posted on June 23, 2007 10:15:06 AM new
Gov't Struggles to Cope With Wounded GIs
Updated 12:30 PM ET June 23, 2007
By MARILYNN MARCHIONE
(AP) - More than 800 of them have lost an arm, a leg, fingers or toes. More than 100 are blind. Dozens need tubes and machines to keep them alive. Hundreds are disfigured by burns, and thousands have brain injuries and mangled minds.
These are America's war wounded, a toll that has received less attention than the 3,500 troops killed in Iraq. Depending on how you count them, they number between 35,000 and 53,000.
More of them are coming home, with injuries of a scope and magnitude the government did not predict and is now struggling to treat.
"If we left Iraq tomorrow, we would have the legacy of all these people for many years to come," said Dr. Jeffrey Drazen, editor-in-chief of the New England Journal of Medicine and an adviser to the U.S. Department of Veterans Affairs. "The military simply wasn't prepared for its own success" at keeping severely wounded soldiers alive, he said.
Survival rates today are even higher than the record levels set early in the war, thanks to body armor and better care. For every American soldier or Marine killed in Iraq, 15 others have survived illness or injury there.
Unlike previous wars, few of them have been shot. The signature weapon of this war _ the improvised explosive device, or IED _ has left a signature wound: traumatic brain injury.
Soldiers hit in the head or knocked out by blasts _ "getting your bell rung" is the military euphemism _ sometimes have no visible wounds but a fog of war in their minds. They can be addled, irritable, depressed and unaware they are impaired.
Only an estimated 2,000 cases of brain injury have been treated, but doctors think many less obvious cases have gone undetected. One small study found that more than half of one group of wounded troops arriving at Walter Reed Army Medical Center had brain injuries. Around the nation, a new effort is under way to check every returning man and woman for this possibility.
Some of those on active duty may have subtle brain damage that was missed when they were treated for more visible wounds. Half of those wounded in action returned to duty within 72 hours _ before some brain injuries may have been apparent. The military just adopted new procedures to spot these cases, too.
Back home, concerns grow about care. The Walter Reed hospital scandal and problems with some VA nursing homes have led Republicans and Democrats to call for better care for this new crop of veterans.
A lucky few get Cadillac care at one of the VA's four polytrauma centers, where the most complex wounds are treated with state-of-the-art techniques and whiz-bang devices like "power knee" or "smart ankle" prosthetics. Others battle bureaucracy to see doctors or get basic benefits in less ideal settings.
Mental health problems loom large. More than a third of troops received psychological counseling shortly after returning from Iraq, and a third of those were diagnosed with a problem, a recent Pentagon study found. The government plans to add 200 psychologists and social workers to help treat post-traumatic stress disorder and other issues.
No one knows what the ultimate cost will be. Harvard University economist Linda Bilmes estimates the lifetime health-care tab for these troops will be $250 billion to $650 billion _ a wide range but a huge sum no matter how you slice it.
Who are the wounded?
Lee Jones, 24, of Lumberton, N.C., was severely burned on the face, hands, feet and legs when his Humvee was hit with an IED two years ago. A partial amputee with speech and other problems from a severe brain injury, he now does work therapy delivering mail at a VA hospital and tries to re-establish life in a nearby apartment with a wife and baby daughter.
Marine Cpl. Joshua Pitcher, 22, from upstate New York, is a Purple Heart recipient who returned to Iraq after he was shot in 2005. Half of his skull was removed to allow his brain to swell as he now recovers from a brain injury and shrapnel wounds from a grenade blast in February.
Maj. Thomas Deierlein, 39, is a New York City marketing executive who served five years after graduating from West Point. Twelve years later, called up as a reservist, he nearly died of bullet wounds that shattered his pelvis, leaving him with a colostomy and learning to walk again.
Joseph "Jay" Briseno, 24, of Manassas Park, Va., was shot in the back of the neck by an Iraqi in the early months of the war. One of the most severely wounded, he is now a quadriplegic, on a breathing machine, blind and unable to speak, but aware of what has happened to him.
"The mistake in Vietnam was, we hid the injured away from folks so they didn't get to tell their stories. Now it's important that we let them tell their stories to the public," said Dr. Steven Scott, director of the Polytrauma Rehabilitation Center at the Tampa VA Medical Center in Florida.
