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Rehabilitation Colloquium Reflecting on the Past. 7 – 8 October 2008 Dr Graeme Killer AO Principal Medical Adviser Department of Veterans’ Affairs. AIM. My aim in this brief presentation is to revisit some of the health and rehabilitation challenges of World Wars 1 and 2 and Vietnam.

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Rehabilitation colloquium reflecting on the past l.jpg
Rehabilitation ColloquiumReflecting on the Past

7 – 8 October 2008

Dr Graeme Killer AO

Principal Medical Adviser

Department of Veterans’ Affairs


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AIM

My aim in this brief presentation is to revisit some of the health and rehabilitation challenges of World Wars 1 and 2 and Vietnam


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I’ve come up with a definition which may not suit everyone but lets work through it. The word rehabilitation is derived from the medieval latin word rehabilitare, which means to restore. In the widest sense, the word rehabilitation, could be used in terms of restoration of confidence, self-esteem, reputation, physical, mental or social wellbeing, ability to work, or all these things. So it is important to understand the objectives of rehabilitation shouldn’t be thought of only in terms of returning to paid employment. To the individual and his or her family these other objectives are probably more important


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WORLD WAR 1 but lets work through it. The word rehabilitation is derived from the medieval latin word rehabilitare, which means to restore. In the widest sense, the word rehabilitation, could be used in terms of restoration of confidence, self-esteem, reputation, physical, mental or social wellbeing, ability to work, or all these things. So it is important to understand the objectives of rehabilitation shouldn’t be thought of only in terms of returning to paid employment. To the individual and his or her family these other objectives are probably more important


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With experience, doctors’ perspectives but lets work through it. The word rehabilitation is derived from the medieval latin word rehabilitare, which means to restore. In the widest sense, the word rehabilitation, could be used in terms of restoration of confidence, self-esteem, reputation, physical, mental or social wellbeing, ability to work, or all these things. So it is important to understand the objectives of rehabilitation shouldn’t be thought of only in terms of returning to paid employment. To the individual and his or her family these other objectives are probably more important

changed. They came to see that a man’s

capacity to endure in war was determined by

many things – heredity, upbringing,

‘character’, the society he came from,

how he felt about the war, his relationship to

his fellow soldiers, the length of time he had

been fighting, whether his wife has been

unfaithful – quite apart from the military

circumstances in which he found himself.

They realised, too, that in the military context

collective factors often mattered more than

individual ones such as morale and unit

leadership.


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THE REPATRIATION COMMISSION MEETING THE REHABILITATION NEEDS but lets work through it. The word rehabilitation is derived from the medieval latin word rehabilitare, which means to restore. In the widest sense, the word rehabilitation, could be used in terms of restoration of confidence, self-esteem, reputation, physical, mental or social wellbeing, ability to work, or all these things. So it is important to understand the objectives of rehabilitation shouldn’t be thought of only in terms of returning to paid employment. To the individual and his or her family these other objectives are probably more important

The newly formed Repatriation

Department put in place a package of

rehabilitation that included medical

treatment after discharge, provision of

artificial limbs (for which the Repatriation

Department developed special expertise),

education fees, tools of trade, professional

instruments, blocks of land and livestock.


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The key issues in rehabilitation from WW1 were: but lets work through it. The word rehabilitation is derived from the medieval latin word rehabilitare, which means to restore. In the widest sense, the word rehabilitation, could be used in terms of restoration of confidence, self-esteem, reputation, physical, mental or social wellbeing, ability to work, or all these things. So it is important to understand the objectives of rehabilitation shouldn’t be thought of only in terms of returning to paid employment. To the individual and his or her family these other objectives are probably more important

  • The Government through the Repatriation Department provided wide ranging rehabilitation measures for returning WW1 veterans

  • There was strong community and political support for the veteran community

  • There was little understanding of the mental health issues of returning veterans and mental health services for veterans and the wider community were primitive and not conducive to rehabilitation

  • Some veterans with shell-shock self-managed their health problems through return to hard physical labour

