A total of 25 patients, took time to participate in this study whereby 14 were males and 11 were females. The participants were between the age group of 20–60 years. With respect to ethnicity 15 were of I-Taukei background while 10 were Fijians of Indian descent. The Marital status breakdown included 5 single participants and 20 participants were married (Table 1).

Table 1 Demographic characteristics of participants (n = 25)

Theme identified

The thematic analysis of the interview found the 5 themes emerging from the main theme of perception of dental services. The Five main themes identified for perception of dental services include: Waiting time before treatment, Cost of Treatment, Accessibility of services, Privacy and confidentiality and Range of treatment options (Table 2).

Table 2 Themes and codes identified

Theme 1: Waiting time before treatment

All the patients described the waiting time before seeing a dentist and receiving treatment as long and dissatisfying. The late start in the working time was considered as the reason for prolonged waiting time.

“I was referred to the clinic from Nausori one day before, I came at 7am before they even opened the clinic, and I was seen by the dentist at 10am. I don’t know what took them so long… this is very frustrating as I have to go back to work and my pay will be cut for 2 hours”. (P4, a 33 years old Indian male).

Staff taking sick leave on Monday’s was also a reason identified by participants that contributed to the waiting time.

“The waiting time is bad at this clinic as I had to wait for 3 hours before I could be seen by a dentist. When I asked the front desk person the reason for the delay, I was informed that most of the dental staff are on sick leave. Monday fever I guess”. (P13, a 37 years old I-Taukei, male)

Another participant highlighted the need for more dental staff and the slow work process of the current staff as something that increases waiting time at the clinic.

“I think this clinic needs more dental staff as with the current staff they are very slow, I had to wait for an hour before being seen by the dentist.” (P24, a 44 years old Indian, female).

The option of going to a private dentist was also mentioned by a participant to avoid the long waiting time.

“The waiting time is so bad that next time I would prefer to see a private dentist even if it costs me a lot. I can’t waste my time waiting to receive dental treatment at this clinic.” (P6, a 30 years old I-Taukei, male)

Likewise, a participant raised the issue that dentist’s relatives are seen first which again prolongs the waiting time of patients waiting in line for their turn.

“Waiting time becomes longer for us because sometimes the dentists relatives are seen first, I saw that happen today the guy just walked in the waiting area and out came the dentist to take him inside. Who you know system is being practiced here.” (P19, a 27 years old Indian, male)

P19’s comment was validated by, P7, a 44 years old I-Taukei, Female who stated:

“I don’t have an issue with the waiting time as my relative is dentist here and I get seen fast.”

It was also highlighted by some participants that children and school children should not be made to wait as they have to get back to school after receiving treatment.

“School children should be given priority as they need to get treatment fast and get back to school, it was very frustrating having to wait for about an hour before my son could be seen by the dentist.” (P20, a 38 years old I-Taukei, female)

Similarly, another participant stated.

“My 5 year old son had a very bad tooth ache and was crying, I asked the receptionist if my son could be seen immediately as it was an emergency…. I was told to take a number and wait, I waited for 2 hours with my son who was in pain and the whole time crying. No compassion.” (P9, a 25 years old I-Taukei, female)

Participants also stated that there was no compassion as dentists don’t have a sense of responsibility towards patients and are lazy, especially in government clinics.

“We can’t expect much from the government dental clinic because it is government, never mind the dentist study in overseas but when working in Fiji all the same. Lazy and no sense of responsibility that’s why we poor patients have to suffer.” (P18, a 35 years old I-Taukei, male)

“No value for human pain here…. take a number, sit and wait for your turn never mind you are about to die of that tooth pain. It can take about an hour before one is seen by the dentist” (P12, a 31 years old I-Taukei, female)

Theme 2: Cost of treatment

The CWMH dental clinic is a government funded facility, but since the dental materials procurement becomes expensive, cost of certain services provided needs to be paid by the patients at a very subsidized rate.

Majority of the patients on the other hand feel that the cost of service is a bit too much and the idea of paying for a government service does not go down well from the perception of the participants as many are not earning enough to afford this service as mentioned by P2, a 45 years old Indian, Female:

“I do not like the idea of paying for this service. This is part of the CWM hospital we don’t pay to see the doctor than why do we have to pay to see the dentist? This is just bad ripping poor people off.”

Likewise,

“Why do we have to pay for something that we have already paid for? We are tax payers so in a way we have already paid for the service even before using it. I think the government is broke that’s why charging us so much fees.” (P23, a 55 years old Indian, male)

The recent Covid-19 pandemic which caused job loses, was also identified by participants as a reason why they find the cost of treatment expensive.

“ I paid my dental fees but feel that it is a bit too much especially for us who don’t work and now because of covid I feel it’s going to get tougher to seek dental treatment with these types of fees in place.” (P14, a 35 years old Indian, female)

The participants also identified the issue of inferior treatment being given to them and when they return they are asked to pay again for that service.

“They charge us fees but the filling they do comes out in a few months when I returned as it is counted as return job they said I will have to pay again…… I don’t know if I can take this issue to consumer council or not but it’s very bad.” (P16, a 33 years old Indian, male)

Some participants blamed the government for not caring for the poor elderly patients who have to borrow money to pay for dentures with the added burden of visiting the clinic many times before they get their dentures.

I needed dentures (false teeth) last year but could not pay for the cost. Iam old and retired civil servant I don’t have money in my pocket every day. I had to borrow money to so that I could get my dentures done, may be the government could consider poor people like us.” (P1, a 60 years old I-Taukei, female)

While, (P3, a 58 years old Indian, male).

