Category Archives: MED

April 25, 2013 · 4:22 pm

Friends of Kelly Hunt Start Online YouCaring.com Fundraiser for Hunt Family

State Department Public Diplomacy Officer Kelly Hunt was wounded on the April 6, 2013 suicide attack in Qalat, Afghanistan. About a week after the incident that killed five Americans and seriously wounded Ms. Hunt as well as three others, and as she was moved to a hospital in Germany, her friends back home, Brian DeNicola, Regan Hildebrand, Becky Reindel, Jen Vinci, Beth Doyle-Hudson & Valerie Cizl decided to organize a fundraiser to support Ms. Hunt’s family.

“Becky met Kelly at work.  Brian and Regan met her through rowing.  Jen, Beth and Valerie knew her from elementary school.  She touched our lives in many ways and the last few days have been difficult for everyone.” 

On June 8, Regan will be climbing Mt. Rainier in Seattle, Washington.  He was originally going to climb the mountain for fun.  In light of Kellly’s accident, he’s now climbing Mt. Rainier for her and will stand on the summit on June 12 for Kelly. 

The fundraiser located at you caring.com - http://www.youcaring.com/medical-fundraiser/climbing-for-kelly/52529 - had $1,000 for its original funding goal. As of this writing, the fund has raised $7093 from 114 supporters across the Foreign Service, EPA, colleagues in Afghanistan, folks from the University of Tennessee and the News Sentinel newsroom, and from friends and friends of friends.

Screen Shot 2013-04-13

Over in FB,  the Kelly Hunt’s Road to Recovery page also put together by friends provided a link to the fundraiser with the following note:

We have been contacted by so many wonderful people across the world who are interested in donating to Kelly’s family in order to help ease the costs associated with traveling to see her when she arrives at Walter Reed, and other costs that arise during this time. Please visit the page below if you would like to contribute financially. All proceeds will go directly to the family. Thank you!  

Ms. Hunt’s mother, Dinah told us that the help organized by friends “will allow us to be with our daughter.”  If you are want to help, check out the youcaring page here.  If you want to send messages of support to the Hunt family and/or follow her recovery, you can check the Kelly Hunt’s Road to Recovery in Facebook where her mother provides regular updates on Kelly’s condition including the following:

I know that people in the DC area are eager to see Kelly, however, it won’t be possible for quite awhile. She’s in intensive care right now.  I want to thank everyone for their prayers and words of encouragement. They are definitely helping our family to cope. This is a marathon; not a race sprint and I appreciate your support.

We understand that a separate hometown fundraiser was also done by several friends of Ms. Hunt last April 20 at the Deja vu Nightclub in Lorain, Ohio (thanks JA!).

– DS

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April 21, 2013 · 2:16 pm

Zabul Attack: Walking But Not Lost, More Details But Not Official; Plus Update on Kelly Hunt

On Friday, April 12, the AP citing a senior State Department “not authorized to speak to the news media” reported that the initial reports that members of the group were in vehicles, as well as subsequent media reports that they were lost, are incorrect.

The official reportedly provided the details on condition of anonymity.  This report contradicted the eyewitness account of an Afghan reporter cited by McClatchy news on Wednesday, April 10.

You may read the full AP report here.

Last weekend, The Skeptical Bureaucrat  (TSB) posted about this here:

It’s quite bad enough already, judging by the details that have come out so far. Let’s see … the book donation visit to the Sheik Baba Metti school by a team from the U.S. Embassy and PRT Zabul was announced to the press one day in advance. But, despite that lack of operational security, the team was allowed to walk to the school from the PRT’s base at FOB Smart rather than use protected vehicles. The roughly 100-meter long route to the school evidently wasn’t swept before the team’s walk, or blocked to traffic during the movement. The team’s military escort didn’t know which gate to use to enter the school – a school that the PRT itself funded and regularly visited – which required the team to double back to FOB Smart and further expose themselves to attack.

Lastly, the attack reportedly involved a roadside bomb as well as a suicide driver in a bomb-laden vehicle. If that’s true, it means that the Taliban were able to plant a command-detonated bomb in the street immediately outside FOB Smart despite the surveillance that street was undoubtedly under by both the U.S. and Afghan military.

There is reportedly an ongoing FBI investigation. The FBI investigates bombings in the U.S. and overseas where incidents were acts of terrorism against U.S. persons or interests. But this is the war zone. Was there also an FBI investigation on the suicide bombing that killed a USAID officer and wounded an FSO in Kunar Province last year? (Update: We’re told by a blog pal in Afghanistan that the FBI investigates a lot of different incidents in Afghanistan and that there is “nothing unusual” with them investigating the April 6 attack.  Was also asked about an ARB for Camp Bastion.  Camp is under military control so that’s a clear exception to ARB regs; nothing to keep DOD from pursuing its own inquiry but we haven’t heard anything moving on that direction. Read this piece by Rajiv Chandrasekaran on the Taliban attack that resulted in the deaths of two Marines and the largest loss of allied materiel in the 11-year-long Afghan war).

No way to tell right now if there will be an Accountability Review Board. As TSB pointed out, there is a limited exception for convening an ARB if the security incidents involving serious injury or loss of life occurs in Iraq or Afghanistan. We found an exemption for incidents between October 1, 2005-September 30, 2009. In December 2009, that exemption remained in effect through September 30, 2010.

