The problem afflicts thousands of people like Peterson who work with combat vets. Some experts call it “secondary PTSD” or “vicarious traumatization”; others prefer “compassion fatigue.” The Army’s term is “provider fatigue.” Although it’s not listed as an illness in the standard diagnostic manual, it can be seriously debilitating. Symptoms range from nightmares and “invasive thoughts” to anxiety, insomnia and hypervigilance. Case studies often mention a dread of work, including failure to keep appointments and carry out necessary follow-up with patients; in addition to absenteeism, effects often include errors in judgment, difficulty in concentrating, emotional numbness and religious doubts. The symptoms are part of everyday life to many Department of Veterans Affairs caregivers and to staff at military hospitals like the Walter Reed Army Medical Center.
The military is looking for solutions to the provider-fatigue problem. A 2006 internal advisory on health care for troops in Iraq reported that 33 percent of behavioral-health personnel (counselors and psychiatrists) and 45 percent of primary-care specialists (doctors and nurses) complained of high or very high burnout. The rate among chaplains was 27 percent. Last summer the Army launched a pilot “provider resiliency” program to help cope with secondary PTSD, and Maj. Edward A. Brusher of the U.S. Army Medical Command says the plan is to take the program worldwide. Landstuhl Regional Medical Center in Germany—usually the first stop for wounded troops coming out of Iraq—set up some of the first provider-fatigue workshops after the war began. Similar therapy groups are scheduled for May at Walter Reed.
The VA encourages its personnel to talk out their feelings at weekly sessions, but the stress builds up anyway. Counselors need to know how to spot the problem in themselves, says Matt Friedman, executive director of the VA’s National Center for PTSD. “If a therapist finds that they can’t listen to another awful war story or that they can’t shut down once they’re at home with their kids, that should be a warning sign,” he says. Fixing the problem can be something else again. Like many others who work with the VA system, Bob Schwegel is a veteran himself. He helps Iraq vets apply for benefits, but it’s tougher and tougher for him to continue as he listens to their stories. “I get flashbacks of Vietnam,” he says. “Sometimes I have to just get up and walk away.” One thing is sure: the VA’s problems won’t solve themselves. The system is already overwhelmed. Now homecoming vets have to deal with one more kind of collateral damage: traumatized caregivers.
title: “Hundreds Of Iraq Vets Are Homeless” ShowToc: true date: “2022-12-09” author: “Laurence Thompson”
Atiya (who asked that only his first name be used for safety reasons) is one of thousands of members of the Iraqi security forces who have been wounded on the job. That attack, near the town of Abu Ghraib last Wednesday, was the third time Atiya, 32, has been hit by an IED since he joined the Guard last year. He was quickly taken to the American-run Combat Support Hospital, known as the Cash, in the Green Zone, often the first stop for critically wounded soldiers. “These guys are in harm’s way more than any other slice of the Iraqi population,” says an American doctor at the Cash who asked not to be quoted by name.
During a speech last year, the then secretary of Defense Donald Rumsfeld noted that Iraqi security forces take casualties at “roughly twice the rate of all Coalition forces.” That’s approximately 40,000 wounded and more than 6,000 dead, grim numbers by any measure. (Both the Iraqi Ministry of Defense and the U.S. military refuse to divulge data on Iraqi wounded for “security reasons.”) “I’ve lost many friends,” says Atiya, a soft-spoken man with a thick black mustache and receding hairline. At the Cash, Iraqi and American soldiers receive the same state-of-the-art care until they’re stabilized. But for the Iraqis, it’s downhill from there. “The problem is what happens afterward,” says the U.S. doctor. “The safety net is very low.”
Most of the Iraqi soldiers are first transferred to a hospital in central Baghdad that, by local standards, has decent equipment and well-trained doctors. Some Sunni troops are terrified of being absorbed into the public-healthcare system, which is run by officials with ties to the Shiite cleric Moqtada al-Sadr. All the Baghdad hospitals that receive Iraqi wounded have heavy security to guard against insurgents.
