“It’s A War Zone Out There: The View Of ‘Un-Seen Injuries’ From The Field.”
Guest Author, Alex Quade: Award-winning, Embedded War Reporter
As a war reporter, I have had a unique view of all the angles: from downrange with the troops… to back with them on the “home front”… from care-givers, to policy-makers… from commanding generals, to veterans… from corporations, to charitable organizations.
I’ve witnessed some amazing things; but not all of it… good; especially, when it comes to the re-integration of troops with, what I will call, “un-seen injuries” of military Post-Traumatic Headache (or PTH)… which, to me, includes Traumatic Brain Injury (or TBI), and Post-Traumatic Stress Disorder (or PTSD). We do, out of haste, lump these two together, when, in actuality, and on the long term, they are very separate and distinct problems. It talks to a “cookie-cutter-approach,” warriors and their families tell me, that the military, medical and therapeutic professions are trying to take.
This is compounded by the fact that Traumatic Brain Injuries are never predictable. They are different for each person, and, for each person, they take on different personalities and complexions within a diagnostic and treatment plan which although can be based on age, drugs, stress factors, etc., can also be triggered by the body and brain itself without rhyme or reason.
Two good analogies, which someone in the Special Operations community told me, come close to describing this uniqueness: like riding a bull, or like being in the path of a tornado. Both are recognizable. We've all seen photos. All bulls look pretty much the same; however, no matter how many times a rider flies out of the chute, even if it is on the same bull… the rides, experience and outcome is going to be different. We've all seen tornadoes in pictures and on television news, but people who have experienced them will tell you, they are all different. It is indescribable… because of the unpredictability of the storm, its pattern and the sheer force which impacts lives years after. And so it is, according to troops I’ve interviewed, the same with military-related Post-Traumatic Headache: it is something which can impact the lives of service members, veterans, and their family members, years later.
My observations from covering troops in war zones since 1998 are: a “cookie-cutter-approach” does not necessarily work in the continuing care of troops with these injuries back into their unit… nor does it work in the continuing care of veterans, and their families, back into the civilian community.
The editors asked me to share stories: examples covering some of the issues and where things stand from the perspective of the troops I’ve covered in war zones, as well as their families.
So, for your background: I was embedded in Afghanistan during a huge air assault operation in Helmand Province… involving Rangers, Special Forces (the “Green Berets”), the 82nd Airborne’s 1-508th Parachute Infantry Regiment and Combat Aviation Brigade (“Air Cavalry”), as well as Air Force Special Operations Command aircraft and elements, and Other Government Agencies. The helicopter I was supposed to be on… was shot down by the Taliban, killing all onboard (classified information from that operation made headlines on WikiLeaks recently). Back home, I followed up with everyone on that mission…. and one of those service members is allowing me to share his story of re-integration with military-related un-seen injuries, since it illustrates some of the issues.
In his own words: “…Alex! My perspective is: the Army is actually trying to take care of returning soldiers but the ball gets dropped soon after returning home. The Army's way of “checking-the-box” was: for me to fill out a post-deployment questionnaire. I checked the box that I did want to seek help when I got back home. The Army never followed-through! Alex, this is especially important for me, because I was in the National Guard and returning to civilian life. (Yes, there were resources available in the pamphlets they gave me… but no post-deployment-care for me to roll-into…. just a, ‘Thanks for serving’ and, ‘See Ya!’)…”
“…Alex, if I had a leg blown-off, they would have kept me on active-duty until they medically-boarded me. For some reason, (un-seen injuries)… they let go… until the soldier gets into crisis-mode, which can be too late for some. For me, when I was in crisis-mode… dealing with the (pain) and trying to seek help… I didn't have the strength, at times, to care for myself…”
That service member’s story… represents what many of these troops and their families are going through as they try to get treatment and re-integrate with un-seen injuries.
I asked some of this Nation’s Medal of Honor recipients, and their families, about these issues… and they want you to know, that even some of them have had difficulties over the years. One said, “Communities need to be more aware of the stressors of un-seen injuries… so we can all deal with things such as the spike in suicides, substance-abuse, marital-relationship discord, and rising divorce rates.”
All of this requires action, despite Department of Defense budget cuts, health care industry changes, and political elections. So, what is needed? What can military commanders, leaders, policy-makers, health-care experts and providers, and communities… do to help make the transition “seam-less” for those active-duty troops and veterans suffering from military-related un-seen injuries, as well as for their families?
