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Care for Iraq wounded a national shame

Much of the medical care for wounded Iraq vets remains a national shame . Mental problems caused by either brain injury or post-traumatic stress will be a legacy of this war for decades, reports NBC's Robert Bazell.

Much of the medical care for wounded Iraq vets remains a national shame. The mental problems caused by either brain injury or post-traumatic stress will be a legacy of this war for decades.

During emergency operations, the quality of life-saving care to the acutely wounded, the rapid evacuation to hospitals in Germany and the United States, and the dedication of the doctors, nurses and medics involved is extraordinary.

The situation changes drastically once the wounded come home. They face a medical system that is clearly overwhelmed and strapped for resources.

Vast overhaul needed
The reason is clear. From the onset of the war, the government failed to acknowledge the cost of treating so many badly wounded. The news that centered on filthy building No. 18 at Walter Reed Army Medical Center only highlighted a tiny part of a nationwide system that needs a vast overhaul.

Take the case of Sergeant Michelle Rudzitis, who lost her left leg to a roadside bomb. The blast also shattered her pelvis and several other bones. She has endured multiple surgeries and constant pain. Despite all that, she remains an amazingly upbeat person and regards the Army as her family.

“I love everything about it. It’s in my blood,” she tells me.

The genial mode shifts when asked about her stay at Walter Reed. While much of her care has been compassionate and excellent, during her time at Walter Reed she has encountered a bureaucracy often staffed by indifferent, uncaring and overworked clinicians who often fail to show up for appointments, she says.

If the soldier misses an appointment, he or she is punished. When the doctor or social worker fails to appear, there are no consequences.

“Once you become an outpatient, basically it is, ‘here is your wheel chair and thank you for coming,’” Rudzitis told me. “There is no set program. There is no list of people you need to see. There is no ‘how to,’ ‘where to go,’ no phone numbers.”

Treating brain injuries
I have written before about the incidence of brain injury (sometimes diagnosed, but often not), when soldiers and Marines get blasted by numerous roadside bomb blasts. Whatever the quality of body and vehicle armor, the brain — which gets shaken like jelly — is frequently damaged.

Responding to the increasing numbers of troops who suffer traumatic brain injuries along with other wounds, Congress mandated the Veteran’s Administration to set up polytrauma centers at four VA hospitals. The system now has 48 beds nationwide, but what might the future needs be?

“Some of the statistics suggest that 60 percent to 65 percent of the people who are injured may have had  a brain injury,” Dr. Stephen Ezeji-Okoye, deputy chief of staff at the Palo Alto, Calif., VA tells me. “But what about all of the thousands or hundreds of thousands of people who've been deployed who don't identify themselves as having an injury? There could be a huge influx of people that suddenly present.”

That's not counting those who will suffer from post-traumatic stress.

Solving the problems

All of these problems are well known to the commission set up by President Bush when the Walter Reed scandal first broke. The commission’s mandate is to provide a detailed plan for solving the maze of medical problems troops face when they return home.

Commission co-chair Donna Shalala has been a highly competent university president and Secretary of Health and Human Services. However, my greatest faith lies with former senator Bob Dole, the other co-chair.

In the Dole biography “What It Takes," author Richard Ben Cramer describes the young, gravely wounded officer near the end of World War II. Given up for dead time and again, Dole was warehoused for months with little care, left to lie in terrible pain and in his own stench. Two years after his wound, rehabilitation was little help.

“He was knocked back to childhood, learning to walk, eat dress, himself, write … but without even a baby’s physical attainments: control of limbs, the strength to reach, push, grasp. And without a child’s sense of wonder, without the fresh discovery of triumph,” Cramer writes.

When Dole finally found a surgeon in Chicago who could genuinely help him, the Army was no longer paying for his care. The doctor, also a vet, donated his skills. Dole’s family and friends in Russell, Kan., raised the money for his trips to Chicago and his time in the hospital.

Bob Dole knows how much a wounded vet can be forced to endure.  Let’s hope he helps all those who are suffering today.