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VANGUARD Spring/Summer 2015

INSIDE • VSO Spotlight:

A look at the VFW and its advocacy for Veterans

• New Arm - New Life:

Army Veteran Pamela Witfield comes to grips with new prosthetic

• Culture of Understanding: Explaining what it's like to be a Veteran to non-veterans


Letter to the Editor I am writing to express my sincere gratitude and appreciation for the care and thoughtfulness you have given my grandparents. In particular, your time and attention to them in the aftermath of the tragic shooting at the El Paso VA Clinic on Tuesday, January 6, 2014 was exceptional. My grandfather Joseph Leeah is a patient at the VA clinic. He is almost 90 years old, and although he gets around pretty well, he uses a cane, he has significant hearing loss, and due to macular degeneration, he is blind. He and my 90-year-old grandmother—who also has a hard time hearing and uses a cane— were waiting at the pharmacy at the time of the shooting, when the facility was locked down.

Joseph Leeah in his U.S. Navy unifrom.

After the lock-down announcement, my grandparents, along with other people in the pharmacy, were quickly whisked away to a locked room. There they waited a couple of hours for law enforcement to give further instructions. They were given very little information about what was happening. Eventually, they were

escorted outside to a staging area in the parking lot—by this time, they had been at the clinic for several hours. The circumstances were stressful and frightening for anyone, but especially exhausting for two elderly people with physical limitations. When I talked to my grandfather the next day, he bragged about how nice, helpful, and professional everyone was during the crisis. But he named you personally as especially kind and thoughtful. Indeed, according to my grandfather, over the years that he has gone to the VA clinic, you have stood out as particularly friendly, helpful, and responsive. I just wanted to take the time to thank you for making the stressful situation a little less frightening or uncomfortable for my grandparents. First, once my grandparents were evacuated from the pharmacy, you checked in on them—you gave them a friendly, familiar face to turn to if they needed anything. Then, recognizing that it was getting cold outside, you offered to get blankets for them. Even better, you escorted them to an ambulance to keep them warm and rested while they waited for further instructions. You continued to monitor them to make sure they did not need anything during the ordeal. And finally, after they were released to go home, you called to make sure that they made it home safely. I can only imagine the enormous stress and emotional impact the incident had on you personally, and I truly appreciate the extra time and attention you paid to my grandparents—I am guessing that they were just two of

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Joseph Leeah in his wife, Jean .

many people you took care of that day. Although you may view your actions as just a part of your job, I believe that you went above and beyond and I can assure you that you made an enormous difference. You provided my grandparents with assurance that someone was looking out for them and some security that they wouldn’t get lost in the shuffle. And as a family member who lives so far away, it is comforting to know that people like you are there to help them. Thank you. I hope that you will share my letter with your management. I’m happy to talk to anyone who has any questions. Sincerely, Jessica L. Srader


VANGUARD

VA’s Employee Magazine

Inside Features

Spring/Summer 2015 Editor: Gary Hicks

5

Continued Service

7

VSO Spotlight

Staff Writers: Jennifer Sardam Reynaldo Leal

12

A VAMC tackles the Opiate Crisis

18

VA and Tribal Nations Join forces

Designer: Reynaldo Leal

20

Recovering From Addiction

24

Sexual Health: it's time to talk about it

28

The Ghosts of Iwo Jima

32

A look Around VA

38

VA Doctor Calms Would-be Jumper

Photo Editor: Robert Turtil Published by the Office of Public Affairs (80D) U.S. Department of Veterans Affairs 810 Vermont Ave., N.W. Washington, D.C. 20420

COVER PHOTO: By Rey Leal A Veteran celebrates VE Day in Washington, D.C., May 2015.


My VA

Images from around the Department

TOP: A Veteran is given a hearing test by a VA employee. More than 700 Veterans received medical attention, clothing and toiletries at Washington, D.C., VA Medical Center’s Winterhaven Homeless Veterans Stand Down (ROBERT TURTIL). BOTTOM LEFT: Miss Texas 2014 Monique Evans signs autographs during the National Salute to Veteran Patients at the Olin E. Teague Veterans Medical Center in Temple, Texas (BRIAN GAVIN). BOTTOM RIGHT - Dallas Cowboy Cheerleaders greet Veterans during National Salute to Veteran Patients.

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CONTINUED SERVICE

Veterans who serve Veterans

Mary Hershey served in the US Army from 1974-1976 as a Military Policeman and Detective. She was attached to an Ordnance Company at Fort Carson, Colorado. In addition to bomb security, directing traffic, and special event details, Mary worked undercover for Military Police Intelligence for a period of time. After leaving the service, Mary attended college where she earned her Master’s degree in Education, with a specialization in Counseling & Guidance. She is profoundly grateful for the GI Bill which made all her education possible. Mary came to the Department of Veteran Affairs in 1993, looking for a way to pay service to Veterans, especially those who served in combat. She is currently the Acting Site Manager for the Santa Barbara and Oxnard CBOCs, which are part of the VA Greater Los Angeles Healthcare System. She feels privileged to walk among heroes each day, both men and women, former enlisted and officers, and those wounded externally and internally. She credits her team members at the Santa Barbara Clinic for inspiring her every single day. Mary piloted a shoe-shining service to Veterans in the clinic and found it to be one of the highlights of her work. “ Shining the shoes of a Veteran is both a deeply respectful and enlightening experience.” She challenges other VA employees across the country to give it a try.

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VA TAKES ACTION

TO IMPROVE

CUSTOMER SERVICE

VA continues to take action to improve Veterans experience with the department by identifying performance improvements that simplify VA operations and improve customer service. MyVA is a large-scale, cultural transformational effort started by VA Secretary Bob McDonald in September aimed at making VA become more Veteran-centric and productive, while empowering employees with the knowledge and tools they need to better deliver service to Veterans. Performance improvements play a vital role in MyVA being successful. MyVA task force teams conducted a series of robust discussions and listening sessions last fall with more than 2,000 employees from across the country to understand customer service successes and barriers as well as to capture employee suggestions and ideas on what processes and procedures should be changed for a more positive VA experience. Performance improvements that could make the most impact to Veterans were identified for immediate action from those discussions and from ideas and suggestions made by employees nationwide through the VA Idea House website to identify areas for potential improvement at their local facility. Performance improvement teams began creating execution strategies for each identified improvement. “The MyVA work we are doing is to provide Veterans with a world class service experience when they receive their earned care and benefits and to support, as well as empower, employees that encounter Veterans each day” said Bob Snyder, executive director

Philadelphia employees participate in VA 101 training of the MyVA Task Force. “MyVA performance improvement teams are on the ground regularly, meeting with employees to engage them in solution–development sessions for shortand long-term improvements. These ongoing conversations are crucial in helping us shape solutions and understand enablers of high-quality service. They also are helping VA establish an infrastructure that supports a culture of continuous performance improvement.” Nearly 20 MyVA performance improvements are underway as part of a VA -wide strategy to ensure performance and outcome improvement. Veterans are already seeing more streamlined service when they contact VA call centers. At the suggestion of an employee, VA implemented policies to eliminate additional steps required of Veterans by allowing call center agents to suspend or resume certain benefit payments at the request of Veterans who reach out. Other employee suggestions for how VA can improve performance are underway to include: • Standardize signage and improve wayfinding materials so Veterans and their families can easier navigate VA medical centers; • Developing VA 101 training to ensure that employees gain a stron-

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ger knowledge about the department and the benefits and services available to eligible Veterans as well deepen employees’ knowledge and understanding of Veteran needs; • Implementing a direct scheduling process for ear and eye care so Veterans can bypass primary care and schedule appointments directly with Audiology and Optometry • Examining the use of expanding public Internet (WiFi) access across all VHA facilities for Veterans and their families • Meeting with employees on how to engage Veterans to better meet their expectations and needs through town halls Other performance ideas in progress are focusing on how to improve or eliminate VA internal processes that impede customer service, equipping employees with the tools they need to better do their jobs and examining external partnerships to expand outreach services to Veterans, among others. “Continuous improvement is our focus.” said Snyder. “It’s about working together to leverage the pockets of excellence to create the change needed so our Veterans are proud to call VA, ‘my VA.’”


VSO Spotlight

THE VFW

115 years young and still serving The Veterans of Foreign Wars of the United States was born from wars long ago, and the relevance it continues to pay forward to every new generation is based on the total understanding of what it takes to serve in harm’s way, as well as what it takes to successfully transition back into an American society that by and large today chooses not to serve. The VFW is the nation’s largest and oldest major combat veterans’ service organization. The nonprofit membership organization traces its roots to 1899 when its founders began returning home from the Spanish-American War and later, the Philippine Insurrection, to discover that the American government provided virtually no healthcare or rehabilitation programs for their service-connected wounds, illnesses or injuries. To the VFW, a nation that creates veterans has a sacred obligation to care for them when they return home, so these combat veterans banded together to create an organization to change the way America treats those she sends to war — and more than 115 years later, that mission contin-

ues.

The strength of the VFW is in its relevance to all who served, regardless of where or when. With more than 1.3 million members and 6,800 Posts throughout the United States and abroad, the VFW is the most respected and powerful veterans’ voice inside the White House and Congress as it advocates on behalf of the interests of 22 million veterans and more than 2.3 million active-duty military, Guard and Reserve members, and all of their families. The VFW works with Congress to create and enhance those Quality of Life programs and services that benefit veterans, service members and their families, and to defeat any legislative proposal that does not. The VFW has been at the forefront of creating nearly every Quality of Life program provided by the Departments of Veterans Affairs and Defense — from improved healthcare and disability compensation to new GI Bills, traumatic injury insurance, hazardous substance exposure compensation, family caregiver support, and better programs and services for women veterans. The VFW is now actively engaged to end sequestration and to ensure the Veterans Access, Choice and Accountability Act of 2014 is properly implemented so that the VA can identify and fix what’s broken, hold its employees appropriately accountable, and restore the faith of veterans in their VA health and benefits systems. The VFW’s nationwide network of more than 1,500 VA-accredited service officers helps hundreds of thousands of veterans to recoup billions in compensation and pension, plus they represent more than 4,000 veterans and survivors annually before the Board of Veterans Appeals in Washington. Through a joint DoD/VA program entitled “Benefits Delivery at Discharge,” or BDD, VFW Service Officers also assist transitioning military

members to complete and file their VA claims paperwork on the nation’s largest military installations and in military-populated regions. Through the Marine Corps Wounded Warrior Regiment, VFW Service Officers also assist previously discharged wounded, ill and injured Marines with their VA claims and appeals, as well as assists student veterans in more than 1,100 Student Veterans of America chapters with their GI Bill claims and other earned VA benefits. The VFW’s slogan, “No One Does More For Veterans,” is a challenge for the entire organization to keep paying it forward to every generation of serviceman or woman. Along with its national legislative and service officer support, the VFW also organizes and sponsors thousands of community, military and veterans’ outreach events that include: • Hosting 2 million military members and their families at departure and homecoming ceremonies; • Volunteering more than 11 million hours at 1,400 VA facilities; • Awarding $5,000 educational scholarships to service members and veterans; • Providing $3.2 million in annual 6th through 12th grade patriotic scholarship competitions; and • Delivering $5 million in grants to help 3,600 military families in emergency financial situations through the VFW Unmet Needs program, with program eligibility extending up to 36 months after an honorable discharge. Every returning war veteran inherits a solemn duty to make things better for succeeding generations, and for more than 115 years, the Veterans of Foreign Wars of the United States continues to lead the fight to ensure that a nation that creates veterans takes care of them when they return home. Learn more at www.vfw.org.

