COUNTERING MILITARY RECRUITMENT
Articles: Military Service: Casualties
The New Wartime Body
Izzy "Socket" Klatzker, wiretapmag.org
September 6, 2006
When amputee vets return from Iraq, they may get the latest technologyavailable for replacement limbs, but they rarely get the job training or
physical and emotional support they need to rejoin civilian life.
What happens when one's body becomes the war zone, the setting for
patriotic pride, and the argument for technological advances that alter
scientific and economic landscapes? It often means returning with a
different sense of self and relationship to one's body for U.S. soldiers
back from Iraq. Re-entry varies from the conceptual to the physical, and
amputee veterans are returning from the Iraq war faced with transitioning
back to civilian life without straightforward support to navigate the
military health care system or job opportunities.
The Homecoming
Jody Casey, formerly a 19 Delta Cavalry Scout sniper now organizing with
Iraq Vets Against the War (IVAW), set the tone of our conversation, "I
wasn't ready for re-entry. I wasn't briefed about anything regarding
re-entry. So, on top of dealing with the anger and isolation of being back,
I also had to be my own advocate." Casey advocated for work, securing
mental and physical health care in a society that does not understand the
realities of war. Counseling programs "were pushing all these pills my way
without even hearing what I was going through, then they set me up with a
counselor who has never known combat."
He faced similar frustrations when looking for employment. "The job on the
top of the list was to be a teller at Wal-Mart. No offense to anyone who
works there, it's just that I felt unseen, insulted, and under-valued. ..
They trained us only to re-enlist or work for Black Water Security or KBR."
[Kellogg, Brown and Root is a former subsidiary of Halliburton] Both are
mercenary war-profiteer subcontractor companies currently patrolling,
fighting, and "providing security" at a much higher pay rate than U.S.
soldiers receive in Iraq. Casey stressed the enormous need for worker
retraining programs and a modified GI bill that includes part-time and
vocational students. "I only got trained to kill and be a solider."
Casey matter-of-factly shared some ideas about how a worker re-training
program could look. He suggested vocational training, something akin to
"helmets to hardhats," utilizing an apprenticeship model, but provided by
the Army. "Such a program could help you retrain from war on many levels
because right now they are unleashing unstable people back into society."
The Body
Sources from Walter Reed Army Medical Center in Washington, D.C., estimate
that since the onset of the Iraq invasion and occupation upwards of 400
U.S. soldiers have come back needing amputations and prosthetics (30
percent have multiple amputations) . According to icasualties. org, since
April 2003, between 18,000 and 20,000 U.S. soldiers' injuries include
second- and third-degree burns, bone breaks, shrapnel wounds, brain
injuries, paralysis, and eye damage. In addition, 9,744 U.S soldiers
wounded in action returned to duty between 2003 and 2004, while 8,239
soldiers did not return to war.
"The rocket went through my leg like a knife through butter. It was a
terrible scene ... there was just blood and muscle everywhere," Tristan
Wyatt, 21, reported in a November 9, 2003, L.A. Times article entitled
"Hospital Front." A rocket had cut off his leg and those of the two other
soldiers with him four months earlier in Fallujah, a type of injury treated
frequently at Walter Reed. Doctors Dennis Clarke and Jim Kaiser both
reported (upper extremity) amputations from the elbow down, (lower
extremity) above the knee or through the hip resulting from roadside bombs,
bullets, and IEDs (Improvised Explosive Devices). Kaiser concluded that
"explosion injuries are vicious; they affect multiple body parts; for
example, if one gets hit on the right side, part of the right leg, arm, and
oftentimes their face gets exploded and pocked-up."
"We were always working with a base of 100 patients at any point in time,"
began Dennis Clarke, a visiting Orthoist-Prosthetis t who specializes with
lower extremity amputees. "On any given day, Walter Reed's orthopedic wing
has about 50 inpatients and another 180 outpatients, " says Jim Kaiser, who
spent one week as a guest prosthetist at Walter Reed's Occupational Therapy
Department in 2004. Working consistently, with hardly a break for lunch,
they made fittings for new prosthetics and adjustments on old ones, and
cleanings of amputation sites were constant.
