Posts Tagged ‘Army’

Finally

Posted: July 9, 2013 in Uncategorized
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A 93-year-old retired dentist finally received his diploma from The Citadel 64 years after being pulled from college to serve in WWII. Sadly, he passed away Friday, only a week after the diploma was presented to him.

Provided by the Robert Williams family Vincent Williams (from left), 91, holds the diploma presented Saturday to his brother, Robert, 93, by a 2013 Citadel graduate, Marine 2nd Lt. Scott Holmes.

Provided by the Robert Williams family Vincent Williams (from left), 91, holds the diploma presented Saturday to his brother, Robert, 93, by a 2013 Citadel graduate, Marine 2nd Lt. Scott Holmes.

FOB Fenty / Jalalabad Air Field

It’s not easy deploying an infantry brigade to Afghanistan from Hawaii. Just getting there required a multi legged trip that turned into the most convoluted journey I have ever been on. In my mind, the logical route would have been to head west to Japan or Korea. From there one could easily fly over into Russia then down into Afghanistan. Quick and easy. Instead, we flew north from Hawaii to Alaska. From Alaska we flew up over the north pole to Germany.  Then we flew over Europe to Kyrgyzstan where we arrived at Manas Air Transit Base. Needless to say, it took several days just to get to Kyrgyzstan.

Chapel-tent at Manas in Kyrgyzstan

We flew out of Manas on an Air Force C-17 after several relaxing days enjoying Air Force facilities. When we crossed into Afghan airspace the crew chief made everyone put on their body armor and helmet. That was pretty disconcerting. After about 90 minutes in the air we landed at Bagram Air Field. As we all descended down the ramp out of the back of the aircraft we were met by a gorgeous view of snow-capped mountains. It was raining and cold. It was not at all what I had expected of Afghanistan in April.

For those who haven’t visited, BAF is a complete dump and there are entire websites dedicated to humorously showing love for its peculiarities.  Most guys in my unit would up spending almost a week there living like homeless refugees in overcrowded flooded tents. I got lucky and wound up catching a flight out of there after only a few hours, skipping two days worth of “vehicle roll over” training.

About five days after leaving Hawaii I finally arrived in Jalalabad via a “combat landing” in a C-130.  For those who aren’t familiar with a combat landing, it’s when the pilots decide to go from being in the air to being parked on the ground in about thirty seconds. Its fun. Our plane actually landed at JAF/FOB Fenty around 2200. I will never forget my first look at FOB Fenty. I was standing under the tail of a C-130, it was pitch black and the only lights I could see were from across the runway where the main part of the base was.  I was hot, sweaty, and smelly. The smell of jet fuel and burning wood filled my nostrils. Dust and dirt being churned up by the propellers stung my face.  I looked out across the runway and thought: so this is my new home for a year? I couldn’t make out any buildings, just lights from windows. It looked like anywhere and nowhere at the same time.

They herded all of us together and walked us single file across the runway for accountability. My XO, who had arrived several weeks earlier, was there to meet us. She took us to the Company Command Post (CP) and had us sign in and account for our weapons. Then they took me to my room. I was pretty tired when I arrived but I had the hardest time sleeping well that first night.

I spent the year living in a one story cinderblock building. Each building had a couple of hallways with 8 rooms made of plywood. The walls went about 8 feet up but the ceilings were about 10 feet tall.  The beds were mattresses on plywood racks up high with a little desk below.  The guy I replaced basically got thrown out as soon as they heard I was coming and I believe he wound up sleeping on a filthy cot in the hallway the first night I was there.

My first morning in Jalalabad was an exciting one. I woke up disoriented and exhausted from lack of sleep. I took a much-needed shower, grabbed some food and then made my way down to the clinic. The dental clinic at JAF is close to the flight line and was two buildings down from where I lived. In the same building we had a surgical team with two operating rooms, a small physical therapy clinic, pharmacy, patient hold area, and admin area.

As I was walking out of my building I saw a lot of commotion by the clinic. People were running around. Golfcart-like vehicles called “Gators” were zipping back and forth. I picked up my pace a little bit and asked someone what was going on.

