Providing Servicemembers With Care and Respect
When U.S. servicemembers began returning from the first Gulf War, many faced a bewildering and frustrating set of health problems for which their care providers could find no cause—some were excessively fatigued; others experienced memory and concentration problems; many had joint pain or chronic indigestion. Collectively, the symptoms became known as Gulf War Illness or Gulf War Syndrome.
More than 100,000 servicemembers were afflicted with these symptoms, leading to the establishment of the Gulf War Health Center in 1995. Now called the Deployment Health Clinical Center (DHCC), it has since expanded to provide clinical treatment, conduct research and educate primary care physicians on the unique needs of military members who have served in combat.
In those early days, the key to the center’s success was for its staff to never question the suffering caused by the symptoms. Instead, they focused on assisting servicemembers in any way possible to mitigate the effects of their illness. The center rapidly developed the intensive treatment component of the Comprehensive Clinical Evaluation Program, created specifically in response to Gulf War Illness.
In the late 1990s, teams led by U.S. Army COL Charles Engel, a psychiatrist and epidemiologist specializing in medically unexplained illnesses, developed a three-week specialized care program, focusing on individual and group therapy and education, physical therapy, occupational therapy, and alternative medicine. The number of HJF employees who support Engel’s clinical programs and research efforts has increased from about 15 in the early years to about 40 today.
In 2001, the Gulf War Health Center transitioned to DHCC, the clinical component of three national centers of excellence devoted to deployment health.
Although DHCC’s research program began with a focus on illnesses associated with the 1991 Gulf War, its portfolio has involved more than a dozen demographic and epidemiological projects, nine health services research projects and clinical trials. Major focus areas include post-war syndromes, especially illness related to the Gulf War, medically unexplained physical symptoms and posttraumatic stress disorder (PTSD) that occurs subsequent to combat, sexual assault or terrorist attack. Many of these research projects involve collaboration with the Department of Veterans Affairs.
In the nation’s current conflicts, the center assists warfighters in various ways. One is via the Re-Engineering Systems for the Primary Care Treatment of Depression and PTSD in the Military program. This initiative trains primary care personnel to conduct PTSD screenings during regular visits with patients using a three-component model of prepared practice, nurse care facilitator and behavioral health supervisor. This process has several benefits, including the removal of some of the stigma associated with seeking help for mental illness and the institution of regular monitoring.
The program, in place at 15 military sites, has screened more than 120,000 primary care patients for combat-related depression and PTSD. Plans involve its implementation at 17 additional sites. Also, DHCC has launched a web-based training module that will be mandatory for all primary care personnel.
Other highlights of the past year include an ongoing clinical study of Prazosin, a drug designed to treat high blood pressure that may reduce nightmares, and a trial studying a brief, web-based, self-management tool for PTSD based on cognitive-behavioral therapy strategies.