Behind a Smile with Dr. Shauntel Ambrose

Journey through South African Dentistry: Triumphs and Challenges with Dr. Thabo Twala

• Shauntel Ambrose

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Ever walked in the shoes of a dentist in South Africa? Come, join us in a captivating journey with Dr. Thabo Twala, the President and CEO of the Dental Professionals Association (DPA) in South Africa. As a young graduate navigating through the complexities of apartheid, Dr. Twala's experiences provide a fascinating peek into the history of dentistry and its evolution in South Africa. We explore the remnants of apartheid in the field, the struggles prevalent in obtaining education and sustenance, and also the impact of changing policies on the profession.

The Dental Professionals Association (DPA) was formed in 1992 as a social club for dentists, and it has since grown to become an important organization in South African dentistry. Dentists in South Africa face challenges in rural areas, including limited access to specialized dental services and changes in the medical aid space. The DPA aims to upscale dentists through the Ortho Academy and provide support for dentists in building successful practices.

As we steer the conversation towards leadership and inclusivity in dental practice, Dr. Twala imparts valuable insights. Learn the importance of valuing employees, creating an inclusive environment, and the pivotal factors that contribute to the success of a dental practice.  So tune in and be prepared to be enlightened, inspired, and entertained.

Speaker 1:

I'm Shantel Ambrose and I'm a dentist, and I host a healthcare business podcast that shares tips from the healthcare industry leaders. So, whether you're a startup or needing a push in the right direction, a family business or just looking for mentorship, join us. So, hello everyone, it's me again, it's Shantel, and we are behind a smile, and today I have a very important guest, and I must tell you he's one of the most patient men I have ever met, and I'm very grateful to introduce you to Dr Tavo Twala. Now Dr Tavo Twala is the president. He is the CEO of the Dental Professionals Association, and on your WhatsApp picture is live minimally, tell the truth, don't hold grudges, dream big, exercise, meditate, eat well. Avoid seeking approval from others. Express gratitude for what they already have. I want to introduce you to a man that is part of the leadership of dentistry in South Africa. Welcome, dr Twala.

Speaker 2:

Thank you. Thank you so much for telling me. Thank you for the introduction. I'm not sure if I live by what I follow or what's up later. Probably that's what I aspire to. But thank you so much. I'm so honored to be here again for the motion.

Speaker 1:

Listen, dr Twala, I'm excited to have you on board and I think that your role in South African dentistry is really important, and so we want to talk about that a little bit. But I want to start off with can you share a little bit about your journey? How did you get to head this organization? How did you start with the DPA?

Speaker 2:

So I graduated in 1995 and immediately when I graduated I became a member of the DPA. And I knew I may not know that around 1998, at the time in South Africa there were several dental associations. Then they all came together, including the DPA, to form what came to be known as the South African dental association, and then, within the dental association, the DPA remained as a special interest. That's how I trace my participation in the DPA, and then, around 2015, I was elected to be the chairperson of the DPA. Yes, so that's how I'm here.

Speaker 1:

Now, dpa is an important organization and just in the terms of the history of SA, and I would love for you, if you can just share us a little bit of information, a bit about the DPA.

Speaker 2:

So the DPA was actually founded in 1990 as a social trap of dentists. You know that during apartheid black people were not a means to study dental. It is only when the former Nodunza, now the Tata-Makha University, established a dental faculty, I think in 1984, that black people could have a faculty at which they could say to become dentists. So the first graduates were I think they started around 1988, 1989. So around 1992 there were about 15 dentists who were graduated by that time and then they thought that they should come together. Initially it was a social trap that they could, but it was probably just the legs that they took to just be a social trap. But then, because there was political pressure all around the DPA, then Droy and Drot was then another American and dental professional association. So that's what it was. So we became part of the SA and DPA. Of course we I think the people at the time. They had to take care of themselves because they were social. But then a lot of the struggle was done in the anti-apartheid space. So that's what the SA-DP did and then therefore DPA also did that. So around 1994 then we had the defense democratic connections and around 1996, 1997, the dental associations felt that even the new dispensation. Let's talk, let's, from one dental association which ultimately culminated in the formation of the South African Dental Association in 1990, 1998. I must say that I was one of the first National Councilors of SADA at its formation. Yes, so that's how it was.

