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Situated in a remote corner of the Moree Plains Shire in northern New South Wales, Boggabilla is home to about 1500 people, most of whom are Aboriginal, and it has suffered through many tough years. For its part, the local school has had issues with attendance.

To encourage more children to come to school, the teachers created a visual attendance grid. When a child came to school on time, they鈥檇 get a green sticker. If they were late, they received an orange sticker. If they didn鈥檛 come to school at all, they were given a red sticker. Signs on school doors asked 鈥淗ow green is your grid?鈥� Too often, the answer wasn鈥檛 what the teachers were hoping for.

Kim Szerdahelyi is the Project Manager of Oral Health at the Poche Centre for Indigenous Health at the University of Sydney. She regularly visits Boggabilla School because the Poche Centre provides a free dental service from what was once the school鈥檚 photographic darkroom.

鈥淟ast year one of the teachers at Boggabilla said he wanted me to see something,鈥� she recalls. 鈥淗e showed me the attendance grids and it was amazing 鈥� there was more green. And the green began growing from when we started our dental program at the school.

鈥淭hat was incredible to me 鈥� really powerful.鈥�

Allowing for how most children feel about going to the dentist, why would a dental service actually improve school attendance? The fact is, dental health can have a profound effect on a child鈥檚 ability to function at school.

Dharini Ravindra and Petra Vasic are both final-year dental students. As part of their studies they were required to undertake a four-week practical placement in a regional area, and they took the two places that were available with the Poche program.

Though they both admit to being very much city people, they were soon working in some of the state鈥檚 most remote and disadvantaged locations.

鈥淚鈥檇 never been anywhere that remote,鈥� Ravindra says, now back in Sydney with Vasic for their final exams. 鈥淚t was a different world. Also, the level of oral health was a lot worse than I ever, ever expected.鈥�

As well as Boggabilla, they worked in Toomelah, which had grown from an Aboriginal mission in the 1930s into a community so impoverished that in the 鈥�80s and 鈥�90s it was the focus of national attention and shame. More recently, there have been some positive changes for the people of Toomelah, yet dental health remains a signicant problem.

鈥淭he rates of decay and tooth loss were pretty high,鈥� Vasic says. 鈥淭heir parents had lost teeth, so the kids expected to lose their teeth as well. They didn鈥檛 really understand the idea of prevention.鈥�

Vasic herself had an experience that no dentist would want. She had to remove a badly decayed permanent tooth from a nine-year-old girl.

The local water in some of the communities is part of the problem. In Toomelah, the current water supply is sourced from a single artesian bore using an electrical pump. The Poche team hear from the local children that the water tastes horrible and sometimes makes them sick. Bottled water isn鈥檛 an option because it鈥檚 more expensive than soft drink. 鈥淭he result is that many of the children in these communities don鈥檛 drink water at all,鈥� the Director of the Poche Centre for Indigenous Health, Kylie Gwynne, says.

鈥淪o, in consultation with the elders and other people in the communities, we鈥檝e started a program where we鈥檙e installing free bubblers that filter and chill the water. We want everyone to have access to clean, cool, yummy water.鈥�

As the water program gets underway, the green stickers on Boggabilla鈥檚 attendance grid show that the Poche dental program is already changing things. A child with a toothache or mouth abscess can鈥檛 sleep, and if they go to school at all they can鈥檛 concentrate in class. As the Poche clinicians make regular visits to schools such as Boggabilla and Toomelah, they take away the pain and educate the children and their parents about how to keep teeth healthy.

There are longer term health benefits as well. Poor dental health has been linked to heart disease and possibly even kidney problems, diabetes and low birth weight in babies.

Working from the Edward Ford Building at the University, Gwynne designs Poche Centre programs in collaboration with elders and local organisations. Together, they figure out where the programs are needed and how they鈥檒l work.

鈥淭here鈥檚 been a long and unhelpful history of clever white fellas coming up and saying 鈥榳e can solve your problems鈥�,鈥� says Gwynne. 鈥淭he initial thing for us was about building trust, having lots of conversations and listening. Then doing what we promised to do.鈥�

The Poche Centre was established after a $10 million donation in 2008 from Greg Poche AO, who revolutionised the transport industry with Star Track Express. Poche, his wife Kay and best friend Reg Richardson AM, felt strongly about improving Aboriginal and Torres Strait Islander outcomes, and their donation allowed the University to create the Poche Centre for Indigenous Health. It has three active priority areas: healthy kids, healthy teeth and healthy hearts.

The Poche Healthy Teeth program now works across 10 communities employing new-graduate sta, including oral health therapists and graduate dentists, as well as local Aboriginal dental assistants and support people. Costs are kept down by using existing infrastructure at schools and healthcare centres, and equipment that is mobile and portable.

Rostered senior clinicians provide supervision for the new dentists, on a pro bono basis.

Another key plank of the Poche program is getting it ready for community management. This is set to happen in 2019, with more local people already taking service delivery and management roles, and this year 157 Aboriginal scholarship holders are studying from Certicate III level through to PhD, with a view to delivering future clinical services.

鈥淭here鈥檚 a mythology that to do things in partnership with communities is time consuming and expensive,鈥� Gwynne says. 鈥淭hat鈥檚 not true. We are the demonstration of that.鈥漈he Poche Centre program is important for another reason. As Ravindra points out: 鈥淣o one else is doing what they鈥檙e doing out there.鈥�

Written by George Dodd
Photography by Wayne Pratt and Sarah Rhodes (BA 鈥�96 MPub 鈥�09)