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Prakash Chandran: This is Mission In Action, a podcast from St. Mary's Healthcare in Athens, Georgia, focusing on patient-centered care under our mission to be a transforming healing presence within our communities. I'm Prakash Chandran.

In August 2019, St. Mary's partnership with the Veterans Administration was established to pursue the goal of improving coverage for veterans and educating St. Mary's employees on the significance of veteran service and how to provide better care. This initiative was named St. Mary's Military and Veterans Health Program. And here to talk more about it is Jeff Brown. He's the Vice President of Support Services at St. Mary's Healthcare.

So Jeff, it's really great to have you here today. I wanted to start by asking why is the focus on our active duty and veteran populations so important?

Jeff Brown: Well, that's a great question. And thank you for having me today. After the events of September 11th, the global war on terrorism began. And this conflict, a lot of people don't even realize has lasted longer than the Vietnam war. I mean, we're in September of 2021 now. Just last month in August, we did the final troop pull out of Afghanistan. So as a result, we now have tens of thousands of veterans that are living in our communities who live with those recent and time scars of war, both the visible and those invisible scars.

Now, we have veterans that are everywhere. Just in the ZIP code that I live in and that I'm sitting in right now, there are almost 5,000 veterans who live in this one ZIP code. But when you look deeper, there are millions of veterans across the country, many who've survived combat such as World War II, Korea, Vietnam, Desert Storm. And just the interesting fact, there are still over 300,000 World War II veterans that are alive today. But because we have such a large influx of veterans in our communities now that are living with those recent visible scars of war, it is really important for us to turn our focus on those because they present with these unique and different I'll say challenges to their healthcare that we need to be able to recognize.

Prakash Chandran: Wow. You know, I think you said something there that just hit me, that the fact that this most recent war on terrorism had been going on for longer than the Vietnam War. And it's one of these things that, especially, I think, in today's society with everything that's going on, I think some people forget that we were still at war and there are still people that are fighting for our freedom. And so can you talk a little bit about, you know, the nature of when someone gets deployed, especially most recently what they have to go through and then some of the scars that they may come back with. And I know obviously there's injury and some visible ones, but I imagine there's also some invisible ones as well, so maybe you can give a high level on that.

Jeff Brown: Oh, absolutely. Two common invisible scars that we see. The first is just survivor's guilt. You know, "I'm in a Humvee. We ran over an IED. All my buddies in the Humvee were killed except me," you know, "Why?" So many people come back with just those survivor's guilt. "Why me? Why didn't I go with my buddies? Why didn't they live?" And then you have the other one that we see is the moral injury. And if you think about the moral injury, you know, we're all raised in a society where, you know, you're taught to respect the law. You're taught not to kill. You know, you're taught not to murder. But when you're serving in the military and when you're serving in combat, you know, it's either kill or be killed. And so that moral injury of "I pulled the trigger or I did something that took someone else's life or cause some massive injury to someone, but it was either them or me" and you have to make that split second decision during that time of crisis, you know, that doesn't just leave the individual. That individual comes back with that guilt that they carry around for the rest of their lives. And so those are the two primary invisible scars that we see.

Prakash Chandran: And I also think that related to the moral injury that you're talking about, and this might be kind of a delicate question. But I imagine that there are some people that didn't necessarily agree with the reasons why we went to this war, the reasons why it went on for so long. And they're also coming to terms with the things that they had to do over there with a war that they fundamentally didn't agree with. Are you also seeing moral injury as it relates to that?

Jeff Brown: Not as much because we have to remember that we are living in a day and time now where there is no draft. So people aren't pulled away against their will. I mean, we are fortunate that we have a military that is a volunteer force. I am a veteran myself. I walked down to the recruiter's office. I signed up, you know, on my own free will. And I am also a veteran of Operation Desert Storm. And sure, it was a very tough phone call for me to make to my parents to say I'm about to be deployed to Saudi Arabia. But, you know, it was what I had signed up for. And there is a definite sense of pride of serving your country. The people that serve in the military, I mean, they have a pride and a sense of purpose that is just second to none. So we don't see that today as we may have seen like in the post-Vietnam era where you had, you know, a draft in place. It was either go to college, I believe was the old story. You go to college or you go into the military. You know, you had your draft dodgers. You had people that were going to Canada or anywhere to get away because they were not fundamentally buying into the reason why we were in Vietnam. So we don't see that today like we did in the late '60s, early '70s.

Prakash Chandran: Yeah, I'm so glad that you made that clarification. And I think it's an important point to emphasize that this is all 100% volunteer-based. So we just have to be so grateful for the people that step up and rise to the occasion like yourself. So again, as I'm sure you've heard many times, we really appreciate your service.

So let's move back to this program. I want to learn a little bit more about how the St. Mary's Military and Veterans Health Program benefits the veterans that are coming in to see it?

