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The War Comes Home: Covering the Plight of the Badly Wounded

 
 
Reply Mon 11 Jun, 2007 08:47 am
The War Comes Home: Covering the Plight of the Badly Wounded
By Dennis Anderson
E & P
June 10, 2007

When a local service member dies in Iraq newspapers cover the family and community reaction. But what happens -- or should happen -- when the victim is horribly injured but survives? A former embed, editor, and father of an Iraq war veteran, reflects.

A week ago a Lancaster mother -- one of the soldier-mothers in my hometown in Southern California -- left to tend to her wounded son at Brooke Army Medical Center at Fort Sam Houston, Texas. How much the world has changed for Stacie Tscherny in the span of that one week.

Days earlier, she learned that her son, Army Spc. Jerral Steele Hancock, was seriously wounded in the fighting around Baghdad.

It was Memorial Day. It was his 21st birthday. This birthday, this crossing of the bridge into formal adulthood with the privilege to drink a legal beer would herald the last time Spc. Hancock would have two arms. And it would be the last time he would take a normal step or experience physical comfort or ease.

Serving as a tanker with the 1st Squadron, 8th Cavalry, Spc. Hancock was catastrophically wounded in an explosion that hit his armored vehicle. The vast majority of traumatic injuries inflicted in the Iraq war are not from gunfire, but from explosives.

In January the military marked the 500th American surviving with wounds that involved amputation.

In the past six months to a year, increasingly, a powerful new kind of explosive is inflicting more damage and more grievous injury. The evolution has been an evolution from the Improvised Explosive Devices (IEDs) to increasing use of the Explosively Formed Penetrators (EPFs).

"They can take out a Stryker, a Bradley, even an Abrams tank," said Sgt. Travis Strong of Palmdale in a recent interview with me at his home at Balboa Naval Medical Center in San Diego. Strong was wounded severely enough both legs were amputated above the knee from the EPF explosion that destroyed his Stryker armored infantry carrier last year.

Sgt. Strong is another hometown soldier from the coverage area of the paper I edit, the Antelope Valley Press, a resident of Palmdale, a community of 130,000 on the edge of the Mojave Desert an hours drive from Ft. Irwin, the Army National Training Center.

In the past year or so when soldiers from our communities sustain traumatic injuries, as the newspaper's editor -- and as a "Blue Star Father" of a serving Marine -- I usually get the informal notification call from Blue Star Mothers, a support group for parents of serving military.

Sgt. John E. Allen of Palmdale was killed on St. Patrick's Day. It has been axiomatic that death and traumatic injury take no holidays.

Customarily, in coverage of the traumatic injury of local troops, it's been my practice as a journalist with contacts in the military extended family network community to also be ready to move forward, or, if the family needs their zone of privacy borne from anguish, to back off.

People who have been badly hurt may want to tell their story. They usually do not want to tell it when every nerve ending in their battered body is in agony. But for the most part, they have been willing to share accounts of their extraordinary ordeal. It may take weeks or months to get ready to share that story, but the story is always compelling, always worth telling.

These wounded soldiers and Marines, these troops hurt in this continuing war that is fought by ambush with devastating explosives are the heralds that tell us what the cost of this war ultimately will be.

They also are the "canaries in the coal mine," in that their care and their needs require all the scrutiny that an activist press can provide. God knows most of our profession was not diligent enough, probing enough, or demanding truth from power enough in the run-up to war. See Thomas Ricks in "Fiasco."

Absent a devastating attack on the American homeland, it is to be hoped national media will engage in greater diligence before another foreign war gets a push from the White House and a pass from Congress, and the American people.

The lessons of military and congressional blind-spotting on Walter Reed Army Medical Center are all too fresh at the moment.

Accounts of care at the urgent-immediate post combat injury stage are that the care is first-rate. But the strains and burdens that families of the wounded will undergo are urgent also. And those needs need to be reported, by national media, by local media -- by anyone with the means to see and the megaphone of communication to use.

In one case recently our newspaper covered the story of a National Guard soldier whose military insurance was canceled before final surgery to remove steel rods emplaced to repair his mangled legs, which were fractured in an IED blast that destroyed his Humvee.

It only was after news of the incident surfaced that the military and its insurance overseer effected a quick about-face and remedied the situation. This has got to be the first war waged by Americans where after-care for troops is handled through health maintenance organizations and insurance.

"You cannot believe what these young guys have gone through," Stacie Tscherny, the mother of trooper Hancock, said. "Arms, legs, burns. They've lost eyes, they have burns to their faces."

And she related that our country's wounded are unbelievably strong-willed and strong-minded, the young men in the beds at Brooke, the catastrophically wounded from this war.

