National Nurses United

TBI:2 5/27/08 12:35 PM Page 15 Watson concurred about the importance of working with families, but pointed out "that in many cases there is no core family" and TBI sufferers are on their own. A AP PHOTO/THE NEWS TRIBUNE, LUI KIT WONG Tina Sundem, right, a nurse who treated Rory Dunn for injuries he received while in Iraq, gets a hug from Dunn. Dunn is a former soldier who suffered a traumatic brain injury near Fallujah, Iraq, in May 2004. their families, and their survivors are daunting and growing." And yet the military has lost 22 percent of its psychologists in the past several years, most from burn out. At Walter Reed, soldiers with PTSD outnumber amputees 43 to 1, but the hospital has no PTSD center. "TBI can be missed," said Watson, the Cleveland VA psychiatric nurse. "People demonstrating psychological problems can be sent to the general psych unit where they are locked up." Soldiers are also routinely treated with medications rather than therapy. A study by Veterans for America found that some soldiers were taking 20 different medications at once, some of which canceled others out. Soldiers also have difficulty finding therapists because the VA pays below-market rates, and even cut those reimbursements 6.4 percent in 2007. The result is that some 30 percent of psychologists are unwilling to take on military patients. For regular soldiers, one 45minute session once a month is not uncommon, and they may be treated by a different health professional each time. This situation may be worse for the National Guard and Reserves, who make up almost half of the troops deployed in both wars and who, according to the Veterans for America study, "are experiencing rates of mental health problems 44 percent higher than their active duty counterparts." Healthcare for such troops may be inferior to that offered to full-time regulars. The problem is broader than just psychological services. A Harvard study found that 1.8 million vets under 65 have no healthcare or access to the VA. "Most uninsured veterans are low-to-middleincome workers who may be too poor to afford private coverage but are not poor enough to qualify for Medicaid or free VA care," the study found. "The insurance situation is horrible," agreed Landau. Therapists like Landau and Jacobs point out that while TBI may affect an individual, its consequences ripple out to a much wider audience. "You have to mobilize [TBI sufferers'] support system," said Landau. Educating a TBI sufferer's family is essential, and very possible to do. But many in the military are not trained in skills like family therapy. M AY 2 0 0 8 s grim as the current situation looks, most health professionals say there is hope for many TBI sufferers. Gean said that when she was in school, conventional wisdom was that damaged brains couldn't heal. "But we now know that the brain can heal. It has an intrinsic plasticity that allows it to recover, and this is particularly true for the young brain." On the psychological side, while recovering from TBI may take a long time—Landau said sometimes from five to 10 years—if the proper care is given, recovery is possible. Jacobs agreed the recovery period may be extensive, but, "things do get better over time." Rehabilitation, however, is expensive, and it is by no means clear how many victims exist. Between TBI and the kind of damage that substance abuse inflicts, Landau guessed that "40 percent of the returning vets will have physical and psychological difficulties." No one has put a final figure on what that will cost, but $14 billion over the next 20 years is not out of the question. Right now the resources don't meet the demand. "Currently the VA system cannot manage patients with TBI," said Dr. Heekin Chee of Boston's Spaulding Rehabilitation Hospital. Jacobs agreed: "The infrastructure that exists is not going to be able to cope." UCSF researcher Weiner ticked off what he sees as at least some of the solutions: "First, every one of these people has to have access to quality clinical care, and physicians need to get educated about this syndrome. Second, we have to create a national database on this so we can figure out what is going on, and what we can learn from clinical treatment. Third, there needs to be a lot more organized research on these people." Weiner said the federal government has made $300 million available for research, "which sounds like a lot of money, but really isn't." Following the revelations of inadequate medical care at Walter Reed, Congress has gotten more involved in the issue. Last July Congress passed the Wounded Warrior Bill, S 1606, to improve care for troops and veterans, and the House Energy and Commerce Committee just passed a reauthorization of the Traumatic Brain Injury Act, HR 1418, to support research and rehabilitation for TBI sufferers. Rep. Bill Pascrell led the push for the bill. "This is not just for the military," said Pascrell's communication's director Caley Gray, but for TBI sufferers nationwide. It has taken a war to put the issue of TBI on the nation's health agenda, but the cost of that awareness in blood, flesh, and decimated relationships is high. Even if the war ends soon, there will be hundreds of thousands of soldiers and veterans who will bear the burden of TBI. Sorting out how to deal with it may well test the nation's mettle far more than the conflicts that produced the damage. For Gean, who has seen some of that wreckage first hand, the solution is clear: "We have to do something for these soldiers." I Conn Hallinan is a foreign policy analyst for Foreign Policy in Focus and a columnist with the Berkeley Daily Planet. Carl Bloice is a freelance writer based in San Francisco. W W W. C A L N U R S E S . O R G REGISTERED NURSE 15

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