Improving health care for veterans has become a matter of national attention and has gained increasing attention from the medical community. With the current surge of veterans reintegrating into civilian society it is critical to improve the training of the next cadre of providers who will provide care for our veterans. It is widely known that veterans receive care in all aspects of the health system, thus providers in veteran focused care facilities, military health serves and civilian locals must be aware of the unique needs of veterans. It is perhaps even more important to educate civilian providers who may be unfamiliar with the unique physical, mental and emotional needs related to military service. Course Audience - all health professions learners, example: - medical students, resident physicians, dental students, - nursing students, advanced practice nurses, - social work, pharmacy student as graduate level learners - as well as any and all health professionals interested in veteran-centered care What You Will Learn: This course will provide learners the opportunity to engage with material to facilitate their understanding of the origins of Academic Medical Centers and Veterans Administration affiliations, recognize and manage the influence of bias, class, and power on the clinical encounter and self-reflect on their biases that particularly affect U.S. military veterans. This course also features several video clips from the acclaimed documentary, Where Soldiers Come From, directed by Heather Courtney. The views expressed in this course are those of the authors and do not necessarily reflect the position or the policy of the Department of Veterans Affairs or the U.S. government.
06.02 - Where Soldiers Come From& the Impact of Combat Related Illnesses (Part 2)
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Из курса от партнера University of Michigan
Service Transformed: Lessons in U.S. Veteran Centered Care
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Unit 6
Unit 6 highlights the importance of partnership and collaboration across professional disciplines to enhance veteran centered to achieve optimal health.
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Monica Lypson, M.D., M.H.P.E.Associate Chief of Staff for Education, Ann Arbor Veterans Affairs Healthcare System and Professor of Internal Medicine and Learning Health Sciences
University of Michigan Medical School
Paula Ross, Ph.D.Director, Advancing Scholarship and Medical Sociologist
Office of Medical Student Education
The next two segments are actually quite exciting.
And we're going to talk about where soldiers come from.
Where soldiers come from was a very important documentary that really had
an impact on how I thought about veterans.
We've shown clips of this video as well as the entire documentary to various faculty
and learners to really understand why veterans
might enlist, what's the process of reintegration, etc.
And here's a quote from the producer director of this documentary.
Her goal was to get to know the soldiers as people rather than soldiers,
and I think that the film does a nice job of that.
Heather Courtney returned to her home town in the upper peninsula of Michigan,
and really followed the trajectory of several young men as they went from
teenagers to soldiers to veterans, and what the impact of
combat-related illnesses had on their life and their transition and reintegration.
So I think, when you watch these clips, you'll get an idea about
some of the issues we talked about, both in unit five around reintegration, and
also some of the issues that we talked about in the previous segment around
common mental health issues related to veterans.
This is where you can find the video if you want to watch the entire documentary.
So this clip is from Dom.
>> I'm Dominick Spenelli, I'm age 20.
[MUSIC]
>> Yeah, this shoulder, it should be higher.
Yes, that's it, and this shoulder should be even lower.
And that's it, everything's correct.
>> I think I want to get like as much school as possible.
I'd love to just sit at a desk and draw all day.
>> Who did that?
>> Me. I did everything.
All this shit.
I did all this shit.
>> I wasn't too sure about him when I first met him.
[LAUGH] He was different,
his style was different but I think that's what made me like him.
I like that part.
>> That one that looks all old?
>> We're pretty attached really soon on.
And we really click.
I'm very comfortable around him.
Just seem like he was supposed to be good.
I felt good, so.
Never came to my mind that I would ever date someone in the military,
so it's all >> Get kicked out of the army for that.
>> I joined the National Guard just for
the money and the fact that it's only one weekend per month.
I basically just asked all my friends if they were interested in making money.
So now there's like eight or nine.
Now it's a committment that we all made.
Now we're all doing it together.
You hear rumors like we'll be going by then and there but
you really don't know what to believe.
And we talk about it, what it's going to be like to leave and
like what it's going to be like to come back.
We don't really talk about one of us get shot,
which one's going to pick him up really.
>> Nice job.
>> [SOUND] I, put on like,
sixty five pounds,
since basic.
>> [LAUGH]
[SOUND]
>> Always fucking around.
>> Is there anybody here that has not been overseas?
Our very first convoy we got into country we got hit by an RPG.
It's serious business over there.
>> Did you see that?
>> Yeah. >> The fucking window opened.
>> I was right there.
>> Boom. >> I was right behind you.
>> I almost shit myself.
I turned around and I saw it.
>> Good afternoon. >> Good afternoon.
>> Is a real life things for you that we saw over there, all right?
Take this training serious, during our time there we had 27 Purple Hearts.
We don't want you to have to put one those on your soldiers' chest.
IUD went off right next to him, two weeks ago just had surgery again.
We've been home over two years.
That's how bad he was- >> All right listen up.
The part you've been waiting for, I guess.
Permanent orders 1A08101005.
The Army National Guard Unit and
their members are ordered to active duty in support of OEF.