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NEW ARM - NEW LIFE By Claudie Benjamin

Army Veteran Pamela Winfield

N

ow healing from horrific injuries, Army Veteran Pamela Winfield, is being trained to use a prosthetic arm with the expert help of VA staff like Prosthetist Christopher Fantini, an expert with advanced upper extremity prosthetic technologies. Life is also moving forward with regular training provided by Occupational Therapist Roxanne Disla. Ms. Winfield is a good Samaritan who lost her left hand above the wrist when a crazed 22 year-old attacker severed her arm with a samurai sword. Amazingly, she says, “I would do it all again.” She draws strength from the VA experts dedicated to her care and comfort from her therapy dog, a Chihuahua, ”When I cry, he licks away my tears.”

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At 50, Ms. Winfield carries herself with grace and speaks with assurance. Born in Louisiana, Ms. Winfield joined the US Army straight out of high school, "to be the best that I could be." After serving in Korea and at bases throughout the U.S. during her seven years in the army, Ms. Winfield was honorably discharged and went to work as a cook and later as a supervisor of a catering company on an oil rig in the Gulf of Mexico, This was work she loved, “It was like a family. We were out on the rig for 2-6 weeks at a time. After eight years on the job, Ms. Winfield retired because of the recurrence of a service-related back injury, that required surgery. Following her operation, Ms. Winfield said, “I wanted to start a new life.” She moved to an apartment building in New York City and, using Craig’s List, hired a nurse to assist in her care. Five months after moving to New York, Ms. Winfield heard a struggle, “Like someone was being slung from wall to wall,” on the floor above her. Within minutes, she found herself pulling the mother of the attacker away from danger while being pursued herself by the attacker. Stabbed 16 times, Ms. Winfield somehow managed to drag herself into her home and slam the door shut with her legs. Ms. Winfield was taken by ambulance to St. Barnabas Hospital and transferred to JJ Peters Bronx VA. After emerging from an induced coma to stabilize her condition, “I woke up in an ICU without a hand.” She understands her hand was not salvageable and that the amputation was necessary. Mr. Fantini first met Ms. Winfield two years ago years ago at her hospital bedside. He was accompanied by Fran Niegocki, an occupational therapist at JJ Peters. “I recall thinking, as Ms. Winfield calmly and graphically described what had happened to her only a week prior, that this woman was amazingly composed and I was extremely impressed with her heroism and attitude,” said Mr. Fantini. “Ms. Winfield was amputated at the wrist joint on the left arm and was educated on various

prosthetic options. Due to the long length of the residual limb, the choice of operational prosthetic components is limited, since there isn’t enough room to add an active prosthetic wrist unit (as it would be asymmetric in length as compared with the right arm).” The Amputee Care Team at the JJ Peters VA, along with Mr. Fantini, consulted with Ms. Winfield to prescribe the most appropriate devices that would allow her to regain as much functional and body image recovery as possible. The first prosthesis made for Ms. Winfield was a lifelike custom silicone prosthesis, made to match the right hand in size, shape, texture and color. Soon after that, an externally powered (“myoelectric”) prosthesis was made using a simple electric hand that opened and closed in a single grip pattern. A “myoelectric” prosthesis is an externally powered prostheses that utilizes electromyographic electrodes, commonly referred to as EMG electrodes. The EMG electrodes can be thought of as antennae that pick up the electrical signal given off by muscle tissue as they contract. These signals are then amplified and converted into commands used to control Ms. Winfield’s prosthetic hand. Ms. Winfield participated in occupational therapy, both before and after the myoelectric prosthesis was made, at the JJ Peters VA, to increase her proficiency at using the prosthesis and myoelectric controls. After having the myoelectric prosthesis for over a

year, Ms. Winfield no longer fit into this prosthesis and needed a new one. She was introduced to a new prosthetic hand that features individually motorized fingers enabling her to open/ close the prosthetic hand in variable grip patterns, more like a natural hand. Ms. Winfield was very eager and excited to start the process of getting the new prosthesis with the upgraded hand. Due to the increased functional options, this device is more complex than the earlier electric hand Ms. Winfield had used, and requires more training for use. Today, for the process of training with Ms. Disla, Ms. Winfield uses the hand she will use in the future, but it is attached to a “training arm” and does not have the life-like skin and modeled, colored form that her prosthetic will have in the future. The training arm is fitted with small electronic devices that allow Ms. Winfield to command her arm to move into a series of grips used for different types of activities. Ms. Disla challenges Ms. Winfield to work on activities like holding a fork to hold a piece of bread in place, while she cuts it with her right hand.” It’s extraordinary to watch, and Ms. Winfield is impressed by her own progress. “It’s amazing me. It’s really hard. It’s all about being able to do the activities of daily life,” she said. Winfield was honored on October 21 by the NYC Mayor’s Office of Veterans Affairs when Commissioner Loree Sutton, a physician and retired Brigadier General, presented her with a plaque acknowledging her heroism.

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Summer of Service: Join in serving Veterans VA begins a new nationwide initiative today to increase the number of people and organizations serving Veterans in their communities. It’s called “Summer of Service” and we are asking citizens across the country to join us in serving our nation’s Veterans. “We have made progress over the past year addressing the challenges we face in delivering care and benefits to millions of Veterans and their families,” said Secretary Bob McDonald. “While there is more work to do to honor our sacred commitment to Veterans, we also recognize that VA cannot do it alone. We are asking Americans everywhere to join the Summer of Service and help us give back to those who have given so much to our nation.” In the coming weeks, VA will be working closely with congressional partners, Veterans service organizations, mayors and local communities, private sector and nonprofit organizations, and VA employees to identify new and innovative ways to support VA’s commitment to care for those who “have borne the battle” and their families. As part of VA’s Summer of Service, the department will hold an open house at VA facilities the week of June 28. We are inviting members of the community interested in supporting Veterans to come and join us and see how they can help serve our nation’s heroes. VA leadership has set several goals we hope to obtain before Labor Day. These include: Increase the number of VA volunteers; Increase the number of community partners; Recruiting more health care professionals and clinical support staff to further expand access to care and reduce homelessness; and Page 10 | VANGUARD | Spring/Summer 2015

Host congressional members and staffs at VA facilities across the country so they can see firsthand how Veterans are being served and what their needs are. The Summer of Service initiative will build on VA’s volunteer program which currently has about 76,000 volunteers around the nation. While that might seem like a lot of volunteers, consider that VA completed more that 46 million appointments last year across 1,700 points of care. There are plenty of opportunities remaining to those who want to give back to the Veterans in their community. While the central focus of the campaign is increasing volunteerism and community partnerships, VA will ramp up recruitment efforts to bring in the much needed doctors, nurses and medical support professionals necessary to provide timely and adequate care to our Veterans while simultaneously conducting the most comprehensive reorganization in its history – called MyVA. “There is no mission more noble than serving Veterans and their families. At VA, we constantly strive to improve the way we do our job,” said McDonald. “State by state, community by community, person by person, there are a number of ways we can all come together to serve Veterans. From expanded partnerships with the private sector and nonprofit organizations, to accelerating hiring, to celebrating the commitment of VA employees and volunteers – we need the help of communities everywhere to succeed.” Volunteers can help to serve Veterans by visiting http:// www.volunteer.va.gov/ to find out the needs of your local VA facility. Follow #VASummerOfService on Vantage Point, Twitter, Facebook and Instagram, and join VA in caring for America’s Veterans.


CONSUMMATE

PROFESSIONAL By Margaret Hornberger

The Continental Who’s Who has recognized Veterans Affairs (VA) Maryland Health Care System Chaplain Susan Turley as a Pinnacle Professional in the field of government service and named her the 2014 National Association of Professional Women’s VIP Woman of the Year for outstanding excellence and dedication to her profession and the achievement of women. The Continental Who's Who recognizes professional individuals and organizations each year who "stand-out" in their specific field. Included are executives and officials in business, science, education, philanthropy, religion, government, finance, law, engineering, etc. Turley, the associate clinical pastoral education supervisor for the VA Maryland Health Care System, manages the Clinical Pastoral Education program, an interfaith, multi-faith program designed for those seeking ordination and board certification in professional chaplaincy and for faith leaders seeking advanced skills and theory in chaplaincy and spiritual care. “As a VA chaplain who has the privilege of ministering to Veterans and their family members, I am truly humbled and appreciative of this recognition,” said Turley. “It is an honor to help Veterans who have experienced illness, trauma, poverty

Susan G. Turley, M.Ed., M.Div., BCC, the associate clinical pastoral education supervisor for the VA Maryland Health Care System, is the recipient of the Continental Who’s Who as a Pinnacle Professional in the field of government services and is named 2014 National Association of Professional Women’s VIP Woman of the Year.

and violence transform their suffering into wisdom and regain a fulfilled and joyful life,” she added. Turley, who joined the Gold Star Mothers after her son, Private First Class Keith Jesse Moore, died while serving in the U.S. Army in Iraq in 2006, works closely with fellow VA chaplains in the areas of grief and loss, trauma, end of life care, and spiritual counseling to enrolled Veterans and their family members. To help educate those wanting to learn how to be an effective presence to others who have suffered loss and trauma, Turley recently developed a film about mothers who have lost their children in war titled, “Broken Hearts Lifted Spirits: Mothers of the Fallen Speak Their Truth.” The film serves as an education and training resource.

