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Serving veterans

Otago's Health of Veterans, Serving Personnel and their Families Research Theme is raising the profile of, and providing a more co-ordinated approach to, the health-care needs of our military veterans.

As the centenary of the start of World War I approaches, now is the time to focus on the health of our contemporary veterans, says Associate Professor of Occupational and Environmental Medicine David McBride.

McBride is the director of the University of Otago's Health of Veterans, Serving Personnel and their Families Research Theme, which brings together Otago researchers who have an interest in issues that affect veterans.

The theme's steering committee includes Professor David Baxter (Dean of Physiotherapy), Professor John Broughton (Preventive and Social Medicine, Director of the Ngāi Tahu Māori Health Research Unit), Associate Professor Brian Cox (Director of the Hugh Adam Cancer Epidemiology Unit), Associate Professor Darryl Tong (Oral Diagnostic and Surgical Sciences) and formerly included Dr Karen Brounéus (Centre for Peace and Conflict Studies).

“The way that New Zealand took part in the Great War is regarded, by some, as a national coming of age,” says McBride. “The research theme came about partly because the timing was right, with the Anzac centenary coming up.”

Prior to the establishment of the theme, no one was really looking at the health of veterans and Veteran Affairs New Zealand was not commissioning research, he says. Researchers were involved with the military, but there was no overview or co-ordination.

“The initial aims were to get some research off the ground, bring people together and raise the profile of military veterans' health care. We've certainly done that.
“One of our major aims was to develop collaborative links, especially with CAMVH – the Centre for Australian Military and Veterans' Health – and the Canadian Institute for Military and Veterans' Health Research [CIMVHR]. Last year CIMVHR had an international symposium for the first time and we were invited.”

The University already had a Memorandum of Understanding (MOU) with the Centre for Military and Veterans' Health at the University of Queensland and has since developed another with the Uniformed Services University of the Health Sciences (USUHS) in Washington.

In 2011, Otago signed a MOU with the New Zealand Defence Force, making the University a preferred provider of research services for the military.

“That kind of formal relationship is important when working with the military. If they need information or policy advice, for example, it can lead to research opportunities.”

Having an army background has helped when it comes to understanding how the military works and what soldiers are facing, says McBride. He is a Lieutenant Colonel in the Royal New Zealand Army Medical Corps and had been a reservist in the British Army since 1973. He served with the New Zealand Army in East Timor in 2000 and 2001, and in Afghanistan in 2005 and 2011.

“Being on operational service tends to give you a different perspective. If we put people in harm's way, we should minimise the risks as much as we can. There's enough risk from improvised explosive devices and ballistic injuries without suffering diseases and other illnesses and conditions that are preventable. We don't want Agent Orange to happen again.”

A key challenge is to get commanders interested in “doing it better”, especially as occupational health and safety has been viewed in the past as something that stops people from doing things, says McBride.

“Commanders are responsible for the health, safety and welfare of troops. We're asking them to think about the immediate consequences of hazards, but also about the long-term impacts. There is health information coming through, but commanders need advisors to help interpret it.”

New Zealand also has a responsibility to its international partners, he says.

“New Zealand needs to pull its weight in commissioning research – to contribute to knowledge. We need to be good corporate citizens of the wider international community.”

One of the major pieces of research to have already come from the research theme is “The Mortality and Cancer Experience of New Zealand Vietnam War Veterans Cohort Study”, which showed that New Zealand and Australian soldiers who served in the same location in Vietnam had an increased rate of leukemia and head and neck cancer.

“The Vietnam veterans' study was carried out in close association with the veterans and we are using it as a model. The veterans are very keen that we learn from their experiences with adverse exposures and that it does not happen again.

“We still have to be more certain about the environments in which we're deploying and what the risks are. We're getting a lot better at that, which is where research can inform practice.”

Another project is looking at otoacoustic emissions technology to assess firearms impulse noise and to detect early noise-induced hearing loss.

“There is also ongoing research into biomechanics, which is all to do with the mechanics of load bearing. There is a high level of lower limb injuries, such as rolled ankles, in the military. It's somewhere that we really must apply prevention.

“We ask, 'How is this intervention going to benefit a soldier, sailor, airman etc.?' If it's not going to, why do it?”

Gathering input from a range of people is an important part of the process, says McBride. The theme holds an annual colloquium – an “informal gathering” for academic discussion.

“I think that we have been very successful, in the years that we have been running these, in engaging a wide audience that includes serving personnel and families along with the veterans themselves. They know the problems that need to be solved.”

A major difficulty of studying veterans' health is identifying the veterans. The Vietnam study was made possible because an artillery officer, Con Flinkenberg, did not throw out pay records from the 1970s and they could later be used to identify veterans.

McBride is currently working on a research proposal to establish an “Anzac cohort” that would identify veterans and find out if they have particular health problems.

“More contemporary operations have been in peace-keeping or enforcing, and the troops are classified as veterans by the Defence Force – they go on a potentially hazardous operational deployment. But they don't think of themselves as veterans.

“The Defence Force also doesn't know how many of their personnel identify as being Māori. They don't see any need because of the strong cultural heritage, so there is no ethnicity indicator in the records. We know that Māori have poorer health in general, but not so in the military. To find out why, we would have to go out and ask the standard census questions.”

With the research theme now in its third and final year, McBride is looking to the future and the possibility of creating a research centre for veterans' health at the University of Otago.

“We can achieve quite a lot in three years: during the first two years we were getting out into the defence community and sowing the seeds of ideas, and these are now starting to grow. People are seeing the benefits of engaging with the University community.”

There are many areas that need further research, he says, such as the post-conflict re-integration of servicemen. The military is also not immune to the problems facing society in general, such as substance abuse, family violence and mental health.

“Mental health is not as visible as physical health within the defence force. Shell shock in World War I was not recognised and in World War II mental injuries were not dealt with well at all. People carried the scars to their graves.

“In the First World War they used to talk about 'a lack of moral fibre' as being a weakness in the individual. We now know much more about post-traumatic stress disorder. We need to find better ways to identify it, treat it but, most importantly, prevent it.”

McBride believes a veterans' health research centre could serve as an “interface” between the military and the University.

“Other universities are involved with the military and there's quite a lot of ad-hoc research on military topics, but no co-ordinated approach to it. I believe a centre would give Otago a strategic advantage over other universities.

“It is a model that has worked well in Australia and Canada. It would be nice to think that we could do it here.”


Photo: Alan Dove
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