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Service and Deployment - med.upenn.edu
Transcript of Service and Deployment - med.upenn.edu
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From War to Home:The Health Impacts of MilitaryThe Health Impacts of Military
Service and DeploymentGala True, PhD
Philadelphia VA Medical Center
University of Pennsylvania School of Medicine
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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/OIFReview findings from a community engaged research project with OEF/OIF Veterans to gain insights into health impacts of military service
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Do you routinely ask your patients h h h d i hwhether they ever served in the
military?y
1= Yes1= Yes2= No
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The Unasked Question*The Unasked Question
Military health history:• Did you ever serve in the military?• When and where were you stationed?
W d t A t O ?– Were you ever exposed to Agent Orange? – Were you ever treated for parasitic or tropical diseases?
• What was your job description? y j p• Were you physically injured? • Have you ever been treated for a service‐related condition?condition?
• Were you affected psychologically by your military experiences?
*Brown, J.L. JAMA. 2012; 308 (18): 1869‐1870.
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What percentage of the U.S. population of males > 65 years old are veterans?*veterans?
1 10%1=10%2=25%3=40%4=50%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. 2010 American Community Survey 1—Year Estimates. http://www.census.gov/acs/www/.
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Over 20 million U.S. veteransOver 20 million U.S. veterans
• Less than half (40%) receive some portion ofLess than half (40%) receive some portion of care from Veterans Health Administration
• Majority use health care resources covered by• Majority use health care resources covered by Medicare, Medicaid, or private insurance
2 6 illi 9/11• 2.6 million post‐9/11 veterans– 17% women
– 26% are 55 years +
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PhotoVoice as an Educational Intervention f / *to Improve Care of OEF/OIF Veterans*
• 40 Veterans who had served at least one 0 ete a s o ad se ed at east o edeployment 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,
d ti l h lth?and emotional health?– What challenges do you face when you come home? – What barriers and facilitators do you face when itWhat barriers and facilitators do you face when it comes to accessing care?
– Where do you find strength and support?
*VA HSR&D Grant PPO 10‐255, PI: True
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Images from DeploymentImages from Deployment
• Environmental exposuresEnvironmental exposures
• Extreme physical stress
i d l l• Disrupted sleep cycles
• Loss of comrades/survival guilt
• Military Sexual Trauma
• Combat exposure/traumasCombat exposure/traumas
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Photo courtesy of Sam Console http://www.serviceandsacrifice.blogspot.com/ 9
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11Photo courtesy of Sam Console http://www.serviceandsacrifice.blogspot.com/
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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.
Th b thiThey burn everything there…trash, feces, everything.
I developed a nasty cough from it.
You get used to it…
You have more things toYou have more things to worry about than what you’re breathing in.
Drew B.
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This is for my friend Mark. I was with him when he
got killed;he got shot right through
the headthe head.
It bothered me quite a bit.
He had a wife and three kids.
I can’t stop feeling guilty about his deathabout his death.
If it had been me it would not have been such a big deal.
Tommy C.
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We had an Air Force lieutenant almost got
d th braped 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.
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That was a bad day. There was a group from the 101st staying there and they had a car bomb thatThere was a group from the 101 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 got a lot of bad dreams from that dayI ve got a lot of bad dreams from that day.
LRD
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Making the TransitionMaking the Transition
• Suicide and suicidal thoughtsSuicide and suicidal thoughts
• Coping through alcohol and drugs
l• Unemployment
• Difficulty driving
• Homelessness
• Complicated family reintegrationComplicated family reintegration
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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,g y ythen 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 ’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.
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Back from our second deployment, we were away for training.M d kill d h lfMy 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.
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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 teamI 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 numbAlcohol makes me numb. For me, numb is as good as it gets
sometimes.
Michael B.
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When you’re an infantry guy, they give you whatever you want to either stay up or to go to sleepto 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. Th h j ff hThen they just cut you off when
you get back. They tell you— this was our
briefing –‘Whatever happened over thereWhatever 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 shouldersworld on my shoulders.
Jamie B.
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I feel like an alien in civilization. It makes it tough for me toI 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.
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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 p gnightmares;
it's wrongly imposed on me.
When I think about my time there, y ,
I don't have a welling of pride.
Overall, it was a damning experience.
Toby BToby B.
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I don’t do good with crowdsI 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.I feel like I can t be in control if there s that many people.
Tiffany J.
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Five years after leaving IraqIraq
I still have anxiety driving.
When I am confined with tno way to escape,
it feels like I am being funneled into a kill zone.
Tracy P.
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I was feeling really down thatI 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 unemployed and I’m havingI m unemployed and I m having trouble getting work.
I saw that as having still a long road, trying to get back into the workforce.the workforce.
And also, just in life in general; I still have a long way to go.
Philip LPhilip L.
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My mom took this photo the morning I came home from Iraq.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.
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Barriers to CareBarriers to Care
• Frustration with paperwork and bureaucracyFrustration with paperwork and bureaucracy
• Stoicism/culture of silence
di i• Medication– Perception of overreliance on drugs for treatment
– Adverse reactions
– Trade‐offs between taking meds for pain/anxiety and functioning
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I shot this to express how I feel about the healthcare system.
It is like a maze.
The system is not set up for l t t lk th h thipeople to talk through things.
When I finally got a doctor, my practitioner was asking me
this battery of really intrusivethis battery of really intrusive questions,
but there was no space to work it out.
There is a serious lack of listening.
People will ask you questions, p y q ,but no one is listening to you.
Chantelle B.
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We had a lot of females that got raped.
We had males that got raped. Okay?
You’re in that situation whereYou 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 reportedSo, 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. y
Raquel R.
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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 p , yknow?
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.
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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 h ll ’go on happy pills.’
Scott S.
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Resilience, Healing, & the FutureResilience, Healing, & the Future
• Ways of healingWays of healing– Writing, art, being outdoors, being with other veteransveterans
• Seeking out peaceful spaces
F il• Family
• Pet therapy
• Finding a ‘new normal’
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d b k lI ride my bike a lot.It helps clear my mind.
This tattoo, my brother got it
and I did it just to match himmatch him.
I am really good friends with my little brother.
We grew up together and have just been
carrying on like little y gkids ever since.
Tommy C.
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These are the things that decorate my room.
I like to do the drawing and color them inand 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 CMichael C.
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It was really serene.
Everything was perfectEverything was perfect.
There was nothing bad about that day.
I really needed a day like that;I really needed a day like that;
I just got to contemplate a lot of things.
I don’t really get too many y g ydays like that.
Micky D.
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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 h b lf?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.
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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
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I think there’s a desire in our culture to forget, to move onmove 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 could quickly make it into GI Joe.
I never imagine a cure.A d it’ diffi lt f i th diAnd 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.
LRDLRD