Report written by Dr Malcom Coombs.
Humanitarian Work in The Pacific Islands.
In November 2017 Heather and I were transferred to The Kingdom of Tonga from The Marshall Islands where we had been supporting Humanitarian Missionaries from The Church of Jesus Christ of Latter-Day Saints who were working on Education and Health projects. The main health issue was Type 2 Diabetes due to the basic diet among the islanders, imported rice, as it was the cheapest source of food. Majuro is mainly a coral atoll, with soil only in a very small area, hence there was very little fresh produce. Following our move to Tonga we continued to work with others who were involved in the efforts to control Type 2 diabetes among the islanders, albeit from different reasons. This we did after we had finished in the Dental Clinic for the day.
Our move was prompted by the need for an Oral Surgeon to work at the Liahona Dental Clinic. Heather, being a Registered Nurse, was very involved in setting up health and hygiene procedures and initiating infection control in the clinic as far as it was possible with the equipment and facilities.
However, to work in the Kingdom of Tonga, I had to provide certified copies of all my qualifications and two character references. Staying for more than 30 days also meant work visa requirements which involved a very thorough health check.
The Liahona Dental Clinic is located on the campus of the Liahona High School on the main island of Tongatapu. The school has some 1500 students, (50/50 boys and girls), about 200 of whom boarded being residents from the outer islands of the Kingdom of Tonga, from PNG, Vanuatu and Fiji. We offered treatment to all students and the general public.
Sadly, there was too much dental decay, again as a result of the poor diet and a strong influence of many small shops selling an abundance of very cheap food with high sugar content, such as instant noodles, candies, lollies and soft drinks. Two generations previously, when families lived off the land – and Tongatapu is extremely fertile – dental decay was much less prevalent. Today, many young children are put to bed sucking on a lolly on a stick. It was very disheartening having to treat children with decay in nearly all their deciduous teeth. We had a two-year-old with rampant decay in all 20 teeth and draining sinuses from several of the stumps of her anterior dentition. Very sad to see.
The clinic also supported a general dentist from USA who solely performed restorative work. Although he was kept very busy, more than half the patients presenting had unrestorable teeth, and/or multiple retained roots. Periodontal disease was also a significant problem particularly among the older patient and we had a local girl who had been trained to do scaling and cleaning who was kept very busy removing gross calculus from her patients’ teeth. A local Tongan custom is to have gold inlayed into their maxillary anterior teeth. This was done as either a gift from parents to children or in memory of a loved one who had passed away. However, the gold was not cemented into place. It was attached to the teeth by use of pins or clipped in place. This left an area for plaque to accumulate under the gold and cause decay with subsequent loss of the tooth. Tongans all have very large teeth and very solid bone, so extractions were never straight forward.
We had a small budget to use for supplies but the majority of equipment and disposables was donated by Dental Trade and short term visiting dentists from USA, Canada and New Zealand who came to work in the clinic for short periods.
We were provided with adequate living accommodation, occasionally no water or electricity but with torches and bottled water we managed very well. We even survived a category 4 Cyclone Gita. Fortunately, the clinic suffered no damage and it was work as usual after the initial clean-up, and we continued to see an average of 25 – 30 patients per day.
There was a huge amount of damage from the cyclone but no loss of life, which the Tongans attribute to their way of life of keeping the Sabbath Day Holy. It is written into their constitution that Sundays are for family time and worship. No business is to be conducted, the shops are closed, and there is no sport played.
After 12 months we are now back home here in Sydney and having to re-adjust to “civilisation”. So much more traffic and everything is rush, rush, rush. In the Islands everybody smiled and greeted each other despite having very little of monetary value. Captain Cook christened Tonga ‘The Friendly Isles’ and this is certainly the case.