Training healthcare providers to ‘win the hearts and minds’ of veterans

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    I don't sleep well very often.  I have a lot of strange dreams and nightmares and I usually wake up distraught, - Toby Bodnar wrote as part of the veteran photo project. (Courtesy of the VA Center for Health Equity Research and Promotion)

    I don't sleep well very often. I have a lot of strange dreams and nightmares and I usually wake up distraught, - Toby Bodnar wrote as part of the veteran photo project. (Courtesy of the VA Center for Health Equity Research and Promotion)

    Part of the VA system overhaul to address long patient wait times is to offer veterans more access to community-based primary care doctors without incurring additional costs.

    Already, a lot of veterans who have served in Iraq and Afghanistan receive care at non-VA doctors offices, and there is a push to make sure all healthcare providers are better prepared to serve these patients, and to understand their unique needs. A recent event at the Hospital of the University of Pennsylvania brought together care providers and veterans for frank conversations on this topic. 

    “Up until a few years ago, I had no clue I had a problem,” Camden native Drew Bendler told a group of Penn nurses, describing who he was when he returned from Iraq a few years ago, as he struggled to adjust to civilian life. Bendler still wears his hair army short, his face betrays the sign of struggles and sadness experienced in his life. He describes how he has lost fellow soldiers to drugs and suicide in the years since returning from war.After returning from his last deployment, he felt out of place and alone. He had turned to drinking, but wasn’t aware it had gotten out of hand.

    “It took a long, long time,” he said.  “My problem with my denial was my isolation.”

    Bendler believes that healthcare providers could play an important part in helping veterans – but they have to know how to talk to this group.

    “A veteran who has been trained to be quiet and to be a tough guy, so to speak, he might not be ready to open up to a healthcare provider,” he explained to the nurses in the audience.

    ‘We went to war, while America went to the mall’ 

    Bendler said he often felt like nobody could relate to his experience, or wanted to hear about it.

    “Soldiers often say ‘we went to war, while America went to the mall,'” he said.

    For civilians, it’s easy to forget what these veterans have experienced on their deployments, agreed VA researcher Gala True who spoke at the event with Bendler. She recently organized a photo project where veterans expressed their experiences of war and coming home in powerful images and words. True and veteran co-presenters now use these images when talking to healthcare providers, like the Penn nurses.

    One slide shows an alarm clock that reads 2 a.m. Army veteran Tiffany Johnson took this picture, as a way to illustrate her post-deployment insomnia. “It would take me a long time to get to sleep. When I did get to sleep I had nightmares, and then I didn’t stay asleep that long,” she recalled.

    Johnson now works at the Norristown vet center, and does these presentations to encourage healthcare providers to engage veterans. “Even before you prescribe all that medication and all that other stuff, ask me about my experience,” she said.

    Ask about sleep, ask about drinking

    Gala True says sleep can be a way to open up a bigger conversation with a veteran.

    “‘I know you are sleepless but I’m concerned about your alcohol use, and by the way, drinking can actually mess up your sleep, so if we’re going to address your sleep, we have to address your drinking,’ she suggests as an example. “The vet will understand that.’ 

    Another photo slide created by a veteran shows a bottle of vodka, next to a bottle of cold medication. It says “Alcohol makes me numb. For me, numb is as good as it gets sometimes.”

    True says health care providers who come to her presentations and see these images are eager to learn more.

    “All the questions afterwards are aimed to the veterans – ‘what is a good interaction? If I meet a veteran who is in denial, how can I deal with that?'”

    Drew Bendler says it’s pretty simple: Show interest.

    “The healthcare provider needs to win the hearts and minds of the soldier that needs the treatment. I mean, once you find out that veteran’s experience say ‘hey, glad to be home’ and ‘thank you for your service’ goes a long way.”

    One of the nurses attending the presentation, Larissa Morgan, says what she’s learned here about reaching veterans applies to all good patient care.

    “Asking questions, being attentive, individualizing care based on who that person really is and getting an understanding of who that person is,” she said. 

    The photo exhibit that explores veterans’ struggles with returning home from war is traveling around the country, and will be shown in Boston next.

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