Entrance to our clinic and the surgical team

A suicide bomber had walked onto a nearby FOB and killed eight or nine individuals – mostly Afghans if my memory serves me right, and wounded several American servicemen and one civilian contractor.  I remember seeing the MEDEVAC birds coming in for the very first time and watching as the survivors of the attack were brought to our medical facility for treatment. I went down to the flight line and helped carry some of the wounded off of the helicopters. I remember the smell of blood throughout the clinic, followed later by the unforgettable odor of the disinfectant they use to mop the floor after it gets soaked with blood. I remember the look of exhaustion on the faces of the wounded and the slow defeated way they walked. There were several patients that had to be carried in that day, but I can’t remember them distinctly now as they just blend with all the others we carried in that year after them.

Those first few days were a rapid orientation to what was going to become my world for the next twelve months. By the time our year there ended, 20 soldiers from my brigade had been killed in action and dozens more from our supporting units had lost their lives as well.

I have been thinking back a lot recently to my time in Afghanistan. I kept a journal that I wrote in every day and I also wrote several longer descriptors of several significant events throughout the year. At the time, I thought that I would never forget the details of that year. Going back and re-reading what I wrote made me realize I have already forgotten a lot of the details.

So I am hoping to begin telling some of the more interesting stories from my deployment. Some of them are funny, some of them are pretty messed up, all of them are worth sharing.

The plan is to work chronologically starting with my first few days in Jalalabad in April of 2011…

While unpacking my household goods from my most recent Permanent Change of Station (PCS), I came across part of an old presentation I gave in the Officer Basic Course on the History of Army Dentistry.

I noted some interesting statistics about the US Army Dental Corps and the wartime service of its dentists.

During WWII there were 15,292 dental officers on active duty in the US Army. 20 were Killed in Action, 5 more succumbed to wounds received in contact. 10 died in captivity. 81 died of disease and non-battle injuries. One dentist, CPT Benjamin Salomon was posthumously awarded the Medal of Honor.  That brings the total number of Army dentists who died while fighting overseas in WWII to 116.

In the Korean war there were 2,641 dental officers of whom 370 served in conflict. 2 were KIA, 2 were Missing In Action of which one was declared dead.

During the conflict in Vietnam there were 2,817 dental officers. 290 were in Vietnam at any given time. 4 dentists were killed and 4 dental assistants were killed.

Currently the US Army Dental Corps has about 1,000 dental officers. I have no idea how many have served in the Global War on Terror in Iraq or Afghanistan, but none has died. One dental assistant was killed in Iraq when the helicopter he was riding in made an emergency water landing.

Now that I am home from Afghanistan and the dust has settled, I have decided to come out of hiding for the sake of this blog. I still want to work toward sharing my experience as an army dentist with those out there who are interested in reading.

My year in Afghanistan was long. I deployed as the dentist for an Infantry Brigade Combat Team. My brigade was deployed to a remote and violent part of Afghanistan along the Pakistani border. I was the officer in charge of a small expeditionary dental clinic that supported approximately 8,000 US and Coalition forces throughout our Area of Operations, and I was the only dentist in the AO.  The majority of my time was spent seeing dental patients at my clinic. Over the year I saw approximately 1,300 patients whose problems ranged from infected wisdom teeth to trauma from IED blasts.

My dental clinic was at a larger sized FOB and co-located with a physical therapist, a team of physicians, nurses, and PAs, a preventive medicine officer, and a Forward Surgical Team (FST). As expected, the surgeons handled quite a bit of war-related trauma throughout the year. Since there was no oral and maxillofacial surgery support in all of RC-East, I had the opportunity to go into the operating room to help the surgeons repair some maxillofacial trauma. I remember assisting two of the general surgeons on a neck dissection after a guy took several AK-47 rounds to the head and neck. A bullet went in through neck and came out through his left parotid gland (one of the major salivary glands). They wanted my assistance dissecting and exploring the parotid and its duct into the oral cavity. I also had several opportunities to handle facial lacerations, and even remove shrapnel from a soldiers face after he was wounded by a mortar round.