"There was always something to do and someone to see to. We were very, very
busy," Kaiser continued. "Some prosthetics we made were arms; most were
leg/lower extremity from explosions and many of the same people had
multiple amputations. " Two factors -- the war's urban setting and quick
response time -- have vastly increased the survival rate for the wounded
compared to Vietnam. However, since Vietnam, the number of those wounded in
action has risen from 3 percent to 6 percent, according to Wendy Y. Lawton
in the George Street Journal, December 10, 2004. Dennis Clarke continues,
"When one third of your patients have more than one limb missing, the work
and stress and attention is different and accelerated. "
The Technology
"Vets are provided with a training leg with the most high-tech components
(mechanical parts) and myoelectric hands and elbows. Civilians do not get
offered such things. These vets motivate research for new technology ...
being tested on vets by such companies as Ossur and Otto Bock," remarked
Chicago orthoist-prosthetis t John Angelico of Scheck and Siress.
In the field of orthotics and prosthetics (O and P), an orthoist
specializes in planning, making, and fitting orthopedic braces, and a
prosthetist makes artificial body parts (limbs and joints) called
prosthetics, prosthetic devices, or singularly, a prosthesis. Hip
disarticulation is an amputation through the hip joint removing the entire
lower extremity. What was once a rare surgery has become more commonplace
in the field since the Iraq war. Myoelectrics utilizes the electrical
properties of muscle tissue from which impulses may be amplified, a
technology that adapts and compensates for the wearer's natural gait and
any irregular terrain, slopes, or steps. The most commonly used device on
vets coming from Iraq is the C-Leg, a myoelectric leg developed by the
companies Ossur and Otto Bock.
"I was surprised the veterans were receiving [myoelectric technology]. We
had to struggle with the VA (Veterans Administration) to authorize knee
technology. It took a year to get authorization. And then years later
Walter Reed was giving that away to anyone." Jim Kaiser shared his insights
on how the army has improved treatment of amputee vets. "Then, a vet could
get one knee prosthesis, a carbon flex foot mechanism and a spare
prosthesis. Their goal was to make sure a vet has a prosthesis to wear and
one spare." While the standards apply today, the technology and care are so
vastly different that it seems that the army is more willing to support
vets from Iraq than their predecessors from Vietnam. Greater research and
development of upper extremity technology has triggered a $4 million grant
from the federal government for Dr. Kuiken at the Rehabilitation Institute
of Chicago. According to Kaiser, "It was the most money spent on
prosthetics since Vietnam."
Dennis Clarke explained that the Department of Defense has created a "dream
team" of experts brought in on a contractual basis since early on in the
war. The volume and complexity of these injuries make it essential to bring
in outside specialists. "Now there are three people permanently on staff at
Walter Reed in the Prosthetics Department as well as the additional
civilian folks brought in."
When wounded on the battlefield, soldiers are flown to the Landstuhl
airbase in Germany. Marines are sent to Bethesda while the Army is sent to
Walter Reed, with all surgical procedures performed stateside. Innovations
in sanitation, swelling control, and the use of digital cameras and
scanners complement the plaster molds taken for every patient needing a
prosthesis.
They send the records to Iowa for the Socket Interface, creating a
personalized socket or suction system and joining it to the actual
prosthetic device. The Socket Interface is done entirely on CADCAM --
computer designed, computer manufactured technology -- in approximately 48
hours with minor adjustments and alignments in person, but largely done on
the computer. The success rate is high.
According to Clarke, the rehabilitative process is comprehensive, "Daily
therapy of walking on parallel bars, transferring from one position to the
next, and ultimately using crutches, to using one crutch, to using a cane.
This process can take from 2 weeks to 2 months. Some patients were there
eight weeks total, some were there 18 months."
