Part II: Meeting the challenge on the front lines

Published Aug. 22, 2006
By Master Sgt. Orville F. Desjarlais Jr.
455th AEW public affairs

KANDAHAR AIRFIELD, Afghanistan -- EDITOR'S NOTE: This is the second in a series of three articles about Air Force combat stress control teams in Afghanistan treating troops on the front lines.

Fifty percent of all service members who visit a combat stress control team at Afghanistan forward operating bases are diagnosed with combat-related stress.

"Just knowing they're not crazy makes them feel better," said Capt. Will Moore, a member of the Kandahar combat stress control team.

The team is here at the request of the Army, called a request for forces. The Airmen augment the Army with psychologists, psychiatrists, social workers and mental health technicians. Both Canadians and Americans make up the Kandahar team, which sends even smaller teams to the field in their battle against combat stress.

The Air Force sent its first teams under the current RFF earlier this year. Today, the teams are late into the second rotation, which began in April.

Mental health professionals say military members are more apt to recover quickly if they are treated at or near their forward-deployed location, such as at forward operating bases, or FOBs.

Treatment on the front lines
"The further we send them to the rear to receive treatment, the less likely they are to be returned to duty," said Lt. Col. Rhonda Ozanian, combat stress control team leader, Task Force Med., at Bagram Airfield, Afghanistan. "If we treat them close to the fight such as at the FOBs, we return troops to duty more quickly."

She compares the situation to troops on mid-tour leave.

"Sometimes military personnel don't want to return," she said. "As they get closer to returning, or as they wait to return to their FOB, the burden of the return becomes heavier and heavier."

Colonel Ozanian said studies have shown that treating military members close to the combat operations - with the noise, the bombings, the gunfire, the food, the smells - is important for a quick recovery. She said she doesn't want troops receiving treatment for combat stress to forget they are in a war. "We want them to stay in proximity to their unit to help them cope with their problems," she said.

The colonel said treating close to the battle also helps with unit cohesion. Separating a service member from a unit causes that patient to disengage psychologically and makes it much harder to become part of the team again once that person has recovered. Treating them on site alleviates that problem.

"This is a place where bad things are happening," said Maj. Jocelyn Kilgore, Kandahar's team chief. She's a psychiatrist from Andrews Air Force Base, M.D. "The events are not 'normal' for what we know back home, and the expectation can be to react as if it were normal."

Combat stress can build up in troops over time and take its toll, or a "significant event" can trigger it, like an improvised explosive devise detonation.

"A unit may have seen two of its personnel get blown up by an IED," Colonel Ozanian said. "We no longer rush in to do critical incident stress debriefings. Now, when a significant event occurs, the combat stress control team holds back and allows the unit to pull together, to talk, to bond and to try to make sense of what happened."

"Later," she said. "We step in to help with acute symptoms management and to conduct psychological debriefings if needed."

Needful of R & R
One approach to lessen chronic stress buildup from combat conditions is the Army concept of unit restoration for members showing significant signs of stress. The concept is simple. Basically, they allow their members 24 to 72 hours for the five Rs: Rest, reassurance, replenishment, restore confidence and return to duty.

"This approach, often used informally, allows commanders and first sergeants to pull back troops just slightly in order to reconstitute before returning to the fight," Colonel Ozanian said.

At Tarin Kowt Forward Operating Base, Afghanistan, troops need only dial 9 then their stateside telephone number. No phone cards or charges apply. They also offer free internet access - even wireless.

"A chance to communicate back home is a morale booster for all of us, but for personnel whose missions take them to remote sites facing high-intensity operations coming in for a shower and a phone call is huge," the colonel said.

When a troop needs more than the unit can provide, that's when the combat stress control team steps in.

"People discover that their coping skills are not working as well as they used to," Major Kilgore said. "We then need to teach them new skills."

To teach new skills to the people who need them, the combat stress control team must visit the FOBS, and they get there any way then can, be it airplane, helicopter or convoy.

"Our teams can easier relate to someone's experiences if they, themselves, have been on a ground assault convoy, or ridden in a Chinook (helicopter)," Major Kilgore said. "We get to see our patients at the most fundamental levels. We get to sit where the Soldier sits, convoy where they convoy and eat where they eat. It's important for us to see the battlefield through their eyes."

FOB hopping
The combat stress teams are making more visits to forward operating bases, which they call FOB hopping, than last year. In July 2005, teams were forward deployed to FOBs a total of 38 times. In July 2006, they spent a record 112 days forward deployed.

The Air Force team consists of a psychologist, two psychiatrists, three social workers and six mental health technicians. From that team, smaller forward-support teams may be made up of only two people each, which are pre-positioned across the theater.

Teams bed down at FOBs for three to seven days, teaching stress preventive measures and treating patients when the need arises. They work closely with chaplains and other medical professionals. Like chaplains, they, too, walk around -- which they call "walk-abouts" -- to provide easy access to troops, sometimes having to put up with some good-natured ribbing.

"When we walk around, a guy will grab his friend and say, 'You need to talk to this guy,' or 'You found me!'" Captain Moore said.

While doing walk-abouts, the captain said he also assesses each base by chatting with the service members.

"People are very honest about their circumstances. They aren't afraid to say something sucks or that it's great," he said. Later, he makes suggestions to the commander.

"The mission is most satisfying," the captain said. "Of all the things I've done in my life, I can say this is the most meaningful. I can see I make a difference. Deployed personnel are having a significant struggle and have seen things so horrifying that they can't seem to function. To be able to work with them and to see them improve is so rewarding I can't describe the feeling. It's an experience of a lifetime."

Psychiatry is a word derived from the Greek for "healer of the spirit."

How apropos.

(Next, Part III: Ways to recognize and treat combat stress)