Jeff Brown: Sure. Absolutely. And many people would say, you know, "Why can't, you know, veterans just access to VA?" Well, the VA system is stressed. I mean, just like normal community hospitals today that are coming through the COVID pandemic. You know, the resources and community hospitals are stressed, but they're even more stressed in the Veterans Administration. You know, their resources are limited. Their schedules are backlogged. And that's really where our Military and Veterans Health Program comes into play. You know, many veterans like myself have their own private insurance through their own employers. And it's just easier for us to access healthcare locally.

Additionally though, you know, the VA can't always provide a service or can't provide a timely service. And so the VA will reach out to community hospitals like St. Mary's for help. St. Mary's is a member of the Veterans Community Health Network. We take Tri-Care. We take CHAMPVA's insurance. So having community partners like St. Mary's is a win-win not only for the VA and for the veteran, but it's also a win-win for St. Mary's as well.

Prakash Chandran: Yeah. I don't think people have any idea the type of volume that the VA must see. You know, there are just so many veterans that are needing help and assistance that a program like the one at St. Mary's is critical to helping to assist and support the need that's out there. So I want to move on to the colleagues or the staff members at St. Mary's. How exactly are they prepared or trained to meet the needs of a veteran?

Jeff Brown: Great question. Veterans especially those that we talked about already that served during times of conflict, they just have unique healthcare needs. If you think about it, they have injuries that a normal community hospital just won't see on a regular basis. You know, I'll give you some examples. Blast injuries, especially those genitourinary injuries. Someone stepped on an IED or a mine, and that upward explosion just causes massive trauma to the inner thighs, to the lower pelvis. Another thing that you would see in this population is just traumatic amputations. You would see, you know, abdominal injuries that are just not from your normal car wreck. And then if you go backwards in time and going back to the Vietnam era, you see things, you know, like Asian Orange exposure. I mean, that is still very real to this day.

So in order for us to prepare our staff for that, all colleagues at St. Mary's are requested to take a two and a half hour military and veterans health training program. So this program is an in-depth dive into what it's like to serve in the military, to serve during a conflict and to simply understand military culture. During the course, our trainers go over different types of injuries and illnesses like the ones I just mentioned and others that are associated with that service in the military. And then to help guide our physicians and nurses, at the time of registration and intake, our registrations have a set of questions they ask all patients when registering for services here at St. Mary's. One of those questions is, "Are you a veteran? If the answer is yes, which branch of the military?" You tell them, and then it follows an algorithm that just takes them down a path.

All those questions are in our system. And so when the patient is sent on to their site for testing, or they're sent to see the physician, the nurses, the physicians, the technical staff, such as laboratory, radiology, they have access to all of that. And so it could lead them down the path of more questions that would be unique just for that veteran.

And lastly, before we send the patient off from the registration desk, we'd give them an identifier. All veteran patients get a patriotic red, white, and blue bracelet. And that just is really is a gift for them, but it's really more of a unique identifier for our staff. So when our staff sees someone that has one of those bracelets on, they know automatically, "Okay. This is a veteran. Thank them for their service. And then let's look and see what questions they answered and is this something that we need to know for their presentation and symptoms that they're having today."

Prakash Chandran: Yeah, it is amazing. You know, a lot of the things that you're speaking about, that specialized care that is required and that specialized attention isn't something that people normally think about, but it is so critically important to service the people that are really just defending our freedom. So it's wonderful that they go through that training program and you have these measures in place to recognize when there is a veteran in the program. How are these veterans responding to this program that you've put together?

Jeff Brown: Well, I'm going to be honest with you. The response has been great. I mean, it was a little slow out of the gate because we haven't really done a lot of advertising on this program because we wanted to get, you know, a certain percentage of our colleagues trained before we started to really roll this out on a more public basis.

But just in the word of mouth and a few speaking engagements I have done on the program, we have seen quarter after quarter our number of veterans that are showing up at our facilities increase even through the COVID pandemic, where we may have taken a slight dip one quarter when we were at our initial surge. We have seen those numbers bounce back and it's just been amazing to see. I know now that when I'm walking down the hallway, I'm seeing more and more, you know, patients and visitors in our hospital that's, you know, Navy veteran, World War II veteran, Vietnam veteran. You know, they have the hats on or the shirts on, and I always make it a priority if I see someone to stop them and say, "Thank you for your service" and just chit chat with them for a few minutes, because these people love to tell their story. As I'm a Navy veteran, so as we used to stay in the Navy, you know, we love to tell our sea stories, you know. So it's this really important for me to engage with these individuals. And it's really important that people see me as the leader of this program, engaging with our veteran patients and also with our veteran colleagues. I mean, we try everything we can on Memorial Day and especially on Veterans Day to recognize our colleagues for their services with just the social media campaigns -- so those social media campaigns have been very popular by the way -- and anything we can do just to raise awareness and to just recognize these people for their service.