The future may hold a very different series of events, technologically
speaking, for U.S. vets needing prosthetic devices. According to Lawton's
George Street Journal article, "$7.2 million from the Department of
Veterans Affairs was earmarked in 2005 for a team of researchers working to
restore natural movement to amputees -- particularly Iraq veterans. Within
five years, scientists based at Brown [University] and the Massachusetts
Institute of Technology hope to have created 'bio-hybrid' limbs that will
use regenerated tissue, lengthened bone, titanium prosthetics and
implantable sensors that allow an amputee to use nerves and brain signals
to move an arm or leg. Work through the Providence VA Medical Center falls
into six research programs."
"The prosthetic industry is moving forward because of war," Dennis Clarke
observed. "War is the single driver of technology in our profession. The
net effect of these young and vibrant amputees is that they are pressing
forward and doing well; that makes us look good. Technology does not lead
change. Need leads change, and war is good for business because it
necessitates need. One could argue that as earnest an anti-war statement
could be made regarding the same issues." When people talk about war being
good for business and good for technology, it's important to recognize who
ultimately benefits and who pays with their lives. Recruiters are enticing
people into war with promises of making money, but soldiers are not coming
back wealthy. Soldiers are coming back in body bags or with serious
injuries. With their lives and bodies changed, vets come back owing more
money in the face of increased medical expenses and often in worse
situations than they were in upon leaving.
The Figures
According to Corey Flintoff on the NPR program Day to Day, the cost of the
invasion of Iraq could top $2 trillion -- much greater than any Bush
administration estimate -- when estimates include long-term costs such as
replacing worn out or destroyed military equipment, debt incurred to
finance the war, and providing lifetime care for disabled veterans.
The most commonly needed device by Iraq vets is the myoelectric arm that
ranges in price from $25,000 to $35,000 (according to Dr. Kaiser). The
C-Leg microprocessor knee costs $50,000 with additional costs of
components. Expensive technologies, yet these figures fail to consider
vets' other healthcare costs such as surgeries, medications, doctor's
appointments, and physical therapy.
Insurance programs sponsored by the Veterans Administration include the
Service-members Group Life Insurance (SGLI), with the supplements of the
Traumatic Service-members Group Life Insurance (TSGLI), Veterans Group Life
Insurance (VGLI), Family Service-members Group Life Insurance (FSGLI), and
Service Disabled Veterans Insurance (S-DVI). Each consists of its own rules
and regulations, claims processes, fiscal calendars, and terms of
eligibility. The TSGLI took effect on December 1, 2005, as a new program
for service members who suffer from severe trauma: total or partial
blindness, total or partial deafness, hand or foot amputation, thumb and
index finger amputation, quadriplegia, paraplegia, hemoplegia, third degree
or worse burns, traumatic brain injury, and coma. Yet, the myriad
regulations dictate that beneficiaries had to file claims with the SGLI
prior to December 1 in order to apply for TSGLI.
The Department of Veterans Affairs (VA) benefits booklet is a confusing
description of programs, muddling the options available to vets. Examples
of the poor wording include terms like "severely disabled" or "otherwise in
good health" as requisites for coverage. This represents a bureaucratic
nightmare considering that a soldier may need multiple insurances to meet
their medical and life expenses. Yet, who judges good health and on what
basis? Such are the obstacles encountering returning veterans who
frequently are incapacitated, possibly not conscious, and focused elsewhere
upon arrival from combat. The booklet makes no mention that vets can get a
liaison or advocate to help mediate their medical needs. Taking initiative
is vital to accessing any of these benefits.