Part of my job as the brigade dentist was to “flex forward” and support our more remote soldiers in more than twenty outposts throughout the mountains and valleys of Nangarhar, Nuristan, Kunar, and Laghman provinces. Throughout the year I traveled on 18 “battlefield circulation” trips throughout this AO. During these missions I would travel forward with my assistant to provide evaluations and preventive care to our most remotely deployed combat soldiers. My assistant and I would fly to some small observation post or outpost up in the mountains for a day or two. While my resources limited me to very basic procedures while on a mission, these trips proved to be a very valued service to the war fighter and much appreciated by their commanders. Life on these small outposts was very different from life back at my larger base. The movie Restrepo did a pretty good job detailing what life is like for these guys out at these small outposts and I would highly suggest it as a primer to what life has been like for the infantry in this war.

Life on my FOB was pretty good and relatively safe. It made me appreciate the little things we had (like flushing toilets).  Although we got mortared somewhat often during certain months, I never really felt like I was living in a dangerous place. However, towards the end of the deployment  a small group of insurgents did successfully mount a VBIED attack against my FOB that resulted in 9 deaths and approximately 20 wounded Afghan Forces. We took enough casualties that morning that I actually had to act as the triage officer for a short while because all of the physicians and surgeons were busy inside.

Looking back on the deployment I am glad that I was there. I’m proud to have served as an army dentist in a time of war and I am immensely honored to have deployed with an infantry brigade. I witnessed many events and ventured to many places that I will never forget. The deployment was more difficult on me and my family that we had anticipated. The year-long separation was very challenging and stressful on my marriage and my relationship with my young son. I feel we are stronger for it, but I wonder if there will be lingering effects of this separation for some time. The professional isolation was overwhelming at times, but I have no doubt it has made me a better dentist.

While my future in military dentistry is dubious, I hope that I can continue to serve as a reference to any dentist who is deploying with a brigade in the future. I hope this blog continues to serve as a source of information to all those who read it.

I recently returned from R&R from Afghanistan. I took leave at roughly the halfway mark instead of at Christmas as originally planned. It was a good decision as I don’t think I could have waited much longer.

“R&R” is military-speak for Rest and Recuperation Leave. The Army gives 15 days of non chargeable leave for all those deployed for greater than 9 months. For those who were here during the 15 month deployment days, they got 18 days of leave. Those who are only here six months don’t get R&R. The Army is the only service that routinely deploys service members for a year. As such, 95% of those going on R&R are Army.

The Army will pay for a round trip ticket to anywhere in the world you want. All you do is say where you want to go and they give you the itinerary – as long as your paperwork is in order. Your leave doesn’t go into effect until the day after you arrive at your final destination so altogether it takes you out of the game for almost a month. It is a pretty generous program.

Getting home took several days, but was not as big of a hassle as people make it out to be. I left Jalalabad around 2300 on a Thursday for a quick flight on a C-130 up to Bagram Air Field (BAF). There we received some middle of the night briefings on where we would be staying (tents), where the dining facility was (by our tents), what to do with all our gear (carry it with you), what we had to do tomorrow (turn in weapons), and when we needed to show back up to try to get a flight to Kuwait (early tomorrow morning).

The R&R tents at BAF were in pretty rough shape. No showers, port-a-potty’s only. That tent is a public health outbreak waiting to happen. On top of that, they put the male R&R tent right next to a set of really nice barracks for the guys living at BAF.  You could see the steam coming out of their indoor bathrooms in the morning.  The Pat Tillman USO however is pretty classy – a nice western style building with free wi-fi, free coffee and snacks. It was a nice clean place to hang out while waiting for a flight. After almost 24 hours in BAF, I boarded a C-17 for the flight out of Afghanistan.

