Debbie lives and works in Darwin in Australia's Northern Territory and for one week of each month travels ‘out bush’ to treat children and adolescents in Aboriginal communities.

‘Every therapist has an urban component of their work and a rural component,’ explains Debbie. ‘The reason we started was that the dentists were going out there and noticing that there were a lot of teenagers with massive holes in their sixes and they didn't have the manpower to help, so it was put to the therapists – did we want to go out there?’

A pilot programme followed in the early 1990s and Debbie was one of the first therapists to start going out bush. She finds the rural work a hugely satisfying part of her role.

‘I love it. You've got little children that don't even speak English until they're six or seven and you're having to try and do work on them, so when you find you can communicate with these kids without any words really it's great.’

Debbie says building the trust takes time. ‘It's not just about going out there and saying we've got a service, come and get it,’ she explains. ‘Initially they're quite shy and sometimes it might take a year to get some children to come to the clinic, but then they will allow you to work on them after time.’

As trust is so important, working in the communities is a long-term commitment. At present Debbie travels to Daly River, Peppimenarti and the remote Emu Point. She has been treating these communities for three years and previously worked in Bathurst Island for four years and East Arnhem for five.

Debbie and her assistant Martine Tulloch travel to the communities in a four wheel drive vehicle. ‘I drive, Martine acts as co-driver!’ laughs Debbie.

‘We'll drive out to Daly which is about a three hour trip from Darwin. We stay in Daly and the next day we drive to Peppimenarti and from there we treat Emu Point.’

The communities have varying facilities. The bigger Daly River has a brand new dental clinic in its health centre but in Peppimenarti Debbie shares a room with the doctor and has to pull all the equipment out and put it away after each visit. The even smaller Emu Point doesn't have a clinic at all.

‘Normally we'd go to the school in Emu Point and examine and then they'd come to us for any treatment because there's not a clinic out there. You make the best of what you can. Sometimes you might have to do extractions and things like that under a tree! It's not infection control and occupational health ideal … but you do what you can do.’

In Aboriginal communities, apart from cleaning and scaling the children have very good teeth because they eat more bush tucker.

However, it's not all bad news. ‘You find in Aboriginal communities, especially in places like Emu Point, apart from cleaning and scaling the children have very good teeth because they don't have access to shops and they eat more bush tucker,’ says Debbie. ‘But then in Daly River, which is a lot more westernised, they have access to the cola and the chocolate so their teeth are a lot worse.’

Working in the communities certainly provides its share of challenges. ‘When I very first went to Bathurst Island I hadn't really done a lot of bush work,’ laughs Debbie. ‘Off I went and I'm sitting there in this dental clinic with all these little kids around and I was trying to teach them how to brush their teeth. They're all looking at me very blankly and I thought they're not getting this – I don't know what it is I'm doing but they're not getting it. I didn't realise that I was telling them how to brush their teeth and they didn't even know what a toothbrush was!’

They knew what teeth were but they hadn't seen a toothbrush. What I did was the same, but how I put that across had to change.

Incidents like this made Debbie change her whole way of thinking. ‘You're going back to basics – holding the toothbrush up and saying “this is what's called a toothbrush, you use this to brush your teeth,” – they knew what teeth were but they hadn't seen a toothbrush. It's all relative – what I did was the same, but how I put that across had to change.’

Debbie has also learnt that life works at a different pace in the communities. ‘In Emu Point I ring the teacher and say I'm coming out on such and such a day, bring the children over and she'll either say I'll come in the morning or in the afternoon. With Aboriginal kids there's not a specific time – you don't say come at 10am, you say just come before lunch or come after lunch. They're quite happy to sit and wait and they don't care if there's 10 people in front of them or 10 people after them. It's not a big drama. You're doing the same thing but just doing it differently.’

The challenges of Debbie's workload are not restricted to her dental work. The travelling itself can provide its own hazards.

‘We've done a four wheel drive course and a rural first aid course and we're well-equipped, but you've still got to be vigilant,’ says Debbie. ‘It's not just driving down the road and doing your work.’

On one occasion Debbie and Martine were the first people to come across an accident on the road from Darwin to Daly River. ‘There was a guy stuck under a car and we had to get a jack and then drag him out. It was just me and Martine, calling an ambulance that had to come from so long away.’ Another hazard is the wildlife. ‘Kangaroos, horses, cattle … your eyes are peeled all the time.’

Table 1

So while Debbie finds the work rewarding, she's glad it's restricted to one week per month. The rest of the time she focuses on her urban workload, rotating around seven schools.

‘I don't think you could do rural all the time – it's a balance between your work and your life,’ she says. ‘I think you can offer the best when you're out bush because you've had that time at home to get back into what you normally do. And then it's nice – my assistant and I treat it as something different, we get out of town, it's refreshing — it's always changing, it's always challenging.’

Table 2

See Table 1 and Table 2

Table 1 Northern Territory
Full size table