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Identifying Appropriate Care for Veterans Returning to Rural Communities

By: John Blossom, MD, Director, California Area Health Education Center Program

The wars in Iraq and Afghanistan have had a substantial impact on rural Americans. The loss or wounding of rural youth has been painful and tragic. Returnees are at risk for two serious and potentially disabling disorders to which rural health care providers must pay particular attention.
Many returnees (including active service, National Guard, and contractees) have been found to suffer from post traumatic stress disorder (PTSD), traumatic brain injuries (TBI) or a combination of the two. PTSD is probably the more familiar to most. TBI, however, is relatively new. Veterans may have suffered occult brain damage when exposed to explosives such as improvised explosive devices. They may not have been diagnosed and may not be aware that they have suffered an injury at all. 
The veterans administration has recognized the seriousness of these disorders; its outpatient and inpatient health professionals are preparing themselves to meet the needs of these returnees.
Unfortunately, many returnees will come home to their rural families and communities which are not located near to VA facilities or services. To compound matters, VA benefits are not as accessible to National Guard members as they are to regular service members and are not available at all to contractees. Consequently rural America’s health professionals and hospitals will have to identify and care for those with these syndromes. They will require education on how to identify and care for returnees with PTSD and TBI.
What will they need to learn? The symptoms of both PTSD and TBI can have variable times of onset - from immediately to years after exposure. The symptoms can also be subtle, episodic, and resemble other disorders. Not infrequently alcohol and drug abuse are the first symptoms. Withdrawal and personality changes can impact families and communities. Angry outbursts and even violence are not uncommon.
What should happen? Rural providers must acquaint themselves with the symptom complexes of PTSD and TBI. Clinics, hospitals, and private practice providers should investigate TriCare, the insurance provided to National Guard members. Open lines of communication to VA facilities are a must. Finally, and most importantly, health care providers should take each patient’s military service history in order to identify at risk men and women and help the returnee back into the rural community with appropriate care.