By Brenda L. Mooney
U.S. Medicine Editorial Director
Until my father enlisted in the U.S. Army in 1942, he lived in Brooklyn, NY. That changed after serving honorably in Europe during World War II.
As soon as he disembarked from the troop ship, he telephoned a woman he met while in training at Camp (now Fort) Stewart, GA. Within hours, he was hitchhiking to Vidalia, GA, to propose marriage to the woman, who became his wife and the mother of my two sisters and me. By the end of 1946, he was a resident of rural Georgia and essentially stayed there for the rest of his life.
Who knew he was the very early harbinger of a current trend: the tendency of veterans to move out of cities and into rural areas in the South and West?
The VA’s recently-released 2014-2020 strategic plan cited “a noticeable trend” for higher growth in the veterans’ population in those areas. An earlier study from West Washington University also indicated that most veterans now settle in the South and Southwest and that, as the total number of veterans in the United States has declined over the past three decades, the veteran population is increasingly concentrated in states with significant rural populations.
Former Defense Secretary Robert Gates noted in a 2010 speech at Duke University in Durham, NC, about the military-civilian divide that a significant percentage of Army personnel are now concentrated in Texas, Washington, Georgia, Kentucky and North Carolina.
The changing demographics and the need to deliver quality healthcare in remote areas has presented both a dilemma and opportunity for the VA. A number of articles in the 2014 Compendium of Federal Medicine discuss how federal medicine has responded to meet the needs of veterans everywhere.
One example is epilepsy treatment. U.S. veterans deployed since 2001 suffer high rates of epilepsy and other neurological disorders, and the VA now has more than 100,000 patients being treated for seizure, epilepsy or related diagnoses. The challenge is not only differentiating the types of seizures and appropriately treating them but also to getting the care where it is needed. In response, the VA’s Epilepsy Centers of Excellence are expanding telehealth services.
Another area where telemedicine is widely used is dermatology. In fact, VA researchers have been investigating the safety and usefulness of mobile applications. Now, a mobile app is on the drawing board to help veterans recognize and manage their dermatological issues, such as rosacea or skin cancer.
In addition, a new VHA treatment module has been designed to help chronic obstructive pulmonary disease (COPD) patients help themselves. Slated for introduction later this year, the online tool will allow patients to work more closely with their physicians to maximize lung function and improve the quality of their lives.
Other changing demographics, such as increases in obesity in the general population or higher asthma rates, also have affected how the military deals with medical issues.
The Army has determined that bad habits developed during deployment and on military bases can cause healthy soldiers to gain weight after retiring from the Army. In fact, more than 70% of veterans end up overweight. To combat that trend, the Army is pilot-testing a Performance Triad program where non-commissioned officers take the lead in teaching healthy habits.
Obesity is not the only health issue complicating military recruiting and training. In 2001, a little more than 7% of Americans had asthma. By, 2010, that prevalence had grown 12% to an overall rate of 8.4%. Accession standards have now been relaxed so that recruits who had childhood asthma but have not been symptomatic since age 13 can enter military service. The new policy has been a success, with most servicemembers with waivers for childhood asthma staying in the military after passing basic training.
Managing chronic illness is a continuing effort for the VA – with the more than a million patients with diabetes being a foremost concern. An article on page 22 discusses how HbA1c screening is widely used to monitor glucose control and even to diagnosis diabetes but lacks accuracy in a range of patients with hemoglobinopathies. . A new study, supported by the VA, lays out the benefits of alternative biomarkers to determine hyperglycemia.
While accurately diagnosing illness is a high priority, the VA also seeks to take a step back from that and gain better understanding of the epidemiology of the illnesses that plague veterans. One of the most intriguing medical mysteries of our time is why the first Gulf War cohort has one of the highest incidence rates for multiple sclerosis (MS) ever reported — 7.3 per 100,000 men and 24.7 per 100,000 women. The latest VA research, suggesting that the servicemembers most likely to develop MS were those who were not actually deployed in the 1990-1991 Gulf War, might be raising more questions than answers. Read the discussion in this issue.
Other articles in the Compendium discuss medical advances unimaginable even during the first Gulf War. In the last three years, for example, a panoply of new drugs has changed nearly everything about treatment for chronic hepatitis C viral infection — who can be treated, the length of therapy, the common side effects, the mode of administration and, most significantly, the cure rate. That’s especially significant for the VA, the largest provider of HCV care in the United States.
In addition, significant treatment advances are now available for cutaneous T cell lymphoma (CTCL),a class of non-Hodgkin’s lymphoma which has been linked to Agent Orange exposure. The article on page x discusses the improving prognoses for veterans suffering from this painful and often deadly cancer.
Many of the innovations in medical treatment and delivery, described in these articles, would be unimaginable to my father, who died in 1997 after a long battle with Parkinson’s disease, and certainly to his comrades-in-arms who fell in battle in Europe and the Pacific.
How proud the Greatest Generation was, however, to defend a nation that still cares so much for the men and women who put their lives on the line to defend it. I trust you find U.S. Medicine’s 2014 Compendium of Federal Medicine both interesting and informative – and even a bit inspiring.