A matter of conscience: Dr. James Rolfe's mission to bring quality dental care and education to Afghanistan.
Article Type: Cover story
Subject: Dental care (Buildings and facilities)
Dental hygiene (Buildings and facilities)
Mouth (Care and treatment)
Mouth (Buildings and facilities)
Dentists (Management)
Dentists (Social aspects)
Author: Trota, Michi
Pub Date: 01/01/2009
Publication: Name: The Dental Assistant Publisher: American Dental Assistants Association Audience: Academic; Trade Format: Magazine/Journal Subject: Health; Science and technology Copyright: COPYRIGHT 2009 American Dental Assistants Association ISSN: 1088-3886
Issue: Date: Jan-Feb, 2009 Source Volume: 78 Source Issue: 1
Topic: Event Code: 440 Facilities & equipment; 200 Management dynamics; 290 Public affairs Computer Subject: Company business management
Product: Product Code: 8021000 Dentists NAICS Code: 62121 Offices of Dentists
Persons: Named Person: Rolfe, James; Rolfe, James
Geographic: Geographic Scope: Afghanistan Geographic Code: 9AFGH Afghanistan
Accession Number: 207540012

Life in war-torn Afghanistan is worlds away from the sun--kissed palm trees and sparkling beaches of southern California, but for the last eight years, Santa Barbara dentist Dr. James Rolfe, DDS, has lived with one foot in each world, intent on improving the lives of the Afghan people through his organization, the Afghanistan Dental Relief Project (ADRP), a 501(c)3 nonprofit charity dedicated to providing dental care to a region of the world that desperately needs it.

Decades of struggle against the Soviet Union, a Civil War, and the current U.S. war have left Afghanistan devoid of any coherent infrastructure or civil services. According to UNICEF, infant, child and maternal mortality rates in Afghanistan are among the world's highest. The average lifespan is a mere 42 years and only 30 percent of men and 10 percent of women can read and write. Security is tenuous at best--humanitarian organizations often have to travel with armed guards in some parts of the country. Diseases such as typhoid fever, malaria, cholera, parasitic fly bite, or hepatitis run rampant.

Dental care conditions are severely compromised. There are currently only 134 dentists to serve a population of 27 million, which amounts to only a single dentist per 200,000 patients. Sterilization practices are lax and treatment methods are often crude--untreated dental conditions resulting in death are not unheard of.

Dr. Rolfe's journey began in 2002 when, moved by the plight of orphaned children in Afghanistan with no access to dental care, he volunteered at a remote mountain province orphanage. There he spent 17 hours a day, seven days a week providing much-needed dental treatment to the children for three straight weeks. The children whom he had treated often acted as his "assistants."

"When I saw how grateful they were, I cried," he said. "They couldn't wait to get treatment." Although he wouldn't return to Afghanistan for an other two years, in a sense, Dr. Rolfe never left. In spite of the risk and adversity, or perhaps because of it, Dr. Rolfe chose to forgo a life of comfort as a private practice dentist in order to found and run ADRP.


Initially, he gathered donations of used and repaired dental equipment to ship to facilities throughout Afghanistan, but he quickly became convinced that providing auxiliary education was the best chance ADRP had to help improve the lives of Afghans. Dentists could expand their scope of practice, the disadvantaged would have the opportunity to improve their lives and enjoy better health, and the technical infrastructure of Afghanistan could be raised in a small way.

Five years later, after running what Dr. Rolfe describes as "an obstacle course" of government corruption, inflated land prices, tribal warlords, quickly depleting cash and logistical hurdles, ADRP has created a permanent dental care and training facility in Kabul, complete with a modern clinic, and is finalizing work on a complete six-station full--service commercial dental laboratory, the first of its kind in all of Afghanistan. Networks of Afghan volunteers organize housing and provide support services for volunteer dental health workers who travel to Afghanistan, often at their own personal expense.

The school and clinic are contained in a large compound located in Karte-Char, a suburb southwest of the city center. Dr. Rolfe and ADRP volunteers built the clinic back in California, inside a 40-foot shipping container that was then shipped to Afghanistan, along with 120,000 pounds of dental equipment and supplies. The clinic consists of three complete operatories with X-rays and cavitrons, a modern sterilizing area and a complete laboratory, all of which are supplied with plenty of clean water and electricity.

The school offers four dental training programs to the local population, offering Afghans the chance to hone their skills as dental assistants, dental clerical workers, dental hygienists, or dental laboratory technicians. Students receive training both in the classroom and as assistants to volunteers who are treating patients at the clinic. The program is approved by the Ministry of Public Health of Afghanistan and is sponsored by the Kabul Rotary Organization.