Following the findings of “accountability” from the ARB on Benghazi, we are not holding our breath on an ARB on this latest incident. After not seeing any ARBs convened for several attacks on embassy properties with significant damages last year, we’re starting to think that an ARB in its current authority is not the best use of time/resources to assign accountability.

The notion that an ARB is convened to investigate security incidents that result in “serious injury, loss of life, or significant destruction of property” and then keep the result secret and the interviewees secret is absurd. Add to that the fact that the Secretary of State did not even convene an ARB for all the mob attacks last year which resulted in significant destruction of embassy properties, makes one think that the ARB on its present form is not as useful or effective as it should be.  It also leaves the recommendation on whether or not the Secretary of State should convene an ARB on the hands of the Permanent Coordinating Council in the State Department, staffed by people who answer to their chain of command.

So - we’d much rather see the FBI conduct these investigations.

Also last Thursday, Lt. Col. Justin Kraft, the Zabul Provincial Reconstruction Team commander released the following statement via FB:

We recently lost three of our nation’s finest warriors. They were sons, brothers, one was a father, and all were men who lived, served and died with honor. They gave to their country and their brothers and sisters in arms the last full measure of their courage. 

We are less for this loss. 

Please keep their families in your thoughts and prayers at this difficult time.

DOD identified the three soldiers killed in the April 6 attack but to-date the identity of the DOD civilian who perished in the same attack had not been released. Who was he/she? Did he/she leave behind a family?

On April 14, Staff Sgt. Chris Ward was buried at Oak Ridge. According to knoxnews.com, Maj. Gen. Jeffory Smith, commander of Fort Knox, Ky., presented  the Purple Heart and the Bronze Star to Ward’s mother. The passing of these casualties was heartbreaking  to their loved ones, fellow soldiers and largely ignored by the public. The death of  three  soldiers in the battlefield of Afghanistan … not much was said.

On April 18, knoxnews.com also reported that Kelly Hunt, the State Department employee wounded in the attack arrived earlier this week at the Walter Reed National Military Medical Center in Washington.  Friends of Ms. Hunt at her home state are organizing a fund-raiser online to help the family.  You can check it out here. We have been looking but have not been able to find a contact email for the organizers.  The family Friends of Ms. Hunt have also put up a Facebook page – Kelly Hunt’s Road to Recovery , it includes updates from Dinah Hunt, Kelly’s mother.

 

– DS

 

Updated on April 22@1720 PST with info on ARB

Updated on April 22 @21:41 PST with FB page correction; page put up by friends not family.

 

 

 

 

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November 25, 2012 · 11:33 am

Retired Ambassador Ryan Crocker Takes Plea Bargain in DUI Charge

After three postment of his DUI hearing in Spokane, Washington (originally scheduled for September 12, then postponed to October 10 and later to November 5), Ambassador Crocker finally had his court hearing on Nov. 21.  According to the Spokesman.com, the former ambassador pleaded guilty to “a reduced charge of reckless driving in connection with a drunken auto accident” this past summer. Excerpt:

The 63-year-old retired diplomat accepted the plea bargain this afternoon in Spokane County District Court. He faced a drunken-driving charge following a collision with a semitruck at a busy Spokane Valley intersection on Aug. 14. He drove away as a witness tailed him, authorities said. No injuries were reported in the collision.

“Your honor … I’m extremely sorry for what I did,” Crocker told District Court Judge Sara Derr. “I failed in my responsibilities to my community and to myself. I can assure you, it will never happen again.”

Crocker declined comment following the hearing.

The Spokesman also reported that Ambassador Crocker’s attorney, Julie Twyford, told Judge Derr that her client recently had brain surgery to treat a subdural hematoma. The judge accepted the plea recommendation, which came from the Spokane County Prosecutor’s Office.  Ambassador Crocker must pay a fine of $1,000 and his driver’s license will be suspended for 30 days as part of his sentence according to the report.

A webmd lookup says that a subdural hematoma is a collection of blood outside the brain and that this is usually caused by severe head injuries.  The bleeding and increased pressure on the brain can be life-threatening. While in some cases the condition stop and resolve spontaneously, others require surgical drainage.  More here.

 

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August 24, 2012 · 5:16 am

Ambassador Crocker Arrested for Hit and Run and DUI in Spokane

We were not always happy with Ambassador Crocker’s often glass is full assessment of what was going on in Afghanistan when he was the Ambassador there, but the following news is not one we were hoping to read on his second post-retirement.

KXLY.com of Spokane, Washington (h/t to The Cable’s Josh Rogin) reported that Ambassador Ryan Crocker was arrested at 2:05 in the afternoon on August 14 by the Washington State Patrol for hit-and-run and driving under the influence in Spokane Valley. The report cited the State Patrol saying that Ambassador Crocker crossed two lanes of traffic, clipped a semi and damaged the passenger side of the Ford Mustang he was driving. He was pulled over, taken into custody and transported to the Spokane Valley Precinct where he received a sobriety test. He reportedly had a .16 BAC (blood alcohol concentration) on one test, twice the legal limit in Washington State. Another test reportedly indicated a .152 BAC.

“It was fairly obvious that Mr. Crocker was highly intoxicated ,” Briggs [Washington State Patrol Trooper] said, adding that the arresting trooper said that Crocker was very cooperative throughout the incident.