Turley also expresses her spirituality through watercolor paintings that she uses as a therapeutic tool to help heal emotional wounds. Turley holds a Master of Science in Education from Suffolk University and received her Master of Divinity in Religion from the Pacific School of Religion. She was ordained as one of the first women in the Swedenborgian Church in 1980. Turley, who is a longstanding member of the American Counseling Association, also has two years post graduate training in Family System’s Therapy that included a focus on mental health. Her ministry has included spiritual counseling to those affected by AIDS, homelessness, addiction and abuse recovery.


From the Frontlines: The opiate crises and one inner-city VA’s approach to pain management By Heidi Klingbeil, MD and Jim Connell, PAO

High-strength painkillers, or “opioids,” represent the most widely prescribed class of medications in the United States, according to the National Office of Drug Control Policy (NODC). “The CDC has classified prescription drug abuse as an epidemic,” says the NODC. “While there has been a marked decrease in the use of some illegal drugs like cocaine, data from the National Survey on Drug Use and Health show that nearly one-third of people, aged 12 and over, who used drugs for the first time in 2009, began by using a prescription drug non-medically.” Unfortunately Veterans have not been spared, and the VA has responded to the opiate crises by

enacting the Opioid Safety Initiative, which is being implemented nationwide. Local implementation of this initiative has been aggressive and successful. Veterans Integrated Service Network (VISN) 3, which incorporates the New York/New Jersey Metro region, has the lowest percentage of patients on opiate pain medications in the nation. In support of this effort, the Bronx’s James J. Peters VA Medical Center (VAMC) has been a key driver in achieving this statistic. The Bronx factors prominently into this initiative, because several years before the current crisis, leadership at the Bronx VAMC had concluded that the rate at which

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opiates were being prescribed was far higher than the benefits which were being realized. They started early with the implementation of a plan to address the situation. “It was evident that many patients might actually be far more successful at creating a life for themselves, if they were not so dependent on our medications,” said Dr. Heidi Klingbeil, chief of physical medicine and rehabilitation, and director of the pain management clinic at the Bronx VAMC.“ At the same time, there was also ample evidence that prescription drugs were being diverted into the community. For both reasons, and out of concern for our patients and their families, we decided to embark


on a path that would be safer and more effective for the patients that needed our help. At the same time, we would be a better neighbor to our large, inner-city community.” Pain is an individual experience, and no medical provider can argue with a patient’s perception of pain. With that in mind, the Bronx VAMC endeavored to shape a VISN 3 pain policy that would help to guide providers in effectively treating pain, and, at the same time, be patientcentered. The first tenet of our policy became the need for a real diagnosis. Many patients had been in the VA system for years, and some had been maintained on high doses of opiates. Their diagnoses had often not been any more specific than “back pain,” and no recent X-rays or other tests existed. It was thus determined that a diagnosis had to be more specific. Furthermore, patients whose pain defied diagnosis and was deemed to be “neuropathic” (nerve-related pain), were offered more appropriate medications. Studies have shown that opiates are not the correct medication for treating neuropathic pain. Secondly, it was felt that any individual with pain should be given the opportunity to get better. This meant that active participation in a physical program tailored to the

patient, with a goal of remediating their pain, was essential. For many, this meant a course of physical or occupational therapy, that would lead to a home exercise program. Others who were unable to start such a program were first brought into the MOVE!® Weight Management Program, or started in the gentler therapeutic pool. Opiates were continued in order to allow them to participate in such programs, but they were not provided in lieu of the therapies. Finally, it was essential that some benefit be realized from the opiates prescribed, or they were tapered. Thus a concrete increase in the Veteran’s ability to function, and decreased pain scores, were the grounds for continuing opiates. With the support of our facility leadership, our providers increased the availability of alternative medicine to patients in our pain clinic. “The majority of our pain clinic providers now use acupuncture in their regular clinics as a first alternative,”said Bronx VAMC director, Dr. Erik Langhoff. “Chiropractic treatment is also offered, as well as a range of volunteer-led activities such as yoga, tai chi, massage, and Reiki.” Over the course of the past several years, the facility has successfully weaned hundreds of its patients from opiates altogether.

For countless others, providers have been able to safely decrease their dosage so they can maintain some sense of normalcy in their lives. The response from patients was somewhat unexpected. Instead of the anger and anxiety we expected, many patients expressed heartfelt gratitude for their new lease on life. In fact, many patients who were unemployed due to pain issues were able to return to gainful employment, as a result of this positive progress. In following up on the patients in our pain management program, we do perform the usual urine drug testing and other monitoring. Some patients have repeatedly shown they are not actually using opiates themselves. These patients have been discharged from the clinic. Still other patients clearly were dependent on opiates, although there was no obvious physical source for their pain. Thus we have started a collaborative relationship with our psychiatry service, and moved quickly to diagnosis a substance abuse problem, or a self-medicating syndrome, related to other psychiatric conditions, such as bipolar disorder, that could be better treated with medications specifically for those conditions. Although change is not always viewed favorably by its intended beneficiaries as they experience the transformation, our experience has been very positive. Within a relatively short period of time, our new strategy was showing significant progress and, ultimately, it has resulted in many compliments and improved lives, bringing Veterans and their families to a new and healthier lifestyle. An incidental and positive corollary is the fact that our opiate prescription rate is one of the lowest in the nation, and the Bronx VAMC has become a better neighbor to our remarkable and diverse community.

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SERVING VETERANS

Making tennis more accessible to Vets By Lelia Jackson The Department of Veterans Affairs and the United States Tennis Association (USTA) Foundation formed a national partnership to make tennis more accessible to Veterans at VA medical centers around the country. “We are very excited to be partnering with the USTA Foundation to improve Veterans’ physical fitness and ultimately their overall health and well-being,” said Dr. Carolyn Clancy, Interim Under Secretary for Health. The USTA Foundation will support VA by providing coaching, instruction, equipment or use of courts or other technical assistance to sustain a tennis clinic, along with their recently developed “Warrior Tennis Curriculum,” an electronic manual that provides rehabilitation therapists guidance through text, pictures and videos on how to use tennis as a

therapeutic option to help Veterans stay fit and active. Although open to all Veterans, this optional tennis program can help interested VA medical facilities offer patients a way to become more physically active through an enjoyable sport. Several VA medical centers have already taken advantage of this wonderful partnership to help their local Veterans. Some programs are just starting up and others are well on their way to being fully part of their recreational activities. The Palo Alto Health Care System staff, along with Recreation Therapist Angela Kwan and a local tennis professional, have incorporated tennis in their outpatient services for seriously mentally ill Veterans. The Minneapolis VA Health Care System has a very active and dynamic

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tennis program. Angie Erickson from the facility’s Spinal Cord Injury Center (SCI) has been working with Tony Stingley, Director of Training and Outreach from USTA Northern. The tennis professionals match an able bodied therapist or counselor with each wheelchair player to do the activities. The Minneapolis VAMC runs its program twice per month and the number of attendees ranges from 1 – 10 each session. This includes inpatient and outpatient Veterans receiving care at the Minneapolis VA Spinal Cord Injury & Disorder Center, Polytrauma Rehabilitation Center, Pain Clinic, Community Living Center, and MOVE, the VA’s national weight management program. The Augusta Charlie Norwood VA Medical Center’s tennis program is very robust and offered to in and


out patients. Recreation Therapist Becky Halioua commented that although the program is not mandatory, the facility has as many as fifteen Veterans participate each week. All of the equipment is provided by local tennis professional Lisa Krupp. She runs the tennis clinic each week for one hour. The hour is broken up into drills that include stroke production, how to hit a forehand, backhand, volley and serve, as well as doubles play. “Each week is different, new players, new accomplishments, but the bottom line is fun. We try to make it one hour of forget about challenges, appointments or life,” said Lisa Krupp. VA facilities interested in establishing a tennis program or learning more can contact the VHA Office of Community Engagement at CommunityEngagement@va.gov to get connected to a tennis organization or military@usta. com for a copy of the Warrior Tennis Curriculum.

Connect. It matters. Friendship. It matters. Ask the question. It matters.

Family. Compassion. It matters. Support. It matters. Listen. It matters.

It Matters. © 10/13 VHA

Because you mean so much to them.

Confidential help for Veterans and their families

Confidential chat at VeteransCrisisLine.net or text to 838255

Connect. It matters. Friendship. It matters. Ask the question. It matters.

Family. Compassion. It matters. Support. It matters. Listen. It matters.

It Matters. © 10/13 VHA

Because you mean so much to them.


VA and Tribal Nations Join Forces to Aid Homeless Veterans

A Veteran receiving a blood pressure check at one of the Tribal Blood Pressure stations By Ozzie Garza They came here in droves, dozens of them, from under bridges, cardboard makeshift shacks, and from homeless shelters. Others came in busses and some were dropped off by Good Samaritans wanting to help. Their destination was the Iscani Gym in Anadarko, Okla. this past Nov. 7. Despite their differences in age and background they all have something in common. All are military Veterans who served their country honorably. They also are homeless. To help these patriots and their families, eight tribal nations along with the U.S. Department of Veterans Affairs (VA) hosted an inter-tribal Veterans Stand Down, a program where an array of services are brought to one location making them more accessible to homeless Veterans. The Stand Down for homeless veterans program is modeled after

the Stand Down concept used during the Vietnam War to provide a safe retreat for units returning from combat operations. At secure base camp areas, troops were able to take care of personal hygiene, get clean uniforms, enjoy warm meals, receive medical and dental care, mail and receive letters, and enjoy the camaraderie of friends in a safe environment. Stand Down afforded battle-weary soldiers the opportunity to renew their spirit, health and overall sense of well-being. To have a successful Stand Down and achieve the program’s objectives requires a wide range of support services. Those services were provided by eight tribal nations: Delaware Nation of Oklahoma, Caddo Nation of Oklahoma, Kiowa Indian Tribe of Oklahoma, Comanche Nation, Wichita and Affiliated Tribes, Apache Tribe of Oklahoma, Ft. Sill Apache Tribe of Oklahoma, and the Cheyenne and

