Perspectives on military medicine

Military Medicine, Sep 2003 by Winkenwerder, William Jr

The Importance of the work that you are undertaking cannot be overstated. It really is very important, particularly at this time in our nation's history. All of us in military medicine have a mission, and, in some ways, that mission is not changed from what it was 12 months ago. We are about ensuring that our Armed Forces are ready and fit to fight. We are about the business of ensuring that medical professionals are trained and ready to support armed forces in combat. We are about delivering a high-quality health care benefit to our entire military family, to the war fighters, to their dependents, and to retirees and their dependents and their family. That is our commitment.

Well, what has changed are a couple of things in my judgment. The first of these is the urgency with which we must approach what we have to do. It seems that we've just got a lot that we have to do, and we've got to get it done, and it won't wait. It won't be acceptable that we wait 2 or 3 or 4 years to get certain things done. They have to be done now. Second, to get those things done, we need to communicate, collaborate, and coordinate with many others in ways that have not been at least immediately visible or necessary in the past. And by that, I mean the following: the military health system needs to communicate, coordinate, and collaborate among all three services and between the front-line delivery of health care and the management and administration of the TRICARE program and the health affairs office. The coordination has to take place first and foremost among all those component parts of the military health system. And, then, to be effective in the Department of Defense (DoD), you have to have very good communication, coordination, and persuasion with the leadership in the Department or you don't get the resources. You can't make the changes that you need to make.

But it goes beyond the Department itself to the rest of the federal government, particularly at this time. Importantly, the Department of Health & Human Services, our coordination with the Centers for Disease Control-their work, with Food and Drug Administration, with the new Office of Emergency Preparedness, with the Centers for Medicare and Medicaid, Agency for Health Care Quality and Research, with the Veterans Administration, who we share an important mission of taking care of our veterans, and then finally with the stand up of homeland security, and the new Department of Homeland security And I think I've even been surprised myself in coming in and having some sense, as Dr. Laughlin mentioned, of what it's like to function in government with the amount of coordination, collaboration, and communication that is necessary with all these other component parts of government to get the job done. They really touch on everything that we do, and we many times touch on what they do. So I spend a lot of my time trying to do that kind of coordination and communication.

As we proceed with our work, I think it is really important to remember what we are fighting for. And, in my view, it represents the most basic of principles that this country was founded upon over 200 years ago, which our founding fathers said were so obvious they were self-evident. Among them is freedom in all its forms, and the rule of law, which, to me, means respect for individuals, their rights, their property, and their religion or religions, their ability to worship, and finally it means opportunity, opportunity for everyone. So, our fight and what we're struggling for is very important, and not just for ourselves, but for the rest of the world. What has happened in Afghanistan is very heartening, not just because of the political or the military victory. I think it is heartening to many Americans to see that the Afghan people, hopefully for the first time in many, many years, are able to come together to form a government, to form a society that will give hope to their people. They've been a ravaged country, and they've been torn apart. And there are many other areas of the world in which that's true. And, for better or for worse, the rest of the world does look to the United States, and we have this critical role to play. And we can't be everywhere, and every place at all times, but where we choose and where we must be, we have a very important job to do. It must be done very, very well.

I have to share with you a story from a recent trip I took to the European theater. I stopped at Landstuhl Regional Medical Center, which is the main medical center for us in Europe, and the point at which many, many, over 500 now injured service members have come from the theater to get definitive care since last October. As I made my way around Landstuhl, I met briefly with a young Afghan soldier who was critically wounded in an ambush by Taliban forces, and he had lost both of his legs-above the knee amputations. I was amazed that he had a great big smile on his face. He spoke a little bit of broken English, and as I talked to him and to others who obviously knew about his situation, they said this is an amazing guy. He'd obviously been devastated by this injury, but he was actually very happy and hopeful. I wondered at his optimism, and he said two things. First, he will be able to learn English, by speaking here with Americans, which will be important for him for his future. Second, he was learning how to operate a computer. He was excited about that because he could go back home able to speak English and with computer skills. We had left him with that, besides the fact that we had saved his life. So he was a very thankful man. This gave me a glimpse at [what] kinds of situations occur, really highlighting the importance of what we're doing.