Surgeon General Describes Transition Unit Challenges

By Lisa Daniel
American Forces Press Service

May 5, 2010 - Walk into any of the Army's 29 warrior transition units, the Army's surgeon general said yesterday, and you will find people struggling through the worst time of their lives. Anger, depression, suicidal thoughts and substance abuse can cloud the efforts of soldiers and their families as they struggle to recover the people they had been before combat changed their lives.

Asked about a recent New York Times article that depicted neglect and suffering among injured soldiers in the Army's care, Lt. Gen. (Dr.) Eric B. Schoomaker said during a Pentagon Channel interview that he doesn't doubt some soldiers and families are "not completely satisfied with what we're doing for them."

However, he added, wounded warriors must struggle with the difficult challenges.

"We were early to recognize that we begin at a disadvantage with soldiers and the families because they come back with a serious illness," he said, "and we in the medical system and the Army at large are working with the soldiers and families under conditions they would never have chosen to be in, and we wouldn't have chosen it for them."

The newspaper based its findings on a visit to a transition unit at Fort Carson, Colo. Schoomaker acknowledged that such individual cases could be found at any of the units, but added that they don't represent the totality of the work being done in rehabilitating soldiers and giving them hope for the future.

Schoomaker said he talked to the transition unit commanders after reading the article. "Every one of them told me, 'Look, this could have been my unit,'" he said. "Some of [the families] are really struggling with being given back a soldier who was not the soldier they were when they went off to war."

More than 9,300 soldiers with a variety of physical and psychological problems have passed through the units since they were created in 2007 to help wounded warriors transition to their next stage of work and life -- a life that may or may not include continued military service, Schoomaker said. For a variety of reasons, he added, their efforts to again be the soldier they wanted to be stall to some degree.

Despite the difficulties that soldiers in transition units are experiencing, Schoomaker said, he and the transition unit commanders welcome the media in the units.

"Many of these folks are in real pain," he said of the soldiers. "They're suffering. And in their desperation, they are having problems seeing their way through to a brighter future, and some take extreme measures to get past their pain. You'll see all those things."

But that's not the whole story, the general said.

"You'll also see [soldiers] focused on 'How I can be a soldier again?' or 'How I can be a productive citizen again?'" he said, as well as volunteers helping them get there.

The media are a conduit to the public, and the public should see that, he added. "These are your sons and daughters," the general said. "These are your brothers and sisters. These are members of your community who've taken an oath to protect your country. Why should we not be willing to show them that we're trying everything in our power to heal them, to rehabilitate them, and to provide the transitional services they require?"

Families also struggle. They have to cope not only with their soldiers' changes and how to care for them, Schoomaker said, but also with the Army's continued expectations of wounded warriors as soldiers, including showing up for appointments. And in some cases, he noted, soldiers choose to limit or not allow their family's involvement in their recovery.

"Sometimes it takes tough love, which a family is not always willing to extend," he said. "It's heartbreaking for them to see someone who has gone into uniform whole of mind and body, and now see what they're going through. And sometimes they misinterpret very important steps they need to stay on the path to healing."

To the extent possible, the general said, transition units use a comprehensive plan to help families with caregiver skills, living arrangements and financial problems related to caring for the soldier. The "triad of care" at the center of the program – a commanding officer, nurse case manager and primary care manager – take a broad approach to rehabilitation, even requiring soldiers to master two athletic events before leaving the program, he said.

"It's our obligation to teach you how to live your life as fully as possible, and even to find new opportunities for you," Schoomaker said. The sports requirement "seems kind of cruel, but soldiers will say it is one of the things that taught them confidence," he said.

Schoomaker acknowledged that warrior transition units have higher suicide rates than the Army at large, and that substance abuse is a problem.

"The [units] are focused on people who've lost their dream of being a particular kind of soldier or who might have lost a part of their body that to them is associated with being a whole person," he said.

Unit staff members look carefully to try to identify soldiers at risk of drug abuse, and they watch them carefully to make sure they're not overmedicated or amassing large quantities of prescription drugs, Schoomaker said. All prescription drugs must come from a single doctor, and large quantities are not prescribed, he added.

Transition units are difficult places, Schoomaker said, not only for the soldier patients and their families, but also for the soldiers who volunteer to work there.

"This is a tough assignment," he said. "We're concerned about compassion fatigue. Some of our initial [noncommissioned officers] and officers thought it would be like leading any other platoon or squad, but found out this really tested them to their limits."

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