Remote possibility

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Dr Jijesh Nhalila Valappil, Australia's most remote private dentist.
Dr Jijesh Nhalila Valappil, Australia’s most remote private dentist.

Dr Jijesh Nhalila Valappil had no idea where the Gove Peninsula was when he first arrived from India. Today, he is the area’s only dentist, and one of the most remote practitioners in the country. And he couldn’t be happier about it, discovers John Burfitt

It would be a fair assumption that most people couldn’t point out where Nhulunbuy is located on the map of Australia. It’s doubtful if most people have even heard of the tiny town with its population of 4000.

That was the case with Indian-born dentist Dr Jijesh Nhalila Valappil who arrived in Australia in 2007 to complete his dentistry studies. Today, Dr Valappil, 30, is the sole dentist in Nhulunbuy, and speaks so passionately about his adopted hometown that he should be signed up by its tourism board.

For the record, Nhulunbuy is located on the Gove Peninsula in north-eastern Arnhem Land in the Northern Territory. The town, a 17-hour drive east of Darwin, was created in the 1960s to service the nearby bauxite mine and aluminum smelter. The area was also the home of the late Yothu Yindi frontman, Mr Yunupingu, and used for location filming on the Australian film, Ten Canoes.

With Arnhem Land to the west, the Arafura sea to the north and east, and the Gulf of Carpentaria lying south, Nhulunbuy would have to be one of the most remote towns in Australia. That would surely make Dr Valappil earn the title as the most remote dentist in the nation.

But that is a claim, with full respect to accuracy, that does not sit comfortably with the good doctor. “I might be Australia’s most remote dentist in private practice, but I don’t think I can be called the most remote dentist as I know a few public dentists who fly into even more remote communities than this one,” he says.

“But I love living here as this is such a beautiful part of Australia. As you fly in, you see the coastline and beaches, and the town has an amazing way of life. And it is not a quiet town. In fact, it is very, very social as there is always something going on to get involved with.”

If the Rural Health Workforce’s DRISS (Dental Relocation & Infrastructure Support Scheme) program needs a poster boy to promote the benefits of dentists moving beyond the city fringes and into remote communities where they are needed, then Dr Valappil might well be it.

It was the DRISS program which resulted in him setting up his practice in Nhulunbuy in 2012. At the time, the town had not had a dentist for six months, nor a regular dental service for five years.

It was actually Dr Valappil who took the initiative and approached the RHW about setting up a clinic and not, as it might be assumed, the other way around.

At the time, the dentist was working in two practices on the Gold Coast. He had previously worked in Fairy Meadow on the Illawarra coast in NSW after completing his Masters in Public Health degree and Australian dental licensing qualifications at the University of Wollongong in 2009. He had previously graduated as a dentist in Bangalore, India.

The plan had always been to return to India once he had finished his Australian studies, but with so many work opportunities offered upon graduation, Dr Valappil decided to stay in Australia to further his skills.

It was during a road trip holiday through Cooktown, Queensland, in 2012 that his career plans took the dramatic new turn that headed him in the direction of the Gove Peninsula. “A dentist friend of mine who has a practice in Port Douglas was on the trip with me, and when he discovered there was no dental service in Cooktown, he called the local newspaper to place an advertisement for his clinic.

“It was a journalist on the newspaper who told us that the front page story in another of their newspapers, the Arafura Times, was about there being no dentist in the whole Gove Peninsula. That sparked something in me, and yet, I had no idea where Gove even was!”

Dr Valappil then set about researching what opening a practice in Nhulunbuy would involve, but most importantly, would also cost. He spoke with Chris Handbury, previous director of the NT Government’s Oral Health Services, who was very keen on getting a private practice into Gove.

At the time, however, the only clinic resources available in the town were an old dental chair and a steriliser. In a rough estimate, he predicted the cost would be in the vicinity of $100,000.