The State Patrol believes he was intoxicated by alcohol, not prescription drugs, due to odor and the high blood alcohol count. The WSP added Thursday there is no way Crocker could have crossed two lanes of traffic, hit the semi and continued to drive without knowing it.
[...]
On Aug. 15, the day following his arrest, Crocker pled not guilty to the hit and run and DUI charges. Both charges carried a $1,000 bail.
[...]
His next court appearance is scheduled for September 12.

Read in full here.

Just a day before this incident, Yale News reported that Ambassador Crocker has been named Yale’s first Kissinger Senior Fellow at the Johnson Center for the Study of American Diplomacy and was scheduled to teach both undergraduate and graduate students during the 2012-2013 academic year.

In his long career with the State Department, Ambassador Crocker served as ambassador six times.  He was the United States Ambassador to Afghanistan from 2011 to July 2012. He was also previously  United States Ambassador to Iraq from 2007 to 2009, to Pakistan from 2004 to 2007, to Syria from 1998 to 2001, to Kuwait from 1994 to 1997, and to Lebanon from 1990 to 1993.

Of course, prior to becoming ambassador he served in a host of other places like Qatar and Iraq.  In 2003, he was also a political officer at the US Embassy in Lebanon when it was hit by a suicide car bomb. A total of 63 people were killed in the bombing: 32 Lebanese employees, 17 Americans, and 14 visitors and passersby.

Almost all mention of Ambassador Crocker’s name also mentions some of the most dangerous hotspots where he served since joining the Foreign Service in the early 1970′s.  We don’t stop and pause often enough to ask if we can send our diplomats to all these dangerous places in the world over and over and over again without any personal consequences on their part. What part of themselves did they lost in Beirut or Peshawar? We never really ask and they did not tell, except sometimes, decades later.

Kristin K. Loken was a Foreign Service officer with USAID who worked at the US Embassy in San Salvador for two years in the late 1970s during El Salvador’s brutal civil war was later diagnosed with “post-traumatic shock syndrome,” (the term used for PTSD in the early 1980s):

“I went to my boss and told her I thought I was going through some postwar emotional problems and asked if the State Department or USAID had some counseling services available. She said she was sympathetic but thought senior people would probably frown on my having emotional problems, and advised that disclosing my condition might negatively affect my eventual tenuring with USAID. So it would be best to keep a “stiff upper lip.” Her advice was to see a private therapist, for which she would give me as much administrative leave as I needed.”

In her 2008 FSJ article on PTSD (Not Only for Combat Veterans (p.42)), she writes about subsequently working on the Lebanon program and the 1983 US Embassy Beirut bombing:

In April 1983, I had just left the city and arrived back in the U.S. when the embassy was blown up. In the bombing, I lost my mission director, Bill Mc-Intyre, our Lebanese secretary and many other colleagues and good friends with whom I had worked for the last year.
[...]
I noticed that many of the symptoms of the previous PTSD episode returned at this time, but I felt that if I were patient, they would pass as they had the first time.
[...]
More than two decades after I first experienced PTSD, the symptoms have for the most part passed — except when I am overcome by exhaustion, physical pain, illness or stress. Then I can feel myself slipping back into a bad place.

We cannot presume to know what is ailing Ambassador Crocker or if he has been screened for PTSD.   We can only hope that he gets better.  An unnamed official told CNN that “the serious health problem he had in Iraq came back, so he is forced to leave a year early for genuinely serious health reasons.” The State Department Spokesman also confirmed this to the press last May without additional details when news first broke that Ambassador Crocker is stepping down from his post at the US Embassy in Kabul.

We note that Ambassador Crocker was reportedly arrested at 2:05 p.m. with a .16 BAC, twice the legal limit in Washington State.  USVA’s PTSD page notes that PTSD and alcohol use problems are often found together.  Below is a a description of what happens when an individual has a BAC of between .12 to .15:

.12-.15 BAC = Vomiting usually occurs, unless this level is reached slowly or a person has developed a tolerance to alcohol. Drinkers are drowsy.

Drinkers display emotional instability, loss of critical judgment, impairment of perception, memory, and comprehension.

Lack of sensor-motor coordination and impaired balance are typical. Decreased sensory responses and increased reaction times develop. The vision is significantly impaired, including limited ability to see detail, peripheral vision, and slower glare recovery.

Here are other important details on PTSD and alcohol use from USVA:

  • Having PTSD also increases the risk that an individual will develop a drinking problem.
  • Up to three quarters of those who have survived abusive or violent trauma report drinking problems.
  • Up to a third of those who survive traumatic accidents, illness, or disasters report drinking problems.
  • Alcohol problems are more common for survivors who have ongoing health problems or pain.
  • Sixty to eighty percent of Vietnam Veterans seeking PTSD treatment have alcohol use problems.

We don’t know that we’ll hear from Ambassador Crocker, himself. But we hope he speaks out.

In any case, when my best friend in the Foreign Service retired, he got a signed certificate from the Secretary and once or twice a year, he gets a statement of pay from some office at State and that’s about it. He gets more correspondence on military news, pay, benefits, etc. from the U.S. Armed Forces from where he retired prior to joining the State Department.

What support can Ambassador Crocker expect from the State Department?

We’ll shortly find out.

Domani Spero

Update:  Seattle’s kirotv.com covers this here.   CNN is reporting that he was charged, car impounded then released on his own recognizance.  According to CNN conditions of his bail, as outlined August 15, include “refraining from committing any crimes and consuming alcohol or drugs except as prescribed by a doctor, the court docket states. Crocker was also ordered to go to a drug testing office within 24 hours and undergo alcohol testing twice a month.”