Prakash Chandran: Now Jeff, I think it's clear that you are setting an example, you know, stopping and, you know, thanking people for their service. I'd love to actually focus on you for a second. You know, you mentioned that you were a Navy veteran. Why did you decide to either start or get involved with this program? Tell us a little bit about your journey and why this is so important to you.

Jeff Brown: Well, Trinity Health, one of the CEOs at our bigger hospitals in Maryland is a national retired brigadier general. He was a surgeon in the Army and this was his vision. And he hired someone to lead that program who is also a retired colonel from the Army, a retired surgeon. And so he came to St. Mary's I believe if memory serves me correctly in 2018. And he spoke to us about this program. This is something that they're trying to get started throughout Trinity across the country. And as I sat there and I listened to his presentation, I bought in right away. And as soon as that meeting was over with, I went to our CEO and said, "I'm happy to lead this. Please let me lead this. Please. Let me take this on." I just have a passion for this population. And I know that we have veteran employees that are here. I know that one of our principle trainers, she is the wife of a Marine of 20 plus years, 25 years I do believe. She wears that badge, you know, proudly and she is hands down our key trainer. And I've had colleagues stop me in the hallway after going through her training class and they say, "I had no idea" or the funny thing I hear is, "You didn't tell me I was going to need a box of tissue to get through this two-and-a-half hour class." But her name is Ann Gomes. She does a great job with this program.

And, you know, when you have a passion for something, it's not work, you just do it. And for me, this is not another thing on my task list I have to check off at the end of each day or the end of each month. This is something that just comes very naturally. And I wanted to give back because I, I've been in. I've done it. I've had to make that phone call to my family. And I just want to give back.

Prakash Chandran: It's truly amazing, Jeff. Before we close here today, I just wanted to ask you, what do you feel are the biggest healthcare challenges facing our veterans and active duty military today?

Jeff Brown: Really, you know, just those invisible scars that we talked about early on. You know, if you think about you're in an environment that you can't escape and you're under a constant state of stress, the entire time you're there, there's never a way to relax. There's never a way to get away from it. There's always some loud bang off in the distance. And, you know, you know what that is aimed at. There's somebody out there who's trying to do you harm. So when you come back to society, normal society that we know, you know, it's hard to let that go. And re-assimilating, getting back into normal society can be a challenge.

So the VA will tell you one of their biggest challenges is mental health. But, you know, we have a mental health challenge across this nation as it is. But when you add all of the things that the combat veterans have seen and dealt with, you add that into it, there's no reason why when you look at the statistics about veteran suicide, you know, there's no reason that explains why that number is so high and we really need to do all we can to help these folks assimilate back into society, help give them the support they need, that they're safe, that they're back in a friendly land and they're safe. And when a car backfires, you know, going down the street, it's not someone shooting at them.

Prakash Chandran: So I have two things that I want to ask before we end today. The first is that there's going to be potentially a veteran or someone who is in active duty that is listening to this, that, you know, I imagine this might resonate with them, maybe they're even in a place where they don't think that they need the help. You've probably worked with a lot of these people before. Is there a message that you want to leave them with?

Jeff Brown: You're not alone. Come here. We'll get you the help. If we don't have the help immediately available, just come here, we will get you the help you need. But you're not alone.

Prakash Chandran: And finally, you know, people that are not in the military or they're not veterans like myself, you know, outside of thanking everyone for their service, what is something that we can do to help?

Jeff Brown: I'll be honest with you. Just thanking them for their service is really all that a veteran needs. I mean, when people stop me and say, "Oh, thank you for your service," I already don't even know what to do with that, you know? It means a lot when someone says it, but, you know, I volunteered. I love the country I live in. I love the people that I served. I did it for my family. I did it for, you know, my fellow Americans. So, you know, just thanking them for what they did, thanking them for their service, that goes so far. But if you pick up on a cue that someone needs a little bit more or they may be struggling, just tell them about this program and tell them to come to St. Mary's and we will do everything we can to get them to help they need.

Prakash Chandran: Well, Jeff, I think that is the perfect place to end. Thank you so much for sharing more about this program today. And again, just thank you so much for your service and for the sacrifice. And it's hard for me to, honestly, not to be choked up a little bit just hearing you talk. But I just can't tell you how appreciative I am, that there are people like you. And I know that there's a lot of them that are willing to volunteer and sacrifice themselves for the freedom of this country, so thank you again.

Jeff Brown: You're very welcome. And thank you for having me.

Prakash Chandran: That's Jeff Brown. He's the Vice President of Support Services at St. Mary's Healthcare. For more information, you can visit stmaryshealthcaresystem.org, and you can click find a service or specialty at the top of the page and search for military and veterans. And the first link that you click should take you directly to the program home page.

If you found this podcast helpful, please rate and share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This has been a Mission In Action, a podcast from St. Mary's Healthcare in Athens, Georgia, focusing on how we provide patient-centered care under our mission to be a transforming healing presence within our communities. Thanks for listening.