Veterans: just who are they?
When is a young woman who’s never been involved in armed conflict eligible for a Gold Card? What about a 6-month-old baby? As ANZAC Day approaches on April 25, it’s a good time to reconsider our image of just who a veteran is, say key spokespeople for the RSL and the Department of Veterans Affairs.
Many GPs and other health professionals think of veterans as ‘a little old man with a chronic disease and a Gold Card,’ says Rod Bain, NSW Returned and Services League of Australia (RSL) state vice president, who served in Vietnam and who plays a role in several RSL committees including the MATES committee, which reviews veterans’ pharmaceutical requirements.
‘But they can range from a two-year-old paediatric patient of some of these guys who have been killed overseas, to wives and families – a lot of women, wives of Vietnam vets, and their children have secondary PTSD [Post-Traumatic Stress Disorder]. Some of these guys may have been a five-star pain to live with.’
Dr Graeme Killer AO, principal medical adviser at the Department of Veterans’ Affairs, agrees.
‘We really have three cohorts: Korean and World War Two veterans, who have problems of chronic disease, dementia and mental health problems; Vietnam veterans who are now in their 70s and who are developing the same chronic conditions, particularly the mental health problems; and the younger veterans,’ he says.
The third cohort includes those who have served in the armed forces, young war widows and children.
‘Sixty-nine thousand have served since Timor, who will potentially come into our system,’ Dr Killer says.
‘We’re now taking in the younger group, and also young war widows: these are the very sad tales, not just of soldiers in Iraq and Afghanistan, but it’s also the wives and families who have lost fathers and husbands.
‘One of the interesting things that has come out of the younger cohort is that some health care providers haven’t understood that babies of 6 months may well have a Gold Card.
‘One Gold Card widow took her young baby to see a paediatrician, and the receptionist said: “We don’t accept Gold Cards for children”. I don’t think it’s entered into the minds of many Australians that we have young war widows and children who need the benefits of the system.’
What problems affect veterans?
Dr Bain says that one increasingly problematic issue is that of traumatic brain injury, which he says is ‘a big problem we’re having with Afghanistan and Iraq ex-servicemen, which is all about concussion.
‘This happens when they’re exposed to home-made grenades and where explosions go off within 100 metres of them, and their brains rattle around inside their skulls but there’s not physical trauma,’ he says.
‘There may be chronic headaches, there may be memory loss, lots of problems with skills like organising themselves; one big problem is ongoing headaches, and we can only treat these initially with Panadol because nearly all the other headache medications have some sort of anticoagulant side-effect; we can’t be certain with these people, till we get them to really good X-ray facilities, that they haven’t got a bleed inside their head.
‘By and large they don’t have good X-ray facilities in the field, so it’s cause for considerable anxiety.
‘And a few probably do have long-term problems in terms of memory loss that can occur almost like epilepsy: they’ll sit across the desk from you and suddenly say: “I know your name, but why are you here?”
‘Here’s a person in their late 20s or early 30s and they may experience early onset of Alzheimer’s and it’s terrible. Once that kicks off, there’s not a lot you can do about it.’
Other problems for veterans can include mental health issues, including those related to suicide prevention and drug or alcohol problems, as well as those related to ageing for those in the older cohort.
Several programs are in place to help improve health outcomes for veterans, while the Department of Veterans Affairs itself has been around since April 1918.
‘There’s been such an overwhelming acceptance of repatriation by the wider Australian community, and particularly by health providers, and [ANZAC Day] is an important time to reflect and understand how the system has impacted directly or indirectly on so many Australians,’ Dr Killer says.
‘In 1918, 60,000 Australians were killed and 230,000 returned, and many of those were combat casualties; now we only had a population of 4.9 million so when you reflect on that, you can see the impact of World War One on families and towns and right across the nation.
‘We’re looking at 84 years of repatriation with the Department of Veterans’ Affairs providing care to Australian veterans and war widows.’
One key program is Veterans’ MATES (Medicines Advice and Therapeutic Education Services). This has been developed by the Department of Veterans’ Affairs to assist in managing medicine use in the veteran community.
It provides up-to-date health and medicine information for health professionals and veterans, and uses data from prescriptions claims to identify veterans who may be at risk of medication misadventure.
‘Veterans’ MATES has exemplified the good relationship that Veterans Affairs has with providers,’ Dr Killer says. ‘The program has been recognised by the World Health Organization as an exemplar program, and that’s because of the relationship with our providers would fit well into that.’
Dr Bain also highlighted the relatively new Co-ordinated Veterans Care (CVC) program, and that pharmacists and assistants may have a role in promoting the program.
‘A number of individuals or professions can suggest to patients that they get on the program.
‘The CVC program is designed to prevent unplanned hospitalisations, to get the practice nurse to visit or phone these individuals at least once a month, and not wait for the individual, who is often older but not always, as they often say they don’t want to bother the doctor and wait till the symptoms get really bad.
‘Even the cheapest hospital bed in a hospital in Australia costs $660 a day, even in a public ward, so it’s an exercise in saving money but also in helping keep people in their own homes longer and not end up in care. It’s win-win for the veterans and the government.’
He says another program has just been funded which could involve ‘cutting edge’ communication with older veterans, where they can supply information such as their current blood pressure or blood sugar readings on a daily basis in order to tackle chronic conditions earlier.
by Megan Haggan