  • There was an understanding that unit morale and leadership were important features in prevention of shell-shock in a post-war environment


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WORLD WAR 2 but lets work through it. The word rehabilitation is derived from the medieval latin word rehabilitare, which means to restore. In the widest sense, the word rehabilitation, could be used in terms of restoration of confidence, self-esteem, reputation, physical, mental or social wellbeing, ability to work, or all these things. So it is important to understand the objectives of rehabilitation shouldn’t be thought of only in terms of returning to paid employment. To the individual and his or her family these other objectives are probably more important

There are some comparative statistics

between WW1 and WW2 that are important

in understanding different challenges and

rehabilitation between the two wars. While

the numbers who served in WW2 were

considerably greater than in WW1 both the

numbers who died of wounds and total

battle casualties deaths were far less.

However, in WW2 we had in excess of

20,000 prisoners of war (POWs), many

prisoners of the Japanese with high

mortality rates from those working on the

Thai-Burma railway.


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PRISONERS OF WAR (POWs) but lets work through it. The word rehabilitation is derived from the medieval latin word rehabilitare, which means to restore. In the widest sense, the word rehabilitation, could be used in terms of restoration of confidence, self-esteem, reputation, physical, mental or social wellbeing, ability to work, or all these things. So it is important to understand the objectives of rehabilitation shouldn’t be thought of only in terms of returning to paid employment. To the individual and his or her family these other objectives are probably more important


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Dr Rowley Richards one of the 43 but lets work through it. The word rehabilitation is derived from the medieval latin word rehabilitare, which means to restore. In the widest sense, the word rehabilitation, could be used in terms of restoration of confidence, self-esteem, reputation, physical, mental or social wellbeing, ability to work, or all these things. So it is important to understand the objectives of rehabilitation shouldn’t be thought of only in terms of returning to paid employment. To the individual and his or her family these other objectives are probably more important

Australian doctors on the Thai-Burma

Railway said the POWs responded well to

rehabilitation on their return and this was

because:

  • They were a survivor population

  • Mateship was paramount forged in hell and this continued after returning home

  • Strong family support

  • Many had been immunised for hard times because they came out of the depression

  • A positive mental attitude

  • Strong leadership in the camps


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VIETNAM but lets work through it. The word rehabilitation is derived from the medieval latin word rehabilitare, which means to restore. In the widest sense, the word rehabilitation, could be used in terms of restoration of confidence, self-esteem, reputation, physical, mental or social wellbeing, ability to work, or all these things. So it is important to understand the objectives of rehabilitation shouldn’t be thought of only in terms of returning to paid employment. To the individual and his or her family these other objectives are probably more important


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On review there have probably been a but lets work through it. The word rehabilitation is derived from the medieval latin word rehabilitare, which means to restore. In the widest sense, the word rehabilitation, could be used in terms of restoration of confidence, self-esteem, reputation, physical, mental or social wellbeing, ability to work, or all these things. So it is important to understand the objectives of rehabilitation shouldn’t be thought of only in terms of returning to paid employment. To the individual and his or her family these other objectives are probably more important

number of initiatives that have contributed

to the rehabilitation of Vietnam veterans

and their families:

  • Vietnam Veterans’ Counselling Service (VVCS) – 1981

  • Australian Centre for Posttraumatic Mental Health (ACPMH) – 1995

  • The Heart Health Program – 1997

  • Access to new pharmaceuticals

  • New education initiatives with the Australian General Practice Network (AGPN) (pathways to care study)


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VIETNAM VETERANS’ COUNSELLING SERVICE (VVCS) but lets work through it. The word rehabilitation is derived from the medieval latin word rehabilitare, which means to restore. In the widest sense, the word rehabilitation, could be used in terms of restoration of confidence, self-esteem, reputation, physical, mental or social wellbeing, ability to work, or all these things. So it is important to understand the objectives of rehabilitation shouldn’t be thought of only in terms of returning to paid employment. To the individual and his or her family these other objectives are probably more important

The VVCS was not based on the medical

model and allowed veterans and later their

families to seek counselling in relation to

their mental health problems and it has

pioneered health promotion programs

particularly in relation to the use of alcohol

but outcomes would be improved if stronger

links were developed with general

practitioners and divisions of general

practice.


