Thursday, March 05, 2009

Traumatic Brain Injury

As Cedric and Wally noted (see their "Belle of the ball" and "THIS JUST IN! MARTHA STEWART, WATCH YOUR BACK!"), today Barack holds his big health conference. Not "on the table" for our 21st century Martha Stewart is single-payer health insurance. Remember that as you read Kenneth J. Theisen's "Obama Calls for Record Military Spending!" (World Can't Wait):

When George W. Bush was president he often referred to himself as a "war-time president." And with two official wars and military attacks against many other countries he deserved the title. But most of the American population got tired of more than seven years of war and Barack Obama was elected. Despite what he actually said, many that voted for him expected him to end the war policies of the Bush regime. But with the submission of his record military budget; his decision to increase the size of the military by nearly 100,000 troops; his decision to send 17,000 more troops to Afghanistan; and his decision to leave tens of thousand of troops in Iraq; it appears that Obama also wants to be known as a "war-time president." Okay! I know he really does not want to be called that, but he certainly deserves the title as much as Bush did. At least Bush was half-way honest about it.
Obama's baseline Pentagon budget will be is $533.7 billion for fiscal year 2010. This is about 4% more than the last year of the Bush regime. But it does not include the costs of fighting the wars in Iraq and Afghanistan (The White House is also asking for another $75.5 billion in supplemental funding to finish out fiscal year 2009, which ends September 30, 2009. It is further asking for $130 billion in supplemental funding for fiscal year 2010, and this will likely not be enough to actually fight those wars in 2010.)
Obama's Pentagon budget does not include the cost of maintaining and improving the nation's nuclear stockpile (that is in the Department of Energy Budget), and it does not include the tens of billions spent on intelligence agencies such as the CIA and NSA, which are also involved in the war-making of this country. The $533.7 billion also does not include the Veteran Affairs budget where Obama is asking for $52.5 billion in funding or the $42.7 billion he wants to spend on Homeland Security, or the $51.7 billion he requested for foreign affairs which includes billions to be given to Afghanistan, Pakistan, Israel, and other nations to fund the "war on terror." When all the military and war-making costs are added up, the cost of making war approaches a trillion dollars per year for the U.S. Obama is the commander-in-chief who presides over this vast war machine which destroys people and wealth. All these costs are expenses necessary to continue the U.S. empire around the world.

Debra Sweet also has a strong commentary at World Can't Wait and we'll try to note that in today's snapshot. Touching on health care again, Gregg Zoroya's "360,000 veterans may have brain injuries" (USA Today) reports:

Pentagon officials estimated for the first time Wednesday that up to 360,000 Iraq and Afghanistan veterans may have suffered brain injuries. Among them are 45,000 to 90,000 veterans whose symptoms persist and warrant specialized care.
Army Brig. Gen. Loree Sutton provided the estimate during a news conference about March as Brain Injury Awareness Month. She heads the Pentagon's Centers of Excellence for Psychological Health and Traumatic Brain Injury.

AP's Pauline Jelinek observes that "roughly 1.8 million" American men and women "have served in Iraq and Afghanistan" and that, prior to yesterday's announcement, the highest estimate had been by the RAND Corporation which offered the figure of 320,000.

The Defense Centers of Excellence is part of the Department of Defense and focuses on TBI and psychological health. Kathy Helmick is the Director of TBI Clinical Standards of Care and we'll note her post "About Traumatic Brain Injuries" in full (assuming it to be the equivalent of a press release):

