Beyond Boundaries by Sam Mittelsteadt, editor & creative director

Beyond Boundaries 

This Townie has practiced in an Antarctic research station 7 times over the past 10 years—which is just one stop on his lengthy international dentistry itinerary

by Sam Mittelsteadt, editor and creative director

Several times over the past few decades, my friend Shannon has spent part of her year working at what’s very nearly the end of the Earth: McMurdo Station, a research station in the Antarctic. The station—operated through the U.S. Antarctic Program, a branch of the National Science Foundation—was established on Ross Island, 850 miles from the South Pole and the solid ground farthest south that is accessible by ship.

McMurdo, one of three year-round U.S. Antarctic science facilities, is the logistics hub of the U.S. Antarctic Program; its 100-plus buildings include dormitories, power and water distillation plants, stores, clubs, warehouses and research labs. During winter months, about 250 residents are working there in research or support roles; in summer, the population swells to 1,000 or more.

And if any of those residents have had a root canal (or even a cleaning!) while they’re down there, chances are Dr. Bob Koff performed or supervised it. The Colorado-based dentist has traveled to the Antarctic seven times over the past 10 years—and while that destination would be impressive enough on its own, it turns out that McMurdo is just one of several dozen places around the globe Koff has visited to perform dentistry, starting with a trip to China in 1985.

Fresh off retiring from his Colorado Springs practice, Koff shares details—and lots of photos—about where he’s been over the past nearly 40 years.

You’ve been combining global travel and charitable dentistry for almost four decades, starting with a 1985 trip to China. How did you learn about that first opportunity, and what inspired you to take the plunge?

My wife at the time, Pat Koff, was (and is) a well-known respiratory therapist who had published the book Neonatal and Pediatric Respiratory Care. The humanitarian aid organization Project Hope contacted her to help set up an intensive care unit in Hangzhou, China, for a month at a time with a nurse and physician. Pat went in 1984 and when they asked her to return in 1985, I wanted to go as well. Project Hope didn’t have a dental program, so I made one up, gathered dental materials I liked to use, got them donated by the dental manufacturers, and off we went. The trip convinced us that it was a wonderful way to travel—to do some work and get inside the system and culture, instead of just being an outside tourist.

That trip was your introduction to asking companies to provide materials and equipment to be used during your overseas treatments. What did you learn from those early interactions? How did you arrange the shipment of larger elements like endo equipment?

I learned fairly quickly that dental companies were happy to provide materials I was promoting because they were the ones I preferred to use in my office and I could speak about them from personal experience. I wasn’t asking for a fee for my services, and even when I asked them to fund the trips in 1986 and 1987, it was just to cover my expenses with no profit built in. After the trips, I would send them a report with photos, which turned out to be good PR for them. I tried not to take advantage of their generosity and would ask for just a few items—but if they offered to give me more, which happened more as the years went by, I learned to say, “Thanks, I’d love to take your whole new endo system.”

I’ve always traveled pretty light and can go for months with just carry-on bags, so in the days when airlines allowed two free bags of 50 pounds each, I had plenty of room for dental materials. On some trips, like Nepal and Madagascar, where we bought portable dental chairs, compressors and vacuums, we would ask for a baggage exemption because of the volunteer nature of the trip. Usually the airlines were understanding and waived excess fees.

In 1991, you spent an entire year abroad doing charitable dentistry work across the globe from Belize and Honduras to Romania and Israel. How did you find these opportunities, and how did you arrange and organize the itinerary?

It was often a series of opportunities that came up, and you develop a sense of what sounds good. Just be open and willing to get up and go!

  • For example, we had been to Belize, so that was a starting point.

  • Then I came across a dentist in Honduras who was doing work and looking for volunteers, so we signed up to join him.

  • Guatemala was a place we had heard was a good place to take Spanish lessons, so we figured to stop there for a month and while we were there, I walked to the local hospital and said I was a U.S. dentist and would be happy to do some volunteer work, so I ended up working with the dentist a few days a week.

  • Costa Rica was next, and Whaledent asked me to help with a dental booth at a conference, so we worked that into the itinerary.

  • We spent the summer in Romania after I heard a radio promo about Citizens Democracy Corps, called the 800 number and said we would be in Europe for the summer with a Eurail Pass, so where did they need help?

