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thedrifter
05-05-03, 11:41 AM
U.S. readiness in caring for returning troops a priority

Lessons learned from 1991 war, officials say

By Bruce Lieberman
UNION-TRIBUNE STAFF WRITER

May 5, 2003

In late March, as a sandstorm stalled the U.S. assault into Iraq, Veterans Affairs Secretary Anthony Principi watched the news and worried. The fighting had scarcely begun, but U.S. troops, his two sons among them, already were under attack by dust, dirt and sand.

"That's what worries me . . . other than the kids who really got banged up pretty bad," said Principi, whose agency serves the nation's veterans. "It's what they were breathing in."

Federal officials, veterans groups and researchers who have studied Gulf War Syndrome from the 1991 Persian Gulf War assume at least some troops will come home sick, possibly from illnesses difficult to identify, but they disagree over whether the government is prepared to quickly diagnose and treat them.

Veterans say successful medical care will depend on whether the Department of Defense fully informs them of any toxins that troops may have been exposed to.

"If they come clean with all that, and then the VA has the direction to investigate, then I think it's a good thing and I think they're prepared," said Bobby Price, an officer with the San Diego chapter of Veterans of Foreign Wars. "It's all going to (depend) on truth and honesty."

Pentagon and Veterans Affairs officials say important improvements have been made to better care for military men and women. However, some gulf war veterans and scientists say the government is still failing to adequately track the health of troops, including at least 50,000 Marines and sailors deployed from San Diego County.

On March 25, a week after bombs began falling on Baghdad, a congressional committee criticized the Department of Defense for not conducting medical exams and collecting blood samples before and after deployment, as mandated by a 1997 law.

Instead, the Pentagon has issued brief medical questionnaires to troops and used periodic HIV tests to serve as blood samples.

"The current medical practices of (the Department of Defense) are half-hearted and they are a public disaster waiting to happen," said Steven Robinson, executive director of the National Gulf War Resource Center in Washington and a gulf war veteran.

Last week, the department announced changes. Troops will be given a longer questionnaire and "health assessments will be conducted face to face with trained health care providers."

Also, blood samples will be taken within 30 days after troops leave Iraq and stored at a repository in Maryland.

The samples could provide vital information if veterans become ill and their doctors cannot easily diagnose the cause, say researchers who have studied Gulf War Syndrome.

Experts say they do not expect troops to fall ill in anywhere near the numbers seen after the 1991 Persian Gulf War, when thousands of troops returned home ill or became sick with a series of mysterious and sometimes debilitating illnesses now known as Gulf War Syndrome.

This time, troop exposures to oil well fires, pesticides, nerve gas and other environmental toxicants are believed to be far fewer – often nonexistent.

"We may see small numbers (of sick troops) here," said Dr. Robert W. Haley of the University of Texas, who serves on the Research Advisory Committee on Gulf War Illnesses at the Veterans Affairs Department. "I don't expect to see a large thing like we saw before if it's true that chemical weapons was the exposure that caused Gulf War Syndrome, and we think that it was."

Nearly 700,000 U.S. servicemen and servicewomen served in the Persian Gulf War. Of those, studies suggest 26 percent to 30 percent are affected by a complex of multiple symptoms in connection with the war, according to Veterans Affairs. The symptoms include chronic fatigue, muscle aches, gastrointestinal problems and cognitive impairments.

Frustrated veterans and their doctors have been unable to identify what caused the illnesses because so little medical information is available from that war. Health screenings and blood tests for gulf war troops were not done before or after deployment. Exposures to toxins were not closely tracked.

It wasn't until 1997 that the Pentagon announced that about 100,000 U.S. troops may have been exposed to nerve gas after U.S. forces demolished an Iraqi ammunition depot near the southern village of Kamisiyah shortly after the war.

The Department of Defense has acknowledged that chemical weapons were released into the environment after the bombing of two other storage sites, and that as many as 70 special forces troops may have been exposed to toxins.

Just last month, the department released a report concluding that at least 41,000 troops in the Persian Gulf War also may have been overexposed to pesticides.

Several studies suggest brain and nervous system damage found in gulf war troops is consistent with exposure to nerve gas and pesticides. Researchers also have associated the drug pyridostigmine bromide with chemical changes in the central nervous system that could lead to symptoms seen in ill gulf war veterans.

An estimated 250,000 troops took the drug during the war as protection against soman nerve gas.

This time in Iraq, the Pentagon and Veterans Affairs are more prepared to face any potential health problems once troops return home, said Principi, who is from La Jolla.

"I think we've done a much better job in the current conflict in Iraq, to track unit deployments, individual deployments (and) to know where they were at any one time, vis-a-vis any kind of exposure," Principi said.

Veterans Affairs has developed guidelines for its physicians who might treat ill veterans. They are intended to help doctors become better informed about the health risks associated with the Iraq war so they can better evaluate the concerns of individual troops, said Dr. Mark Brown, director of the Environmental Agents Service at the Department of Veterans Affairs.

"Twelve years ago, we did not have those in place and it left a hole," Brown said.

Arnold Gass, associate chief of staff for external clinical services at the Veterans Affairs San Diego Health Care System, said physicians will be listening carefully to veterans.

"You really turn the control over to the patient, who would come in and be allowed to describe what he or she went through," Gass said. "That (will) allow for the broadest possible net to catch anything that was perceived to be a problem by the servicemen and women themselves, not just something hinted on down from on high by some general or some administrator from the VA."

Despite the progress, the military faces several more challenges, including:

As of last week, battlefield medical records from Iraq remained classified and were not available to the Veterans Affairs Department or Department of Defense physicians. The Pentagon has worked for five years on a new system to deliver daily medical reports from medical units abroad to Defense Department physicians in the states, but the system was not ready for the war, said Dr. Michael E. Kilpatrick, deputy director for the Pentagon's Deployment Health Support Directorate.

Only 40 percent of troops were completing pre-and post-deployment health questionnaires as of a year ago, according to an investigation by the General Accounting Office that will be published soon, Kilpatrick said.

On April 15, the GAO reported in a separate study that medical records for the Army's 90,000 early-deploying reservists remain incomplete. Among the findings: About 68 percent of the required two-year physical examinations for reservists older than 40 had not been performed. About 148,000 reservists were called into active duty by last month.

The military has worked to improve the rate at which troops complete pre-and post-deployment health questionnaires since the GAO report on compliance was released last May, Kilpatrick said.

"Certainly the data we have between May 2002 and prior to this current deployment, the numbers are much better," he said.

The Pentagon has not yet compiled data for the Iraq war.



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Bruce Lieberman: (619) 293-2836; bruce.lieberman@uniontrib.com


Sempers,

Roger