To most Americans, the failure
of the Iraq War is best measured by the remorseless
count of their dead — 3,300 soldiers, with nearly
three more, on average, added every day. But the recent
scandal surrounding the US Army's biggest hospital,
Walter Reed, has cast a spotlight on the plight of the
war's wounded.
For American soldiers, Iraq is
above all a war of the wounded and the disabled. Effective
body armour and improved battlefield medicine have transformed
the soldier's survivability. Nowadays, if you're still
alive when the medic arrives, you're unlikely to succumb
to shock or blood loss. The flip side of this success
story is that more and more soldiers are living with
debilitating wounds.
Dr Ronald Glasser, a Minneapolis
physician who did his military doctoring long ago in
Vietnam, and parlayed his experiences there into the
1971 bestseller 365 Days, has tracked the sea-change
in military medicine. "In World War Two, US forces suffered
1.6 wounded for every man killed. In Vietnam, they suffered
2.8 wounded for each man killed. In Iraq, the US military
is suffering 16 wounded for each soldier killed."
In his 2006 book Wounded: Iraq
to Vietnam, Dr Glasser warned of an alarming preponderance
of blast-related brain injuries in soldiers returning
from Iraq. These are often soldiers who would have been
killed by shrapnel in previous wars, but who are saved
by their body armour. "Often you can peel the armour
off a severely wounded soldier," he says, "and find
not a scratch from the neck to the pelvis."
SOFT
TARGETS
But body armour doesn't protect the arms and legs, and
is useless at protecting the brain from blast. These
two limitations have defined the two injuries for which
this war is notorious — missing limbs and traumatic
brain injury.
"These are doctors who know exactly
what to do when a kid is pulled out of a motorcycle
wreck on the highway," says Dr Glasser, "but when they
look at the brain tissue after an explosion they see
a homogenous mess and say 'that's beyond fixing'." The
treatments that work with typical traumatic brain injury,
with tearing, shearing wounds, often don't seem to help
with blast-related injury. Families complain that rehabilitation
gets them nowhere.
THE
UNTREATED
An explosive shockwave, travelling at thousands of feet
per second, can do terrible things to nerves. A landmine,
for example, typically causes the myelin sheaths to
shear off nerves on the leg in the days after the explosion.
It's been suggested that the overpressure from an explosion
creates microscopic gas bubbles in the brain, which
then pop, leaving tiny cavities that never heal. Worst
of all, it's feared that these injuries have affected
tens, even hundreds of thousands of soldiers who were
never counted among the wounded.
Dr Stephen Xenakis of the Psychiatric
Institute of Washington is a retired brigadier-general
who formerly led the Army's Southeast Medical Command.
He sums up the emerging picture: "First, you have obvious
head wounds: fractured skulls, penetration, major trauma.
We have about 800 cases like that, maybe 1,000 now.
Second, you have soldiers who suffered concussions from
blast, some temporary loss of consciousness, memory,
hearing, registering on the Glasgow scale. You'd expect
to find some mild brain injuries in that category. But
finally, you have literally hundreds of thousands of
troops who've been exposed to blast, maybe repeatedly.
We don't know the long-term effect on these soldiers.
That's the big worry."
SHELL
SHOCK INDEED
Too many soldiers are reporting too many symptoms. The
Pentagon has estimated that a quarter of the soldiers
who've served in Iraq will develop PTSD. The symptoms
of PTSD are remarkably similar to mild brain injury
— confusion, depression, irritability and fatigue.
When PTSD was first identified, in World War One, it
was called Shell Shock. It was thought polite to attribute
such psychiatric symptoms to the effect of explosions.
The term may have been more apt than they knew.
It seems likely that the war will
leave a legacy of these symptoms, some due to blast,
some to PTSD — with the system unable to cope with
either type or even tell them apart. Drs Glasser and
Xenakis agree there is a woeful shortage of head doctors
of all types. Of the Veteran Affairs's (VA) 175 sites,
100 offer no PTSD treatment.
"I'm hoping the private sector
will step in with some well-planned research," says
Dr Xenakis. "We need to understand what we're dealing
with. There isn't the necessary expertise in the Army
to do that."
AN
ABOUT FACE
The Pentagon, which halved research funding into brain
injury in recent years, has just announced a new brain
injury research "center of excellence." And from now
on, returning soldiers will be screened after three
to six months for unnoticed brain injury.
Dr Xenakis was the commanding general
who 10 years ago directed the implementation of the
Army's modern healthcare system, known as Tricare. So
is he optimistic that the system can cope with a glut
of brain injuries? "No. Particularly since everyone
in the leadership has just resigned over Walter Reed,"
he says.
"Don't think the VA can get out
ahead of this," warns Dr Glasser. "They're just trying
to keep afloat."
|
