My career, my profession and my passion

By Margie Steffens OAM ADDH, B.Sc Dent (Hons) FICD

Being a relative latecomer to the dental world, it still surprises me how many years I have been a dental hygienist – 40 years in the profession and the past 30 of those years have been without a doubt the most rewarding, exciting and challenging years of my career.

A few people know from the very outset of their working life, and maybe earlier, what career they would like to pursue. For myself, I knew I was interested in health and people. This was a good start, but I had no idea where to begin. So I dabbled in many areas of health and hospitality before answering an advertisement in my local paper in the Adelaide Hills for a dental assistant.

Being up for a new challenge I successfully applied and realised very early that while I was learning new skills it was not where I wanted to be. I dutifully completed the required two years of dental assisting that would qualify my application for dental hygiene studies. I add here that my employers at the time were incredibly supportive of my seeking further education and happily recommended me for the course.

The course at that time was conducted at the Adelaide Dental Hospital (ADH), located on Frome

Road which was still considered part of the Royal Adelaide Hospital (RAH). We were very fortunate to have access to specialists from every field of health. This was very helpful for our electives and first aid that was conducted by a nursing sister in addition to visits to the Intensive Care Unit (ICU) supervised by one of the dental hospital-based dental hygienists, and visits to the dental clinic at the Queen Elizabeth Hospital (TQEH)

At this time the course was a jam-packed 15 months in duration. With a youthful brain and enthusiasm, there were no computers so all notes were handwritten during lectures. I must agree with Dr Montessori, the Italian doctor who began the Montessori teaching system, that posits with now >> good evidence that “the pathway to the brain is through the hand” – along with other systems for creating those everimportant neural pathways. That aside I am very pleased to have the advantage of computers as a means of electronic pathways and connections! We also had four periodontists, one of who is still very much part of our world, Dr Bryon Kardachi, and sadly no longer with us Drs Brian Shephard, Sven Johansson, and Rob Hirsch who many of you will remember as being a real champion of dental hygienists and a wonderful friend to many.

The final practical viva day is imprinted in my mind forever. An unseen patient, full examination, treatment plan, begin treatment followed with an oral viva. I don’t believe my patient had ever had a clean before and thankfully I was able to say to my examiners that I could rationalise truthfully that I had not performed a satisfactory debridement. There is no shame in admitting your lack of knowledge or expertise.

I went on to work for 10 years in private practice, and whilst recognising that this was not where my passion lay, it gave me very important underpinning values. These included patient care, respect and diligence for detail, working

TOP RIGHT & ABOVE: The class of 1980 (Back row L-to-R) Sue Neeft, Sue Frazer (Senior Lecturer), Margie Steffens, Dr Rob Wiedenhofer (Senior Dentist), Di Synon, and Jean McNicoll; (Front row L-to-R) Liz Moreton, Sophie Karanicolas, Pina Romano, and Nelda Frolow in a team, attention to detail and time management (something I have always struggled with – however Special Needs Unit was my lifeline as this was not a driver for ‘productivity’.

After the birth of my second son, I was increasingly unsettled for a range of reasons working in private practice. Then an opportunity arose in a research clinic at the ADH High Caries Risk Clinic under the guidance of Dr John McIntyre. This was a chance to learn with the best. John is a published academic and had been involved with early research into the use of fluoride and minimal intervention techniques for remineralisation and maintenance of caries in very challenging populations e.g. drug and alcohol misuse, psychiatric, and homeless. The clinicians in this area were mostly dental hygienists (Marilyn Jolly, Virginia Street, Amanda Trennery, Di Synon and Sue McPherson). This was a fantastic opportunity to be part of an intervention that demonstrated that minimal intervention did indeed preserve even the most damaged dentitions, and if regular care and education were undertaken further deterioration could be circumvented. Unfortunately in the early 1990s, funding was taken away and the unit was closed, much to our frustration. It was at that time a seed was sown for me. This wasn’t good enough! Something had to be done and so an idea began to grow.

A position became available in 1992 in the Special Needs Unit (SNU). My life in private practice was finished and I began my career (the absolute joy of my life) working in this unit. I originally started under the guidance of Dr Liz Coates (a force of nature) and then with Associate Professor Sharon Liberali (a compassionate and loyal leader and a dear friend) until my retirement from the unit in 2022.

The past 30 years have enabled me to be true to my philosophy about what a healthcare professional truly is and what we learn every day from our patients.The opportunities I was afforded whilst working in the public sector, higher education and being a member of the DHAA include:

• Collaboration with TAFE Paradental Studies program, hosting Japanese dental hygiene students that extended over 20 years. I even learnt a smattering of Japanese.

• Hosting international tour groups through the ADH. I had the immense pleasure of hosting the inimitable Dr Esther Wilkins. A prolific author of Clinical Practice of the Dental Hygienist.

• Along with Dr Dymphna Cudmore, we developed the Supported Residential Facilities (SRF) program for SA Dental Service (a project that has now become the homeless scheme with SA Dental)

• Inaugural chair for the Aged Care SIG (now incorporating the Aged Care Chapter in the capable hands of Lynda Van Adrighem and Ali Taylor).

• During this time, I attended the National Aged Care Alliance meetings. A time of learning about large groups with much political context and how to get a foot in the door.

• Past president and national councillor for DHAA SA, and attended State Oral Health Plan meetings. This was a very interesting time when much change occurred with the government taking a bigger role in the directives for the Oral Health Plan.

