Rotary Club of Ballarat West

Transcription

1 1 Rotary Club of Ballarat West Report on the Rotary Tonga Visits Overview of the Fifth Visit OCTOBER 2000 This was the fifth Rotary Dental Work Party to Tonga.. The first visit was in 1996 as part of the twinning project between the St. John of God and Vaiola Hospitals. Visits have been made each year since then by multidisciplinary groups of dental health professional volunteers, who in most cases have paid their own expenses and donated their time. The aims of this project have always been to help by ongoing support, education and donations, rather than to do. This year's team consisted of Dr. David Goldsmith (dentist, team leader), Dr. Rudy Jansen (dentist), Peter Copp (dental equipment specialist), Peter Jones (plumber), Garry Harrowfield (Rotary volunteer), Cindy Thompson (dental nurse) and Camille Lewis (dental nurse) Rotary dental team with some of the donated dental materials This year the team spent two weeks in Tonga (October 17- Nov. 1 st.) and visited the hospital dental clinics on the islands of Tongatapu, Ha'apai and Vava'u. People met included the Chief Dental Officer at Vaiola Hospital, Dr. Viliami Latu, and the dental officers at Ha'apai Dr. Tule 'Akauola, and Vava'u, Dr. Susitina Namoa. Interviews were held and good meaningful contacts were made with the Minister of Health, Dr. Viliami Tangi, Health Administrator Tonga Finau, Senior Planning Officer, Sunia Soakia, Tonga Health Planning Manager, Dr. Lynleigh Evans, Moala Simiki, Director of Nursing, Nuku'alofa Rotary Club President, Steve Finau, AusAid First Secretary to the Australian High Commission in Nuku'alofa, Dr. Leanne Merrett and many others.

2 2 What was achieved The installation of a large amount of dental equipment, donated by the Royal Melbourne dental Hospital into the Vaiola Hospital Dental Clinic and a Panoramic X-ray machine in the Radiology department, (more details below) St. John of God Hospital in Ballarat donated many Medical items (consumables, wheelchairs, a steam autoclave etc.) for the Vaiola Hospital. Books (259 cartons) were donated by Rotary International for the Tonga High School library, which had just burnt down 3 weeks earlier.(and thus losing its library) 15 Computers were donated by Rotary International and were sent to St. Bernard's College in Nuku'alofa. Water samples were taken from 5 different locations on Tongatapu, and also from Ha'apai and Vava'u for chemical analysis. Verification and Documentation of the sterilisation procedures was introduced in the Vaiola Hospital Dental Clinic. Repairs to equipment was carried out at the Ha'apai and Vava'u dental clinics Some $35,000 new dental consumables (anaesthetic, composite, compomer and Glass ionomer filling materials, fissure sealants, cements, instruments, etc) were donated to the dental clinic. A new Swedish invention, Cariesolve, which enables some fillings to be done without injections or drilling, was left for Dr. Tule 'Akaeola to trial in Ha'apai on her around the Islands circuit..(provided by Henry Schein, Australia). Posters on Oral hygiene Instruction (customised to the Tongan language) were put as educational material in the Vaiola Hospital dental clinic waiting room. Dental Equipment 5 Complete Dental Units - three Adec Dental-Eze Units and 2 Adec 1005 Units from the Royal Melbourne Dental Hospital. (a "Unit" = Chair+ operating light +spitoon +handpiece / triplex controls)- there was only one complete Dental Unit operating at Vaiola before. 5 Adec Operating carts (this enables a single standing dental chair to do fillings) - only 2 working at Vaiola previously. 2 Belmont Dental chairs (from Sydney United Dental Hospital) 3 Dental Autoclaves (Dental health Services Victoria) 3 Cavitron Ultrasonic scalers (none working at Vaiola as of Sept.2000) 5 Operating stools

3 3 A wall mounted Siemens dental X-ray machine (a vital back up for the only existing unit) 5 Amalgamators ( to supplement the only one working as at Sept ) 4 Pelton & Crane Operating Light Reflectors Adec 1005 Dental Unit Much of this equipment was installed and working when we left. Instruction in the installations was given to Mr. Sioeli Manu from the Vaiola Hospital Engineering department. Spare parts are available for all the equipment that we brought, (this contrasts with much of the equipment previously at Vaiola which was obsolete, with spare parts no longer manufactured.) OPG X-ray Machine Each successive year we have seen an increase in the number of patients being serviced by the dental clinics in Tonga and this new equipment should have large benefits in the ability of the dental clinic to do fillings and surgical extractions more efficiently. A cental suction system would further improve the through-flow of patients. Unfortunately this is one item that our group cannot provide, as a new system specially designed for Tonga is needed in this case. However the dental staff does a remarkable job with the facilities they have and the Tongan patients receive year-round care, including emergency and after hours care, for basically little or no cost to themselves. Each year we have seen continued improvements in the clinic, and perhaps we could recap how we have seen these changes over the past five years that we have been involved in visits to the Tongan dental clinics.