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August 2, 2012 · 3:19 am

US Embassy Uganda: Emergency Msg to US Citizens on Ebola Outbreak, Oops, Scratch Dat — One Confirmed Case of Ebola Virus

On  July 28, the US Embassy in Kampala released the following Emergency Message to U.S. citizens:

Emergency Message for U.S. Citizens | Confirmed Case of Ebola Virus in Uganda

This Emergency Message is to alert U.S. citizens residing and traveling in Uganda of an outbreak of Ebola virus.  On July 27, 2012, local Ugandan press reported 12 deaths due to a “strange illness.”  Laboratory tests conducted by the Uganda Virus Research Institute and the United States Centers for Disease Control and Prevention (CDC) have confirmed, to date, that at least one victim was infected with the Ebola virus (Sudan strain).  The Ugandan Ministry of Health, U.S. CDC, and international partners are investigating the case to determine the extent of the outbreak and if additional cases are present.  At this time, the cases appear to be centered in Nyamarunda Sub County, Kibaale district, although one suspected victim is reported to have traveled to Kampala for treatment at Mulago Hospital where he subsequently died on July 22, 2012.

Ebola is a deadly but preventable disease.  The virus has the potential to spread from person to person, especially among health-care staff and family members who care for patients with Ebola Viral Hemorrhagic Fever. A person suffering from Ebola usually presents with sudden fever, headache, joint and muscle aches, sore throat, and weakness, followed by diarrhea, vomiting, and stomach pain.  A rash, red eyes, hiccups and internal and external bleeding may be seen in some patients. Symptoms become increasingly severe and may include jaundice, severe weight loss, mental confusion, shock, and multi-organ failure. There is no standard treatment for Ebola HF.  Patients receive supportive therapy.

The likelihood of contracting Ebola is considered extremely low unless there has been a direct contact with body fluids like saliva, urine, or blood of an infected person or animal or the body of someone who has died from the disease.  Since the virus spreads through direct contact with blood and other body secretions of an infected person, people living with and caring for Ebola patients are at a higher risk of becoming infected.

The U.S. Mission in Kampala and the CDC office in Uganda recommend that U.S. citizens residing and traveling in Uganda avoid contact with people exhibiting the symptoms described above.  To minimize the risk of contracting Ebola, avoid direct contact with body fluids (blood, saliva, vomit, urine, and stool).  Practice good hygiene, such as washing hands carefully and thoroughly with soap and water, or with alcohol-based hand cleanser if soap and water are unavailable.  Avoid communal washing of hands during funerals or other public gatherings.  Avoid contact with dead animals, especially primates, and refrain from eating “bushmeat.”

Read the whole message here.

English: Biosafety level 4 hazmat suit: resear...

English: Biosafety level 4 hazmat suit: researcher is working with the Ebola virus (Photo credit: Wikipedia)

Here is what the CDC posted about the ebola outbreak on the same date:

2012: Ebola Hemorrhagic Fever Outbreak in Uganda

On July 28th, 2012, the Uganda Ministry of Health reported an outbreak of Ebola Hemorrhagic fever in the Kibaale District of Uganda. A total of 20 probable human cases, including 14 fatalities, have been reported since the beginning of July. Laboratory tests of blood samples, conducted by the Uganda Virus Research Institute (UVRI) and the U. S. Centers for Disease Control and Prevention (CDC), confirmed Ebola virus in five patients, two of whom have died. All reported illnesses and contacts are being investigated.

A team of experts from CDC is traveling Uganda, to work with Ministry of Health and international partners in determining the extent of the outbreak and locating, testing, and treating any additional cases. A laboratory team will also assist in diagnostic testing.

Here is the statement that the Ministry of Health released in Kampala, Uganda:

EBOLA SUSPECTED CASES INCREASE IN KIBAALE DISTRICT
KAMPALA – 07/03/2012 – The Ministry of Health Wishes to inform the public that the number of suspected Ebola cases registered at Kagadi Government Hospital in Kibaale district has since yesterday increased from seven to 18 patients. Currently there are three confirmed cases and 15 suspects admitted at the isolation facility. The patients are receiving the appropriate treatment from the medical team dispatched from the National Task force jointly with local hospital staff. Most of them are responding positively to the treatment administered to them.

The increased number follows the quick response given to suspected alerts from various parts ofthe district. The patients are currently admitted at the hospital isolation facility after they presented with Ebola signs.

There have been no more deaths recorded since the announcement of the outbreak on July 28th, The death toll still remains at 14.

A total of 16 samples have since the outbreak been collected from the suspect cases for investigation at the Uganda Virus Research Institute. The Ministry of Health Surveillance team in Kibaale district is actively and closely following up to 40 people who are suspected to have got into Contact with the dead. These contacts have not shown any signs of the disease but will be monitored for 21 days. After 21 days, they will be declared Ebola-free meaning that they did not contract the disease.

At Mulago National Referral Hospital, a total of eight health workers who attended to the suspect case are closely being monitored. An isolation policy arrangement to last 21 days has been put in place as active monitoring continues.

The Ministry of Health further informs the public that plans are underway to set up Isolation Facility at Mulago National Referral Hospital in readiness for any alerts and suspected cases from Kampala and neighbouring districts.