It took about 4 hours to get to Kuwait. We landed at  Ali Al-Salem Air Base, an old Kuwaiti Air Base that looked like it had taken a punishing back in Desert Storm. After that it was an hour bus ride to Army Life Support Area, Kuwait. Kuwait was much nicer than Bagram, Afghanistan. They had showers, actual toilets, and clean tents to stay in. I spent one night there then boarded a contract civilian aircraft for a flight back to the states. We had one stop in Ireland in the middle of the night to refuel and stretch our legs. After that it was on to Atlanta and then off to my final destination. There were no awkward welcome celebrations in Atlanta, no cheering crowds, no firetrucks showering the “Freedom Flights” like people said there would be. Just a simple briefing and that was it.

Seeing my wife and son again for the first time in six months was amazing. My son had grown so much since I left. Now he was using real words, running at full speed, and could actually answer questions and  follow simple instructions. He was a little leery at first, but I could tell he remembered me. My wife was more beautiful than I remembered. The time at home was great and I was surprised how quickly I forgot about Afghanistan and how rapidly I adapted to civilian life. It was a much, much needed break. I needed the downtime to re-asses my priorities in life and do some serious thinking about where I am headed.

Looking back on the first half of this deployment I can see how I have changed as a person. The past six months in Afghanistan have left a mark on me (I’m not sure if it’s a stain or a scar, but either way its permanent).  Although I feel like the same person I definitely look at life, the Army, and dentistry a little differently. I have seen some things and places I never thought I would ever see as a dentist. I am more skeptical and less trusting in others -even those in uniform- than I was before I came here. I have learned some very important lessons in humanity and the human condition. I almost forgot how awesome America is. We are not a people or a nation without flaws, but we are still the best country in the world. After seeing the life of the average Afghani, I have nothing to complain about. I’m an American citizen. As are my wife and son. That means a lot more to me now.

So I’m halfway there. I was happy to be home but a small part of me was excited to return to Afghanistan. I’m ready to finish the job, return home for good, and put this behind me. R&R was awesome but I dreaded having to say goodbye again.

***UPDATE***

I’m back in Afghanistan. Seven Months down. Five to go. Saying goodbye to my wife and son was harder than I expected. A six month PROFIS deployment to a place with a bunch of other dentists seems like a good deal now. A year is just too long to be this professionally isolated. I say that fully understanding that for most soldiers 12 months downrange followed by 15-24 months at home-station has been the norm for years. But for a dentist six months is just about right. In six months you don’t lose too many clinical skills. Trying to do quality dentistry in a sub-standard “Expeditionary” Dental Clinic for a year is really stressful. Now I’m starting to worry about my professional skills when I get back. I haven’t prepped a crown in over a year. I haven’t completed a root canal in 8 months or so. My back is really beginning to bother me because my dental chair here doesn’t recline properly so I have to lean over too much. I’m starting to do things I would have never thought of doing in garrison because when you have seven sick call patients, a broken chair, a failing suction system, an aching back, and no one to help out, you start thinking: “You’re all alone buddy. Find a way.”

This next five months or so is going to be challenging. Am I even going to be a good dentist anymore after this? I hope its like riding a bicycle and that when I’m back in garrison, all my skills will come back naturally. I hope I will remember more than I have forgotten.

More importantly, I hope I don’t forget all the lessons I have learned out here. It is easy to forget the bad when you get back to the good.

Here it is. The much anticipated “downrange review” of the Danner Combat Hiker. The overall consensus is in: These boots suck. I will caveat this by saying that Im no Tora Bora mountain climbing SF dude who is wearing these things in the middle of winter. But unlike many reading this, Ive actually worn these boots for several weeks- both in garrison and in Afghanistan.

So a little background…We were all required to wear them post RFI for several weeks back in garrison. That means I wore them every day in the new multicam duds. I wore them on a short 6 mile ruck march and I wore them on the flights over here and I wore them in Kyrgyzstan. I gave them all the benefits of the doubt. My initial thoughts when putting them on were that they were stiff and heavy, but relatively comfortable and not too hot.  Then on the trip over here people started complaining. It seemed like EVERYONE was complaining about them. Peoples feet were aching. The lacing system became a nightmare – they wouldnt get tight, they came undone, the laces wouldnt stay tucked in. As soon as our flights took off – off came everyones boots. Mine included. Originally I thought these boots might just turn out awesome. I was wrong.

