Immersed and contributing: JCU dental students on Malaita

Friday, November 15, 2019
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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.

Reflections...
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.