Speaker 2:

Unfortunately, the measure did not really result in the full integration of different elements that came to form the South African Dental Association, especially at a cultural level. I think that's where the digitalities were experienced to the extent that all the different associations came together. But the structure that actually remained was the structure of the old Dental Association of South Africa, whether it was the branches, whether it was the culture, whether it was in any way. So I think people who were traditional members of the DPE were feeling rather isolated and unwelcome but nonetheless we did our best to make it work, the scientific TK with the changes in the medical skin environment. So, as you may know or imagine the first majority of DPE members, they work in townships, they work in rural areas, they work in very far-fung places, but the main source of funding for the practice is virtually medical aid.

Speaker 2:

So the changes that are taking place in the medical aid space affect us clearly and we felt that the South African Dental Association at the time had actually lost interest in dealing with the changes in the medical aid space and, in fact, especially with respect to dental managed care. We think that there was a lot of collaboration between the association and managed care company to put into effect managed care as we know it now in the case. So I think that that was the course of our happiness and, unfortunately, around 2013, the marriage between the DPE and the South African Dental Association came apart. Yeah, I think in the nutshell, that's what? Of course, there's still a lot of collaboration, but, yeah, but the marriage has the clues to exist.

Speaker 1:

That journey is an important journey and it's one that we actually don't get enough chances to listen to.

Speaker 1:

I think that it appears that you were a pioneer of your times much earlier on, before you even read DPA, from what it sounds like, because it took a lot of courage to be part of the professional fabric. And what was that like being a student then? Now, not all of our exposure comes from being able to be in sort of the city areas, and that makes a huge impact if you're running a practice, because you have to take into account just community care. That involves transport, it involves other costs that your clients are seeing that are really quite significant to just being a really busy practice in the middle of a really busy town. So I think that the DPA is able to really offer support to dentists who are part of the process of knowing that not everyone's journey was the same as a dentist, as a practitioner, and certainly not as a patient. I really respect that about you. You're also a dentropinir, you have a number of different practices and you are the founder now of the Ortho Academy. So can you tell me a little bit about that?

Speaker 2:

So, because you did ask me about the pre-apartment, the democratic era, you know, for us, especially at the level of universities, in fact I think for most black people, you know, even in school, in high school, the anti-apartment struggle was all over. It affected us in each and every way. So you know that environment we grew up in. You know the environment of struggle. When we went to the university it actually intensified a lot. So, for instance, you know, at the university that I claimed when I was still there, I mean all the students were obviously black students, with a few Indian students as well, but all the lecturers, all the professors, the administrative staff, you know they were right and you know there was always. You know tension, right, because we were living during an apartment. You know, even in the lecture halls you know the anti-apartment struggle was ongoing. You know all the time. So you couldn't actually separate. You know your educational process, you know, from the broader anti-apartment struggle. It was always at the end of time and that's the environment that the TPA actually right. And the history of Ragels and unfortunately, even in post-apartment, you know, we find that. You know there's still a lot of ragels that can go to take place. So I think that's the background from most of the TPA strength books, the same.

Speaker 2:

Now, as you rightfully say, we don't all come from the same privileged background. I mean, it's easy to say that you guys are dentists, you guys, you know you've made it, you are, but the truth is not exactly the fact. You know, for instance, you know a lot of us actually struggled, you know, number one, to get university and also to sustain themselves during universities, I mean at university, you know, from funding, from accommodation, and you know all sorts of things that you know some city people may take for granted. But you know many of us actually struggled, you know, to be able to get the basics that needed to, you know, to succeed. So a lot of the dentists, you know, for them it was a big struggle to, you know, just to graduate, to become dentists. Now, as soon as they graduate, you know of course the first day is great because everybody's got a post, public service post, great salary, you know, every month. But when they finish it's a different quality because structuralists in South Africa you feel hasn't changed. There is a lot of change, yes, but you know structurally there's still, you know, division. You know the division between the poor and the rich, there's the division between the black and the white, and you know all sorts of things.

Speaker 2:

So we find that you know a lot of the young dentists who graduate for a variety of reasons. You know they invariably have to go back and you know, if they're going to go into practice, establish a practice in the township, in a rural area, for many reasons, for cultural reasons, because it's the community that they are an event, it's the community that initially they won't visit. It is what they can serve. So you know they simply go back and but as soon as they start, challenges come about. Because now you know you are generally working within a community of working, you know. So you know if you are, people are going to pay you out of pocket, they're not going to pay you a lot of money. The prices therefore are pressed, you know, simply based on the affordability of the community around you, right? But luckily, most communities will have several servants, government workers, police, nurses, teachers, and generally those people will be on one medical aid or program, or they will be in certain communities where people are working in ventures, corporate offices and so on, but you know, still staying within the communities, and those people will also have medical aid. So that is what actually makes medical aid such an important source of funding, you know for all the townships, because medical aid has now become a limited fund, so that your scope of practice as a dentist who went in a township area becomes really limited to what is being funded by medicals.

