From War to Home: Service and Deployment. Gala True, PhD Philadelphia VA Medical Center University of Pennsylvania School of Medicine

Transcription

1 From War to Home: The Health Impacts of Military Service and Deployment Gala True, PhD Philadelphia VA Medical Center University of Pennsylvania School of Medicine

2 Objectives: Understand why a patient s military health history is relevant to providing evidence based, patient centered care Review findings from a community engaged research project with OEF/OIF Veterans to gain insights into health impacts of military service

3 Do you routinely ask your patients whether h they ever served in the military? 1= Yes 2= No

4 The Unasked Question* Military health history: Did you ever serve in the military? When and where were you stationed? Were you ever exposed to Agent to Orange? Were you ever treated for parasitic or tropical diseases? What was your job description? Were you physically injured? Have you ever been treated for a service related condition? Were you affected psychologically by your military experiences? *Brown, J.L. JAMA. 2012; 308 (18):

5 What percentage of the U.S. population of males > 65 years old are veterans?* 1=10% 10% 2=25% 3=40% 4=50% * US Census Bureau American Fact Finder Table B21001: Sex by age by veteran status * US Census Bureau. American Fact Finder. Table B21001: Sex by age by veteran status for civilian population 18 years and over American Community Survey 1 Year Estimates.

6 Over 20 million U.S. veterans Less than half (40%) receive some portion of care from Veterans Health Administration Majority use health care resources covered by Medicare, Medicaid, or private insurance million post 9/11 veterans 17% women 26% are 55 years +

7 PhotoVoice as an Educational Intervention to Improve Care of OEF/OIF Veterans* 40 Veterans who had served ed at least one deployment in support of OEF/OIF Given cameras, asked to tell their stories with focus on 4 questions: How does a deployment impact your physical, mental, and emotional health? What challenges do you face when you come home? What barriers and facilitators doyou face whenit comes to accessing care? Where do you find strength and support? *VA HSR&D Grant PPO , PI: True

8 Images from Deployment Environmental exposures Extreme physical stress Disrupted sleep cycles Loss of comrades/survival guilt Military Sexual Trauma Combat exposure/traumas

9 Photo courtesy of Sam Console 9

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11 Photo courtesy of Sam Console 11

12 Once the sand storms come everything would stick to you. You look like a snowman with sand. You re constantly breathing in dust and dirt. They burn everything there trash, feces, everything. I developed a nasty cough from it. You get used to it You have more things to worry about than what you re breathing in. Drew B.

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14 This is for my friend Mark. I was with him when he got killed; he got shot right through the head. It bothered me quite a bit. He had a wife and three kids. I can t stop feeling guilty about his death. If it had been me it would not have been such a big deal. Tommy C.

15 We had an Air Force lieutenant almost got raped on the base. She had to fight for her life. My M16 was my best friend. We would go to the mess hall, the theater; we d go to the gym, everywhere with the M16. I d take it to the showers. Raquel R.

16 That was a bad day. There was a group from the 101 st staying there and they had a car bomb that exploded. We had to dig through the mud. We had to recover body parts to send home. It was a long day we had. I ve Ive got a lot of bad dreams from that day. LRD

17 Making the Transition Suicide and suicidal thoughts Coping through alcohol and drugs Unemployment Difficulty driving Homelessness Complicated family reintegration

18 For about a month or two I was depressed, I wanted to kill myself. I could find no joy in anything. I thought maybe if I crash my car, then I can face my fear, because I am sick of living like this. Something told me, God is calling me. I said it out loud in tears, God you are calling me. When I said that I felt like God himself touched my shoulder and said Now you understand, like he was there with me. Jose G.

19 Back from our second deployment, we were away for training. My commander killed herself. That s the room she was staying in; Room 22. She hung herself in the bathroom. She went through with it. Raquel R.

20 The first deployment wasn t bad. The second deployment we had casualties, KIAs [Killed in Action], WIAs [Wounded in Action]. I was on the recovery team. We were picking up body parts and putting them in the bags. It was rough. I have an alcohol problem. I m not going to lie. It s not glamorous. It s not like it is in the movies. You feel like you re drowning. You can t come up for air. Alcohol makes me numb. For me, numb is as good as it gets sometimes. Michael B.

21 When you re an infantry guy, they give you whatever you want to either stay up, or to go to sleep, or to not feel the pain. I was taking Percocet. I was taking Morphine. I was taking Valium. I was taking Klonopin, Dilaudid. One medication they gave me was like speed; I think it was Ritalin. After a while, you just get addicted. Then they just cut you off when you get back. They tell you this was our briefing Whatever happened over there stays over there, cool? Then you re on the streets looking for shit. You re looking and then your life just goes right down the tubes. I feel like I ve got the weight of the world on my shoulders. Jamie B.