  • Israel was a formal program out of an NGO in New York I signed up with for the month of November 1991. So it was a series of unrelated events that fit into a year of travel.
I was interested enough in traveling that in 1985 I approached the owner of a travel agency in Colorado Springs, who allowed me to become an “outside sales agent” for his business. It meant I could learn the computer skills with the help of his full-time staff and get a tutorial on the system and some travel benefits as a part-time employee. It was a great introduction to my first computer and let me get inside the travel industry.

Another good example was a CDC project in Tomsk, Siberia, for a month in 1995. At the end, in late September, my buddy and I traveled to Moscow and St. Petersburg as tourists, but stopped in to say hello at the American clinics we had heard about in both cities. The St. Petersburg clinic manager told us their dentist was leaving in December and they needed a new dentist to fill that role. I brought the information home to my family, and a few months later we moved to Russia!

I figured out my U.S. dental education was well respected around the world, and the less developed a country is, the less it worries about formal licensing and is happy to have volunteers to help. More-developed countries get more formal with requirements—and I found the less-developed countries more appealing just from an adventure standpoint, too, so it was easier to work in those places.

From a logistics standpoint, I’ve learned how to travel with the basics—with a credit card and the right attitude, you can weather a lot of unanticipated events.

What was most memorable about practicing in St. Petersburg, both personally and professionally?

Most of the interesting stories seem to be about dealing with Russian mafia patients. They usually paid in wads of U.S. $100 bills, and sometimes had burly bodyguards stand behind me while I was working.

You figure out quickly that the system doesn’t work very well if you follow the rules, so most people learn a way to bend or go around the rules to make it work. A good example is that when I was there, gold was not allowed in a private clinic because it was controlled by the state government. When a patient from the U.S. consulate wanted a gold crown on my recommendation on a posterior tooth, he asked why I couldn’t send the case to my lab in Colorado to get the gold crown made. I told him Russian customs would most likely take the gold crown as it entered the country, so that wouldn’t work. He said they wouldn’t do that if it was sent through the diplomatic pouch and voila—that’s how we did it!

On a personal level, most Russians we met and became friends with were pleasant folks who all wanted the same things in life—good schools for their kids, opportunities to advance, and a life of good friends and family. Wars and government interference in our lives are things the general population isn’t in favor of, and often are a result of individuals craving wealth and power.

That sounds like a lot of windows where you were away from your single-doctor practice in Colorado Springs. What arrangements would you have in place for when you were overseas to help make sure your patients didn’t feel abandoned?

The early trips were usually for a month at a time, and I figured out that the key was to keep my overhead low and manageable. I did my own hygiene and had only one full-time employee, who was OK with not getting paid when I was away and the practice was closed. I’ve always shared office space with another dentist who would cover emergencies (which were no more than a handful when I was away for a few weeks or a month).

For the times I took a full year off—1991, 1996, 2002 and 2012—I referred my practice to a colleague and stopped paying rent, salaries and most of the usual overhead. I sent a letter to my patients before, during and a few weeks before returning to inform them I was doing well and planning to return to my practice on a certain date.

I retained around 95% of my patients and always returned to a busy schedule, which convinced me that if you develop a trusted relationship with patients, they will often wait for treatment and continue to return to your practice.

The other important lesson is if you have good emergency coverage available, whether you’re gone for a day or a year, people are comfortable in that knowledge and will wait for routine care.

The arrangement I’ve had with colleagues in town is if they see my patients for routine or emergency care, they need to treat them like their own patients. So it’s expected to charge them for a new procedure, like a filling or root canal, but not to recement a temp crown or a postoperative issue like a dry socket. It’s also understood if a patient of mine wants to change dentists after they see a colleague, that’s fine as long as they weren’t solicited to change, and it’s an understanding that has served me well for 38 years in Colorado Springs.

Today it’s easy to keep in touch with email, and instead of photo albums of my trips, I have pictures and stories on my website. It seems my travels were good internal marketing, and patients seem to like to hear the stories when I see them in the office.

Eventually, you’d traveled to every continent but Antarctica … then you discovered there was an opportunity there, too. But you had to wait several years before you could actually head to the South Pole.

I wanted to go to Antarctica for a number of reasons: the last continent, and stories of spectacular scenery and wildlife. (I was a zoology major undergrad.) I found a typical eco-tour leaving from Argentina in 1998 and went with a buddy.

