An Officer and a Dental Man
Kevin Priest '10 DDS, MA shares his experiences serving in Afghanistan as a dentist in the Army Dental Corps.
It's hard to believe it's been 10 years, but I can remember sitting in my dormitory room during my sophomore year at John Carroll University as an undergraduate student. I remember watching the invasion of Iraq, the "Shock and Awe" campaign, and my feelings about our country being at war. I remember talking with my friends and thinking that it was crazy that we were now at war. I knew we had already gone into Afghanistan at this point but for whatever reason the "Shock and Awe" campaign is when I started to think a little more seriously about serving my country.
I knew the cost of dental school in addition to any existing loans from my undergraduate studies could be a burden that could take years to pay off. It was during my sophomore year at John Carroll that I inquired about the Health Professions Scholarship Program, or HPSP, that the military offered. As I looked into what the scholarship provided, I knew this was a path meant for me. Not only would dental school be fully funded, but I would have the opportunity to serve my country as a dentist, provided I was accepted to dental school.
By the time my senior year at John Carroll arrived, I knew I had to start the process of applying to dental school. The pre-dental program at John Carroll along with the Pre-Health Professions Society really helped guide me in the right direction. I distinctly remember Dr. Michael Rowland visiting John Carroll as the Ohio State University College of Dentistry Admissions representative. Being from Ohio, I knew I always wanted to go to dental school at Ohio State but Dr. Rowland further convinced me that it would be the perfect place to start my dental career. Having begun the application process to dental school, I next looked more closely at what a military lifestyle as an officer and as a dentist entailed. I looked into the Army, Navy, and Air Force, all of which had their respective health professions scholarship programs. After talking with multiple recruiters from all three services, I decided that the United States Army was the best option for me. All three services had great and equal programs but I chose the Army because of the multiple post-graduate opportunities as well as the individual attention I received from my Army recruiters.
My decision to finally join the military was pretty easy since I had been thinking about such a career for a number of years. Nonetheless, I still had reservations. Would I deploy? Where would I work? What does the military involve outside of dentistry? I wanted to ensure that I was accepted into dental school before making a final commitment. My desire to serve was real although becoming a dentist was my true long-term goal. In January 2006, I finally received my letter of acceptance to The Ohio State University College of Dentistry. Now that I knew the location of where I would attend dental school, the application for the military scholarship could begin.
After paperwork and several weeks of waiting, I was notified that I received the scholarship that would finance my dental school education in its entirety. In return, I would then serve 4 years as an active duty dentist.
From September of 2006 to June of 2010, I attended dental school but only had to train with the military for a total of six weeks. Those six weeks were dedicated toward learning how to become an Army officer at the Basic Officer Leadership Course, held at Fort Sam Houston in San Antonio, TX. The Army did not require any further training until I entered active duty in August 2010 at Fort Campbell, KY. It was here that I enrolled in the 12-month AEGD (Advanced Education in General Dentistry) program. I started treating active duty soldiers and other military beneficiaries at this point. It was here that I learned to become more proficient at molar endodontics, oral surgery, prosthodontics and periodontics. I didn't realize the full value of this residency training until several months after I graduated. After residency training, I was assigned to Fort Drum, NY as the Brigade Dental Surgeon for the 3rd Brigade Combat Team, 10th Mountain Division. This position meant I would be the only dentist for roughly 3700 soldiers both in the United States and in deployed environments if the unit deployed.
After finding out about my assignment to Fort Drum in late 2010, my commander at Fort Drum gave me a call in March of 2011 welcoming me to his unit. At this time I was informed that I would be deploying to Afghanistan shortly after my arrival in August. I was both nervous and excited for this opportunity and could not believe that I would be supporting Operation Enduring Freedom with the historic 10th Mountain Division!
Once I arrived at Fort Drum in August 2011, I completed pre-deployment training, which included roadside bomb identification and weapons qualification with M-16 and M-9 weapons. There were also many other lectures on the culture of Afghanistan as well as what to expect after arriving in the country. My pre-deployment training occurred during the last week in September and first week of October. After the training ended, my flight overseas was scheduled for October 10, 2011. Those of us deploying were told that we would board a bus from Fort Drum and then travel to Baltimore, Maryland. From there we would board a plane and head to Ramstein Air Force Base in Germany and then on to Incirlik Air Base, Turkey. After a few hours in Turkey, we then boarded another plane en route to Bishkek, Kyrgyzstan (Manas Air Force Base) which was a former Soviet Republic. Bishkek is one of the main soldier and supply staging areas for the U.S. military in Afghanistan. We stayed in Kyrgyzstan for a few days until our flight departed to Kandahar, Afghanistan. The flights from Fort Drum to Kyrgyzstan were like any normal civilian experience; all of our luggage was placed beneath the plane and we were allowed one carry-on. Leaving Kyrgyzstan, however, was much different. We were required to put on all of our protective gear to include kevlar helmet and body armor. We also had to carry our weapons, albeit with no ammunition. I can honestly say it was unnatural carrying a weapon onto a plane! Once we landed in Kandahar, it was a pretty surreal feeling. The airport was very busy, mainly with large military C-17 and C-130 planes. There were also a few civilian planes that flew in and out of Kandahar, although those were mainly for civilian contractors working in Afghanistan.