22 I feel like an alien in civilization. It makes it tough for me to function in normal American society. I ve tried dealing with it different ways. I ve spent lot of time out in the woods. Some people call it homeless; I call it being an outdoorsman. Micky D.

23 I have a lot of issues with the things I should be judged for; things I did when I was in Iraq. It's something that always is heavy for me, trying to balance out that bad karma, or whatever it is that I built over there. The stereotype of a stoic soldier who is proud and strong and doesn't have nightmares; it's wrongly imposed on me. When I think about my time there, I don't have a welling of pride. Overall, it was a damning experience. Toby B.

24 I don t do good with crowds. I m standing in the hallway and I had my back to the wall, nobody behind me; I can observe everything that s in front of me, but there s still too many people. I feel like I can t be in control if there s that many people. Tiffany J.

25 Five years after leaving Iraq I still have anxiety driving. When I am confined with no way to escape, it feels like I am being funneled into a kill zone. Tracy P.

26 I was feeling really down that day, and I saw a picture as something that matched my mood. The bell tower s just standing all by itself in a grey brick, grey background, just like my mood. I was feeling alone, all by myself. I m Im unemployed and I m Im having trouble getting work. I saw that as having still a long road, trying to get back into the workforce. And also, just in life in general; I still have a long way to go. Philip L.

27 My mom took this photo the morning I came home from Iraq. The kids were dazed, and I was overwhelmed. Frankly, Christmas was a bit rough, trying to get to know one another again. I left for Afghanistan 3 weeks later. Tracy P.

28 Barriers to Care Frustration with paperwork and bureaucracy Stoicism/culture of silence Medication i Perception of overreliance on drugs for treatment Adverse reactions Trade offs between taking meds for pain/anxiety and functioning

29 I shot this to express how I feel about the healthcare system. It is like a maze. The system is not set up for people to talk tlkthrough h things. When I finally got a doctor, my practitioner was asking me this batteryofreally really intrusive questions, but there was no space to work it out. There is a serious lack of listening. People will ask you questions, but no one is listening to you. Chantelle B.

30 We had a lot of females that got raped. We had males that got raped. Okay? You re in that situation where people don t want to see, don t want to hear, don t want to speak. It s like a triple effect. So, it s not reported. And when the soldiers come back, they re living with that. A lot of them have jobs where they could lose their job. Seeking help could be a flag in your record. So you have a lot of people who don t want to say. Raquel R.

31 That s after a medication reaction. It has happened 6 or 7 times. They re not sure what causes it. My face would get so big that the pressure would hurt, you know? So now I'm very careful about what I take. If anything, I don't take medications I m supposed to because I don't want that happening again. Micky D.

32 There s a pill for everything now. The fast fix. We re addicted to pills of one kind or another, and they keep pushing them on TV. I guess I m a little bit discouraged that so many people are hooked on medications. I very rarely see anybody [say], Go through psychotherapy before you go on happy pills. Scott S.

33 Resilience, Healing, & the Future Ways of healing Writing, art, being outdoors, being with other veterans Seeking out peaceful spaces Family Pet therapy Finding a new normal

34 I ride my bk bike a lot. It helps clear my mind. This tattoo, my brother got it and I did it just to match him. I am really good friends with my little brother. We grew up together and have just been carrying on like little kids ever since. Tommy C.

35 These are the things that decorate my room. I like to do the drawing and color them in. Because as long as my mind is occupied the thoughts of doing things to myself don t fit in. They can t find space. Michael C.

36 It was really serene. Everything was perfect. There was nothing bad about that day. I really needed a day like that; I just got to contemplate a lot of things. I don t really get too many days like that. Micky D.

37 This one particular rose was growing up away from the rest of the bushes. It seemed like it was reaching for the sky. I thought what is this flower doing out here by itself? It seemed like it was trying to get away and move on to something higher, something bigger. It was kind of growing up and maybe growing in a different direction. Camille B.

38 That s one of those buildings under construction. I kind of see my life in that way. Kind of like that neighborhood, I m kind of under revitalization, you know? I was a Marine. I got my peak at one point and I kind of deteriorated but I m trying to fix my life back together. MDK

39 I think there s a desire in our culture to forget, to move on. There are some things that you should not forget. Some things I think you should not move on from. I could quickly forget what it is to go to war. I could quickly make it into GI Joe. I never imagine a cure. And dit it s more difficult for you in the audience to hear that I m troubled by these things; I haven t moved on, that there is a cost to this. LRD