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Arapaho Tribes, in collaboration with the VA’s Office of Tribal Government Relations and the Oklahoma City VA Medical Center. They all came together to serve the Native American homeless Veteran population in and around the Anadarko Indian Community. More than 160 Veterans and widows were treated to a myriad of services that included health care, mental health treatment, housing, vocational rehabilitation, flu shots, job and employment counseling. In addition, offices such as Office of Special Trustee and the Bureau of Indian Affairs CFR Court provided information on services available to tribal members. A half dozen barbers were on hand to provide free haircuts, while other volunteers distributed winter clothes to help these Veterans prepare for the cold weather. Many thanks was given to the Cheyenne


and Arapaho tribes, who catered the hot meal, and the Kiowa War Mothers Society provided boxed thanksgiving luncheons for the Veterans to take with them. The eight tribes came together in this joint effort that was spearheaded by Mary Culley, VA’s tribal government relations specialist for the Southern Plains and Eastern Region and Lottie Jay, Delaware Nation Housing Director. “The biggest purpose targeting Native American Veterans in this area is to get a projected head count of homeless Veterans in this very rural part of Oklahoma. “Generally, as Indian people, we don’t self-identify with the term homeless. In our culture we support our families and take them in, provide them an extra bed, or a couch to sleep on, so by not identifying with that term, we really don’t have a true account of numbers where our homeless Indian Veteran population is concerned,” said Culley. “By collaborating with the tribes we are starting to initiate demographics of our Veterans. We are also using this opportunity to teach tribal staff, how to best service their tribal Veteran population, by also teaching them and helping them understand VA services and processes. This event was a collaboration of eight different tribes coming together to help our Veterans which has never been done before in this region and it was a very successful event. All of the tribes and agencies who worked on this event did an outstanding job” Culley pointed out the support and encouragement provided by the tribal leadership, who all wholeheartedly embraced the event, has more than opened the doors of collaboration between the VA and tribal nations within the State of Oklahoma. Also embracing the Stand Down were the Veterans and their families as evidenced by the smiles on their faces. As one Veteran put it, “I could feel the love and appreciation that was on display today, “A big thank you to all.”

Cheyenne and Arapaho Lt Governor Cornell Sankey, Cheyenne and Arapaho Governor Eddie Hamilton, VA’ OTGR Mary Culley, Delaware Nation President Clifford Peacock, and Delaware Nation Vice President C.J. Watkins take time out to pose for a group photo. Several Tribal Leaders were in attendance and talked with several Veterans and widows.”

A local Veteran meets and talks with other Veterans at the Stand Down after going through and receiving services.

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Creating a Culture of Understanding By Karen Collins Now, more than ever, the emphasis across the Department of Veterans Affairs has been on embodying VA’s “I CARE” values and providing excellent customer service. The best way to achieve this is by being truly Veteran-centric in all interactions across all areas of operation, from the health care team to the environmental services workers to the staff in billing and coding. To be Veteran-centric, we first need to understand our patients (or customers). That is why James A. Haley Veterans’ Hospital (JAHVH) and clinics in Tampa, Fla., created an educational series about military culture. This series was designed to teach non-Veteran employees how military service is its own culture that shapes the attitudes and reactions of both those who have served and their families. “Providing great customer service is essential for us to provide the best health care and experience possible for our Veterans and their caregivers,” said Suzanne Tate, JAHVH assistant director and patient-centered care champion. “Understanding what Veterans experienced and how that shapes and defines their expectations and relationships is a big part of that process. We want to give our employees the tools to better serve our Veterans.” The Military Cultural Awareness series was first conceived during the JAHVH strategic planning retreat as a means to improve patient satisfaction and engagement. Over time, and with the input of a team of volunteer employees, it developed into a series of three educa-

Active-duty Service members discuss culture shifts occurring in today’s military.

tional events. The first class was a lunch-andlearn overview of the cultural history and differences between the branches of service provided by members of the JAHVH clinical psychology team. The predominant feedback from the staff who attended was that they wanted more – more time, more information and more sessions so their coworkers could get the same information. The second session in the Military Cultural Awareness series was a Veteran panel discussion. The panel featured active-duty personnel and Veterans from a range of different eras and branches of service. The training started with each panel member giving a brief overview of his or her military experience followed by the opportunity for the audience to ask the panel questions. This was so well received that staff are continuing to schedule the panel members to individual service staff meetings. “I participated in the military panel to help employees be able to understand how Veterans think and feel – to empathize [how] you have to be able to relate,” said Adam Ferguson, an Army Veteran of Operations Enduring Freedom, Iraqi Freedom, and New Dawn, and member

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of the Veterans and Family Advisory Council (VFAC). “The audience seemed eager to hear about the various experiences of the Veterans as well as how the different services had many commonalities.” The final educational opportunity in the series was a Military Cultural Awareness Expo open to all staff, Veterans and visitors. The expo featured a variety of booths and displays from Veteran employees sharing their personal military experiences, from active duty from the different military branches to community partners such as Amputee Veterans of America Support Team, the nation’s only all-amputee color guard, and displays from the Armed Forces History Museum, out of Largo, Fla. All three events in the educational series were well received by those who attended. JAHVH plans to repeat the series in fiscal year 2015, and expand it to clinics and staff located outside the main hospital campus. “Our vision is to honor those we serve by providing five-star primary to quaternary health care,” said Tate. “To be five-star, we must provide excellent customer service and to do that, we need to know those we are here to serve. That’s why we created this military culture series.”


LEARNING

HOW TO

PREVENT VETERAN SUICIDES By Tom Kramer Let’s say you’re an administrative assistant at a VA medical center. Your job this morning is to start calling patients –there’s a whole list of them– and remind them they have an appointment today at the hospital. But this one Veteran you’ve just called doesn’t sound so good; she sounds depressed, really depressed, and she suddenly tells you she’s contemplating suicide. What do you do? Tell her to hang up and call 911? Give her the number to the Veterans Crisis Line? Life and Death “We came to realize that every single person in our medical center needs training in immediate suicide intervention,” said Raphael D’Ausilio, a peer support specialist at the Salisbury VA Medical Center in North Carolina. “Everyone needs to know how to talk to a Veteran in crisis. It can mean the difference between life and death.” That’s why D’Ausilio and co-worker Tony Peeler, both Army Veterans, teamed up recently and launched a training program called ASIST, which stands for Applied Suicide Intervention Skills Training. Developed by LivingWorks Education, ASIST is the same

program used to train operators of the VA Crisis Line. Each two-day class can accommodate up to 30 students. “It’s just like first aid,” said Peeler, a nurse at the Salisbury VA. “You want everyone in your facility to know how to do CPR, right? Now we want everyone to know how to handle a suicide intervention. “The ASIST class simply makes you more comfortable with conducting an intervention,” he continued. “No matter who you are, or what your job is here, we want you to be able to talk one-onone with someone who’s in crisis.” Finding Your Safe Place “This training empowers our frontline people to intervene in a crisis situation and perhaps save someone’s life,” said Dr. Stephen Russell, a psychologist at the Salisbury VA who took the ASIST training in March. “It provides a much broader safety net than we had before.” Tony Peeler said students in the class are taught how to get a suicidal Veteran to what he calls ‘a safe place.’ “At some point in the conversation you assist them in making a safe plan,” he explained. “A safe plan gets the Veteran out of immediate danger. Suggest they go for a walk with their dog. Suggest they call their neighbor and get a ride to the emergency room. Suggest

they read a book, or go get something to eat. A safe plan can be anything.” Raphael D’Ausilio said the ASIST training class places a big emphasis on learning how to be a good listener. “If someone is suicidal, you want to listen to their story,” he said. “If you ask them what’s wrong, they’ll tell you. You want to listen, and you want to get them to what we call a ‘turning point.’ “A turning point is an anchor to life,” he continued. “It’s that point in the conversation where you begin steering them away from death and toward life. If they have children, you might ask them, ‘Don’t you want to be here to help your children grow up?’ Don’t you want to see them graduate from college, or get married?’ People who are contemplating suicide are just too distraught to think about any of that… “And if they don’t have kids,” he added, “or grandkids, or a spouse, then listen for something else that’s meaningful to them. Perhaps their dog. Something seemingly small may cause them to back away from the cliff they’re on. Anything that will get them to a safe place, at least for the moment.” Solutions “The training taught us how critical it is for the Veteran to come up with their own solution, their own turning point, and that you’re just there to assist them in doing that,” said Casey Payne, a medical support assistant at Salisbury who recently took the ASIST training class. “It’s mainly about being more understanding,” she concluded. “We learned that when a caller is suicidal, you want them to talk to you and get their feelings out. They don’t want to be judged, or told to do this, or not to do that. They just want someone to listen. And if you listen long enough, they’ll start thinking of solutions on their own without you telling them what to do.” Are you a Veteran in crisis or know someone who is? Call the Veterans Crisis Line at 1-800-273-8255 (Press 1) or visit www.veteranscrisisline.net

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A FOCUS ON RECOVERY

Veterans receiving treatment for addictions and mental illness, credit program with saving lives By Jayna Legg Photos by Mary Waterman The four two-story frame homes on 24th Street resemble others on the block, with concrete patios and gas grills in the backyards and tidy flower beds and stepping stones in the front. Like other households, there’s yard work to do during warm weather months, daily menus to be planned, groceries to be bought, floors to sweep and laundry to do; it’s all posted neatly on bulletin boards in the common areas and discussed during regular household meetings. But that’s where commonplace domesticity stops, and extraordinary living begins. The homes are occupied by a select group of people, of all ages and backgrounds, united by their Veteran status and now the most important mission of their lives – to recover. Recovery, which encompasses the overarching goal of attaining

employment and ultimately paying for a place to live, is the only business of the 18 men who reside in the Lovell Federal Health Care Center (FHCC) Compensated Work Therapy/ Transitional Residence (CWT/TR) homes at any given time. The majority of the residents are recovering addicts of some kind, and/or living with mental illnesses, which resulted in them losing their jobs, their homes, their families, and in many cases, their will to live. “I was going to bed at night and wishing that I wouldn’t get up in the morning,” said program graduate Otis Norsworthy, Jr., today one of the three house managers who live in, and oversee, the CWT/TR homes. “That’s when I changed my mind about getting help. I knew I had to do something,” Norsworthy said. Norsworthy is a Veteran of the Army and has been a house manager for several years. He is unpaid for the