So once we got here to Afghanistan the CSM authorized us to wear our old tan boots. Why? I have no idea. But as soon as that was put out the combat hikers disappeared. A few people are still wearing them but the one individual I talked to said the only reason she is still wearing them is because she didnt bring her tan ones. So the army spent $310 per pair and bought two pair per soldier in my brigade. Thats $310 x 2= $620 per soldier. $620 x 3,500 soldiers = $2,170,000 of boots just for my brigade!!!

So it is officially released and public knowledge – my unit is getting ready to deploy to Afghanistan. For those who haven’t heard, they have changed the camouflage pattern for Operation Enduring Freedom from the digital gravel-esque ACU pattern to the new super-sexy Multicam! Since this pattern is new and only for use in theater, we all had to get issued brand new everything. I’m talking everything – new uniforms, new equipment, new camelbacks, new rucks, boots, etc. Its a lot of stuff.

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The process of getting all this wonderfulness to the soldiers is called RFI – Rapid Fielding Initiative. They basically fill a warehouse with all of the required gear and the soldiers spend the better part of a day going through stations in which we try on and are issued said piece of equipment. It was really exciting – like Christmas morning exciting.

All this new gear appears to be really high quality. Phenomenally expensive however. I asked one of the civilians who seemed to be in charge of the RFI process how much all this cost? His answer: Between $10 and $13,000 per soldier. The new boots – which are just Danner hiking boots – retail for over $300 a pair. They are surprisingly comfortable and breathable. I wore them around for an hour the other day here in Hawaii and was quite impressed.

It blows my mind how much money the Army has just for gear. They spare no expense when it comes to taking care of soldiers. I would say about 1/3 of this stuff I will never use. The boots are awesome, but do I really need two pair? Especially since the old boots are rumored to be authorized for wear in the Multicam uniform as well. How about the $800 dollar Level 7 Parka top? This is for -40 degrees! I don’t even think it gets this cold in the region of Afghanistan we are going to. But better to have and not need than need and not have, I suppose.

Dentists assigned to a brigade will no doubt get the opportunity to do one of two rotations – NTC or JRTC . These rotations are approximately one month long and are designed to simulate being deployed to either Iraq or Afghanistan. My brigade just completed a month-long rotation at NTC and I was privileged enough to go along for the whole ride. I heard all these horror stories from folks about NTC so I was a little concerned going into it. It really wasnt that bad.

Here is my NTC story: We left Hawaii on a chartered Delta 747. It was just like a normal 747 except it was full of soldiers and guns. They took everyone E-7 and above and flew us first class. That was awesome. We flew straight from Hickam AFB to this tiny desolate place called Victorville, CA. It used to be George AFB back in the day but was closed in 1992 as a result of the BRAC.  We landed just before midnight. They wheeled a staircase up the side of this giant aircraft in the desert and we just deplaned right there. It was a little weird hanging out underneath the wings of this giant craft that just ferried us across the ocean. They gave us 15 minutes to smoke and use the latrine then herded us on to busses for the journey to Ft Irwin. We arrived at LSA Warrior AKA the Rotational Unit Bivouac Area (RUBA) around 0200.  We stood around outside for about 45 minutes while they unloaded our bags, gave us briefings on where we were, and told us where we would be staying – giant tents that held about 150 people.

We spent about a week in the RUBA. The living conditions weren’t really that bad. We had a PX, Burger King, laundry facilities, and the infamous “Gut Trucks” that served the cheapest and most delicious coffee on post. There were showers, flushing toilets, and a dining facility that served hot food even though it was outdoors and standing room only.

