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Military medicine better in US than in Britain
- tony hall (20 March 2007)
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Memorializing our Mental Health Commitment
- Stefan P. Kruszewski, M.D. (21 May 2007)
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tony hall, Retired Consultant Physician (Home address): 5 Manland Avenue, Harpenden, Herts. AL5 4RE
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My experience as a physician in the US Army in Vietnam, the Walter Reed Army Medical Center in Washington, DC, and the Ministry of Defence in London has shown me that the care of wounded troops is far superior in the US than in Britain. My son recently trained in the US Army in the infantry and then as a combat medic. He never complained about the quality of the training or medical care of the troops. Uwe E. Reinhardt, a professor of political economy, noted reports in the Washington Post that seriously wounded soldiers at the Walter Reed Army Hospital were housed in rodent-infested wards with holes in the ceiling and peeling paint on the walls. The commanding general has been fired, and hopefully, the problems have been cured. Wounded British troops have fared much worse recently in British hospitals. Troops with bullet wounds and amputated limbs are being treated on open wards, next to civilian patients, including pensioners and mentally ill patients at Selly Oak NHS Hospital in Birmingham (Ref. 1). The troops have been abused on the wards by British Muslims who are anti- war (Ref 2). I reported the superior treatment of wounded US military in Veterans' Administration Hospitals in all major US cities throughout America (Ref 3). The US Military Hospital at Ramstein in Germany has an excellent record of care for our soldiers (Ref 4). I advised Des Browne, MP, the Secretary of State for Defence, to visit US Military Units in my letter to him (Ref 3) and he did not reply to my letter. Yours faithfully, Tony Hall Ref 1: Rayment, S. 'Injured troops put into mixed civilian wards'. Sunday Telegraph, 17th September 2006. Ref 2: Watt, J. 'Servicemen should be treated in secure surroundings'. Daily Telegraph Letters, 4th October 2006. Ref 3: Hall, T. 'Lessons not learned over the care of wounded soldiers'. Daily Telegraph Letters, 5th October 2006. Ref 4: Shanahan, P. 'Soldiers in hospital'. Daily Telegraph Letters, 13 March 2007. Competing interests: None declared |
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Stefan P. Kruszewski, M.D., Psychiatrist, addictionologist Harrisburg, Pennsylvania 17112 USA
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Uwe Reinhardt’s remarks, in a piece titled the “The trouble with US military medicine’ was published in 17 March 2006 BMJ. (1) In it, he says that America’s high-ranking political commitment to our soldiers is more in word and pageantry than deed and resolve. He highlights the deplorable conditions of Walter Reed Army Hospital. He asserts the failure of America’s top military officials to recognize and accept the negative consequences of their decisions to send troops into Harm’s Way. I agree with both the substance and spirit of his comments. Reinhardt, however, does not go far enough in his criticism---at least as it fails to illuminate the psychological problems and the inadequate supportive mental health treatment of war veterans. Those problems include: 1. Inability of the American mental health system, primarily through lack of funding and failure to (generally) attract sufficient numbers of highly qualified personnel, including clinical psychologists and psychiatrists, to understand the differential diagnostic nuances of returning veterans. • That lack of a resource includes the inability of many clinicians to discriminate the psychological elements of posttraumatic stress disorder from the neuropsychiatric sequelae of toxic exposure, closed (or open) head injury, response to physical trauma, and adverse effects of post-war illicit drug and polypharmaceutical treatments. (2) 2. The failure of American mental health systems, including the poorly-funded Veterans Administration and any other system designed to treat war-affected individuals, to plan for not only the acute manifestations of serious mental problems that confront returning vets, but also those that will plague them, and their families and loved ones, for years. • This obligation goes far beyond preventing suicides. (2, 3, 4) 3. To anticipate the negative psychological responses, including the likelihood of significantly delayed onset, of veterans and veterans’ families who become increasingly aware as years pass that they and their loved ones may have been sent to war for reasons other than they once believed. • Physical and mental disabilities can explode when an individual suddenly recognizes that he or she has been misled, misused, or, as Reinhardt states, becomes aware that he was exploitable ‘human capital.’ What happens to a fighting man or woman who realizes he or she has fought not for honor and glory(as in World War II) or the realization of the American dream(the Revolutionary War), but perhaps for some less honorable cause? 4. The gamut of emotional reactions and behaviors that result from dishonesty, deception, misrepresentation, torture, drug addiction, joblessness, social alienation, family dysfunction, cognitive impairments, helplessness, loneliness, rage, disenfranchisement, disease, dismemberment and death. • The resources needed to effectively deal with these issues do not come from a medicine bottle, so treatment cannot be hastened by psychiatric drug prescriptions provided in the context of ten-minute sessions every month [even if the personnel were available to exercise that solution.] The solutions must come from a willingness to put forth an enormous multi-focused effort that include the finances and personnel available to address long-term mental, emotional, addictive, cognitive and physical health demands, as well as occupational, financial, family, social, spiritual, and interpersonal needs. America’s Memorial Day 2007 is upon us. We can do better for those who serve on behalf of our Republic in these trying times. Stefan P. Kruszewski, MD Harrisburg, Pennsylvania USA 17112 (1) Reinhardt, U. (17 March 2007). The trouble with US military medicine BMJ; 334:565 (2) Tomlinson, K. (Accessed 5.19.2007). Treating Veterans with Serious Mental Illness—The VA’s Ability to Deliver Quality Care. Accessed at http://www.nami.org/Template.cfm?Section=Issue_Spotlights&template=/ContentManagement/ContentDisplay.cfm&ContentID=26966 (3) nbc6.net. (Accessed 5.19.2007). Report: Vets Mental Health Treatment Poor. Lack of 24-hour care Options Concerning. Accessed at: http://www.nbc6.net/health/13296699/detail.html (4) Veteran Administration Office of Inspector General, Washington, DC 20420. 10 May 2007. Healthcare Inspection. Implementing VHA’s Mental Health Strategic Plan Initiatives for Suicide Prevention. Report No. 06-03706-126 Accessed on May 18, 2007 at: http://www.va.gov/oig/54/reports/VAOIG-06-03706-126.pdf Competing interests: None declared |
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