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Post by gailkate on Feb 10, 2010 10:30:01 GMT -5
Our media are focusing on returning vets this week, as another contingent has just come home. (MPR has a very good series you could link to (here's today's story minnesota.publicradio.org/display/web/2010/02/05/trying-reach-rural-vets/ ) I'm copying this letter to the editor because the link is tricky and it's so moving I feel sure you'll all want to read it. America's veterans: the anatomy of homelessness Regularly, I get calls from the media asking if I have any vets of Iraq or Afghanistan sleeping outside yet, homeless. I tell them to call me in seven years. There's a pause, then a "why?" I tell them it's not that our Marines, soldiers, airmen, sailors and midshipmen who come back pressed and with a crisp haircut immediately move to a homeless shelter. While most will come back to love and purpose and maybe even a parade, others return to begin a new battle. First, there's a breakup in their marriage. Then, they live with family if they can. Then, our heroes will stay with friends. After they've overstayed their welcome, they'll become residents of pay-by-the-week motels. Finally, we see them after they had to give up the car in which they slept. Now they are homeless. When I ask the media if they want to talk to homeless vets who served in the Persian Gulf, Vietnam, Korea or the Second World War; they're not particularly interested, probably because no one else is. Seven years from now, when we are in North Korea or who can imagine where, they might come calling for the homeless vet news story of the day; I'll offer an Iraq or Afghanistan vet and they'll decline. Time passes quicker than we realize, though, and now we've been at war seven years and guess what? Last week, I had a homeless vet in my office who has done two tours in Iraq and is sleeping under a bridge in Minneapolis. Don't call me, though; he and his fellow bums or heroes find their participation in our consumption of the news of the day the least of their concerns. MONICA NILSSON, MINNEAPOLIS; DIRECTOR OF STREET OUTREACH, ST. STEPHEN'S HUMAN SERVICES
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Post by BoatBabe on Feb 11, 2010 10:39:36 GMT -5
Yup.
Currently, we have several elderly single men (widowed, long divorced, never married) WWII vets who would be homeless if it weren't for the Seattle Housing Authority. The conditions are poor, but not as bad as living under a bridge. Most of them spend their day riding the bus. Coffee and Cookies Fridays at the bank is a big deal.
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Post by hartlikeawheel on Feb 11, 2010 18:24:12 GMT -5
My nephew came home from Gulf War and in rapid succession
1. Married a woman whom he'd known for a couple of months.
2. Had her disappear on their wedding night.
3. Got drunk and drove into a freeway bridge.
4. Spent half a year in a coma.
5. Spent another couple of years learning to walk, talk, and put his life back together again.
He was tank reconnaisance on The Highway of Death.
My uncle came home from WWII fighting Rommel in Northern Africa, full of shrapnel. He'd left a job as Postmaster and a chance to play semipro baseball. Upon his return he moved in with his aunt and father and spent the rest of his days drinking himself to death.
Between those two wars fall Korean Conflict and the Vietnamese War. I hear little of the damage to Korean War vets but had a speedy education on what Vietnam did to those who served there when I began working for the State.
Some of my Vietnam Vet friends are still dealing with their issues.
There are personality types which just shouldn't be subjected to the horror which is war. Understatement.
Were the Greatest Generation of more sturdy stuff or do we just have more permission to be damaged?
The homeless problem of all ages is increasing in MN. It's hard to understand for most of us that for many is is a choice.
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Post by brutus on Feb 11, 2010 19:13:19 GMT -5
Different times, Hart. WWII vets suffered the same afflictions. However, they were "Shell shocked" rather than having PTSD, and so on. They were expected to come home, hang up their uniforms, don their work clothes and go right back to being mechanics, farmers, weldors, and so on.
They dealt with their soldier pasts by burying their noses in a bottle, by beating their wives and kids, or they taught themselves more positive ways of dealing.
~B~
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Post by Jane on Feb 11, 2010 19:42:45 GMT -5
I agreed, the "Greatest Generation" just came home and kept quiet and suffered and made others around them suffer. But there was no such thing as PTSD, so they had nothing to call it.
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Post by hartlikeawheel on Feb 11, 2010 23:18:27 GMT -5
Well. They called it "weak."
But I'm wondering if this generation hasn't been more sheltered from the cold facts of life. Our entertainment is so very violent but not "real." We don't watch our loved ones die in the living room. We don't slaughter animals. And more emphasis has been put on me, less on us.
From what I understand suicide is at a high among our military now. Seems to me with all the resources available now there should be better mental health.