On departure for Texas last week, Tscherny was relieved that her employers extended her two weeks on short notice to go be with her son. Now she has been there a week. He has lost much. An arm to amputation. Skin to burn injuries. Other injuries that may impact mobility. Too
soon to tell. For trooper Hancock, life will never take a more serious or devastating course short of mortality.

"We communicate by blinking," his mother told me. "His first sergeant was home on leave, and he came in to see him, and he was happy about that."

The military is putting up Hancock's mother in apartment-style housing on the medical campus. Suddenly, two weeks does not seem like enough time to tend to the needs of her son.

"We asked -- I asked -- does he want his mother to stay there with him, and he blinked ?'Yes.'"

Spc. Jerral Steele Hancock -- 21 years old -- is heavily medicated for pain. But severe pain is unavoidable with the fragility of his wounded body because too much pain medication impacts blood pressure, circulation and the heart.

"I think he understands what happened now with his arm," the amputation, she said. "He cried tears, and I said ?'Don't worry, honey. There's lots of these young men who are coming back."

Lots of these young men are coming back. And how we, as a nation, treat them, and how we as a nation honor them, and how we -- as a nation -- see to their effective care and rehabilitation will define the kind of nation that we are, in war or peace.

Spc. Hancock's mother recounted in a telephone interview from Brooke, "I think how is it that he survived moves through two hospitals in Iraq, then on to Germany, then here to Texas, and I wonder with these young men how they maintain the spirit to not just die."

She does not want to leave her son's bedside. She does not want to leave the side of the son who communicates with her by blinking "yes" or "no" for understanding his needs, his feelings, his responses to questions.

While in support of her son at the trauma center, the U.S. military provides a "per diem" stipend for immediate family, a stipend that amounts to $1,600 a month -- or, about $400 a week.

On leaving Lancaster where she resided for about a year, Tscherny had a new job that she commuted to in the San Fernando Valley. Her expenses are about average, which is to say that the $1,600 covers a little less than half the ordinary living expenses.

There is her home and its payments. Her son, and his young wife (who also is a mother) also has a house.

How to do it? What to do?

"I am going to try and do anything I can to be with my son while he needs me," his mother said.

She said she has had conversations with great young soldiers, remarkable people. She said she has formed a friendship with a young G.I. who lost his eye, and part of his face, and who knows the ground of recovery.

Is there any way you can imagine that Spc. Hancock will not need his mother, and anyone close to him, for all time to come?

Is there any way you can imagine that handling of the treatment, and support for immediate family in such circumstance should fall short of actual need?

If we can approve $100 billion to run this war in its fifth year, it is hard to conceive that we do not have the money it takes to tend to the needs of immediate family of our military's most injured and vulnerable souls.
--------------------------------------------------------------------------------

Dennis Anderson ([email protected]) is editor of the Antelope Valley Press in Palmdale, Ca. He twice acted as an embed in Iraq, and his son has served there. He has written often about the war for E&P.
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BumbleBeeBoogie
 
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Reply Sun 16 Sep, 2007 08:43 am
Veteran Hospitals: PTSD care inconsistent
VA studies: PTSD care inconsistent
By Chris Adams | McClatchy Newspapers
September 16, 2007

WASHINGTON ?- The Department of Veterans Affairs, which touts its special programs to treat post-traumatic stress disorder in returning soldiers, spends little on those programs in some parts of the country, and some of its efforts fail to meet some of the VA's own goals, according to internal reports obtained by McClatchy Newspapers.

In fiscal year 2006, the reports show, some of the VA's specialized PTSD units spent a fraction of what the average unit did. Five medical centers ?- in California, Iowa, Louisiana, Tennessee and Wisconsin ?- spent about $100,000 on their PTSD clinical teams, less than one-fifth the national average.

The documents also show that while the VA's treatment for PTSD is generally effective, nearly a third of the agency's inpatient and other intensive PTSD units failed to meet at least one of the quality goals monitored by a VA health-research organization. The VA medical center in Lexington, Ky., failed to meet four of six quality goals, according to the internal reports.

A top VA mental-health official dismissed the reports' significance, saying veterans receive adequate care, either in specialized PTSD units or from general mental-health providers. In addition, he said, some of the spending differences aren't as extreme as the documents indicate, and the department is working to increase its resources for mental health treatment.

As the VA prepares for a surge of Iraq and Afghanistan veterans experiencing PTSD, it's come under fire for staffing and funding shortfalls in its mental health units and for the wide differences in how much it spends on such treatment at its medical centers.