Speaker 2:

I think that is the issue. So now, but then again you know there are many other structural sectors that are happening. So in as much as you know, it's not a one-sided switch. All because now. But you also find that you know things are changing. A lot of people are, you know they're starting their businesses, they are moving into suburbs. You know things are changing. But then also what is changing is that you do find people who then demand, you know, more specialized dental services Because of all the changes you know, especially the social economic changes that are. The challenge that comes is that you know you're up to this point your scope of practice has been limited, right, but now suddenly the democratic changes and the social economic changes demand more from you and you've got a problem because your scope of practice has been limited.

Speaker 2:

The other issue is that there is very few special dental specialists in South Africa. I mean, if there's something that is beyond your scope of practice, the simple thing to do is to refer your patient or your specialist. But we have a problem that we, you know there are very few specialist practice, especially around in the rural areas, you know, in the far flung areas. So you'll only find those specialists are concentrated in Johannesburg, victoria, cape Town. You know the big city, but you will not generally find that. So that is another problem that the problems are faced with, and specialized specialist services are really expensive to. If you find a specialist, good luck, but then if you send your patient to a specialist, then the patient cannot afford the treatment that is offered by specialist, because specialists tend to be very anxious.

Speaker 2:

The problem statement then, for us, especially within the TPA, is that what do we then do? So at some point we took a very conscious decision. The only thing that we can is to really upscale our members. We have to upscale our members so that, of course, we would laugh at many of them to become specialists, but you know it's not always possible. It's not possible really that they can be done a specialist.

Speaker 2:

So the decision that we took was that we need to engage on a concerted effort to upscale the members of the TPA, bearing in mind that there's a lot of causes that are taking place but they are not generally accessible to a lot of people. So we have to create an environment where you know which is accessible to a lot of people so that they can upscale. So we took a decision then to form study groups, national study groups in various fields. Endodontics was one, because it was probably the pre-care center, because people were demanding. They didn't want to remove teeth anymore. They were demanding, you know, endodontic care and what we learned at university we realized was not quite adequate. So we had to invest a lot of resources into training our members to become proficient in endodontics.

Speaker 2:

Orthodontics is one you know people, our patients, are demanding, and it's either. We then made a decision also to form an endodontic study group. That's how, actually, the Ortho Academy came around. So the Ortho Academy is actually just a, it is just a study group. It is not a formal institution, it's a study group. You know that is called the Ortho Academy headcoordinated.

Speaker 2:

I've delivered a lot of workshops, I've developed a lot of lectures and so on. So that's how it is. And you know, not only that, and of course we arrived. We've had about 400 people that have you know, come to study with us with a lot of success, because now we are able now to respond to the needs of our patients, the needs of our community, and not only in orthodontics, but we also do work in the, in plant dentistry, we also do work in static dentistry, and so, oh, the big thing that we are trying to do is practice management and the transformation, because we really want people to really, you know, be good patients but also to become, you know, better business people. So I don't know, should I go on?

Speaker 1:

Yes, yes, you must. I think that you'll be hosting your annual congress soon, so I just I wanted to share with everyone that's coming up now on what date.

Speaker 2:

It will be on the 2nd of December. It will be held at the range resort in Oloquani in the Boko, a very beautiful facility for clinical therapy and for, you know, if I may say so, people will be able to bring their families and you know it's going to be a weekend of fun for the dentists, yes, definitely, but it can also be a weekend of, you know, relaxation for the rest of the family.

Speaker 1:

Yeah. So I'm very sad not to attend because I told you that when I heard that I was speaking at the event and then I couldn't make the commitment, I was really sad about it. But I would love all of our listeners to know how to. How do they get on board? How can they join the congress? Is there HRL details that maybe we can just have our listeners know about?

Speaker 2:

Yes, for sure. I think the easiest thing is just to log on to the GTA website, wwwgpaorgza, and all the information about the conference are there, including the, you know, the online registration links. Yes, that is the easiest way to do it. It's looking good. It's actually quite a different one, because we have intentionally planned this conference to also include other members of the dentality. So everybody will be there. So the dentists will be there, the dental therapists will be there, oral accidents, dental assistants, receptionists, you know, practice administrators.

