Civilians Get Up-Close Look at Naval Warrior Care

Navy Rear Adm. Christine S. Hunter, commander of Naval Medical Center San Diego, talks with alumni of the Joint Civilian Orientation Conference, a DoD community outreach program, during their trip there Nov. 21, 2008. The group received an insider’s look at the state-of-the-art warrior care provided at the facility. DoD photo by Fred W. Baker III   (Click photo for screen-resolution image);high-resolution image available.

The group of alumni of the Joint Civilian Orientation Conference, a Defense Department community outreach program, toured the massive complex nestled in the hills here that provides medical services to 250,000 active-duty servicemembers, their families and retirees.

Nicknamed Balboa because it’s located next to the city’s Balboa Park, the facility boasts nearly 6,000 staff made up of about an even mix of military and civilians, said its deputy commander, Navy Capt. Paul D. Pearigen.

In addition to serving those living in the region, the facility provides health care services for 50 Navy ships, five submarines, 168 Navy squadrons and three Navy bases. It also serves Marines at nearby Marine Corps Air Station Miramar and Marine Corps Recruit Depot. It has 11 medical clinics and 10 dental clinics spread throughout the county.

The 268-bed, multi-specialty facility has served the area for more than 80 years, and splits its mission among preparing to deploy its medical teams in support of operational forces, delivering health care to the region and shaping the future of military medicine through education, training and research.

On any given day, the pharmacy will fill 6,500 prescriptions, totaling about 2.4 million annually. It handles 4,000 dental visits, gives 1,000 immunizations daily and delivers about 300 babies monthly, Pearigen said.

The blended staff gives variety and stability to the facility, as active-duty personnel rotate out and others are deployed, Pearigen said. In 2008, the hospital deployed nearly 700 of its active-duty force to fill key medical roles abroad, including in Iraq and Afghanistan. It also deploys medical staff in support of the San Diego-based Navy hospital ship the USNS Mercy.

The civilian group was treated to an insider’s view, donning scrubs to tour the hospital’s operating rooms which feature some of the latest in high-technology computer systems and robotic surgery and receiving a demonstration of a new $3 million imaging system that scans patient’s problem parts and renders four-dimensional models, allowing better and safer diagnosis and treatment, doctors said.

They also toured the year-old $4.4 million Comprehensive Combat and Complex Casualty Care, or C5, facility and a new 8,000-square-foot Fisher House. In the complex’s mental health department, the group saw the Navy’s latest efforts at treating post-traumatic stress disorder in a virtual reality lab.

“We are very privileged and honored to be able to provide these kinds of services to our wounded warriors,” Pearigen said. “For our staff to be able to able to provide our patients with cutting-edge technology and diagnostics, and really be able to provide the best of the best to our patients … is a real thrill for all of us.”

The C5 facility was created because of a gap in comprehensive rehabilitation services for limb injuries and amputations for servicemembers who were based and whose families lived on the West Coast, Pearigen said. Before, most of those cases received care at East Coast facilities such as Walter Reed Army Medical Center in Washington, D.C.

“For those family members who are from California or Oregon or Nevada, to have to go to the Beltway for seven, eight, nine months or more … to work through that rehab was obviously quite challenging,” Pearigen said.

Because of the large Marine presence in the region, as well as an Army presence from the nearby National Training Center at Fort Irwin, Calif., there was a need for a West Coast center of excellence for amputee care, he said.

In fact, more than 25 percent of servicemembers needing rehabilitation services for limb injuries and amputations from combat were based or from the West Coast, said Jennifer Town, director of the C5 program.

“We wanted to get those servicemembers closer to their units and their families for their recovery,” she said.

Work on the multi-million dollar facility began in November 2006, as a 27,000-square-foot facility used for physical and occupational rehabilitation was gutted.