So we're doing Operation Enduring Freedom in Afghanistan,
the effective MOV station date 1201.
[MUSIC]
>> We're doing a cache sweep, it's a mine detector and a pick axe.
[MUSIC]
Pretty much it?
>> Yeah.
>> Right here. [MUSIC]
>> Man, this sucks!
[MUSIC]
Holy fuck does that smell good.
>> It's their shitter, man.
>> Dude you gotta sweep it all right.
>> Come on.
>> If you find something in there I dig it up anyway, so just sweep it.
>> Pretty serious sitting here man.
Now they're all laughing at me.
Thanks a lot.
[MUSIC]
That thing is just glorious.
Smell it for awhile.
You want to see it.
Hear it?
>> Yeah.
>> Okay.
>> That's fucking' it man.
Nothing, nothing.
>> Fuck.
Just fuck.
Fuck it.
Right. >> Mac, you want to come dig on
all this shit?
We've got it.
That's mines.
>> Looks like an IED.
>> That's kind of what it looks like.
>> Yeah, we don't want back business.
>> Something is there.
At least two.
>> Another IED.
>> The same one.
The same one.
>> Roger we have a fine break.
>> Supposedly the land owner that owned the land is going to jail.
Like I don't look at as I put a Taliban in jail.
If he was even Taliban or not, I don't even know.
I look at it as I affected that guy's life for the rest of his life.
Everyone around him It's going to be affected by it, and
then at the same time I found a cache.
And that IED won't ever explode, so I also affect people in that way.
So it goes both ways for a lot of things.
I mean, these people farm and take care of their families.
They barely have any money and then maybe a Taliban guy will come in,
give them a bunch of IED's, and tell them to put them in the road or
they're going to kill his family or he's not going to get the money.
So, he's going to put them in the road.
The thing is, if someone came to your house in the United States and
said, shoot your gun at that cop car when it drives by, or
else I'm going to come here tomorrow and kill your two young daughters, and
your family, and then you have to base on how you would react.
A lot of people get blown up by an IED, and
they want to run off and kill whoever pulled the trigger.
Even when I got blown up, I kind of asked myself why it happened.
>> We're here for the reintegration workshops Supporting the soldiers.
>> Shots.
What a stupid weekend.
>> Three months.
We've only been home about three months.
He's kind of changed a bit, and I guess it's just a little odd to get used to,
and It's been stressful.
>> From the deputy chief of staff in the United States Army National Guard.
There's a particular concern for members of the 1431st [INAUDIBLE] company the unit
has been nationally recognized for
surviving repeated attacks by improvised explosive devices.
The severe blast that goes with an IED can damage a brain and
lead to a condition known as TBI, Traumatic Brain Injury.
A TBI is often known as an invisible wound,
due to the fact that you may need, may not see physical damage to the head.
However, because of the effects on the brain usually there's a behavior change or
memory problems,TBI.
>> Do you think you have that?
>> Probably.
Traumatic brain injury? [INAUDIBLE]
my traumatic brain injury.
>> So why are you so hostile?
He always tells me that he's never been like this before,
and then now he comes back and he's more You're in a bowl, and restless,
and he is relating it to being deployed.
[SOUND] And then it's hard, because sometimes I don't understand.
Trying.
[SOUND] Before, he never snapped like that.
Over, like a cup being in the wrong spot or something.
Everything's hard right now, Heather.
>> Tired right now, I want to go home.
They said that, I'm probably suffering from a major case of TBI.
I mean, you can't do anything for the brain.
I mean there's no treatment for TBI.
I mean a little bit more anxious, irritable.
>> Let's go.
>> All right, good afternoon.
[APPLAUSE] The first image [INAUDIBLE] is soldier.
I went to Afghanistan in 2009 with my friends and the National Guard.
That was the craziest thing I learned over there, is that
a lot of people that do put bombs in the roads are paid to do it by the terrorists.
Where they're paying innocent people to do bad things.
The second image, which is the blue, it's the word changed.
>> Getting your mind set from just being a normal college student to be preparing to
go to war, was one of the most difficult transitions in my life thus far.
The third image is a teenage boy, small town boy.
This image is a teenager to represent a pre-war in my younger days.
I tried to make the character look more carefree than the soldier.
Working this big was a huge accomplishment and a great confidence booster for myself.
And I just want to expand my graffiti and urban art in my next couple years up
in Grandview.
>> I think it's very appropriate, [INAUDIBLE] changed.
I think it's great and I'm really glad he did it.
I think, really showed his character a lot.
>> Give him one, Charlie's Angels.
[LAUGH] >> There you go.
>> [LAUGH] >> You're completely embarrassing me in
front of the whole art department.
>> So you just watched a clip.
The director was kind enough to give us permission to collapse Dom's story into
a short clip, and in that story, we want you to think about
how the patient's history might have impacted their current medical condition.
How military service might influence their patient's history or
what their presenting with.
And investigate their trajectory of transition or
re integration from active duty, a service person to civilian.