The public is therefore requested to stay calm as everything is being done to manage the outbreak. The Ministry of Health advises the public to ensure that the recommended safety measures are adhered to and to refer any suspected cases to a nearby health facility for check up. Ebola presents with fever, vomiting, diarrhoea, abdominal pain, headache, measles-like rash, red eyes, and sometimes with bleeding from body openings.

The original statement is online here.

The US Embassy in Kampala cites local press reports which calls the death the result of “strange illness.“  As the Examiner points out, our own CDC has had a long term presence in Uganda and operates a VHF lab in cooperation with the Uganda Virus Research Institute.

So here is what we don’t get –

Why would the embassy emergency message cites press reports about “strange illness” instead of using the information from the CDC?

The embassy emergency message of July 28 cites only one confirmed case infected with the Ebola virus.

The CDC information dated July 28  calls it an outbreak and cites 20 probable human cases, including 14 fatalities, plus, confirmed Ebola virus in five patients, two of whom have died.

The one emergency message with no follow-up message to-date did not mention that the Kibaale district cases have increased from seven to 18 patients. Nor did it mention the three confirmed cases and 15 suspects admitted at the isolation facility. Nor did it mention that the Ministry of Health Surveillance team in Kibaale district is actively and closely following up to 40 people who are suspected to have contact with the dead. Nor did it mention that a total of eight health workers who attended to the suspect case are also closely being monitored under the government’s isolation policy which last for 21 days (the incubation period for Ebola HF ranges from 2 to 21 days).

Although July 28 emergency message is prominently displayed on the embassy’s website, there is no mention of that message on the embassy’s Facebook or Twitter pages. US Embassy Kampala/FB talks about the London Olympics, and the most effective approach Uganda can take to stop terrorists.  Here is what US Embassy Kampala has on Twitter in a 5-day span, not one mention of e-bola:

And so — one more example of just how integrated is the embassy’s social media outreach with its primary consular function.

The Examiner notes the USG presence in the country and the absence of travel restrictions:

Several other U.S. government agencies are active in Uganda and have personnel there. The Peace Corps has about 122 volunteers in the country. U.S. military personnel regularly exercise with their Ugandan counterparts and Special Operations forces have been deployed there since October 2010. The U.S. Agency for International Development participates in 154 projects in that nation.

There is no traveler’s warning from the CDC for Uganda concerning the Ebola outbreak. The U.S. Embassy in Uganda issues a warning message to U.S. citizens in Uganda but has not suggested any travel restrictions.

Just two days before the ebola outbreak, forty-five Peace Corps Volunteers started their service in Uganda.

This is not the first reported instance of ebola outbreak in Uganda in recent history. In 2000/2001, there were 425 reported cases with 53% deaths; in 2007/2008, 131 reported cases with 37% deaths; and a single case in May 2011 which resulted in death.

Domani Spero

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June 29, 2012 · 12:49 am

Ron Capps | Back From The Brink: War, Suicide, And PTSD

Ron Capps retired from the Foreign Service and the Army reserve in 2008. During a twenty-five-year career, he served  in Kosovo, Rwanda, Afghanistan, Iraq, and Sudan, just about all the hell holes on earth.  He is founder and director at Veterans Writing Project.  He blogs for the Battleland blog at TIME Magazine and in his personal blog, The Next Lost Generation.

In a 2010 issue of Health Affairs, Mr. Capps wrote, Back From The Brink: War, Suicide, And PTSD. The piece is one of the most poignant agonies of post-traumatic stress disorder I have read.  He imagined the dead coming to talk to him every night asking, “Why didn’t you do more to save us?”  He had memories of “the dead, the mutilated, the burned.”  He wrote a story where the protagonist shoots himself in the head with a pistol.  He borrowed a gun, and put a gun to his head.  A timely phone call from his wife saved him.

“When the phone rang I jumped—startled—and nearly shot myself. This was almost comic, because I was already planning to kill myself and was holding the pistol in my hand. So I would have pulled the trigger while the pistol was pointed at my foot rather than my head. The ringing phone broke the spell.”

He was afraid to ask for help, writing, “I thought I would be ridiculed, considered weak and cowardly.”  This from a man who had two Bronze Star medals and tours in Airborne and Special Ops units.

He also writes about Question 21, the one that keeps many soldiers from asking for help. This was changed under Secretary Gates but apparently some things remain the same.

The magazine won’t allow republication on the web (we asked), so go read it in full at the HA website.
Domani Spero

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· 12:45 am

Quickie | Running Amok: Mental Health in the U.S. Foreign Service

Via Diplo Denizen by James Bruno (author and ex-diplomat comments on foreign affairs & writing). Mr. Bruno is the author of political thrillers Permanent Interest and Chasm and an Afghanistan thriller, Tribe; all available via Amazon Kindle:

In the second year of my Foreign Service career, I was assigned to Vientiane, Laos.  My deployment was accelerated by my predecessor’s seeking and being granted a one-year curtailment of his tour of duty because he was going bonkers.  Moreover, an admin officer had to be removed in a straitjacket after holing himself up in his house and smearing the walls with his own feces, another victim of mental and emotional stress.  I, on the other hand, thrived at this isolated outpost, our only one in Indochina five years following the fall of Saigon.  The setting was a cross between “Heart of Darkness” and “Casablanca.”  My seizure at gunpoint and brief incarceration by the authorities, which prompted a diplomatic row, was just one of the pressures at this surreal place.  Years later, in civil war-torn Cambodia, the State Dept. regularly sent a psychiatrist to post to measure our stress levels amid coup attempts, assassinations, 12-14-hour work days seven days a week and an unhinged ambassador.  At another embassy, one of our largest, the Secretary of State discreetly sent out two senior officials to gently pry our prominent career ambassador out of his job in the wake of his increasingly bizarre behavior, including public denunciations of an American ally.
[...]
In recent years, the number of Foreign Service personnel medevacced for mental health reasons has doubled.  One study revealed 15 percent of FS members suffered from PTSD.  A similar study done by the Defense Dept. found that 17 percent of soldiers returned from Iraq and Afghanistan suffered from the same condition.  As the U.S. has gotten involved in more overseas conflicts, the pressures on our diplomats have compounded.