The facility re-opened in October 2007 and now includes a gait lab that helps diagnose servicemembers’ use of their prosthetic legs, a prosthetics lab and a physical therapy room that looks like a high-tech gymnasium with a range of muscle- and cardio-development machines. An occupational therapy room resembles an apartment with a bedroom, kitchen and bathroom. There, those in therapy re-learn daily tasks using their prostheses, such as making a bed, cooking and changing a child’s diaper.

The centerpiece of the complex is a 3,500-square-foot courtyard converted into an all-terrain area, where servicemembers learn to adjust and work through real-life scenarios such as adjusting to varied stair heights and maneuvering on different ground surfaces and ramps. A 30-foot climbing wall spirals toward the sky and is used for rebuilding upper-body strength and improving agility.

“This is getting servicemembers back to the activities of daily living,” Town said. “In the Vietnam era of health care, all of these servicemembers would have finished their inpatient care and been discharged from the military and gone into the VA system for their follow on care. But … we’re retaining many of these servicemembers who want to stay on and are capable of staying on.”

The complex has two pools -- one for therapy and the other for an adaptive kayaking program, in which the kayaks are modified to accommodate servicemembers’ injuries. Many of the servicemembers are eager to re-learn how to manage the sporting activities they enjoyed before they were injured, and others want to try new activities, such as snow boarding, surfing and climbing, Town said.

“There’s an incredible spirit of resiliency with these servicemembers,” Town said. “Recreational therapy has been a really great avenue to plug these servicemembers into part of their rehabilitation and recovery care plan, because … these are young athletic kids that were doing a lot of different types of sports and activities before they were injured.

“We’re either trying to get them back into the activities they were doing before their injuries, … or we’re plugging them into doing things they never thought they would be able to do,” Town said.

At the mental health facility, the group was able to virtually get a feel – and a smell – of the battlefield.

The facility uses virtual reality to recreate the sites, sounds and even the smells of battlefield events that have caused post-traumatic stress as part of a treatment program aimed at lessening the effect the event has for the servicemember, said Dr. Robert McLay, research director for the mental health department.

“For a long time, it seemed that some soldiers just came back [from war] mentally broken,” McLay said. “To some extent, it seemed that a lot of them didn’t get better. Some of them did. Some of them didn’t, and we weren’t exactly sure [why].”

McLay said new treatments developed in the past two decades are getting “pretty good” at helping servicemembers recover and returning them to active duty or helping them cope with civilian life.

The most established therapy is “exposure therapy,” McLay said, which allows servicemembers to confront what they’re most afraid of – often the memory of a traumatic event. Confronting the memory allows the servicemember to normalize it and overcome it, he said.

Before, this was most commonly achieved by servicemembers talking about the event until it became less physically impacting, McLay said.

The department now uses virtual reality simulations to enhance the therapy and recreate the experience. The system offers detailed simulations of front-line combat. Looking very much like a combat video game, the system uses a vibrating platform to simulate action, goggles that render a 360-degree view of the simulated combat environment, and even caplets that simulate the smell of gunfire and diesel smoke.

McLay has deployed to Iraq with the system, he said, and about 85 percent of those who use the system are able to return to duty.

In addition to the medical facilities, the group toured the recently opened Fisher house on the Balboa complex. The 8,000-square-foot house boasts 12 bedrooms, 13 bathrooms, a common living area, dining room and kitchen with adjoining family room. It is the complex’s second Fisher house.

Dr. Kerry Evers, director at Pro-Change Behavior Systems in Rhode Island, said overall she was surprised by the level of care at the facility.

“The level of comprehensive care that we are giving to our wounded warriors and to our vets is amazing,” she said. “The level of technology and care, personal service, that they’re showing is far beyond anything that I expected.”

Denis Bilodeau, a member of the Orange, Calif., city council, also said he was impressed at the level of care provided by the facility.

“I was very impressed with the quality of health care that our military and their families are receiving,” he said. “The quality of the medical facilities was top-notch. Literally, I don’t think it could have been better.”