4 4 Dental Priority Areas for Tonga. The first Rotary Dental team that went to Tonga in 1996 made a needs assessment report in which we identified five priority areas needing help in the dental clinics. These were, in order of priority; Infection Control and General Cleanliness, Maintenance and Supply of Equipment, Preventive Services, Material Shortages and Availability, and Staff Training and Development. I would like to outline what the Rotary teams (and the dental clinics themselves) have achieved in these areas since that first visit. There is no doubt the dental clinic at Vaiola hospital has made huge improvements since A.) Infection Control This was the number one priority area from the start and we enlisted the support of Rod McLean, a senior lecturer in Infection Control at RMIT University in Melbourne. Rod was a part of three Rotary FAIM dental work parties. 1. W.H.O. studies showed a 15-19% exposure of blood donors in Tonga to Hepatitis B, a blood-borne virus that is readily transmittable in a dental clinic. 2. Instruction was given to the dental staff on how to properly sterilize the dental instruments and dispose of infectious waste in the Vaiola Dental Clinic in 1997 and donated autoclaves were installed. The first meeting of the Vaiola Hospital Infection Control Committee took place with Rod McLean on this visit. 3. An Infection Control Nurse was appointed in the Dental Clinic. (Robyn Scanes - AUSAID sponsored) Video filming at Vaiola Hospital by Scientific Photography student Karen Burns from RMIT. University.. 5. A professional Infection Control Training Video was made using the existing staff, equipment and facilities, and voiceovers done in English and Tongan language versions. (Sponsored & edited by RMIT University) Further autoclaves donated and daily verification and documentation of the sterilisation cycles introduced at Vaiola Hospital Dental Clinic A new Sterilisation Room is being constructed at Vaiola Hospital dental clinic. 8. Keio Kava, Dental Assistant at Vava'u completes a 3 month Infection Control course at Otago University, New Zealand Huge improvements have been made in this area over the past 5 years B) Maintenance and Supply of Equipment 1. Peter Copp, a specialist dental equipment engineer from Melbourne came on the fist team in 1996 and also in 1997, 1999 and He has visited the clinics on Tongatapu, Ha'apai and Vava'u, repairing broken equipment and giving advice and instruction in maintenance. Without doubt Peter has been absolutely crucial to

5 5 the success of our visits. I doubt that there is any other technician in Australia that could have achieved what Peter has done in Tonga. 2. On all of our visits Peter Copp has done installations of dental equipment, all of which we chose as being suitable for Tongan conditions and with spare parts available. Much of the original equipment was obsolete with no spare parts available. 3. A great deal of the dental equipment that is now in use at the Vaiola Hospital has been donated by these Rotary teams. For instance this year 5 dental units, 7 chairs, 5 Adec Operating carts, 3 autoclaves, 3 Cavitrons, an X-ray machine and an OPG machine were delivered to Vaiola. Most of this equipment was installed and working when we left and will triple the ability of the staff to do fillings in teeth, and still leave some spare equipment for spare parts and installation on other islands. 4. Two brand new Adec dental chairs, 9 new high speed handpieces, clean water kits and a central suction system were installed at Vava'u last year, and a new compressor this year. New Adec chair, Vava'u (1999) 5. Repairs were done to equipment in Ha'apai and an old dental autoclave repaired and put back into use where previously only boiling water was available for disinfecting in the dental clinic. 6. Instruction on the installations and maintenance of this latest equipment was given to Jo Manu of the Vaiola Hospital Engineering department. (If funding can be made available we would strongly recommend Jo Manu spend 3 months in Australia living and working with Peter Copp to be fully trained in the repair and maintenance of the dental equipment specifically of the type used in Tonga.) 7..Help is still needed in the Prosthetic (Dentures) area. This this!

6 6 Preventive Dental Services 1. A DMFT (Decayed/Missing/filled teeth) survey was done by the work party in 1998 to WHO criteria which showed a threefold increase in the dental decay levels in Tonga since This survey which is accepted by WHO in their Global Data Bank, has resulted in Dental Services in Tonga being put on the priority list of the Ministry of Health 4 year old Tongan boy 2. A further survey is planned for next year. 3. A School Dental Van has been allocated by DHSV for delivery to Tonga next year, and Kylie Blake (part of our first team) has offered to commission it and train the Dental Therapists in Tonga in the use of this $200,000+ facility as a Preventive Dentistry centre. Funding is needed to get this to Tonga. 4. Water samples were taken from different locations throughout Tonga and they have been sent to Melbourne University for analysis of the Fluoride content of the water. This, together with other data collected, could be used by the Ministry of Health to decide whether to recommend the Fluoridation of the reticulated water supply in the capital Nuku'alofa, as a way of reducing the tooth decay levels in Tonga. (Separate report to come later). 5. Each year the group has brought over toothbrushes and toothpaste for use in dental health education in the schools. Preventive dentistry poster, customised to the Tongan language put up in the waiting room at Vaiola Dental Clinic. D) Material Shortages and Availability 1. The Australian Dental Supply companies throughout Australia have been very generous in their support of all the dental work parties and each year we have

