Bella Miller is a recently qualified registered nurse in Western Australia, she lives there with her husband but also qualified as a dental nurse in the UK 12 years ago. She recently went to East Timor or Timor Leste with a charity as a volunteer dental nurse to help some of the country’s poorest and most remote village access free dental care. East Timor is an independent state at the eastern end of the Indonesian archipelago. It was only declared an independent state in 2002 and there has been conflict and unrest over it’s occupation by Indonesia for several decades. It has a humid and temperate climate but the rainy season can severely damage roads making the remote districts difficult to access.
Bella, tell us a little about yourself.
It’s always difficult to know how to respond when someone asks you to talk about yourself, so I usually focus on what I do. I have been a dental nurse for the past 12 years, originally studying and working in Stratford-upon-Avon, UK, and taking my exams at the Birmingham Dental Hospital. I am originally from Newcastle, UK but in 2011 I moved with my then boyfriend, now husband to Perth, Western Australia where I began studying again. In 2014 I graduated as an Enrolled Nurse (EN), and completed my studies to become a Registered Nurse (RN) earlier this year. I have worked all through my studies as a Dental Nurse (DN) and have also taken part in 2 voluntary missions to Timor Leste (TL).
How did you get involved with the Timor Leste Dental Program and was volunteering something you were always interested in doing?
I’ve been interested in volunteering ever since I started in a ‘caring’ profession. While working in customer service and retail, I was aware of things happening in the world that were not ok, but they were vague – hovering on the edge of my reality. When I started working as a dental nurse, education forced me to confront that not only were there more global humanitarian problems and injustices than I could possibly have imagined, but that I felt obligated to contribute to a solution in any way that I could. In the early days, most of my efforts went towards fundraising for charities such as Dentaid and Bridge to Aid, but as my experience and qualification levels progressed, I felt more confident in my ability to contribute in a hands-on fashion. I have worked with Dr John Moran, a dentist here in Perth since I arrived 6 years ago, and for the past two years, I have accompanied him on his annual voluntary service in TL.
Tell us about a typical day in your clinic
My team while I have been with the Timor Leste Dental Program (TLDP) has been made up of my boss John (JM), another Perth dentist Dr John Whyte (JW), and myself acting as DN for both of them. During our two-week visit to TL we stay with the Jesuit brothers in a Catholic mission in Railaco, which comprises of a church, a clinic, kitchens, dormitories for orphans and visitors, and school rooms. Our day usually starts at 6am when the church bells ring for mass, and although I am not religious, they are impossible to sleep through so I would invariably get up at this time too. The mission has running water, but no heaters or showers, so the morning wash is completed with the help of a bucket, icy water, and the willpower to chuck it over your head. After this rather bracing start to the day, there is typically a steaming pot of dangerously strong Timorese coffee and freshly baked bread rolls from the convent next door.
By 7am, JM, JW and myself would be on the road in our ancient Toyota Land Cruiser, loaded to the roof with supplies, heading out to a rural village that has been selected by the program as being particularly in need of assistance. The weather in the mountains of TL at the time of our travels in May/June is sunny and cool, with frequent, sudden rainstorms. This, coupled with the poor state of the roads and mountainous terrain means each commute takes about an hour, even when the village is only a few kilometres away. When we arrive at our station for the day, we are usually directed to a schoolroom or shed that has been deemed adequate by the villagers to act as our clinic, then a flurry of activity ensues in order to get our equipment set up as quickly as possible. Typically a queue of prospective patients will have formed before we even arrive, so the pressure is on to get to work. As I have to act as DN for two practitioners simultaneously, with upwards of 50 patients a day, I need to be able to anticipate their needs, locate and deliver the necessary equipment and consumables, and assist chair-side, without wasting valuable time running back and forth.
The procedures that we undertake are simple and effective – nothing complex or heroic. Patients will usually arrive at the clinic with a specific issue such as pain or a broken tooth, which the dentists will treat along with any other problems they can see. The problem with dental disease is that it is not always symptomatic, so a person may not know that they have decay until they see a black cavity, or the pain of an abscess wakes them in the night. Once a tooth has died and is causing infection, the only recourse in an environment such as this is an extraction. In a more developed country, root canal treatment can be undertaken in order to try and save the tooth, but as this relies on several visits and impeccable infection control, it is just not feasible in TL. With regards to fillings, these are invariably done using a hard wearing, fluoride releasing composite material known as Glass Ionomer. This is ideal for TL as it is easy to mix and place, will last a long time, and helps to prevent further decay in the future.
I have two main concerns as the nurse on these trips, the first of which is caring for the patients. The dentists can sometimes get a little hyper-focused on the teeth and forget that there is a person attached to them. They are incredibly caring, however in the fast paced environment of the rural clinic, there is little time left over for handholding, especially when you add in a language barrier. Thankfully, there are almost always locals with a good grasp of English who are more than willing to help translate and reassure. I have managed to pick up the basics of the most prevalent language of TL (Tetum), but I would still rely heavily on the local volunteers when trying to comfort a small, crying child who has just been told that they need to have four teeth removed.
