Military, Civilian Partnerships Improve Troop Care

By Fred W. Baker III
American Forces Press Service

Nov. 6, 2009 - The photo splashed onto the two large screens in the conference room looked scary. The man's black hair was choppy and tousled. Looking straight into the camera, his eyelids drooped abnormally, revealing the dark-red tissue deep in the sockets. His swollen lips sagged to bare his bottom teeth. Scars cut across his face.

"This soldier would have been very welcome last Saturday night at Halloween," said Marine Corps Gen. James F. Amos, assistant commandant of the Marine Corps. "The kids in his neighborhood would have said 'Great costume. Who did your makeup?'"

The photo was not, however, of a soldier made up for Halloween. He was a disfigured casualty of war.

And while internally his wounds may have been well on their way to recovery, on the outside his scars would have made it difficult to return to any measure of normal life.

"We were sending him out into civilian life saying, 'This is as good as it gets. Thanks for serving your country,'" Amos said.

The next slide Amos projected showed the same soldier without most the disfiguring facial features. His lips were not as swollen. The scars were not as deep, and most of his nose was intact. His face was not the same as it was before his injuries, but the improvements were dramatic, and ongoing.

"He can walk out and go to his child's school play or PTA conference and without terrifying the kids," Amos said.

The general used the slides to illustrate the best of the military's partnership with civilian medical doctors.

Amos opened the Partnership for Military Medicine symposium held here today that aimed to bring together top military and civilian medical practitioners in an effort to boost the cooperation between the two to help troops recovering from the more advanced war wounds. About 150 doctors, nurses, scientists, military and civilian officials, and a handful of wounded warriors, turned out for the symposium. It offered panelists speaking on topics ranging from infectious diseases to humanitarian aid to traumatic brain injuries and post-traumatic stress disorder.

Already, around the world, civilian experts have teamed with medical treatment facilities to provide historical breakthroughs in treating some of the complicated wounds suffered in the wars in Iraq and Afghanistan. Still, there is more to be done, Amos said.

It was a civilian medical practice that restored the soldier's facial features. The general acknowledged that the military simply cannot afford to train and keep the more highly skilled, specialized medical practitioners. "We can't afford to keep them, yet they reside out there in civilian medicine and at great medical universities and hospitals across this country. And you know what I found? They want to help," Amos said.

Amos has seen his share of troops disfigured by war. He has traveled to Iraq, Afghanistan and all parts in between, meeting with troops and families in military treatment facilities. He praised military medicine, but said it was simply unprepared for the volume of injured troops that infused their overflowing facilities during peaks in the two wars.

"When I say we were ill-prepared, it's not because our hearts weren't right, but the magnitude of the numbers became staggering," he said. But military medicine, science and technology stepped up to the task, he added, and he praised advancements in amputee and burn-victim care.

Amos said he is hardly concerned now about simple gunshot wounds. They'll be well cared for, he said. Even some amputations -- such as a single, below-the-knee amputation -- have, sadly, become routine, and are no longer the threat they were at the start of the wars.

Two weeks ago, Amos visited a young Navy SEAL who lost his leg in the war.

"I can look him in the eye and tell him, and be completely honest, he will be fine," Amos said. "He will run again. He will serve again. And he will continue with a very happy and fruitful life because of the capabilities that we have."

But Amos's slides pointed to the more seriously injured troops, where military medicine stops, and the specialized skills found only in the civilian market start. Probably the starkest example was Marine Corps Capt. Josh Maloney, whose right hand was destroyed by a bomb in Iraq in 2007.

A civilian transplant specialist successfully attached a new hand to the Marine in March. Amos met with Maloney after the transplant.

"Josh walked up to me, grabbed my hand and shook it as firmly as I'd shake the hand of anybody in this room, and I went 'Holy smokes!'" Amos said.

It was Amos's final few slides, however, that pointed to he need for greater collaboration.

One picture, taken two years ago, showed Amos with a few young, healthy Marines, standing in the sun, looking very Marine-like. It was a celebration photo taken on one of Amos's trips to Iraq. The three Marines had survived the blast of a 200-pound bomb. The mine-resistant, armor-protected vehicle in which they were riding was mangled. But the three walked away with no apparent injuries.

"We sat out there when we had that picture taken and we high-fived each other, and it was great," he said.

Amos attributed their survival to the MRAP and to the billions of dollars spent by the Defense Department to provide the vehicles.

"I felt good. I said 'America saved your life,'" he said. "This is the reason we did it. Those three young men went home to their wives and families. They're OK."

The general paused.

"Not yet," he said.

Two months ago, Amos again met with one of the Marines in the picture. This time, it was at the National Naval Medical Center in Bethesda, Md. Amos's final slide showed the once smiling and fit Marine lying in a hospital bed, swollen and disheveled, with wires strung from monitoring machines taped across his body.

When the Marine survived the blast, there were no scans in place to ensure there was no internal damage. He looked healthy on the outside. It turns out the Marine suffered a traumatic brain injury. It was the seventh blast the ordnance specialist had endured.

The young Marine's endocrine system was knocked "haywire," Amos said. The endocrine system is similar to the body's nervous system, but regulates metabolism, tissue function and internal functions such as temperature and water balance. His back also was broken. The Marine finished his deployment, but needed heavy painkillers to make it home.

For two years, it was one problem after another, Amos said. Now he stood before the Marine again, this time with his wife by his bed in tears.

"He lost his life in the two years that followed," Amos said. "I'll be honest with you, we let him down. And I'll just leave it at that."

Now, though, the Marine is receiving treatment at the Johns Hopkins Hospital in Maryland, reportedly one of the best facilities for endocrine system treatment. Navy medicine "has their arms around him," Amos said, but they have to go outside to a civilian hospital for the care.

"That's collaboration. That's where that really, really deep talent on the bench resides," Amos said. "The wounds are so severe that we need your help."

Amos said he is sometimes frustrated by the resistance of some in military medicine to reach out to their civilian counterparts. But those walls are coming down, he promised. Now is the time to talk collaboration, the general said.

"If you're not wearing this uniform ... but you're out there [as] just a regular American scientist or doctor or technician, ... we need your help," he appealed. "We can't do this without you."