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AUSTRALIAN CENTRE FOR POSTTRAUMATIC MENTAL HEALTH (ACPMH) but lets work through it. The word rehabilitation is derived from the medieval latin word rehabilitare, which means to restore. In the widest sense, the word rehabilitation, could be used in terms of restoration of confidence, self-esteem, reputation, physical, mental or social wellbeing, ability to work, or all these things. So it is important to understand the objectives of rehabilitation shouldn’t be thought of only in terms of returning to paid employment. To the individual and his or her family these other objectives are probably more important

ACPMH has had a significant role

nationally and internationally in policy

direction by educating both providers

and veterans alike in mental health

Problems associated with military

service. It has also had a pivotal role in

accrediting in and outpatient PTSD

rehabilitation programs.


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THE HEART HEALTH PROGRAM but lets work through it. The word rehabilitation is derived from the medieval latin word rehabilitare, which means to restore. In the widest sense, the word rehabilitation, could be used in terms of restoration of confidence, self-esteem, reputation, physical, mental or social wellbeing, ability to work, or all these things. So it is important to understand the objectives of rehabilitation shouldn’t be thought of only in terms of returning to paid employment. To the individual and his or her family these other objectives are probably more important

The Heart Health Program is about

educating veterans in cardiovascular risk

factors and encouraging lifestyle changes

associated with regular exercise. It has been

well accepted by the veteran community and

many veterans have maintained ongoing

participation after many years. The wife of a

Vietnam veteran who had PTSD told me that

her husband’s involvement in Heart Health

was the best thing he had done in married life.

The strengths of this program relate to the

wellbeing that comes from physical fitness,

mateship and the fact that it is a voluntary

program.


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ACCESS TO NEW PHARMACEUTICALS but lets work through it. The word rehabilitation is derived from the medieval latin word rehabilitare, which means to restore. In the widest sense, the word rehabilitation, could be used in terms of restoration of confidence, self-esteem, reputation, physical, mental or social wellbeing, ability to work, or all these things. So it is important to understand the objectives of rehabilitation shouldn’t be thought of only in terms of returning to paid employment. To the individual and his or her family these other objectives are probably more important

New pharmaceuticals have indeed improved

the management of some of the symptoms

of PTSD, the SSRIs have reduced the

hyperarousal symptoms and reduces

irritability and anger and the atypical

antipsychotics i.e. Olanzapine has improved

the ability to sleep. The SSRIs have come

into some criticism because of links to suicide

in some individuals. The issue is primarily in

this case about optimal patient management

and careful monitoring of patients in the first

two weeks of treatment because of the

potential to develop agitated behaviour.


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SUMMARY but lets work through it. The word rehabilitation is derived from the medieval latin word rehabilitare, which means to restore. In the widest sense, the word rehabilitation, could be used in terms of restoration of confidence, self-esteem, reputation, physical, mental or social wellbeing, ability to work, or all these things. So it is important to understand the objectives of rehabilitation shouldn’t be thought of only in terms of returning to paid employment. To the individual and his or her family these other objectives are probably more important

  • Keep rehabilitation program simple and don’t over medicalise i.e. Heart Health, “Men in Sheds”

  • Greater involvement of veterans in developing veteran

    self-help programs

  • Early intervention is the key and there should be properly structured case management approach

  • Rehabilitation programs need to be linked to preventive health programs and assessments particularly related to post discharge medical screening

  • Building on the current links in rehabilitation between Defence and DVA

  • Maximising rehabilitation outcomes within Defence

  • Transition programs for all those leaving the ADF

  • Inclusion of families in rehabilitation programs

  • Rehabilitation packages should include medical treatment, education and vocational arrangements

  • Improved education of health providers in terms of the impact of military service on health of serving members, veterans and their families

  • Greater promotion of self-care and health literacy programs


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