Why do I think more of the GG stuffed it and didn't act it out? Was I also sheltered from that fact? Sometimes I wonder if I've developed those rose-colored glasses about the good old days.
When I think back to my home town (small sample, admittedly) after WWII I don't think there was as much dysfunction as is there now. Just more hidden? As if you could hide anything around there!
Certainly there was no homelessness. People took care of their own, like it or not.
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Post by hartlikeawheel on Feb 13, 2010 17:03:08 GMT -5
So, I'm unsure about the silence. Going in the wrong direction? Said something that irritated? Careless overlook? Or whatever.
I'm suggesting that there is more help available than ever for veterans (as well as teens and other adults) and yet we continue to have increasing problems in many facets of our society. There is certainly some issue at play here other than lack of resources.
It's something to which I've given a lot of thought.
I'd like to provide a counterbalance to articles which seem to imply that help isn't available or that more money is the solution.
Perhaps it's tiresome to hear the call to personal responsibility by our walking wounded and proper utilization of aid resources. But I consider it a crucial message in a society which drops money and turns its back.
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Post by jspnrvr on Feb 13, 2010 18:00:55 GMT -5
Nothing you've said that I can disagree with, hart. I just don't get in on every thread. I'll see what I can contribute tomorrow.
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Post by doctork on Feb 13, 2010 18:25:29 GMT -5
I don't disagree with any of the above either, it's just not something I know much about.
Most vets I see as patients are doing reasonably well, as they have either private insurance (ie, good jobs with health insurance) or cash to pay for the visit. I don't work at the VA but their health care system is regarded as very high quality, head and shoulders over most of the US. The complaint is that there may be long waits to get into the system, linked to funding, or lack thereof. Once in, the patients seems happy with their care, and from the outside, it looks to me to be high quality.
And I mentioned the Navajo code talker WWII I saw earlier in the week - he is in the IHS system, but since he wasn't speaking English to me, and the translator didn't volunteer any issues about his vet status, in that series of one, I didn't see a problem related to his status as a vet.
Homeless vets - well they aren't usually in the doctor's office, they usually stay low-pro. And since that is not one of my "issues," I don't seek out homeless vets. Or homeless in general. And when I do see the homeless, it is an assortment of couch-surfing teens whose parents kicked them out, poor mothers and children, drug/substance abusers who can't/won't seek change, and a host of others with varying reasons for being homeless, certainly not limited to vet status.
I know many people who have served in the US armed services, but not many bring their vet status and related issues to the fore. So I just don't know much about it - are things different now than they were after WWII? I dunno.
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Post by jspnrvr on Feb 14, 2010 17:12:55 GMT -5
So, I'm unsure about the silence. Going in the wrong direction? Said something that irritated? Careless overlook? Or whatever. I'm suggesting that there is more help available than ever for veterans (as well as teens and other adults) and yet we continue to have increasing problems in many facets of our society. There is certainly some issue at play here other than lack of resources. It's something to which I've given a lot of thought. I'd like to provide a counterbalance to articles which seem to imply that help isn't available or that more money is the solution. Perhaps it's tiresome to hear the call to personal responsibility by our walking wounded and proper utilization of aid resources. But I consider it a crucial message in a society which drops money and turns its back. War is brutal and the people who fight them get brutalized. That's a given, has been since we were going at each other with rocks and sticks. Even allowing for "cultural differences", like warrior societies where young men have rites of passage, warfare is a way of life, etc. But I agree that the problem is not lack of funds or resources. I agree with your observations about our swaddled society; I think that's one of the reasons all these "autopsy" shows are so popular. (My blanket term for all these crime scene shows. If folks had a more personal experience with seeing someones guts splayed out, or the remains of a vibrant human being stretched out on a slab they wouldn't be so anxious to see it in make believe.) Likewise, I think there is a disconnect with our returning warriors. Our general population is not involved in a "war effort", like in WWII. Guys came back from Europe and Africa, Asia and the Pacific crazy as hell. One of our neighbors was part of Eisenhower's units that opened up the death camps. Don't think that didn't stay with him. But, in general, they were welcomed home. Their families didn't know what they had been involved in, the movie reel news was sanitized, but the community was there. And yeah, people "stuffed" it. It was to be a long time until the Oprah Nation. Life is life and it isn't always pretty, so we take our sorrows and disappointments, or nightmares and regrets and we pack them up and move on. All my business is not your business. What is our business is to love one another. That can mean a shoulder to cry on, an ear to listen, a hand up (not a handout). And I don't care what war they fought in, any time I meet a veteran anywhere, I say "Thank you."
