Indonesia's self-taught dental workers say they fill a need in society - just not in Hong Kong

The four had rented a room on their days off to offer treatments such as scaling, trimming, fillings and braces - charging between HK$200 and HK$2,000 - to fellow Indonesians.

In comments to the media, a Hong Kong Immigration Department spokesman said practising dentistry without registration was a threat to health and safety, in a time of Covid-19.

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"The situation is absolutely unacceptable," the spokesman said.

In Indonesia, however, scores of self-taught street dentists known as "tukang gigi" or "dental workers" ply their services legally and are protected by the country's constitution, which recognises them as traditional healthcare workers offering specific services to those who find professional alternatives too costly and out of reach.

The country of 270 million and more than 17,000 islands has a thriving informal industry, with these workers, or tukang, offering all sorts of services, from car repairs to men's grooming and massage. Jakarta residents will attest to how children and teenagers will appear on the streets when it rains with umbrellas, offering to shelter pedestrians for small fee.

Government statistics show about six in 10 of the Indonesian workforce are in the informal industry. Experts point to how they have been especially disenfranchised by social distancing restrictions of the Covid-19 pandemic that have kept their customers at home and not spending money.

MEET THE 'DENTIST'

Muhammad Tohir, 28, is an economics graduate and a self-taught dentist. Since 2016, he has been operating from a ramshackle shop on a busy Jakarta street near a railway track.

Working from 9am to 10pm daily, Muhammad sees to requests such as teeth scaling and whitening. He declined to reveal how much he charged but said he earned at least 5 million rupiah (US$350) a month -though his income tanked at the start of the pandemic -and it was enough to provide for his family.

In the capital city, a permanent filling at a public medical centre costs up to 50,000 rupiah (US$3.50) per tooth, according to a 2018 gubernatorial regulation. Dentist consultations at private hospitals in Jakarta cost at least 150,000 rupiah (US$10.40) on average. The city's minimum wage is US$305 per month.

"I don't do braces or tooth filling because they are permanent. My services are limited to follow the law," said Muhammad. "I also make dentures but only from acrylic, because they are easy to make and follow the rules set by the Health Ministry."

The dental worker claimed he was licensed by the Health Ministry, but admitted he did not fill a form or do anything to acquire a permit.

Muhammad was raised in a family of farmers in Madura, an island in East Java. His father and uncle also made dentures for neighbours and relatives, later passing on the skills to him when he was in school.

In 2012, he moved to Jakarta for university, where he became interested in dentistry in his second year as one of his friends was training to become a dentist. 

"So I learned dentistry from medical books published by the University of Indonesia. I borrowed them from a friend who studied there," Muhammad said.

"I also learned from YouTube videos made by foreigners. Dentures brands usually create videos about how to make dentures, featuring dentists in their tutorials," he said.

"Apparently making dentures is not hard. The explanations in the books are more complicated than in practice," he said. "I realised this was where my passion lay."

Upon graduating, Muhammad borrowed money from his parents to set up a dental clinic - though describing it as a clinic is a stretch.

Aside from using a repurposed barber's chair he does not have a sterilisation kit or an X-ray machine, so it could take "up to six appointments" to make a good set of dentures, he said.

"My goal in the next few years is to have those equipment so I can be more professional," Muhammad said, adding that he was keen to study dentistry serious if "the passion is still there" in the future.

More immediately, he said he was looking forward to the rebound in business that he attributed to "the public's dwindling concern about Covid-19".

"I'm happy when I get paid," Muhammad said. "It means people are happy about my service, which makes me feel useful to society."

PROTECTED, BUT CONTROVERSIAL

The existence of informal dental workers is controversial in Indonesia, where the government in 2011 sought to ban their services after complaints of dental risks at the hands of tukang gigi.

However, the constitutional court ruled in 2013 that the jobs needed to be protected as they were a traditional health service usually passed down through generations. 

According to the court, informal dentists had existed long before the first dentistry academy, the Indonesia School tot Opleiding van Indische Tandartsen, was established in the city of Surabaya in 1928. 

The court also saw the jobs as "an alternative for people to receive affordable dental health services" in Southeast Asia's biggest economy.

"As long as the government is not able to provide affordable dental services to the public, any violations carried out by dental workers can be resolved through development, licensing, and monitoring [programmes]," it said. "The constitutional court does not agree with any regulations that hinder dental workers."

The ruling was a major setback for professional dentists, who had been pushing for the informal shops to be regulated for years.

The Indonesian Dental Association said it had been seeking a follow-up to the memorandum of understanding it signed with the police to crack down on the shops and stop issuing licences to those violating the law.

"We have always asked the authorities to regulate these dental shops, but the police say they will investigate only if there's a report from the public," said Iwan Dewanto, the association's deputy secretary general. 

"People are subjected to dangerous risks if they seek treatment from dental workers instead of dentists, as they are not educated in dentistry and there are no [standards of practice] to ensure patients' safety," he added. 

The association logged 1,191 complaints about dental workers from the public between August 2016 to July 2019, related to problems with services such as braces, dentures and tooth bleaching.

In the case of the Indonesian domestic workers in Hong Kong, they were likely being entrepreneurial and saw their services as plugging a gap in healthcare demand from migrant workers, whose needs are often not a high priority for policymakers in host economies.

Eni Lestari, a spokeswoman for the Asian Migrants Coordinating Body in Hong Kong, said there was a demand for cheap, unlicensed services because of the limited insurance protection domestic workers have.

There are about 375,000 foreign domestic helpers in Hong Kong, and about 42 per cent of them are from Indonesia, according to government statistics from last October. The monthly minimum wage for foreign domestic workers in Hong Kong is currently set at HK$4,630.

"Most employers procure health insurance for their domestic workers that only covers illnesses caused by their jobs. The insurance does not cover teeth, eyes, or cancer," Eni said. 

"So when they're sick from common symptoms such as fever, they would seek alternative treatments from unlicensed physicians or go to massage clinics. The physicians could be their friends, or Chinese traditional clinics." 

In Hong Kong, many domestic workers aspire to develop their skills beyond household tasks, and pursue their passions in music, design, languages, computers, and health care, Eni added. 

"But their passion will never turn into a profession as regulations in Hong Kong are quite strict for domestic workers. If you came to Hong Kong as a maid then you will forever be a maid. A maid is barred to earn money from other avenues," Eni said.

This article originally appeared on the South China Morning Post (SCMP).

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