Speaker 2:

Yes, so there's a reason for that because we want to. We want to get, first of all, in Calcades, a team spirit. You know, we can talk more about scaling of a dental practice, but you know, the basis of of growing a dental practice is by having a very good team on the ground to support the growth of the dental. So that is why we are bringing, you know, everybody within the dental team together, you know, so that you know we can all have the same mentality. You know, we can all share the same vision of growth. You know, but these are early days.

Speaker 2:

We think that this is probably the best way of doing it and also and also, to take away the elitist nature of the dental profession. We want to make everybody feel that they are part of the profession. The dentist is not more important to the dental profession than the dental assistant. That is what we are trying to convey. Everybody has got a role to play. Hence we have arranged this conference in this way. By the way, the theme of the conference is growing together. That is what we are trying to do. We are trying to grow together not only as dentists, but as the entire dental this is an inclusive way of leading.

Speaker 1:

I hear that a lot from what you say when you are talking is. I think your leadership style is very inclusive and I think it is something that you offer the organisation at large being the CEO, being the president, to invite everyone on board as a team. What it does is it gives you a cross-bored leadership where you are not looking at the hierarchy structure, you are looking at more an associative structure to lead. I think when people feel included at that level and are part of the vision, at the end of the line, something really magical happens. They are available to more knowledge, more participation and more capacity. They see in themselves the value that they really do benefit not only patients, but they benefit the team at large and they see their value and they acknowledge for it. I really admire that about the way the DPA is going about this inclusive leadership. Now I have to ask you you are the owner of multi-practices. How do you choose that magic team? Are there any tips that you can share with us?

Speaker 2:

I think it comes from the realisation that you need to have a good team. As a dental practice owner, you need to make people feel that they are part of the team. Their role and participation is very important. You need to make people feel valued at that input. Make them feel valued, make them feel that they belong, make them feel that they are within an environment whereby they can comfortably commit, whereby their work is going to help them to progress in life, in their careers, to be able to take care of their family. You need to build trust, confidence in your team. You do that by doing a lot of things Provide training. Don't take it for granted that people will know. You provide training. You communicate continuously and openly, while you are transparent and delegate so that everybody in the team is responsible for the success of the team, in whatever area they are employed. I think that's how it works. The spirit of the team is actually a very powerful spirit. Be a good person, because the work environment is really tough. The people who work with you. They come from sometimes very difficult backgrounds and you need to appreciate them and make accommodations. I will give you an example for you instead as soon as you have a practice in incentive. Well, most of us don't work in incentive, but I will just say this this is a practice that you need to understand.

Speaker 2:

Your cleaner lives, right, you need to know where they live from the practice. Is transport available If you expect your cleaner to be at work at 7 in the morning? Is it easy for your cleaner to actually get to work the time that this person is going to knock off? Is it appropriate? Is it not too late for this person to be travelling on public transport and so on? And you need to take into account all those things In your paystract. You need to factor in all those things.

Speaker 2:

This person, where they are staying. They have to be paying rent or whatever the case may be. There is transport costs. You need to know how many children there are. Are they going to school, what is going on and, in the way that you are going to interact with this person, have a clear picture of who this person is. In certain instances I would visit their family, usually when there is a bereavement or whatever the case may be. We will go and support them. I think for me, that is the spirit of the community that I am referring to and, ultimately people. They feel very good, they feel part of their family and they come to uplift the practices.

Speaker 1:

So I think that is the high trend.

Speaker 2:

But then to scale a dental practice, again, it has to be intentional. Having multiple practices in itself is not the magic formula, because it brings in its own complexities, but I think that making the most of where you are, scale as much as you can where you are. So usually you start as the only dentist in the practice. That is how most practices are. But as the practice goes, one is to make space for other professionals to come in, you make space for oral hygiene is to come into the room, you make space for dental therapists to come into the practice. Once you start doing so, the number of dental assistants and other support staff also increases, the investment in dental equipment also increases, and so on and so on, and your management skills become better. So that is how it goes. Now, once you have established it in one location, it actually makes it possible because, strange enough, once you have a team as the practice owner, you actually start to work less. But then why did then it does? It takes time to set up a second practice as well, because you are not confined eight hours a day to a single practice. After all, there's a team that is in place that is supporting, so you are then able to cope with the best practices from here and because you are not that busy anymore in this one practice, then it is possible to set up a second practice, a third practice and so on. In fact, I know people who have about 10. And obviously it means that you need to work at food teams in place, systems in place to be able to scale to that extent.

