The name Filling the Gap had its foundation in an initiative that ran from 2006-2016 to provide dental treatment to Aboriginal communities in far north Queensland. The group behind that initiative have kindly allowed us use of the name. To honour their legacy, here is the story of what they achieved.
Filling the Gap began as a simple idea between a couple of friends over a few coffees – to do something about the chronic shortage of dentists at an Aboriginal medical service in far north Queensland – where people had a 12-month wait to see a dentist, unless it was an absolute emergency.
Yet across Australia we found there were dentists who were keen to volunteer, to take time out of their practice for week or two to help out.
So in 2006 Filling the Gap was set up by a group of active people to be the bridge between the Aboriginal health services and dentists, so access to consistent and good quality dental services was possible
Having the physical facilities does not lead to having a service. Developing human resources is the key. FTG has been able to assist in the human resources response.
Volunteering was never going to be ‘the solution’ but it could be the beginning of a solution. FTG aims to assist services to develop their own longer term strategy to becoming self-sufficient. The role for FTG was to understand the need, break new ground, find a method for service delivery and then move on. Some sort of sustainable service is established and continues.
FTG is more effective when there is stability in the service that can be built upon. In both Wuchopperon and Danilla Dilba the addition of volunteers was more effective when there was a Practice Manager and other staff within the service within the service who knew the community and needs and was able to act as a liaison point. In this context a rotating volunteer workforce was not a big issue for patients – in actual fact it was viewed as positive – patients and the community apparently looked forward to seeing who the next dentist was.
An interesting fact was observed with the cohorts who were presenting at the clinic. It was assumed that there would be in the first instance much more emergency work required and then the expectation was that would shift more into preventative consultations and dental work. However the number presenting for emergency situations continued beyond the first six or twelve months and the question arose as to why this was the case. Ironically the stability that had been provided at this service meant that as people moved through or in and out of the community they accessed the dental service and it was apparent that through word of mouth the reputation of the work had spread to other communities. Word had started to travel out and people knew that the dental service was now there and available. The cohort was getting larger based on the reputation of the service. It was because we were able at times to supply two or three dentists that also the dental van that hadn’t been used for some time was then able to be used and outreach occurred to places like the Atherton Tablelands and further south to Mission Beach. So it moved a long way.
By recruiting from private practice and who were used to working in metropolitan areas, they came wanting to practice in very different ways to public dentists. The public dentists because of pressure of time and the need to immediately fix very bad mouths through extraction or filling, what our dentists wanted to do everything – restorative, pain management, forward planning. They didn’t want to do a fifteen minute appointment they wanted to make an hour appointment and then a different kind of dentistry then began to take place, which none of us had really thought about. A lot of work was done in that restorative manner and some saw that preventative work may have been good and some was done in terms of education – it bought about a different kind of dentistry that hadn’t been expected. That was shown again, later in Bogabilla and Toomelah. Not only were dentists providing the basics but chose a method of working that fixed people’s front teeth first so that they went away, looking great, with big smiles, so that was a promotion to the community to come and use the services.
Because FTG is a small organisation we were able to be responsive and flexible and providing short and sharp rather than long term engagement. FTG learnt that every organisation that approached them would be different and that FTG was able to demonstrate that flexibility
It also taught a lesson of being able to actively listen to and understand local needs and in that case Dr Ivor Epstein was able to meet and talk with local people about protocols and preventative work and especially around managing diabetes and practical details like having breakfast beforehand. There was a lot of clinical management which he was able to assist with.
It confirmed our reputation both with NT health and the Aboriginal community in Darwin.
What that showed was that flexibility, short sharp engagement rather than long term engagement could work and we were fortunate in being able to recruit two very experience and partly retired dentists. We knew from W. that we had a group of dentists who had returned a number of times and were experience and then able to transfer their experience to this other project, in this case working with homeless people in Darwin. Volunteers weren’t being thrown in the deep end.
So the Darwin project also gave valuable lessons. So we were very interested in listening to and understanding the precise dynamics of every request received.
We saw FTG as working in partnership with community but didn’t see what we were doing as being a substitute for government services – but where appropriate we would have that interaction. The work in Darwin, for example, was only possible with the involvement of NT health but principle relationship was with the Larakia people. But that pressumption was particularly challenged by the project in Bogabilla and Toomelah.
We quickly recognised that consistency and familiarity with dentists was needed. We weren’t going to rely on volunteers but build in to the agreement the use of longer term dentists and solutions. So in this case we thought FTG needed to respond either through locums or getting someone in full time. (Prior to this our role was to assist in volunteers etc…not to provide dentists to fill in government health services). So our role wasn’t simply to fill in the government services but what we did do was to get involved in recruitment but prior to that we used our networks to get a number of locums working on a rotational period. They were all well liked and one in particular.
Alongside doing the work with government we had to do a lot of work with the community. In a way this experience redefined our notion of working with government but also about working in partnership with the community. It was clear what the relationship between the governments was to be, our role was to liaise with the community and develop a system for selecting dentists.
However, it wasn’t such a straightforward matter. As this took about 2 years to get all parties to the table. Prior to that we had tried other ideas which had fallen over. It really took a long time.
Part of that was rethinking the way dentists were selected dentists and how liaison with communities was to occur. Many services had been dropped into that community but many had no engagement with the community and therefore had a patchy track record in delivering outcomes. Part of our challenge in working with the community was to say ‘what are you putting on the table’ to ensure that this health program works and doesn’t fall over?
The issue was there was no material contribution the community could make so the one thing that was discussed was the use of the service. And the motto the community adopted was ‘use it or lose it’, with the proviso that the community also set targets, and if they were slipping behind those targets then everyone would rally around.
It took a long time to build the relationship and trust with the community. Many services had been dropped into community but not sustained engagement on a long term. So we took some principled steps. We talked with everybody, not just one group in the community. We also went very slowly and had community meetings that involved significant feedback and report from FTG. It took at least 8 community meetings. At one stage the only promise that we made, was a promise to come back.
All the issues had to be identified – how are we going to get transport? What is going to happen with the children? A steering group was set up, mostly of workers and some community members.
One of the most joyous things was after coming back with the community report after the first six months. We had done the statistics and we passed around reports at the ‘yarn ups’ and we passed them around to people who were very proud and had a feeling of achievement that this had worked. The numbers of people who had used it, showed that the efforts had paid off.
The degree of intensity of engagement, and sense of pride displayed by the community made an impact on other service providers. So other services began to talk with FTG about the results achieved.
And then when the service was threatened the community actually became a fighting force for the service, the teachers said they had never seen the community so energised before.
Instead of being ground down and passive the community now was responsive because something had worked.