As part of learning about the history of the continent, I learned the U.S. had three full-time stations there and the largest one, McMurdo, employed a dentist from August to February. I contacted the office that interviewed and hired the workers for the station, which happened to be in Denver, hoping to go down for a few weeks, but was told it was a six-month contract.

When I brought that news home, Pat persuaded me it was too long to be away because our daughter was only 5 years old, so I agreed to wait until our daughter went to college. Fourteen years later, I applied again, and have gone seven times in the past 10 years.

What type of practice environment is there in McMurdo? Who’s the patient pool, and what treatments is the dentist expected to provide?

The dental setting at McMurdo is a single-chair operatory with a separate compressor and vacuum.

Before my first season in 2012, I contacted the dentist from the previous season and asked what was on her “wish list” that I could bring to the clinic. Then I contacted several dental companies that had been generous with me on previous dental projects, and they came through with thousands of dollars of donated materials for fillings, endo and oral surgery.

My goal was to be able to treat all dental conditions and not have to send anyone to New Zealand for treatment—a complicated and expensive process for both the patient and the program.

That year, I did more than a dozen root canals, more than 20 extractions and dozens of fillings. I also brought my own digital X-ray system on a laptop to use in place of film and chemicals, and a year later the program bought the same system for all three stations.

I’m the only dentist on the station who is employed during the summer season, and I recruit folks from the medical staff to assist me with procedures, with some training along the way. There is no hygienist, but I’m used to doing my own hygiene in my practice in Colorado, so that’s no big deal.

Initially, I took care of any emergent needs, but within a week or so I had time to also offer exams and cleanings, which proved very popular with people who often don't have that benefit when they’re off the ice.

The services I provided were available to all the folks on the stations, including scientists, support personnel such as the plumbers, electricians and cook staff, and the 60 staff members from the New Zealand station 2 kilometers down the road.

The beauty of the setup is that I was on a salary, so nobody paid for any dental services—I could make recommendations and money was not an issue. Often, just offering to smooth chipped front teeth and provide some simple cosmetic fixes was well received and appreciated. I even did a few crowns on folks when I was there for six months and had the time to send impressions to a lab in New Zealand.

One memorable case was a researcher who had taken a fall in a remote field camp and cracked and displaced an upper lateral incisor. They flew him and his four-person team back to McMurdo by helicopter, and he was concerned the project he had spent years preparing for would be put on hold if he had to go to New Zealand for treatment. I assured him I could reposition his lateral, start a root canal and return him to his field camp that afternoon, and he could return in a few weeks to complete the work.

When it was all done a few weeks later, he was very grateful and asked if he could do anything for me. I gave him the email address of the company that had given me all the materials to do the root canal (Coltene), and he wrote them a nice note, which was good PR all around.

What’s life like outside of practice in Antarctica? Your blog mentions dorm-style housing, but also steak and lobster dinners and a pickleball court! How much opportunity do you have for adventuring outside the station walls when the weather cooperates?

McMurdo is a sprawling station of more than 100 buildings, including dorms built by the U.S. Navy decades ago, a central dining area, a few bars and other social gathering places, and a full-sized gym and other workout settings. In the summer, when the sun doesn’t set and the temps can be in the 30s, there are outdoor recreational trails for hiking, biking and skiing.

Everyone takes an outdoor safety course and the longer trails, like the 11-mile loop on the glacier called Castle Rock, require filing a hiking plan with the firehouse, which includes the names of people in your group, time of departure and return, and taking radios along. If you’re more than five minutes late on your return without notifying the folks in dispatch, they activate the search and rescue team—they take safety seriously, which is good for everyone. The kitchen crew have culinary degrees and put out incredible food, so it’s best to keep active to avoid putting on extra pounds. There are many outdoor recreational opportunities, but you need to be motivated to get out and take advantage of them.

South Pole—about 900 miles inland with a fairly modern building that sits on 9,300 feet of ice—is a whole different setting because it is featureless for more than 1,000 miles in all directions. That station also has a full-sized gym for pickleball, volleyball, basketball, etc., but short walks outside are interesting in the subzero weather and blinding sun.

Your first session at McMurdo was in 2012, and you’ve been back six times since. What changes have you seen—or instituted— since you first started there?