My other main concern is cross-infection control. Infectious diseases such as tuberculosis (TB) and hepatitis are prevalent in TL, and the risk of transmission in the dental surgery is very real. Blood, spit, and other bodily fluids are unavoidable, and though the circumstances are far from ideal, the imperative to prevent transmission remains. As such I focus heavily on ensuring that there are always plenty of gloves and masks on hand, hand-washing facilities are available, and that all areas are cleaned thoroughly in between patients. Part of my mandatory equipment is the autoclave; a portable steam-steriliser that is probably older than I am, but still valiantly runs approximately 20 cycles per day, ensuring that all of our metal instruments are pathogen-free between uses.
The day invariably concludes with the clean-up of our borrowed surgery and packing the truck ready for the next day before heading back to the mission. Dinner is always provided and is exceptional, with mounds of rice, veggies, stews, chillies, and fried tofu – perfect after being run ragged all day. Another cold bucket shower is unavoidable for the hot and sweaty team, before beer and bed, ready to do it all again the next day.
Volunteering for such an important project must feel very rewarding, what was the most important part for you personally?
Seeing people relieved of consistent, nagging pain. Many people in the most remote areas of TL just learn to put up with terrible pain because the nearest dentist to them is in Dili; several days walk away and far out of their financial capabilities. Additionally, there were a f
ew young people who came to us with broken and unsightly front teeth. Although it took a great deal longer than the majority of the treatments, JM went out of his way to restore their smiles, which was honestly incredible to see. Creating whole teeth from mere stumps is an art form and can improve a person’s quality of life to a degree of magnitude. Lastly, it seems so frivolous, but giving gifts to the small children was massively rewarding. Even just bouncy balls or a colouring book, bought from a cheap shop in WA, means a lot to kids who rarely have anything new or that they don’t have to share with several siblings.
Given the extreme poverty of some of the villages you visited, what were the most difficult aspects of being part of this team?
Education. I feel that so many humanitarian issues could be, if not resolved then massively relieved by education. It seems so obvious to us, but many Timorese people found it very difficult to believe that the high volume of sugar in their diets was the probable cause of their rampant tooth decay. A little girl laughed at me when I gave her a toothbrush and told her she needed to clean her teeth with it every morning and night. Several people declined tooth extractions because they were convinced that it would cause the loss of sight in the eye of the same side of their face, and decided it wasn’t worth it. The lack of education also sees girls having to stay home from school when they have their period, popularity of unhealthy lifestyle choices such as smoking and chewing betel nut, preventable chronic diseases proliferating unchecked, and an overall impact on quality of life.
Another difficulty for me was the prioritisation of religious concerns. In villages where the people live in wooden shacks and there is no access to a school within 20km, new churches were being built. The mission at which we were staying boasted a brand new church right next to the existing one, at a cost of $400,000, while the health clinic had rain dripping through the roof. In a country where $50 per week is an acceptable wage, this to me seems incomprehensible. I understand that religion is the cornerstone of many lives around the world – providing community, structure, and support in lives that may otherwise be lacking – but when an institution that is purported to be a force for good in the world places churches above the wellbeing of its parishioners, I am at a loss.
You had a great response on your GoFundMe page. How else do you prepare for a trip like this and what tips do you have for other people thinking about volunteering in ventures like this?
Be organised! If you find yourself going on a mission, it is never too soon to start researching what you may need to take.
Be bold – put yourself forward for any opportunity that sparks your interest. Once you get the first mission complete, you’ll be itching to get back out into the world and do more. If you know that hands on volunteering isn’t for you, you can always help to raise money for worthy organisations by holding bake sales, touting for supporters, and gaining sponsorships for different endeavors (e.g. abseiling, 12km runs, parachute jumps, etc.)
Everyone has their preferences, but my backpack always contains: Hand sanitiser, a book, tissues, wet wipes, a first aid kit, a small pharmacy (e.g. paracetamol, ibuprofen, antibiotics, anti-diarrhoeals, rehydration salts, etc.), a reusable water bottle, sun screen, lip balm, and my phone and ear buds. On recent trips I have also included a small Polaroid camera as the kids adore having their photograph taken and it is a joy to be able to give them a hard copy rather than just showing them on a digital screen.
Do you have any plans to return to East Timor or get involved with any other voluntary overseas projects? What’s next for you as a nurse?
I fully intend to accompany the team again in 2018, even though I will be working as an RN at this time. I have also been invited to join a different charity that travels each year to a village in Nepal to provide Medical and Dental treatment. Although not finalised yet, I am excited to expand my horizons and learn more about being useful in trying circumstances.
If you would like more information about the work undertaken by the Timor Leste Dental Program their website is at https://timordentalprogram.org/