Student nurse's study raising awareness of illnesses connected to burn pits
By DONITA NAYLOR | The Providence Journal | Published: November 19, 2018
PROVIDENCE, R.I. (Tribune News Service) — At first, Chelsey Poisson misunderstood what her boyfriend meant when he told her a lot of his friends from Iraq have died.
She thought he meant in the war. "No," he said. "They died when they came home."
Of the 30 men in his platoon, Kyle Simoni told Poisson, five have died since they left Iraq in 2008. Half the rest, including him, have issues such as sleep apnea, Crohn's disease, tumors, vitamin D deficiencies or endocrine problems, such as an inability to produce testosterone. One went through surgery to reconstruct his entire nasal cavity.
His best friend, Sgt. Patrick Sullivan, 24, of California, he said, died in Germany a few months after they left Iraq, of acute respiratory failure.
Simoni, 31, was in Iraq from January 2007 to October 2008. He met Poisson, now 28, in 2014, when they frequented the same Dunkin' in Plainville, Massachusetts, where she lives with her grandparents. Now Poisson, a nursing student about to graduate from Rhode Island College, and Simoni are engaged.
Another of the five was Sgt. Maj. Robert Bowman, who, upon returning home, ignored feeling sick, having night sweats and losing weight, until he went in for a physical required for his next assignment. Not only did he fail the physical, "they put a port into his chest and started chemotherapy," Poisson said.
Bowman died of a very rare form of bile duct cancer, known as cholangiocarcinoma. She said he believed "it was because of what he was exposed to from the burn pit."
In Iraq, trash was burned in open pits dug into the sand with a backhoe. Jet propellant and gasoline were used to ignite the fire, and then it burned continuously. Lawsuits against KBR, the Houston-based contractor that provided basic services for the U.S. military in Iraq and Afghanistan, have been unsuccessful against company arguments that the government had approved its work practices.
Simoni, who worked as a tank mechanic, told Poisson that everything went into the fire pit. Sometimes they burned trash in 55-gallon drums closer to the garage, he said, but everything was burned in the open: plastic water bottles, packaging, food scraps, crates, tires, unspent ammunition, unused medications, electronics, clothing, solvents, wood soaked in hydraulic fluid, batteries, even tracker batteries from shipping containers, which Simoni said would explode when you threw them in. A complaint against KBR also listed dead animals and human remains, chemical and medical waste, Styrofoam and furniture, according to an article by Michael Riess, "Actually, We Did Start the Fire, and It Keeps on Burning: The Environmental Health Effects of Military Burn Pits in Afghanistan and Iraq."
Riess also cited a 2004 report by the Air Force Institute for Operational Health that listed what made the smoke toxic. Those included dioxins, particulate matter, polycyclic aromatic hydrocarbons, volatile organic compounds, carbon monoxide, and hexachlorobenzene.
Poisson graduated from Attleboro High School in 2009,and enlisted in the R.I. Army National Guard in 2010.In 2013, she enrolled at RIC and in 2016 was awarded a scholarship that paid for the rest of nursing school in return for working two years at a veterans hospital.
"Right away, I knew there was something really special about her," said Prof. Sylvia Ross, who has a doctorate in nursing and teaches at RIC.
"She's so passionate about this topic," Ross said. "Once Kyle brought it to her attention, she started to put two and two together, things started connecting, she did her own research into the literature, that's when she came to me and said, 'I'd like to do an honors class on this.'"
Poisson describes herself as "I'm not the smartest person, but I'm driven."
Ross saw her as a good student. ""She's the first one to class, she's sitting there, and she has done her prep," Ross said. "She does good work, and if she doesn't do good work, she's in your office and wants to know what good work is." As a maternity nurse, however, Ross knew nothing about the military.
Lt. Col. Sheri Boucher, an assistant professor at RIC who had been an Air Force flight nurse in Afghanistan in 2012, came in as an interpreter fluent in both academic and military cultures. "I was kind of the person in between, to help Chelsey understand where Sylvia was coming from" and help Sylvia understand Chelsey's view, Boucher said.
Poisson's first task was to collect all the data she could find. Mostly it was either "all military, no medical; or all medical, no military," she said. She had backgrounds in both.
The Veterans Administration began getting reports of unexplained medical problems in 2006, and a study was ordered. Eventually, Congress required the VA to establish a registry for veterans with health problems after exposure to burn pits. Congress also banned open fires for military waste disposal.
Poisson wrote a 66-question survey and began looking for a minimum of 20 veterans who had been in Iraq between 2003 and 2011. Boucher, Simoni and RIC's veteran liaison helped her find 110 veterans from around the country willing to take part.
The first questions asked where the respondents live, what job they had in the military, their pay grade, whether they smoke and whether they ever participated in a sleep study for sleep apnea.
The next section was about the soldiers' predeployment health: the scores of their last fitness test before being deployed, their list of immunizations required by the military, any symptoms they had that lasted a month or longer, how many hours a week they did fitness training and whether they had shortness of breath.