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Post by jspnrvr on Feb 14, 2010 17:41:42 GMT -5
And you're right, doc, that facilities and equipment at VA centers are generally first rate. Vets are often the first to benefit from new technologies, though generally it's the vet's problems that generate the new solutions. It's a dubious honor, being on the cutting edge of innovation. What I've seen in my limited experience with veterans and the VA is a large degree of waste, duplication and bureaucratic mismanagement. There are a lot of good people working for the VA who get the job done in spite of the system, not because of it.
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Post by hartlikeawheel on Feb 14, 2010 18:40:10 GMT -5
Homelessness. I can understand it if people have been laid off and suddenly don't have the money to pay the mortgage. I can understand it in regards to disability. And the programs are up and running for those folks, though slow.
It's my opinion that many are homeless out of a series of poor choices and some of those choices are deliberate.
The state of MN currently claims that we have as many as 1,700 homeless adolescents on any given night. I don't doubt that from what I've seen downtown at night. And I also don't doubt that some number of them have unpleasant home lives.
But based on experience and observation I'd suggest the majority are unwilling to be constructively involved in their home lives and prefer living on the fly for a precarious amount of time.
Our Salvation Army built a new facility to house homeless men and decided to allow them to drink there. If they aren't able to do that they'll sleep in the railyards or under a bridge.
Since it was built in the downtown area you can imagine the kinds of problems which have accompanied that misguided bit of generosity. I, in fact, lost a transient friend a couple of Springs ago. He'd just gotten out of nearly a year of rehab, hitchhiked to town to visit me and decided to celebrate. Dropped dead on the sidewalk.
There are so many ways Mark could have been depicted in script. A victim of the Vietnam War, a free spirit and wayward adventurer, broken and irresponsible, an addict, victim of tough luck. Take your pick. Depending on the day even he could give you a different version of the reason for his homelessness. He could make you cry with his story or make you laugh. And he knew how to work the system.
I do know this - every time time and money was spent to help him he didn't hold still for long and then was once again on the road. It seemed as long as there was little effort expected on his part he'd stay. When he was called on to be responsible he'd leave and move on to the next place. This was his lifestyle for decades. I don't think he's in the minority.
Perhaps it is a mistaken apprehension on my part, but I've have enough access to the homeless when they aren't making an impression for their helpers to hear a side different than what we read in the paper.
There's a certain mystique to homelessness which is a draw for both the adventuresome and for the helpers and the truth, which must lie somewhere in the midground, is difficult to ascertain.
Do people need help and shelter? Of course. Should we make it easy for them? Possibly not. It could cement a deadly lifestyle.
I'm wondering how things might have been different if the State had spent the money they spent on Mark in the last year of his life on a handful of motivated, but poor, college students.
That sounds cruel and it is not meant that way. Rather a matter of practicality.
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Post by gailkate on Feb 14, 2010 20:04:41 GMT -5
This has gone in a direction I wasn't expecting. Best if I keep out of it.
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Post by jspnrvr on Feb 14, 2010 21:33:14 GMT -5
I went back and read the original article you linked to gail, which I hadn't done before. I think the smaller outreach units are good; we have a couple here locally that veterans utilize that are closer and easier to work with than West Palm or Orlando. Patients have a better relationship with their practicioners, more continuity and consequently get better care. But ultimately it is their choice.
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Post by BoatBabe on Feb 14, 2010 21:56:24 GMT -5
This has gone in a direction I wasn't expecting. Best if I keep out of it. Please, gk, don't stay out of it. Listen, and then say what is true for you. ALWAYS, threads take turns we may have not seen. That means we need your input, and we all need to listen to each other. I am using my SERIOUS voice here. On other threads, we have taken pride in derailing the topic, laughing, and then going back on-topic whenever we choose. This doesn't seem to be one of those threads.
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Post by BoatBabe on Feb 14, 2010 22:07:34 GMT -5
And you're right, doc, that facilities and equipment at VA centers are generally first rate. Vets are often the first to benefit from new technologies, though generally it's the vet's problems that generate the new solutions. It's a dubious honor, being on the cutting edge of innovation. What I've seen in my limited experience with veterans and the VA is a large degree of waste, duplication and bureaucratic mismanagement. There are a lot of good people working for the VA who get the job done in spite of the system, not because of it. No. VA centers are generally NOT first rate. And the vets are Not the first to benefit from new technologies. They are the Very Last. They are not on the cutting edge of innovation. They didn't even get the Seattle Foot until well after our local amputees had it for some time. It is true that there are a lot good people working for the VA who get the very best job done as they can, in spite of the system.
