Word of Mouth - School of Public Health and Community Medicine ...

Filling the GapPart D: DiscussionReflecting on the results described above, theEvaluation Team believes key contributingfactors to the ‘Filling the Gap’ program and itsachievements to date are:• having an existing, well-resourced dentalpractice with highly skilled support staff, and• a strong culture of community ownership,through the agency of community control.The recruitment issues faced by Wuchopperenreflect the national shortage of oral healthprofessionals in regional and remote Australia.This evaluation provides real world examplesof the pressing need – evident in the literature– for publicly funded oral health services thatare accessible to Aboriginal and Torres StraitIslander peoples. The perceptions of the dentalvolunteers and health service staff of the highlevels of untreated decay amongst patients andof the relatively severe periodontal disease, andthe high number of extractions showing in theservice statistics tend to confirm this pressingneed.Before the commencement of ‘Filling the Gap’,Wuchopperen’s service activity reports for 2005showed no significant activity by dentists in thatyear. Since then, ‘Filling the Gap’ volunteershave provided a substantial number of dentaltreatments. However, the evaluation foundfrustration at the amount of dental work that stillneeded to be done, and great concern amongstthose informants who discussed the relationshipbetween high levels of untreated decay andchronic disease.Locally, there is particular need for increasedactivity by the mobile service to provide careto people on the Atherton Tablelands, quite anumber of whom have not seen a dentist foryears, as well as to give integrity to the healthcare check process and related care plans.There is also potential to develop existing levelsof awareness of oral health issues and oral healthpromotion amongst all personnel. The findingssuggest a need for comprehensive preventionwork at all levels of the health care continuumin order to overcome further high levels of toothdecay and tooth loss.A number of factors present themselves in thedata indicating ongoing need for the program:• Although waiting lists are now shorter, thereare still relatively high numbers of newdental patients appearing in Wuchopperen’sservice data in 2007• There is evidence that more women thanmen are presently accessing the service,suggesting that strategies might beconsidered to encourage men to seek care;and• It also appears that patients are presentinglate with dental problems.Therefore, it is arguable that there remains ahigh need for dental care in the region that hasyet to be identified, particularly routine care.In summaryThe outstanding aspect of the program thatseemed to be apparent to all stakeholders waswhat the Evaluation Team has termed enrichingengagement. It seemed that engagement inthe program, whether from the provider or clientperspective, enabled benefits to be gainedbeyond the provision of better dental and oralhealth care.Closely related to the above was the opportunityand benefit arising from two-way learning, withmany interviewees favourably describing theirlearning from other program participants.Respondents indicated also that the feeling ofcultural safety provided by Wuchopperen HealthService embraces the oral health unit within it.Thus, the dental volunteers are regarded withinthat comfortable setting rather than as outsiderswith whom locals needed to relate. The qualityof the Aboriginal and Torres Strait Islander dentalunit staff in particular is core to preserving thiscultural safety.In providing a relatively regular supply ofdental volunteers, the program has enabled thedental unit to support the training of additionalAboriginal and Torres Strait Islander dentalassistants for whom there would otherwise nothave been employment.5