March is Brain Injury Awareness Month and this provides an important opportunity to discuss issues that our warriors and their families face, including the three different categories of traumatic brain injury (TBI): concussion, moderate TBI and severe TBI. Depending upon the degree of TBI, service members can face problems related to attention, memory, behavioral and physical issues, all of which can affect how they function and feel on a daily basis.
Concussion, also known as mild TBI, can be difficult to detect. Concussions are caused by events that entail a blow or jolt to the head, where the person does not necessarily become unconscious. Experiencing multiple concussions within a short period of time can provoke more severe damage than might be warranted by the last injury suffered alone, so it is important for those who have experienced concussions to seek help.
Moderate TBI results in an event-related period of loss of consciousness and observable deficits such as ongoing confusion for days to weeks. Most service members who have experienced moderate TBI are evaluated at theater level medical facilities, and evacuated back to the United States for care.
Severe traumatic brain injury is characterized by an extended period of unconsciousness or amnesia after the injury. The Joint Theater Trauma System, an in-theater trauma care regulating system, helps to insure that wounded warriors with sever head injury go to a theater medical facility with neurosurgical capability. These injured service members have immediate emergency surgical treatment and then have ongoing treatment in the United States.
A very important misconception about traumatic brain injury (TBI) is that it equals a mental health problem - it does not. TBI does have a number of different health components including mental, behavioral, physical and spiritual, however that does not make TBI a mental health issue.

NCD is the National Council on Disability and they issued a report yesterday (which opens in Microsoft Word). This is their press release on the report:

NCD #09–577
March 4, 2009
Contact: Mark S. Quigley
202-272-2008

National Council on Disability Says More Needs to be Done for Service Members and Veterans with Post Traumatic Stress Disorder and Traumatic Brain Injury

WASHINGTON -- The National Council on Disability (NCD) today released a report recommending changes in the continuum of health care provided to service members and veterans with Post Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI).

According to NCD Chairperson John R. Vaughn, "The wars in Iraq and Afghanistan are resulting in injuries that are currently disabling for many, and potentially disabling for still more. They are also putting unprecedented strain on families and relationships, strain that can contribute to the severity of the service member's disability over the course of time."

"The Department of Defense (DoD) and the Veterans Administration (VA) have initiated a number of improvements in the delivery of health care for service members and veterans with PTSD and TBI. They are to be congratulated for these efforts, but more needs to be done."

"Medical and scientific knowledge needed to comprehensively address PTSD and TBI is incomplete. However, many evidence-based practices do exist. Unfortunately, service members and veterans face a number of barriers in accessing these practices including stigma; inadequate information; insufficient services to support families; limited access to available services, and a shortage of services in some areas. Many studies and commissions have presented detailed recommendations to address these needs. There is an urgent need to implement these recommendations," Vaughn concluded.

The report, Invisible Wounds: Serving Service Members and Veterans with PTSD and TBI (http://www.ncd.gov/newsroom/publications/2009/veterans.doc), addresses those concerns and makes 10 recommendations.

1.

A comprehensive continuum of care for mental disorders, including PTSD, and for TBI should be readily accessible by all service members and veterans. This requires adequate staffing and adequate funding of VA and DoD health systems.
2.

Mechanisms for screening service members for PTSD and TBI should be continuously improved, including baseline testing.
3.

The current array of mental health and substance abuse services covered by TRICARE should be expanded and brought in line with other similar health plans
4.

Early intervention services such as marital relationship counseling and short term interventions for early hazardous use of alcohol and other substances should be strengthened and universally accessible in VA and TRICARE.
5.

DoD and VA should maximize the use of Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) veterans in rehabilitative roles for which they are qualified including as outreach workers, peer counselors and as members of the professional staff.
6.

Consumers should be integrally involved in the development and dissemination of training materials for professionals working with OIF/OEF veterans and service members.
7.

Current and potential users of VA, TRICARE and other DoD mental health and TBI services should be periodically surveyed by a competent independent body to assess their perceptions of: a) the barriers to receiving care, including distance, cost, stigma, and availability of information about services offered; and b) the quality, appropriateness to their presenting problems and user-friendliness of the services offered.
8.

VA should mandate that an active mental health consumer council be established at every VA medical center, rather than have this be a local option, as is currently the case.
9.

Congress should mandate a Secretarial level VA Mental Health Advisory Committee and a Secretarial level TBI Advisory Committee with strong representation from consumers and veterans organizations, with a mandate to evaluate and critique VA's efforts to upgrade mental health and TBI services and report their findings to both the Secretary of Veterans Affairs and Congress.
10.

Congress and the agencies responsible for the care of OEF/OIF veterans must redouble the sense of urgency to develop and deploy a complete array of prevention, early intervention and rehabilitation services for PTSD and TBI.

