Immersed and contributing: JCU dental students on Malaita
Story by Fraser Lyon, Nathan Tan and Brenton Wilson
As we flew over glistening, aquamarine water, speckled with reef, we knew this trip would be much more than an ordinary clinical placement. As a group of 3 final year dental students from James Cook University and an Australian dentist supervisor, we travelled to the Solomon Islands for a 4-week immersive experience.
Our flight landed in the bustling city of Honiara. This capital city was merely a stopover, as we were destined for the remote province of Malaita, approximately 100km to the east. Malaita is a province rich in culture and poor in infrastructure. The capital of the province is Auki, where we started our clinical journey.
The provincial hospital, Kilu’ufi, provides some dental services and was our opportunity to engage with local health teams to start our Pijin language learning venture and to understand the oral health situation in the region. So what were the key differences….toothbrushing is not widely practised, particularly among people in remote villages. The highspeed drill was broken, meaning that cavities needed to be excavated in alternative ways. There were no x-ray facilities to determine treatment plans. Treks! Some people would journey more than 8 hours; walking and riding in the back of trucks to access dental care. Last but not least…Betel nut.
This psychoactive nut from the areca plant is chewed with lime to give a short-lived euphoric ‘light-headed’ feeling. Its use is widespread, has cultural and customary importance and is particularly prevalent among men in the Solomons. Without getting into the nitty-gritty of dental sciences, the main consequences of this habit are red-stained smiles, worn down dentition, teeth which are tricky to take out and a susceptibility to mouth cancer.
Our week in Auki gave the local team opportunity to identify two needs from our JCU group. One, to complete a school screening program for 6 and 12 year old children in the remote villages to assist with planning and funding. And two, if the Bank of Queensland Specialist Future Focus Grant Fund can be used to provide two new highspeed drill handpieces. This equipment will significantly improve the quality of dental care being provided in this region.
Crossing to the other side...
Our journey continued from here, on a long 4WD ride to the east coast of Malaita. We decided to take the overland journey to experience the barriers and difficulties people endure to reach healthcare in Auki. This ride saw us traversing the high mountain range dotted with small villages, clear-running streams and fruit trees as far as the eye can see.
After being bogged a number of times, we arrived at an unsuspecting jetty….a few big rocks sticking out into the water. Here we were met by a 16-foot banana boat with a 40HP, which would be our primary mode of transport for the next few weeks.
After loading the 50kg of dental equipment we were carrying, the boat carved through the glassy water towards the village of Atoifi. The regional hospital stands proud on a grassy hill in Atoifi, like something out of a travel magazine. After dropping off the gear, we headed to Gala Island, our home for the next 3 weeks. Windswept and ocean-splashed would be the new normal refreshing feeling we felt on our ‘commute’ everyday to work. The boat navigated its way through a small channel that snaked through the mangroves to an open lagoon. Our home was amazing! A thatched house with large undercover deck would be our sanctuary for the next 3 weeks. With no internet and a little bit of solar power, it was actually like a retreat.
Our clinical work in East Kwaio was rewarding but busy as we are the only dental services to the region each year. Each day we would see up to 35 patients, almost always with long-standing toothaches. The stoicism of local people was impressive, with people waiting months to see our dental team for relief of pain. Most teeth required extraction and the people displayed and indescribable appreciation for the help we provided.
Beyond clinical service, we visited four schools in the region to promote oral health and complete the screening as requested. One of the schools we visited was the first in the region to have running water, providing the perfect opportunity for toothbrushing by the pupils before school. This really highlighted not only the barriers to accessing health care, but reiterated the importance of the upstream, social determinants of health. We had the pleasure of travelling to school with the kids; first in a dugout canoe, then a short walk leaping between boulders, followed by a long, narrow balance-beam boardwalk through the mangroves.
Perhaps the most eye-opening aspect of the trip was the cultural immersion experience we were privy to. We stayed with and became part of a local family. Associated with this honour, there were a number of responsibilities, including understanding and adhering to the village hierarchy and dynamic. Each day, a smorgasbord of local foods was prepared by local village women, fresh from their carefully maintained gardens. Fresh fish and a delicious variety of vegetables cooked over the fire were our daily staples. Our morning wake up was with the boat ride to Atoifi each morning in lieu of no coffee.
It wasn’t all work and no play. Our morning routine included meditation and yoga on the beach to greet the sunrise each day. Whereas swimming, snorkelling, spearfishing, playing cards or lounging in the hammock comprised our afternoons. On the boat we voyaged to deserted islands on our weekends. Some days we were joined by dolphins racing the boat. One of our trips was joined by members from the Australian High Commission who dabbled in fishing, snorkelling and drinking coconuts after our key diplomatic work together was done.