Our soldiers spent the week getting weapons and vehicles ready for the rotation. The docs ran sick call out of a trailer and I had to take any dental patients to the main clinic on post to treat them since we didnt have a field clinic set up yet. The Ft Irwin DENTAC was very accommodating and they were all extremely helpful and friendly. I saw about three patients that week. The rest of the week was spent sitting on my rear. After the week in the RUBA we convoyed out to “the box” for our two weeks of training.

The Box is a training area roughly the size of Rhode Island. It is designed to look and operate just like Afghanistan or Iraq. There are multiple Forward Operating Bases (FOBs) scattered about as well as multiple little villages. During those two weeks the brigade conducted full spectrum operations. They ran convoys, attacked insurgents, got attacked, etc…Our job at the clinic was to run a level two medical facility to treat all real world and “notional” casualties. When we got to the FOB that first night we had four hours to go from tent with dirt floor to fully operational medical facility. The living conditions were austere – no real toilets, no running water, no PX. It took three days to get the shower tents up and running. We ate a lot of MREs those two weeks. You aren’t allowed to take cell phones into the box (although I did) and there is no internet access. Verizon gets good service but nothing from AT&T.

The soldiers at the other FOBs would get attacked by fake insurgents. They would then be flown to our facility for “treatment.” We would triage them, treat them, and evacuate them. We saw 305 pretend casualties those two weeks. The cadre at NTC employs amputees to play wounded soldiers and they do a pretty damn good job acting the part. It was  a real eye opener for our new medics – most of whom have never actually seen any blood or trauma.

After two weeks of life in the box we headed back to the RUBA – convoy style. We convoyed several hundred vehicles about 6.5 miles back over a period of HOURS. You can’t head west at sunset very fast through the desert. We got in late at  night and moved back into the tents we were originally in. We spent the week doing pretty much nothing. Our soldiers stayed busy cleaning weapons and vehicles. The officers, however, were relegated to wander the main post of Ft Irwin like vagrants. We spent hours loitering at the PX, bowling alley, and library. I really felt homeless. After a week of that we headed back to Hawaii.

So overall NTC wasn’t the worst experience I have ever had. It sucked being away from the family but I really think it was a great learning experience for everyone in the unit.

Here are five items I believe would change the overall oral health of our Army:

1. Pit and Fissure Sealants. On all occlusal surfaces of every new recruit and every new LT in OBC. Regardless of caries risk. Caries is a carbohydrate modified bacterial infectious disease. Let’s eliminate it’s ability to live in our population.

2. Remove all partially erupted/malposed third molars indicated for removal – before soldiers leave basic training. I see more symptomatic third molars on sick call than any other dental issue. That isn’t surprising considering most of our patient population falls in the 18-25 year old range. We have an underutilized 4 month exodontia program. Let’s train dentists to do this and station them to run exodontia clinics at our major training installations.

3. Offer whitening to every soldier in uniform. It’s not expensive, it takes up almost no chair time, and there is some (limited) evidence that it can have an effect on decreasing the bacterial load in the oral cavity. Soldiers are more likely to take care of something they are proud of and think is cool. My biggest disease cases are soldiers who have just given up because they are embarrassed of their smile or who have never known what it is like to smile with confidence. Give them a smile they are proud of and they will want to take care of it.

4. Cleanings twice a year. Currently soldiers can have one dental prophylaxis per year unless they have periodontal disease. Although the “twice a year” cleaning schedule was essentially invented by insurance companies and is not really evidence based, it would increase patient encounters for our soldiers. This would create a potential for earlier diagnosis of caries and periodontal issues and shift dental care from treatment to prevention. We would definitely need more hygienists to handle this item.

5. Bring patient education into the 21st century. Come to any dental clinic and you might be lucky to find a handful of outdated trifold pamphlets on how to take care of your teeth, etc in the waiting room. No one reads them. Take a look around. All our soldiers are on their Blackberrys and iPhones. Let’s use facebook, twitter, and user friendly websites to get information to our young soldiers in a more effective manner. Education leads to prevention. Prevention leads to lower disease and non-battle injuries (DNBI) in the force.

Imagine what the dental readiness of our fighting force would look like in five years if these five items went into effect tomorrow?