Australia brought us the Begg technique, largely because of the great distances Dr. Begg had to travel. Well, the tradition continues. Read Dr. Manaf's narrative about satellite offices that are really satellite offices.

I am extremely fortunate that I have a job that I love and I get to work in remote and unusual places as well. Western Australia is a big place, our capital city Perth is at the southwest corner of Australia. It is here that I run my main private practice. Every 6 weeks I pack my equipment and travel to work in four different places: Port Hedland, Newman, Paraburdoo and Narrogin. Some people wonder at my sanity but this has become a way of life for me and it has its challenges as well as many rewarding moments. I am not unique in running visiting country practices of course. Quite a few orthodontists in Perth and other parts of Australia do the same. When you live in a big country where the population tends to be widespread, distances do not mean much any more. Most country patients and parents think nothing of driving 2-4 hours for a 10-minute appointment! It is incredible but true!

Port Hedland: population approximately 11,000 with many young people and children. The main industry is iron-ore mining run by one main company, BHP. It is located 1600 km (960 miles) north of Perth. Traveling time to Port Hedland by air is about 2 hours 15 min, by car it is about 16 hours, by camel a lot longer! I have actually had to drive up to work once when there was a prolonged commercial pilots strike. Result: broken radiator caused by collision with a kangaroo! The climate in Port Hedland is sub-tropical to arid desert. The weather is pleasant in Southern Hemisphere winter (June to August) but very hot in summer. The temperature is around 40 C then. I run a visiting practice here. I rent a room from the local dentist for 2 to 3 days. I supply my own materials, in other words I bring with me all my bands, brackets, pliers etc. I am a regular at the airports and I am known as " the lady with the big bags". I would like to think that they are referring to my luggage! Instruments are prepacked in sterile autoclaved pouches in several standardized 'kits' according to procedures scheduled. Brackets for bandings are pre-selected on organizers. Everybody in the office knows exactly how many bandings; issues, adjustments, debandings, new patient exams and reviews are being done on each trip. My staff in Perth has become very skilled at packing! I do not bring staff up with me, as it would get extremely expensive. The cost of air travel within the state is very costly and costs much more than to travel longer distances say to Sydney or Melbourne or even internationally. It cost more to go to Port Hedland and back than it is to travel to Bali for a 10-day vacation with the accommodation thrown in! Pretty sad but true! Therefore, I employ local people. It is sometimes a problem with staff and trained staff is difficult to get. The population here tends to be somewhat transient and there is a relatively large turnover of personnel. The practice is run very informally in concert with the nature of things in these regions. Off with the Chanel suits and on with the shorts and sandals!

Newman is another BHP mining town. It is 1100 km (660 miles) from Perth and 1 hour 50 minutes by air and 12 hours by car. Population is approximately 7000 mainly of young families and children. Climate is similar to Port Hedland but as it is further inland, Newman gets very chilly in winter. I run visiting practice here where I rent a chair for 1 day a month from the School Dental Service. As usual, I carry all my gear with me and I normally do a day trip starting on a very early morning flight at 5.45AM and returning to Perth on the 6.45 PM flight. Working hours is normally from 8.30AM to 5.00PM.

Paraburdoo: another mining town this time run by a company called Hamersley Iron. The population of Paraburdoo is about 4000 but I get patients from neighboring Tom Price (population 4000) which is about 70km (42 miles) away. The climate is similar to Newman. I run a visiting practice operating from the dental rooms in Paraburdoo Hospital. I normally do a day trip starting at 5.45AM and returning to Perth at 6.45PM. I have only been working in Paraburdoo for 18 months. The population of Tom Price and Paraburdoo had been going to Karratha (500 km or 300 miles away) for their orthodontic treatment but it was difficult because the road is unsealed and very rough and takes 8 hours of travel. The good people of Tom Price and Paraburdoo had enough of this and decided to lobby their Member of Parliament for orthodontic service to their community. This matter was brought up in Federal Parliament and came to the notice of our Australian Society of Orthodontists. The first question the president asked when the lack of orthodontic service in Paraburdoo was mentioned and what steps the society could take to help the situation was " Where the hell IS Paraburdoo?".

Narrogin: this is a town in the wheat-belt of Western Australia. The industry here is mainly farming. The population is about 11,000 and the climate is temperate to Mediterranean much like that of Perth. Narrogin is 270 km (150 miles) from Perth. I run a visiting practice from rented rooms at one of the local dental practices. This centre is extremely busy and I travel here twice a month by car. The journey takes 2 hours in very pleasant countryside. Again I bring all my gear and employ local people as assistants.

I do ALL the clinical work. At each centre, I employ one chair-side assistant and one receptionist. All my practices are fully computerized and I carry all records on my laptop. In the bad old days, before we were fully computerized, I had to bring up ALL the patients' charts. That really made a big difference to luggage! Another use for my laptop is entertainment - I have been stuck at the airport for 8 - 10 hours several times and Scrabble or mindless time wasters like Tetras, Solitaire etc. have proved useful against general loss of cool and screaming!

When I am not traveling, I run my practice in Perth. Appointments and fee collection from the country centers are centralized in Perth. Although all this traveling can be disruptive to a " normal " life and the occasional let downs by the airlines have left me sitting at the airport for hours; I really enjoy what I do. Parents are grateful for the service. I remember one young parent in particular who had twin boys coming for a banding appointment. She was somewhat late and came in looking quite bedraggled and tense. I asked her what happened and she said that she had a hard time on the road as it had been raining heavily and the roads were flooded, she had to go through 2 river crossings and it had taken 3 hours, but, she HAD to get to the orthodontist! She was not about to give up, come hail or high water! We laughed about this 18 months later when the boys came for their debanding appointment.

From a clinical point of view, I have learnt that keeping my inventory as simple as possible… cuts down on my baggage. I use the Straight Wire technique and I try to avoid appliances with many delicate parts. My experience is that, fortunately, emergencies are few and far between and patients and parents are actively encouraged to call us for advice. The rare painful problems are seen to by their general dentists. I have an office policy that all patients who have been issued with active appliances are routinely contacted to find out how they are coping. One of the problems of having so many traveling commitments is that planning conferences and holiday time becomes extremely complicated and needs to be carefully planned. Extended vacations are almost impossible. From a financial standpoint it is rewarding as fees are expected to be much higher in these remote areas. In fact, in Australia people working above the 26th parallel are entitled to a special allowance in their wages.