'This is community empowered': How Wairoa filled the holes in its dental coverage

Sophie O'Neill gets dental care from June Fraser and assistant Lerlene Wright. Photo / Liam Clayton

Matthew Rosenberg, Local Democracy Reporter

When Wairoa's last dentist left town two years ago, residents were faced with a large commute which proved insurmountable for many. So 15 dentists volunteered their time to help plug the gap. Matthew Rosenberg reports.

On a warm morning at the northern edge of Hawke's Bay, a schoolyard is abuzz with music and the hum of chatter.

But the hubbub isn't coming from students at Wairoa College.

Tō Waha — a community-driven initiative drawing 15 dentists from all around the country — has descended on the town of 4500, providing free dental care.

"I had three extractions today, and three fillings. The old mouth is not great at the moment," Trevor Mihaere candidly offers, moments after receiving overdue work on his mouth on Tuesday.

He might be sore now, but he's optimistic the treatment will spell the end of the headaches that have plagued him for months.

Mihaere's story is not an uncommon one in Wairoa.

When the last dentist left town almost two years ago, they were never replaced, leaving over 2000 clients facing either a one-and-a-half hour trek north to Gisborne, or a two-hour trip south to Napier and Hastings for treatment.

This week, Tō Waha made 250 appointments available to people over the age of 18 in and around Wairoa, in hopes it could plug that hole, or at the least, fill some of the cracks.

Wairoa District Council chief executive Kitea Tipuna knows the needs of the community better than most, and says a lack of accessibility to oral healthcare has taken its toll on the town and surrounding area.

"Given the socio-economic profile of this community, costs are an issue for any of our whānau who need dental care," Tipuna says.

Wairoa District Council chief executive Kitea Tipuna says the affordability of dental care is a huge issue for whanau in the community. Photo / Liam Clayton

"This is a short-term fix for a bigger problem, for a bigger issue here in Wairoa."

The numbers paint the picture. Of the 49 people who were seen on the first day alone, the dentists' work included 77 extractions and 43 fillings. But there is a warm and calm air about the place on this sizzling weekday morning.

Dentists putting smiles on residents' faces

While the need is great, Tipuna is encouraged by what he's seeing.

In fact, he says it makes his heart sing. People are receiving life-changing work, chronic pain is being addressed, and community is being created.

Volunteers (30 in total) are welcoming people from diverse backgrounds into a safe space where they can receive otherwise inaccessible healthcare for free.

It's now day two, and the place is pumping, which doesn't seem to surprise Tipuna. Addressing a group of media gathered in the schoolyard, he tells of two friends who each recently needed seven teeth extracted, but were on the verge of cancelling their appointments in Napier/Hastings because they didn't have a driver to bring them back to Wairoa.

"We just happen to be in an isolated part of the country that has a lower household income level, and things just tend to ripple for many of our whānau," he says.

"Do you take time off work, or do you try and put food on the table for your children? These are the types of conversations that our people, our families, have to negotiate."

It's a need that caught the eye of Ashburton-based dentist Justin Wall, who heads up the Māori Oral Health Providers Quality Improvement Group.

Wall is equal parts heartened and heartbroken by what he's seeing unfold in Wairoa.

On one hand, needs are being met, and smiles are being put on faces, quite literally.

On the other, a failing system is being brought into crystal clear focus.

"Being able to come along here is humbling. It's valuable for me personally to be able to see people who are fearful, and override that fear to have the services done in a very welcoming environment," he says.

"This is a good news story. This is community empowered."

But the reality of the situation is also a tough pill to swallow, and Wall doesn't pull any punches when he reflects on why Tō Waha is needed in the first place.

Health outcomes for Māori — who in Wairoa make up 70 percent of the population — are historically poor, and the result of systemic racism which has been built into the system, he says.

Wall estimates that about 55 percent of the country's population are well served by the current oral health system, but the rest are falling through the cracks.

"The system is inherently, at its very base, racist. It was a system made by white men to serve white men, and in the last 25 years to serve white women.

"The problem doesn't lie with the individual. It lies with the system. The individual is the person who suffers from the great failure of the system."

Wall says the health system is bogged down by victim blaming and widespread attitudes that people with poor outcomes have brought it on themselves by making bad decisions.

He argues that people never deliberately make poor choices. Everyone is just doing their best with the information and resources available.

"People should be making outcome decisions (but) they have to be educated to understand what they're getting.

"If you live in Remuera, your decision is whether or not you drive your Q7 or your Tesla. If you're in Ruatoria, you're wondering about how you're going to stop the rain coming through your roof, and make sure your toaster is going to work.

"The problem is that the people who live in Remuera are the people who formulate the policies."

Five hundred kilometres down the road from where those decisions are being made, a glimpse of what accessible, holistic healthcare can look like appears to be blooming.

The reluctant heroes

Wairoa Community Partnership Implementation Group co-chair Sarah Paku was pleasantly surprised by the consistency with which people turned up at their appointments this week, while lamenting that her community had been forced to put up with poor oral health.

"Whānau are just really grateful they've got this opportunity, because they can't travel out of Wairoa — they don't have the funds. They don't have the means to travel out. And they need their teeth done. Lots of people can't eat . . . they can't smile."

It takes a village to organise an initiative like Tō Waha, and in this instance that included collaboration between both the DHB, key community figures, volunteers, hygienists, and of course, the dentists.

Working behind the scenes, Charrisa Keenan is a shining example of the fact that there are no heroes in efforts like this.

She talks enthusiastically about the education they're providing, making sure people are equipped long after they've left the dentist's chair.

When she delves into the three things she knew it would take to get the project off the ground — facilities, money and dentists — it becomes apparent she is a key figure in the operation.

Keenan humbly divulges she is the project lead, but is reluctant to share even her surname because she doesn't want the attention. She knows the kaupapa stretches far beyond the work of any one individual.

While the need is great, so is the eagerness to find a solution. Keenan has a lot to say, but it might be a simple statistic she offers which drives home the hope there could be a brighter future ahead, despite the flaws in the current system.

Tō Waha had to turn away 10 dentists because they were already at capacity.

And for people like Julie Stevens of Wairoa, who said her teeth felt "a million bucks" after her visit, the results are tangible and life changing.

"Listen to that hive of activity out there," she says from inside one of the classrooms.

"It's nice to see a lot of Wairoa people come here and get a service that is so badly needed."