Home from war: U.S. experts share experience in post-deployment care for returning combat veterans with Ukrainian volunteers

On 3 July Ukrainian volunteer community working with combat veterans – Ukrainian servicemen back from ATO familiarized themselves with best practices of U.S. post-deployment care for returning veterans through a webinar.

The online event entitled “Home from War. Integrated Post-Deployment Care: Reunion, Recovery and Reintegration” was presented by two U.S. experts: Lucile Burgo-Black and Stephen Hunt. Both employed with the US Department of Veteran Affairs: Mrs. Burgo-Black is the National Co-Director and Mr. Hunt is the National Director of the Veterans Affairs Post-Deployment Integrated Care Initiative the experts were present in their unofficial capacity at the webinar. Lucile is an internal medicine specialist and Stephen is an occupational and environmental medicine specialist, both of them have been taking care of combat veterans for over 20 years.

The webinar looked at the spectrum of problems that returning combat veterans face and at integrated ways to address them. Organized by Ukrainian volunteer organizations working with ATO veterans: charity fund “Save Ukraine”, initiative “Center for Employment of Free People” and NGO “Ukrainian Association of Professionals for Overcoming Consequences of Traumatic Events” (or NGO “Psychological Crisis Service”) the webinar was followed live by up to 100 viewers, was later posted on You Tube and viewed over 600 times. According to Oksana Voropay of the “Center for Employment of Free People” – initiative that among other work directions helps find jobs for returning Ukrainian servicemen the webinar audience was rather broad and reached far beyond professional psychological community. And that’s what it was meant to be. According to Halyna Tsyhanenko, Senior Research Associate at the Institute for Social and Political Psychology within the National Academy of Pedagogical Sciences of Ukraine, co-founder of the “Psychological Crisis Service” NGO it is quite often that “people not engaged into volunteering or combat actions directly have certain prejudice towards returning servicemen. As per my observations it is primarily caused by information coming from media […] on possible post-deployment disorders,” says Halyna. In this context, she continues “the webinar aimed to create accepting attitude [towards the veterans – edit.], demonstrate that they are common people, that in majority of cases they can cope on their own as well as show how they can be reintegrated as deployment cannot pass unnoticed for mental health even of a mentally resilient individual.”

According to the U.S. experts while each conflict and each veteran have their unique issues there are common conditions that veterans face in most conflicts. Risks and health changes they face can be split into three categories: physical health risks, psychological and social health risks. “Most common conditions for all conflicts are musculo-skeletal injuries with pain, diagnosable and sub-threshold mental health conditions, […] unexplained symptoms […] such as fatigue, mild cognitive disturbances, problems with memory and concentration,” says Lucile Burgo-Black. “In addition to these clinical concerns we see psycho-social concerns impacting family, relationships, education, work, finances and the general quality of life,” the internal medicine specialist continues. “One of the things that we have learned in our nation over the past decade with the conflicts in Iraq and Afghanistan is that there is overlap between many of these conditions,” notes Stephen Hunt. “So it’s important to remember that we’re looking not just at injuries and diseases but we’re looking at general physical health changes,” he adds.

Photo: screenshot of the “Home from War” webinar

Commenting on the presentation slide set to demonstrate the spectrum of problems that veterans face following deployment Stephen Hunt says: “Sometimes as clinicians or healthcare workers we think in terms of the left side of the diagram: PTSD [post-traumatic stress disorder – edit.], depression, chronic pain, TBI [traumatic brain injury – edit.]. What the veteran and their family experience is on the right side of the slide. Our relationship is suffering, or I’m having financial problems, or I’m not able to function socially”.

