For certain dental appointments, Dr Shanash Bishnulall must take extra consideration when preparing for her patients. Today she has covered her instruments with a paper towel. The keen, polished metal can feel threatening to some.
When the patient arrives, Dr Bishnulall uses a calm, soothing voice to introduce herself. She asks them if they are comfortable to lie back in their chair. For some patients it is too vulnerable a position and she must stand to work.
While Dr Bishnulall normally likes to work with her door open, today she must keep her door closed.
For women who have experienced domestic violence, dental and oral care isn’t the first thing that comes to mind when looking for support. Yet the incredible women like Dr Shanash Bishnulall who make up the Healing Smiles program believe this service is crucial to aiding victims on their road to recovery.
The Healing Smiles program was established in Perth in 2018 by former president of the Women in Dentistry Society of WA, Dr Gosia Barley, in the hopes of bridging a gap in the volunteer health sector.
The all-female group of interdisciplinary clinical specialists were brought together by their mutual desire to give back to the community and provide pro bono care to women who have been victims of abuse. The 50-person strong team is made up of dentists, dental assistants, oral health therapists and specialists.
Domestic violence is ubiquitous in Australia, an estimated one in every six women having experienced physical or sexual abuse in their lifetime.
Domestic violence is the leading cause of homelessness for women and children across the country, with 29 per cent of homeless individuals identifying domestic or family violence as the main reason for seeking assistance from homelessness services.
“Dental care allows our patients to have more self-confidence, to remove the constant and often painful reminder of the abuse they’ve endured and reintegrate back into society.”Dr Shanash Bishnulall
This year the program has seen 30 individual emergency and general dental appointments. Over the last four years, Healing Smiles has provided an estimated $240,000 worth of treatment pro bono.
For Dr Bishnulall, a dentist of four years, the need to give back was inherent.
“Growing up and realising … we have a set of skills, we’re women, we have empathy. You feel almost obligated when you have this ability to help other people,” she says.
Dr Bishnulall was involved in volunteer work for a while prior to being elected as a permanent committee member of the Healing Smiles program in April of 2021. As an undergraduate studying at the Sydney University Dental School, she always knew she wanted to work in the medical or healthcare sector but was drawn to the ‘one-on-one’ aspect of the care she could provide as a dentist.
“I liked being able to provide care for the community but working in public health, it takes a long time – if ever – to see changes in your patient base, whereas I can create a lot of impact on one patient in a single appointment [in dentistry].”
Many of the women helped by Healing Smiles are jobless, homeless or refugees. Without a healthcare or Medicare card, it is often impossible for them to access basic dental care.
The Healing Smiles program provides victims with access to comprehensive care, irrespective of their financial, physical and emotional limitations.
Dr Bishnulall says, as a dentist, she is “so acutely aware of how expensive dental care is, and often not available to those who most need it.” The volunteering she has done throughout her career has been inspired by her awareness of this issue.
Healing Smiles’ Clinical Coordinator Dr Jacinta Vu, has worked in the dental and oral health sector for over 20 years, having specialised in oral medicine eight years ago. Dr Vu is also the current President of the Women in Dentistry Society of WA.
She says the positive impact Healing Smiles can have for victims is striking.
“I saw a lady yesterday and she had emailed in about how much being looked after by the dentists in the program had made such a difference. She had gone from being in her abusive situation … to now knowing that she has worth,” she says.
Bridget Robson, a former counsellor to victims of domestic abuse, says the long-term emotional damage of an abusive relationship can take years to diminish.
“They lose so much self-respect, self-esteem [and] self-identity when they’re in that relationship.”
Lack of proper dental treatment can cause long-term oral health problems, loss of confidence and impact job opportunities in the future. In a world defined by physical appearance, looking the part when applying for jobs can make or break an interview.
Dr Vu recalls a patient who told her she felt she was ostracized for her missing teeth, often being perceived as a drug addict, when in fact she had lost her teeth because of physical abuse.
Ms Robson says this picture is all too common.
“You can imagine that she walks in, and everyone’s staring at her mouth and see would see it. And it would reignite that shame and everything else that she’s gone through … but being able to smile … that would really help to empower her.”
Dr Bishnulall says the care provided by the Healing Smiles program allows patients to find some form of normality after their ordeal.
“Dental care allows our patients to have more self-confidence, to remove the constant and often painful reminder of the abuse they’ve endured and reintegrate back into society.”
Despite the overwhelming positives that come from volunteering, Dr Bishnulall is not unaffected by the harsh realities she faces working with her patients.
“It’s really tiring because I think you can’t be empathetic without taking some of it on.”
Dr Bishnulall says she has become more sensitive to hearing about domestic violence in the news, because those women are the same as the women she treats on a daily basis.
She says treating damage in the mouth caused by physical violence and not decay can be emotionally challenging, and she often has to de-stress after an appointment.
Currently, Healing Smiles volunteers work out of their own individual clinics, using the clinics’ resources. This can take time and money away from the organisation where the specialist works and limits the number of patients that can be seen over time.
Thanks to financial support from the State Government, Healing Smiles is hoping to build their own purpose-built clinic within the coming year. Dr Vu says this will make a huge difference for both volunteers and patients.
“Having a fixed-location clinic, where a volunteer can come in, know they’ve got an assistant, know they’ve got the materials, all they have to do is give their time … then they might be able to see three or four patients, as opposed to one [per day].”
Dr Bishnulall says Australia’s reputation for domestic violence is disheartening, but Healing Smiles is making an impact at a community level. Dr Vu believes their efforts will continue to improve the lives of victims across Perth.
“Once you give someone back their physical smile, you actually start to see their genuine smile as well.”