Under Saddam Hussein, an extensive infrastructure was put in place to deal with the casualties of the dictator’s wars. Military hospitals were set up for long-term care and an Association of Veterans’ Affairs helped the disabled and paid out pensions. Now one of the largest former military hospitals is used by squatters and the veterans’ office doesn’t deal with soldiers who signed up after 2003. A spokesman for the Ministry of Defense says that wounded soldiers are looked after well and continue to receive their salaries even if they can’t return to the job. But anecdotal evidence suggests otherwise. Shakir Mohammed, a fair-haired 27-year-old soldier from Baghdad, received severe burns on the right side of his body from an IED attack in 2004. After treatment at the Cash, he says the Iraqi Army forgot about him. “When we left the hospital, no one asked about us anymore,” he says. “All aid stopped at that time.”
Mohammed still has nasty purplish scars on the right side of his body and says he’s often in pain. He’s also back on the job: with unemployment as high as 50 percent, the roughly $550 he receives each month is tough to beat. “There are no other jobs,” says Mohammed. Swathed in bandages, Private Atiya looks down at his missing left leg and says he hopes the Guard can find him a posting in Najaf, his hometown. “I have no regrets,” he says. “I want to serve.”
title: “Hundreds Of Iraq Vets Are Homeless” ShowToc: true date: “2023-01-30” author: “Michael Doonan”
But that was then, before Iraq turned into a quagmire, the Democrats won control of Congress, Rumsfeld was eased out and Bush began worrying more about his legacy. When The Washington Post exposed wretched conditions at Walter Reed Army Medical Center, the Bush team responded as if Texas had been invaded. The behind-the-scenes scramble to rectify the mess at the facility and to take better care of veterans is revealing of a new way of doing things in the Bush administration.
When the Post first published its stories, Bush’s chief of staff, Josh Bolten, called Robert Gates, the new Defense secretary. Bolten, who replaced Andy Card a little more than a year ago, is a results-oriented pragmatist. So is Gates. The two men agreed that swift action was called for. A senior White House official, who requested anonymity discussing the president’s private conversations, tells NEWSWEEK that Gates called President Bush and said: “I’m going to hold people accountable. I don’t know how high it will get. But it will be high.” Bush responded, the official says, “Do what you need to do.”
Firing high-level officials for the mistakes and wrongdoings of their subordinates has not exactly been standard procedure at the White House. After the press exposed the torture of detainees at Abu Ghraib Prison in 2004, 12 service members were convicted of various crimes, but only one, Col. Thomas Pappas, was an officer. Gates, by contrast, went to the top of the administrative chain of command, getting Army Secretary Francis J. Harvey to resign when Gates thought the Army was not taking the Walter Reed allegations seriously enough.
Gates, an Eagle Scout, is quiet, not at all demonstrative and not particularly close to George W. Bush. (He is friendlier with Bush’s father, who made him CIA director for the last two years of his administration.) But he has been known to wield a sharp knife when it comes to slashing through red tape. For a couple of days, Gates watched with mounting vexation as Harvey seemed to play down the horrible conditions at the Army’s premier hospital for wounded soldiers—or, as Harvey blandly put it, “the shortcomings at Walter Reed.” Harvey fired the head of Walter Reed, Gen. George Weightman, only to replace him with the official, Lt. Gen. Kevin Kiley, who had earlier run the military hospital and appeared just as culpable for gross inattention to moldy rooms and snarled red tape. (Kiley was removed after serving only a day as interim commander.)
That was the “final straw” for Gates, says the senior Bush aide, who did not want to be named characterizing Gates’s personal views. (Gates himself declined NEWSWEEK’s interview request.) The next day, at a National Security Council meeting at the White House, Gates quietly pulled the president aside and told him he was firing Harvey, the aide says. Gates summoned Harvey, who was visiting the Army’s infantry command at Fort Benning, Ga., back to the Pentagon. At a short meeting in the Defense secretary’s third-floor office, Gates told Harvey that the Army secretary had not grasped what the Defense secretary had meant about accountability. At a news conference an hour later, Gates said, “Some have shown too much defensiveness and have not shown enough focus on digging into and addressing the problems.”