Counting the wounded can be contentious. Earlier this year, the Department of Defense changed how it tallies war-related injuries and illness, dropping those not needing air transport to a military hospital from the bottom-line total.
Bilmes, the economist, thinks this is disingenuous.
"An accident that happens while they're there is a cost of war, particularly when you factor in the length of deployment" and injury-inducing conditions like very hot weather, carrying heavy packs, and more vehicle accidents because it is not safe to walk anywhere, she said.
As of June 2, 25,830 troops had been wounded in action. Of these, 7,675 needed airlifts to military hospitals and the rest were treated and remained in Iraq.
There were another 27,103 non-battle-related air transports. Of those, 7,188 had injuries. Most occurred from vehicle accidents, training or work-related accidents. Ten percent were sports injuries, said Dr. Michael Kilpatrick, who tracks this information for the Defense Department.
Nearly 20,000 of these "non-hostile" airlifts were for illnesses or medical issues: general symptoms like fever or pain needing tests or evaluation; back problems; psychological problems adjusting to being in a war zone; "effective psychoses" (not able to function or care for themselves); neuroses; respiratory or chest symptoms; depression; head and neck problems (including traumatic brain injury); epilepsy; infections, and muscle pulls and strains.
"I don't want to try to say these are not war-related. Being in the military is a very physically demanding job," Kilpatrick said.
For stress-related problems, the military tries "three hots and a cot" _ warm meals and a chance to sleep. Most of the time it works and troops return to their unit, Kilpatrick said.
Of the troops air evacuated to the military hospital in Landstuhl, Germany, 20 percent return to Iraq and 80 percent go back to the United States for more care or disability discharge.
Of the half-million troops who have left active duty and are eligible for VA health care, about one-third have sought it. The most complicated cases end up at one of the four polytrauma centers, in Tampa, Fla.; Richmond, Va.; Palo Alto, Calif.; and Minneapolis.
These were formed after doctors realized they were missing problems _ amputees who were confused and unable to put on their prosthetics because of undiagnosed brain injuries, and guys who could remember their therapy dog's name but not their doctor's, or who could carry on a conversation but not recall what they had for breakfast.
Troops at these hospitals have an average of six major impairments and 10 specialists treating them.
"The important thing to realize is you could have all of them at once" _ trouble speaking, seeing, walking, hearing, etc., Scott said.
Most of these injuries are caused by IED blasts, which send a pressurized air wave through delicate tissues like the brain, sometimes send it smacking against the inside of the skull and shearing fragile nerve connections that control speech, vision, reasoning, memory and other functions. Lungs, eardrums, spinal cords _ virtually anything _ can be damaged by the pressure wave. Injuries also come from collapsing buildings, flying debris, heat, burns or inhaled gases and vapors.
"Many of these you can't see on an X-ray," such as glass shards that can cause internal bleeding, Scott said.
In prior wars, one of every five to seven troops surviving a war-related wound had a traumatic brain injury, the military estimates. It's much higher in this war.
A pilot project at Walter Reed in 2003 to screen 155 patients returning from Iraq found that 62 percent had a brain injury.
"This is a very rapidly evolving area as a disease," with no screening test, agreed-upon set of symptoms for diagnosis, or even a billing code, said Kilpatrick, the military doctor.
Much needs to be learned about how to treat these injuries, he said, but credited the military medical staff for having the chance.
"It's just amazing to me every day when I look at these numbers," he said. "The good news is that the majority of these people who become ill or injured ... are going to survive and are going to be able to return either to the military or to civilian life and be productive."
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On the Net:
Government casualty data: http://siadapp.dmdc.osd.mil/personnel/CASUALTY/castop.htm
State breakdowns: http://siadapp.dmdc.osd.mil/personnel/CASUALTY/STATE_OEF_OIF.pdf
Defense and Veterans Brain Injury Center: http://www.dvbic.org
A reader recently e-mailed me about casualties sustained by his nephew's Stryker unit in Iraq after an attack by an Iranian-manufactured fragmentary device. "Why," he wrote, "are we not leveling the plants in Iran that manufacture these weapons?"
