"Right now, Americans in uniform are serving at posts across the world, often taking great risks on my orders. We have given them training and equipment. And they have given us an example of idealism and character that makes every American proud."
—President George W. Bush, State of the Union Address, Feb. 2, 2005
James Medwick, class of 2007, managed casualties as an infantry officer in Afghanistan and Iraq before completing his first year at the University of Alabama School of Dentistry. He’s back in class now doing bridges and porcelain veneers having "definitely grown up a lot faster." On the latter side of professional life, Dr. John Caulfield, a 70-year-old oral surgeon, returned to the United States Jan. 30 from an "unbelievably rewarding" 90-day deployment to Afghanistan.
Mr. Medwick and Dr. Caulfield frame a portrait of the health care team deployed to war zones and staging areas or held in ready reserve for continuing deployment—dentists prominent in leadership and service. (Read Dr. Caulfield’s first-person report, page 308.)
The Journal of the American Dental Association this month departs from its standard focus on clinical dentistry to mark the two-year anniversary of the commencement of war. We devote this space to honor the profession’s contributions in this time of war and to hail the men and women who serve, those yet to serve and those returning to service.
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A RESERVIST AT 48
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"We definitely have a story to tell," said Dr. Daphne Ferguson-Young, an assistant professor of restorative dentistry at Meharry Medical College, Nashville, Tenn., who had no military background and "didn’t know if I’d qualify physically and age-wise" when she joined the reserves at 48. Deployed with the 380th dental reserve unit out of Millington, Tenn., in December 2003, Dr. Ferguson-Young did a 90-day rotation in Iraq by way of Kuwait, came home and expects to get the call again. It could happen. (For a look at the 380th’s service mission, see page 302.)
The demand for troops in Iraq remains high as military officials weigh their options for sustaining the war effort. Dentists, physicians, nurses and other members of the health care team rotate in and out of combat areas in support of the troops in theater. "Right now we have 650,000 soldiers on active duty executing missions worldwide, and many of them have met their 24-month cumulative time, so we’ll have to address this," Army Gen. Richard A. Cody testified Feb. 2 at a House Armed Services Committee hearing.
Dr. Andy McDaniel, a dentist wounded in Iraq, said there is increasing pressure on health professionals, particularly medical specialists, to extend their tours. "The Army will not let you leave theater until your relief is there," said Dr. McDaniel, a captain in the reserves who was activated and deployed for a 90-day rotation "in the combat zone."
Dr. McDaniel, an associate in a Warner Robbins, Ga., practice, suffered what he said was "a shrapnel wound in my right arm, very superficial, from mortar activity" at his base. "We were kind of an easy target to hit," he said. He received a Purple Heart, one of several dentists decorated for their service.
Dr. Robert T. Frame, the Department of Veterans Affairs’ (VA) dental chief, was severely wounded in Iraq (his story is available on ADA.org at "www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=446"). He returned to duty last fall. Reporting to the ADA Council on Government Affairs at its Feb. 5 meeting, he said, "I speak in gratitude for you valuing us and our services to this country and as federal dentists." Dr. Frame is in his 12th year in the VA’s Office of Dentistry. He also received the Purple Heart.
The military dental chiefs told the ADA of continuing workforce pressures on the dental team supporting the war effort. "In recent months, the Department of Defense made several important decisions that will influence the personnel staffing of the military dental services," the chiefs said in a jointly signed letter to ADA President Richard Haught. "These decisions will eventually cause a decrease in the number of active duty military dental officers. In order to compensate for the reduction in the number of active duty military dental officers, the military services will require the services of additional civilian dentists."
The letter was signed by Maj. Gen. Joseph G. Webb Jr., chief of the Army Dental Corps, Rear Adm. C.I. Turner, chief of the Navy Dental Corps, and Brig. Gen. Thomas S. Bailey Jr., Air Force assistant surgeon general for dental services.
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‘I HAD TO DO SOMETHING’
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Meanwhile, dentists and students are answering the call to service from dental school, the military, the reserves, the federal dental services and private practice. American dentists serving the international coalition of forces in the Middle East also bring international heritage to war.
