May/June 1998 1

VAnguard

Inside: VBA Vision 2001, 3 ✩ Primary Care Nurses, 10-11 ✩ Secretary West Sworn In, 20

U.S. DEPARTMENT OF VETERANS AFFAIRS

MAY/JUNE 1998

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2 VAnguard

Published by the Office of Public Affairs (80D)

Department of Veterans Affairs810 Vermont Ave., N.W.Washington, D.C. 20420

(202) 273-5738/5735E-mail: vanguard@mail.va.gov

www.va.gov/pubaff/OPAIndex.htm

INTRODUCINGCCCCCONTENTSONTENTSONTENTSONTENTSONTENTS

Dr. Alexander McCausland

VAnguard VA’s Employee Magazine

May/June 1998, Vol. XLIV, No. 4Printed on 50% recycled paper

Editor: Laurie TranterGraphics: Michael Nacincik

❏ Automated Pharmacists 5Robotic systems speed prescriptions

❏ Enrollment Update 7Eligibility law clarified

❏ Alternative Healing 8Some Navajo ceremonies recognized

❏ Resolution Management 9New EEO staff announced

❏ Primary Care Nurses 10-11 More Advanced Practice Nurses Trained

❏ Recognition 13,14Excellence in Nursing; Scissors awards

CCCCCOLUMNSOLUMNSOLUMNSOLUMNSOLUMNS

On The Cover:

“A Southern gentleman doctor” ishow patients and staff describe Dr.Alexander McCausland, the allergyspecialist at the Salem, Va., VAMedical Center. He is 85 years youngand continues his work with veter-ans as both their friend and physi-cian.

On Mondays, Tuesdays andWednesdays, McCausland is at theallergy clinic from 7 to9 a.m. Whenhe finishes atthe clinic, heproceeds tohis privatepractice wherehe works until5 p.m. everyweekday. OnSaturdays hegoes to themedical centerwhere he does hispaperwork andreviews the chartson the patients hewill see the nextweek.

“I just love my patients and I loveto come out here to treat them. Irespect the sacrifices they have madeand value their friendship,”McCausland says. “I am proud of theway this medical center has evolvedfrom a psychiatric custodial hospitalto one of the finest medical centers inthe area. I keep good company whenI come out here to work.”

Reportedly the oldest allergyspecialist in the nation, McCauslandhas seen many changes in allergytreatments in 50 years. “In the earlyyears we gave our veterans nearly100 tests, but today it is around 60.We have medicines today that wedid not have in the beginning.Earlier on all we had to give a patientwas adrenalin and oxygen. We hadno antibiotics. Nowadays, we haveall the wonderful steroid, anti-asthmatic, antihistamine drugs tohelp our veterans live close tonormal lives.”

A native of Virginia, McCauslandhas lived in Roanoke since he was 16years old. He received his pre-medical and medical school educa-tion at the University of Virginia. Heis the founder of and continues to bea member of the Virginia Asthmaand Allergy Society. Recently, hewas honored by a lecture series

established at theirannual meeting calledthe McCausland Lec-tures.

A World War IINavy veteran,McCausland began hiswork at the SalemVeterans Hospital in1948. A chief consultantfor VA andMcCausland’smentor at that time,Dr. Swineford, wasinstrumental in theopening of anAllergy Clinic at

the Salem Hospital. Swinefordrecruited McCausland to run aveteran’s clinic at a separate medicalcenter located on Campbell Avenuein downtown Roanoke, while hemaintained his private practice.

After the Allergy Clinic wasestablished at the VAMC, allergyoutpatients were sent there and thedowntown operation was closed.

McCausland not only loves totreat the veterans, he feels he has aunique relationship with them, abond, a camaraderie.

He tells one story with a twist.“During WWII when I was in theNavy, I had a patient on my medicalward. I couldn’t get him well enoughto go back to duty so I took himbefore the survey board to surveyhim out of the service and today —he is a patient in my clinic.” ❏

By Bill MalcolmSalem, Va., VAMC

16-20

Giant ceremonial flags billowbetween the columns of the MemorialAmphitheater at Arlington NationalCemetery. June 14, Flag Day, was firstofficially observed in 1877 to celebratethe 100th anniversary of the adoptionof the Stars and Stripes as the nation’sflag.