7 7 brought over some thousands of dollars of new donated consumable dental materials. We could provide more if funding for freight was made available. For instance, this year an estimated $35,000 of new materials were shipped thanks to Geelong Rotary Club D.I.K providing a shipping container and donations from Australian supply companies, including a particularly generous one from Dentsply, Australia. (This compares with an annual budget of only $45,000 for these materials in Tonga.) - We could only have brought a fraction of this if we had had to bring it on the plane with us. 2. However, further help needs to be given in funding, ordering, budgeting etc. in this area, as chronic shortages commonly occur with all but the most basic of materials, and this greatly restricts the range of treatments available to patients. E) Staff Training and Development 1. Lectures in Oral surgery and Infection Control have been given by Senior University lecturers Bob Jones and Rod McLean, and also clinical demonstrations have been given by Dr. Rudy Jansen and David Goldsmith. Peter Copp has given instruction on equipment maintenance on all of his visits and involved Jo Manu in working on the installation of the dental units this year. 2. A major facial surgical operation (Le Fort III) was conducted by Dr. Bob Jones last year, and Dr. Fusi Fifita and Dr. Tule 'Akaeola assisted in this 6 hour operation, gaining valuable surgical experience. It is no co-incidence that Dr. Fifita is now in Japan studying Oral Surgery, and Dr. Akeaola has applied for, and received approval for AusAid distance training in Oral Surgery. 3. It is difficult for dental staff to be kept up-to-date on the latest materials and techniques in Dentistry partly due to Tonga's remote location and lack of visiting top quality education professionals. Some suggestions would include; holding weekly local seminars using existing staff to discuss clinical cases and possible treatment options, accessing dental web sites on the Internet, facilities in the clinic, subscriptions to overseas journals., distance learning courses etc. 4. We hope to offer more help in this area in the future. Recommendations; 1. The prime recommendation from this visit is to begin a program of Preventive Dentistry in Tonga as soon as possible. Dental caries levels are rising and consequently the demand for treatment in the dental clinics. (number of patients seen at Vaiola up ~25% from to 48358, and number of extractions due to caries there almost doubling to 24949, in just 2 years ). This would best be done through a co-ordinated and multi-disciplinary approach. AusAid is already preparing a proposal on this subject. We have been given the opportunity by DHSV to offer one (and possibly 2) selfcontained school dental vans as used in the schools dental services in Victoria. These fully equipped and air-conditioned, 2 chair $ units, would we feel, make a great focus for such a preventive centre in Tonga. We would envisage the unit(s) to be used primarily for examinations, toothbrush instruction, fissure sealants and fluoride applications, rather than extractions or fillings. Kylie Blake, a member of our first