Dr. Kaya Strippoli emigrated from Poland at age 17. "I went to [New York University] College of Dentistry and graduated in 2000. I decided to join the reserves after 9/11," she said. "I had to endure looking [at] and breathing the cloud of ashes of 3,000 people as it was settling over ground zero for months. I simply felt like I had to do something." Dr. Strippoli, a captain in a dental unit, communicated with JADA from Balad, Iraq. She had just started building a practice when called to service.
Other dentists activated from private practice sold their practices or kept practices going with the help of colleagues and staff. Some have returned to practice thanking community and country for the opportunity to serve. When Dr. Joe Stanko—"Dr. Soldier," as the Marion (Ohio) Star headlined it—was sent to Iraq, the buddy system was in place. His staff and professional colleagues, practicing and retired, filled in to keep the Prospect, Ohio, practice going.
"I knew that Dr. Stanko could not just close his doors when he was called to active duty," said Dr. Frank Pulskamp, an adjunct clinical faculty member of The Ohio State University College of Dentistry. "I offered to help out due to his private practice being where there wasn’t much other dental support. He had many patients and two office workers who needed him. I don’t really see anything incredible here. Just friends helping friends."
Dr. Frederick D. Hogan of Hamilton, Ohio, was called for duty in Iraq, serving from July through October of 2004. "While gone, I arranged to keep my office open and employees employed by having three dentists come in one day each week," he recalled. "Dr. Joe Copas is one of those dentists and he’s now in Iraq. I am working in his office one day a week in exchange for his coverage in my office. As it is turning out, Dr. Joe will be gone for a longer period than I was. That’s OK and we’ll settle details when he gets back, and I’ll do whatever it takes."
Dr. Michael P. Jung, a reservist, was scheduled at press to redeploy March 6 with the 373rd medical company, a dental unit, "soon after my Kosovo mission," which ended last May. He was "willing to go a little earlier" as part of this Ohio buddy system, "citizen soldiers helping each other out." Dr. Jung is the dental service chief at the Chalmers P. Wylie VA Outpatient Clinic, in Columbus, Ohio.
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NO COMPLAINTS
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Dentists interviewed for this report discuss difficulty and sacrifice without complaint. A parent died, a spouse was injured, a first child was born while they were at war.
"I took a tremendous financial loss, but I wanted to be in the reserves and serve the country and that goes with it," said Dr. Alka Cohen, a pediatric dentist, a colonel in the U.S. Army Reserves and the first female commander of the Tennessee-based 380th medical company dental service. She led the unit on its first combat deployment.
"I think the dental profession really needs some recognition for doing what they do, being involved in this war, and what the dental officers have done for our soldiers, and the ones who stayed behind and helped with my practice," Dr. Cohen said. "To me, serving the country was giving back for giving me the opportunity and education to do what I wanted to do in life."
Dr. Cohen was born in Bombay, India, and became a U.S. citizen while in college. (Dr. Cohen says thanks; see sidebar at left.)
Dentists wrote from Iraq saying they were "honored" to tell their stories. For Dr. Lee Knox Jr., this is his second deployment, having been pulled out of dental school to command a transportation unit during Desert Storm, the 1991 Persian Gulf War. As a dental officer, Major Knox commands "the dental assets" at the main and remote sites supported by his command. He has some 15 dental officers doing dentistry, all rotating every three months unless they ask to extend their tours of duty, and some have.
"Yes, for whatever reason, good pay, patriotism, some docs are extending," said Dr. Jung. "Col. Bruce Tancek (D.D.S.) and I extended three months in Kosovo last year. Of nine M.D.s and D.D.S.s [who] went to Kosovo, six extended for three months. We were a very cohesive group, same ages and life situations, great camaraderie. I was honored to serve with them."
Some dentists who joined the reserves pre-war and pre-9/11 are now in Iraq. "It hadn’t impacted my career until I decided to sell my practice prior to mobilization," said Dr. Martin Hritz, who recently e-mailed JADA from Tikrit. "It is Sunday and the elections here are just about over. What a great feeling going around. I went for a jog today (very cautiously) and just thought how awesome it is that the Iraqi people are for the first time voting in a truly democratic election. Things went much better than expected this week, and today." He signed off, "Peace, Marty."