My first season at McMurdo was a standard six-month contract, but I convinced the folks at University of Texas Medical Branch, Galveston—which has the subcontract from Leidos, a defense contractor, which is funded by the National Science Foundation, which runs the U.S. Antarctic Program—that I could fulfill my job as a dentist in six weeks, so the dental contract has been a six-week deployment since 2014. (There was a long government shutdown in 2013, so no dentist from the U.S. was sent that season.) The program bought a digital X-ray system and I’ve brought down more modern dental equipment including newer handpieces, newer curing lights and composite systems, a full range of endo supplies and other materials like better matrix systems.

There is no other dentist when I’m not there, but some of the medical staff who return each year have learned how to deal with basic dental repairs like chipped teeth or lost fillings.

How many other dentists travel to McMurdo to practice during a typical year? Do “newbies” receive any sort of training before they land?

There’s only one dentist for six weeks (early January to mid-February) for the program, and the rest of the time, I’m the consultant off the ice. Typically, I get two to four dental consults a month from the medical staff at the three stations, and between the writeups and digital X-rays, I can advise them how to treat the patients.

In 2015, I started doing a dental workshop each August in Galveston at the orientation for new medical staff before they head south. I found a dental office willing to lend me an operatory for two three-hour sessions, where physicians, nurses, physician assistants, nurse practitioners and even the pharmacist get hands-on training about taking digital dental X-rays, using a mirror, explorer, perio probe and tooth sleuth, and the basics of dental anatomy. The goal is to teach them to feel comfortable taking a history, then looking inside someone’s mouth to help diagnose a problem that they can send me to discuss.

I’ve gone down seven times in the past 10 years, and I believe there were dentists in the past who went for a few years running, but so far we haven’t found a replacement who wants to return for multiple seasons.

Which products and equipment are your “musts” in this practice situation?

The upgrades I’ve been able to bring down include handpieces from Kavo, endo and composite systems from Coltene, matrix systems from Garrison, delivery systems from Centrix and numerous products from Ultradent. It’s a fairly well-equipped dental office for general dentistry, with a goal to be able to treat most routine dental procedures.

After 38 years of practice, you recently decided to sell your Colorado Springs practice and retire from dentistry. What’s next on the agenda?

It’s been 40 years since I graduated from UF in 1982, so it seemed like a good time to retire from my practice and have the flexibility to be spontaneous. I don’t feel like I’m retiring from dentistry, but more from the responsibility of running a practice.

For the next few years, I plan to keep my Colorado and Alaska dental licenses. In August, I spent a few weeks 30 miles north of the Arctic Circle, doing locum work in Kotzebue, Alaska, then spent a few days seeing the sights in Anchorage.

I’m also open to fill in for dentists in places like Kwajalein, which I checked out recently, or to do some volunteer work in Poland on refugees from Ukraine.

I might even go back to Antarctica once the quarantine requirements are gone, because the last time I went, in 2020–2021, it required four weeks of hotel isolation before arriving, and I’m not interested in repeating that. I feel fortunate to be able to retire in good health and with enough energy to enjoy a little work and a lot of play!

35+ Years of Travel and Service

We asked Dr. Bob Koff to recap all the dental projects he’s traveled for during his nearly 40-year career. We weren’t quite prepared for the full list!

May 1985: My first trip to China with my (now ex-) wife, Pat. She was doing a project with Project Hope to set up a neonatal/ pediatric ICU in Hangzhou for a month. Project Hope didn’t have a dental program, so I created one at my own expense.

May 1986: We returned to China, and this time added Shanghai to the list. I asked four dental companies to pay $1,500 each to fund the trip, and spent a month doing lectures and demonstrations.

June 1986: Whaledent sponsored me for a week in South Korea to provide lectures to dentists in seven cities, from Seoul to Busan (in the south).

April 1987: The third trip to China lasted for a month, and included my mom. (Pat had a new job, so she couldn’t take the time off.) The trip included Hangzhou, Shanghai, Xian and Beijing for lectures and demonstrations. Dentsply and Whaledent split the cost of the trip, about $3,500 each.

September 1988: I did a volunteer dental project for a month in Kathmandu with a Colorado engineer who had devoted his retirement to help the people of Nepal. Another dentist and I worked in clinics set up around the city, including at an orphanage and a neighborhood social center.