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Post by hartlikeawheel on Feb 14, 2010 23:47:27 GMT -5
I'll second the encouragement to discuss subjects upon which we disagree. Trusting that this ragtag gang of inbreds has enough education to be able to do so without a free-for-all.
I'm not interested in forcing my issues on anyone here and care about what you all have to say.
Conversation is good, yeah? Maybe I'll learn something. And I have a lifetime of interesting experiences to draw from.
Not going to do much googling of facts and figures though. I'd consider that debate and debate doesn't work for me.
I don't know how MN services compare to WA, Babe. I sometimes hear grumbling about the VA and I'd think it should be standardized, but I'm not aware we've had any sort of scandal as I've read of different places.
I think soldiers' needs should be addressed. Obviously.
I also think in these hard times when we are robbing from Peter to pay Paul that we're going to have to start looking at what is the most constructive use of our money.
And I don't believe that waste and duplication in the system is the only problem. There is also misuse of the system. How much of it is done by veterans I don't know and I would hope and guess that among people who have been willing to give their lives for their country the number is small.
It's not a political issue for me (heaven knows I'm as apolitical as they come) as much as it is one which promotes strength and wellness in the people and the system.
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Post by gailkate on Feb 15, 2010 1:30:18 GMT -5
I'm sorry, I don't mean to wimp out. But we have some bad history of getting into topics that maybe are just too volatile to discuss without the immediacy of voices and facial expressions.
I do think that the reputation of the VA system has far outlasted its real quality. Yes, many good individuals, but care of vets has deteriorated significantly. Sure, there are probably some who've enjoyed cheap of free care who could have afforded to pay private insurance. I don't mind when people "get away with" more than they actually earned. They aren't the majority by a long shot.
But mosly this was about the forgotten ones whose lives have been shattered by war and our willingness to forget about them once they return. I think comparing WWII - a good war - with those that were far less defensible is just apples and oranges. I think essentially guerilla wars, where a little kid or a an old lady could be armed or being used as a decoy, or where innocent civilians are daily victims - these take a psychological toll worse even than storming Normandy Beach. Whatever the ravages of all wars, isn't it safe to say that Vietnam was the first to turn tens of thousands of kids into addicts? Those are the ones we see under bridges and alongside highway ramps. I don't think they chose that life.
And the soldiers coming home now with brain injuries and PTSD have lived a different kind of danger than men in previous wars. There aren't many actual battles compared to the continual IED threat, the fear and helplessness of never knowing where the next explosion will come from. There isn't even a clear-cut enemy army. As the woman said in that letter, those guys are going to be the next wave of deeply afflicted survivors. Our record of helping them hasn't been great, but maybe we'll get better at it.
I heard an interview last week with a writer named David Finkel who published a book called "The Good Soldiers" this past September. It sounds as if it could be one of the definitive books about this war, and I think I might force myself to take it out of the library. I don't read as much as I should, but it's important to at least try to understand.
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Post by doctork on Feb 15, 2010 6:30:39 GMT -5
I am curious why many of you think that veterans' care has diminished in quality or is poor quality. I did some of my training in VA facilities years ago, and there is no comparison to today's overall quality, and I do not mean just the general medical advances made nationwide. Many/most VA Hospitals used to be backwaters of often very poor care, and there were few out-patient clinics other than those at the hospital. If one looks at quality statistics today - infectious complications, surgical outcomes, age-appropriate health maintenance stats - as a whole VA facilities are better than US hospitals & out-patient facilities in general.
Within the limits of the laws and the regs, all vets were promised "free care" as a part of the compensation for their service, so they have paid for it, it's not a hand-out. It is not a needs-based or welfare system, so it is not our place to judge whether they "should" use their private insurance instead of the VA system; the vet makes that choice. Because funding and facilities are not unlimited, the VA has its own priority system, and those vets with "SCI" or Service Connected Injuries do have priority access over other veterans, as per the regs
I think it's important to distinguish between the DoD (Department of Defense) and the VA. DoD facilities care for injured active duty service members, and when they are discharged/retired from active duty, then they transition to the VA. There was a lot of well-deserved adverse publicity about the dreadful conditions at Walter Reed (a DoD facility) a few years ago, and public outrage forced some needed changes, which can't happen fast enough.