I am a Social Welfare recipient, now I have to travel all the way to Nakasi to get my dentures made, because the CWM denture making department closed, and I have to go to Nakasi plenty times before I get my Dentures…it’s not cheap you now this running around

Some participants on the contrary thought that the charges at CWMH dental clinic was reasonable in comparison to the private dental clinics as, P21, a 39 years old Indian, Male mentioned:

“I don’t think the charges are that expensive. It’s affordable in comparison to the private dental clinics. They really rip us off.”

Theme 3: Accessibility of services

Majority of the participants interviewed did not identify any issues with the accessibility of services apart from a few who had issues with disabled and elderly person’s access like:

“For me coming up to CWM dental clinic is a challenge as I can’t walk properly plus I get off the bus and have to climb the stairs to get here. I think the clinic needs to be situated at a place which is disabled friendly.” (P24, a 44 year old Indian, female)

Similarly,

“My daughter is disabled as she can’t walk. The last time I brought her to this clinic it was an issue finding parking space so that I could get her off and then use her wheel chair to cart her to the clinic. I think the government needs to make this clinic disabled friendly and provide specified parking spots so that we don’t face any issues when getting our disabled family members to the clinic.” (P15, a 36 years old Indian, male)

A participant mentioned that staff are grumpy with normal patients and wondered how the disabled people may be treated considering they are not able bodied.

“For disabled people accessibility would be an issue. First in getting to this clinic and second in receiving treatment, look at the dentists we have they are so grumpy with us normal people imagine what they would do to a disabled person. I think that is one of the reasons why a disabled person does not seek dental treatment at government dental clinic.” (P12, a 31 years old I-Taukei, female)

Another participant mentioned the dental chairs used by the dentists in this clinic that are not disabled friendly as it does not incline up and down.

“This clinic has accessibility issues when it comes to disabled people. Just go inside and see the chairs that they work on is so bad it does not go up or down so how would a disabled person climb onto a chair that is high. Better to go to private clinics if one is disabled and needs dental care.” (P2, a 45 years old Indian, female)

This was experienced by P5, a 60 years old I-Taukei, male who stated:

“I am 60 years old and sometimes need dental care. Coming to this clinic is not easy due to its location and then the equipment’s that the dentists use. I asked the dentist to lower the dental chair so that I could sit properly but he said it does not go down because it is bad and not yet fixed. I had to sort of jump up as I am short and old and the unfortunate part is that the dentist just stood there watching did not even consider to help me…….. I would rather not come here again and embarrass myself never mind my teeth falls off that’s ok.”

Theme 4: Privacy and confidentiality

Many of the participants interviewed did not identify any issues with the privacy and confidentiality. On the contrary there were a few participants who raised some crucial issues when it came to their privacy and confidentiality with regards to the treatment room and handing of patient folder the at this dental clinic like P12, a 31 years old I-Taukei, Female mentioned:

“The treatment room is not a room it is sort of open from the bottom and the top so what the dentist is saying in the other room to his patient can be heard by the patient in the neighboring room. I think there needs to be closed rooms to maintain privacy.”

Similarly, P16, a 33 years old Indian, Male stated:

“They don’t even close the door, while the dentist was working on my tooth another dentist worked in to have a chat with the dentist while she was working on my tooth and all this was happening as I lay there with my mouth wide open. I felt embarrassed where is the privacy and confidentiality part which they are supposed to maintain.”

In regards to the folder privacy issue at the clinic P11, a 36 years old I-Taukei, Male indicated:

“Is there anything private and confidential in a government facility? Look the reception staff they carrying the patient folders as if it’s nothing. What if the folders contain vital information about a patient who has HIV/AIDS? The way it is being handled all information can leak out. This is the reality of a government hospital”

Theme 5: Range of treatment options

Patients expressed concerns with regards to the range of treatment options provided and available at the CWMH dental clinic, with some stating that options are very limited and they have to use the private dentists for advance treatment options.

P6, a 30 years old I-Taukei, Male stated:

“Some of the services are not available here and we have to go to the private clinic which is much more expensive. What’s the use of having this clinic than when it can’t provide the care needed.”

Similarly, P23, a 55 years old Indian, Male said:

“They said because of covid they only do pull out of tooth and no filling. So I asked the dentist than what about my tooth which needs filling? He said go to the private dentist, but I told him it would be expensive to which he responded it’s not his problem. Covid or no covid the treatment options at this clinic is very limited and the staff pathetic as usual.”

Similar sentiments were shared by another participant who stated that treatment would depend on the availability of materials and with basic care:

P19, a 27 years old Indian, Male said:

“The treatments options here are limited only basic care is provided, that too will depend on the availability of materials. Sometimes it’s a waste of time coming here better go to private clinics with wider options for treatment.”

Another participant mentioned that some procedures are not available at the dental clinic and they can’t afford private dental treatment thus end up losing their tooth.

P16, a 33 years old Indian, Male mentioned:

“Today I came to get my tooth pulled out because 5 months ago the dentist here told me to go to the private clinic for a root canal or something she wrote on a paper. I went to the private dentist and was quoted a price of about $900 for the procedure which I could not afford and left my tooth like that until today I had it removed because of the pain. If only that treatment option was available at this clinic my tooth could have been saved.”

The issue is not of having qualified dentists but less treatment options given by the government to the people was also highlighted.

P9, a 25 years old I-Taukei, Female stated:

“What’s the use of having so many qualified dentists when the clinic only provides some treatments only? The option is very less, government should look into this as we have qualified people who can give top class treatment with the right resources. The dentists here only know how to pull out teeth, not save them.”

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