blog.bioethics.net

The High Price of Caring for Slow-Healing Wounds

Triumphs of modern medicine - of rapid combat deployed medical theatres inside spaces that would truly shock and awe civilians, of battlefield neurosurgery, the ability to evacuate the horrifically injured to bases with the best technology and brightest minds - have dramatically cut down the loss of life on the battlefield, saving many who in prior wars would have been casualties of war.

But coming home, many of these veterans have discovered that although medicine has advanced, bureaucracy has not. This AP story covers how veterans are being cared for, and how they're not. The major problems something I have seen echoed in other stories, and heard first hand, are threefold:

First, and perhaps foremost, is the simple matter of math. In Vietnam and Korea, there were 3 wounded for every death. Now, because of the advances in battlefield medicine, body armour, and etc, the numbers have shifted dramatically - 16 wounded for every death. This is a good thing, except for when the high rate of wounded come back, needing care, and overwhelm a system that is still expecting to and designed to handle the number of casualties seen in previous wars.

This ties directly into the second issue, which is that the injuries sustained today are different injuries than in the past. This again is for a combination of reasons, but the result is that our veterans come home with injuries that do not heal within a short amount of time. They suffer long term, chronic conditions, the loss of limbs, brain or nervous system damage. By most accounts, the VA does an excellent job at handling the short term, immediate care, especially for the obvious wounds. The problem comes when rehabilitation is cut off early, if it ever begins, or mental distress such as PTSD crops up later.

And this is the third, perhaps largest, area for concern. There is a culture in the military that derides that which cannot be seen - mental illness, PTSD, anything that you can't slap a bandage on. If you can't see it to treat it, there is question of whether or not it's real. Or maybe you're just weak. Reports are out there of people being run out of service for PTSD, claims denied, counseling refused. Servicemen and women are lucky if they can get medication to sleep at night, let alone function through the day. According to the article I linked to, there 1.4 million troops have been deployed in the current war effort - yet less than 100,000 have been treated for PTSD.

The culture of shame is slowly changing - it has to, too many people are suffering. But it doesn't do a lot of good for the culture to change if the system doesn't change with it. As is, our medical care for veterans is continually failing those who have put everything on the line to do what their country has asked, regardless of their own personal feelings on these orders. Isn't it time we focused beyond the short term care of saving lives, and looked at the quality of the life, and the care given, further down the road?

-Kelly Hills