None of this has come without substantial cost. Dr. Rolfe has been criticized for choosing to care for to the poor in a country other than his own. At an age when most Americans are contemplating retirement, the 69-year-old dentist has sunk his entire life's savings into ADRP and now lives on $8,000 a year while putting $100,000 or more per year into the project. Yet Dr. Rolfe firmly maintians that his work with the ADRP is a matter of conscience rather than one of financial comfort, and that what ADRP hopes to accomplish isn't something to which one can easily attach a price tag.

The Dental Assistant presents its in-depth interview with Dr. James Rolfe, DDS.

You have traded living the comfortable life of a successful dentist in southern California in order to run ADRP. What was it about the situation in Afghanistan that caught your attention?

I realized that Afghanistan was not going to receive humanitarian aid from our nation, and I determined myself to actually go there and try to help. I packed 500 pounds of equipment and supplies and flew it there, then went to an orphanage in the remote mountain province of Wardak, working at 11,000 feet elevation for three weeks. I found the orphans there to be extremely intelligent quick learners who had no future without education.

At the same time, I saw people living in a province with no access to dental care whatsoever, a situation in which people were actually dying from multiple abscessed teeth that could not be removed because there was no one to do it. I learned that 90 percent of the people of Afghanistan have virtually no access to dental care.

I really had no choice. I could not allow these people to suffer as a result of my own government's apathy, when our nation, the richest and most powerful nation in the world, should have been helping them. So, I empowered myself to go there and help them, because I could not morally do otherwise, once I knew their suffering. That is how it all started. And, I am happy to point out, it is succeeding and people are benefitting from it.

Please summarize the purpose of the ADRP and its mission.

We want to do several things. We want to train the disadvantaged in dental health technology in order to produce dental assistants that can help dentists with infection control (not currently happening in Afghanistan) as well as dental hygienists (also not currently happening) and dental laboratory technicians to make quality restorations for the dentists in Afghanistan (not happening there either). We want to help empower the brave but poor survivors of 30 years of war to have a future filled with the realization of their dreams. We want to improve the general health of the Afghan people and provide a venue for people in the dental profession from around the world to volunteer and serve in our clinics and schools so that help can go directly to the people and not be diluted by people in power who become obstacles to aid projects and ask for money. We'd like to establish clinics in rural Afghanistan where dental care is not accessible and to staff the clinics with graduates from our programs; provide quality state--of--the--art dental laboratory products to Afghan dentists for a fee, provide quality dental care to the Afghan poor, and provide non-Afghans with dental care for a fee.

How has ADRP altered your lifestyle and worldview?

Many people complain about their lives and the situation in the world but do nothing about it. This project taught me that the power to enact change is within each individual, and that power is waiting to be called forth to change the world. Everyone can make that choice and bring their vision of the future into reality. This is what it has done for me.


To accomplish this, I live in poverty on half of the poverty income, and I am happier and more fulfilled than I have ever been. I know that I am actually making a difference.

Since starting ADRP, how many times have you been back to Afghanistan?

I have been in Afghanistan six times. I have spent three and a half months of this year being in Afghanistan. I was there for two months last winter, working outside preparing the site and the clinic. It was very cold and I actually lost 15 pounds and suffered frostbite. I could tell you some stories, like when the crane was moving the clinic and fell into the septic tank.

Aside from yourself, how many people are currently involved with ADRP?

Probably five thousand people have been involved with the formation and development of the project, including donors of money, equipment, supplies, labor, clerical skills, and advice (there is always plenty of advice). People tell me, "You know what you should do is ..." to which I reply that THEY should do that themselves.

Volunteers are at the clinic constantly, sometimes two or three at a time. We ask them to go for at least two weeks. They pay their own expenses (airfare is now $2,300 roundtrip and takes 48 hours), and they pay $15 per day board and room.

You spent 18 months and 4,000 hours building a self--contained clinic with modern equipment within a shipping container that would be transported upon completion to Afghanistan to serve as a permanent clinic. Could you describe what went into this undertaking?

I got the idea from one of my patients, who is an art professor at the local University of California; he was building domestic housing units from shipping containers. Because no one had built a dental clinic into a shipping container, it took a lot of thought.

Basically, the operatories had to be miniaturized, while allowing all of the functions of a modern office.