A particularly sad case was documented in the September 2010 issue of the Foreign Service Journal.  A former military officer and tsunami survivor, this FSO was assigned to one of the most dangerous war zones six years into his State Dept. career.  He worked 12-14-hour days amid gun and mortar fire.  After being injured in a roadside bomb attack, a State Dept. psychiatrist prescribed an antidepressant for his PTSD.  But the medication caused lack of sleep, loss of appetite and high blood pressure.  When he complained about the side effects, he was prescribed a different antidepressant.  But the side effects continued and he was evacuated from post and placed in psychiatric hospitalization in Washington.  State Dept’s MED office failed to provide him with a doctor proficient in treating PTSD, so he found one on his own.  He was told he could not return to post.  Further treatment did not resolve his problem and he was medevacced again from another post.  He lives in Washington, separated from his wife, and essentially grounded for medical reasons.  His career prospects don’t look good.  This officer is convinced that, had he received better treatment, his current situation could have been avoided.

Continue reading, Running Amok: Mental Health in the U.S. Foreign Service.

Domani Spero

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June 28, 2012 · 12:18 am

Former FSO William Anthony Gooch: No Mercy for Broken Men?

On May 12, 2012, William Anthony Gooch, 52, was sentenced to 12 years in prison – the maximum he faced under a plea agreement in the Nov. 7, 2010 episode, in which Gooch rammed a Jeep into his estranged wife’s home before setting it ablaze.

What was not widely reported is that he’s a former Foreign Service officer.

In the July/August 1998 issue of State Magazine, he was listed as an “FS Specialist Intake.”  In the February 2003 issue of the same magazine, he was listed under “Foreign Service Retirements”

There is no public catalog of what happened to him after he left the Foreign Service. But apparently in 2005, while visiting Roswell, Ga., Mr. Gooch broke into his brother’s gun safe and ended up in a standoff with police where he begged to be shot.

In 2008, he reportedly shot himself in the chest, narrowly missing his heart. The suicide attempt led to a period of sobriety, and a seeming improvement, according to unnamed relatives cited in local reports.

In August 2009, Mr. Gooch was arrested after a six-hour standoff. This time, he also had a gun and was threatening suicide.

In 2010, El Paso County sheriff’s deputies told local news that Mr. Gooch crashed his car into the Black Forest home of his estranged wife, set the house on fire and then barricaded himself inside.  He was reported to be in critical condition in the burn unit at the Anschutz Medical Campus in Denver, according to hospital officials cited in local reports.

On May 12, 2012, he was sentenced to 12 years in prison – the maximum he faced under a plea agreement in the Nov. 7, 2010 episode.

Colorado Springs’ The Gazette had a write up on the hearing that details the unraveled life of former foreign service officer.  Excerpt below:

According to the family’s account, Gooch served in the Navy and the U.S. Agency for International Development before his 1998 transfer to the State Department, where he worked in the security office.

Within months of accepting the new post, Gooch and his family were assigned to Kinshasa in the Democratic Republic of Congo, where tensions were mounting between warring factions, according to his son, Andy Gooch, a private first-class in the Army National Guard and senior at Virginia Commonwealth University.

The six families in their compound were eventually moved out of Kinshasa as violence ramped up, Andy Gooch told the court, describing how they were driven past the dead and wounded on their way to the airport.

His father remained behind to help evacuate other Americans and nongovernmental aid workers, he said.
Gooch told his family that he was detained and beaten by Congolese police during the ensuing choas. He said a fellow Foreign Service officer secured his release.

Later that year the family was sent to Nairobi, Kenya, where according to Andy Gooch’s account, his father helped identify victims in the wake of a 1998 bombing that killed hundreds at a U.S. Embassy.

In Nairobi, the family survived an attempted car jacking when William Gooch shouted for his wife and children to get down while he drove around a road blockade past men armed with AK-47s, Andy Gooch said.

“When I was 10 or 12 years old, I saw things most people don’t see in their whole life,” Andy Gooch said. “If I got that little piece, I can’t imagine what my father saw.”

Said Sotela: “His mental health was deteriorating through the years that he was exposed to that situation.”

Gooch’s career with the State Department ended with a medical discharge in the early 2000s after he suffered a breakdown during an assignment in Kingston, Jamaica, family members said.

According to The Gazette, Mr. Gooch addressed the court in a soft voice, apologized and said he never meant to hurt anyone except himself – by swallowing pills, shooting himself and trying to get “someone else” to shoot him.  “Jumping off a bridge is about my last resort,” he told Judge Greg Werner, before ending his comments with a pledge to take treatment seriously.