A Defense secretary who admits that his top officials have been too defensive? It was such a refreshing idea that some in the punditocracy were ready to declare a New Age of Pragmatism in Washington. Gates’s candor about high-level blundering did seem illustrative of something different stirring in the inner councils of the Bush presidency. During the past several weeks, the administration has reversed course on two major foreign-policy fronts. After years of refusing to cut a deal with North Korea, the administration offered Pyongyang fuel and food in exchange for promises to slow down its nuclear program. And after insisting that the United States would not sit down with Iran until the mullahs gave up their push to build a nuclear bomb, Secretary of State Condoleezza Rice announced that American representatives would be attending a conference between Iraq and Iran to talk about security issues.
When Rice went public with these diplomatic initiatives, Vice President Dick Cheney was not even in the country. Cheney was in Pakistan and Afghanistan at the time, dodging terrorists who set off a bomb outside Baghram Air Force Base while the vice president was “inside the wire.” Suffering from blood clots, and with his valued deputy I. Lewis (Scooter) Libby convicted of perjury, Cheney seems to be drifting into the shadows, no longer the man behind the throne.
Rumsfeld gone, Cheney marginalized. Has President Bush himself gone soft, become a touchy-feely multilateralist? The answer is no—at least not yet, and probably never. White House officials (speaking anonymously about sensitive national-security-policy questions) insisted to NEWSWEEK that Iran’s mullahs have been shaken and made more pliable by the administration’s show of force in the region—capturing Iranian operatives in Iraq, sending two aircraft carriers steaming toward the Persian Gulf. (Gates was all for this saber-rattling, say his aides, who wouldn’t be named for the same reason.) Bush is not about to suddenly reverse himself and embrace the recommendations of the Baker-Hamilton commission (of which Gates was a member) that call for a troop drawdown in Iraq and an all-encompassing international peace conference on the Middle East. What has changed so far in Bush’s administration is more a matter of style than substance—though new ways of doing business can sometimes produce tangible differences in outcomes.
Looking at how the new Defense secretary operates—how his modus operandi differs sharply from the often high-handed ways of his predecessor—is one way to illustrate the new paradigm. From early in his tour of duty, Rumsfeld refused to meet with the Joint Chiefs of Staff in their Pentagon council room, known as the Tank. (“The Tank leaks,” Rumsfeld complained.) All important meetings with the top brass were held in the secretary’s office—on Rumsfeld’s turf, as it were. Gates, by contrast, walks down a floor to the Tank at least once a week. “He meets with us routinely,” says Adm. Mike Mullen, Navy chief of operations. “He’s very open, very engaging.” (Though laconic, Gates is approachable and can, at times, be dryly witty.)
Gates also has a different media strategy. Rumsfeld liked to make reporters squirm by scoffing at their sometimes querulous or ill-informed questions at crowded, televised press conferences. Gates prefers to invite reporters to sit around a table in his office, no cameras present. Gates offers no grand plans; Rumsfeld had sweeping and provocative theories for reforming the defense establishment. The day before 9/11, Rumsfeld called the Pentagon’s bureaucracy an “adversary” that he likened to the Soviet Union—“one of the world’s last bastions of central planning.” Gates is not much interested in institutional revolutions; his focus is almost entirely on trying to salvage a war gone bad. “I have three priorities,” he has said on several occasions. “Iraq, Iraq and Iraq.”
Bureaucratically, Gates operates a bit like a submarine that runs silent, but deep. Within Bush’s inner circle, Gates is “quietly vocal” but “will not carve himself out publicly the kind of role Rumsfeld had,” says Brent Scowcroft, Bush 41’s national-security adviser. “When he has a point of view, he is quite comfortable and not easily swayed.” In 41’s administration, Gates was Scowcroft’s deputy; before meetings of important subcabinet officials, the two men would figure out what they wanted to accomplish, and Gates would be sent in to run the meeting. “Rarely did it come out in a way we didn’t expect,” says Scowcroft, who describes Gates as a “cautious realist,” less conservative than Cheney but more conservative than Scowcroft himself.