However, DoD and the VA are victims of success in trauma care. Nowadays, if an injured service member makes it to medical care alive within 1 hour of injury, he or she has a 90%+ chance of survival, much more than in previous wars. Because of protective gear, the injuries are different, and the most catastrophic are still survivable, but with severe disability, the worst of which is TBI, Traumatic Brain Injury. Then there are also the multiple amputations leading to severe disability also. Neither the DoD nor the VA was adequately prepared for this, as it is a recent development of the current Iraq & Afghanistan wars, but they are gearing up.
gk's article was about distance and access problems vets experience. No question if a vet has to travel 100 miles for care, especially if they are physically unable to drive or don't have a car or gas money, that is a problem. However, in the last 15 - 20 years, the VA has gone from almost exclusively VA Hospital based clinics to the 800 out-patient satellite clinics mentioned in the story, and they have added telemedicine to cover some of the services that can't be provided in the satellites. Those are all services dependent upon adequate funding, and we do need more services offered within reasonable distance.
The issue of homelessness is complex. Certainly the issue of substance abuse is a key issue, and some choose homelessness rather than live in a dry facility where abstinence is required. Are those people irresponsible, or are they sick? I suspect from what I've seen, it's both, but I would lean toward sick more than irresponsible.
Most homeless teens I have seen are the victims of horrendous home situations rather than naughty children choosing to behave irresponsibly. And they are children who deserve adequate food, shelter and medical care rather than blanket condemnation. There is usually a reason for their situation that is not of their own making.
I do think Jay has a point about the social milieu for returning WWII vets. The war effort then involved everyone -most families had members fighting overseas, victory gardens, war bonds, and ration coupons for butter, sugar and gasoline, so the war was a national effort for which almost everyone made sacrifices. WWII also lasted "only" 4 years, while now we have perpetual war involving only 1% of the population. The rest of us can conveniently ignore it, no skin off our nose, except maybe some will pay higher taxes.
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Post by hartlikeawheel on Feb 15, 2010 12:33:45 GMT -5
Reading and thinking here.
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Post by BoatBabe on Feb 15, 2010 13:26:26 GMT -5
Doc asked, "I am curious why many of you think that veterans' care has diminished in quality or is poor quality."
My opinion comes from years of personal experience, starting in 1974 when I worked in veterans' hospitals during my nursing school labs, and stretching to this year when our eldest son, an Iraq war veteran, fell off scaffolding and destroyed his knee.
My first personal experiences with veterans' hospitals included dilapidated buildings; multi-dimensional layers of bureaucracy that frequently delaminated into no one being able/willing to make a decision or plan a course of action; antiquated techniques/treatments long since abandoned by the medical profession in the private sector; shortages of provisions and staff; good staff trying to get by with what they had; completely burned-out staff just punching the time clock watching the minutes tick by so they could leave.
Now when my grandson was born with problems, he and Mom were at the on-base hospital (I'm now assuming this is a DoD facility, as Mom was active duty Air Force.) I went down and stayed with them after they were discharged and cared for them both. When we went to the first post-surgical doctor's appt., Mom was so angry and frustrated with their care, she just started crying when another doctor she had never seen started the exam and was asking inappropriate questions. So I intervened.
I suggested we take a step back and start over. Let me introduce you to Mom. She had an emergency C-section, and she had been told from the time she was 5-months pregnant that this baby was a Down's Syndrome baby, and she has had to wait until today for somebody to tell her if the test results bear this out. Now, you and I can both look at this baby and say definitely, even without the test results, that this baby is NOT a Down's Syndrome baby, so it would be a good thing for you to reaffirm this.
THEN, clearly from your questions, you don't know that this baby had major surgery the day after he was born. If you could find his chart, and address these issues, that would be a good thing. The doctor was mortified and apologized profusely and started over, much to her credit.
Son paid cash to have a University of Washington sports doctor rebuild his knee from his other leg's hamstring so he could avoid the VA. No trust. No option, he felt, because the VA had no idea what that surgery was.
I'm just saying, that's our personal experience. I don't know nuthin about national statistics.
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Post by BoatBabe on Feb 15, 2010 15:47:30 GMT -5
And back to the homeless issue: Our increasingly severe homeless population now camping in our doorways at the bank, do Not have the added burden of being veterans. Most were living-from-paycheck-to-paycheck folks who lost the hand, or were street folks someplace else. They are arriving in droves, bringing their known friends and enemies with them.
They are increasingly violent, screaming, yelling, beating each other up, drinking, drugging in broadlight, falling down convulsing, puking on my car in the bank parking lot, pooping and pissing while sitting on the curb to our landscaping, that sort of thing.
I'm not really compassionate about these people who are increasingly dangerous to me and my staff.