January 1991: The beginning of taking a full year off with an “around-the-world” airline ticket began with a volunteer dental project on Ambergris Caye, Belize. We’d been on a diving trip and noticed a medical/dental clinic built by the Lions Club next to the runway. My real estate buddy, Steve, was my on-the-job-trained assistant and we provided free dental care, sometimes in exchange for meals, scuba diving, windsurfing rentals, etc.

February 1991: I did a volunteer dental project with a retired American dentist in Honduras. The remote setting sometimes involved a two-hour canoe ride to outlying villages.

March 1991: I did volunteer dentistry in Antigua, Guatemala. I lived with a family and took Spanish lessons at a local school in the mornings, then did volunteer dentistry at the local hospital alongside a Guatemalan dentist in the afternoons.

March 1991: I provided lectures to dentists in San Jose, Costa Rica, sponsored by Whaledent.

July and August 1991: I did volunteer dentistry in Romania and Bulgaria with an NGO called Citizens Democracy Corps, which was set up by President George W. Bush to teach free-market concepts to former Soviet Union countries.

November 1991: This was a monthlong volunteer dental project at a children’s clinic in Ashdod, Israel, set up through a New York foundation.

September 1995: I worked at a volunteer dental project in Tomsk, Siberia, through CDC. A clinic in Tomsk—which we later learned was owned by the mafia!—wanted to upgrade to be “like an American clinic.” A recently retired dental colleague from Denver and I provided consulting services and helped them order about $50,000 worth of new dental equipment from Henry Schein to upgrade their clinic.

January through September 1996: I moved with Pat and our then 3-year-old daughter, Lauren, to Russia. I was hired as the “American dentist” in a clinic in St. Petersburg owned by an American and called AMC (American Medical Center). I provided general dentistry and training for the staff.

December 1999: This was a volunteer dental project in Danang, Vietnam, through the East Meets West nonprofit. I did dental lectures on composites, fluoride, sealants and tooth whitening in the dental school in Ho Chi Minh City.

June 2001: Ultradent helped with the arrangements for this volunteer dental project in Bolivia, in a remote village outside Santa Cruz.

August 2002 through June 2003: I moved with my family to Barcelona, Spain. Pat got a job with the University of Barcelona on a first-of-its-kind telemedicine project. I did some volunteer dentistry in two private offices with dentists I met, working on them as well as some friends I had made in town.

October 2005 and March 2006: I took donated dental supplies from a number of dental companies to Cuba. I could not get a permit to work, so I donated the supplies to the dental school and some other clinics.

December 2007: I took donated dental supplies to public clinics in Panama with the help of a Colorado dentist who was from Panama.

December 2008: During this volunteer project to Barcelos, Brazil, I provided limited dental services and donated dental materials from several dental companies.

December 2009: I took donated dental supplies to the one dentist on Easter Island, which is a special territory of Chile.

August 2012: I signed up as the dentist for a six-month contract to work at the U.S. Antarctic Program (USAP) stations, McMurdo Station and Amundsen-Scott South Pole Station. I provided general dental services including routine exams and cleanings, fillings, root canals and extractions, and brought about $15,000 of donated dental materials to upgrade the clinic. After the contract, I remained the dental consultant to the USAP to help the medical staff deal with dental issues when I'm not there.

May 2014: Worked at a volunteer dental project in Madagascar, which had been arranged by a Colorado resident who grew up there and has returned many times to help the people.

January 2015 (and also January 2016, January 2017 and January 2018): I persuaded USAP I could do all the required dental work at McMurdo and South Pole in six weeks instead of six months. I also provided dental training to the medical staff to deal with dental issues when I’m not there. (When I took the season off in 2013 and 2019, I helped USAP fi nd other dentists to go to McMurdo and South Pole.)

June 2017 and June 2019: I provided general dental services in the Aleutian Islands of Alaska through the NGO Eastern Aleutian Tribes, working in clinics in King Cove, Sand Point and Whittier.

November 2019: I provided general dental services to the USAP station called Palmer, which is a five-day trip on a research icebreaker from the southern coast of Chile.

December 2019 through February 2020 (and again December 2020 through February 2021): USAP dentist at McMurdo and South Pole.

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