I had this story the same week that George Gaines died in Barbados.  I just could not get myself to write about two tragic episodes that same week. The prosecutor in this case, suggested in court that Mr. Gooch exaggerated his experiences in a bid for leniency.  Nothing in the press reports suggested that Mr. Gooch was diagnosed or treated for PTSD. But it says he was medically discharged after he suffered a breakdown in Jamaica.

Domani Spero

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June 26, 2012 · 1:36 am

Pick the Long or Short Form, But Take the Post-Traumatic Stress Disorder (PTSD) Screening

Here’s how VA explains PTSD:  Posttraumatic stress disorder (PTSD) can occur after you have been through a traumatic event. A traumatic event is something terrible and scary that you see, hear about, or that happens to you, like:

  • Combat exposure
  • Child sexual or physical abuse
  • Terrorist attack
  • Sexual or physical assault
  • Serious accidents, like a car wreck
  • Natural disasters, like a fire, tornado, hurricane, flood, or earthquake

During a traumatic event, you think that your life or others’ lives are in danger. You may feel afraid or feel that you have no control over what is happening around you. Most people have some stress-related reactions after a traumatic event; but, not everyone gets PTSD. If your reactions don’t go away over time and they disrupt your life, you may have PTSD.  Read more here.

The Department of Veterans Affairs also put together a PTSD screening online which has 17 questions on problems and complaints that veterans sometimes have in response to stressful military experiences. All references are to stressful military experience.  Click here to read each question carefully, then select the answer that indicates how much you have been bothered by that problem in the past month.

I don’t think I’m going bonkers but I took the screening anyway.  The portal says that no information is collected, stored or sent over the Internet. To ensure complete privacy, exit your web browser after completing the screening.

See the text-only version.

Results between 0 and 20 indicate few or no symptoms of PTSD. Results between 21 and 29 indicate minimal symptoms of PTSD. Results between 30 and 85 indicate many of the symptoms of PTSD.   The PTSD Screening is, however, careful to explain that it is not designed to provide a comprehensive assessment or diagnosis of PTSD:

“Only a qualified physician or mental health provider can provide a complete assessment and diagnosis of PTSD. Only a qualified physician or mental health professional can differentiate symptoms of PTSD from other medical conditions. Only a qualified physician or mental health provider can prescribe appropriate treatment for PTSD or other medical conditions.”

The State Department has its own  Four Question PTSD Screener and says, “If you have answered “yes” to three (3) items or more it is considered “positive” and your screening results are consistent with symptoms of PTSD.  Also that if the screening results suggested the need for further assessment/evaluation, to check out the following resources:

  • Visit a primary or mental health care provider.
  • If you are not sure about benefits or don’t have a primary care manager:
    Contact the Employee Consultation Service at MEDECS@state.gov or Call 202-663-1815.
  • Contact the Deployment Stress Management Program at MEDDSMP@state.gov or Call 202-663-1903.
  • Contact MHN Support Services are available through web, phone, and in-person.
    Internet: https://members.mhn.com/ company code: ‘unaccompanied tour’.
    Phone: Call toll free, 24/7 at 1-800-213-5811

As you can see, we tried that company code and it’s a dud.

Domani Spero


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June 25, 2012 · 3:18 am

Post-Traumatic Stress Disorder: The Ticking Bomb in the Foreign Service

Rachel Schneller joined the Foreign Service in 2001, serving in Skopje, Conakry and Basrah, where she was a Provincial Action Officer from 2005 to 2006. In the January 2008 issue of the Foreign Service Journal, she wrote a piece about her personal struggle with PTSD  (See Recovery: When  Surviving Isn’t Enough, FSJ, p. 35). That same year, she was awarded the William R. Rivkin Award for Dissent. The excerpt below is from her 2008 FSJ article:

Since returning from Iraq over a year ago and being diagnosed with the disorder, I’ve gotten a crash-course on the subject. So perhaps I can contribute to the dialog in a way others cannot, by describing what it is like to recover from PTSD.

My PTSD came about due to the conditions I endured while on assignment with the State Department, but State left me to fend for myself when it came to seeking treatment. In June 2006, after having worked in Basrah for several months, I took leave to return to Washington for a few weeks. A Foreign Service National employee in my office had been murdered, and I’d dreamed of hanging myself from my office light fixture.

During leave, I asked the Medical Services Bureau for help and they referred me to an in-house social worker. While telling him about the whole horrible situation, including the dream about killing myself, I broke down in sobs. The social worker was nice but offered me no actual treatment. He did not refer me to a psychiatrist for an evaluation; he did not offer me medication for my depression; and he did not address my thoughts of suicide. Disappointed, but fearful of being labeled a “quitter” or worse, I chose to return to Iraq.

When I think about how poorly State treated me when I sought help, I am outraged. After all, I was in no condition to make decisions about my own well being, any more than an alcoholic can make a well informed decision in a liquor store. Any competent, qualified mental health care provider would have known this. I had requested help but found only more danger. It was as if the ambulance coming for me in my elevator dream not only did not stop for me, but ran over me in the process. I — and everyone else  serving our country in a war zone — deserve much better.
[...]
In any war zone, some people going through the experience will likely come out of it with PTSD. But if the State Department is going to post its employees to war zones, it should be prepared to deal with the mental health aftermath and offer treatment to those who need it.