In the end, we made three operatories with a sterilizing room and a complete lab, with its own diesel generator, high volume suction and air compressor.

The clinic is self-contained and can operate without outside power or water, but is presently connected to existing electricity and well water, both of which I installed myself. During the construction, I worked every available moment, often sleeping only three or four hours a night. I had to go to the hospital twice for injuries caused by not enough rest, once for four broken ribs and a 16--stitch cut on my face, another time for torn rotator cuffs in both shoulders and cuts requiring stitching.

There were many interesting moments such as installing the cabinetry during the wettest year in Santa Barbara history, and ordering our building supplies from the Home Depot, having half of the order delivered (a huge order) with no record of what was not delivered, then taking over a month to get the rest of the order.

We did not know what environment the clinic would occupy, so we had to make it be able to function in any environment.

How long did it take you to find the right place for the clinic?

Initially, I was approached by a warlord to put the clinic on his land, but I found that he was very ambitious for himself, so much so that I did not feel that the clinic and school would work there.

I took equipment to a women's health clinic and worked for two weeks, but I was not able to do very much, and when I left there, everything stopped. I knew that I had to have a clinic there, but the low level of technology there made building it there impossible, so I built it in California.

Land guaranteed by a cabinet minister in a legal contract did not exist after shipping the clinic there, and the shipment had to be returned to America. Land promised by a helpful Afghan family ended up after four months of negotiation to be more expensive than land in Santa Barbara ($330,000 for a plot 65'x65', unimproved).

The land where the clinic resides now was provided by an Afghan-American who had restored his family house in Karte--Char to move his family back, but his wife developed cancer and died; her last wish was to have our clinic occupy the site. We had to develop the project and finish the house, that cost about $50,000.

Now, we have 24-hour electricity from the city and well water, in addition to the new two--story house which supports our guests.

When did the clinic finally arrive and how long has it been in operation? What are the basic day-to-day activities at the clinic?

The clinic has been in operation since mid-June 2008. It treats from 10 to 20 patients a day, providing basic Medicaid level treatment. Patients are seen by our staff Afghan dentist as well as volunteers. The staff dentist works eight hours a day six days a week. He is making $181 a month, three times what he was getting in the city dental clinic where he worked before. There are three chairs, and he has his own assistant.

One of ADRP's purposes is to teach dental assisting to those widowed or orphaned by the war. How are ADRP's training programs structured?

We are emphasizing infection control, as we feel that this is the most important, although all of the skills of dental assisting are covered. Graduates of the program are required to intern in the clinic or a rural clinic (yet to be established) for one month. The training period is three months, so a certificate is given after the fourth month of internship. Graduates can work in dental assisting or apply for either the dental lab training or become hygienists, both of these programs taking four months also. We have 50 sets of hygiene instruments to give out to graduates, and enough denture supplies to allow our dental lab tech program to make full dentures for 35,000 people. The programs are authorized by the Ministry of Public Health of Afghanistan.

What are some of the hurdles you've had to overcome since opening the clinic?

Because the clinic has just been open for three months, I can say that working hard to make enough money to go back again is the greatest challenge. It will cost me $35,000 to keep my office open for the period of one month while I attend two dental conventions and go to Afghanistan for two weeks. Then, I will be broke and have to start all over again.


Considering the Afghanistan government's reputation for corruption, what has your experience working with the government been like?

I explained how the cabinet minister tried to get the clinic shipped there in his name to land that he had legally obligated himself to provide, but that the land was not available. This led me on a merry search for other land during my six-week stay there, which was ultimately unsuccessful.

I eventually had to forge documents in the minister's name and have the shipment sent back to the USA.

Considering the worth of all the equipment and supplies at the clinic, how are security issues handled? Do you have concerns about the safety of yourself, your staff and you patients?

Afghanistan has been at war for 30 years. The infrastructure was completely destroyed, and all the people who could leave did so, taking all the money with them.

This took the heart out of Afghanistan, and left the people with nothing. Following hardship after hardship, individuals there eventually changed into victims, altering their perception of reality and making meaningful interactions difficult. Everyone became necessarily selfish and even deceptive in order to survive.

People working in Afghanistan must acknowledge a certain amount of mental illness that is chronic in the Afghan population. At least 85 percent of contacts from outside individuals were selfishly motivated.

Some acuity is necessary in order to perceive these intentions before they actually become critical, yet each person needs to be given a chance.

This is difficult in many respects. Still, the Afghan people are warm and loving and wonderful to be with. Our project site is behind a high wall and 24-hour guards patrol the property.