The second clip that you'll watch is another gentleman in the same cohort,
Bodey, and what his experiences were as he went off to Afghanistan.
>> Spanksuaries.
>> [LAUGH] >> [LAUGH]
>> Is you're being here with the guys
you know.
I'd rather have these guys have my back, than some guys I never grew up with,
because I know these guys and I really be behind them.
Sure they know the same thing, so.
>> Fuck you.
I need it, this thing sucks.
Emily Gum Truck driver.
I love my job.
[INAUDIBLE] truck and you get hit the most.
So it's always more exciting.
When you find IED's, it's real fun.
>> Who goes to film festivals?
Hippies.
I like good film.
I don't like hippy films, where you watch a balloon for an hour and a half.
>> [LAUGH] >> That is why America is going
down the shitter is because of fucking hippies dude.
They're not even real hippies.
No, they're like fake hippies that smoke a lot of pot.
>> All real hippies wanted to do was get high and [SOUND].
Now all they do is get high.
>> [LAUGH] It just opens the mind.
You're just jealous.
>> No. I'm not jealous.
Trust me. I've been down that road.
Open the mind.
All I did was [NOISE] >> IED, IED
[SOUND] Gunner's good.
>> Good.
>> Your truck all right?
>> Roger, truck's great.
It's probably command wire.
We're going to need a dismount team at our location, over.
>> It was one of the most exciting things I've ever done.
But afterwards you start thinking about it That was fucking, that was pretty scary.
It was better than any drug I've
done in my entire life.
[SOUND] >> Holy shit.
[INAUDIBLE] >> RPG out out.
>> Driver.
Driver, get the hell out of here.
[SOUND] >> Whoa.
I got permanently grounded because I've been blown up too many times.
Said that I can't go anymore because I have too many concussions.
So, I've pretty much been in every blast there was.
I don't want to be the psycho, fucking, crazy PTSD or anything but I don't think-
>> [MUSIC]
>> [NOISE]
>> They don't know what's going to happen.
[INAUDIBLE] what my brain's going to look like when I get older.
>> What does it look like now?
What did the CAT scan show?
>> I've been playing professional football for
20 years >> Okay,
make sure your weapons systems are perfect.
Check your ammo, keep your eyes open.
>> They don't what's going to happen because like with sports concussions,
it's like a hit to your head.
When you get blown up it's a concussion through your entire body, so
they don't know.
They say I could be find in 50 years or I could be drooling.
Not be able to do anything in 50 years, I don't know.
>> That's fucked up.
>> Mm-hm.
>> Why didn't you tell me this?
>> I told you that.
>> No you didn't.
>> That's a thing they don't know [INAUDIBLE] They say at 50 years old
I'll be stronger than an ox.
I'm going to be 50 years old when I start- >> Applies to them.
>> I've been through the VA six times, so fucking ridiculous.
I've done three labs, two CAT scans,
four fucking TBI tests, just stupid.
I have all sorts of stupid fucking medications.
I don't even know what they are, I don't even take them.
The only thing I take is the Ambien.
The rest of the shit, I don't know what the fuck it is.
I don't even sleep anymore, ever.
I'm so tired right now, though.
[SOUND] I'd rather just be back in Afghanistan, life is easier.
All you gotta worry about is getting shot at and blown up.
>> Can I see your slip?
>> Sure.
>> Mental health evening, yeah.
>> So, maybe I'll take him over there.
>> So, yeah, would you like to take him over there?
>> Okay, thank you.
>> You're welcome.
>> They did a lot of psychological background stuff.
That's pretty much what the whole thing was about.
I don't know,
I probably told her things that I haven't told anybody in my life really.
But I don't know why either, she was really nice.
It's the way she looked at you, she looked you right in the eye,
she didn't look away from you.
That's what I liked about her, she didn't say,
I think you should go see this, or you should go do this.
She just listened to me pretty much.
Yeah, there's a couple incidences I would tell her
that I'm not comfortable talking to a lot of people.
And some things aren't, stuff like that.
>> So again, once you've reviewed Brody's story, think about how you
might formulate a patient-centered approach to individuals with TBI,
traumatic brain injury or post traumatic stress disorder.
How might you enhance your diagnostic acumen in the area of military service
related mental illnesses?
What do you need to learn about?
Think about how you might propose a management strategy for this or that or
any other veterans, and hopefully, reviewing this will have you enhance
your skills and clinical assessment skills around mental illness in general.
You'll have some assessment questions to ask about what the clues were to
Brody's diagnoses.
What are the potential barriers in his treatment?
And finally, just to reiterate, this film and these clips hopefully give
you an idea about what it's really like to be, in this case they were soldiers so
they had enlisted into the National Guard or in the Army.
But how the impact of any active duty military
service might have on individuals as people.
The other thing you really want to remember is that mental health
issues are common and sometimes we really need to employ a team approach.
And that's what we'll focus on in the next segment about the implications and
how to deal with mental health issues or
other issues as it to relates to veteran-centered care.
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