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Program aims to help NH health care providers understand toll of war

CENTER STRAFFORD  High on a hilltop above the picturesque village of Center Strafford sits the N.H. Army National Guard training center. Buildings, Humvees and trucks dot the green grass, and, about 10:30 a.m. Thursday, swishing rotors announce that two Black Hawk helicopters have come in for a landing.

Normally, this is where National Guard soldiers go to train for combat, but today it's playing host to a group of medical professionals from around the state.

They're here for "Military Orientation Training for Brain Injury Professionals," an intensive, interactive day where they will learn about some of what soldiers experience in the battlefield, to better understand the physical and mental toll war takes on veterans and how they can better treat their patients who have been in a war zone.

At the beginning of the day Thursday, everyone is given a standard-issue ballistic vest and helmet, ear buds and protective eyewear. Over the course of the day, these doctors and nurses will ride in a Humvee, shoot replicas of automatic weapons, see a medical evacuation and go for a spin in a Black Hawk.

It's a day of firsts for everyone, but it serves an important purpose  giving civilian doctors a better understanding of military culture.

Training, purpose

"Everything we're doing here is for your sake, because it pays off for our veterans," said Dr. James Whitlock, a neurologist who works at the Northeast Rehabilitation Hospital in Salem, told the group.

Whitlock, who formerly worked at the Manchester Veterans Affairs hospital treating soldiers coming back from Iraq and Afghanistan, helped start this training program after some experiences with his patients.

"I was examining young guys," Whitlock said in an interview Friday. "They would come into the office and say they had been blown up. They were on patrol in Iraq."

But when Whitlock asked them questions, he often believed he wasn't getting the full story.

"They would tell me (their story) in varying degrees of detail," he said. "I would imagine one thing, and from what I learned later, it would turn out that what I originally imagined was wrong."

In one instance, Whitlock recalls talking to a veteran about a night when he and his fellow soldiers encountered an explosive. The conversation about the incident was casual and light.

Over the course of their conversation, the man said he didn't remember much between going out on patrol and the explosion, when he found himself suddenly lying in the middle of the road, dazed. But when Whitlock pressed for more details, the veteran said he was the only soldier who had survived the attack.

"This guy's making light of the whole thing ... I'm thinking, 'Whoa, I may be missing big chunks of people's stories,' " Whitlock said.

This experience and others like it convinced Whitlock he needed to get up to speed on military culture, so he talked to a friend at the N.H. National Guard for more information. But the more he learned, the more complicated he realized military culture was.

Changing times

With a different type of warfare being practiced in Afghanistan and Iraq, the types of injuries veterans come home with have also changed. A proliferation of roadside bombs has caused an increase in concussions and traumatic brain injuries in soldiers.

Even though these injuries aren't visible, they are still very serious, military and health officials say.

And in recent years, the military has adopted new protocols requiring soldiers in or near a blast to be screened for traumatic brain injuries, said Richard Oberman, deputy state surgeon for the N.H. National Guard.

Even in the space of four years, the military attitude has changed, according to military officials. In 2004, they said, the mentality was for soldiers to push through their problems. In 2008, the military was actively encouraging soldiers to seek counseling.

"There's absolutely more acceptance," Oberman said. "We're telling soldiers to get help."

Still, though, serious behavioral health issues remain a problem. Suicide rates of male veterans under 30 spiked by 44 percent between 2009 and 2011, according to a January study released by the Department of Veterans Affairs.

Hands-on experience

Throughout the day Thursday, doctors and nurses ride in Humvees and get jostled around, and they also get to experience what a Humvee rollover feels like.

To do this, participants sit in a simulator, which is the body of a Humvee propped on metal legs. With a soldier controlling the turn, the Humvee spins around fully with four people inside, strapped in with seatbelts.

Those who are brave can opt for an "egress" exercise, or exiting the Humvee when it's upside down.

A simulated Humvee rollover is much slower and more controlled than the real thing, but still disorienting. After turning completely upside down you're told to keep one hand on the ceiling and unbuckle yourself with another hand, with about 20 extra pounds of Kevlar strapped to you.

Once the straps are unbuckled, the descent from your seat onto the roof of the Humvee is far from graceful, a sluggish sideways flop that your helmeted head bears the brunt of as much as your arms do.

From there, you squirm around in darkness until you locate the door and pull up on the handle, breathing a sigh of relief as you exit.

Military realities

When his convoy was blown up, the scene in Sgt. Jon Worrall's Humvee was very different than a slow-motion fall. Worrall was a retired Navy veteran who went back to Iraq at age 50. Standing in front of the doctors and nurses attending the training Thursday, he spoke of a 2004 explosion that changed his life.

One night in November, he was asked to drive during a night patrol. An artillery shell went off within 2 meters of his vehicle.

"You can't describe the violence we saw in that half-second," he told the group.

After the blast, Worrall needed 12 surgeries, including getting his thumb joints taken out. But he's worked through much more than physical injury. He dealt with anger and post-traumatic stress disorder and lashed out at friends and family.

"Getting hit with a roadside bomb, there's no retribution," Worrall said. "When you're hit with a bomb, there's not a frickin' thing you can do about it, nothing."

In these situations, you have to live with your anger and sadness over what happened, but Worrall said that counseling and working with other veterans have helped him immensely.

"I got counseling," he said. "Did that cure it? No. Did it help? Yes. I'm not less of a man because I have (a) traumatic brain injury and PTSD. You gotta accept it and it sucks. But it happens ... what are you going to do  whine?"

For the doctors and nurses, it was an eye-opening day.

Gail Blouin, an emergency room nurse at Portsmouth Regional Hospital, wanted to make the most out of her time Thursday. She described the day as "awesome," and "incredible."

"I'm here  I've got to get the experience."

In the end, the purpose of training like the program Thursday is to enable doctors to help soldiers; the first step in this is understanding their experience, Whitlock said.

"I think the more you understand a person's experience, especially if that is very foreign to your experience, the better position you are to provide clinical care."

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