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Post by hartlikeawheel on Feb 15, 2010 16:58:18 GMT -5
You have such a knack for being the one who speaks the obvious, Babe. Always enjoy conversing with you as there's something there to, um, play off of. (Or "off of which to play." Ahem.)
We are experiencing an increase in crime and destructive behavior here as well. Lots of people wandering about with ill intentions in what has been a good little neighborhood for years now.
I've been thinking about my previous posts and am aware that there's more than a little of the personal in my response to the issue of homelessness. And, having spent half a lifetime in the occupations of improving society by helping to improve people, in the last five years or so I find myself making some changes in what I think is/was useful and what is/was not.
I don't know sometimes whether that is wisdom borne of experience or whether it is nasty oldster disillusionment! Remind myself to strive for fairness and rationality. Don't want to offend, but feel as though I prefer to speak of my issues or find someplace where I can.
I do understand your reticence in this thread gk, after the problems which have occured. Sometimes those problems can't be avoided in a group of people and getting through them can enable a deeper sense of understanding, and hopefully cohesion, on the other side.
Accountability comes to mind. Does a veteran deserve unlimited assistance because of his service? How easy should it be for him to receive his help? In an ideal world. . .
Oddly enough, in my college days we were tought that only five percent of people on the street had chemical health issues. I would find it very difficult to support that statistic in present culture.
At what point does the system say, "Yes, you are ill, but now you have received information and assistance in what to do about that. The onus is upon you, with our help, to heal yourself and there are others waiting for this money and message." Actually I think this is the message everyone should get about their health issues.
So whenever I read anything which smacks of urgent and sentimental plea from someone who may only see the "rightness" of helping veterans I want to balance it out. It's best to leave the halo out of the issue as veteran's don't necessarily get issued one at discharge with a lifetime guarantee.
We are fast approaching a time when we will see very unpleasant triage in many social needs. And we're going to have to toughen up and expect everyone else to do the same or it doesn't bode well for our unity.
Guess that's my theme song for the near future.
___________________________________________________
The only complaint from a Veteran which I can recall at present is an acquaintance who had a serious case of PTSD and developed Hep C, probably acquired during his war years, and was assigned a Vietnamese doctor. It was a major thorn in his side and seemed a little unsensitive on the hospital's part but certainly not a unworkable situation for him . And he eventually learned a few things about his resentment and made some new adjustments for the better.
I do admire people who are able to make some personal changes in their attitude and lifestyle to adjust. We've had it so good in this country for such a long time that I can just nearly cry over the attitude of entitlement we've developed personally and project onto our values.
There sometimes seems no limit to our government's attitude that nobody can help themselves without its help. And that is, I think, a crippling approach.
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Post by BoatBabe on Feb 15, 2010 17:35:22 GMT -5
Good observations, hart. And Truly, it is not my intent to offend anyone. These are my personal experiences. They are not numbers I read about, or party-issued opinions, or somebody's agenda I am supporting. It's just what I know from my experiences and from my family's experiences. And by saying that, I am NOT implying that you all are posting numbers that you read about, or are uttering party-issued opinions, or are simply supporting somebody else's agenda. Clearly, some of you have had different things happen to you. Doesn't make it wrong or right. It's just different. I'm not looking for a fight, or to change your opinion. But Sometimes, when we hear others' experiences, it helps us see things differently. I learn something from each of you.
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Post by gailkate on Feb 15, 2010 18:44:30 GMT -5
We all come with our "anecdotal" - read, personal - information. Even K's experience training at good VA hospitals is just one woman's experience in just one or two hospitals (?) quite some years ago. Also I confess I likely mix up DoD, Va hospitals and Va homes, so my anecdotal evidence is probably really really anecdotal. I know that VA hospitals have improved on objective measures. I spent a lot of years working as a Baldrige examiner and learning from people in all sectors - medicine being a big one - about useful and not so useful measures. Rolling up the stats that eventually get cited as an objective measure is an iffy business. Then there's focusing on the measures, skewing overall quality - just as we've seen in education. Moreover, the measures themselves may not adequately reflect quality, but there's a way to count them so they get adopted. We have hospitals here (not VA) that get some good ratings but which doctors I've seen will not use. I don't mean to disparage any sector, because this is tough work. In the words of the sainted Deming (whom some of you might know ) no one intentionally does a bad job, or a half-assed job, or even an insensitive job, like the doc who treated BB's daughter-in-law. But all those factors she so ably listed are at work in medical and social service professions. I'd like to suggest that there are numerous social and cultural factors we weren't dealing with in 1945. (No, I'm not talking ethnic diversity, but a whole library of influences that have hardened us, alienated people, made greed morally acceptable, changes in society that are too huge to talk about in this thread.) Finally, I really hope people can distinguish between the miserably homeless and the bums. There have always been bums, and I'm sorry that BB's experience has been so ugly. People in more hospitable climates are undoubtedly seeing more of that than we do. No one wants to be homeless in a northern winter. Some, however, are so mentally fractured that they do prefer their miserable lives to the strictures of no drinking/no fighting shelters. They are a breed apart and my heart goes out to them. I can understand what hart is saying, but I still think we need to love the sinners. Remember in "The Big Chill" when the idealistic young lawyer says she got out of public defender work because the clients were "so damn guilty"? It was a good laugh, sad but true. Still, I look at every bum, every lazy shiftless thieving S.O.B. and wonder what he was like at Duncan's age. What happened to them? I want us to stop that from happening, and I want us to be merciful to the losers even when they seem undeserving. So much of my life could have turned out differently with a less devoted mom or a black skin or entrenched, generational hopelessness. There but for the grace of God and all that.