The rate of injury is steady with no end in sight. Private individuals are
pooling resources for research projects and individual vet support projects
alike (with others listed at www.fallenheroesfun d.org). The Intrepid
Project has contributed over $14 million to military families, yet many
more families will need help so long as operations in Iraq and Afghanistan
continue. Elizabeth Bernstein wrote in "The Gift Shift," a November 25,
2005, Wall Street Journal article, describing that "the president of the
Intrepid Fallen Heroes Fund had collected well over half of the $35 million
the fund needed to realize its big goal to build a center in Texas where
U.S. troops can recover from war wounds and be a research facility for
prosthetic protocol technologies. "
The high caliber technology provided to Iraq amputee vets has had a side
effect on the access to care for non-vet amputees. Jim Kaiser states that
"The climate in the sector of health insurance is that of [suppressing]
technological costs." According to Kaiser, "Blue Cross considers a C-Leg
experimental; the technology has been available in the U.S. for five years
and in Europe for nine. The insurance companies use terms like
'situational, experimental and lack of medical necessity' in order to deny
people access to technology that is becoming the norm in its field.
Myoelectric arm technology is 30-years [old], which insurance companies
continue to dismiss as experimental. If one does not have bills covered by
the VA, how does one pay to keep up with the expanding field? One
possibility is that non-vets just don't get to participate in this new
technological landscape unless independently wealthy or have very committed
and convincing doctors on their side. Perhaps non-vets may just have to
wait for the insurance companies to catch up."
Dennis Clarke elaborated that one hope for The Fallen Heroes Fund facility
is to collect enough data to lobby mainstream non-military insurance
companies. "It's a fact that the industry has not proven its case yet. We
need to prove to the insurance companies what the real benefit of these
technologies are, how much better are these than the old ways. Our next
step is to change the standard practice of insurance companies." How many
more soldiers must demonstrate such necessity in order to raise the bar for
all amputees?
The Adjustment
The IVAW website quotes Douglas Barber, later found dead by his own hand,
"All is not okay or right for those of us who return home alive and
supposedly well. What looks like normalcy and readjustment is only an
illusion to be revealed by time and torment. Some soldiers come home
missing limbs and other parts of their bodies. Still others will live with
permanent scars from horrific events that no one other than those who
served will ever understand."
Soldiers face a range of realities upon return. Some re-enter with a broad
support network, adequate medical coverage, and stellar care. Others return
feeling like absolutely nothing is intact and any possible resources are
inaccessible and inadequate. Jim Kaiser stresses, "It is essential to
provide constant quality follow-up care [to the veteran] once [he or she
is] released from the VA system." However, he worries that what is offered
post-release pales and is lacking compared to what is offered immediately
post-injury. In his practice of 120 people, 16 percent are disabled. "It is
important to hire disabled people in the business of improving prosthetic
care and not to shut people out." These needs for support, recognition, and
employment may seem obvious to some, but they do not go without saying.
Returning to active duty may seem like the lone option to some vets. Jody
Casey had few prospects upon arrival home from Iraq. After being part of
the U.S. military industrial complex, staying in can be easier than
extricating oneself. "A significant percentage (10-20 percent) of amputee
soldiers remains in active duty," Dennis Clarke explains. "With prosthetic
technology, one can do more than ever after sustaining these types of
injuries and recover faster ... these soldiers are specialists in their
field, and it is better to bring back experienced solders with good
training and combat experience."
Throughout the VA literature and my conversation with Dennis Clarke, much
emphasis was put on remaining in active duty. The push -- after being
injured, healing, receiving state of the art medical care -- is to get back
in the game. Those soldiers on active duty are rewarded with medical care
coverage and accolades. Soldiers who choose not to return have far fewer
options. The war practically creates a "super-soldier" archetype with
bionic limbs and a taste for combat with vengeance running through them.
The focus on active duty inhibits considering alternatives, divesting money
and lives from this war. The creation of the invincible wounded warrior
serves as propaganda for the war machine.
Jody Casey addressed the concept of support. "They don't want you to know
what your rights are ... I had no idea where my local VA was or what my
medical coverage was." He discovered that his coverage was "two years of
full medical and six months of dental." The IVAW and a veterans' support
group are his community now and have become integral to his life. Having
served in Iraq, working with IVAW and Vets for Vets has provided Casey with
a different viewpoint of what the Iraq war is about -- war profiteering
happening at every level. "This is not about liberation" he concludes,
"it's about a few people making a lot of money on the back of the poor and
now people like me have to pay for it with their whole selves."
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