Halyna Tsyhanenko who has been consulting returning Ukrainian combat veterans as volunteer psychologist since early days of ATO shares her experience on what the most common problems that they bring to the table are. “These are problems with sleep. However their main question is that their families do not understand them. He has managed to set up relationships of trust at the front, when he is back he misses those relationships, while his family does not understand that, because they were expecting the same man that departed, and he is back and is different. [Veterans face the need to] first adapt at the front, and then here, it is a huge overload for psyche,” notes Halyna. “Another aspect is the family is waiting for its serviceman to come back, he is back to have a rest and the family that is welcoming him also wants to have a rest. Because while he was out there the wife was working more than usual, was overloaded, was taking care of children and family, was waiting for him, busy sending him something, worrying about him. When he is back he is psychologically not ready to take up all his regular functions while the wife wants to give them away already. Because she is tired as well. Here is where the conflicts start that often even ruin relationships”, says Halyna. “It is in a way reintegration of the family and it develops relations at the same time. If a family gets to the new level of interaction, mutual understanding and acceptance it only tightens relationships,” she explains. There are also some particular cases. “One serviceman told me that after being back he did not want to take off his military clothing. He kept wearing it while sleeping,” says Halyna. “He needed some time to get used to sleeping in bed, get adjusted to the temperature, air, he said he was running outside all the time, found it hard to stay inside the apartment, lacked air.” The adaptation period is quite important including its psychological, physical and social aspects, sums up the psychologist.

Photo: NGO Psychological Crisis Service, http://psyservice.org 

The approach that the U.S. experts presented looks at the spectrum of problems that returning combat veterans face in an integrated way, sees them as a whole. Thus, post-deployment care is also designed in a comprehensive integrated way having as actors not only veterans and healthcare specialists but also veterans’ families and communities as a whole. “What we have to try and do as a community, as clinicians, as a nation, we are the red circle, we are trying to work together to provide support to our veterans and their families for all of these concerns in an integrated way,” says Stephen Hunt. “If we just address one of these issue separately from the others we may not in the end succeed. We have to try to provide accessible integrated support for all of these concerns.”

In course of the Q&A session that followed the presentation the online audience was able to ask questions through Facebook and YouTube. People were interested how a family may get prepared for the return of the serviceman back from war; how to deal with veteran’s flashbacks and memories re-experiencing; what the U.S. state programme for reintegration of veterans is like etc.

Photo: screenshot of the “Home from War” webinar

While answering these questions the U.S. experts tried to elaborate on the practical aspects of their work so that their experience can be of maximum help to the Ukrainian community. “Often it may be helpful to have another veteran talk to the veteran, another veteran who’s had treatment talk to the veteran to say: I was having flashbacks also and here is what really helped me,” emphasized importance of peer help Stephen Hunt answering the question on how to best address veteran’s flashbacks and returning memories. “There are many grassroots organizations that have sprung up with volunteers partnering with the [U.S. – edit.] Department of Defense, with the VA [Veteran Affairs – edit.] to provide support within communities,” Lucile Burgo-Black reflects on the U.S. experience in raising veterans’ awareness of services available to them. “The challenge is to help the veteran be aware of these resources. Having a reliable point of contact who can help put these pieces together is very important. One strategy is to have a centralized web portal for volunteer organizations to put their services on the web. This way everyone can see and then put these pieces together.”

According to the organizers the webinar came as an answer to the existing needs of the volunteer community in Ukraine that works to reintegrate the veterans. Ukrainian volunteers were put in touch with the U.S. post-deployment experts by a U.S. ecologist who came to Ukraine as a volunteer himself, compassionate about the situation. He identified the need for expertise in setting up post-deployment care and helped find the experts. “We were very pleased to be contacted by you,” says Stephen Hunt. “Because wars are occurring all over our planet, all nations, and many people are suffering, veterans and civilians, both. There are things that we can do to support these individuals. And we look at this as the veteran is supported by their families, that are supported by their communities, that are supported by their nations, and that all of us as a species, as a community of nations can support one another in trying to address this suffering, we’re all in this together.” “The place for your combat veterans will be unique to Ukraine and to your current realities,” notes Lucile Burgo-Black. “We will be learning from you as you might learn from us and we thank you for that.” Ukrainian community intends to keep on with webinars on post-deployment care, encourages fellow colleagues to identify the areas of their interest so that each next session is focused on a specific issue, topical to the community.

The webinar “Home from War. Integrated Post-Deployment Care: Reunion, Recovery and Reintegration” is available online in English and Ukrainian.

EMPR