Rumsfeld did not try very hard to conceal his disdain for Congress and his impatience with congressional hearings. Gates, by contrast, dutifully troops up to Capitol Hill to court lawmakers and makes his most impressive asset, Gen. David Petraeus, the new Coalition forces commander in Iraq, available to talk to congressmen by videoconference from Baghdad. Gates can be a sly Washing-ton operator. One knowledgeable Hill source, a congressional budget expert who didn’t want to be named talking about Gates’s game-planning, speculated that the Defense secretary is subtly trying to convince Democrats that they wrest away the strong-on-defense label from the Republicans—by providing a truly huge appropriation, of course, for the Defense Department.
Rumsfeld seemed to take pleasure from bullying or trying to awe other cabinet members. If he did not like the policy coming out of the machinery of the National Security Council, Rumsfeld simply ignored it. Former secretary of State Colin Powell almost despaired of trying to crack the Rumsfeld-Cheney-Bush triumvirate, and Rumsfeld could be rudely dismissive of the then national-security adviser Rice. Gates has taken a much gentler tack, say Defense officials who are familiar with his management philosophy but declined to be identified discussing it. Gates has said to Rice that he believes the secretary of State has to be the voice of foreign policy; the role of the secretary of Defense, in Gates’s view, is to weigh in on the military implications and risk of policy. Gates and Rice talk every morning for 15 minutes; Rumsfeld spoke to Rice maybe twice a week. (Rice and Gates are old comrades; Gates was a fellow Sovietologist and Rice’s boss on the Reagan White House national-security staff.)
According to one informed diplomat, who wished to remain anonymous discussing a sensitive matter, Gates has quietly supported Rice as she has gone around the right-wing ideologues on the national-security staff and in the office of the vice president. Two weeks ago The Washington Post reported that Elliott Abrams, the archconservative national-security staffer for Middle Eastern affairs, had fired off angry e-mails expressing bewilderment over the administration’s deal with North Korea. The deal caught Abrams, normally in the know about all major policy matters, by surprise. (A spokesman for Abrams did not dispute the account.)
Some former high-ranking military officials see Gates as a critical change agent in the Bush administration. “You change your secretary of Defense and all of a sudden we’re talking political engagement,” says Paul Eaton, the retired two-star general who led the 2003-2004 effort to rebuild the Iraqi Army and later called for Rumsfeld’s resignation. “Iran and Syria are coming to the table at a fairly senior level. I can only attribute that to Gates.” That exaggerates Gates’s impact, but few doubt that Gates has at least tipped the balance toward a more nuanced foreign policy. Gates has an important ally in Josh Bolten, who maneuvered for months to get Rumsfeld out at the Pentagon. And President Bush admires Gates’s professionalism and management style, say White House aides speaking under the usual cloak of anonymity. The new Defense secretary certainly had some impact after the Walter Reed scandal broke: Bush and his advisers, who once ridiculed the appointment of commissions and outside advisers as a Clintonesque irrelevance, agreed to set up an outside commission looking into the Army’s medical care. It was Gates who focused the commission on ways to help wounded soldiers who are leaving active duty and entering the bureaucratic labyrinth of Veterans Affairs.
Gates is emblematic of a less hubristic administration. Still, he is undoubtedly too much of a realist himself to think that he can miraculously salvage history’s verdict on the presidency of George W. Bush. At 63, Gates was happily retired from government service, working as president of Texas A&M, when the president called him back to duty. In his memoirs, Gates writes proudly, “I spent more years working [in the White House] than any president but Franklin Roosevelt.” The White House, wrote Gates, “is a poignant place … It seems to me that for those who live and work there, if they are completely honest with themselves, with rare exceptions the most vivid memories are not of victory and joy but crisis and defeat.” Gates has a chance to help pull the Bush administration out of perpetual crisis mode, but, at least in Iraq, victory may be too much to ask.