Back then, most of the town locals either flew to Darwin, Cairns or Bali to see a dentist, or as Dr Valappil was to later discover, simply went without. The majority of Nhulunbuy locals are workers in the local Rio Tinto mines, public servants and from the Indigenous community.

In January 2013, Dr Valappil applied for a series of grants through the RHW’s DRISS program, as the Gove area falls under the RA5 criteria. In other words, the area is about as remote as it gets.

DRISS is a Federal Government initiative managed by RHW, providing grants for relocation and infrastructure to individual private dentists moving to rural areas. It targets the issue of the dental workforce shortfall in rural and remote parts of Australia by helping dentists relocate to those areas, set up a practice and become part of the local community.

Dentists moving to remote areas to open private practices are eligible for relocation and infrastructure grants that range from $15,000 to $370,000.

Dr Jijesh Nhalila Valappil, dental nurse Kayla Honnery and Gove local Nat Short.
Dr Jijesh Nhalila Valappil, dental nurse Kayla Honnery and Gove local Nat Short.

“We were delighted to support a dentist like Jijesh who wanted to practise in a remote area like Nhulunbuy,” says Greg Mundy, chief executive officer of Rural Health Workforce Australia. “In our first year of DRISS, we have allocated 68 grants to dentists to make the move to rural and remote Australia. In addition, his service model has opened up local employment opportunities and given choice of service to the local community.”

Ever since the day the Gove Private Dental Practice opened in July 2013, the appointment book has been full with patients. The clinic operates two to three days every week and also employs two local dental nurses. Dr Valappil now divides his week between Nhulunbuy and the Pines Dental Clinic in Elanora on the Gold Coast.

As Dr Valappil soon discovered, he was going to be a very busy man. “The lack of dentistry in the Gove area had built up quite a list of patients who had lots of work that needed to be done, and rather urgently,” he recalls. “The worst I can remember is a patient who needed 15 fillings and seven crowns and the removal of six teeth. His entire mouth was a mess.

“He was keen to get it all done, but didn’t like travelling and just did not have access to a dentist for a long time.”

Rather than being overwhelmed by the high workload, Dr Valappil says he is thriving on the challenge of making a difference to the small town.

“I am finally seeing a change, and now about 40 per cent of the appointment book is people returning to get their teeth cleaned or for follow-up work,” he says.

“Working here has also taught me to be efficient, organised and resourceful. If you need a specialist piece of equipment, it may take a month to be delivered. Unlike being in the city, you have to factor in a few weeks to get things in.”

And with the Nhulunbuy population having gone without for so long, they presented a long list of needs to be attended to. “There was such a strong demand that I had to make sure we were being efficient and using our time well, but also being sure to take care of what these people needed after such a long time with no access.”

As for the future, Dr Valappil says he has long-term plans to continue to divide his time between his Nhulunbuy practice and the clinic on the Gold Coast. In Nhulunbuy, he recently upgraded his chair and has invested in a range of new equipment. Even the closing of the local Rio Tinto refinery earlier this year and the resulting loss of 1000 jobs has not changed the demand for appointments.

“That was tough for the town, and we all thought it would impact on our work but, so far, it has not done so at all,” says Dr Valappil.

The reality of working in a remote town, far away from the busy lifestyle of a major city, remains a deterrent for many dentists who don’t want to relocate for jobs. Dr Valappil says, however, he has gained far more in spending half each week in Nhulunbuy than he feels he has given up.

“The benefits of being here are so much greater and make up for anything I fear I might be missing out on,” he says. “This experience is so worth it and you get such a sense of belonging when you work in a small community.

“I’ve been so welcomed into this community and I feel they have taken care of me as they are grateful for the service, but really, I am grateful for being here as this is such a nice part of the world. And I love being part of this community. It’s actually a lot of fun.”

The next funding round of the Dental Relocation and Infrastructure Support Scheme opens on 23 February 2015. Find out more at www.rhwa.org.au/DRISS

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