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around-the-clock duties associated with the position but lives rent-free in one of the homes. House managers are required to work a full-time job elsewhere, and to remain drugfree. He completed the program in 1996, when the FHCC was known as the North Chicago Veterans Affairs Medical Center and the program was called the Pride Residential Employment Program (PREP). “I’ve long been a part of this program,” said Norsworthy, a former gang member. “The VA took me in off the street, fed me and clothed me and got me a job. Going through the program gave me the motivation to give back.” In the homes on 24th Street, with the help of fellow former service members including Norsworthy, Veterans have another chance to thrive, to prosper, to regain the lives they lived before they turned to alcohol to cope, or prior to PTSD and


depression driving them to drugs. Veterans come to the homes via different routes, said Social Worker Stephanie James, CWT/TR program manager. Veterans are referred from other FHCC residential treatment programs; some transfer from other VA medical facilities and other Veterans come from the community. “We’ve opened doors to Veterans with a wide variety of issues and disabilities,” James said. For some, the homes are a chance to make things right after relapses. House Manager Darryl Brown remembers clearly how devastating his fifth (and last) relapse was, after seven years of being clean and “getting to a point where I wanted to be, working a job helping people.” When he relapsed, Brown said, “I actually contemplated taking

make it work,” said Brown, an Air Force Veteran. The rules and routines of the homes, coupled with a wholehealth approach to treatment and rehabilitation, form a foundation of success for “graduates,” who are welcome for return visits any time. First things first The Veteran residents are required to work. They are assessed before they enter the program and initially placed in a CWT job on the nearby FHCC West campus in North Chicago. The ultimate goal is permanent employment, which may be in the community, or at the FHCC. Working jobs means they get paid, and in turn, they pay a program fee to live in the homes. Veterans are coached to save money as part of their “discharge planning,” so they have money to rent

In each home, residents sit together at a dining table in the common area for the evening meal, which is served family style. Holidays are cause for celebratory meals with family members and other guests. The homes are tastefully decorated and furnished, with comfortable chairs and pleasant artwork. The newly remodeled kitchens are bright and spacious. Framed photos of the residents are displayed in the living rooms. Each resident has his own room with a desk, bed, and bedside tables. James said the program received $400,000 over three years from the VA to renovate the homes, including kitchen upgrades, new furniture, new floors, and improvements to inside décor as well as new patios, fire escapes and roofs. The task of cleaning the homes

“I was going to bed at night and wishing that I wouldn’t get up in the morning.” - Otis Norsworthy, Jr

my own life … I took all my blood pressure medication and painkillers and started walking.” At the time, Brown was living and working in an Oxford House, a residential recovery program in the community. A fellow Oxford House employee happened by when Brown was walking in the street, picked him up and drove him to what was then the North Chicago VA Medical Center. “I said, OK God, I get the message,” Brown said. “You want me to do this.” Brown is a former gang chief and, as such, found himself constantly fighting the influence of family members and others who wanted to draw him back into that destructive lifestyle. He told his counselor he needed a strict program, and his doctor at the time referred him to the PREP program. “I knew I needed something else, not as loose, to

their own home or apartment after they graduate from the program in six months to a year. Veterans may have the option of moving to a recovery house or apartment after graduation, as long as they remain drug-free and active in a local Narcotics Anonymous (NA) or Alcoholics Anonymous (AA) group. “It’s all about working toward independent living,” Norsworthy said. “You get used to working every day again, and paying bills,” he said, remembering his time in PREP program. “We learned to live life on everyday terms without drugs. We learned how to problem-solve situations without the use of drugs. We learned how to communicate better, how to use empathy, and how to be responsible, and it’s the same in the program today.” Residents take turns planning menus and making shopping lists, getting the groceries and cooking.

also is shared by the residents, on a rotating, 30-day basis. “They are all very proud of their homes,” James said. “They treat the homes as their own.” Program provides structure When they aren’t working, doing household chores, going to counseling and other medical appointments, and attending meetings, residents have homework that reinforces recovery principles. Throughout the program, they are required to complete exercises in a workbook called “Staying Sober.” The first 94 pages are supposed to be done in the first 30 days of the program. Completing the workbook helped Brown realize that his relapses revolved around family connections and interactions. “You have to be honest in the writing, and then you start to see your patterns,” he said. “My family, and my disease,

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Air Force Veteran Courtney Pinnick uses the computer in the common living room. Pinnick said his PTSD and depression symptoms have lessened since he entered the program.

was calling me back.” The homework, chores and regular meetings help provide structure for lives that previously lacked it. Much of the success of the program stems from the support residents receive from other Veterans, who have “been there” and can identify with what each is going through, Norsworthy noted, whether it’s the house managers or their housemates. “One thing we have in common is that we are all Veterans and for whatever reason, we ended up here needing help,” he continued. “I know what he has feelings when he first gets here and he is sitting in that chair. He is scared, he’s has a hopeless feeling, and he doesn’t know what is going to happen.” Brown said every Veteran has to come to the realization that he can’t do it alone. “We have to get them to buy in,” he said. “We have to get them to ask for help, and show them by example that we are here to help them, so then they can turn around and help the next person. “You have to give them a ‘hope shot,’ is what we call it,” Brown said.

There is a tradition at the Thursday night group meeting, where all 18 Veterans gather in one of the homes. The new Veterans share what they want of their personal stories, and at the end, the members of the other homes encircle them.

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Financial Distress Having difficulty paying your copay bills?

VA has programs that may help you with your copay requirements! • Hardship - If your income has recently changed, you may qualify for VA medical care without copays.

• Compromise - You can request a onetime monetary settlement eliminating your current health care debt.

• Repayment Plan - You can establish a plan to spread your current health care debt over a specified period of time.

• Waiver - You can request your current medical copay debts be waived for charges less than 6 months old (180 days). If a waiver is approved, you may also qualify to have Beneficiary Travel mileage reimbursement deductibles eliminated.

For additional information and to see if you qualify for these specific VA programs, contact

1-877-222 VETS (8387) For more information, call toll-free 1-877-222 VETS (8387) or visit our website at www.va.gov/healthbenefits Poster IB 10-380 Revised May2013


“We screen for PTSD. We screen for depression, for suicidal tendencies. We need to be screening for sexual health, too.” - Dr. Jessica Punzo San Diego VA

Sexual Health: It's time to talk about it By Tom Cramer Sex is a big deal, right? So if your sex life isn’t all that healthy, chances are the rest of your life —including your overall health— might not be anything to write home about either. At least that’s the theory being put forward by two VA healthcare providers who feel that VA may need to get over its shyness and start routinely asking Veterans about their sex lives. Delicately, of course. “Every clinician should be asking their Veteran patients about sexuality,” said Dr. Linda Mona, who’s spent the last nine years running an intimacy clinic at the Long Beach VA. “There are many Veterans struggling with this part of their life, which means there are so many families struggling with this issue. “When two people are having a mutually satisfying sexual relationship, it strengthens their connection,” she noted. “And it therefore strengthens the whole family.”

Apparently, however, people just don’t like to talk about it because it’s embarrassing. “Providers don’t know how to talk about it,” Mona corrected. “Patients and providers don’t know how to bring up the subject, because it’s so personal. But if we’re going to provide comprehensive, patient-centered care, if we’ve going to treat the whole Veteran, then we need to broach the topic. And we need to broach it in a respectful way.” The psychologist said trouble in the bedroom seems to be fairly widespread in a lot of the Veteran population. And no wonder. “We see both men and women coming back from overseas and having difficulties with their primary relationships,” she said. “As a Veteran, you might be dealing with depression, anxiety, or post-traumatic stress disorder. Then there’s perhaps physical and cognitive injuries such as traumatic brain injury or loss of a limb. On top of that, you’re trying to

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fit into your new life as a civilian. And while all that’s happening, you may be on several different medications for all these psychological or physical injuries. When you mix all this together; is it any wonder your sex life is suffering? “To make matters worse,” she added, “your inability to reconnect sexually with your partner just adds to all these other stressors.” Dr. Jessica Punzo, a psychology fellow at the San Diego VA, agreed that Veterans seem to have a lot more stressors to deal with than the general population. “When you transition from the military to civilian life, you have a lot of things coming at you,” Punzo said. “You’re trying to get to your therapy sessions, to your doctor’s appointments. You’re trying to reconnect with your wife or your husband, your kids. So sex is one of the things that gets pushed to the bottom of the list. But research shows that as sexual satisfaction increases,


so does overall quality of life. “If all is not well in the bedroom,” she warned, “it may possibly show up in other parts of your life outside the bedroom.” And for some Veterans, there’s the additional complication of military sexual trauma, or MST. “Many people who’ve had a sexual trauma have difficulty with sex later on,” explained Punzo, who provides individual and group therapy for Veterans who’ve experienced MST. “Even if a victim of MST wants to be intimate with their partner, they may not be able to. There tends to be a lot of shame that comes with experiencing a sexual trauma. Any kind of closeness or intimacy with another person can trigger flashbacks.” Punzo said it’s up to VA healthcare providers to broach the touchy subject of sexual health. “It’s worth doing a sexual health assessment on all of our Veterans,” she said. “It should be standard. We screen for PTSD. We screen for depression, for suicidal tendencies. We need to be screening for sexual health, too. If our initial assessment indicates a sexual issue, we can start the process of addressing it.” Linda Mona agreed. “Our job as VA clinicians is to create a forum in which to discuss sexuality,” she observed. “Veterans don’t have to talk about their sex life if they don’t want to. But if Veterans want to discuss the topic, we need to give them the opportunity. We need to train our providers on how to bring up sexual health as a routine part of any screening we do.

Photo 1: Dr. Linda Mona, VA Long Beach Healthcare System “I have patients who have good, solid intimate relationships with their partners,” Mona continued. “Their foundation is stellar. But that doesn’t mean they aren’t having problems with their sexual relationship. The VA can help them with that, but first we have to know there’s a problem. If we don’t ask them, chances are they’re not going to tell us.” The psychologist noted that most Veterans go through at least one health screening every year. “They’re seen by a team of professionals, including a primary care doctor, a social worker, a psychologist and others,” she explained. “At some

point during the screening, there should be a question posed to them about their sexual health. Some member of the team should ask a question that goes like this: ‘To what degree are you satisfied with your sex life?’ Or maybe this: ‘Are there ways in which your other health issues might be interfering with your sex life?’ “It’s a way to open up a dialogue,” she continued. “If the Veteran answers that all is well in the bedroom, fine. If not, then we need to be prepared to refer them to the appropriate professional for follow-up.”

ExploreVA Take the first step with one click: #ExploreVA benefits for Veterans and their families.

