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POLICY/POLITICS: Iraq, planning and the VA

In a op-ed in the LA Times, called The battle of Iraq’s wounded Linda Bilmes points out that the number of wounded servicemen and women from the Iraq war/occupation is incredibly high relative to the 3,000 deaths. Something like 50,000. And once the current generation is discharged from the army, the VA —which is already stretched— is going to be overwhelmed.

I’ve just read Imperial Life in the Emerald City which is a mind-blowing account of exactly how screwed up the initial occupation of Iraq was. Not only was there no plan of any form before the invasion for what the occupation ought to be like, but the only people who were thinking rationally in advance about what it should have been like (in State and other departments) were forcibly prevented from getting involved. I thoroughly recommend the book (by WaPo reporter Rajiv Chandrasekaran).

But, as if you needed to know after their “preparations” for occupied Iraq and Katrina, it’s for sure that this Administration has done no planning for the wave of disabled veterans that’s about to hit the VA. Now that they finally control the purse strings, let’s hope the Democrats can do better.

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  1. Please support early naturalization of foreign born Physicians of US Veterans Affairs to become US Citizens.
    Significant number of highly qualified and US trained but foreign born physicians providing an essential national service by providing high quality medical care to our nations veterans including the care of injured solders returning from Iraq. There are unfair restrictions for these physicians to become US Citizens at this time due to current immigration regulations.
    Most of these highly qualified physicians who are educated and trained in US universities and hospitals, and now providing essential service to our nations veterans have to wait five long years to obtain the permanent residency status in USA and another additional five years to become naturalized US Citizens.
    As a result of this unfair ten year long waiting period required to become US Citizens after starting their dedicated service to highly deserved US war veterans, these highly qualified VA physicians are forced to give up their equal opportunity employment rights that are mandated for all OTHER US Government employees.
    Current US Government employment regulations prevent non Citizen VA physicians from due advancements, promotions and even a simple transfer to other VA facility, therefore essentially making them virtual “slaves” for VA Hospitals they are initially assigned to. (US Government employment regulations restrict appointing a non citizen physician to any VA physician vacancy if a US citizen physician is available to accept the position even if the US citizen physician is less senior and less qualified and less experienced than the non citizen VA physician who is still in the ten year waiting period to become a naturalized citizen).
    To remady this unfair treatment of non citizen VA physicians who are providing an essential US national service, please support to amend the current immigration regulation so non citizen physicians who are employed by department of Veterans Affairs are allowed to become naturalized US Citizens after completing five years of service to VA provided they have already received US permanent residency status without having them to wait additional five years to become naturalize citizens.
    Currenly early naturalization is only available to spouses of US citizens and non citizen US military personnel.
    Ganga Hematillake, MD
    VA Physician
    110 Quince Court
    Hollidaysburg
    PA 16648

  2. Keeping the wounded from our eyes is just as deceiving as the Bush administration’s attempt’s to hide the war dead from public view. But Americans have come to expect no-pain wars with tax cuts thrown in. No wonder we’re in such a mess in Iraq.

  3. I find it remarkable how much focus has been given to ‘the fallen’ without equal recognition given to the disabled. Clearly better personal armour has increased the ratio of dead:disabled which is a blessing for many;however, lack of budgetary and staffing preparedness to handle the life long health-related services required for these young men will haunt us for decades to come.
    As a physician who worked at the VA system for 10 years, I have seen the devastating consequences of war. What gets little notice, however, is the psychological effects….Hoge et al(JAMA 2006 Mar 1 295:1023)published a cornerstone paper on this issue. They looked at occupational and health utilization outcomes for 1 year among soldiers returning from Operation Enduring Freedom in Afghanistan (n = 16,318), Operation Iraqi Freedom (n = 222,620), and other locations (n = 64,967). They found servicemen from Iraq had the highest rates of psychological illness (19% vs 11% from Afghanistan, and 8% from other regions). Sadly only one-third actually sought mental health services. The primary reason for avoiding medical screening or seeking care is social stigma (Hoge NEJM 2004).
    Veterans repeatedly tell me that the military culture is replete with social stigma around psychological illness such as post-traumatic stress disorder (PTSD), anxiety (GAD), and depression (MDD). In my personal experience treating veterans, these disorders not only have profound effects on the serviceman themselves but the entire family, often leading to divorce, domestic violence, and financial catastrophe.
    Let us hope the parties can find common ground to increase the VA budget for these servicemen.

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