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Post by doctork on Feb 15, 2010 20:32:06 GMT -5
I think the discussion is good, even or especially when we have differing opinions. We're still civil, which makes all the difference. I spend a lot of time at Esalen, where Fritz Perls was a local hero. He of the saying "Contact is the appreciation of differences." Maybe I wasn't clear about my own VA experiences during my training in the late 1970's - largely the same as yours BB. And I was at VA Hospitals that were affiliated with well-respected medical schools, so they were among the best. We used to moan when we would get a transfer from a "backwater" VA Hospital because we knew the patient would be a real train wreck who had likely been receiving poor care up to the point of transfer. Now I don't work at the VA, but I do see patients who receive some of their medical care at the VA, and overall the reports are surprisingly good. Surprising because I remember what it was like when I worked at the VA. These patients tell me things about their care that is consistent with the overall statistics, though I am well aware of the pitfalls of aggregate data. However, these reports have been consistent across CO, WA, WV, and now PHX. In Bellingham, most of my vet patients were receiving their VA care in Seattle. Aside from the long drive to /Seattle, they were largely (but not 100%) pleased with their care at the Seattle VA. The complaints generally were about the bureaucracy and the wait to get into the system, not the quality of care. But that is why I queried the basis for your opinions on the VA as rendering sub-standard care. BB, obviously your son did not have confidence in VA orthopedists' ability to rebuild his knee. I can't recall off-hand if any of my veteran patients had ortho problems - I'm thinking they were more typically medical - heart disease, GI disease and diabetes come to mind. That care was good. I also see they are trying really hard to institute good care in GYN, recognizing recently (!) that there are many female vets now, and that GYN care is now filtering back with positive reports. Military orthopedics - I'd bet on high quality in the DoD facilities where they are dealing with all the complex traumatic fractures, and issues of amputation v reconstruction. After vets get rebuilt/rehabbed in the DoD facilities while on active duty, then upon retirement/discharge they transfer to the VA where they are theoretically in maintenance phase, though I think the VA still does a lot of PM & R (rehab). Maybe by the time it gets to the VA, the ortho services aren't so good at rebuilding non-SCI knee damage. UW on the other hand, has a stellar reputation for sports medicine-type ortho surgery (though I hope they have remedied their reputation for excessive nosocomial infections). And BB, I'm gathering that the active duty service member was in a system with old-fashioned paper charts? Reports are that the VA is all computerized on a unified chart, so the question of identifying a newborn's recent surgery shouldn't arise there - should be obvious at the top of the problem list. Here at the IHS, we have the VA EMR (electronic medical record) system, and I just ask the patient to bear with me, or tell me what is going on with them, while I bring up the chart on the computer. Then I know what's going on. Anyway, I'm sorry those incidents happened to your family members, as they really "shouldn't" happen at all, be it VA, DoD or private sector. And if there is strong nationwide citizen sentiment that veterans should get only SCI related care, or that care should otherwise be limited, then we should ask our reps to make that law and enforce it. But until the law is changed and service members are told in advance that their post-service care is limited to XXX (whatever) then I think we should keep our word and deliver what we told them they would get. Including compassionate care for BB's d-i-l and grandchild, and competent rebuilding of her son's injured knee. It's bad enough we stint by putting the entire load of multiple wars on a scant 1% of the population. I don't think it's fair to change their rules mid-stream because we have suddenly decided we would rather not pay, or we have noticed that some vets take advantage of the system, so we will punish all of them. As far as the homeless you describe BB, I don't think homelessness is an excuse for criminal behavior - which is what you describe. From 90 miles away in B'ham, it always appeared to me that Seattle was ridiculously permissive with its homeless population. Yet for those homeless who had mental illness and substance abuse problems contributing to their homelessness ("dual diagnosis" in the lingo), it seemed to me that treatment was in short supply. Multiple failed rehabs? I know that happens, but I also see people who can't get even one chance at rehab. Maybe we need a "3 strikes and you're out" policy to even it out for all. I do remember that line from "The Big Chill." The lawyer thought she would be defending noble Bobby Seale and Malcolm X types and instead it was a dispiriting array of guilty scumbags. Who BTW do deserve a competent public defense of course...