Navy officers shipped out with hope and expectation, one of whom was the only dentist for 2,600 sailors and marines aboard an amphibious assault ship. "How dangerous is this mission we are about to begin?" Dr. Gina K. Blakeman wondered as San Diego receded from view. "I never imagined I would ever be taking a journey quite like this when I was in dental school in San Antonio, Texas."
Dr. Richard Adcook is a third-generation Navy officer and the first dentist in the family. Of working conditions in southern Iraq, he said, "We worked in a field dental clinic, in a tent. We had compressors and sterilizers and sinks and X-ray machines and other basic equipment needed to provide care, but not anything like you will find in any regular office.
"Field dentistry is difficult under the conditions in the Middle East," he continued. "Imagine doing dentistry in a tent, no air-conditioning, over 100 degrees. It is dusty. Everything in the tent has a fine layer of dust covering it. You are armed and have your gas mask within an arm’s reach.
"It can be stressful for the patients in that environment, so if we can help them get more comfortable, that is one less thing they have to worry about," he said. "It is hard on the equipment, but it can be especially hard on the personnel. I am proud of what we did as a dental detachment, and I had a wonderful staff. The only regret that I have is that I missed the birth of my first child."
Some kept journals and recorded their experiences, reporting their experiences through professional and public media even as their replacements moved into theater. Dr. Richard Wolfert, a lieutenant colonel in the Army National Guard Reserve, was deployed to Iraq with A Company, 118th medical battalion. Tufts Dental Medicine shared with JADA his dispatches from the field. (Excerpts from Dr. Wolfert’s journal are reprinted with permission of the publisher from Tufts Dent Med 2004;8(2):20–5. Copyright © 2004 Tufts University School of Dental Medicine.)
"We offer emergency dental services, restorative care, endodontics (only as far as pulpectomy), oral surgery within reason because of the ‘dirty’ environment in which we work and minimal prosthodontics, including recementing existing crowns, post build-ups, temporary crowns. There are a few oral surgeons in theater, but they are busy with face injuries, so getting impacted 3rds out is near impossible. We do have a hygienist, so he does some hygiene services. I’ve treated a fair number of TMD patients, but I have been referring them to stress management as an adjunct."
Dr. Russell Czerw, who commanded what may be the only dental battalion deployed in combat, speaks of "field expedient dentistry" and sending troops "to very hostile areas" to provide care. It came down to this, he said: "My commander wanted me to go with him to war."
Army Col. Czerw of the 93rd medical battalion (dental service) went to war with 16 dental, medical, veterinary and combat stress units under a reorganized command. "We don’t even believe there was ever a dental battalion deployed in time of war," he said. "I was very proud of the team and how they responded to a new organizational structure."
While in theater, they took all patients, military and civilian, U.S. and international, combat casualties and detainees. Dentists went into the streets wearing camouflage and body armor, taking dental care to the locals—Iraqi villagers who had never seen a dentist—volunteering for humanitarian missions and organizing them. They also handled other assignments.
Dr. Robert Langsten is an Air Force dentist who spent five months in a staging area "doing things I never thought as a dentist I’d be doing," smallpox vaccinations and mass casualty assignments among them. "We were not exactly well-liked where we were. We took our gas masks, chemical gear, helmets and flak jackets with us. For about three months I even ate with all my combat gear on."
Dr. Langsten is stationed at Eglin Air Force Base. He is a co-author of several published papers on the military and dental experience in supporting the war effort.
Dr. James R. Farrar, a Navy dental scholarship graduate, Louisiana State University School of Dentistry, "wore many hats." Dr. Farrar embarked on a 10-month tour of duty in "our global war against terrorism" in Kosovo, Djibouti, Kenya, the United Arab Emirates and combat operations in Iraq.
He talks not just of dentistry but also of running supply convoys in hostile areas and serving as the officer in charge of humanitarian missions, mass casualties and mortuary affairs. He is among the dentists resuming professional life after combat duty.
"I will be leaving the Navy this summer to begin an endodontic residency program back at LSU," he said.
Their stories continue.
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A RESERVIST AT 48
'I HAD TO DO...