I completed my Iraq tour at the end of July 2006 and returned to Washington, where I began my next assignment, long-term training at the Foreign Service Institute. After all I’d been through, I was grateful  to be home alive and in one piece, reunited with family and friends. But soon I just stopped functioning normally. I was unable to sleep. I started getting lost on my way home from work, waking up in a sort of fugue state blocks away from my apartment in Georgetown. I don’t remember precisely how, but I burned myself several times so badly that I scarred — yet I didn’t feel it. I only noticed the burns the next day. Rage overwhelmed me. I nearly attacked another person in one of my FSI training classes, but walked out of the class in time and had a meltdown in the bathroom. (That poor woman had no idea how close she came to being strangled by me for making a completely innocent comment.) I couldn’t keep up the  pretense of being normal any longer.

Regions of the brain affected by PTSD and stress.
National Institutes of Health

Last week, I posted about a grievance case by a Senior Foreign Service Officer who claimed PTSD and whose suspension was affirmed by the Foreign Service Grievance Board. In its FSGB filing, the State Department contends the following:

“Grievant served approximately one year in [REDACTED], [REDACTED] and returned to the U.S. on August 11, [REDACTED].  He served nearly seven months at the [REDACTED] without incident, and then, on March 2, [REDACTED] was assigned as Office Director to the Bureau of [REDACTED] and his misconduct began. Grievant waited until almost six months after he was removed from [REDACTED] to seek any medical advice.”

The Foreign Service Grievance Board in affirming the suspension writes:

“The year and a half referred to by the social worker encompasses the first seven months after his return to the U.S. from [REDACTED] when grievant served at the [REDACTED] apparently without incident. Grievant has not stated what he did in {REDACTED]  or what experiences he had that could have caused PSTD. He has presented no testimonials from others at the [REDACTED] or prior to his service in [REDACTED] to support his claim that PTSD accounted for his “out of character” behavior afterwards. There was no evidence that the claimed PTSD impacted any other aspects of the grievant’s life beyond the threatening and demeaning and bullying behavior that formed the basis for the discipline in this case.”

See, nothing happened in seven months, so how could he possibly have PTSD?

I don’t know how knowledgeable is the FSGB about PTSD, including an occurrence described as Delayed Onset PTSD, which can happen anywhere after six months to four years of the traumatic event. Or much longer than four years in some cases.  In fact, according to the LA Times, just a few weeks ago, Tech Sgt. Stanley Friedman, 92 was finally compensated for PTSD by Veterans Affairs (it was called shell shock or battle fatigue when he served nearly 70 years ago) for his service during World War II.  Our Foreign Service folks have not only served in war zones but have been subjected to  terrorist attacks, natural disasters and other traumatic events overseas.  I fully expect that the FSGB will be called on many more times in the foreseeable future to adjudicate cases relating to PTSD in the Foreign Service.

There is no question that the State Department needs to do a better job at screening for PTSD in the Service rather than its “cursory 3 hour High Stress Debrief session” plus handouts or one-day High Stress Assignment Outbrief Program, MQ-950 (which appears to be available only to employees and not/not to family members).  And by the way, spouses/partners who may be working in high-stress posts will not necessarily be working when they are back in the U.S., so they would presumably fall under the Non State Employee category.  The tuition rate for that category for taking MQ-950 is $260.

Rachel commented about the grievance/PTSD blog post, which I am highlighting below.

My heart goes out to everyone involved in this case. The employee having served in a PRT in what must have been extraordinarily difficult circumstances. The bewildered employees who felt threatened by the disturbing behavior of their boss. The State Department system, which has so little capacity for dealing with situations like this, which will only become more prevalent as more and more of us serve in combat zones. And come back.

A couple of things- a diagnosis of PTSD is your best defense, and can only be made by a qualified professional. A social worker cannot diagnose. If you have served in a combat zone and come back acting weird, please do everyone a favor and go see a psychiatrist or psychologist who can actually give you a diagnosis. You will not know you have a PTSD when you come back. You will just feel different and angry all the time. Trust me, get diagnosed. It is the only way to get good treatment.

Second, PTSD is a ticking time bomb. It is completely to be expected that someone with PTSD will come back from their service in a combat zone and be able to hold it together for a while. Luckily for me, I lost it only a few weeks after coming back and so was able to get treatment quickly. But in many cases, someone will not “lose it” for months or years afterward. You get triggered by something and BAM! You are right back in the war zone. That trigger may happen soon or it may not happen for a long time.

Third, you are an adult and so even if you have PTSD, you still are responsible for not attacking people or otherwise breaking the law, and you can and will be held responsible. PTSD is not a license to break the law. It does not make yelling at people OK. The soldier who “lost it” and killed all those innocent Afghani civilians a few months back? He probably had major PTSD, but he also killed a bunch of innocent people. Getting suspended from State is a good thing, because if you have PTSD you need to get treated, and this is your wake-up call.

And State, this sort of situation is going to keep happening. We need to do a better job of handling this sort of PTSD situation. It is only a matter of time before someone comes back and instead of yelling at their employees, actually does someone, or themselves, physical harm.

While I do believe that the State Department has the responsibility for conducting more effective PTSD screening for returnees, I also agree with Rachel’s point that mental health is an individual responsibility.  As she puts it plainly, “if you wait for State to get its act together on PTSD, you will be crazy for a long time.”

Wednesday, June 27 is PTSD Awareness Day. DiploPundit will be blogging about this topic the whole week.

Domani Spero

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