20 February, 2007

Walter Reed, Bureaucracy and Military Medical Care

UPDATE: Chuck has an absolute must-read on this. Seriously, don't miss it. John and Andi also make some great points.

This is practically old news by blog standards, but I didn't have time to sit down and write anything intelligent about it until now. But first, a couple of clarifications: the second WaPo article (about Mologne House) was a breathless, vile and agenda-driven piece of **** ; the first WaPo article (about Building 18, an outpatient residential facility) was also breathless and agenda-driven but largely accurate in the issues it raised about the problems at Building 18 and the broken bureaucracy of med boards and treatment/housing for the wounded after their initial hospitalization. It's that first article I'm addressing here.

The only thing in the first article that was new to those of us "plugged in" to the wounded and related issues was the physical condition of Building 18. The rest of it has been a sad reality for years (we've all heard/have horror stories), and is a great deal of what has motivated our involvement in volunteer and non-profit activities that do more than just "support" the wounded and their familes with words (the post-hospital care and the "boards" issues are a disgrace, but can only be fixed largely through governmental action--something that moves with grinding slowness, unlike the nonprofit/volunteer sector).

The standard recommendation from honest medical personnel in even the best civilian hospital is that no one should stay in a hospital unaccompanied by a smart and self-possessed loved one to stay on top of the patient's treatment. There are too many opportunities for error or indifference through understaffing/stupidity/exhaustion, and a loved one knows and cares for the patient far more than any doctor or nurse ever will. That bit of advice goes at least double for anyone suffering the tender mercies of a standard government bureaucracy cloaked in medical garb. That doesn't excuse the situation, but it's a statement of the reality that must be dealt with today (hopefully we can make tomorrow better).

So, why did it take the Washington Post (and other outlets these last few days) for these issues to get the attention needed? Three big reasons:

1. Though some of the issues have been addressed in the last six months or so, nothing motivates a lethargic bureaucracy like self-preservation. In this case, those responsible at WR suddenly had everyone from the President to the most-junior congressman breathing down their necks.

2. Many veterans who have experience with the military bureaucracy don't believe it ever can or will be fundamentally changed (read the comments in that link, too).

3. Those of us wanting to help the wounded knew the conditions from contacts/experience and decided we could be more effective by just going around the government behemoth rather than engaging it.

The rest I don't have time to write what (or the way) I want to, so you get it in bullet points:

  • The WaPo didn't write this story because they cared about anything like truth, justice, or what our troops deserve. I have multiple first and second-hand sources who tell me they have long been hitting up military families (both in and out of the services) to tell their stories for just such a series as they have been doing. Contrast their manipulative and breathless prose with Army Times' excellent in-depth reporting on the problem.
  • As has been pointed out elsewhere, the fact that the WaPo pursued this story for so long without ever engaging the people responsible for the conditions tells us that the the suffering and burden on the wounded was not what drove them. If it were, they wouldn't have waited 'til now to go public; rather, they would've confronted those in charge with the problems and made that their story. In short, the wounded veterans are being used as pawns in a political/media war.
  • More than money or politics, this is fundamentally a failure of leadership at the mid and lower levels.
  • For more on this story, read the excellent writings of Andi (here, too), John and Smash [as with all the milblog links above, the comments are worth a read].
  • What can you do to help? This is a case where grassroots political action is necessary (I prefer non-political, non-profit work because I seem to have a knack for it. Anybody up to working the political side?). If you want to fundamentally change the system, it takes engaging the lawmakers... who then hopefully exert the necessary pressure on the bureaucrats. It takes years, and I don't have that kind of patience. But I will gladly follow someone who does.