• I attended round table senate discussions in Canberra and had a particularly memorable meeting presided over by the Honourable Tanya Plibersek, a remarkable woman.

• Inaugural chair for Special Needs SIG

• The delight of being able to advocate on behalf of the DHAA and the CODP on radio and television interviews about the inequities in oral care and services for the older population and the various vulnerable and marginalised groups.

• Teaching BDS, BOH and ADOH undergraduates in clinical skills, lectures about Special Needs Dentistry and later about Homelessness and Community Outreach Dental Care.

• Taking students out of the clinic to visit aged care facilities, supported residential facilities and later homeless and refugee centres.

Was I up to the next challenge? Yes indeed I was!

2009 – 2011 was the seed I mentioned earlier and it was about to burst forth, “how to provide care for people who either did not have a Health Care Card (HCC), were on such a low income they could not afford private health care, were homeless, refugees and generally marginalised through social circumstances”.

In between all this just to ensure I was busy enough I completed a B.Sc. Dent Honours!

In 2009 I formed a project group with the blessing of Professor Johann DeVries, then dean of the dental school, Prof Richard Logan (now dean of the dental school), Prof Lisa Jamieson (director of ACPOH), Dr Eleanor Parker and Dr Peter Cathro.

With an Australian Dental Research Foundation Grant (ADRF) we undertook a year of visits to the homeless centres and from the research, education and screening sessions, we published some journal articles and presented posters at international conferences. The next step was to establish a clinic for these very people.

The new journey was at the same time frustrating and wonderful. It consisted of door knocking, phone calls, visits and meeting after meeting. Then persistence paid off when a door opened and I met with the CEO of Common Ground (now Housing Choices SA / Common Ground) Sue Crafter to discuss their new build at Light Square. I could not have timed it better, but how was I going to find the money for the inclusion of the dental and medical rooms?

A new grant round miraculously became available and the University (Professor Justin Beilby, Executive Dean of Health Sciences and Professor De Vries) asked me to apply as the grant was contingent on Increased Clinical Training capacity and the universities vision statement included better community engagement.

I was successful and so the rest ‘as they say is history. Community Outreach Dental Program (CODP) was built and the clinic had a home. 11 years on and I can look back at our achievements:

• Care is being provided through a referral system and our engagement with the homeless sector, refugee associations and numerous support agencies.

• It is a pro bono service that relies on volunteer dentists, grants and external funding which is always a huge challenge.

• Students from BDS, BOH and ADOH have the benefit of learning about their commitment as a health care provider to utilise their skills to help all people in the community- a time to learn about their privileged positions in life and how much richer they are for being there to help people who truly need a kind word and a gentle hand.

• Through the CODP activities such as;

– Screening sessions at some centres

– Dental Health Awareness week activities

– Homeless Connect Expo

– International Students visiting for electives

– Engaging more effectively with First Nations support groups and service provision – what an energising and educational experience for me.

– Annual Sleep-out organised by the Adelaide University Dental Students Association (AUDSS) help raised funds for CODP

– In 2020 I had the honour of being nominated to be Patron for the AUDSS. It was wonderful to see young enthusiastic people who genuinely care about their profession, and to then be awarded Life Membership with the AUDSS.

– Somewhere in between I received the great honour of the Order of Australia Medal (OAM) for services to the community in the provision of dental and health care for the homeless and vulnerable in Adelaide in 2017. This was a most overwhelming experience.

In 2017 a service award from the DHAA and life membership, and Special Service award from the Pierre Fauchard Academy of Oral Health International, for service to the profession and marginalised sector – the first non-dentist to receive such an award in Australia.

In 2019 I was the first non-dentist to be awarded an Honorary Fellowship with the International College of Dentist – again such an honour to be considered for this and ICD have been such supporters of CODP in awarding grant money each year.

I cannot thank our industry partners enough for their generosity of donations and reduced cost of products (Henry Schein Cares and Dental Concepts – thank you) and also for dental practices that donate stock.

I can happily say after managing a tripartite agreement between the University of Adelaide, ADASA, and HCAU, and finding a great young dentist Dr Harry Perkins to take over my role I believe the CODP is in good hands.

For myself, am I retired?

Next chapter – project work with TAFE, ARCPOH including Indigenous oral health projects and where ever the wind takes me.

What have I learnt?

Gratitude for the opportunities I have been given to improve my life and to be fully engaged in the community. I am reminding myself about the importance of self-care and to act with grace – a lesson for us all.

Joy in teaching and learning. Oh yes, and learning about the doubtful joys of grant writing. Joyful when you have success!

Enduring friendships with colleagues, students and patients.

The importance of truly listening and sitting down with my patients, and allowing them to tell me their stories. Through their stories, I have learned to be patient, diligent in detail, kinder and more willing to accept they know so much more about their health and ultimately what they need from us as healthcare providers. We as health professionals have a duty to be advocates for people who don’t have a voice!

It’s OK to feel sad, discouraged and inadequate, but never to dwell on it. I have learnt to accept my own failings and frailties which makes me more accessible to my patients - bravery is allowing yourself to show your vulnerability honestly and thoughtfully.

Each person is unique and we are given particular gifts that we can either choose to hold onto – but I believe to give generously and wholeheartedly the world around you becomes more vibrant and joyful. Knowledge shared multiplies and increases the capacity for change that reaches further than you can imagine.