I went “straight to the source”: warriors suffering from military Post-Traumatic Headaches and un-seen injuries, and their families. They shared with me the following broad points that are rarely “officially” discussed, but reach to the heart of the matter. (The over-lying theme is, it is very important to shift the paradigm with this issue.)
1. There is no “quick fix” solution for un-seen injuries; “quick fixes” only act as an incendiary. Everyone needs to realize that programs should be conceived as five, ten, fifteen, even twenty-year endeavors. There needs to be dedicated follow up treatment and therapy for both the service member, or veteran, and the family. This should be the norm, not the exception.
One care-giver of a retired soldier told me, “Society is focused on the wounded. Families of those suffering (from military Post-Traumatic Headaches and un-seen injuries) have needs, too. Spouses, parents, and other family-members need to move on with their lives, too. All the support is ‘wounded-based’… and family-members and care-givers end up fading into the background.”
2. Education is a big piece. The education piece should not only be for the troops themselves, but more importantly, for those 1) that are being placed in charge of these programs; 2) Employers; 3) First-responders; 4) civilian hospitals and treatment centers; 5) families; and 6) other soldiers who do not know how to cope with troops suffering from un-seen injuries in their units.
a. For those in charge of military programs, this needs to be more than a two-week course. Most Wounded Warrior programs on military installations are run by personnel who have not seen combat, yet feel they “know all they need to know,” because they went through a two-week indoctrination course. A specific example troops and their families cited to me frequently is: the “Cadre” (or Chain of Command) in the Warrior Transition Battalions.
One poignant story punctuates this point: the wife of one of these Wounded Warriors, who was having “problems” with his Cadre, shaved her husband’s head bald so the scars from his military-related head trauma would be apparent to his Command. That way, it would be “visually apparent” and they would remember that he does, indeed, have Post-Traumatic Headaches and un-seen injuries. The wife told me, she resorted to this extreme, and she said, “humiliating,” measure, to remind his Cadre that her husband’s demeanor and actions may be misinterpreted or misunderstood as “being a difficult soldier”, when in actuality, when the hurting soldier is under stress (i.e., dealing with military bureaucratic frustrations)… his “irritability thresh-hold” may be lower. The wife said, “Soldiers with un-seen injuries should be applauded for ‘muscling-through’ their military work-day.”
b. First-responders and hospital personnel need to recognize the triggers and symptoms of un-seen injuries. If a First-responder with flashing, emergency vehicle lights approaches a service member, or veteran, suffering from un-seen military-related head injuries, they may very well trigger a negative reaction (or “stressor”).
c. Families need to be placed in therapy programs to also recognize triggers, recognize memory lapses are the norm, not the exception (i.e., that “sticky notes” shouldn't be removed), and to help understand why Dad or Mom gets up every hour, on the hour, to do perimeter checks, or why a car backfiring can put someone into a cold sweat.
d. Service members, as well as many civilian employees of the Army are currently going through mandatory suicide classes. There are no classes on helping a Soldier re-integrate back into their unit, who is suffering from military Post-Traumatic Headache and un-seen injuries. Sometimes those Soldiers find themselves ostracized or criticized for short-term memory loss, lack of, or over-concentration, panic attacks, and anger management.
e. Downrange, military leaders may need to to learn step in. In war zones, I’ve observed that due to the high operations and battle tempo, fatigue, Spartan living conditions (where overall health and hygiene may not be optimal)… many warriors may just chalk up their “headache” as part of the daily slog “in the suck”. Over-use of stimulants such as caffeine, chewing tobacco, or diet pills (“For energy”, they say), may mask some injury symptoms. Ninety-nine percent of the troops want to stay with their units “in the fight”, so they may not report their exposure to blasts (from Improvised Explosive Devices), or secondary concussions.
A General and a Sergeant Major in the U.S. Army Special Forces (the “Green Berets”) community, told me similar stories: that no one in the active-duty Special Forces community wants to single themselves out and seek treatment or report an injury or blast. “At some point,” the General said from overseas, “A ‘senior guy’ or leader must directly intervene (write this down, Alex!), and save the (Special Forces) Operators out there from themselves.” Stateside, the Sergeant Major re-iterated, “No one wants to be ‘the bad guy’ and make a team member (get help, which could remove him from the mission). Leaders need to do that little extra work to ensure the (Special Forces) Soldier is taken care of. For instance, every time we were hit with an Improvised Explosive Device (or IED)… I always went to the ‘Med Shop’ downrange and told the doctors about everyone who had been near the blast. Even if they don't feel anything now, you never know what could pop up years from now.”