In the section on deployment, they were asked how long they spent in Iraq, at how many bases, if they were ever stationed at Joint Base Balad, whether they experienced sandstorms, how they got rid of their trash, their level of concern about the burn pits, the items they burned or saw being burned, the symptoms they had, how many hours of physical training they did while deployed, whether they trained outside and how many miles a week they ran, whether they lived in buildings, tents or other housing, how many uniforms they were issued, how often the uniforms were washed and who washed them.
The postdeployment questions matched those from predeployment, plus a question about their civilian jobs.
"It was all online," she said. "We used Survey Monkey." While she waited for responses this summer, she said, "people would call me and tell me stories. I couldn't believe it."
One told her that contractors removed hazmat from storage and burned it in the open pits.
Another sent her photos that purportedly showed burn pits, banned since 2014, being used as recently as October 2018.
She quoted part of that person's email: "The burn pits have probably taken years off everyone's life out here."
Her hypothesis was that between pre- and postdeployment, soldiers experienced a significant decrease in fitness and increase in medical symptoms lasting more than a month.
Her results, she said, confirmed her hypothesis. Calling the analysis rudimentary because the college had not hired a statistician, Ross said Chelsey's results support her hypothesis."
Nearly everyone, a percentage in the mid-90s, said their trash was burned in open pits.
A full 100 percent passed their fitness tests before deployment, but the percentage who passed after deployment was in the low 60s.
Before being deployed, nearly 90 percent reported no symptoms of medical problems, and the remainder reported only acid reflux and indigestion, Poisson found.
During deployment, her survey found that symptoms increased significantly. Chronic headaches, chest pain and tightness, loss of smell, burning eyes and throat, vision sensitivity, flu-like symptoms, diarrhea, sinus pressure and pain, and recurring nose bleeds were among the symptoms reported.
After the soldiers came home, almost half had chronic headaches and slightly more than half had memory loss. Three-quarters reported shortness of breath, and there was a significant increase in sinus pain and pressure.
"I found it interesting that a lot of symptoms that were present during deployment decreased after Iraq," Poisson said. Burning in throat and eyes, coughing and choking spells, discolored phlegm, itchy and irritated throat, breathing pain, nausea and recurring nosebleeds all decreased after the person left Iraq.
She created a website at hunterseven.com, where she will post the results once the college has published them. Already on the site is a list of chemicals and their toxic effects, and resources for veterans. She and Simoni formed a nonprofit and found sponsors to pay the cost of keeping the information easily available. She is working on screening questions that medical providers can adopt to help reach an accurate diagnosis faster.
In the last phase before she delivers her nursing honors presentation, on Dec. 5 at 3 p.m., called "An Exploratory Study of Iraq War Veterans' Exposures to Burn Pits and Other War-Related Experiences," she has been working on raising awareness. A candidate for a masters in social work, MSgt. Paul Santilli, who served three deployments in Iraq and will graduate in May has become the backbone of this phase by indulging his passions for veteran advocacy and policy reform, she said.
They met with Kasim Yarn, director of Rhode Island's Office of Veterans Affairs. They met with a member of U.S. Sen. Sheldon Whitehouse's staff. As his office said in an email last week: "We appreciate the work they have done to shed light on this issue. Senator Whitehouse is in the process of reviewing the issue before deciding on a legislative approach."
That answer is "upsetting because this is a time-sensitive issue," she said.
They also met with U.S. Rep. David Cicilline.
"It was horrifying to hear that this practice occurred," Cicilline said later, calling Poisson's research "an extraordinary example of citizen activism" by "an extraordinary woman who served in the R.I. National Guard and founded an organization dedicated to educating veterans and health care providers.
"Her activism caused me to become a champion for this legislation," he said, adding that he immediately signed up as a cosponsor of the House bill.
The Burn Pits Accountability Act (H.R. 5671) would require the U.S. Department of Defense to note, in each service member's file, whether that person was stationed near a burn pit; enroll the service member in the Airborne Hazards and Open Burn Pit Registry and require both the secretary of defense and the secretary of veterans affairs to share information about exposure to burn pits and toxic airborne chemicals.
Poisson, who will graduate in mid-December, said she wants people to know that "Burn pits are the Agent Orange of Iraq and Afghanistan."
The herbicide used in Vietnam to kill vegetation had severe health effects on veterans.
The VA denied for years that Agent Orange caused health problems but now recognizes its link to certain cancers and diseases. Any veteran who served anywhere in Vietnam from Jan. 9, 1962, to May 7, 1975, is presumed to have been exposed and is entitled to benefits.
"This is real," Boucher said. "It's validating for military members" to know "that they're not going crazy, they are sick, there's other people sharing the same symptoms."
Susan Zeier holds a sign showing the different elements that were burned in pits. Her son-in law was diagnosed with cancer and it's believed to have been contracted due to exposure to burn pits when he was a soldier in Iraq. Zier was at a news conference in front of U.S. Capitol in Washington on June 7, 2018.
MICHAEL S. DARNELL/STARS AND STRIPES