What is the current situation with ADRP's supplies and equipment? Is there anything in particular that the clinic is in need of?

We are always in need of volunteers and financial support. Some people spontaneously feel like helping and even raising funds. Others gather supplies, while others travel there to help at their own expense.

We currently need an instructor for our dental assisting training program to be teaching for a minimum of four months in a volunteer or salaried capacity, with board and room provided (see ADRP's classified ad on page 48 for details).

What is ADRP's current status? Are there any projects in particular that you are focusing on?

We are trying to establish a rural clinic in Hazarajat, in the City of Bamiyan where the giant Buddha was destroyed. The Hazara people are discriminated against by some Afghans because they are descendants of the Mongol armies of Genghis Khan. We hope to train some Hazara people to work in a clinic that we intend to set up in Bamiyan.

What kind of response have you had in raising awareness of ADRP here in the U.S. ? How much support have you been able to establish?

The American people need to wake up and realize that problems exist in the world that our nation has caused, neglected, and ignored. We need to know that we are individuals with all the power to make things change, and that the government is not going to do it for us. Too few people are aware of this.

However, the people we have gotten are dedicated and a significant factor in advancing the project ... but too few. This can be changed by making people more aware of the needs there.

What are your observations regarding the current state of Afghanistan?

Only 27 percent of the support needed by the Afghan government to operate comes from within Afghanistan. Yet $300,000,000,000 has been spent by our nation on military efforts since 2002. Still, 4,000,000 people are trying to live in Kabul without running water or electricity.

Wealthy Afghans returning to Afghanistan have bought up the cheap land, using money made living in other nations during the wars, driving up the price of land beyond belief.

There are three million orphans, 70 percent malnutrition haunts people who cannot find work, and only 30 percent of people can read and write. Cholera, typhoid fever, and hepatitis plague people constantly.

Resolving these problems from within Afghanistan without outside support is impossible. What change could we imagine if we were to provide Kabul with water and electricity? It was once a modern city with electric buses and girls in miniskirts.

You are obviously drawn to Afghanistan's land and its people. What have you loved best about your experience there?

I am drawn to Afghanistan because I have been emotionally changed by the need there. While the culture is exotic, I am not fascinated by it, but instead I am doing something that needs to be done.

I was abandoned by my parents as a child, and I have been deeply affected by that, to the point that I see the Afghan people as having been abandoned in like manner, and I must help any way I can.

What do you hope that ADRP will ultimately be able to accomplish? Do you think your goals are possible considering the odds ADRP faces?

We form a thought about our desires in our minds, and the mere thinking about that thought makes it materialize into reality in the future. Our thoughts become the stepping stones that we will walk on tomorrow.

We hope to help Afghanistan recover from 30 years of war and poverty. In a small way, we are doing that. Some people have become changed and inspired by our vision.

We know that we cannot do everything, but we can certainly do what we can do. In an arena with so much need, anything is better than nothing. Just empowering people to know that they can do something is a magnificent goal.

What should anyone who is interested in the project do to help?

Raise awareness of our need to be more conscious, to make meaningful decisions that create goodness, and apply ourselves to raise awareness of the needs of Afghanistan and our responsibility as the "big brother" of the world to set an example.

Any final thoughts you would like to share with our readers?

Follow your hearts to wherever they might lead.

For more information about the Afghanistan Dental Relief Project, visit http://www.adrpinc.org. Dr. Rolfe can be reached via e-mail at adrp@ verizon.net or at 805-963-2329.

Typical Dental Characteristics of Patients in Afghanistan (taken from www.adrpinc.org)

"Dental Characteristics of Afghanistan residents are mostly affected by the almost complete lack of dental care during their entire lives. While Afghans generally have more spacious mouths, their teeth generally are not crowded, and impacted third molars are less commonly seen. Teeth are generally wellaligned with some anterior spacing. The most commonly seen problem was heavy calculus deposits that had hardened with age and could only be removed with an ultrasonic scaler. Frequently encountered are submerged roots, remnants of teeth destroyed by caries years ago. As age of the patient increases, so does the extent of pathologies, since it is cumulative without the benefit of care."

(Editor's Note: Shortly before attending the Annual ADA Conference in San Antonio, Dr. Rolfe made his sixth trip to Afghanistan to finalize the commercial dental laboratory, prepare the classroom for the students, film a documentary movie requested by CNN, and prepare the outbuildings for the coming winter.)

Michi Trota is the Managing Editor for The Dental Assistant.
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