The agency maintains that it delivers consistently high-quality treatment. "The best measurement of success, and what really counts, is how well we are doing in improving our patients' health," the agency's top medical official, Michael Kussman, said in a statement to McClatchy Newspapers earlier this year. "When we make comparisons among our facilities, our results are uniformly positive."

The spending and quality numbers are in two reports that a VA mental health-research office produces each year. The reports used to be readily available to the public, but the VA removed them from its Web site in the past year. McClatchy obtained the most recent reports, for fiscal year 2006, under provisions of the Freedom of Information Act.

One of the reports indicates that the number of veterans using the VA's specialized outpatient PTSD services is growing much faster than the number of medical appointments the VA is providing. The report shows that the number of veterans treated grew more than 4 percent from 2005 to 2006, while the number of appointments the VA provided grew just 1 percent, meaning that the average number of visits each veteran got dropped.

The report also says that the data "suggest considerable variability" across the VA in the delivery of some PTSD services.

"It is the task of thoughtful planning, performance assessment and clinical care to assure that, as VA passes through a period of major change during the years to come, the treatment provided to veterans with PTSD is equitably distributed, accessible, effective and efficient," the report concludes.

Paul Sullivan, a former VA official who works for the advocacy group Veterans for Common Sense, said the numbers indicated that the VA wasn't prepared to treat the number of soldiers who were coming home with PTSD.

"If the ominous trend continues or if all our Iraq soldiers return home quickly, VA's crisis may deteriorate into a full-blown catastrophe," he said.

The VA already is contending with the influx of troops from Iraq and Afghanistan as well as Vietnam-era and other veterans battling the ailment.

The agency provides mental health treatment at inpatient hospital wards and outpatient clinics. Care also is divided between general treatment and specialized programs for conditions such as PTSD.

The specialized programs are staffed by experts who concentrate on PTSD, and they've "long been recognized as an essential feature in treatment of military-related PTSD," one of the reports concludes.

"The availability of specialized PTSD programs is an important indicator of the quality of health care provided by VA," it says.

The most prevalent type of specialized program is an outpatient unit called a PTSD clinical team, and members of Congress and VA experts have pushed the agency to establish such a team at every VA medical center.

The VA has 153 medical centers, and one of the reports lists 103 centers with the special PTSD clinical units as of the end of fiscal 2006. The VA has added such units rapidly in the past year, and by the end of this year about 120 centers will have them, according to a May statement by the department.

Spending varies widely among the units, however, from more than $2,000 per treated veteran in centers in The Bronx, N.Y., and Boise, Idaho, to about $300 per treated veteran in Augusta, Ga., and about $200 in Palo Alto, Calif., one of the reports says.

Ira Katz, a top VA mental-health official, said different medical centers used different accounting systems but that the VA was working to make its PTSD care more uniform across the country.

"We want to increase the expectation of what kind of care every veteran can expect, no matter where they are," Katz said.

VA leaders are to meet this fall to help standardize the agency's PTSD program offerings. Over time, Katz said, spending on the programs will increase and the range among different centers will narrow.

Gauging the effectiveness of PTSD treatment is an inexact science, but one of the reports attempts to do so.

For treatment in hospital inpatient and other similar units, VA researchers track veterans' PTSD symptoms as well as their abuse of drugs or alcohol, propensity for violence and work habits.

They then adjust the results to account for the differences in the veterans being treated at each VA center, such as the severity of the veteran's mental illness.

Overall, the results show, treatment is effective: PTSD symptoms are reduced, for example. But some programs were better than others.

Only about 40 of the 153 VA medical centers had the specialized inpatient units, and not all of them had enough data to analyze. But 11 of the 36 that did, including the Lexington center, failed to meet at least one of the treatment goals the report tracked.

The VA researchers also came up with what they said was an overall measure of quality similar to a "cumulative grade-point average."

Lexington got the lowest marks; the VA center in Coatesville, Pa., was first. Katz said the Lexington medical center already had started to receive funding to support 20 new mental-health workers in an attempt to boost its outreach, education and treatment.

In a series of e-mails, however, he dismissed the reports' significance, saying they were produced by an internal VA research unit that's outside the agency's "formal quality improvement process."

Although the unit has been refining and publishing financial figures for several years, Katz said, the financial figures for individual PTSD programs aren't "meaningful" because of the VA centers' differing accounting procedures.

As for the services being provided, Katz said that veterans who weren't being cared for by the VA's specialized programs received "comparable care" from the system's general mental-health units. Finally, he said, the differences in outcomes among the units are minor.

"VA is always looking for ways to improve the care it provides," he said. "The apparent differences in spending and outcomes are possible signals, not scandals."
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