S/SW blog philosophy -

I credit favorite writers and public opinion makers.

A lifelong Democrat, my comments on Congress, the judiciary and the presidency are regular features.

My observations and commentary are on people and events in politics that affect the USA or the rest of the world, and stand for the interests of peace, security and justice.

Tuesday, March 06, 2007

Warriors in clashing cultures

The current stories about Washington's Walter Reed Hospital and the military health care system illustrate a clash of cultures. There are people of good will, and who are trying hard, in all arenas of the controversy. It is important to understand where the differences lie.
When disparate cultures clash it is because they see things very differently, sometimes to the point of killing each other. Wars in the Middle East now seem to be unending. The West, in particular the U.S., clashes with radical Islamist factions in the Middle East and warriors on both sides get killed and wounded. Those Americans who die come home to the United States in caskets. Those who are wounded eventually come into the U.S. military's medical system.
When the United States wages war there are terrible - and some surely unintended - consequences to those who become wounded. Since the November elections we are witnessing ever-escalating clashes between the cultures of the legislative and executive branches of government, and between Republicans and Democrats. We are seeing in the current news a set of consequences to our nation's wounded warriors that is deemed by all to be unacceptable, and by far too many in the military and Congress, unknown.
Clashing cultures - Unfortunately for the wounded, we are learning they may still be in a conflict, even as they try to heal. We civilians are becoming aware that there are major cultural differences, just within the war making military-industrial complex:
  • Culture of the military vs. civilian culture - Only someone who is currently serving in the military or someone who is related to someone in the military can know how deep those differences are. We civilians without military connections have only intuitions about how wide the difference must feel to people in the military culture. A wounded fighter must not feel abandoned by his or her military "family."
  • Culture of officers vs. that of enlisted men and women - the military emphasizes these differences in many ways, such as who is giving or taking orders, the uniforms, differences in pay grade and perks, length of enlistments, etc. It is a very hierarchical system. But every wounded warrior must have access to equal medical care.
  • Active duty vs. the culture of "guard and reserves" - the cultural and legal differences remain; all of today's warriors have been joined in a tightly stretched all volunteer military. Any differentiation of benefits, as wounded warriors from the different sectors go through the system, must never penalize any segment of this integrated military population.
  • Political appointees vs. career professionals - In our democracy it is important to have competent civilians in charge of the military, but too often political appointees lack the vital expertise necessary to doing an adequate job. Appointing mere political hacks means poor performance on behalf of our wounded warriors.
  • Business culture vs. governmental culture - Business needs to make a profit. Government needs to provide service. One of the most pervasive aspects of the current wars is an over-reliance on privatization of services that should be provided by a well-supported military. No corporation should profit from taking care of our wounded "on the cheap."
  • Legal culture vs. bureaucratic culture - It seems that every department in the current executive branch of government is suffused with lawyers. And the Department of Defense is no exception. And wounded warriors have not always been served well by these lawyers. In an effort to follow privacy laws, for example, warriors' medical records are not always as accessible as they need to be for continuity of care between DOD and the VA.

Clashes within American culture also come into play in this crisis. War is very dangerous to one's mental health. As a former mental health professional (a clinical social worker) I have long been aware of the stigma of mental illness. The military is a general replication of our American cultural norms. Thus, it is still far less OK to have mental, than to have physical wounds. The military has yet to come to grips with how to spot, adequately diagnose and treat mental and brain injuries.
The Fourth estate vs. the government - We only learned of the nature of the problems within the government's military system of health care because of the outstanding investigative work of members of the mainstream media, specifically, the Washington Post. They, on behalf of all of us, are exposing the government's maltreatment of wounded citizen soldiers. We bloggers join them in our own small ways.
Helping professionals - doctors, nurses, social workers, and psychologists are all socialized by our various professions' rules, dogma and ethics. These professional values will sometimes clash with the military. Case managers, ombudsmen and patient advocates may have conflicts of interest. If they try to do good jobs for wounded warriors, and also save money for the bureaucracies for whom they work, there will be conflicts. What we are seeing in the news is the result of patients and/or clients losing out and losing trust.

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