8 dental work party in 1996, has offered to commission the van and train Tongan Dental Therapists in how the unit is used in Victoria, and I believe Kylie would be an exceptional person to do this. She has worked in the vans herself, and following her promotion she now works in Ballarat in the management of this service with Dental Health Services Victoria. Funding would be needed to ship over the van(s) and for Kylie's airfare but she would be prepared to volunteer her time (1-2 months). Coupled with surveys ( we would next like to do a longitudinal one in two secondary schools to provide practical information on the progression of the caries problem in Tonga), possibly considering the fluoridation of the reticulated water supply in Nuku'alofa (a preliminary report will be available soon on this ), and some of the AusAid proposals, the attack on Tonga's rising caries rate caries rate could be co-ordinated and monitored. 2.A central suction system be installed at Vaiola. This would greatly increase the efficiency of the dental clinic. The new equipment that we brought will allow more fillings-type work to be done but the materials we brought this time do require a dry field to allow proper bonding to the teeth. (hence better, longer lasting fillings) 3. Support should be given for exchanges of personnel between Tongan staff and members of past Rotary dental teams. The experience that we have gained over five years in understanding the unique problems facing the dental system in Tonga I believe gives us a good insight into how to better target education and training that will have a much more useful application on returning to Tonga. Two examples: Jo Manu supervised and was involved this year in the installation of the equipment at Vaiola Hospital and developed a good understanding and close relationship with Peter Copp whilst this was happening. Jo has had already had some training in the dental area in Sydney, but this was with brand new equipment and not of the type that is in operation in Tonga. Peter Copp had offered to instruct Jo Manu in the repair and maintenance of the same type of equipment that is used in Tonga. The suggestion is that Jo lives and works with Peter Copp in Melbourne over a three month period in which time Jo would receive intensive and extensive experience in the repair and maintenance of a wide variety of dental surgeries and that by the end of that time he should be competent in the repair of much of the dental equipment needs at Vaiola or the other island clinics. Peter Copp is prepared to offer accommodation with his family in his own home, and all that Jo would need would be the sponsorship of his airfare and minimal living expenses. Secondly, Dr. Bob Jones, senior lecturer in Maxillo-facial surgery at Adelaide University, supervised the training of Amanaki, who has just commenced work as an Oral Surgeon in Tonga. Bob Jones was also a member of our 1999 Rotary dental team. It would be useful to continue this association as Dr. Jones has operated at Vaiola as well as in Bangladesh (for 10 years as a visiting Oral Surgeon), Nigeria, and he is also responsible for the accreditation of Oral Surgery facilities in other countries including New Zealand. The possibility exists if Dr. Jones were to be sponsored as an exchange then major Oral Surgical operations could be done conjointly between Bob and Amanaki that may otherwise have to be sent to New Zealand or Australia. Examples would be such operations as cleft palate/lip surgery, plastic surgery. Orthognathic surgery etc. as well as general ongoing advice and training in new surgical techniques. The result would be to make Tonga more self-sufficient in the more advanced oral surgical techniques. 8

9 9 If these were successful then similar situations could also apply in the future to dental nursing, dental technicians etc. 4. Dental Laboratory. A volunteer Dental Technicians work party could greatly help in this area. There is a great need for both partial and full dentures, as Tonga has high rates of both dental caries and periodontal (gum) disease. So far our Rotary teams have had little input into the Prosthetic department of the Dental clinic but a team of Rotary Dental Technicians from Ballarat has expressed interest in visiting Tonga in Standardise the Infection Control Operating Procedures on the most appropriate procedures necessary to sterilise / clean instruments and equipment at the various dental clinics in Tonga e.g. autoclaving blood contaminated items, wiping over equipment with soap/alcohol etc. These should be defined, printed out, (in English and Tongan languages), laminated, and put on display in the sterilising areas. 6. Vava'u Hospital; Whilst not strictly part of the Tonga Dental Project we feel that is essential that major infrastructure help be given to the Vava'u Hospital. Very little maintenance has happened in the hospital since it was built by the Australian Government in The staff there does a wonderful job in the circumstances and they are both deserving and very appreciative of any help that is forthcoming. We have a list of urgent needs collated from several audits there, and can make available photos and videos of the current situation to any interested parties. (possibly Rotary International and AusAid.??) The three most urgent needs are; plumbing, computers and a medical technician. Conclusion I believe the Rotary Tonga Dental Health Project is now at the stage where it is starting have a positive and permanent effect on the dental health of a Pacific Island nation. The future proposed ventures if implemented will greatly enhance this. This project has already received overseas interest and that now that we have gained the confidence and respect of the Tongan and AusAid health authorities I feel that it is imperative that the Tonga Ministry of Health, Rotary and St. John of God support it as an ongoing project.

10 10 Acknowledgments. We have received great support for our project from many sources, and too many to mention them all, but I would particularly like to thank the following; St. John of God Hospital in Ballarat Dental Health Services Victoria Royal Melbourne Dental Hospital RMIT University in Melbourne Adec International and Adec Australia. Oral-B, Colgate-Palmolive, KERR Australia, Dentsply Australia, Henry Schein Australia, ESPE, GC, SDI, Astra, Halas, Commonwealth Dental, Geelong Rotary Club Donations-in Kind and Barry Bell Dr.Robert Osmond (OPG machine) Sydney United Dental Hospital Dental Alternatives Pty. Ballarat West Rotary Club / Nuku'alofa Rotary Club. All the staff at the Vaiola, Ha'apai and Vava'u Dental Clinics. Thank you all for your support, for without this we would have achieved nothing. For further details on the Tonga Dental Heath Project please contact: Dr. David Goldsmith Ballarat West Rotary Club 11, Lyons Street North Ballarat 3350, Australia dgold@netconnect.com.au fax

11 11 In-between the work that these Rotary dental teams have done, they have also made time to enjoy meeting the friendly Tongan people, to see beautiful tropical islands, and to participate in many of the exciting activities that Tonga has to offer. We have sincerely enjoyed all of our visits to Tonga. A good day's fishing on Vava'u, 2000 dental team. Ha'apai; Dr. Tule Akauola, dentist at Hihifo Hospital, with a beautiful Coral Trout