NCD is an independent federal agency responsible for reviewing and evaluating policies, programs, and practices that promote the full integration, independence, and productivity of people with disabilities, and for advising the executive and legislative branches on matters affecting people with disabilities.

For more information, please contact NCD’s Director of External Affairs, Mark S. Quigley, at mquigley@ncd.gov or by telephone at 202-272-2008.


Meanwhile Martin C. Evans takes the local pulse in "Snapshot: Local opinion on Obama plan to end Iraq war" (Newsday) and we'll note this opinion expressed by Mark Dudenhoffer:


"For us just to leave is a sour feeling because we lost a lot of guys over there and we put a lot of hard work and a lot of sweat into it. Guys take a lot of pride in that. To see it all go down like nothing, it would be a shame to see it go down like something like Vietnam, where the soldiers there, all their buddies there, all those hardships they went through are just words in a book sitting in a library. It's just a shame. I think we should stay there. I think we should keep a presence."


Did the US lose a lot of "guys"? Do "guys" take pride in that? Are you aware how many women have died serving in Iraq? Are you aware how moronic you sound even before we get to the point of your "continue the war!" rah-rah? For someone who supposedly wants to honor "a lot of hard work and a lot of sweat," you are very quick to discredit all the women who served in Iraq, aren't you? Words matter and your Palooka Joe opinion might cut it in a Warner Bros. WWII film but they're out of date and not reflective of the current war -- and, again, that's before we even get to your "continue the war!" nonsense.

For the record, Martin C. Evans finds no one who wants the troops out. The closest is someone who does, but not too quick, and is really glad John McCain's on board with Barack's plan.

As for Barack's draw down, Steve Chapman noted the following in "Obama's retreat on Iraq withdrawal" (Chicago Tribune):

During the campaign, Mr. Obama pushed a plan to withdraw one or two combat brigades per month until they were all out. Only two things have changed in Mr. Obama's 16-month departure plan: It will take longer than 16 months, and we won't depart.
Instead of May 2010, the target date has been pushed back to August of that year. Nor will he bring back one or two combat brigades each month. Instead, The New York Times reports, Mr. Obama plans to withdraw only two between now and December, or one combat brigade every five months.
The administration claims it will speed up the pace of withdrawal next year. But if someone says he's going to sober up tomorrow, it doesn't mean he will definitely do it tomorrow. It just means he definitely won't do it today.
What we can deduce from the new timetable is that for now, we are staying put. As for what happens next year - well, why cross that bridge before we come to it?

Champan is not of the left (as he himself would admit) but he is someone who spoke out against the illegal war long before it started and continued writing columns objecting to it.

Iraq's Foreign Ministry announces:

His Excellency Ambassador Christopher Prentice, British Ambassador of the United Kingdom in Iraq, gave a lecture to the students of the 26th diplomatic course (26) with the presence of the Dean of the Foreign Service Institute Ambassador Ziyad Khalid.
The lecture dealt with bilateral and future relations of the United Kingdom and Iraq and the strategic priorities of the British government in Iraq for 2009, which include encouraging an effective Iraqi government that represents the spectrum of all Iraqi people and national reconciliation, supporting the state building process through constitutional reforms, legislations and general elections, assist in the rebuilding of Iraqi economy and trade and encourage Iraq to build good neighborly relations and increase the effectiveness of the main international community and international organizations in Iraq, and continue to provide advice that contributes to the stability of Iraq, consolidating the reputation of the United Kingdom as a source of skills and experience for Iraq to strengthen institutions in the international community. The lecture also addressed other related issues.
A discussion between the Ambassador and the audience on Britain's role in helping Iraq, the Iranian nuclear file, interventions of Iraq's neighboring countries and other countries.
The lecture was attended by several Ambassadors at the Ministry .


Ahmed Rasheed and Michael Christie (Reuters) report that, moaning over the drop in the price of oil per barrel, Iraq's Parliament has trimmed $4.2 billion from the budget ("nearly 7 percent"). For those wondering, the Parliament still has no Speaker.

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