‘Filling the gap’ in Afghanistan

Most people would be very concerned and want to contact a dentist to arrange for prompt treatment. You might be given antibiotics and pain medication, and your great concern would be lessened, knowing that you had access to proper care.

In another country, you might not be as concerned. You would know that no treatment was possible, because there were no dentists. So you would resign yourself to endure the pain, as you had done in the past, and hope for the best. Or you might access a barber, who would take the tooth out without anesthetic. No thought of antibiotics or pain medication would cross your mind, as these things are not available, either. All of your life you had lived in poverty, along with your neighbors and fellow villagers, with hardly enough to eat. You had never owned a toothbrush in all your life.

This country is Afghanistan.

Afghan health

Ninety per cent of Afghans, 29 million people, have never seen a dentist. With only 134 dentists, each dentist would have to serve a quarter million people. However, dentists congregate in big cities, and rural areas have no access to care. Ninety per cent of the Afghan population live in rural areas that are completely unserved by dentistry.

Dental conditions left untreated lead to eventual pulpal necrosis and chronic infection. This is a progressive condition, eventually leading to multiple abscessed teeth and, in some cases, a systemic septicemia infection that is lethal. Many people in Afghanistan die from their teeth problems. But now, there is hope for the dental needs of the Afghan people.

The tragedy of Afghanistan

Over 30 years of war have made Afghanistan into a desperate place. The nation is filled with poverty and hardship. Over 3 million orphans search for some kind of meaningful future. Widows and single mothers are everywhere, begging in the streets, trying to survive. So many adults died that the average age there is only 14. Due to the great challenges of just staying alive there, 20 per cent of young children die before the age of 5. The birth death rate is the highest of any nation in the world. Twenty children a month are killed or maimed by mine explosions. Many children are affected by post-traumatic stress disorder, and 80 per cent of older children feel that life is not worth living. But there is hope. And that hope lies in education.

Inspiration for change

The Afghanistan Dental Relief Project was founded in 2003, following a visit to the Central Highlands province of Wardak. Taking 500 pounds of portable equipment to an orphanage at 11,000 feet elevation, Dr James Rolfe of Santa Barbara, CA, USA, spent three weeks treating the orphan boys there. He would first treat one of them, and then he would have the patient become his assistant. He discovered that around 85 per cent of the boys were fast learners and adapted well to the challenges of dental assisting. Seeing that the boys had no future without education, he imagined training them to be professionals.

Toward the end of his visit there, Dr Rolfe Began to see people living in the surrounding area. What he saw shocked him; many people had multiple abscessed teeth, and some were on the verge of death. How could this be, he thought. Then he learned that there was no dental care available in the entirety of Wardak Province, about the size of Connecticut. No dental care whatsoever for over 200,000 people.

Why not train the orphans to be dental technicians?

Dr Rolfe returned to Santa Barbara and, with the help of local craftsmen, converted a 40-foot shipping container into a modern dental office with three chairs, a sterilizing room, and a complete dental laboratory, all self-contained with its own water supply and electricity. He then shipped the clinic and an additional 60 tons of dental supplies and equipment at his own expense to a site in Kabul, donated by a generous Afghan-American family. Now, the clinic is up and running with three dentist seeing patients each day, treating about 20,000 patients a year. But where do the orphans come in?

The Kabul School of Dental Technology

In 2007, the Kabul School of Dental Technology was formed. Students were selected from the local population of orphans, widows, handicapped, single mothers, and socially disadvantaged populations. The eager students study hard for four months of intensive course work and clinical experience, and become Certified Dental Assistants. Graduates can immediately get a job with local dentists, or choose to continue their education to get an additional certificate as a dental hygienist or dental laboratory technician. The program has allowed the clinic to see many more patients and to provide a higher standard of care for patients coming there. And it’s all provided free of charge.

Many of the students endure hardships in order to attend the school. They are extremely dedicated, always coming early, and working hard to master the technical material. In August 2009, the full-service commercial dental laboratory was opened, and now dentists throughout Afghanistan have a reliable resource for their crowns and dentures, rather than sending their work to Pakistan for a questionable product. Recently, a chrome partial casting machine was added to the dental laboratory, which will soon allow production of chrome frameworks.

The first class of dental hygienists ever produced in Afghanistan is now working in the dental hygiene field, providing local dentists with a service, which was not obtainable previously; you just could not get your teeth cleaned there, previous to their graduation. Now, people line up for this service.

Making social change

The educational program has opened up new opportunities for these students. Orphans with no future now are able to determine their own lives as productive individuals. Women from the ADRP program have become authority figures in a male-dominated society. Many people have been able to access dental health care in a sophisticated system, which has improved their health and longevity. Better access to dental care should help people live longer in Afghan and raise the average mortality from only 42 years. ADRP recently opened a clinic in the women’s prison there.

All graduates are taught the atraumatic restorative technique promoted by the World Health Organization, in which lay people are trained to excavate gross caries without anesthesia and place glass ionomer restorations. Each student is given a kit of instruments and restorative material when graduating and encouraged to participate in field trips to rural clinics where no care is available. After training, they are encouraged to practice the technique in underserved areas by themselves.

Promoting volunteerism

Many dentists have journeyed to the clinic from all over the world, paying their own travel expenses, to volunteer at the facility and teach, work in the laboratory with the students, or treat patients. In addition, other dental professionals such as dental assistants, dental hygienists, and dental lab technicians also volunteer. Guests stay in a modern, secure guest house, which provides comfortable sleeping accommodations, meals, laundry, hot showers, and internet to communicate with the folks back home, all for a small cost.

Information about travel and volunteering can be accessed on the website below.

What you can do

With a little change, you can make a big change. One hundred per cent of all donations go directly to the support of our project. We have no salaried employees, and we all pay our own expenses. Become a member, by joining ADRP with a monthly contribution, and help support the work in the clinic and in the school. Help us build a permanent facility on the present clinic site, and move the shippable clinic to another town, so that we can begin another training site in that town to benefit the local residents. Give a child complete dental care for US$15. We need donated supplies instruments and equipment. Dentists are encouraged to contribute their gold scrap to the project, where it can be recycled to provide funding for supplies and operating expenses. We all became dental professionals because we love doing dentistry; let’s experience the joy of using that knowledge and skill without a fee, for the good of mankind.

Donations are tax-deductible, as ADRP is a 501(c)3 non-profit organization. Donations can be sent to ADRP, 31 E. Canon Perdido St.; Santa Barbara, CA 93101. For more information, please visit the website www.adrpinc.org or e-mail the headquarters at adrp@verizon.net. Dr Rolfe can also be contacted at +1 805 963 2329.