Local dentists take their services to the South Pacific

BUCKHANNON — Dental services are always in demand in the Kingdom of Tonga, made up of more than 170 islands in the South Pacific.

Dr. Stephen and Sue Johns returned to the United States earlier this fall after a 23-month mission in the Kingdom of Tonga. During a presentation at the Buckhannon Church of Jesus Christ of Latter-day Saints, they shared details about their experiences in Tonga — where only 36 of the 170 islands are inhabited.

The senior mission through the Mormon Church allowed Johns and his wife to put their dental, orthodontic and clinic management skills to the test in an underserved country.

The Johns lived on the campus of Liahona Middle and High School, first established by the church in the 1940s/1950s. The Mormon Church has had a presence in Tonga since 1891. Liahona is on the major island of Tonga, Tongatapu. Liahona has 1,200 high school students and 300 middle school students. Two other middle schools on the island are part of the church’s education system and feed into Liahona High School.

The student population was one of the populations the dental clinic served, along with missionaries and lastly, the general public.

“When we saw the demand that these people had for dental services, it was overwhelming,” Steve said. “When we got to the clinic some days, the waiting room was completely full of people and they were going out the door.”

The clinic began seeing patients at 8:30 a.m. but there would be people lined up two hours early.

As the Johns delved into their mission, they learned early on that the Tonga people had severe dental problems.

“Very, very seldom was it just a simple cavity,” he said. “Usually it was a root canal or something of that nature.”

That is when Sue, who helped manage the clinic, brainstormed what could be done to help the students.

“She in conjunction with one of the volunteers, developed a program where we were screening the students for any dental problems they may have and then we were teaching them some of the principles they needed to know in order to take care of themselves,” he said.

Every middle and high school class at Liahona went through the one hour and 15-minute screening process which consisted of three parts – the actual screening, a hands-on lesson in brushing and flossing techniques and an interactive video to get the students interested in good dental health and diet.

The Johns took their screening program on the road, traveling to other islands and doing screenings wherever they could make a spot.

“When we did that, we literally had to have them lay on the stage of the school auditorium and do our screenings,” he said at the first school.

Sue said the work was overwhelming but they were encouraged by the dental education and screening they were able to do with the students.

“Once we screened all the students, we felt good about the education we did,” Sue said. “I’m sure there had been dental education in the past but it just hadn’t clicked. We did our best to try to get them enthused about their dental health and health in general.

“They are very wonderful students to work with,” she said. “They are very unspoiled by the world and very respectful.”

The missionaries and the students were the main priorities of the clinic with the general public the third priority.

“Once we saw the needs of the students, it was really overwhelming,” Sue said. “We could have worked seven days a week, 24 hours a day and not accomplished everything that needed done. That was hard. It was really hard to have the desire and to know how much people needed it.”

There is a government dental system but on a big island with about 55,000 people and only about eight or nine dentists, it could not keep up with the need either.

“Most of the time in our mission, we had at least one other dentist. Sometimes we had more than that like with the Midwestern group,” she said.

“There were a few private clinics but most of them were operated by dentists who worked for the government clinic during the day and they would see private patients in the evening. There just was not sufficient access to care and it was really hard. You couldn’t work around the clock and yet you didn’t know where they were going to go or how they were going to be treated.”

Steve said he was able to do some orthodontic work and make partials.

He shared some examples including one young man who had some major realignment.

“Not all dentists who are going to go over there do orthodontic work so we had the opportunity to get him into a more pleasing situation,” he said. “It was one of the joys of our mission to be able to do this.”

Although partial dentures were also life-changing for some of their patients, the likelihood that they will need repairs in the future make them not always the best option.

Sue said, “We worried about everyone with a partial because if it breaks, they are going to be left with a problem in getting it replaced. The hospital makes partials but it’s beyond the reach of many of the residents.”

The clinic the Johns worked in had seven chairs. There were also a couple volunteer dental assistants from the school and community, but twice a year, the clinic would receive a major boost.

The College of Dental Medicine-Arizona at Midwestern University’s Glendale campus provided supplies, equipment and even manpower.

The students would come with several faculty members for one week in the spring and two weeks over Thanksgiving.

“When they came, they brought 16 students per week so in the fall they actually had 32 students come,” he said. “They would have four to five faculty members. I learned so much from them.

