National Rural Health Day Raises Awareness for Veterans in Need

By Laura Phelps

Young people living in rural zip codes are more likely to join the Army than others -- but when they return home, they're without basic services and help

Phelps-Post.jpg

When Technical Sgt. Tom Marcum returned home to his wife on September 22, 2008, after nine months in Iraq, the couple of 18 years were elated to see each other. But the joy soon faded when April Marcum realized that, although her husband looked the same, he was not the same man she had known most of her life.

"Within a few days, I started noticing he was not himself," she said. He had told her about the explosion on the phone, but downplayed his injuries to just some ringing in his ears.

Sgt. Marcum was deployed as a combat arms weapons expert to the Ali Air Base in Iraq when he was injured in July 2008. He was getting a mobile armory ready for transition and working outside by himself when incoming mortar exploded 35 yards away.

After returning home, he would call his wife from his job at Moody Air Force Base in Georgia because he wasn't sure where he was supposed to be. He would have trouble remembering if he had eaten breakfast so he would just eat twice. But when Marcum sought treatment at the small medical clinic on the base, he was tested and told to just "suck it up and go back to work."

At a later evaluation at the Veterans Administration's Tampa Polytrauma Rehabilitation Center in Florida, he was diagnosed with a "traumatic brain injury with a blow-out fracture to the right orbital wall; he had vision, hearing, and cognition deficits with short-term memory loss and chronic migraines. He also sustained a right shoulder injury and has an otolith disorder." On top of all of that, Marcum was told he had post-traumatic stress disorder.

Today is the first National Rural Health Day, and VA Office of Rural Health (ORH) Director Mary Beth Skupien said she's proud of how far the office has come since it began three years ago. The office is most focused on getting veterans better access to care close to home and specialty care in their communities, she said.

Forty-one percent of veterans in the VA system live in rural areas, according to ORH. There are 22 million veterans, and 6.1 million live in rural areas, of which 3.3 million are enrolled in the VA system. A study from ORH found that distance was identified as the most important barrier for rural veterans seeking care.

Plus, soldiers from more recent wars are increasingly coming from rural areas, and rural VA users also are growing, according to the office. Young people living in rural zip codes are 22 percent more likely to join the Army.

April Marcum described the process of seeking medical care as "a lot of unknowns" for her husband and family members. They have two boys -- Jared, 14, and Gabe, 11, who was diagnosed with secondary post-traumatic stress disorder even before Marcum got his proper diagnosis. After finally navigating the system, April Marcum said they have found doctors who are making a real difference in their lives. "We have some truly amazing medical people that are on our side who want to help Tom as much as I do," she said.

But, like many other rural veterans, the problem is that the VA hospital they go to for this care is two hours away from their home in Ray City, Georgia, and the closest Vet Center is over an hour and a half away. There is a community-based outpatient clinic about 20 miles from their home, but April Marcum said the clinic is very limited in what can be treated there.

The Marcums are not the only ones for whom distance is a problem when seeking care. While psychiatric disorders are lower among rural veterans seen by the VA compared to those in urban areas, rural veterans often have lower health-related quality of life, according to ORH. Rural veterans are also less likely to access their care, despite greater health care needs, the office stated, and, particularly, veterans have lower access to care for PTSD.

In May 2010, Marcum was placed on a temporary duty retirement list. A year later, the couple went to San Antonio, Texas, for a re-evaluation by the medical board. In September, April Marcum said they were told her husband would be officially retired on November 6. She said she was upset that he did not receive a letter thanking him for his nearly 15 years of service. Now Marcum no longer reports to work, and April Marcum has had to quit her job look after him.

Marcum was a career military man, but his pay from the Air Force quickly dropped from $4,000 a month to $1,800 a month. The Marcums had to start paying Tricare premiums and copays. Because Tom Marcum did not have the joint Department of Defense and VA rating when he retired, he could not apply for combat-related special compensation or many non-profit grants.

While Marcum walks with a cane with a religious fish symbol carved into the handle, it would be difficult otherwise to pinpoint him as a wounded veteran. He doesn't seem to be someone that would need constant supervision, but he does. And no longer being able to provide for his family has brought about a whole new set of problems, according to April Marcum. "He needs to be supervised to prevent him from harming himself or burning our house down," she said.

The family quickly found themselves dipping into their life savings of close to $20,000, and in a year it was gone. She said if it wasn't for non-profit assistance paying their mortgage, she's not sure what they would do.

* * *

Only nine percent of all physicians, 12 percent of pharmacists, and 10 percent of all psychologists/psychiatrists practice in rural communities, according ORH. That poses unique problems for health providers, and they're turning to telehealth as a solution.

ORH now has telehealth projects that can treat for cardiovascular care, gynecology, diabetes, mental health, and other issues. Procedures like mammograms and pap smears can be done from a closer, telehealth location with a registered nurse and video conferences. "At first we didn't know how veterans would like it," Skupien said. But an ORH survey shows most do.

And, the office just launched the ARCH project to contract out care, which is uncommon for the VA. The pilot will run for three years and is being offered in five communities: Caribou, Maine; Farmville, Virginia; Pratt, Kansas; Flagstaff, Arizona; and Billings, Montana.

The Marcums had a video phone installed in their home by the VA, but only occupational therapy providers are willing to use it.

While his family is doing better managing the stress associated with Sgt. Marcum's injuries, times are still hard. April Marcum said her youngest son, still struggling with secondary PTSD, continues to have anxiety issues that makes it hard for them to travel for events like September's Defense Forum panel held in Washington. Still, Tom Marcum said both of his sons have talked about joining the military. And he will support them if they enlist.

Image: Laura Phelps.

This article available online at:

http://www.theatlantic.com/health/archive/2011/11/national-rural-health-day-raises-awareness-for-veterans-in-need/248347/