Speaker 2:

If I may just go back to the dental conference, we have one of the members of the DPA who's gone through this. He's incredible. Those are exactly what he wants people to be, the people that they want to be exposed to, because it's like each and every one of us. Actually, I know him very well because we were at university at exactly the same time, but at this point in time, he's got 10 dental practices. He's a commercial farmer. He's got a dentist. He's running dental practices. He's got wines that are selling in macro and the weekend day and probably many other places. He's the CEO of a major organization. He's the deputy chair of the university. He can sell. He's incredible how one person can do so, and those are the inspirational stories that we want to hear so that we can inspire each other, but especially the other dentists that look, your life is not confined to a small called a dental practice. So if you think bigger, if you're smarter, you can achieve a lot more. That is what we hope to engage people on when we go to the conference.

Speaker 2:

But, in general. That's what we are trying to do at the DPA to make our members realize that there's great opportunities out there. We should just be awake and alert and ready to take advantage of the opportunity. And so, yeah, that's the value of this community, I told to keep on inspiring each other, to be building each other.

Speaker 1:

Well, that's amazing, that's inspirational. I want to know is now what are the other benefits of your membership?

Speaker 2:

There's a lot. So, for instance, associations by their nature are political structures, so they be members, some level of political power, okay. That being the case, say, for instance, now there's a lot of debate in parliament regarding the national health insurance as well that national health insurance, when it gets implemented, it will affect dentists. Necessarily, it will affect communities that you have seen, it's the custodians office in San Afrika. We have to make input. Now it's more powerful if you make that input as a group, not as an individual. So that is the political power that I'm referring to. When we engage with medical students, we can only engage with them based on the political muscle that we carry. That the political muscle is the product of the membership that we ask. And so those are some of the things that we are currently having a matter before the Public Business Commission whereby we are challenging what we think are the competitive practices of the healthcare companies that they treat as so more than anything, that is the political power that we are referring to.

Speaker 2:

But there's also a whole lot of things that we are doing. A lot of work in the educational space, like I've decided to do for the medical staff Nationally, contributes to the continuing professional development. Obviously, you have an association with the mental protection, so we join forces with third parties, such as the mental protection, to provide specific benefits to our membership. Essentially, that's what an association does those things that new associated people cannot do. That's what an association should step into. Yeah, that's part of the difficulty that people. That's what people don't understand. People. They just want what they can see. But in fact, there's a whole lot of work that is going on in the background. There's a lot of engagement with government, with medical students, with mental protection, for instance, and many other entities in the background. On behalf of the member.

Speaker 1:

So thank you for that. I just wanted to who is the doctor-twarler that comes home from work now? What keeps you grounded and what keeps you motivated? What are your go-to daily stress busters?

Speaker 2:

It's a very difficult question, I don't know. I usually tell people that I actually rest at work, so I must say that my work does not stress me at all, mainly because I've got an incredible team that I'm working with, so I actually enjoy going to work. The discipline of orthodontics, so my daily life is great. I've practised this in the Northwest and in Houtains, so I spend a lot of time travelling, which is great, which clears my mind. Spending time with my kids is great. That's how I do. I study a lot. I study a lot. It keeps me busy, focused. In fact, I'm having an examination in Atlanticology tomorrow. I've got three other degrees, not dental degrees, so those are the things that I do a lot. I love news I'm a news giant and watching soccer that's what.

Speaker 1:

I do.

Speaker 2:

Those are the things that I do.

Speaker 1:

Well, that's fantastic. Well, I just want to thank you for making up the time and for sharing all of, I think, those aspects that we don't often talk about and the level of inclusion that you're able to offer dentistry I think it's quite exceptional. I really appreciate the time that you've given us and we are looking forward at seeing you at the Congress. So we're inviting everyone today to clean the beach with kind brush and a hossa. So on the 3rd of December, if you are in Cape Town, meet at the public swimming pool at Sea Point at 8 o'clock to 9 o'clock. Bring as many friends and family and get together for the beach cleanup. It's an initiative to get rid of plastic waste, make it a kind of breathing environment, make it a kind of swimming environment, make it a kind of living environment.

Speaker 1:

So the clean the beach initiative with kind brush and a hossa is happening on the 3rd of December at Sea Point, so we're hoping to see you there. We have covered starting up and how to turn your vision into a business, and in our future episodes we look at leadership, we look at multi-practice success. I'm grateful for you and I would love to hear your ideas. What questions do you need answered? Please drop me a mail at behindersmile2atchillailcom. I look forward to hearing from you and remember you are heard, you are seen and on this platform you are invited. Let's make it happen together.