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HONOR FLIGHT The Honor Flight Network is a non-profit created solely to honor America’s Veterans for their sacrifices. The group transports our nation’s heroes to Washington, D.C. so they can visit and reflect at the memorials erected in their honor. In another 5-7 years almost all of our World War II veterans will be gone. This tour is their "last hurrah" – a small token of appreciation for everything they've done. To learn how to apply for a flight, or volunteer, visit http://www.honorflight.org/. VA's Office fo Digital Media engagement within the Office of Public Affairs covers quite a few of these flights, to see more visit www.flickr.com/photos/ VeteransAffairs/ and on VA's blog, VAntagePoint at www.blogs.va.gov/VAntage/.

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THE GHOSTS OF

IWO JIMA By Tom Cramer

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Former Marine Ted Drews survived the nightmare of Iwo Jima, but the nightmares caught up with him decades later. Photo by John Hickey/ Spring/Summer 2015 | VANGUARD | Page 29 Buffalo News.


T

ed Drews was 18 and a high school senior when he was drafted and sent to Marine Corps boot camp on Parris Island. It was 1944, and World War II was raging. “They needed bodies,” Drews said. “Like everybody else, I got a letter from President Roosevelt telling me my services were required.”

home town of Buffalo. He married, got a job in repairing heating and airconditioning units. Later he would become a bridge operator. Then came retirement, and that’s when the trouble started. Drews, then 70, grew increasingly irritable. There would be angry outbursts and long periods of depression.

A High Cost

Nowhere to Hide

In short order, Drews found himself in the middle of a bloodbath called Iwo Jima. More than 19,000 Marines were wounded during the five-week battle for Iwo Jima, and 6,821 died there. It remains the costliest battle in Marine Corps history. “When a Marine died, you had to cut his dog tags off and carry him back to the temporary cemetery we had made there on the island,” Drews explained. “A bulldozer would dig a big trench, and then at the bottom of the trench you’d dig a few feet further down and that’s where you placed the body.”

“When he was depressed he wouldn’t talk; he wouldn’t eat,” said Drews’ wife of many years, Phyllis. “Our whole family was very supportive during all this, but they were confused. We just didn’t know what was going on. And it was getting worse and worse.” Drews admitted he’s the kind of guy who prefers to keep the past locked away deep inside. “I carried that stuff around for years,” he said. “I would try to hide it, and if it came out I would try to repress it all on my own. But as I got older I couldn’t hide it anymore. I guess when you get to be older, things start to pile up. “I’m lucky I have a good family,” he added. “And a good wife.” Then there were the nightmares. “He would wake up yelling,” Phyllis said. “He’d be thrashing about and calling for help. He’d even fall out of bed sometimes. I’d be lying there awake half the night, upset and worried. I’d be wondering to myself, ‘What can I do to help him?’” “I can’t even remember what I was dreaming about,” Drews said. “But that’s a plus as far as I’m concerned.” Finally, about 10 years ago, Ted and Phyllis Drews decided they’d had enough. The exhausted couple found their way to the Buffalo VA, where they sat down with a compassionate social worker. “He talked to both of us for quite a while,” Phyllis said. “He was able to get Ted to open up a little about his

Not Like in the Movies The 18-year-old Marine didn’t realize it at the time, but the things he was experiencing on Iwo Jima would haunt him ––and burden him–– for the rest of his life. That burden would later get a name: post-traumatic stress disorder. “The bodies of those Marines, well, it’s not like you see in the movies,” said Drews, who is now 89. “They’re not lying there peacefully with their arms folded across their chest. They didn’t look like that at all. When you found them in the jungle some of them would be sitting up; some of them would have their arms and legs in the air.” After the war, Drews went on to lead a quiet, uneventful life in his

experiences on Iwo Jima. I was sitting there listening, and I was flabbergasted. Here I’d known this man for over 40 years and, until now, I had no idea what he’d been through, because he’d never, never talked about it.” Falling Into Place At the end of their conversation the VA social worker suggested to Drews that he could be suffering from something called post-traumatic stress. He promptly referred the couple to VA’s PTSD experts in Batavia, New York. “The day we saw that wonderful social worker is the day everything started falling into place for us,” Phyllis observed. At the Batavia VA, Drews finally began getting the care he had needed ever since his days as young Marine dodging bullets —and burying his buddies— on an island in the South Pacific. His healing didn’t happen overnight; several years of face-to-face time with a psychiatrist would be needed to quiet the ghosts of Iwo Jima. “Me and my doctor, we talked things out,” Drews said. “Toward the end of our conversations, he’d call my wife in and talk to both of us. He explained a lot of things to me. He was really good.” “He even gave us his card, and said if we ever needed him, to call him right away,” Phyllis said. She added: “I’m glad Ted’s not having nightmares anymore.” To learn more about how VA is helping Veterans with PTSD, visit the VA National Center for PTSD Website at www.ptsd.va.gov Need immediate help? Call the Veterans Crisis Line at 1-800-273-8255 (Press 1) or visit www.veteranscrisisline.net.

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Reflections on Pride

By Vincent Immiti I recently had the occasion to visit Washington, DC as part of my VA duties. Specifically, I was there in my role as a Graduate Healthcare Administration Training Program board member on a training assignment for trainees in the program. Some of the trainees I knew and some of them I was meeting for the first time. Many of the trainees were Veterans who had served their country with pride, and were now seeking to continue their service as civilians in the federal workforce. On our third day in DC, we traveled to the VA headquarters office, where Lincoln’s quote is emblazoned into the granite block outside the main entrance. As you probably know, it reads: “To care for him who shall have borne the battle and for his widow, and his orphan.” These words speak to me in so many ways, but primarily, because it is the cornerstone of our VA mission. As luck would have it, it set the tone for my whole week. The next day, we took the trainees to Capitol Hill to meet with our VA staff there. The complexity of our system of government was beginning to become more evident. As part of the visit, we were led on a guided tour of the Capi-

tol Building. It was then, as the tour guide described some of the actions that had taken place there and across the country, that I began to re-connect the points in time in our history. I even came to better understand my place along that line as a senior manager in the service of my country. The history of the United States is rich in patriotism and courage. The courage of the founding fathers to separate from England, and the courage of the colonists to fight for their freedom, became the foundation for generations of Americans, for years to come. Brave Americans, filled with pride for their country, have always stepped up to serve our interests in so many ways. We enjoy the freedoms that our forbearers secured on our behalf, and we continue the fight so that we can free others from tyranny and oppression. I left the Capitol with a heightened sense of patriotism, and it invigorated me. Upon returning home, I watched the new movie,“American Sniper,”about Chris Kyle, a true American Hero. What affected me deeply was seeing how Chris was when he returned home. He was detached, withdrawn and seemingly lost. At one point in the movie, he meets a soldier in an auto repair shop and the soldier called him a hero. He was clearly uncomfortable with the concept. What struck me most was his interaction with his VA therapist. It started along the same lines. Kyle was detached and withdrawn, he claimed that he had no problems. Instead of taking him at his word, his therapist did something which I found incredible… when Chris said he was only doing his job, protecting his fellow soldiers; the therapist used that sense of responsibility to create therapy for Chris. He created a way for him to use that desire to protect others, to heal himself. It was a wonderfully simple way to treat a patient and have that patient participate in helping others. The events of the past week, re-

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awakened my pride in being an American. In particular, it reawakened my pride in working for the VA with, and for, our veteran patients. The events that have rekindled these feelings are as separate and distinct as points on a map, or months on a calendar, but they are inextricably connected, in a very intimate way. So why am I proud? I’m proud because I work for the government, in the service of our Veterans, in the greatest country in the world. We have our problems, yes, but we work to correct what we see, and we move on. I toured the capitol of our great nation and felt proud to be a part of our government workforce. Watching that movie after being in DC, brought it all home, and made me proud of being part of our healthcare system. To see what we did for Chris Kyle, helping to return him to the man he was before the war, made me proud. As someone who cares deeply for those who have served, I am proud to work for the American people. I am proud to work for the Department of Veterans Affairs doing the noblest of work, for the most deserving of mankind. What I am most proud of is working with the many professionals of VA. It inspires me to see all of you work so tirelessly, every day, to improve the lives of our nation’s veterans, and to fulfill Lincoln’s promise, inscribed on the wall at 810 Vermont Ave. Yes, we “care for him” and, “for her,” and we do so in the service of those who served, and that is something for which we can all be very proud. Vincent Immiti is the Associate Director of the James J. Peters VAMC, a position he’s held for nearly 6 years. He holds a Master’s Degree in Business Administration in Healthcare Management and is also an Adjunct Professor at St. John’s University. He is a member of the Graduate Healthcare Administration Training Program Board, as well as a member of the VA’s Regent’s Advisory Council for the American College of Healthcare Executives.


AROUND VA In Memoriam The Department of Veterans (VA) mourns the tragic loss of one of its own – Dr. Timothy E. Fjordbak, a mental and behavioral health psychologist, who was killed during the shooting at the VA Outpatient Clinic in El Paso on Jan. 6, 2015.

While we may not fully understand why a person so committed to carrying for Veterans would lose his life in such a harrowing way, we do understand the commitment and dedication of those in the front line of VA health care. His loss is deeply felt by not only by his fellow VA employees in the El Paso VA Outpatient Clinic but by the entire VA family. Fjordbak was constantly praised by those he had treated and helped. His colleagues who worked closely with him remember Dr. Fjordbak as a caring and dedicated provider who always put his patient’s wellbeing first. He cared more for others more than himself. After the U.S. response to the Sept. 11, 2001 attacks caused many soldiers to return from the Middle East with brain injury and PTSD, Dr. Fjordbak left his private practice in Georgia to work at the VA Outpatient Clinic in El Paso to do what he could to help returning troops with

their recovery. He cared for his patients as if they were family. Now his VA family mourns his loss but as one co-worker put it, “Tragedies can tear us apart or they can bring us together. I think this tragedy has really brought us together.”

Patient Bowling VA Illiana Health Care System (VAIHCS) recently re-opened the Social Activity Room (SAR)/Recreation Hall and Patient Bowling Alley. The renovation of the SAR/ Recreation Hall provides a state of the art room that can be utilized for patient activities, educational sessions for employees, cultural diversity events and a multitude of other activities/events. With the location of the SAR/Recreation Hall in the middle of the campus helps provide access for patients and employees to participate in activities/events.

Changes made to the SAR included: complete stripping of the existing SAR and Recreation Hall, upgraded room with state of the art modern themed finishes, lighting, acoustics, wheel chair access to the stage with lift availability and motorized blinds and sound system. VAICHS also re-opened the patient Bowling Alley. The Bowling Alley was named the John Wright Bowling Lanes. John Wright was a Veteran and a former volunteer in

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Recreation Therapy. Mr. Wright left his entire estate of $1.5M to Recreation Therapy. Approximately $275,000 of the money was utilized to renovate the Bowling Alley, which had not been in use for over ten years. Mr. Wright was an avid bowler and spent many hours helping Veteran’s bowl when he was a volunteer. "Wright Lanes will provide our Veterans with an enjoyable leisure time activity, especially during the cold winter months," says Japhet Rivera, Director. Changes made to the bowling alley included: Freshly painted walls, new reflect ceiling upgrade light, Brunswick refurnished the lanes, underground ball return and new electronic scoreboard. (Current machine is still in working order.)

Honoring Veterans At the Tuscaloosa (Ala.) VA Medical Center, every day is Veterans Day as we care for our nation’s heroes. In our Community Living Centers (CLCs), GEC staff strive to make each Veteran feel special and cherished. This was particularly evident recently when the staff of Freedom Hall CLC pulled together as a team to make a young Marine’s dream come true. Late in September, retired U.S. Marine Col. Lee Busby, contacted GEC social worker Renea Motte to request assistance with coordinating efforts for Freedom Hall resident Shan Strickland to attend the Marine Corps Birthday Ball scheduled for Nov. 1 at the Wynfrey Hotel in Birmingham, Ala. Col. Busby, a board member of the Alabama Marines Foundation and a VA volunteer, had been very active in providing socialization and friendly support to Shan, a 30-year-old Vet-


eran who has been a resident at the Tuscaloosa VA since 2008. Shan had previously attended the Marine Corps Ball and was very excited to be able to do so again. Much work went into making this happen. Ms. Motte collaborated with Anastasia Reddick, Freedom Hall unit manager, to identify staff that would be able to attend the event with the Veteran. Ella Wilson,

Freedom Hall nursing assistant, volunteered to attend the event with the Veteran, and Cory Hardy, Magnolia House guardian, volunteered to provide the transportation by driving the Magnolia House van. Michael Meredith, Freedom Hall registered nurse, measured Shan and found that he had outgrown his uniform. The team then put their heads together to discuss options. One option was to forgo the uniform and simply purchase Shan a new suit. Another option, proposed by Col. Busby, was to find a uniform Shan could borrow. Shan, however, had his heart set on wearing his uniform. This was important because a Marine’s uniform tells his story. Each stripe and each medal is a valued symbol of their service. Because this meant so much to him, the decision was made to alter the uniform so he could wear it. Shan

gave permission, and Joanne Davis, GEC nurse practitioner, made the necessary alterations to his coat, pants and belt. To complete his ensemble, his shoes were located and new socks purchased. Nicole Varnado, GEC dietitian, contacted dietitian student Mary Wood, whose husband is a Marine Corps recruiter, and white gloves were obtained. On the Thursday prior to the ball, Freedom Hall staff, with the help of recreation therapist Benjamin Nunn, held a dress rehearsal with photos taken by photographer, April Jones. After a few more alterations were made to his uniform, the big day arrived. That Saturday, Nov. 1, staff spent the day getting Shan ready. Every detail was assured, thanks to Gwen Bonner, RN; Mattie Chambers, RN; and Juanita Bailey, nursing assistant. “He was like a kid at Christmas time. He couldn’t stop smiling,” said Mattie Chambers. “He was so excited.” Ms. Wilson described how countless fellow Marines approached him during the ball to thank him for his service and to offer their assistance if needed. The staff of Freedom Hall are very proud to have played a part in making this special Marine’s dream come true.

Data Security: ICAM Today the Department of Veteran's Affairs conducts multiple transactions involving sensitive information - whether that is personally identifiable information or other employee, contractor, or customer data. As the number of users and

systems that are interfacing with this data grow the threats to the information and the infrastructure supporting it multiply as well. Identity, credential and access management (ICAM) plays a critical role in protecting the infrastructure and data from cyber threats both internal and external. The good news is that the ICAM Project Management Office has been established within the OSP to develop and execute a robust solution to alleviate security deficiencies and to provide services to realize the VA's ICAM holistic vision and strategy. While the ICAM PMO will be managing a portfolio of ICAM projects, aligned with the Federal ICAM (FICAM) Target State Architecture the initial focus of the ICAM PMO team is management, planning, and implementation of the Onboarding solution. We have all been through the current VA onboarding process and understand that it causes delays in employee and contractor start dates, access issues to both facilities and IT devices which can cause delay in benefits and services to our customer - the Veterans. The Onboarding solution in development by the ICAM office will provide an automated unified solution across the VA saving both time and money by eliminating individual site processes, manual steps, and inefficiencies that currently stand in the process. In the coming months, be on the lookout for more information on the progress of the onboarding solution. For more information, please contact the ICAM PMO at ICAMPMO@VA.gov

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Being Green has its Awards

Above: Workers inspect solar panels at the Amarillo VA Health Care System parking lot. Left: Energy manager for the Amarillo VA,

Sam Hagins, gives a tour of the facility in Amarillo.

By Patrick Hutchison Route 66 is home to many landmarks. Among them are the solar panels that soak up the sun that beats down on the cars in the parking lot of the Amarillo (Texas) VA Health Care System. The panels have attracted many cheers from the residents of Amarillo, and travelers along the old Route 66, and have earned a 2014 Federal Energy and Water Management Award from the Department of Energy. The award combines two projects: the photovoltaic-covered parking and the thermal storage system that cools the hospital. The thermal system is 32,000 gallons of stored ice in 18 tanks. The ice is produced at night when demand is low, and then used to cool the hospital during the day when the demand on power is high. “Burning” the ice to make cold air flattens out the demand on kilowatts, which saves money. “The money we can save on utilities gets put back into a Veteran’s quality of life here,” said Sam Hagins, energy manager for the Amarillo VA.

Hagins is an electrical engineer with a bachelor’s from the University of South Carolina and a master’s from the University of Dayton (Ohio). His career started in the Air Force as an acquisitions officer for aerospace systems. Hagins began what has been the focus of his career—energy conservation—17 years ago, while assigned to the civil engineering squadron at Sheppard Air Force Base in Wichita Falls, Texas. In 2007, the Department of Veterans Affairs offered him a job as the energy manager for the Amarillo and Big Spring VA Health Care Systems. Combining the reduction of consumption that the thermal storage provides with the energy production that the solar panels provide has been a winning formula. The solar panels cover 721 parking spaces, protecting cars from rain, snow and hail. That number of solar panels produces 3.6 million kilowatt hours of energy, or a third of the power that the Amarillo VA uses. That’s enough energy to run 332 homes; however, it’s

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a day-to-day operation. “Some days, we actually produce more power than we need,” explains Hagins. “We produce the most in the fall and spring, and that is exported to the power company.” Currently Amarillo is the only VA to export power. Several hundred thousand kilowatt hours are exported each month, thanks to both the thermal system and the solar panels. The award has only encouraged more energy-saving projects. In the future, Hagins has plans to leave behind fluorescent lights in favor of LED lights. He also wants to replace the steam heating system with hydronic heating. “Steam was a great technology in the 1800s,” Hagins said, with a smile, “but I’d like to bring us up to the 21st century.” With the innovation of using both thermal and solar energy as a benefit to Veterans, it’s a safe bet that Sam Hagins has helped the VA reach the 21st century and beyond.


Winterhaven Homeless Veterans

Above: Veterans received new boots at the Winterhaven Homeless Veterans Stand Down thanks to generous support of the HUD Affinity Group. Left: A community volunteer helps a Veteran at the recent Winterhaven Homeless Veterans Stand Down held at the Washington DC VA Medical Center. (photos by Robert Turtil)

By Gloria Hairston On a bitterly cold Saturday morning, Jan. 24, homeless, atrisk and underemployed Veterans arrived with hope and anticipation at the doors of the Washington D.C. Veterans Affairs Medical Center’s Winterhaven Homeless Veterans Stand Down. Hundreds came, 618 men and 86 women to be exact, all with the prospect of receiving the care and attention that could change their lives. The day-long annual community outreach event is dedicated to providing displaced Veterans the health care, benefits and resources they have earned and deserve. VA staff and volunteers, Veteran Service Organizations, active military personnel, along with more than 60 organizations, federal and state government agencies and community partners joined forces under one roof to make this year’s Winterhaven one of the most successful.

This is the 21st year the Medical Center has hosted the event and this year services were expanded to Veterans who are underemployed, placing the focus on preventing

If you, or a Veteran you know, are homeless or atrisk of being homeless, visit www.va.gov/homeless or call 877-4AID-VET

homelessness among Veterans. “Winterhaven is our opportunity to bring together the community to not only take a stand to prevent homelessness among Veterans, but also to eliminate homelessness one

Veteran at a time. Together we serve as beacons of light to Veterans in need.” said Brian A. Hawkins, medical center director. The full day of services included: health screenings; housing, education and employment opportunities; substance abuse counseling; mental health and psychosocial services; dental exams; HIV testing; and free warm clothing, personal care items, boots and shoes. Veterans also were able to access resources to help avoid foreclosure, manage finances and were treated to a hot lunch and a free haircut. This comprehensive effort to end Veteran homelessness continues every day at the Washington D.C. Veterans Affairs Medical Center’s Community Resource and Referral Center (CRRC) where VA staff and community partners are available to assist Veterans seven days a week, 24 hours a day.

