By Claudia Perry
Independent journalist
A group of AHCJ members were treated to a tour of the Jesse Brown VA Medical Center and presentations about the center's care on April 22, 2010, as part of Health Journalism 2010.
Psychologist Eric Proescher and Mark Galben, a clinical social worker, talked about the changing demographics of VA patients. The newest veterans are a mix of career army and activated reservists and National Guard. The VA has found that it needs new ways to make contact with Gulf War and the New Gulf War vets.
The old VA was all male and pretty evenly split between black and white. Increasingly, veterans are Latino as well as female so the VA had to become more proactive. About 3,000 National Guard reservists went to Iraq and Afghanistan from the Chicagoland area. Those vets were younger, busier and more reluctant to seek help. The VA implemented a case management system to screen and identify needs and help patients navigate the VA. Two people at the Jesse Brown VA Medical Center do outreach full time. Half of the reservists have no military base to go to, while those on active duty have Department of Defense health care.
The VA also developed post-deployment clinics. The post-deployment clinics are not like the Vietnam-era centers, which were community-based mental health clinics and had a different chain of command than the VA.
Proescher outlined some of the issues this population is facing, including changes he has noticed since he started in 2005. The veterans want to get back to their lives and they are not disability-focused. With the struggling economy, Proescher says he is seeing the same guys who are more depressed and need more help. They have many psychosocial issues.
In the case of Vietnam veterans, the process was slower and many might not have survived the injuries that today's veterans are living with. There has been an increase in amputations and traumatic brain injuries since Vietnam and Desert Storm.
Case management has changed. Veterans who suffer from multiple issues, such as post-traumatic stress disorder and substance abuse, are now treated for both simultaneously. The traditional masculine values of self-reliance, self-control and strength can make a good soldier, but they can interfere with readjustment. Galben has blended yoga, reiki and other mind-body interventions and called it "Battle Body Retraining," which de-emphasizes the New Age, touchy-feely aspects.
In one example, Proescher says a veteran who had PTSD psychosis came to Battle Body Retraining hunched and withdrawn. After a movement exercise of walking in circles and following the leader to music, the veteran was giving the thumbs up and standing tall.
In a partnership with the Department of Defense, the VA is reaching out through a national call center. National Guard reservists now have access to screening and the same care as honorably discharged veterans of any branch of service.
Seventeen percent of active duty vets are women and 11 percent of them have seen combat. The Veterans Administration has been adjusting its model of care to suit women better. The women's unit at Jesse Brown has female doctors plus changing tables in restrooms and child- friendly waiting areas. Twenty percent of people enlisting are women. The unit is separated from where the men are treated. On active duty, one of five women experience sexual trauma. That figure is higher for those who seek help from the VA.
According to Ken Khuans, M.D., the criteria for diagnosing PTSD keep changing. Experts now point to a life-threatening traumatic experience. If three months or more after the experience, a person suffers intrusive recollection of trauma, physiological reactions and avoid anything that reminds them of the trauma, then you are considered to have PTSA. It has a significant impact on social and personal lives. Ten to 18 percent of returning vets have PTSD. It's estimated that 30 percent of returning veterans have other mental health issues.
Suicides are harder to track with civilian integration, so the VA has partnered with the National Suicide Hotline and has suicide prevention teams throughout hospital. Suicidal issues are noted in records so all providers are aware and can follow up.
Medical records in the VA are kept up to date electronically with the Computerized Patient Records System, which uses software developed by the VA. All of the VA medical centers and clinics can communicate with each other and the data is backed up throughout the VA system so even if there's a major power outage or other catastrophe, the records will be available. This was a huge help with veterans who were displaced in Katrina. The system is intuitive and makes it easy to talk to other VA hospitals and clinics.
Six percent of casualties from Iraq and Afghanistan result in a major limb amputation. Richard Weir, a researcher with the VA, talked about prosthetics and how the body talks to them. Lower limb amputations outnumber upper limbs by 10 to 1 among vets. Myoelectric control, in which electrical impulses from muscles drive the limb, is the best control for now. Weir says better hands are being designed, but noted that adding complexity loses robustness. They have received some funding from the Advanced Research Projects Agency (ARPA), whose research computer network was the forerunner to the Internet.
The DEKA arm (featured on "60 Minutes" some months ago with its developer, Dean Kamen) is now in clinical trials. The old arms do not have a powered shoulder joint. Weir had a prosthetic arm available for writers to examine. It weighs about 7 pounds, which is close to the weight of a real arm.
