On The Frontlines: Assessing Traumatic Brain Injury Care in Afghanistan

Dr. Zafonte in Afghanistan

As part of the Mass General/Red Sox Home Base Program, Dr. Ross Zafonte TBI Research Program Leader and Dr. John Parrish, Executive Director accompanied General Peter Chiarelli, Vice Chief of Staff of the US Army and his team to Afghanistan to build a culture of concussion awareness in the Army.

Exiting the C4 Transport plane, it quickly became evident to the visiting group of physicians from the Mass General/ Red Sox Home Base Program that the otherworldly landscape of Afghanistan was just the start of a unique and transformative experience. Home Base Senior Advisor General Fred Franks (ret), Dr. Ross Zafonte, TBI Research Program Leader and Dr. John Parrish, Executive Director accompanied General Peter Chiarelli, Vice Chief of Staff of the US Army and his team to Afghanistan. General Franks has believed for some time that it was important for clinical leaders at Home Base to see first-hand the extraordinary commitment the military has made to identifying and treating the “invisible wounds of war— PTSD and TBI”—in theatre.

“Under General Chiarelli’s leadership, the Army is doing everything within its power to aggressively address these invisible wounds of war. The experience was extremely helpful to us in looking for novel approaches to
TBI. We learned something from everyone we met, caregivers and service members alike,” said Dr. Zafonte.
The group visited four Afghanistan bases stopping to see the Army’s Restoration and Recovery Centers at each base. From sophisticated facilities to unassuming tents for rest and relaxation (R&R), the Army is working
to build a new culture of concussion awareness. Soldiers who have been knocked unconscious are screened for TBI, then spend a few days recovering and rebuilding from their concussion. The R&R facilities are safe, quiet,
dimly lit, and there are caregivers to talk with about one’s experience.

One caregiver the group spoke to referred to the concussions his fellow soldiers receive as “brain sprains.” “If you sprain your ankle, you get off it for a few days, to give it time to rest and heal. We have the same approach
for concussions,” he said.

In addition to care, the military has made significant investments to educate our troops about the invisible wounds, and to reduce the stigma of seeking care. Service members are repeatedly told that combat stress symptoms are a
normal reaction to abnormal circumstances and the responsible thing to do is get help. These overall efforts also extend to the military reaching out to the clinicians and researchers in both public and private care to ensure they
can continue to provide support to soldiers from the front lines and the transition back to their civilian lives and beyond.

“As the Defense Department continues its dramatic draw down from Iraq and Afghanistan, we need to recognize that the invisible wounds of war are very real, and will be with our young service members and their families
for a long time to come. We owe it to these brave heroes to ensure we are doing everything possible to support them. It is imperative that we create the collaborative partnerships to ensure a strong health safety net for our
returning veterans and their families for the long term,” said Dr. Zafonte.

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