The Gulf War Health Center's Specialized Care Program

Washington, D.C. December 23, 1997 (GulfLINK)- Chances are, you've heard about the Department of Defense's Comprehensive Clinical Evaluation Program (CCEP). So far, nearly 50,000 Gulf War veterans have enrolled in the program, with many completing both Phases I and II. But, did you know that there is a Phase III? Phase III is currently offered at only at one location, Walter Reed Army Medical Center, Washington, D.C.

There a team of 15 medical professionals are making a big difference in the lives of some sick Gulf War veterans. This diverse organization is the Army's Gulf War Health Center's Specialized Care Program, or Phase III of the CCEP.

"We are veterans' advocates," said Dr. Charles Engel, Chief of the Gulf War Health Center and Director, Specialized Care Program. "We bust our butts for veterans," Engel said. "Patients who come here, have already completed Phase I and II of the CCEP, and are still having medical challenges and are experiencing difficulties with daily living."

The Department of Defense's evaluation program was established June 7, 1994 with the goal of providing in-depth evaluations of Gulf War veterans who are serving in one of the active or Reserve components, or are retired. Walter Reed's Specialized Care Program was initiated in January 1995 by then Major General Ronald R. Blanck, hospital commander. The SCP's mission is to deliver a coordinated multidisciplinary treatment program designed to address persistent, disabling symptoms among Gulf War veterans or family members that remain undiagnosed after appropriate medical evaluation; and/or are unlikely to respond to specific biomedical treatments.

The program is modeled after internationally recognized centers for management of chronic illness. It provides state of the art care for those suffering multiple symptoms such as: fatigue, joint pain, headache, digestive problems, skin rash, weight gain or loss and memory problems. Success in the program requires treatment of overall functional status and quality of life rather than a narrow set of symptoms. Normally between three and eight patients participate in each intensive three-week outpatient program cycle. Spouses are encouraged to attend if possible.

The program provides carefully coordinated delivery of care that takes into account many medical perspectives. Program participants work closely with an internist and a health psychologist, Engel explained. Other members of the health care team include a physiatrist, occupational therapist, physical therapist, fitness trainer, wellness coordinator, clinical social worker, and a nutritionist. There are other medical specialists available depending on the patient's medical needs.

The key objectives of the program are to provide opportunities to improve in work performance and other activities of daily living, to promote overall well-being, including better stress management and interpersonal skills through the practice of positive health behaviors, and to actively involve each participant in creating an individualized care plan.

"It takes a while to gain their trust-they have suspicion of the military health care system," said Dan Bullis, a retired Army sergeant major and Administrator of the Gulf War Health Center. "People have been lead to believe that you go to a doctor-get a pill-and get better. We try to teach the patients an understanding of what the bio-medical system can, and cannot, do for you."

The program differs from most medical treatment programs because it focuses on the patient from a different perspective. Three intervention teams, the physical, medical and psycho-social teams provide care. Participants attend both group and individual training sessions as well as a number of participatory seminars.

"A big part of my job is to convince them that bio-medical model leaves them high and dry. Searching for more and more tests, and more medical treatment-probably won't solve their problems. We show them the person-centered model of care rather than the disease-centered model will work, " said Dr. Roy Clymer, a psychologist for the SCP staff. "We try to give the patients the point of view that symptoms are just something to be fixed. We show them ways to minimize the impact the symptoms cause in their lives."

A typical day for a participant might include individualized fitness training, occupational and individual therapy, physical therapy, wellness activities, medical tests, nutrition therapy and a participatory seminar.

"I came here batting .500-and I'm leaving batting 1,000," was the way Sergeant First Class (USA-Ret) George Washington summed up his experience. "This program helped me in several ways -- getting exercise, learning the correct way to take my medicine, and, how to control my blood pressure," said Washington.

Staff Sergeant Elvis Dixon, 29, active duty USMC, served with the 8th Marine Regiment, 2 Marine Division in the Gulf War agrees. "This helped me realize that you must take care of yourself and not let things build up...that you have to break patterns to change your life, such as eating properly and exercising," said Dixon. "This program gave me the chance to reflect and refocus my life. It's been a blessing to me."

Sergeant First Class Delisa Smith, a member of the 158th Air Traffic Control Battalion at Fort Bragg, NC, said "it changes your outlook, teaches you how to deal with chronic pain ... it teaches you how to make it."

"I got excellent support from my unit," Smith said. "My battalion commander told me he wanted me to get the best care available, and that's what I've received here," she said. "This program has been an answer to my prayers."

For more information on the SCP, visit the Gulf War Health Center's Internet homepage at: (http://www.wramc.amedd.army.mil/departments/ gulfwar, or call (202) 782-6563.

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