This incredible island immersion was genuinely life changing! Although we have given our time and skill to these appreciative people, we believe we have taken so much more away from this trip. We have a better understanding of health in low-resource settings, local customs, the Pijin language and the social determinants of health. It has certainly confirmed this is the first of many volunteer trips for us in the future.
“Lukim iu moa”
See you later
Funding for this placement was jointly provided by the Australian Government's Columbo Plan and the individual students. Clinical supervision was voluntarily provided by Dr Michael Robinson on behalf of JCU.
JCU medical and dental student placements are supported by JCU's Associate Professor David MacLaren, Foundation Member of the Atoifi Health Research Group, and Dr Jason Diau, CEO Atoifi Hospital and Adjunct Lecturer at JCU.
Photos supplied by Fraser Lyon, Nathan Tan and Brenton Wilson.
With water now flowing, toilets are next
This has been an exciting month in East Kwaio. Imbo School, a church-run primary school with about 100 children from Wyfolonga, Abitona and surrounding villages, has had three water taps installed. This is the first time the school has had running water for the students since its establishment almost 50 years ago.
Encouraged and supported by Mr Shayne Humphries, Manager of Capability Projects at Hunter Water (Newcastle, Australia), the school now has two taps and a basin for students, and an additional tap for public use.
“Ours is the first school in our district to have taps”, explained Chief Hensen from Abitona Village, “and we are very happy for our children.”
Following this success, a village meeting was facilitated by Atoifi Health Research Group leaders Chief Esau Kekeubata, Mr Tommy Esau along with the leaders of Abitona village last Sunday, 30 September.
Plans were made for student and staff toilets and wash facilitates that are easy to maintain, culturally appropriate and take into account the needs of all students, including senior girls who are menstruating. It was reaffirmed that education and appropriate toilet facilities were essential for both male and female students to allow the best outcomes.
The meeting was also attended by AHRG leaders Dr Michelle Redman-MacLaren, who facilitated discussions about needs of menstruating girls, and Mr Tommy Esau, who discussed toilet designs and resources required.
“It was excellent to have the specific needs of girls discussed in the meeting”, Dr Redman-MacLaren said. “Right now, some girls in East Kwaio don’t go to school when they are menstruating because there is no way to manage their periods.”
Since the meeting, a group has met, sketched plans and plans are now being made for the building of the toilets, with additional support from Mr Humphries.
For more information about this story, please contact Tommy Esau: firstname.lastname@example.org
To read about the water, sanitation and hygiene situation for girls in the Pacific, you can read our published review for free here: https://iwaponline.com/washdev/article/8/3/386/41301/Water-sanitation-an...
1) Chief Rex Silas with a student from Imbo school at the new basin and taps (photo supplied by Shayne Humphries)
2) Tommy Esau leading a community meeting about Imbo school toilets at Abitona village (photo supplied by David MacLaren)
Who is getting malaria, where and when? A new study underway
By Stephanie Wheeler*
The Atoifi Adventist Hospital staff knew that it had been a big year for malaria (so many patients presenting and so many slides to examine!), and communities had noticed more people becoming unwell in their villages too. Since the last malaria study at Atoifi in 2014, malaria data has been carefully collected, but not yet analysed.
With a sense of changing malaria epidemiology in recent years, a new study commenced in September to understand the current situation of malaria in East Kwaio. Data were entered electronically and analysed to describe who is getting malaria, where and when. Cases were also analysed by malaria species, and by number of hospital presentations for malaria.
As data only ever show a small part of the story, initial results were presented to key hospital staff and community leaders for input on the context of the findings. The group brainstormed many solutions and recommendations for next steps both within the hospital, and community-led initiatives.
We look forward to sharing the results soon!
*Stephanie Wheeler (RN, MIPH) is a Field Epidemiology trainee with the Australian National University and Hunter New England Health Protection in Australia.
To read the previous AHRG Malaria paper, please visit: https://ojs.wpro.who.int/ojs/index.php/wpsar/article/view/274/415
Photo: Stephanie and Dorothy Esau enter malaria data for analysis (photo credit Peter Massey)
Analysing data can be fun!
Learning quantitative analytical skills can be challenging.This can involve extensive time slaving over textbooks and worksheets. However there are fun and practical ways to gain the same skills using a ‘learn-by-doing’ approach.
In September 2019 Associate Professor Peter Massey delivered a series of ‘learn-by-doing’ workshops with final year students at Atoifi College of Nursing. Students worked together with coloured jelly beans to learn how to calculate disease rates, and investigate the prevalence of disease and disease outbreaks in different populations and sub-populations. Coloured jelly beans were used to represent different populations and sub-populations.
Students reported that they had increased their problem solving and analytical skills – and had lots of fun during the activities. Analysing data can be fun!