“The university would literally send over crates of supplies and equipment that we needed in the clinic,” he said. “They would ask what we needed and so we would make a wish list out. Almost invariably, they got everything that we requested. They were amazing.”

Through their suppliers, Steve said the school was able to get a lot given or discounted that was donated to the church and government clinics.

“They literally brought over $1 million of equipment and supplies,” he said.

“We had requested they bring the digital X-ray system,” he said. “ X-rays have been a real problem for the entire dental community there. The supplies are very expensive. The film they used to use was expensive and the machine was very heavy. To get them where they needed to be was a real problem.”

Besides the students, the clinic hosted 16 to 18 other groups during the Johns time in Tonga.

“We had many wonderful volunteers,” Sue said. “Most of them were from the United States although there was a Welsh dentist who served for four months.” The Johns even had dental help from a grandson and from their friends and long-time dental practice partners, the Condes.

Although the Johns spent 23 months in Tonga, they did not learn much of the language but did not have trouble. There were usually people around that could interpret.

“Tongan is a very difficult language to learn — at least it was for us,” he said.  “The school itself is considered to be an English immersion school so the students should know and understand English.”

Not only that, but the country encourages English learners.

“The church authorities especially are strongly encouraging the students to learn English;  this is just a doorway to them to greater education in their lives and greater advancement in their lives,” he said. “In order to work for the government they will need to know and understand English.”

There are also Peace Corps volunteers and a large percentage of them are in primary schools helping to further English education.

Still, Sue said, “A number of the people who come to the clinic  — the younger children and the elderly — don’t necessarily speak  English.”

As legend goes, the demi-god Maui went fishing one day and used a large fish hook to pull up Tongatapu along with the rest of the South Pacific and even Hawaii, according to the Johns.

The population of Tonga is about 107,000 but about two-thirds of the population live on Tongatapu which is 26 miles from one end to the other.

While there, the Johns also learned the customs of the Tonga nation.

For example, typical Tongan formal dress for men consisted of skirts and a sort of woven mat that was worn like a belt. Women had different mats and there were mats for formal and informal occasions.

Sue  said, “People will have a small wardrobe of these mats because they are really important. It’s still an important part of the culture.” This was a concern when Sue was asked to sing with a formal music group and needed the right dress. Wearing the wrong dress and mat would be inappropriate. Luckily, another woman was able to find Sue the appropriate formal wear and she was able to be part in the choir.

“They are wonderful singers,” she said. “They sing with their hearts and they express their faith through their songs. It was just really an honor.”

At the central fresh market, produce and vegetables were sold.

“Some of the fruits are grown locally,” she said. “There’s always coconut, bananas, watermelon, papayas year round. There are seasons for things like pineapple, mangos and passion fruits, and they will import apples, oranges and pears from New Zealand.

“Most of the vegetables are grown locally in Tonga either by Tongan families or by many Chinese growers who have immigrated to Tonga.”

Houses are not heated in Tonga and most homes and even the school use cross- ventilation because electricity is so expensive on the island.

“The hottest it ever got was 89 or 90 degrees, but when it is 90 degrees and almost 100 percent humidity, it can be pretty uncomfortable,” he said.

The lowest temperature the Johns saw was 60 degrees.

The main export used to be coconut but as Thailand surpassed Tonga in exporting coconuts, the kingdom turned to butternut squash and pumpkins.

Although the main roads show nicer houses, turning off the beaten path reveals the poorer side of Tonga.

Many live in houses with scavenged materials or made out of thatch. Outhouses are still the norm.

Sue said, “Nowadays, if families have the means, they will try to build cinderblock houses because they are very resistant to hurricanes and weather.”

Tonga was and is still an agrarian society. “In Tonga, there is a strong tradition of living in a village and having a village life,” she said. “They would plant various root crops that are very easy to grow and hold in the ground for a long time so you can dig them up as you need them.

Steve added there are many people who work for themselves making jewelry, carving wood, weaving.

“It’s becoming a more modern society,” he said. “Most people have cell phones. It’s hard, especially for young people to find jobs. There are jobs in government, education and retail but not much industry.

“Some people are successful in starting small businesses, developing a skill and being able to make a livelihood from it.”

After the Johns left their mission, an interim director was brought in for a couple months and other volunteers were filling in until a year-long dentist would arrive in the late fall.

The Johns moved to Texas soon after this presentation to be closer to family.

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