Kandahar was an absolutely huge air base. We were told that approximately 40,000 people worked within the confines of this air base to include military and civilian personnel representing many NATO countries. Kandahar had multiple dining facilities, or DFACs. Once you showed your ID card, you could enter and select any food items at no charge. If you didn't want to eat at these facilities, Kandahar was equipped with pizza places, smoothie shops and various other restaurants. These restaurants, however, required patrons to pay. I didn't expect these types of places to exist in a deployed environment but I suppose everyone appreciates a reminder from home at some point. After spending a few days in Kandahar, I headed out for the place where I would be stationed for the next 5-6 months, named Forward Operating Base (FOB) Pasab.
In order to get to Pasab, one either had to fly by helicopter or drive via convoy. My first trip to FOB Pasab was via convoy, which made me pretty nervous. In retrospect, it really was not a big deal, but at the time I was extremely worried about IEDs (Improvised Explosive Devices), or roadside bombs. Nevertheless, I made it to FOB Pasab safely.
Now that I was finally at Pasab, I can say that it was not what I expected. The base was lined with concrete barriers that were approximately 30 ft high. Each road within the base was lined with these concrete barriers. The appearance of the FOB was akin to a rat maze. The entire base was only about 1.5 miles long so there was not a whole lot of room for maneuvering. I worked at an aide station with 2 physicians, 2 physician assistants, an occupational therapist, and a physical therapist as well as a nurse. We didn't have surgical capabilities due to the lack of a general surgeon or anesthesiologist. Because of our limited surgical capabilities, we were classified a level 2 as opposed to a level 3 facility. Each medical treatment facility in a deployed environment is labeled as level 1, 2, or 3. A level 1 facility has the least medical capability while a level 3 has the most. Typically a level 1 is in the least secure or permanent location whereas a level 3 is in a more permanent location, functioning much like a medical center would in the United States. A level 2 is as austere as I could be placed because dentists (and physical therapists) are only found in level 2 or 3 locations.. There were multiple level 1 facilities located near us but they consisted solely of one medical provider, either a physician or physician assistant.
We all had great relationships with each other and spent time together when not working. Every place that I needed access to, including my aide station (where my dental equipment was located), sleeping quarters (which were tents with bunks in it), dining facility, and gym was all within a five-minute walk. It was nice having everything so close, but after a while all I wanted to do was leave, if only because I felt so confined in my cement-walled space. Our FOB would occasionally be hit with rocket propelled grenade rounds. Fortunately, these events occurred only about ten times in my six-month tenure. Sometimes, you would hear them explode and other times you would not. Fortunately, the Taliban soldiers who fired them seemed to have little aiming precision. However, there was one instance where one of the rounds hit the retaining wall just outside our helicopter landing area. Despite being 200 yards away, I could see the flash on impact and smell the burning ammunition from the incoming round. Every time one of these rockets hit, it was a sobering reminder that I was not within the comforts of the United States and was in fact in a combat zone in the middle of a war-torn country.
While deployed, my job was to provide emergency, as well as some routine, dental care to the US soldiers, contractors and Afghan soldiers. The care I provided included restorative work, oral surgery, and endodontic therapy. Due to the limited lab capabilities, prosthetic treatment was not available. It was here that I really began to appreciate the training I received in my AEGD. The dental clinic I worked in was a plywood office. We had our portable field dental equipment that we could pack up in about 4 footlocker sized tuff boxes. It consisted of a motor that ran my hand-piece, suction and water spray, a portable dental chair, and then another 2 or 3 boxes full of dental materials and supplies. My daily patient load ranged from 5 to 20 patients. There were a few times that I had to defer certain patients to the following day because more emergent cases needed to be treated. I had to constantly prioritize patients since I was the only dentist at my base and within a 50-60 mile radius. That distance does not seem significant although is tremendously so when considering transportation in a combat environment. For the most part, I performed every kind of treatment I could handle. At some times, I might have considered referring patients although that would have involved a 25-minute trip by helicopter or a 2-hour ride via convoy, and would also take the soldier away from his primary responsibilities for a longer period, so I tried to make as few referrals as possible. My 6 months in Afghanistan really made me appreciate what I have in the United States. I am however, grateful of my time deployed because it really forced me to become a better dentist.
In addition to working at the aide station at the level 2, I was also mobilized to other FOBs in our area of operation, or AO. My brigade's entire area of operation consisted of 4 different FOB's. FOB Pasab was the only one in our AO that had a level 2 aide station with dental capabilities. Given the intensity of combat operations in conjunction with transportation coordination difficulties, many soldiers in need of dental care were not able to travel to my location. As a result, my commander felt it would be easier to move me (with my dental assistant) to the soldiers' locations at the different FOBs in order to provide the emergent care that was so desperately needed. My brigade constructed a fully functional dental clinic inside of shipment container, affectionately known as the "doc in the box." It had running water, cabinetry, and enough room for one dental chair, a dentist and dental assistant. In my tenure, we journeyed to four different FOBs and saw approximately 100 different patients during three different trips.