3. Outstanding facilities or treatments should be identified and used as models. Set up forums for these folks to determine what they are doing and how it can be applied. For example, Dr. Alan Finkel, at the Traumatic Brain Injury Clinic at Womack Army Medical Center at Fort Bragg, North Carolina, is hearing directly from the soldiers he is treating, with a specific regimen, of some improvements in their military Post-Traumatic Headaches. The Mentis Clinic in El Paso, Texas is having success working with Soldiers with un-seen injuries by taking a different spin on the process, and because they are more attentive to the successes of small steps, as opposed to establishing a goal of total recovery. “Paws4Vets” is another program that seems to be working, matching dogs, scheduled to be destroyed, with veterans suffering from un-seen injuries and military Post-Traumatic Headaches. One thing hindering this program is getting these dogs recognized as "therapy dogs" so they enjoy the same privileges as “Seeing-Eye dogs”. But, the important lessons from these programs, troops tell me, are that they seem to be working.
4. There needs to be a better way to re-integrate service members and veterans back into civilian life. Troops train and fight in hostile environment conditions… but when they come home, many need to re-learn how to be a civilian again, albeit it with lingering un-seen injuries from their military time in harm’s way.
a. Employers should be giving incentives to assist and support the reintegration process, as well as the rehabilitation and treatment program over the long haul. One veteran with strong opinions on the importance of education regarding un-seen injuries, told me, “Not only does the public at large need to know more about it, but human resources folks at the numerous corporations that hire veterans need to come to learn that it is an issue that, while debilitating to some degree, when understood, is manageable.” He added, “Perhaps organizing and offering seminars for corporate officers and human resources officers might help them learn more about the issues.”
b. Half-way houses should be established, as well as retreat centers “out in the boonies”. These would be environments where guys and gals would feel protected… where they can't self-medicate; where they can be placed in anger-and-stress-triggering situations and learn to cope; where they can receive a variety of complementary treatments for their military-related Post-Traumatic headaches and un-seen injuries before they go back home, or, while they are home, but before they get into “crisis-mode”.
c. Establish more mentor programs for the troops. Also, mentor and give incentives to caregivers, therapists and counselors.
This is not “just a military problem”. This is an issue that will impact us all: our economy and our communities. Veterans I’ve talked with say, policy-makers need to be aware that the Department of Defense does not do a good job sussing out residual blast exposure. Medicare does not cover “cognitive rehabilitation”. So, while veterans may get some services… they tell me, perhaps “cognitive rehabilitation” should be included in coverage. And, if veterans are not getting timely treatment at over-loaded Veterans Affairs facilities, some say, it will become a burden on the civilian community (i.e., the State of Texas recently conducted a study about this, and found that the economic impact is huge).
One veteran made the suggestion, “Perhaps private (off military installations) health service providers would consider seeing at least one service man or woman pro bono (as a way of ‘giving back’ to those who have fought for America) until the military, and the Veterans Affairs clinics are better able to increase resources.”
Which brings us to a final “broad point” straight from the troops and their families…
Warriors who fight, and have fought, for the United States and now bear the un-seen injuries and scars resulting in military Post-Traumatic Headaches… should not be made to feel defeated back home. For everyone trying to affect change or make a difference in the lives and health of the troops and their families (from policy-makers and leaders…to health care providers and medical professionals… to the troops, themselves, and their families): here are words of advice to from my late mentor, Medal of Honor recipient, COL Robert Howard, who always told me, “When it is obvious that the goals cannot be reached… do not adjust the goals… adjust the action steps!”
***Award-winning, Freelance War Reporter, Alex Quade, recently returned from nearly 18-months on-and-off in Iraq and Afghanistan covering U.S. Special Operations Forces on combat missions. Ms.Quade is the recipient of the Congressional Medal Of Honor Society’s “Tex McCrary Award For Excellence In Journalism” for her war reportage. The Medal of Honor recipients present the award to individuals who, through their life's work, have distinguished themselves by service or unbiased coverage of the United States Military through journalism.***