filled teeth shows that before their third birthday, 66 per cent of children had caries experience (decay, missing or filled teeth). This was 93 per cent for children aged six years,” says Dr Fadwa Al-Yaman from the Australian Institute of Health and Welfare.

The challenge of turning the crisis around in the Kimberley has been enormous so it required a significant financial investment from the Owen Family Trust. Each weekly trip costs $14,000, but for Dr Owen, the investment has provided an enormous social return. After five years of flying visits, the KDT is now able to focus on prevention. “When we started 95 per cent of our work was emergency care—extraction surgery—and now we are down to about 45-50 per cent,” he says. Thanks to corporate sponsorship four times a year every child receives a new toothbrush and toothpaste, and one for each member of their family.

As Dr Patel talks from his air-conditioned surgery in Perth he won’t ever be drawn into what it’s like being confronted with such poverty and enormous social problems. He only sees the positives.

Today care in the outback has been made a little easier with KDT having access to a purpose-built truck, owned by the Kimberley Aboriginal Medical Services Council. “We now have the luxury of having a fully operational dental unit with all your top spec equipment,” says Dr Patel—one that even provides overnight accommodation.

Although that comes down to interpretation. “The truck is built for the bitumen and didn’t ‘survive’ the rough conditions of the Tanami Desert Road from Halls Creek to Alice Springs. A recent trip over 170 kilometres took eight hours and when we opened the doors of the mobile clinic, the floor was littered with nuts and bolts and dental chairs had fallen apart,” says Dr Owen.

What they both agree on is that each volunteer comes back to their city job with highly developed problem solving skills. Without access to the most basic equipment including an autoclave, the same standard of care is expected whether the service is under a tree in Warmun or Macquarie Street, Sydney.

How do you remove a 14-year-old’s molars in the kitchen of a disused school?  How do you perform the surgery in front of her five siblings who follow you around a dental deck chair that is heightened by a platform precariously placed underneath?

Dr Owen believes that being able to overcome these challenges are indispensible to any dentist. “We tell our students, you have to have the confidence to get into trouble to be able to get out of trouble,” he says.

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