The Poche Centre at the University of Sydney provides dental clinics in some of the state's most disadvantaged areas. The clinics have improved school attendance, community oral health and provided a model for effective service delivery.
Situated in a remote corner of the Moree Plains Shire in northern New South Wales, Boggabilla is home to about 1500 people, most of whom are Aboriginal, and it has suffered through many tough years. For its part, the local school has had issues with attendance.
To encourage more children to come to school, the teachers created a visual attendance grid. When a child came to school on time, they’d get a green sticker. If they were late, they received an orange sticker. If they didn’t come to school at all, they were given a red sticker. Signs on school doors asked “How green is your grid?” Too often, the answer wasn’t what the teachers were hoping for.
Kim Szerdahelyi is the Project Manager of Oral Health at the Poche Centre for Indigenous Health at the University of Sydney. She regularly visits Boggabilla School because the Poche Centre provides a free dental service from what was once the school’s photographic darkroom.
“Last year one of the teachers at Boggabilla said he wanted me to see something,” she recalls. “He showed me the attendance grids and it was amazing – there was more green. And the green began growing from when we started our dental program at the school.
“That was incredible to me – really powerful.”
Allowing for how most children feel about going to the dentist, why would a dental service actually improve school attendance? The fact is, dental health can have a profound effect on a child’s ability to function at school.
Dharini Ravindra and Petra Vasic are both final-year dental students. As part of their studies they were required to undertake a four-week practical placement in a regional area, and they took the two places that were available with the Poche program.
Though they both admit to being very much city people, they were soon working in some of the state’s most remote and disadvantaged locations.
“I’d never been anywhere that remote,” Ravindra says, now back in Sydney with Vasic for their final exams. “It was a different world. Also, the level of oral health was a lot worse than I ever, ever expected.”
As well as Boggabilla, they worked in Toomelah, which had grown from an Aboriginal mission in the 1930s into a community so impoverished that in the ’80s and ’90s it was the focus of national attention and shame. More recently, there have been some positive changes for the people of Toomelah, yet dental health remains a signicant problem.
“The rates of decay and tooth loss were pretty high,” Vasic says. “Their parents had lost teeth, so the kids expected to lose their teeth as well. They didn’t really understand the idea of prevention.”
Vasic herself had an experience that no dentist would want. She had to remove a badly decayed permanent tooth from a nine-year-old girl.
“The initial thing for us was about building trust – then doing what we promised to do.”
The local water in some of the communities is part of the problem. In Toomelah, the current water supply is sourced from a single artesian bore using an electrical pump. The Poche team hear from the local children that the water tastes horrible and sometimes makes them sick. Bottled water isn’t an option because it’s more expensive than soft drink. “The result is that many of the children in these communities don’t drink water at all,” the Director of the Poche Centre for Indigenous Health, Kylie Gwynne, says.
“So, in consultation with the elders and other people in the communities, we’ve started a program where we’re installing free bubblers that filter and chill the water. We want everyone to have access to clean, cool, yummy water.”
As the water program gets underway, the green stickers on Boggabilla’s attendance grid show that the Poche dental program is already changing things. A child with a toothache or mouth abscess can’t sleep, and if they go to school at all they can’t concentrate in class. As the Poche clinicians make regular visits to schools such as Boggabilla and Toomelah, they take away the pain and educate the children and their parents about how to keep teeth healthy.
There are longer term health benefits as well. Poor dental health has been linked to heart disease and possibly even kidney problems, diabetes and low birth weight in babies.
Working from the Edward Ford Building at the University, Gwynne designs Poche Centre programs in collaboration with elders and local organisations. Together, they figure out where the programs are needed and how they’ll work.
“There’s been a long and unhelpful history of clever white fellas coming up and saying ‘we can solve your problems’,” says Gwynne. “The initial thing for us was about building trust, having lots of conversations and listening. Then doing what we promised to do.”
The Poche Centre was established after a $10 million donation in 2008 from Greg Poche AO, who revolutionised the transport industry with Star Track Express. Poche, his wife Kay and best friend Reg Richardson AM, felt strongly about improving Aboriginal and Torres Strait Islander outcomes, and their donation allowed the University to create the Poche Centre for Indigenous Health. It has three active priority areas: healthy kids, healthy teeth and healthy hearts.
The Poche Healthy Teeth program now works across 10 communities employing new-graduate sta, including oral health therapists and graduate dentists, as well as local Aboriginal dental assistants and support people. Costs are kept down by using existing infrastructure at schools and healthcare centres, and equipment that is mobile and portable.
Rostered senior clinicians provide supervision for the new dentists, on a pro bono basis.
Another key plank of the Poche program is getting it ready for community management. This is set to happen in 2019, with more local people already taking service delivery and management roles, and this year 157 Aboriginal scholarship holders are studying from Certicate III level through to PhD, with a view to delivering future clinical services.
“There’s a mythology that to do things in partnership with communities is time consuming and expensive,” Gwynne says. “That’s not true. We are the demonstration of that.”The Poche Centre program is important for another reason. As Ravindra points out: “No one else is doing what they’re doing out there.”
Written by George Dodd
Photography by Wayne Pratt and Sarah Rhodes (BA ’96 MPub ’09)