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Post by BoatBabe on Feb 15, 2010 22:12:20 GMT -5
"You have such a knack for being the one who speaks the obvious, Babe. Always enjoy conversing with you as there's something there to, um, play off of. (Or "off of which to play." Ahem.)" Thanks, hart. I'm still giggling here at your sentence structure, and your willingness to put yourself out there. "So much of my life could have turned out differently with a less devoted mom or a black skin or entrenched, generational hopelessness. There but for the grace of God and all that." gk, I agree. I could take this to the logical extreme (and in My Mind, the Humorous, silly, laughable opposite, which is what I do So Well to diffuse tension, but I don't think you are into that right now . . . I do frequently say, "Leave it lie where Jesus flang it." My Canadian friend taught me that years ago. It is a good thing to do sometimes. Doc said, "And BB, I'm gathering that the active duty service member was in a system with old-fashioned paper charts? Reports are that the VA is all computerized on a unified chart, so the question of identifying a newborn's recent surgery shouldn't arise there - should be obvious at the top of the problem list." Yes, the active duty service member was my daughter-in-law and she was in the base hospital. Madigan. I'm sure you've heard of it. Paper charts. Paper charts that the doctor admitted she had no idea where to find, until she heard that the newborn had surgery. She was sure the chart was "upstairs." And you are exactly right, doc. That should not have happened to anyone. And I really appreciate your good listening and your willingness to do so. Really. Serious business here. I'll tell you more homeless stories as soon as I eat this fabulous oyster po boy Dahhlink just served.
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Post by hartlikeawheel on Feb 16, 2010 0:32:05 GMT -5
gk, tell me what a Baldrige examiner is, please? Not familiar. I do appreciate the comments regarding statistics. I've become wary of such over the years. The word "sinners" is no longer in my vocabulary, but I'm hoping you don't think that I don't have care for all the Creator's creatures. To clarify, I 'm not sure I can make a distinction between "bums" and the "miserably homeless." What I am talking about is discernment about when a gift is enabling and when it is enriching. I think this applies to all humans and not just the homeless. And it applies as well in the difference between a caretaker and a caregiver. The one who is being helped and the one who is giving help are flip sides of the same coin to my perspective. They are mutually either interdependent or dependent on each other. One perspective is healthy for the individuals involved and society and the other isn't. I can't use an example of this in veteran's lives because I don't have one but here's one from my family life: Marion's folks had seven sons. The first four worked hard to keep the farm running and receive little but room and board. The ones on the end were able to enjoy their childhoods and little was expected of them. I'd guess that Marion's mom felt a little guilty about how difficult life was for the first kids and indulged the last ones. And I know for a fact that after twenty-five years of doing diapers she had, by the last child, developed a need for her children. She was a simple woman and did what worked best for her. She needed to be needed and that lay beneath her lavish treatment of her children. I doubt she could have verbalized it. The result was the three youngest failed to gain independence. I won't go into detail as it's grim. Two of them are dead and the other lives on the farmplace which is falling into ruin. He spends his days smoking and drinking and has gained so much weight that I'd say he is now nearly totally disabled. It's a sad story and one I think needn't have had to happen if those kids had been taught self-discipline and accountability. I believe that, given enough time and elaboration, I could make an analogy to a society which is overflowing in riches. Oh please do understand what I'm saying otherwise I'll think you've decided I hate sinners. After all, they're the funnest.
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Post by gailkate on Feb 16, 2010 0:55:56 GMT -5
I think I understand, and I know you're not a judgmental woman. I think I'm too tired (having spent the evening figure-skating till my feet hurt) to say anything intelligent, but I'll ponder some.
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Post by hartlikeawheel on Feb 16, 2010 17:11:19 GMT -5
You figure skate? Tres kewl.
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