Well, that would make too much sense. It's obvious Iran is at war with us -- and not just in Iraq, where its agents and proxies kill and maim Americans by arming and organizing some of our many foes there. Throughout the region, from Hamastan (Gaza) to Hezbollah-land (Lebanon) to Taliban strongholds in Afghanistan, the Islamic Republic of Iran, along with Syria, is pursuing its war against us, and our interests. But we pretend, as a matter of policy, not to notice.
Why?
I don't claim to know the whole answer, but fear must surely figure into it -- fear of wider war, which I guess is natural, but also fear of a deeper truth, which is more difficult to overcome. That deeper truth starts with the realization that our strategic interests do not lie within the borders of Iraq. After all, what do we get even if the "surge" succeeds in establishing security in Baghdad and even if -- and this is the impossibly big "if" -- the Iraqis manage to establish a functional government?
The answer, under the best of circumstances, would seem to be a Shiite state that not only enshrines sharia (Islamic law) above all, but also promises to be a natural ally of Iran. Which doesn't exactly sound like an ally in the war on terror, or whatever we're calling it these days. Worse, even if we ultimately manage to have established "the new Iraq," we still won't have addressed the greater problems posed by the old Iran and Syria.
And why is it that all we can hope to get out of our costly, lengthy Middle Eastern war is just another Western-hostile Sharia State? Here comes another difficult realization: It turns out that bringing democracy to Islam just brings democracy to Islam. In other words, ballot booths don't change the illiberal aspects of Islam; they merely provide for them to be voted into office.
At the end of the election day, it's still an Islamic culture -- whether it's in Iraq, the shrinking Palestinian Authority, Afghanistan, or elsewhere. As such, it functions more or less according to guidelines laid out in a supremacist theology that fails to recognize the equality of women and non-Muslims, and, in its political manifestations, is doctrinally ill-suited to Western alliances that are anything but fleetingly expedient.
Of course, this realization is the Big No-No, the stake through the heart of multicultural teachings that give life to platitudes that everyone -- every culture, every religion, every people -- is the same, or, rather, wants the same things. (How many times have we heard the president or the secretary of State talk specifically about the normalcy of theoretical "Muslim Moms and Dads," even as actual "Muslim Moms and Dads" were celebrating mass murder committed by their suicide-bomber offspring?) For most, if not all, of our leadership, civilian and military alike, this is the blow to be warded off at all costs. As in: Live multiculturally or die.
And so, it seems, we crouch defensively over Iraq as though the secret to our national security lies within these lines on a map drawn by colonial powers in the early 1920s. We hone in on its provinces, its cities, its sects, its militias, its religious rivalries, its turf battles. We freely risk our men's lives and limbs in its dangerous neighborhoods, along bomb-mined streets, past booby-trapped houses, where we seek to destroy (or arrest) hunkered-down enemy fighters -- as though our men were worth less than their civilians.
Our soldiers learn to tell tribe from tribe and gang from gang, as though it were really our business. And in Baquba this week, where we have massed troops against 300 to 500 Al Qaeda fighters dug in among civilians (because they know we value our men less than their civilians), we are attempting to tell thug from thug. According to The New York Times, our men are equipped "to take fingerprints and other biometric data from every resident who seems to be a potential fighter."
And here lies another part of the answer for my letter-writing reader as to why Iran continues to fire away at us with impunity: In waging war through a microscope, we have lost sight of the big picture.
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"While the democratic party complains about everything THIS President does to protect our Nation": "What would a Democrat president have done at that point?"
"Apparently, the answer is: Sit back and wait for the next terrorist attack."
posted on June 23, 2007 09:14:59 PM new
Well, it's nice to see you finally realize the futility of the war in Iraq.....don't tell me you're actually learning something !!!
You did post the following so there may be hope for you yet....unless , of course, you don't understand your own posts :
Linda_K
posted on June 15, 2007 02:40:06 PM
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"First They Came for the Jews"
First they came for the Jews and I did not speak out
because I was not a Jew.
Then they came for the Communists
and I did not speak out
because I was not a Communist.
Then they came for the trade unionists
and I did not speak out
because I was not a trade unionist.
Then they came for me
and there was no one left
to speak out for me.
: