Veterans Health Administration - 75 Years: A Legacy of Service. The Future of Care.

A A Legacy Legacy of of Service.

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CONTENTS 14 Second to None

42 Volunteers for Veterans

An inside look at how the Department of Medicine and

The Center for Development and Civic Engagement

Surgery was founded

(CDCE) builds on a century-and-a-half of service.

By Katie Delacenserie, VHA Historian

By Craig Collins

19 VHA Timeline 1865-2021 24 Dr. Margaret D. Craighill, 1898-1977 The military’s first commissioned woman doctor changed the way the Army – and the VA – practiced medicine.

By Craig Collins

30 Building From Our Past: The Evolution of VA Hospitals The architecture, look, and footprint of Veterans’ hospitals have changed significantly since the first hospitals opened after the Civil War.

By Katie Delacenserie, VHA Historian

36 VA’S Hidden Gem The nation’s largest health professions trainee program

50 Veterans Canteen Service 75 Years of comfort and community

By Stacy Papachrisanthou, Director of Marketing and Communications, VCS

54 VA Research Approaching a century of lighting the way

By Craig Collins

62 Advancing the Mission to Preserve VA History

By VA History Office Staff

66 The Future of the Veterans Health Administration Challenges and opportunities in the next 75 years of VHA

improves quality of care, VA workforce

By OAA Communications Staff

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Published by Faircount Media Group 450 Carillon Parkway, Suite 105 St. Petersburg, FL 33716 Tel: 813.639.1900 www.defensemedianetwork.com www.faircount.com EDITORIAL Editor in Chief: Chuck Oldham Managing Editor: Ana E. Lopez Senior Editor: Rhonda Carpenter Contributing Writers: Craig Collins Katie Delacenserie, Stacy Papachrisanthou DESIGN AND PRODUCTION Art Director: Robin K. McDowall ADVERTISING Beth Hamm OPERATIONS AND ADMINISTRATION Chief Executive Officer: Robin Jobson Chief Operating Officer: Lawrence Wayne Roberts Business Development and Marketing: Damion Harte FAIRCOUNT MEDIA GROUP Publisher: Ross Jobson

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HISTORY

SECOND TO NONE An inside look at how the Department of Medicine and Surgery was founded

By Katie Delacenserie, VHA Historian

“I don’t think there’s any job in the country I’d sooner not have nor any job in the world I’d like to do better, for even though it is burdened with problems, it gives me a chance to do something for the men who did so much for us.”

– Gen. Omar Bradley

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NATIONAL ARCHIVES PHOTO

On Aug. 15, 1945, just one day after VJ-Day, while the nation was still celebrating the end of four long years of war, Gen. Omar Bradley was sworn in as the second Administrator of the Veterans Administration. Speaking to a group of reporters afterward, Bradley, acknowledging his hesitations about accepting the position, stated, “I don’t think there’s any job in the country I’d sooner not have nor any job in the world I’d like to do better, for even though it is burdened with problems, it gives me a chance to do something for the men who did so much for us.”

While the federal government had provided medical care in some form to Veterans since the first Soldiers’ Homes opened after the Civil War, the post-World War II era saw the need to dramatically re-envision the role of VA in caring for nearly 16 million new Veterans. One of Bradley’s first decisions was to enlist Dr. Paul Hawley, the former chief military medical officer of the European theater, as his head medical adviser. Bradley and Hawley took on the challenge of modernizing VA health care while also recognizing that the mistakes of the past that led to the Bonus Marches of 1932 and other controversies should not happen again.

U.S. troops aboard the USS General Harry Taylor return to New York, Aug. 11, 1945.

With the conclusion of World War II, the Veteran population increased by 16 million.

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DVA PHOTO

Most pressingly, Bradley and Hawley needed to recruit thousands of doctors to meet the immediate demand. The war and an outdated hiring process limited to the confines of the Civil Service System had left the ranks of VA doctors depleted, and the remaining eligible workforce for hire was on average more than 60 years old. Hawley knew that the best doctors were coming out of medical schools, and he led the charge to create new academic partnerships and a new hiring structure.

Partnering with the nation’s best medical schools would allow the VA to benefit from the research and teaching talents of these institutions, provide training for Veterans pursuing medical education after the war, and gain a younger and more innovative workforce that could be directly hired outside the Civil Service System.

U.S. ARMY PHOTO

NEW HOSPITALS IN LARGER CITIES AND CLOSE TO MEDICAL SCHOOLS

In addition, if Hawley wanted to affiliate with the best medical schools, then the location and structure of VA hospitals themselves would need to change. The sprawling campuses like Soldiers’ Homes and hospitals that followed the Civil War and World War I were often located in rural areas and were oftentimes built as congressional pet projects. Bradley and Hawley decided that in order to serve the greatest number of Veterans, new hospitals would need to be

Above: Dr. Paul Magnuson, Gen. Omar Bradley and Gen. Paul R. Hawley, MD, architects of the Department of Medicine and Surgery, are pictured from left to right in 1946. Left: Gen. Paul R. Hawley, MD, VA’s first medical director.

A MEDICAL SERVICE SECOND TO NONE IN THE WORLD

built near larger cities and close to the major medical schools with which they now sought to affiliate. A greater emphasis was placed on innovation in these “Third Generation” hospitals, and large amounts of space were dedicated solely to research in what was slated to be the largest hospital construction project at the time.

The push to reform VA medicine was not without challenges though, as both Bradley and Hawley threatened to resign in late 1945 over hiring reforms. In the end, with overwhelming support, Bradley and Hawley’s ambitious plan prevailed, and on Jan. 3, 1946, President Harry S. Truman signed into law PL 97-293, creating the Department of Medicine and Surgery within VA.

While Bradley and Hawley’s tenures were brief, their vision ushered in a new era of Veterans’ health care. One publication at the time noted that, “In two years, General Bradley has transformed the medical service of the Veterans Administration from a national scandal to a model establishment.”

Hawley’s comments at the time of the founding of the VHA retain their sense of inspiration and challenge: “With the signature of the Medical Department Act, our objective is clear, a medical service for the Veteran that is second to none in the world. Around the splendid nucleus of excellent men and women in the VA medical service, we shall build an outstanding service.” Seventy-five years later, countless doctors, nurses, volunteers, students, and public servants make their own miracles every day to ensure Veterans’ health care remains second to none in this nation.

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TIMELINE

VHA TIMELINE 1865-2021

NATIONAL LIBRARY OF MEDICINE PHOTO

1866

• Veterans Bureau is established by merging the three World War I Veterans programs

1

1923 • The first African American Veterans’ hospital is dedicated in Tuskegee, Alabama

2

• The Eastern Branch at Togus, Maine, is the first NHDVS campus to open in November 1866 2

1924 • Lt. Col. Joseph Henry Ward, MD, becomes the first African American hospital director

1867 • Emma Miller becomes the first woman employee in VA’s history, serving as the matron for the Central Branch of the National Home for Disabled Volunteer Soldiers in Dayton, Ohio

3

1870 • The NHDVS opens its first permanent hospital building at the Central Branch in Dayton, Ohio

• The first research program is established and the Veterans Bureau begins conducting the first hospital-based medical studies

• President Herbert Hoover consolidates the Veterans Bureau with the National Home for Disabled Volunteer Soldiers and Pension Bureau, re-designating it as the Veterans Administration (VA)

• Lucy Minnigerode becomes the first Superintendent of Nursing and oversees care for those afflicted by the 1918-1919 influenza pandemic and returning World War I Veterans

VA IMAGE

1925

1930

1919

1932 • The Tumor Research Laboratory at the Hines Hospital in Chicago is the first hospital to receive funds from the VA Central Office specifically for research

• The Public Health Service builds the first modern-era Veterans’ hospitals for the Bureau of War Risk Insurance and provides health care to World War I Veterans

1944 • Veterans’ benefits are greatly expanded through the Montgomery “G.I.” Bill

1921 • Native Americans become eligible for full Veteran benefits including medical care 3

• The NHDVS accepts women Veterans for medical care and hospitalization for the first time

1945 1. National Home for Disabled Volunteer Soldiers (NHDVS), Dayton, Ohio.

2. Eastern Branch, NHDVS, Togus, Maine.

3. Native American soldier, 1919.

• Veteran population increases by 16 million with the end of World War II 4

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CREDIT

NATIONAL ARCHIVES PHOTO

1865 • President Abraham Lincoln authorizes the National Home for Disabled Volunteer Soldiers (NHDVS) in March 1865 to provide medical and convalescent care for discharged members of the Union Army and Navy volunteer forces one month before the Civil War ends 1

TIMELINE

• The Prosthetic Appliance Service is established within VA

5

• The first Mental Hygiene Clinic for outpatient mental health services opens in Los Angeles • Rev. Crawford W. Brown is appointed as the first Chief of Chaplaincy Service with the establishment of a National Chaplaincy Service

6

• VA establishes the standard for developing better-fitting, lighter artificial limbs through studies of human locomotion, enhanced surgical techniques, and modernized design and manufacturing methods

• The Department of Medicine and Surgery is created by Public Law 79-293 on Jan. 3 • Within the first six months of 1946, VA’s full-time physician staff increases from 600 to 4,000

• Gen. Bradley and Gen. Hawley leave the VA

1948 7

1952 • 1952 Veterans Readjustment Assistance Act (Korean War G.I. Bill) provides benefits to Korean War Veterans 6

• Dr. Margaret D. Craighill becomes the VA’s first Chief Medical Consultant on women Veterans’ medical care and appoints the first 10 women doctors at VA to treat women Veterans

1954 • Segregation based on race ends in VA hospitals

• Veterans Administration Voluntary Services (VAVS) is created on April 18

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• First facilities for women Veterans are constructed in the Bedford, Massachusetts, and American Lake, Washington, hospitals • Public Law 792 authorizes a program of research in prosthetics, orthotics, and sensory devices

• Hines Hospital in Chicago becomes the first VA facility to affiliate with a medical school, teaming with Northwestern and the University of Illinois

• Public Law 79-636 establishes the Veterans Canteen Service (VCS) “for the primary purpose of making, to Veterans hospitalized or domiciled in the hospitals and homes, for purchase at reasonable prices, articles of merchandise and

history

1947

1946

• VA Memorandum No. 2 establishes affiliations with medical schools to help train physicians and other medical personnel needed to work in VA hospitals. Affiliations with 63 of the nation’s 77 medical schools are developed by 1948

• Gen. Bradley announces that VA will build 183 new hospitals – 105 general, 49 neuropsychiatric, and 29 tuberculosis, providing an additional 151,500 beds – in 39 states. It is the largest proposed federal Veteran hospital construction program in

4. Armistice Day parade, 1945. The Veteran population increased by 16 million at the end of World War II. 5. Gen. Omar Bradley, Gen. Paul Hawley, and Dr. Paul Magnuson, 1946. 6. Air Force Sikorsky H-5 helicopter evacuating wounded during the Korean War. 7. Dr. Oscar Auerbach.

1956 • Drs. Norman Farberow, PhD, and Edwin Shneidman, PhD, launch a three-year study at VA on suicide.

Their work forms the nucleus of VA’s Central Research unit for the Study

DOD PHOTO

• George A. Kelly is appointed as the first psychology consultant to help design the new VA psychology program

• VA develops and tests effective therapies for tuberculosis using the multicenter clinical trials approach. This approach leads to development of the Cooperative Studies Program, which has since produced effective treatments for diseases and conditions including schizophrenia, diabetes, depression, heart disease, and stroke

AUSTIN HISTORY CENTER

• Gen. Paul R. Hawley becomes the Chief Medical Director of the Veterans Administration in September 5

services essential to their comfort and well-being”

VA PHOTO

4

NATIONAL LIBRARY OF MEDICINE PHOTO

• Gen. Omar Bradley is sworn in as Administrator of the Veterans Administration in August 5

of Unpredicted Death, and brings the study of suicide to academia

8

• Dr. Valerija B. Raulinaitis, MD, becomes the first woman to lead a VA hospital when she becomes Director at the Leech Farm Road Hospital in Pittsburgh, Pennsylvania 9

1958 VA PHOTO

• The first definitive proof of the connection between cigarette smoking and lung cancer is made by Dr. Oscar Auerbach, MD, a pathologist at the East Orange VA Hospital 7

1959

1975

9

• VA’s first atomic reactor is installed at Omaha VA Hospital, ushering in era of “atomic medicine”

• Nobel Prizes are awarded to VA researchers Dr. Andrew Schally, PhD, for his research on peptide hormone production in the brain; and Dr. Rosalyn Yalow, PhD, for her development of radioimmunoassay to detect and measure various substances in the blood 10

VA PHOTO NATIONAL LIBRARY OF MEDICINE PHOTOS

• William Chardack, MD, and Wilson Greatbatch, MS, of the Buffalo VA Hospital, and Andrew Gage, MD, invent the first clinically successful cardiac pacemaker 8

1978

1961 10

1962

1979

1963 11

NATIONAL ARCHIVES PHOTO

1966 • Public Law 89-785 makes medical educational training a part of the VA’s mission along with patient care and research, including a mandate to train health professionals for the nation in addition to its own staffing needs

1970 • Research begins on planning and developing the Electronic Health Record (EHR)

• Congress passes the Veterans Health Care Amendments Act of 1979. VA sets up a network of Vet Centers across the country, separate from other VA facilities providing various counseling services and treating post-traumatic stress disorder (PTSD)

1982 • VA given fourth mission by Congress in PL 97-174 to improve the nation’s preparedness for response to war, terrorism, national emergencies, and natural disasters by developing plans and taking actions to ensure continued service to Veterans

1969 • The first heart transplant operation in a VA hospital takes place in the Palo Alto Medical Center by Dr. William W. Angell, MD

• VA begins offering special access to medical care, including physical exams, to Vietnam Veterans with Agent Orange health concerns 11 • The first VA hospital named after a woman is dedicated in Bedford, Massachusetts, as the Edith Nourse Rogers Memorial Veterans Hospital by Congress

• Dr. Howard W. Kenney, MD, is appointed as the first African American Hospital Director in a formerly all-white hospital, at the East Orange VA Hospital

• The first successful liver transplant is performed at the Denver VA Hospital by Dr. Thomas E. Starzl, MD, PhD

• The number of medical schools affiliated with VA reaches 100 when the North Carolina School of Medicine affiliates with the Fayetteville, North Carolina VA Hospital

1977

1960

• Researchers pioneer the concepts that lead to development of computerized axial tomography (CAT scan)

1972

8. William Chardack, MD, Wilson Greatbatch, MS, and Andrew Gage, MD, invent first successful cardiac pacemaker. 9.

Dr. Valerija B. Raulinaitis, MD, becomes first woman to lead a VA hospital. 10.

Dr. Andrew Schally, PhD, and Dr. Rosalyn Yalow, PhD, 1977 Nobel Prize winners. 11.

A helicopter sprays Agent Orange over forest during Vietnam War.

1983 • The Rev. Meredith Hunt becomes the first female full-time Chaplain at VA

1984 • The nicotine patch and other therapies to help smokers quit are developed by VA researchers

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TIMELINE 12

causes Werner’s syndrome, a disease marked by premature aging

1997 • VA establishes eight Comprehensive Women’s Health Centers and four Stress Disorder Treatment Centers

1985 • The Seattle Foot is developed by Dr. Ernest M. Burgess, MD, PhD, at the VA hospital in Seattle. The foot uses a patented spring to aid patients’ push off when taking a step

• The first three Mental Illness Research, Education, and Clinical Centers (MIRECCs) are funded by the VA

1988

• VA researchers identify a gene associated with a major risk for schizophrenia

• The Women Veterans Health Program is established

• VA researchers identify a gene that causes a rare form of dementia, providing a potential target for treatment of Alzheimer’s disease

13

• The VA Medical Center in Saginaw, Michigan, is renamed after Aleda Lutz, becoming the second VA facility named after a woman and the first named after a female Veteran 13

• VA researcher Dr. Ferid Murad, MD, PhD, is awarded a Nobel Prize for his discoveries relating to nitric oxide, a body chemical that helps maintain healthy blood vessels

1999 • VA launches the first treatment trials for Gulf War Veterans’ illnesses, focusing on antibiotics and exercise

2000

1991

• VA researchers show that the colonoscopy is superior as a primary screening mechanism for colon cancer

• The Department of Medicine and Surgery is re-designated as the Veterans Health Services and Research Administration and called the Veterans Health Administration

2001

1993 • Congress authorizes medical care for Gulf War Veterans for conditions possibly related to exposure to toxic substances or environmental hazards

14

• The first clinical trial under the Tri-National Research Initiative begins on an antiretroviral therapy for HIV

2003

14

• The VA-Indian Health Service partnership is established

• VA launches My HealtheVet nationwide.

Today, the personal health record portal has more than 2.5 million registered users

1994

2004

• The Center for Minority Veterans (CMV) is established • The Center for Women Veterans is established

• Establishes a major center of excellence, in partnership with Brown University and MIT, to develop state-of-the-art prosthetics for Veteran amputees

1995

2005

• VA Medical Centers become grouped into 22 Veterans Integrated Service Networks

1996 • VA researchers identify the gene that

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U.S. AIR FORCE PHOTO

• VistA, VA’s first image management system, provides VA physicians with immediate access to patient medical images, regardless of location. The system manages radiologic, pathology, gastroenterology, and laparoscopic images, as well as electrocardiograms

VA PHOTO

1998

1990

12. Viola Johnson becomes first African American woman to lead a VA hospital. 13.

1st Lt. Aleda Lutz, namesake of the first VA hospital named for the first American woman to die in combat in World War II. 14.

Soldiers during the Gulf War, 1991.

• VA announces major funding initiatives for research on neurotrauma, chronic pain, and other health problems prevalent in combat-wounded Veterans returning from Iraq and Afghanistan

DOD PHOTO

• Viola Johnson becomes the first African American woman to lead a VA Hospital when she becomes Director of the Battle Creek, Michigan Medical Center 12

2006

15

• The Jack C. Montgomery VA Medical Center in Muskogee, Oklahoma, becomes the first VA Medical Center to be named after a Native American

2007

2013

• VA’s National Suicide Prevention Hotline becomes operational

• VA collaborates with researchers in Europe and Israel to develop and test a new type of artificial pancreas that could lead to major improvements in care for diabetes

• VA unveils the first powered ankle-foot prosthesis, developed in collaboration with researchers at MIT and Brown University 15

• VA announces the formation of new research consortia to study PTSD and traumatic brain injury

VA PHOTO

2008 • VA launches a nationwide expansion of Alzheimer’s-caregiver program • VA publishes results of one of the first randomized clinical trials comparing different treatment approaches for those with traumatic brain injury

2014 16

• Defense Advanced Research Projects Agency (DARPA) and VA sign MOA under which DARPA will fund DEKA Research and Development Corp. to produce prototype arms and VA will fund researchers in VA to conduct clinical testing of the arms

VA PHOTO

• The DEKA Arm (now LUKE Arm) is approved after a 2014 study led by researchers from the Providence VA Medical Center and Brown University

17

• VA launches phase 2 of the Women Veterans Cohort Study, examining data on more than 900,000 Veterans to better understand women’s health needs, health care use, and outcomes

2015

2009 • VA initiates the largest health study ever of Vietnam-era women Veterans

• VA launches a study of light therapy to improve brain function in Veterans with Gulf War illness

• VA begins first-of-its-kind study at VA Medical Centers to optimize the design of an advanced prosthetic arm

• VA awards major contracts to help develop natural touch sensation for prosthetics users

2010

17

2018 • VA launches a telehealth program to serve Veterans living in rural areas who have PTSD

2011 • VA launches the Million Veteran Program (MVP), which establishes one of the world’s largest databases of health and genetic information for use in future research aimed at preventing and treating illness among Veterans and all Americans 16

2012 • VA finds that therapy combining stem cells and growth factors may help heal spinal cord injury

2017 • VA contributes to advances in a braincomputer technology that now allows fast, accurate typing by people with paralysis

• VA combines efforts with U.S. Army and U.S. Marines to study ways to prevent suicide among active-duty service members and to determine why certain service members develop PTSD while others do not

DARPA PHOTO

• VistA Evolution launches with a goal of providing essential health information technology to Veterans and clinicians and allows Veterans to have seamless access to their health record

2019

15. First powered ankle-foot prosthesis developed by VA, MIT, and Brown University researchers. 16. Million Veteran Program launched in 2011. 17. DEKA arm is approved after Providence VAMC and Brown University study.

• VA joins the PREVENTS initiative to prevent Veteran suicides, in part through the development and implementation of a national research strategy

2020 • VA begins a national four-year study on the impact of COVID-19 on Veterans

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HISTORY

DR. MARGARET D. CRAIGHILL, 1898-1977 The military’s first commissioned woman doctor changed the way the Army – and the VA – practiced medicine.

By Craig Collins

Maj. Margaret D. Craighill.

BORN TO SERVICE

It shouldn’t be surprising that Craighill was drawn to military service; she was a third-generation Army officer. Born in October 1898 in Southport, North Carolina, she was one of six daughters.

Her father, Col. William E. Craighill, and her grandfather, Brig.

Gen. William Price Craighill, were West Point graduates who served in the Army Corps of Engineers – her grandfather as Chief of Engineers from 1895 to 1897.

Her first job after college was with the Army: Craighill graduated Phi Beta Kappa from the University of Wisconsin in 1920 with an A.B. degree, remained to complete a Master

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Veterans Health Administration 75

of Sciences degree in 1921, and then took a year off from her studies to work as a physiologist for the Army’s Chemical Warfare Service (now the Chemical Corps) at Edgewood Arsenal, Maryland. Soon she was accepted and enrolled in the Johns Hopkins University School of Medicine, where she earned her MD in 1924. For the next few years, she held several postgraduate positions at Johns Hopkins, where she was assistant resident of gynecology until 1928, and at Yale University, where she was an assistant instructor of pathology.

U.S. NATIONAL LIBRARY OF MEDICINE PHOTO

It took two world wars, but the American military was finally compelled, in 1943, to get over the belief that doctors should be men and nurses should be women.

Many women had already defied this stereotype by the time the United States entered World War I, but despite the great need for their expertise, none were considered for military service as physicians. Ultimately, the U.S. Army hired more than 50 women doctors as contractors during World War I, but none were commissioned. At the beginning of World War II, the doctors in the Army and Navy Medical Corps were all men.

The workforce demands of World War II led to the formation of what would become the Women’s Army Corps (WAC), which began as an auxiliary unit that, again, hired women nurses and doctors as contractors before conferring “relative rank” onto commissioned nurses.

During the war, about 147,000 women served in the auxiliary or the WAC, and by 1943 it was obvious that this new corps of medical professionals needed its own women leaders. On May 28, 1943, Margaret D. Craighill, MD, a 44-year-old doctor and dean of the Woman’s Medical College of Pennsylvania, was appointed as the Army’s first woman medical officer.

Two weeks before the director of the WAC, Oveta Culp Hobby, received her own commission as an active-duty colonel, Craighill had become the first woman doctor to become a commissioned medical officer in the Medical Corps, with the rank of major.

It wouldn’t be the last time Craighill would set a historic precedent. Her career has left an indelible mark not only on the military, but also on the Veterans Health Administration – and on the entire medical profession.

LEGACY CENTER ARCHIVES, DREXEL UNIVERSITY COLLEGE OF MEDICINE PHOTO

After leaving Johns Hopkins, Craighill was an assistant surgeon at Bellevue Hospital in New York, working under the supervision of J.A. McCreery, MD. During this time she maintained her own obstetrics and gynecology practice in Greenwich, Connecticut, while also serving as an assistant surgeon and attending gynecologist at Greenwich Hospital.

Craighill’s impressive career in women’s health attracted the attention of the Woman’s Medical College of Pennsylvania (WMCP, now part of the Drexel University College of Medicine), the second medical institution in the world established to educate and train women to earn the MD degree. In 1940 – by which time the school had graduated more than 1,000 women physicians – Craighill was appointed acting dean.

She saw opportunities for reform and improvement in the 90-year-old school, and launched major changes to the curriculum, improvements in studentfaculty relations, and a better working

Margaret D. Craighill, center, the only woman in this group photo among otherwise male members of the Army Medical Corps.

relationship with the Woman’s Hospital of Philadelphia – the teaching hospital where many students earned their first clinical experience.

The “acting” designation was quickly dropped from Craighill’s title, and she was named dean of the medical college.

While she held this appointment, she was also assistant gynecologist at Philadelphia General Hospital. When the United States entered World War II in 1941, Craighill took an immediate interest, joining the War Manpower Commission and the Procurement and Assignment Service within the Office of Defense Health and Welfare Services – an organization designed to field requests for medical and dental personnel from federal agencies, maintain a list of available personnel, and stimulate interest among medical professionals in volunteering for military service.

Within two years, Craighill’s involvement in the war effort would become much more direct.

A MILITARY FIRST

In his profile of Margaret D. Craighill in the spring 2018 edition of the Army Historical Foundation’s journal, On Point, Lt. Col. G. Alan Knight notes that one of her close friends and allies – and almost certainly one of the people who influenced her appointment to the Woman’s Medical College of Pennsylvania – was the eminent Emily Dunning Barringer, MD, a pioneering physician whose many firsts included her service as the nation’s first woman surgical resident.

Barringer, who became president of the American Medical Women’s Association (AMWA) in 1942, was among those who lobbied for women doctors to serve as commissioned officers in the Army

Craighill, starting from scratch, initiated and developed medical policies related to Army women.

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Left: Lt. Col. Margaret D. Craighill receiving the Legion of Merit Award in 1945. She went

MARSHALL FOUNDATION PHOTO

LEGACY CENTER ARCHIVES, DREXEL UNIVERSITY COLLEGE OF MEDICINE PHOTO

to work for the VA in 1946. Below: Lt. Col. Margaret D. Craighill with Director of the Women’s Army Corps (WAC) Col. Oveta Culp Hobby.

Medical Reserve Corps. On its website, the Army’s Office of Medical History points out the dire need at the war’s outset: “Five months after the declaration of World War II, approximately 3,000 fewer physicians were on active duty with the Army than at the end of the same length of time after the declaration of World War I.” Congress needed little further convincing, and the law known as the Sparkman-Johnson Act – which granted women the right to receive commissions in the Medical Corps of the Army and the Navy, as well as in the U.S. Public Health Service – was signed into law by President Franklin Roosevelt on April 16, 1943.

Within three days, Craighill was offered an appointment to the Medical Corps, and her Army upbringing compelled her to act: She divested herself of her civilian responsibilities and obtained a leave of absence from the medical college, and was commissioned about six weeks later.

Before passage of the law, Army women belonged to the Women’s Army Auxiliary Corps (WAAC), a unit of women trained primarily to fill roles such as switchboard operators, mechanics, bakers, drivers, and clerks. Tens of thousands more women enlisted in the corps than had been anticipated, and the Sparkman-Johnson Act was motivated, in part, by the understanding that these women would need qualified professionals to organize, coordinate, and oversee their working and living conditions, including their health

care – and the knowledge that qualified professionals were more likely to join an organization that would recognize them with commissions.

When Craighill was commissioned, the WAAC had been reorganized as the WAC and incorporated into the Army. She was assigned to be Consultant for Women’s Health and Welfare within the Preventive Medicine Division of the Office of the Surgeon General, reporting directly to the Army surgeon general and in liaison with WAC Director Col. Hobby.

It was an unprecedented role. Craighill, starting from scratch, initiated and developed medical policies related to Army women. One of her first undertakings was to visit Army induction stations to

learn how medical screening was affecting WAC recruitment. She found that at most enlistment stations, women were screened in the same way as men, often by people who had little or no training in women’s health – which resulted in women with tumors, or pregnant women, being inducted. Craighill developed and implemented new procedures that included examinations for pregnancy, tumors in reproductive organs, and other medical concerns Craighill described as “problems of health peculiar to women.”

She established standards for screening and for women’s medical care, and over time, as women’s health needs were addressed, the rate at which women recruits were rejected increased, while the rate of disability discharges decreased significantly.

During the war, Craighill was responsible for inspecting the field conditions of all women in the Army, including the provision of medical care and the development and implementation of hygiene courses. She met with a board of Army physicians to create a set of standards for acceptability of women medical officers, and served as an adviser on their assignment. In their book, Women Doctors in War, Judith Bellafaire and Mercedes Herrera Graf noted that this advisory role sometimes chafed: “… there was a strong tendency,” they wrote, “to assign [women doctors] as women, rather than as doctors.” Craighill believed these doctors were too often assigned to WAC units, to treat women, rather than to units where their expertise could do the most good.

Craighill also wanted desperately to go overseas. It took her a year and a half to convince her superiors that she should do so – but when she did, she undertook an inspection tour of women’s living conditions that lasted eight months and spanned the globe, taking her to facilities in England, France, Italy,

27

Left to right: Craighill, Col. Elizabeth C. Strayhorn, commandant of the WAC Training Center at Fort Des Moines, Iowa, and WAC Deputy Director Lt. Col. Helen Hamilton pictured during a WAC officer conference at Fort Des Moines, Sept. 18, 1945.

Egypt, the African Gold Coast, Iran, India, China, the Philippines, and New Guinea. In all, she traveled an estimated 56,000 miles, dispelling fears that women would perform poorly in cold or tropical climates.

The mental health of Army women before, during, and after service became a particular interest for Craighill, who stressed the importance of standards for evaluating mental health. She advocated for establishing mental health units in WAC training centers to improve the performance of examiners. This was ultimately done in 1944 by Col. William C. Menninger, who’d founded, with his father and brother, the world-renowned Menninger Foundation, a psychiatric school and clinic in Topeka, Kansas.

For her distinguished service in World War II, Craighill was promoted to lieutenant colonel and awarded the Legion of Merit. She separated from service on April 8, 1946.

NATIONAL ARCHIVES PHOTO

CHARTING A NEW COURSE FOR VA HEALTH CARE

Even before she’d left the Army, Craighill was tapped by Gen. Omar Bradley to conduct an inspection tour of Veterans Administration hospitals “to give some suggestions,” she wrote to a colleague, “on the care of women patients.” It was the first position of its kind in the VA. Her time as chief consultant on medical care for women veterans established a historic precedent; as she’d done in the Army, Craighill advocated for increasing the numbers – and expanding the roles – of women doctors in VA hospitals. In 1946, nine other women doctors were assigned to VA posts across the country – two of them graduates from the Woman’s Medical College of Pennsylvania. Their mission was “to see that medical care for women veterans in VA hospitals and homes over the country [was] kept at the highest possible standard at all times.”

This effort to develop standards and policies for women’s health care evolved into what became, in 1951, the Defense Advisory Committee on Women in the Services. The offices and programs in place within the VA today – the Women Veterans Health Care Program, the Women’s Health Research Network, the Women’s Health Services Office, and more – can all trace their origins back to the work begun by Craighill and her colleagues after World War II. Craighill returned briefly to the WMCP after her service, with the intent to remove the “Woman’s” designation and eliminate the gender stereotypes she’d seen holding women doctors back in the Army. Her efforts to create a coeducational medical school by negotiating a merger of WMCP and Jefferson Medical College in Philadelphia, however, were thwarted, and she resigned in frustration. The merger eventually happened – in 1970.

The G.I. Bill offered Craighill the chance to resume her studies, and she jumped at the opportunity to learn more about the field that had fascinated her during the war: In 1946, she enrolled at the newly established Menninger Foundation School of Psychiatry in Topeka, and graduated as a member of its first class. She served as chief of the psychosomatic section at the Winter VA Hospital in Topeka from 1948

to 1951, when she joined the staff of the Menninger Clinic. Ultimately she decided to return east to continue her studies, and graduated from the New York Institute of Psychoanalysis in 1952.

Until 1960, Craighill conducted her own private practice in medicine and psychology in New Haven, Connecticut, but maintained her interest in women service members, writing and publishing many articles on the mental health of women in the Army. She also served as chief psychiatrist in residence at the Connecticut College for Women in New London. Craighill died at the age of 78 on July 20, 1977, at her home in Southbury, Connecticut.

As a pioneer, Craighill had often been frustrated with how women doctors were viewed and treated: “I must acknowledge that I am feeling discouraged over any progress I can make in regard to establishing better conditions for the women doctors,” she wrote to a colleague, Capt.

Gladys Osborne, during the war. “There is such a deep-rooted prejudice which arises in such unexpected places, it leaves me baffled sometimes.” But the progress she did make was remarkable – historic. Her legacy is indelible today, in the quality of medical care delivered to women service members and Veterans, and in the service of women at the highest levels of the medical profession.

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IMAGE COURTESY OF DAYTON VAMC

VA HOSPITAL EVOLUTION

Building From Our Past: The Evolution of VA Hospitals PHOTO BY JAMES STEAKLEY/WIKIMEDIA COMMONS

The architecture, look, and footprint of Veterans’ hospitals have changed significantly since the first hospitals opened after the Civil War.

By Katie Delacenserie, VHA Historian

Today’s VA Medical Centers and the wide range of services they provide for Veterans are ingrained into the fabric of modern American society and culture. The architecture, look, and footprint of Veterans’ hospitals have changed significantly since the first hospitals opened after the Civil War and are still evolving to meet the latest in medical innovation and contemporary research needs.

Top: A contemporary illustration of the National Home for Disabled Volunteer Soldiers in Dayton, Ohio. The First Generation hospitals comprised multiple buildings. Above: The National Soldiers Home in Milwaukee, Wisconsin, was built in 1867-68. It was one of 25 buildings

FIRST GENERATION

First Generation hospitals were constructed by the National Home for Disabled Volunteer Soldiers for the care of Union

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comprising the National Home for Disabled Volunteer Soldiers, Northwestern Branch, and survives today.

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Above: An illustration of the campus of the National Home for Disabled Volunteer Soldiers, Eastern Branch. Right: The First Generation Togus VA Medical Center hospital building is still in use today.

Civil War Veterans between 1866 and 1930. Home Branches were built in Togus, Maine; Dayton, Ohio; and Milwaukee, Wisconsin, among others – a total of 11 in all.

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Hospital Features • Miniature cities with multiple buildings • Residential communities • Located on large tracts of land in rural areas • Provided lifelong medical, surgical, and holistic care as well as burial grounds • Picturesque landscapes • First racially integrated federal civilian institutions SECOND GENERATION

The next set of Veterans’ hospitals was constructed between 1919 and 1940 for

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Above: The Lexington VA Medical Center, one of more than 50 Second Generation hospitals. Right: The Bay Pines VA Medical Center Building 1 in Florida. The Second Generation hospitals were built between 1919 and 1940, and in the case of Bay Pines, expanded during World War II.

PHOTO BY ROMAN EUGENIUSZ/WIKIMEDIA COMMONS

World War I Veterans and are known as Second Generation hospitals. Locations of more than 50 Second Generation hospitals include Hines, Illinois; Bay Pines Florida; and Tuskegee, Alabama.

Hospital Features • Focused on rehabilitative services instead of lifelong care • Classified into three types: general medical and surgical, tuberculosis, or neuropsychiatric • Located on large tracts of land in rural areas • Typically had “H” or “I” footprints, with standardized building plans • Featured Classical Revival or Colonial Revival architectural elements • Segregated by race, with the hospital in Tuskegee becoming the first segregated federal Veterans hospital

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PHOTO COURTESY OF LEO A DALY

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THIRD GENERATION

Third Generation hospitals were authorized for World War II Veterans beginning in January 1946. Under VA Administrator Gen. Omar Bradley, VA hospitals began to modernize and partner with medical schools and conduct scientific medical research as never before. Fifty-two new hospitals were built in total from 1946 to 1958, including those in Michigan, Colorado, and Missouri, while several others were acquired from the Army and Navy, such as the Carl Vinson VA Medical Center in Georgia.

Hospital Features • Located in populated areas and near major medical schools • Slated to be the largest federal Veterans’ hospital construction program in history • Focused on rehabilitation and returning Veterans to civilian life • Classified into three types: general medical and surgical, tuberculosis, or neuropsychiatric • “Skyscraper” era of Veterans’ hospitals • Entire floors and wings devoted to medical research and innovation • Racial segregation officially ends in 1954 LOOKING FORWARD

The recently opened Ambulatory Care Center on the Nebraska-Western Iowa

Top left: The Brooklyn VA Medical Center, one of more than 50 Third Generation hospitals built after World War II. Top right: The Third Generation East Orange VA Medical Center in New Jersey, a good example of what became known as the “skyscraper era” of VA hospitals. Above: The new Ambulatory Care Center on the Omaha VA Medical Center campus provides a look into the future of VA medical facilities.

Health Care System’s Omaha VA Medical Center campus is a first of its kind. Built with a combination of public and private funds made possible by the CHIP-IN for Veterans Act of 2016, it is a model for the future direction of Veterans’ health care.

Ambulatory Care Center Features • Fully dedicated Women’s Health Clinic specializing in gynecological services and

providing women Veterans with access to mental health, social work, whole health, and maternity care • Combines three primary medical clinics with additional specialty clinics, radiology facilities, and five new dedicated ambulatory surgical suites • Veteran-themed features such as a Healing Garden

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PHOTO BY ALEX DIFIORI

ACADEMIC AFFILIATIONS

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VA’S HIDDEN GEM The nation’s largest health professions trainee program improves quality of care, VA workforce

By OAA Communications Staff

CREDIT

In 1946, VA Administrator Gen. Omar Bradley and Chief Medical Officer Gen. Paul R. Hawley faced an enormous challenge: 100,000 Veteran patients returning home from World War II and only 1,000 VA physicians to care for them.

So they planned an unprecedented strategy: partner VA hospitals with U.S. medical schools to recruit doctors, train the next generation of health professionals, and care for the nation’s Veterans.

What began as a groundbreaking idea has now led the Veterans Health Administration (VHA) to become the premier health professions training program in the country. With more than 120,000 trainees each year in over 40 health professions such as pharmacists, nurse practitioners, and physicians assistants, it’s a mission that is improving quality of care for Veterans while developing the best and brightest – many of whom choose to spend their careers at VA. Just as Dr. Karen Sanders, Deputy Chief Academic Affiliations Officer for VHA, did.

When Sanders began her internship in 1977, her first rotation was at the Providence, Rhode Island VA. “They literally handed me a stack of like 25 cards and said, ‘these are your patients, doctor,’” Sanders recalled.

Some residents may have been daunted by the task. But not Sanders, who said she was “immediately hooked” on Veterans and the VA. Forty years later, she’s gone from trainee to helping lead the VHA Office of Academic Affiliations (OAA), overseeing the mammoth clinical training enterprise. It’s an enterprise conducted in collaboration with 144 of 152 medical schools accredited by the Liaison Committee on Medical Education (LCME), 34 out of 34 accredited Doctor of Osteopathic Medicine degree-granting schools, and over 1,800

Left: Each year, VA provides training to more than 120,000 health professions trainees in more than 40 disciplines such as physicians assistants, pharmacists, and nurse practitioners.

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Above: Nearly 70% of U.S. physicians complete at least part of their training at VA.

COURTESY OF KAREN SANDERS

unique colleges and universities educating health professions trainees.

Today, nearly 70% of U.S. physicians complete at least part of their training in VA, as do more than 60% of U.S. psychologists – a clinical discipline VA was instrumental in the development and accreditation of in the 1950s.

VA went on to help establish recognition of the physician assistant profession in the 1960s and played an integral role in the development of Geriatric Medicine as a specialty in the ’70s. In the 2000s, VA

Right: Karen Sanders, MD, Deputy Chief Academic Affiliations Officer, Veterans Health Administration.

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led the development of Palliative Care and Traumatic Brain Injury specialties and added 1,500 new physician resident positions. Today, OAA continues to grow affiliate partnerships to provide better access to Veterans while ensuring VA remains a driving force in health care innovation and training for decades to come.

While Sanders was beginning her VA career, VA was furthering its strategy by co-locating more than 70 VA medical centers with their academic affiliates.

What began as a plan to improve the quality of care at VA now equally benefits VA’s affiliates, with more than 70% of physicians in VA teaching facilities also holding faculty appointments at their VA’s medical school partner.

“The quality of VA is directly related to the quality of its people,” said Sanders, “and that is directly related to the academic affiliations.”

The ability to teach, provide clinical care, and conduct research is also a significant

Deputy Chief Academic Affiliations Officer Dr. Karen Sanders (left) discusses nurse training programs with OAA Clinic Nursing Director Jemma Ayvazian.

recruitment and retention strategy for VA in building its health care workforce.

“You can do all these things and never leave VA,” Sanders said.

One key strategy for the future of health professions training is interdisciplinary training, according to Sanders.

In 2011, OAA led the charge to transform primary care education out of silos by training post-graduate trainees – medical residents, physician assistants, social workers, pharmacists, and others – side by side. Trainees benefit from enhanced knowledge and respect for other professions’ contributions while developing skills needed to lead and work in multi-disciplinary care teams.

Sanders said it’s an important adjustment that helps trainees understand all

viewpoints and know what their colleagues do in keeping Veterans healthy.

With 92% of trainees stating they are satisfied or very satisfied with their VA training experience and 72% expressing willingness to work for VA in the 2019 VA Trainee Satisfaction Survey, the future of VA and its academic mission is extremely important to Veterans and the department.

“I am so proud of the role that OAA plays in enhancing our affiliation relationships and bringing trainees into the VA. I know that we improve the quality and timeliness of care for Veterans,” Sanders concluded. “Without affiliations, VA just wouldn’t have the excellent staff that we do. … It’s a hidden gem.”

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VOLUNTEERS

Maura Campbell, voluntary service specialist at the VA St. Louis Health Care System, received The Beryl Institute’s Volunteer Professionals Award for Excellence for her work implementing VA’s Compassionate Contact Corps.

VOLUNTEERS FOR VETERANS The Center for Development and Civic Engagement (CDCE) builds on a century-and-a-half of service.

By the middle of 2020, as the lockdowns and quarantines of the COVID-19 pandemic stretched from weeks to months, the lives of American military Veterans had changed dramatically: Many were literally cut off from the services they relied on to stay healthy and engaged in their communities; tens of thousands found themselves having to learn how to use computers and equipment that would help them teleconference with their health care providers. Appointments through the Veterans Health Administration’s Video Connect program increased more than tenfold, from 10,000 to 120,000 appointments a week.

But the Veterans didn’t have to adapt to these new realities alone. At the Ralph H. Johnson VA Medical Center in Charleston, South Carolina, for example, students launched a “Bridging the Digital Divide” program, in which they helped Veterans with virtual appointments and other technological challenges. The Fisher House Foundation donated computer tablets, so Veterans

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who couldn’t have visitors in the hospital could still connect with family and friends.

In the months before COVID-19 vaccines were authorized by the U.S. Food and Drug Administration (FDA), a new organization was formed out of an existing phone-buddy program: the Compassionate Contact Corps, a group of volunteers who reached out to Veterans, particularly those in rural areas, who were isolated and starved for social interaction.

The social support program, consisting of regular telephone or teleconferencing visits between volunteers and Veterans, was popular, and spread quickly from region to region.

Senior Corps volunteer support of VA’s Choose Home initiative also proved crucial during the pandemic, as volunteers fanned out across the country to perform tasks – delivering groceries and medicine, or visiting (outside, at a safe distance) – that allowed older Veterans who were at risk of moving into a long-term care facility to remain safe at home.

VA PHOTO

By Craig Collins

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For the people who delivered these services to Veterans, and every organization, such as the Fisher House, that provided material support, their greatest reward was knowing they’d returned, in some small degree, the favor America’s service members have bestowed in service to their country. It’s a tradition that dates to the Civil War, when volunteers were first organized on a large scale to support service members and Veterans.

EARLY VOLUNTEER ORGANIZATIONS

Not long after the first shots were fired at South Carolina’s Fort Sumter in April 1861, a Women’s Central Association of Relief (WCAR) was established in New York.

While one of its first functions was to register nurses for service in military hospitals, the WCAR’s primary purpose was to channel public support for the war effort and organize a volunteer system for procuring supplies on the home front. Women knitted socks, made bandages, prepared food and “comfort bags” that included books, checkerboards, combs, stationery, dominoes, and other items, sat at the bedsides of wounded or sick soldiers, and raised money to purchase medical supplies.

The WCAR’s chairman, Massachusetts clergyman Henry Bellows, realized in a visit to Washington that the group’s efforts needed to be organized nationwide, with a presence in the nation’s capital, to provide advice and assistance to the Union Army regarding medical care and the general welfare. Within weeks of the war’s onset, a larger U.S. Sanitary Commission (USSC) was formed, with Bellows as its president, and was officially endorsed by President Abraham Lincoln. The commission – at the time, the largest national volunteer organization in U.S. history – was created by legislation on June 18, 1861. The WCAR became a supply branch of the USSC. Originally formed to “look into the health and sanitary conditions of the Union Army and make recommendations to the government,” the USSC went much further than that in support of warfighters and Veterans. From its headquarters in the U.S. Treasury Building on Pennsylvania Avenue, the commission established local branches in cities throughout the North, where fundraisers were held to buy medical supplies, ambulances, hospital ships, and personal supplies for wounded and

Top: A meeting of the ladies of New York at the Cooper Institute, on April 29, 1861, to organize a society to be called “Women’s Central Association of Relief,” to make clothes and lint bandages, and to furnish nurses for the soldiers of the Union Army. Above: U.S. Sanitary Commission lodge at Convalescent Camp, Alexandria, Virginia, 1863.

recovering soldiers. Throughout the war, USSC volunteers raised an estimated $25 million. Volunteers read to soldiers; recorded the burial locations of those who’d died in battle; corresponded with their families; and much more. The American public was passionate about the war effort, and the legions of volunteers included the poet Walt Whitman,

the novelist Louisa May Alcott, and Frederick Law Olmsted, the landscape architect who designed New York’s Central Park.

The U.S. Sanitary Commission also helped to establish the tradition of establishing “soldier’s homes” for Veterans – transitional places where soldiers who were out of medical jeopardy,

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but who could not return to service, could convalesce. About 60,000 amputations were performed during the war – more than in any other U.S. conflict – and volunteers grew increasingly concerned with how to care for and support men who had lost limbs. In March 1865, just a month before his assassination, Lincoln signed legislation creating a National Asylum of Disabled Volunteer Soldiers, the first federal institution in the world established exclusively to serve disabled Veterans of the volunteer forces. The board that chose the site described the facility as “a home, where subsistence, quarters, clothing, religious instruction, employment when possible, and amusements are provided by the government of the United States.

The provision is not a charity, but is a reward to the brave and deserving.” A few years later, its name was changed to the National Home for Disabled Volunteer Soldiers, and by 1929, there were 11 branch facilities throughout the country.

Because the U.S. Sanitary Commission disbanded after the war, volunteer support for Veterans was virtually nonexistent for a time. The National Homes were relatively self-sufficient for the rest of the 19th century, and Veterans’ needs were met by a Post Fund, established in the National

A Red Cross nurse cares for a wounded soldier during the holiday season in World War I.

Homes’ founding legislation, that could raise money and accept donations.

When American service members began fighting the next big war, World War I, medical care and other benefits were provided to Veterans by the Treasury Department, through its Bureau of War Risk Insurance and the new Public Health Service. The work of these agencies was supplemented by volunteers from the American Red Cross, the nonprofit humanitarian organization founded by Clara Barton in 1881.

The Red Cross’ auxiliary workforce performed many tasks, including clerical work, laboratory assistance, social work, and nursing. Because the Public Health Service was limited, by law, to providing for the medical needs of soldiers and Veterans, Red Cross volunteers were encouraged by the surgeon general to provide for other needs: offering reading materials and other entertainments, sometimes live shows or concerts; taking Veterans on automobile rides; providing comforts such as pajamas and socks; and generally working to boost the morale of

patients at the Public Health Service’s Veterans’ hospitals.

The consolidation of these efforts to provide medical and other benefits to Veterans began after the war, with many Red Cross functions being taken on by the federal government – often by former volunteers who signed on as employees in the agency that would become, in 1930, the Veterans Administration (VA).

THE VA VOLUNTARY SERVICE (VAVS)

Volunteer organizations once again stepped up to come to the aid of service members and Veterans as the United States began to mobilize for war in 1941.

In June 1945, after Germany’s surrender, President Harry Truman appointed Army Gen. Omar Bradley, who’d commanded three corps of soldiers during Operation Overlord, the invasion of Normandy, to lead the VA. In choosing Bradley, a fellow Missourian, Truman signaled he wanted a leader who would, while maintaining the agency’s commitment to World War I Veterans, have insight into the needs and

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interests of a new generation of Veterans.

Bradley implemented a sweeping overhaul of the administration, establishing several programs modeled after successful War Department programs. One of his first reforms was the establishment of a Special Services division within VA to support the morale and social well-being of Veterans, particularly those among the more than 670,000 service members who had been wounded in World War II. The new Special Services division, led

by Army Col. Francis Kerr, was organized under the new Medical and Surgery Department, and administered four major services: canteen, chaplaincy, recreation, and library. In May 1946, a National Advisory Committee was established to coordinate and integrate the supplemental assistance of volunteer organizations within Special Services, a program defined and established as the VA Voluntary Service (VAVS). The eight organizations comprising this first committee – the American Legion and its Auxiliary, the American National Red Cross, Disabled American Veterans (DAV) and its Auxiliary, United Service Organizations (USO), and Veterans of Foreign Wars (VFW) and its Auxiliary – are now among more than 50 that coordinate the efforts of a vast network of volunteers and partners.

James H. Parke, a Veteran of the Army’s Special Services, was tapped to lead VAVS, which he directed for nearly a quarter-century before his death in 1970. Charlotte von der Heyde, who had served as a Navy lieutenant in World War II, was appointed to serve as the liaison between VAVS and the national voluntary service organizations.

In the ensuing decades, VA’s volunteer program, administered by a professional staff at a national office, grew into one of the largest and most accomplished corps of volunteers in the federal government: By 1974, when most of the 2.7 million American men and women who served in Vietnam had returned home, the number of volunteer hours contributed through the program exceeded 10 million. By the time the VA was elevated to cabinet-level status – as the Department of Veterans Affairs, established in 1988 – VA volunteers were being placed in more than 150 different assignment categories and serving in a variety of settings, including VA readjustment counseling centers, community service centers, and contract nursing and residential care homes.

$20,000 James H. Parke Memorial Fund Youth Scholarship Award winner Daniel Finney (left) volunteered his summers to serve Veterans.

TODAY’S CDCE: FROM “NICE” TO “NECESSARY”

In the spring of 2021, VHA’s 75th year of existence, the number of hours contributed by VA volunteers surpassed 1 billion.

That number, astonishing as it is, does not capture the scope of the effort that has evolved to serve the needs of Veterans and their families. By the end of one of the most transformative years of the service’s existence, it had become clear that the name of the service itself didn’t capture it, either: In December 2020, after 74 years of being known as the VA Voluntary Service, the organization changed its name to the Center for Development and Civic Engagement (CDCE).

In a conversation with VHA Historian Katie Delacenserie and producer Shawn Spitler during an episode of VA’s Standing Ready podcast, CDCE Director Sabrina Clark, PhD, explained that for decades, the VA Voluntary Service had been known primarily as the coordinating hub for volunteer activities that served Veterans and their families. “We got locked into an identity,” Clark said, “about being only about volunteers. And what went missing was the donations, the philanthropic activity, the partnership activity,

and all the things we do with corporations and nonprofits. That piece of the work – the development piece, about forging relationships – these things were always critical to who we were, but our name didn’t really reflect that.”

At its core, the CDCE remains unchanged; it works through several established programs, including: • the Student Volunteer Program, which provides VA medical center treatment teams with valuable liaisons. The James H. Parke Memorial Youth Scholarship, established to honor the service’s founding father, provides opportunities to student volunteers to further develop their skills and contribute to the well-being of Veterans.

• the National Salute to Veteran Patients, which began in the 1970s, is a weeklong expression of appreciation – by Veterans groups, military personnel, civic organizations, businesses, schools, local media, celebrities, sports stars, and other individuals – for the more than 9 million Veterans cared for at VA facilities throughout the country.

• the Volunteer Transportation Network, established by Disabled American Veterans in 1987, which provides transportation to Veterans receiving services at VA or authorized facilities.

• the Physician Ambassador Program, created in 2017, which recruits and places fully licensed volunteer physicians and clinicians to serve, without compensation, in a health care team at a VA medical facility.

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Left: Volunteers from Zeta Phi Beta Sorority, Inc., lend assistance for a Drive-Through Baby Shower at the Atlanta VAMC. Middle left: Operation Song connects Veterans telling their stories with professional singer-songwriters who record them as songs. Bottom left: About 69 Home Depot and Tampa Police Department volunteers help improve the grounds around CDCE PHOTO

the James A. Haley Veterans’ Hospital Spinal

TAMPA VA HOSPITAL PHOTO BY ED DROHAN

CDCE PHOTO

Cord Injury Center June 2, 2017.

Corporate volunteerism has become part of these core capabilities in recent years, as company-sponsored volunteer programs allow employees to put their specialized skills to work for Veterans.

Employees of Home Depot, for example, have installed donated ornamental plants to spruce up the entrance of a VA facility – and the company also operates a grant program to help fund the development

and repair of Veteran housing. Along with the Physician Ambassador Program, which elicits contributions from highly skilled professional volunteers, these initiatives exemplify what Clark describes as a movement from volunteers providing merely “nice” services – reading to Veterans, showing appreciation, or otherwise boosting morale – to include more “necessary” services, such as making sure Veterans complete their scheduled medical appointments.

The Compassionate Contact Corps, led by Navy Veteran and CDCE Deputy Director Prince Taylor, has expanded to be administered from more than 80 sites throughout the VA health care system, where volunteers and VA professionals – without a mandate or funding from Congress and without a top-down directive from the secretary or under secretary – have decided that reaching out to isolated Veterans is an important thing to do, and have organized a social support network that reaches as many as possible.

As the nation emerges from the pandemic, it’s clear that the CDCE, like so many institutions, has been transformed – permanently, in ways that are just now becoming apparent. These changes are welcome to Clark, who has been overwhelmed by the variety of volunteers and partners who have leapt to the aid of Veterans. The future of the CDCE, she said, will continue the trend she’s seen in her time as director: “The diversity of people and organizations we will bring in …

There will be organizations that never thought there was a place for them in VA … being flexible and adaptable in this time is bliss, because it just keeps us growing and responsive to what Veterans need.”

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VETERANS CANTEEN SERVICE

VETERANS CANTEEN SERVICE 75 years of comfort and community

Established in 1946, Veterans Canteen Service (VCS) was created to provide articles of merchandise and services at reasonable prices to Veterans in the VA health care system, along with caregivers and visitors. Since its conception, VCS’ mission continues, incorporating a strategic Veteran-centric approach emphasizing the importance of service to Veterans and supporting VA’s overall mission.

VCS employees provide retail, food, and vending services across the country. Its operating vision is simple: become an integral part of the VA community and deliver merchandise and services of exceptional quality and value in an environment consistent with high levels of satisfaction and comfort. These guiding principles are the “strategic drivers” of the programs and services offered today.

The VCS PatriotStore offers a large variety of items that can be found at any major retailer, including electronics, men’s and women’s fragrances, military apparel, giftware, snacks, and much more.

VCS is proud to “give back” to the VA community by supporting VA’s national rehabilitation events, Fisher Houses, disaster relief efforts, homeless Veterans programs, women Veterans and suicide prevention programs, the Warrior to Soulmate program, and other activities.

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IMAGE COURTESY OF VETERANS CANTEEN SERVICE

By Stacy Papachrisanthou, Director of Marketing and Communications, VCS

Above: VCS employees support the National Veterans Wheel-

PHOTOS COURTESY OF VETERANS CANTEEN SERVICE

chair Games in Orlando in 2018.

Then and Now Above: In this café scene from the 1950s, lunch specials are displayed at the former Allen Park VA Medical Center in Dearborn, Michigan. Right: VCS employees work at the Orlando VA Medical Center’s café in 2015.

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Then and Now

Left: Retail store at the Edith Nourse Rogers Veterans Hospital in Bedford, Massachusetts, in 1966. Middle: Snacks for sale at the Bronx VA Medical Center’s retail store in 1960. Right: Retail store merchandise for sale at the Orlando VA Medical Center in 2015.

Then and Now

Left: Café scene from 1953 at the former Livermore VA Medical Center in California, now part of the VA Palo Alto Health Care System. Middle: VCS employees work in the café at Ohio’s former Brecksville VA Hospital in the 1960s. Right: Café

PHOTOS COURTESY OF VETERANS CANTEEN SERVICE

at the Washington, DC, VA Medical Center in 2019.

Then and Now

Left: VCS employees with the South Texas Veterans Health Care System in 1975. Right: VCS employees support the National Disabled Veterans TEE Tournament in Iowa City, Iowa, in 2018.

VCS Mission: To provide America’s Veterans enrolled in VA’s health care system, their families, caregivers, VA employees, volunteers, and visitors, reasonably priced merchandise and services essential to their comfort and well-being.

Please visit our website: http://www.vacanteen.va.gov Shop online: www.shopvcs.va.gov Like us on Facebook: www.facebook.com/VAcanteenservice Follow us on Instagram and Twitter: @VACanteen

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VA RESEARCH

VA RESEARCH Approaching a century of lighting the way

In September of 2021, a team of VA researchers added to the medical community’s growing understanding of a novel coronavirus which, just two years earlier, almost nobody knew existed. The study, reported in the Journal of the American Society of Nephrology, compared data from almost 90,000 people who’d recovered from the virus known as SARS-CoV-2 to data from a control group of more than 1.6 million people who had not had the virus. Among its findings was that those who had the viral disease now known as COVID-19 – even a mild or moderate case – had three times the risk of end-stage kidney disease, requiring dialysis or a kidney transplant, than the uninfected.

Led by Ziyad Al-Aly, MD, chief of research and development at the VA St. Louis Health Care System, the study was one of many launched within the previous year-and-a-half – some of them, like Al-Aly’s kidney study, deep dives into medical record data in search of insights about risk factors, disease pathways, and

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outcomes for COVID-19 patients; some of them clinical trials exploring vaccines or therapies for the disease; and some of them observational studies to better understand its clinical course. All of these studies, of course, were launched – and several completed – within the first 18 months of a global pandemic that severely limited the ability of professionals to work together and learn how to combat a new and bewildering disease.

How such a research program came to exist, is capable of rapidly mobilizing the nation’s foremost clinical experts against a deadly disease, and learns from hundreds of thousands of volunteer participants, is a story that reaches deeper into American history than most people realize. Now nearly a century old – older than the National Institutes of Health – the research program of the Veterans Health Administration, now housed within the Office of Research and Development (ORD), funds more than 2,250 total projects, partners with more than 200 medical schools and other institutions, and supports the work

PHOTO BY MITCH MIRKIN

By Craig Collins

of more than 3,600 investigators who are funded directly by ORD or by outside sources. Principal investigators are often VA clinicians on the leading edge of medical knowledge. Over more than nine decades, the program has pioneered therapies and technologies that have contributed to the well-being of the nation’s Veterans and people around the world.

PHOTO BY FRANK CURRAN

ORIGINS

It was after World War I when the nation’s concept of a hospital began to change. Long considered charitable institutions designed to serve the poor, the hospitals of the U.S. Public Health Service became, with the 1921 creation of the Veterans Bureau, anchors of a federally funded health care system for Veterans of World War I. In 1924, Congress extended federal hospitalization benefits to Veterans of every war, regardless of disability, and within a year the bureau was caring for 30,000 hospitalized Veterans.

A 22-member Council on Medical Affairs, established to offer the bureau advice, quickly recognized that knowledge gleaned from such a large patient population could be of great benefit in advancing medical science and the delivery of health care to Veterans. The council recommended a system of diagnostic hospital beds, the establishment of a research program emphasizing investigations related to Veterans’ health care needs, and the publication of the bureau’s research findings in a journal.

Articles published in the United States Veterans Bureau Medical Bulletin, issued continuously from 1925 until 1944, depicted a hospital-based research program aimed at curing diseases through systematic observations, with an emphasis on outcomes. Under the leadership of the bureau’s first Research Chief, Dr. Philip B. Matz, MD, physicians published articles on topics such as malaria, cancer, tuberculosis, the long-term effects of chemical warfare, cardiovascular health, and morbidity and mortality among Veterans with mental illness. This early work produced several influential studies that were later published in the nation’s most prestigious medical journals. It also contributed to observable outcomes: Tuberculosis, the predominant condition treated at early Veterans’ hospitals, accounted for only

Opposite page: Leonardo Tonelli, PhD, (right) and research assistant Brent Stewart are conducting mouse studies to learn about the role of the immune system in mental health. Above: William Unger, PhD, a PTSD clinician and researcher at the Providence VA Medical Center, has studied the use of virtual reality in PTSD treatment.

about 13 percent of the conditions treated by the middle of the 1930s.

During its first several years, the bureau’s research was conducted without direct federal funding – a circumstance removed in 1930, when the bureau was expanded, renamed the Veterans Administration, and established its own research laboratories. The first VA-funded laboratory, the Tumor Research Unit at Hines Hospital in Chicago, received funding in 1933. It was here that Dr. Robert Schrek, MD, one of the first researchers to study the effects of radiation on cancer cells, discovered the link between sun exposure and skin cancer. Two additional VA laboratories were established in 1935: the Neuropsychiatric Research Unit in Northport, New York, and the Cardiovascular Research Unit in Washington, D.C. The Cardiovascular Research Unit would later publish a study in the New England Journal of Medicine that demonstrated a link between cardiovascular disease and hypertension among World War II Veterans.

VA RESEARCH IN THE POSTWAR ERA

Veteran research, along with many other government functions, entered a dormant period as doctors entered service in World

War II. At war’s end, the VA employed about 2,300 doctors, nearly three-quarters of whom were still on active military duty.

VA would emerge from World War II with an expanded structure and purpose, courtesy of Public Law 79-293.

In January of 1946, the law established the Department of Medicine and Surgery (forerunner to the modern Veterans Health Administration), and authorized the agency to directly hire its own doctors, dentists, nurses, administrators, and other professionals. The law also provided the legal basis for affiliations between the VA and American medical schools, which had provided valuable expertise and insight to military medicine during the war.

The new VA offered good pay, a large patient cohort treated in state-of-the-art facilities, and the opportunity to serve one’s country alongside colleagues from some of the nation’s best medical schools.

Within six months of the law’s passage, VA’s full-time physicians had increased from 600 to 4,000.

As dedicated VA staff physicians began leading clinical studies of Veterans’ health issues, the findings inevitably carried implications for the general population. In every decade after World

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biological substances such as hormones, vitamins, and enzymes. Their discovery is today considered one of the most important in the field of endocrinology.

on anti-rejection medications that increased transplant survival rates.

VA PHOTO

Oscar Auerbach, MD

VA PHOTO

NATIONAL LIBRARY OF MEDICINE

War II, the VA research program employed world-class investigators whose groundbreaking discoveries are now everyday knowledge for health care professionals:

• Michael DeBakey, MD, often called the “father of modern cardiovascular surgery,” performed many firsts throughout his illustrious career: He pioneered dozens of procedures including aneurysm repair, coronary bypass, and endarterectomy, which save thousands of lives each year.

He also performed some of the first heart transplants, and supervised the first multi-organ transplant in 1968.

For 55 years, DeBakey chaired the dean’s committee at the Houston VA Medical Center that now bears his name.

William Oldendorf, MD

• Oscar Auerbach, MD, a pathologist who began his VA career in 1947, built on Schrek’s tumor research and became the first physician to link smoking to lung cancer – and later, to heart damage.

Rosalyn Yalow, PhD

VA PHOTO

Thomas Starzl, MD

The idea of the CT scanner was originated

• At the Bronx VA Hospital, beginning in 1947, Bernard Roswit, MD, and Rosalyn Yalow, PhD, investigated health issues related to Veterans who’d been sickened by radiation exposure during nuclear weapons testing in the Pacific. Yalow would later collaborate with Solomon Berson, MD, at the Bronx VA to develop radioimmunoassay, a technique that traces radioisotopes in the blood to allow measurement of

• William Oldendorf, MD, of the West Los Angeles VA Medical Center (now part of the VA Greater Los Angeles Healthcare System), invented the idea of a computerized tomography (CT) scanner, which assembles multiple X-ray images of structures into crosssectional images, or “slices,” of the body, during the 1950s. VA researchers eventually turned Oldendorf’s idea into a working CT scanner.

• Thomas Starzl, MD, a transplant surgeon and research scientist for more than 50 years at VA medical centers in Chicago, Denver, and Pittsburgh, was widely regarded as the “father of transplantation,” with research that not only focused on surgical transplants – he performed the first successful liver transplant in 1967 – but also pioneered work

VA PHOTO

VA PHOTO

by William Oldendorf, MD.

Michael DeBakey, MD

• Endocrinologist Andrew Schally, PhD, directed hypothalamus research at the New Orleans and Miami VA Medical Centers and developed the knowledge of how the brain controls body chemistry through the release of peptide hormones. A full-time VA

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VA PHOTO

NATIONAL LIBRARY OF MEDICINE

Andrew Schally, PhD

Edward Freis, MD

researcher since 1962, Schally still leads a laboratory at the Miami VA. • Virologist Ludwig Gross, MD, in the 1950s and 1960s, discovered two different cancer-causing viruses at the Bronx VA Hospital (now the James J. Peters VA Medical Center).

NATIONAL LIBRARY OF MEDICINE

Ludwig Gross, MD

the Nobel Prize in Physiology or Medicine.

Along with Oldendorf, Starzl, Gross, Freis, and DeBakey, they are also winners of the Lasker Clinical Research Award, one of the most prestigious science prizes in the world. The Lasker was renamed to honor DeBakey – the Lasker-DeBakey Clinical Medical Research Award – in 2008.

Freis’s hypertension drug trial was groundbreaking in more than one way: Its success led to the 1972 establishment of VA’s Cooperative Studies Program, which is charged with coordinating multicenter clinical trials that evaluate novel therapies or new uses for existing treatments. It was an early-21st-century VHA-wide clinical trial involving nearly 39,000 participants at 156 VA Medical Centers, for example, that led to FDA approval of a shingles vaccine.

AN EVOLVING RESEARCH PROGRAM; A LEARNING HEALTH CARE SYSTEM

• In 1964, Edward Freis, MD, launched the first multicenter, double‐blind, randomized placebo‐controlled trial to determine the effectiveness of antihypertensive drugs in preventing or delaying serious cardiovascular events and organ damage. The study was conducted among more than 500 patients at 17 centers, and demonstrated that early treatment of high blood pressure with these drugs could save lives.

These are just a handful of the trailblazing VA researchers who have transformed medicine. Yalow and Schally, along with former Palo Alto VA researcher Ferid Murad, MD, PhD, are the VA’s recipients of

The evolution of VA research has been influenced by several factors: Veterans from different conflicts, for example, have had different health care needs. High rates of human immunodeficiency virus (HIV) and hepatitis C infections among Vietnam Veterans led to an increasing focus on these diseases by VA researchers.

As traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) became known as the “signature injuries” of the Iraq and Afghanistan conflicts, the VA mobilized considerable resources, often in partnership with the Department of Defense, to gain insights and seek solutions. VA researchers have helped shape the medical community’s basic

understanding of the disorder, publishing and disseminating some of the first evidence of PTSD-related biomarkers.

VA’s research programs have also changed to meet the special needs of its Veteran patient population as it ages: Beginning in 1975, to accommodate aging World War II and Korean War Veterans, VA began training interdisciplinary teams of specialists, and Congress later authorized Geriatric Research, Education, and Clinical Centers.

Changes to the way VHA delivers health care have also influenced the focus of VA research: In the 1990s, as the VHA began to increase its emphasis on primary and preventive care, rather than the hospital-based model, VA’s clinician researchers became key collectors of population-based data to document the impact of these changes.

While clinical, biomedical, and rehabilitative studies had always been an important focus of VA’s research program, these new investigations of the quality, safety, and efficacy of care – conducted by a Health Services Research and Development (HSR&D) Service that traced its roots to the 1950s – have become increasingly important, particularly as more Veterans seek care from community providers under the Veterans Choice Program.

In 1998, aided by a trove of data available from electronic health records, the VA established a new initiative aimed at translating research in high-priority areas into clinical practice: the Quality Enhancement Research Initiative (QUERI).

QUERI has supported nearly 400 studies that inform the implementation of best practices in clinical care, including the nationwide deployment of integrated primary care mental health services and a national registry for monitoring outcomes of cardiac catheterization.

VA researchers have also capitalized on – and often participated in the development of – technological innovations. In the 1980s, a team of researchers led by Murray Jarvik, MD, PhD, and supported by both the VA and the University of CaliforniaLos Angeles, experimented with the transdermal absorption of tobacco compounds, and ultimately invented the nicotine patch, a method of nicotine replacement therapy that helps reduce withdrawal symptoms associated with quitting smoking. VA investigators have also been at the forefront of prosthetics research and development: the “Seattle

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Left: Technician Yasamin Azadzoi processes samples in the Million Veteran Program biorepository in Boston, Massachusetts. Bottom left: Melina Kibbe, MD, today dean of the University of Virginia School of Medicine, won a 2008 Presidential Early Career Award for Scientists and Engineers for her VA research focused on nitric oxide. In this 2009 photo, she reviews a lab image with Nick Tsihlis, PhD, at the Jesse Brown VA Medical Center in

PHOTO BY JERRY DALIEGE

PHOTO BY FRANK CURRAN

Chicago, Illinois.

Foot,” attachable to either a below- or above-the-knee prosthetic leg, was developed by VA researchers and released in the mid-1980s. Its simple design allows lower-limb amputees to run and jump.

The completion of the Human Genome Project in 2003 led to a transformational effort within VHA: the Million Veteran Program (MVP). So far nearly 850,000 Veterans have volunteered to provide genetic, military service, lifestyle, and health information to the largest database of its kind in the world, an integrated health and genomic database tied to the nation’s largest health care system. Several studies of the

MVP cohort have been completed or are underway, examining the role genes play in cardiovascular risk, anxiety, substance abuse, metabolic disorders, Gulf War illness, kidney disease, PTSD, schizophrenia, age-related macular degeneration, and other diseases or disorders.

Investigators in these studies examine genetic and other data from anonymous blood and tissue samples, donated by Veteran volunteers and stored at the Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC) in Boston. The ability to sequence genomic information has

anchored several initiatives aimed at discovering drugs or therapies that target specific genetic variations. New health care initiatives, such as the National Precision Oncology Program, launched in 2016, and the Precision Medicine in Mental Health Care (PRIME) Program, have been built on these research efforts.

Many leading-edge technological breakthroughs by VA researchers have been in the field of neuroprosthesis and brain-computer interfaces: Using digital technology, researchers have been able to simulate the activity of both sensory and motor neurons, with surprising results.

Probably the highest-profile demonstration of these capabilities occurred in 2011, when a team including VA researchers demonstrated that people with tetraplegia, using a brain-computer interface, could control a robotic arm to perform basic tasks. These advances have helped VA researchers explore a new realm of capabilities for prosthetics, many of which were developed with their input.

One of the most important aspects of VA’s research program may be the way it leads to a direct and immediate enhancement of the care Veterans receive.

It’s a largely intramural program: Investigators can lead VA research projects only if they have at least a 60 percent commitment to the VHA system; and because more than half of principal investigators are also VA clinicians, they have a close personal understanding of the health care needs of Veterans, and of the system that serves them. It’s a relationship that rewards researchers and Veterans alike: a team of the highest-caliber professionals, leaders in their fields, collaborating to advance the state of the art and provide the best possible medical care to American Veterans.

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VA HISTORY CENTER

An exterior view of Building 129, the Clubhouse, seen in 1871 as Veterans march past in formation. The Clubhouse is one of two buildings on the Dayton VA Medical Center campus being refurbished to serve the National VA History Center (NVAHC).

ADVANCING THE MISSION TO PRESERVE VA HISTORY History was in the making in early 2020 as the nation experienced the start of a pandemic, creating a “new normal” of social distancing while wearing face masks. It also marked Secretary of the Department of Veterans Affairs (VA) Robert Wilkie’s declaration on April 10, 2020, establishing an official VA History Office (VAHO), and within that, the National VA History Center (NVAHC).

VA had been one of the few Cabinet-level federal agencies without a program institutionalizing its history. A few months earlier, in July 2019, VA welcomed Col. Michael Visconage, USMC-Ret., as the first-ever chief historian. Once Visconage took the helm of VAHO, his top priorities were building the VA History Program and overseeing development of

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Veterans Health Administration 75

the NVAHC on the 400-acre campus of the Dayton VA Medical Center (VAMC) in Ohio.

Opened in 1867, this medical facility, now a National Historic Landmark, was one of 14 “branches” of National Homes for Disabled Volunteer Soldiers (NHDVS) established after the Civil War. Thousands of Veterans lived, worked, and received medical care in the Central Branch Home, and were interred in the adjoining National Cemetery.

SAFEGUARDING ARTIFACTS AND DOCUMENTS

The NVAHC will consist of two historic buildings remaining from the NHDVS Central Branch, now treasured parts of

the Dayton VAMC. The Old Headquarters (Building 116), a two-story, 10,800-squarefoot French Second Empire-style building constructed in 1871, will house a museum with public exhibitions, educational areas, and administrative space for staff.

The second structure is the Clubhouse (Building 129), a two-story Renaissance Revival-style brick building built in 1881. The Clubhouse is slated to provide VA’s History Program with 18,300 square feet of space to be used for artifact storage and the public archives.

Both buildings are currently undergoing significant renovations that will convert them into state-of-the-art exhibit and archival facilities.

In August 2020, Wilkie marked the official establishment of the NVAHC – and

PHOTO COURTESY OF DAYTON VAMC

By VA History Office Staff

PHOTO COURTESY OF DAYTON VAMC

Top: The interior of Building 129 shown in 1881, with Veterans relaxing and playing pool. Above: Building 129 undergoing restoration. The 18,300-square-foot Clubhouse will be used for public

PHOTOS COURTESY OF DAYTON VAMC

archives and artifact storage.

the start of the renovation work – at a ceremony on the Dayton VAMC campus.

Visconage, who participated in the ceremony, stated that, “These two historic structures, built not long after the Civil War, will be a home for some of VA’s most significant artifacts and documents.” He further noted that, “The National VA History Center will bring together all three administrations within VA to tell the story of the unique relationship between America and our Veterans.”

After construction is complete, historians, researchers, writers, Veterans, students, and members of the public will be able to access historical VA artifacts and documents. Senior Archivist Robyn Rodgers, who joined the VA History Office in October 2020, has focused equally on textual and digital collections, thus making materials available more quickly to researchers.

Working in a temporary artifact and archival storage facility on the Dayton

VAMC campus, Rodgers also oversees the growing collection of COVID-19 materials (documents, images, oral histories, and artifacts) from VA employees and facilities across the country – a project brought to fruition by the effort of VA historians from the Veterans Health Administration (VHA), Veterans Benefits Administration (VBA), and National Cemetery Administration (NCA), as well as several dedicated “detailees” (VA employees temporarily assigned to the History Office) and graduate students.

Serving as the chief archivist at NASA before joining VA, Rodgers is experienced in establishing programs in ways that combine archival best practices and ethical collection standards.

She says, “I am proud to be an inaugural member of the VA History Office, working to bring about the National VA History Center Archives and helping to preserve the story of VA’s commitment to our Veterans. ”

Rounding out the VA History team is Kurt Senn, the department’s first curator.

Senn joined VA in May 2021, having previously served with the National Archives and Records Administration as the deputy director of the William J. Clinton Presidential Library. Senn is responsible for collections management standards, developing exhibit concepts, and beginning the hunt for key artifacts from around VA. According to Senn, “These important items will be preserved in controlled environments for light, temperature, and humidity following the best professional practices.”

The historians from VHA, VBA, and NCA work closely with Visconage, Rodgers, and Senn, acting as the core project team developing the NVAHC visitor experience. After developing an initial concept, they will work with museum and archives specialty contractors to renovate the buildings. Initial rehabilitation work preparing the two buildings for final build-out is underway. This preliminary work should be completed in two to four years. The NVAHC’s nonprofit partner, the VA History Center Foundation, is responsible for fundraising for the final renovation phase.

Senn is leading the NVAHC core project team, which held its first on-site planning meeting in Dayton in early August 2021. While in Dayton, the team toured the Dayton VAMC campus, including the buildings that will house the exhibitions and collections. This provided the group with a sense of place and a foundation from which to develop exhibit themes and concepts. They also participated in brainstorming sessions that produced a draft mission statement for the NVAHC and a main theme for the exhibits.

SNEAKING A PEEK AT THE NATIONAL VA HISTORY CENTER AND MORE: PROMOTING VA HISTORY ONLINE

History buffs won’t need to wait until opening day; the NVAHC is being developed with a capacity for remote access to virtual exhibits and archives.

Early resources the VA History Office offers include: • VA History Office website at www. va.gov/history. On the VA History Features Page, visitors read about the first item placed in the NVAHC Archives: an 1861 Bible from the pulpit

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PHOTO COURTESY OF DAYTON VAMC

com/accounts/USVAHO/subscriber/ new enables current and new visitors to the VA History Office website to receive updates on new features, Veterans stories, and progress updates on the development of the NVAHC. ENVISIONING A FUTURE THAT COMMITS TO THE PAST

PHOTO BY ROBERT KUMMER, DAYTON VA MEDICAL CENTER

Top: A historical photo of Building 116, the Old Headquarters building, as a part of the post-Civil War National Home for Disabled Volunteer Soldiers. It will house a museum with public exhibitions, educational areas, and administrative space for staff. Above: Then-VA Secretary Robert L. Wilkie and Judge Dennis J. Adkins (Montgomery County, Ohio) review the proposed plans to restore the unique late-19th century Funeral Tunnel between the Dayton VA Medical Center and the Dayton National Cemetery, one of many historic features on the Dayton VA campus, Aug. 10, 2020. Wilkie and Adkins were wearing masks due to the COVID-19 pandemic during this period.

of the Dayton VA Medical Center Protestant chapel. Other highlights include virtual exhibits created by VAHO graduate and undergraduate students on the National Home for Disabled Volunteer Soldiers using vintage postcards, and on Nobel Prize winner and VA medical researcher, Dr. Rosalyn Yalow. The features page

also includes articles by historians from each of the VA administrations, VAHO detail staff, and student interns.

Senn will use the VAHO website, as well as public presentations and other channels, to keep constituents updated on the collection of artifacts.

• VA History Office GovDelivery Subscription at https://public.govdelivery.

During the August 2021 visit, the core project team developed a vision statement for the NVAHC that reflects the aims of the Center: Promote understanding and study of the unique relationship between the United States and its Veterans through the lens of the VA experience – the care of their wounds, the benefits bestowed by a grateful nation, the contributions of Veterans to society after serving, and the honors provided at their passing.

Through VAHO’s establishment and the development of NVAHC, the department has demonstrated a commitment to collecting, preserving, and presenting its archives and artifacts in a permanent, centralized location. In doing so, VA will ensure that these historic materials are not lost or destroyed, but that they are made available and accessible for the benefit of current and future generations.

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VHA FUTURE

THE FUTURE OF THE VETERANS HEALTH ADMINISTRATION Challenges and opportunities in the next 75 years of VHA

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Veterans Health Administration 75

Informed by the past and focused on the future, excellence in VHA’s Office of Clinical Services is rooted in providing top-tier health care tailored to each Veteran’s unique needs. – Kameron Matthews Kameron Matthews, MD, JD, FAAFP

resources of health care systems around the world – a testament to the agility of VHA’s moving parts and to the dedication of its people.

To maintain this excellence, VHA must continue to adapt. Below, several of its operational leaders offer glimpses of what they see as the greatest challenges – and opportunities – that lie ahead for the people devoted to delivering quality health care and improving the lives of Veterans: KAMERON MATTHEWS, MD, JD, FAAFP, Assistant Under Secretary for Health for Clinical Services and Chief Medical Officer: The VHA Office of Clinical Services comprises 42 unique parent and sub-specialty program offices, including three transformational editions this year: the Tele-Critical Care Office, Electronic

VA PHOTOS

In 1946, when Gen. Omar Bradley, the VA’s new administrator, and Maj. Gen. Paul Hawley, MD, its first medical director, charted a course for what’s now known as the “third generation” of Veterans’ health care, they launched a greatly expanded system of integrated facilities designed to care for a new wave of World War II Veterans, and for Veterans of all conflicts.

Bradley and Hawley both served brief tenures with the VA before returning to military service, but the system they designed included core elements that set it apart from other health care systems: close working relationships with major medical schools; a general hospital model that included mental health care and facilities; the expansion of access to care by either VA clinicians or community providers; a deep and varied research and development capacity; and a corps of dedicated volunteers to complement and amplify VHA’s professional staff. Over the decades, these foundations have anchored VHA, even as it has evolved and adapted to meet the health care needs of Veterans from different generations and from different conflicts. A 2018 study by the RAND Corporation, a nonprofit think tank, found the VA health care system performing better than, or similar to, nonVA systems on most measures of inpatient and outpatient care quality.

In its 75th year, VHA’s people and facilities demonstrated their ability to maintain this high-quality care while keeping patients safe and reaching out to boost their quality of life and social engagement during a global pandemic that strained the

The future of VA health care is bright.

As health care across the country shifts from inpatient care toward providing effective and efficient care through more accessible, patient-centered care modalities, VA faces several challenges and has numerous opportunities to address the changing landscape.

– Beth Taylor

Health Record Modernization (EHRM) Functional Champion Office, and National EHRM Supplemental Staffing Unit.

Informed by the past and focused on the future, excellence in VHA’s Office of Clinical Services is rooted in providing top-tier health care tailored to each Veteran’s unique needs through continuing opportunities to: • Define clinical strategy and policy in order to assure the provision of an enterprise, patient-driven, evidence-based standard of care and reduce unintended variability of outcomes for all Veterans • Support and drive data-driven, outcome-oriented, and resource-efficient field-based oversight and operational improvement • Enable and promote the professional development of clinicians and leaders in order to optimize the operational strength of the health system and delivery of world-class care to all Veterans • Continue to cultivate meaningful partnerships at the federal, state, and local levels that enhance access to care, improve service coordination, and support the use of critical resources • Advance suicide prevention broadly through implementation of the full public health approaches of “SP 2.0” and “SP Now” • Employ a holistic perspective in which physical and mental health and well-being merge into a cohesive whole-health approach based on each individual’s goals and needs • Transform health care delivery to integrate mental and physical health and focus on the Veteran, employing measurement-based care and care consistent with clinical practice guidelines.

The opportunities are key in addressing the office’s current challenges to: • Integrate all clinical services to ensure a Veteran-centric approach to the delivery of evidence-based care • Implement burn-out prevention strategies across the enterprise • Advance enterprise approaches across the health system to allow for optimized usage of the new EHR • Holistically and inclusively respond to the full range of diverse needs of each Veteran and his/her family • Engage Veterans who are not connected

Beth Taylor, DHA, RN, FAAN, NEA-BC

to VHA care, particularly those at risk for suicide, and link them to services to support their mental health and well-being • Embrace a culture of diversity, equity, and inclusion and implement strong practices throughout our organization so there is consistency in how we treat Veterans, their loved ones, and each other • Provide access to care that addresses Veterans’ needs in the time, place, and manner that works the best for them.

BETH TAYLOR, DHA, RN, NEA-BC, Assistant Under Secretary for Health for Patient Care Services and Chief Nursing Officer: The future of VA health care is bright.

As health care across the country shifts from inpatient care toward providing effective and efficient care through more accessible, patient-centered care modalities, VA faces several challenges and has numerous opportunities to address the changing landscape. First, considering the lightning speed in which technology is evolving, VA must be responsive, versatile, and integrated.

In response, VHA’s Office of Connected Care’s integrated telehealth approach has vastly improved the accessibility of clinical services to Veterans. In 2019, VA provided approximately 2.6 million telehealth visits, and was the leading telehealth program in the United States. During the COVID-19 pandemic, telehealth visits increased from approximately 10,000 per month to more than 120,000 per month, an increase of 1,000%, providing services like technology-assisted care transition

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interventions for Veterans with chronic heart failure and chronic obstructive pulmonary disease. VHA remains agile and committed to utilizing digital services to improve the lives of Veterans.

Second, the U.S. Census Bureau reports that by 2030, the number of U.S. residents age 65 and over is projected to be 82 million. The projected number of Veterans age 60 and older is 11 million, and Veteran health care is often multifocal and complex, requiring a collaborative, integrated, and comprehensive model of care that facilitates meeting attainable health care goals for each older adult Veteran. Subsequently, 90 percent of Americans wish to age in place, in the least restrictive care settings possible.

The VA fully supports Veterans remaining in their homes for as long as possible. In response, VA has served approximately 509,500 unique Veterans and spent approximately $3 billion on programs designed to keep Veterans in their home. Services include: Adult Day Health Care; Home Based Primary Care (HBPC); Homemaker/Home Health Aides; Medical Foster Homes (MFHs); Palliative, Hospice, and Respite Care; Skilled Home Health Care; and Veteran-Directed Care. VA continues to develop innovative strategies to provide ongoing support and improve the lives of Veterans, family members, caregivers, and survivors, as they receive care with dignity in the care settings of their choice.

Last, according to the Bureau of Labor Statistics’ Employment Projections 2019–2029, there will be 175,900 openings for RNs per year through 2029, resulting from nurse retirements and workforce exits. As the largest professional group in VHA, at more than 113,000 who serve on the front lines and at every level of the organization, the profession of nursing is the foundation of our health care system. We will ensure that VA’s nursing workforce is capably and optimally positioned to lead all four statutory missions by optimizing nursing practice, strengthening the nursing pipeline, and supporting lifelong learning and career development.

CAROLYN CLANCY, MD, Assistant Under Secretary for Health for Discovery, Education and Affiliate Networks (DEAN): VHA’s collective efforts responding to COVID-19 demonstrated substantial capability in pivoting from in-person to virtual care; successful risk mitigation for Veterans living in congregate settings (e.g., nursing homes, spinal cord injury centers) through employee and patient testing and restriction of visitors; exceptional ability to execute important research studies on vaccines and treatments; and unprecedented service to the nation through VHA’s fourth mission.

The opportunities to transform health care in the future by retaining successful strategies include: • Continued evolution of digital strategies, including remote monitoring, to provide care matched to Veterans’ needs and preferences as well as to train future health professionals • Expansion of research that translates into improved Veterans outcomes • Enhanced and persistent focus on health equity.

Carolyn Clancy, MD

Gerard R. Cox, MD, MHA

Immediate challenges: addressing the impact of burnout and stress on our most important asset, our employees; expanding effective virtual and in-person mental health strategies; understanding the scale and scope of Veterans affected by long-haul COVID; and continuing to balance direct and community care to assure that Veterans consistently receive only the best care.

GERARD R. COX, MD, MHA, Assistant Under Secretary for Health for Quality and Patient Safety: Unintended patient harm is ubiquitous in the American health care system. In recent years, the Veterans Health Administration has committed to avoiding medical errors and reducing preventable harm to Veterans by adopting the principles and methods used by high reliability organizations (HROs).

HROs achieve fewer-than-anticipated accidents or events of harm despite operating in highly complex, high-risk environments – think about commercial aviation or the nuclear power industry. They do so by cultivating leaders who are committed to reducing harm as an organizational priority, by creating a safety culture, and by continuously examining and improving their processes.

VHA’s HRO journey presents both challenges and opportunities. Sustaining leadership commitment despite frequent turnover and competing priorities is an ever-present challenge. Transforming the culture of large, complex health care systems requires years of constant attention and focus.

In particular, a culture of safety depends on empowering all employees to identify risks and speak up without fear of reprisal, which represents an ongoing challenge if organizational stakeholders unduly emphasize individual accountability or discipline in response to unintentional human error. At the same time, implementing HRO tools and principles provides VHA the opportunity to achieve our vision of “Excellence, Every Veteran, Every Time.”

RENEE OSHINSKI, Assistant Under Secretary for Health for Operations The incredible dedication, flexibility, and resilience of the entire VHA workforce highlighted for the nation our

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The incredible dedication, flexibility, and resilience of the entire VHA workforce highlighted for the nation our commitment to high-quality health care for all of America’s Veterans. – Renee Oshinski Renee Oshinski

commitment to high-quality health care for all of America’s Veterans. In these difficult times, we opened our doors to those struggling with the COVID-19 pandemic. We supported state Veterans homes, community nursing homes, longterm care facilities, community hospitals, and alternate sites of care in multiple states. We have much to be proud of!

We will use this foundation to transform our health care delivery system in the future by building on some of our successful strategies, including: • Embracing the new generation of Veterans and enhancing our use of telehealth modalities to improve access • Incorporating an even larger female demographic into the Veteran population • Embracing a new generation of VA employees and ensuring a diverse workforce that reflects our Veteran population.

Immediate challenges: • What does the state of VA post COVID look like, and how to embrace the “new normal” in a post-pandemic era (if/when we ever get there) • Continued balancing of in-house versus purchased care • How to ensure preventative care gaps are met; some Veterans may have been delayed routine visits due to COVID-19 concerns • How to build trust between leadership and staff to ensure a “just culture” and employees report errors?

Deborah Kramer, MS

DEBORAH KRAMER, MS, Acting Assistant Under Secretary for Health for Support: VHA’s response to COVID-19 demonstrated the strength and agility of an integrated health care system geographically distributed across the United States and operating as a single enterprise, and the criticality of VHA as an essential component of U.S. homeland defense and public health preparedness and response. It also demonstrated the fragility of the public health supply chain, the shortcomings of VHA’s antiquated supply chain and support service information systems, and the increased need for VHA infrastructure recapitalization to replace our aging facilities.

Our opportunities include: • Working collectively with our interagency partners to build and sustain a resilient public health supply chain as a critical element of national security • Modernizing our supply chain and support system information technology systems and business practices • Updating, renovating, and replacing our aging infrastructure to support a safer, sustainable, greener, person-centered national health care model.

VHA’s response to COVID-19 demonstrated the strength and agility of an integrated health care system geographically distributed across the United States and operating as a single enterprise, and the criticality of VHA as an essential component of U.S. homeland defense and public health preparedness and response. – Deborah Kramer

Our near-term challenges include: • Changing our approach to purchasing products to entice on-shoring of U.S. manufacturing to improve our national capability against future pandemic and biologic threats

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VHA FUTURE • Undertaking multiple simultaneous major information technology investments, including deployment of a new health care record system, a new financial management system, and a new supply chain system while conducting COVID-19 response and recovery efforts • Developing clinically driven standard designs for our new hospitals and health care clinics that are versatile, modifiable, convertible, scalable, and sustainable, and which contribute to better health care outcomes for our Veterans.

JULIANNE FLYNN, MD, Acting Deputy Assistant Under Secretary for Health for Community Care: With implementation of the VA MISSION Act, community care has become an increasingly essential health care option for Veterans alongside care provided to Veterans within VA facilities. As Veterans have increasingly accessed community care, however, it has highlighted the necessity for greater integration with care provided in VA facilities to achieve better outcomes in the areas of customer service, cost-efficiency, care coordination, and operational agility.

The COVID-19 pandemic has demonstrated the critical importance of VA health care facilities as the backbone of Veteran health care and highlighted some of the challenges associated with care provided by community providers. For example, while community providers were and have been at times unable to provide services to Veterans over the course of the pandemic, VA facilities have been able to operate continuously. At the same time, while VA facilities have been able to quickly adjust based on the latest conditions associated with COVID-19, the highly complex contracting requirements associated with managing VA’s community care network has made it more difficult to evolve and adapt to the latest conditions, due to VA having less immediate and direct control over providers in its network.

These realities have highlighted several opportunities for improvement in order to address long-term challenges in seamlessly integrating care provided within VA facilities and in the community.

Opportunities include: • Integrating financial management of both VA and community care • Integrating and standardizing referral processes at the VA-facility level • Strengthening proper utilization of community emergency care • Simplifying the overall process associated with community care • Implementing value-based care.

Our near-term challenges include: • Cost management associated with increased use of community care and assuring we have optimized care delivery

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Veterans Health Administration 75

Julianne Flynn, MD

Jessica Bonjorni, MBA, PMP, SPHR

• Complex eligibility and payment requirements for community emergency care • Inconsistent knowledge of VA requirements among community providers.

JESSICA BONJORNI, MBA, PMP, SPHR, Chief, Human Capital Management: VHA’s workforce, over 377,000 people strong, is above all resilient. We have demonstrated that not only during the challenging response to the pandemic, but also throughout our 75-year history. But the expectations of the workforce are shifting, both internal to VHA and those who have not yet joined our team.

VHA must be well positioned to attract and retain the best talent to care for our Veterans.

Our opportunities include: • Investing in our workforce with the right balance of professional development, technical skill-building, and upward mobility opportunities • Building our talent pipeline through scholarships, fellowships, and health professions training programs • Partnering with academic affiliates, interagency partners, and private-sector health care organizations to share resources and continue to enhance the diversity and strength of our workforce.

Our challenges include: • Competing in the ever-tightening health care labor market, where predicted shortages of some occupations and specialties will have widespread implications for the broader U.S. health care workforce • Preparing for the future of work as expectations shift around location and timing of how and where we do our jobs • Sustaining our workforce with an eye toward reducing burnout, effectively balancing work and home, reducing administrative burdens, and ensuring we are all able to find joy in the work we do.