During our first trip, which was to a base called Azzi Zullah, I experienced what it was like to treat patients involved in a mass casualty. As a dentist in the military, one of my additional duties in a deployed setting is to be a triage officer. During my undergraduate years, I spent time volunteering for an EMS department. While I never saw anything serious at John Carroll, my EMS training proved to be very helpful in Afghanistan. By the time I arrived in the trauma bay, most of the triage had already been completed. This now meant that I would take care of the less serious injuries as the physicians and physician assistants were busy taking care of life-threatening ones. This specific mass casualty included 11 Afghan local nationals that were in a motor vehicle accident. The age range was from 1 to 48 years of age. There were multiple patients with spinal fractures and head injuries, which were managed by the physicians. I was charged with managing various musculoskeletal injuries and bone/soft-tissue contusions. During my exam, however, I determined that two of the women that were in the accident were actually pregnant (both presumed second trimester). One of the main barriers to overcome was examining a female patient as a male provider. It is not permitted for Afghan women to be examined by a male doctor unless the male elder approves. In this case, the most elder male was not available so I was only able to question the patient through an interpreter. We then called in a medical evacuation by helicopter so that these patients could be treated more effectively in a hospital setting. Seeing a medical helicopter land for an acute medical mission was awesome to witness and is something I will remember for the rest of my life. I was never able to find out how these patients were treated and their clinical outcomes, but I knew I did the best I could with what I was given.
Another rewarding aspect of this deployment was participating as a guest lecturer and teacher for a medical conference that my brigade organized for Afghan medical providers. The Afghan medical providers had limited formal education and lacked the specialized training we receive in the United States or other industrialized countries. These people were essentially well-known individuals within their community that were given the opportunity to treat others. They had no previous training and were selected by a male elder to hold their positions. During this conference, our brigade surgeon, or senior medical doctor, gave a class on labor and delivery (of babies), our preventative health officer gave a class on water purification, and I taught a class on basic oral hygiene. As I prepared my lecture, I tried to keep the concepts simple as I was informed that most of the Afghan population did not have anyone trained to provide dental advice or treatment. All lectures were translated in advance on power point slides with questions held until the end and facilitated by an interpreter. Interestingly, despite creating what I thought was a very basic discussion, my dental portion generated the most questions, ranging from when to start brushing children's teeth to identifying dental emergencies and what actions could be taken to treat those emergencies. After the talks were completed, we held a suture class to teach these providers how to suture using raw chicken breasts. I was truly honored to be a part of this medical conference and help teach these individuals.
In addition to teaching at this medical conference, I attended a CE conference myself. As mentioned previously, I was the only dentist within a 25-minute helicopter ride or 2-hour convoy ride. During my stay in Afghanistan, I tried to refer patients as infrequently as possible. There were, however, specific cases that were well above my comfort level. I made contact with a lieutenant colonel who was the head dentist at the NATO level 3 facility in Kandahar. The NATO level 3 had two general dentists like myself and also was fitted with an endodontist and oral surgeon. The endodontist was Lieutenant Colonel Hwang, and because I had established a rapport with him by phone, he notified me when certain CE opportunities were offered at his location. My command was very understanding of my need for continuing education and also aware of the limited availability of such conferences in a deployed setting. Thus, I was able to schedule a flight in order to attend. The main focus of this training was managing dental trauma in a deployed setting. The conference was also offered to the NATO dentists in the area, including those from Romania and the United Kingdom. It was really interesting hearing their experiences in comparison to mine. It's not every day that you get to participate in a conference with US and foreign dentists!
Aside from the actual dentistry and medical side of the deployment, there was a personal impact to be endured in being so far away from my family. I was married in November of 2010 and deployed in October of 2011. This, of course, meant that I did not get to celebrate my first anniversary with my wife. Luckily for me, both my wife's family and my family kept her busy and were always there to offer her support. I was also fortunate in that I had access to a computer 24/7, at least apart from my mobile mission work. I was able to talk to my wife and family via Skype/G-mail chat almost every night. Being away for 6 months really made me appreciate my family in the United States. I think the deployment would have been a lot tougher had it not been for the countless care packages, cards, and messages sent to be by my family and friends.
All in all, I look back on my deployment to Afghanistan as being a very positive experience. I am very glad that I spent time in Afghanistan supporting our infantry troops that patrol the sands of Afghanistan. At the same time, I am relieved that it is behind me. The knowledge I gained from my dental education at Ohio State fully prepared me to succeed in my residency as well as my deployment. I cannot thank my professors enough for the well-rounded and challenging education that I was afforded.