"There have been times when the stories I have heard are so sad or horrific that I have said to myself, 'I should not be hearing this.'"
These are the words of Charles Kaiman, a clinical nurse specialist at the New Mexico Veterans Affairs (VA) Health Care System in Albuquerque, who has spent almost three decades bearing witness to the effects of posttraumatic stress disorder (PTSD) in combat veterans. His e-mail message to me continued: "I do this work because it's helpful to patients-many improve or fully recover. It also puts me in touch, every day, with fundamental aspects of life, of death, of suffering, of meaning or no meaning. How many jobs do this?" He copes with his own risk of secondary PTSD through painting, and a number of his artworks have appeared in these pages.
I wrote to Charlie because of two coinciding anniversaries. This month we observe the 100th anniversary of the Navy Nurse Corps and the fifth of the Iraq war. These markers remind us of the life-saving dedication of navy nurses and also of the American lives lost in the Iraq war-a war that Los Angeles Times reporter Marjorie Mills characterized on The News Hour in March as "a story that people want to go away."
"I should not be hearing this": it's a common feeling about this war now. But should military nurses be the only ones to listen? It's one reason that AJN is featuring the Navy Nurse Corps on the cover and on page 40. Military nursing has a proud history of advancing both the nursing profession and the care of wartime wounded. In the Iraq and Afghanistan wars, the unprecedented use of improvised explosive devices has led to life-threatening injuries to soldiers. Military nurses-along with advances in the immediate treatment of these injuries-have been central to a mortality rate of about 10% among injured soldiers-a rate dramatically lower than the rates in World War II and the Vietnam War: 30% and 24%, respectively.
We celebrate the work of navy nurses as we acknowledge that more than 4,000 American soldiers have died in Iraq and 30,000 have been injured, some disabled for life. Estimates of the number of Iraqi civilians killed range from 82,000 to more than 600,000, and according to a new report-Five Years Later, a Hidden Crisis-from the International Rescue Committee (IRC), roughly 4.5 million Iraqis have been forced from their homes. According to my calculation, this represents almost 20% of the prewar Iraqi population-the equivalent proportion of all of the residents of the top 50 U.S. cities. The IRC calls it "one of the largest humanitarian crises of our time," one that is largely invisible because the refugees are dispersed in cities and not gathered in camps.
Many Iraqis who have been uprooted are middle-class professionals-teachers, nurses, professors, engineers-who now live in poverty: without jobs, adequate housing, access to health care, or education for their children. Michael Kocker, acting vice president for international programs for the IRC, told me that the safe return of this class of refugees to Iraq is essential for its rebuilding. Those who worked with the U.S. military or contractors are in particular danger, and few have been able to parlay their collaboration with American forces into refuge in this country. The report notes that only 1,608 Iraqi refugees were permitted to resettle in the United States in 2007-far short of our government's supposed target of 7,000. (For more information go to http://www.theirc.org.)
I once had a discussion with a career navy nurse who opposes the current war in Iraq. I asked her whether that caused her any cognitive dissonance. She said no, that American soldiers deserved to have the best of care and she was committed to providing it. It's that dedication to saving and restoring lives that characterizes the careers of the military and VA nurses I have known. All nurses can do their part to care for and about those who bear this war's wounds and scars-whether they're soldiers or civilians.