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Ms. Wheelchair : “Can’t thank the VA enough”

By Walt Bonora When Evelyna Castro sees herself in a wheelchair she doesn’t think of herself as disabled. Instead, she has turned her disability into something positive. Born with spina bifida, a debilitating spinal disorder that happens when a baby is in the womb and the spinal column doesn’t close all the way, Evelyna, 33, has refused to let her condition stand in her way. In fact, she was crowned Ms. Wheelchair Washington of 2014; her platform was Acceptance through Diversity. “Don’t let society or circumstances dictate your life,” says the Washington state resident and native of California. In Colorado, Dick and Cindy Koons care for their daughter, also stricken with spina bifida and wheelchair bound. What they and others like them share in common is the Spina Bifida Health Care Benefits Program, a federal program that covers health care considered medically necessary and appropriate for people with spina bifida (excluding spina bifida occulta). It is managed by the U.S. Department of Veterans Affairs’ Chief Business Office

Purchased Care in Denver, Colo. The beneficiaries are the birth children of Vietnam Veterans, and the children of certain Veterans who had served in Korea along the Demilitarized Zone, who have been diagnosed with the disorder as a result of the Veteran’s exposure to Agent Orange. For Evelyna, a make-up artist, the program has been a godsend. “I can’t thank the VA enough, which has never refused me a thing,” she said. “Every five years I get a new wheelchair, among other services, and I can’t tell you how much that helps. Knowing they have my back relieves a lot of stress from my family and allows me to focus on my work.” For Dick and Cindy, the program has given their daughter, Melinda Marie, the opportunity to lead a quality life. “When Melinda was born forty years ago,” Dick said, “we were told that if she lived, she would probably be mentally retarded and we should consider institutionalizing her. Of course, we had no intention of giving up. We were committed to loving her and giving her a chance to thrive.” The medical support provided by the program, including regular physical therapy and new wheelchairs

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when Melinda Marie needs one, gave the Koons family a tremendous sense of relief. “Without their help, it would not have been possible for her to maintain her physical well-being,” Cindy added. The program was enacted by Congress in 1997 once lawmakers were advised there was a connection between Agent Orange and spina bifida, and approximately 1,300 people have enrolled. Today, it has evolved into a case management climate where VA is looking at better ways to help people stricken with the disorder get the care they need. Case management is a process that allows a manager to assist in facilitating the beneficiaries’ health care with a local medical provider and the program. Ira King, a case management liaison at the Chief Business Office Purchased Care in Denver, Colo., explains that they provide numerous services for the beneficiaries. “We connect them to local case management agencies,” he notes. “We find a full range of services in their local areas that include medical and mental health providers, pharmacies, medical equipment and supplies. We also work with providers of services to make sure the spina bifida patients are not improperly billed.” Thus far the case management liaison efforts have been successful and there is every indication that individual case management will expand further as more beneficiaries become aware of the service. “We want them to know that we are here to help and to provide information and education to them, their caregivers, and providers of services,” King added. For more information, visit www. va.gov/purchasedcare and click on Programs for Dependents on the left and then on Spina Bifida. Or call 1-888820-1756.


Routine VA Exam Becomes LifeChanging Event By Tom Cramer In late August 2014, Army Veteran Denny Thornton visited the Minneapolis VA Medical Center’s eye clinic for a routine eye exam. As it turns out, the routine exam may have saved his life. “I was seen by Dr. Kendra Pollard,” said the 69-year-old Thornton. “She saw a hemorrhage in my eye that shouldn’t be there.” It was not the first time a physician had noticed the problem. “I’ve had this eye hemorrhage for about 10 years,” Thornton said. “I was seen by about five or six different doctors during that time. They all noticed

“She deserves a pat on the back. She took the time to provide great care.” —Denny Thornton

Dr. Kendra Pollard

the hemorrhage, but none of them pointed out to me what might be causing it or recommended further action. Kendra was the first one who did that. She didn’t tell me exactly what it might mean —she didn’t want to scare me— she just said I should get it checked out.” “I wanted to scare him just enough so that he’d go and get an ultrasound,

but not enough to keep him up at night,” observed Dr. Pollard. “When eyes bleed, there’s typically a reason for it. So I wrote a letter to his general practitioner explaining my tentative diagnosis, and the testing that I would recommend, which is a carotid ultrasound.” Thornton’s general practitioner promptly ordered the ultrasound, which revealed a potentially lifethreatening situation. “He told me he thought I’d better see a vascular surgeon,” Thornton said. “He told me I had 100 percent blockage in my left carotid artery, and 75 to 85 percent blockage in the right. Carotid arteries are important for blood flow to the brain.” Less than a week later, the Army Veteran had surgery to clear the block-

age. He credits Dr. Pollard for putting two and two together and realizing that the problem with his eye might be a symptom of something far more serious. “I wrote her a personal note to thank her,” Thornton said. “She deserves a pat on the back. She took the time to provide great care.” “I have his letter right next to my desk,” Pollard said. “I think our Veteran patients are the sweetest and most grateful. I’m glad to do anything I can to keep them healthy.” Thornton said he has only one complaint regarding the entire experience. “The only bad thing about my operation was [that] it didn’t make me any smarter,” he reported. “And it didn’t make me any better looking.”

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VA DOCTOR STOPS WOULD BE

SUICIDE JUMPER

By Uchenna S. Uchendu, MD As I approached the bridge that long night in Miami, I did a doubletake: Is that a person I see precariously perched on the wrong side of the high span about to jump? I was part of a group of canvassers counting and identifying individuals, including Veterans, who were homeless on a night in January 2015. Our team was participating in the Pointin-Time (PIT) Count, and we quickly realized we’d stumbled upon a crisis situation. My professional background and VA’s in-service crisis training immediately kicked in. I calmly introduced myself to the police officer engaging with the individual and let the officer know I was a physician. I noticed that the potential jumper seemed fixated on the flood lights from the patrol-car so I urged the police officer to keep them on. This bought time for emergency responders to intervene. After what felt like an eternity—but was perhaps about 30 minutes—additional police officers arrived and seized a window of opportunity to rescue the individual and place him in the care of other medical professionals.

This was just one of many remarkable moments I witnessed during this humbling night in Miami, on the front lines in the fight to end homelessness in America. For me, the entire experience brought my 13 years of work with Veterans at VA into sharp relief: Veterans who are homeless are also at increased risk of poor health. Homelessness makes any chronic condition—including mental health issues—worse. Although the individual we encountered was not a Veteran, anyone without a safe, stable place to call home may end up in similar life-or-death situations and in need of support. As head of VA’s Office of Health Equity, I’m no stranger to these issues. They are what inspire my work, what motivate my staff and why I volunteered during this year’s count: To better understand what Veterans who are homeless need, and to find the best ways to help. Our canvassing team was trained and organized by VA’s partner, the Miami-Dade Homeless Trust. Members of the Miami Police Department—who saved a life that night—escorted us on foot and in vehicles as we looked for Veterans and other homeless individuals living in places not meant for human habitation around the city. Throughout the night, I had a window into the tenacity of VA outreach staff. They knew the names of local Veterans who were homeless. As they approached familiar Veterans, they

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asked: Why did you miss your last VA appointment? Will you return to VA tomorrow? What can we do to convince you to accept our offers to help you get into stable housing? They did what they could to get these Veterans to VA or other supportive services and on the path to permanent housing—a sure route to better health. VA outreach, working in alliance with the community, is critical to achieving the nation’s goal of ending homelessness among Veterans by the end of 2015. Although I know that last year’s PIT Count estimated that nearly 50,000 Veterans were homeless across the country, my time in Miami made me optimistic that there will be significantly fewer this year. One homeless Veteran is one too many, and so we all must do our part by learning more about VA’s homeless programs and getting involved. If you know a Veteran who is homeless or at imminent risk of becoming homeless, refer him or her to a local VA Medical Center, where homeless coordinators are ready to help. Veterans and their families can also call 1-877-4AID-VET to be connected to VA services. Dr. Uchenna S. Uchendu is an internal medicine physician and the Executive Director of VA’s Office of Health Equity, which champions the advancement of health equity and reduction of health and health care disparities for all Veterans, especially the most vulnerable.


2014 IT Customer Satisfaction Survey Results Released companies who deliver IT services and also use the American Customer Satisfaction methodology. This year the affinity score is 73 while OIT’s enterprise score is 72. The tables pictured below provide the top line results of the survey. In the coming months, OCA will be conducting site level data analysis to gain further insights into VA employee feedback. As in the past, this information will be used to identify specific IT services which would benefit from a change in the delivery of service. For more detailed results visit the IT Performance Dashboard at: vaww.itdashboard.cdw.portal.va.gov/ Pages/CSS2014Results.aspx

The Department of Veterans Affairs’ IT leadership is keenly focused on improving customer satisfaction. This year the survey received nearly 69,000 responses – a 30% increase from last year. The customer satisfaction score increased by 2 index points. In order to provide a professionally recognized metric for VA facilities, the Customer Advocacy Office uses the American Customer Satisfaction Index methodology to measure the internal customer experience. Further, on an annual basis, the VA's enterprise score is compared to an affinity score. The affinity score is derived from an aggregate of 26 organizations and

Veterans Choice Viewer What is the Veterans Choice Viewer?

Where to Get Training and Access

The Veterans Choice (VC) Viewer uses geocoded addresses and appointment wait time information to help VA staff determine whether a Veteran is eligible for non-VA Care under the Veterans Choice Program. The viewer also displays the nearest facility for the Veteran, wait list information, and the status of the Veteran’s Choice Card.

Questions?

Access Forms:

https://csmsp.hec.med.va.gov/vcviewer/ SitePages/Home.aspx

Training Webinar:

Choice Program VC Viewer and Geoburden (TMS Item No. 24021)

Website Link to the VC Viewer:

https://vaww.webapps.best.cbo.med.va.gov/VCViewer

Email questions to: VCViewerAccessGroup@va.gov

Nearest Facility

Veteran Information

John Smith Member ID: 00000 SSN: Enrolled: 9/20/1990 12:00:00 AM Service Connect: N

VC Viewer sample of Veteran eligible based on wait time

Address Status (BAI): Accuracy of Address: BILLINGS MT 59102 Home Phone: 123-456-7890 Work Phone: 555-555-5555

Wait List Information VISN Desired Date

Record Type

VISN: 19 Billings (436GH) Billings VA Clinic 1766 Majestic Lane Billings, MT 59102-6759

MVIICN: DOB: Combat Vet: N Special Authority: Y

Distance: 2.05 miles Date Determined: 12/8/2014

Result: Veteran resides less than or equal to 40 miles and does not meet the exceptions

Cell Phone: 555-555-5555

Medical Facility (Station No.) Veteran Choice Yes/No

Veterans Choice Outcome Veteran is ELIGIBLE based on Wait-Time

Veterans Choice Card Card Status: No Data Status Date: No Data

Clinic Stop Code Name (Clinic No) Clinic Name

Spring/Summer 2015 | VANGUARD | Page 39


Explore VA to see how VA benefits help Veterans live life to the fullest after military service

#ExploreVA

Explore.VA.gov

U.S. Army Veteran Laura Ortiz runs on the beach with a prosthetic leg provided to her by VA.

Profile for U.S. Department of Veterans Affairs

VANGUARD Spring/Summer 2015  

VANGUARD Spring/Summer 2015