The American flag has specialmeaning at VA: not only does it flydaily over VA facilities, it is the partingremembrance VA arranges on behalfof a grateful nation to the next of kinof a deceased veteran. VA will orderabout 500,000 burial flags for presenta-tion this year. Photo by Robert Turtil.

May/June 1998 3

OutlookJoe ThompsonUnder SecretaryFor Veterans Benefits

March 4,1789, the daythe U.S. Consti-tution tookeffect, was alsothe day ourbrand newfederal govern-ment passed itsfirst law to helpveterans. Thusbegan a two

century-long commitment by theAmerican people to help those whowore our nation’s uniform to defendthe ideals embodied in the Constitu-tion. Defending these ideals camewith a very dear price: more than 41million of America’s sons anddaughters served the cause offreedom, one million of whom diedfor that cause. In return, America hasprovided help to these citizen-soldiers in making the sometimesdifficult transition back to civilianlife.

Each wartime era brought anever-changing society, and conse-quently, ever-evolving programs tohelp veterans. The agencies createdto provide this help — the Bureau ofPensions, the Bureau of War RiskInsurance, the National Homes forDisabled Volunteer Soliders, theVeterans Bureau, and the otherforerunners of today’s VA — had tochange and adapt to these changingcircumstances.

Today, we in the VeteransBenefits Administration, the heirs tothis tremendous legacy, find our-selves in a rapidly changing world,one that can be stressful and confus-ing, but also one that provides manyopportunities. We have no choice butto do the things that our predeces-sors had to do: learn, and grow, andchange.

Just as our agency and its prede-cessors helped veterans in the 18th,19th and 20th centuries, so too willVBA do the things necessary toensure that veterans are well servedin the 21st century.

The Road Map to Excellence —Planning the Journey is our plan forchanging VBA to renew our focusand to accomplish our mission.While it is based on the input ofmany VBA employees, as well as ourkey stakeholders, it is the beginningof a dynamic process. It representssome important changes to ourorganizational structure, workflow,job designs, and our relationshipswith veterans, their representativesand our partners in the benefitsdelivery process.

Shortly after my confirmation, Ibrought together a group of seniorVBA managers for a workshop thatfocused on assessing the issues andopportunities facing VBA andagreeing upon VBA’s mission,vision, values and goals for the longterm, and its critically important nextsteps. Based on an assessment ofVBA’s current operations, manage-ment and planning efforts, as well asinput from our stakeholders, weoutlined and defined a series ofobjectives to be achieved by 2001.These form the basis of the VBA 2001vision. Chief among them:

• VBA will be customer-focused and-driven.

• Our work processes will be ownedand shaped by our workforce.

• Teams and teamwork will be ourstructure and manner of operation.

• Innovation will be encouragedand recognized and collaborationwill be a hallmark of VBA workmanagement.

• VBA’s data systems will bereliable, timely, accurate, integratedacross the organization, honest andflexible. Our information technolo-gies will support a centralized policydevelopment and a decentralizedfield office structure.

• Employee skills and competencies

will be identified for every decision-making position. Training will beperformance-based and connected tomeasurable outcomes.

• VBA will work closely with VHAand BVA in improving the quality ofclaims through an improved qualityassurance program.

• VBA will not be bound bygeographical limitations in ourservices to veterans.

• Authority and responsibility tomake decisions will be driven downto the lowest appropriate level.

• VBA managers will share availableresources and reduce redundancies.

• VBA’s field organization will berealigned to better reflect our team-based, customer-focused and restruc-tured organization.

• VBA is committed to improve-ment and change. This is our vision.This is our future. ❏

VBA Vision 2001

VBA’s RoadMap to

Excellence —Planning the

Journey isscheduled

to becompleted in

June, at whichtime the

complete textwill be posted

on VBA’sIntranet for

employees toreview.

4 VAnguard

“It makes all the difference in theworld.”

“Now I don’t have to depend onsomeone else for everything.”

“It’s really been a lifesaver forme.”

These are comments from threespinal cord-injured veterans abouttheir environmental control com-puter system (ECS) during a recentinterview with Federal ComputerWeek.

VA has provided these veteranswith one of the newest versions ofvoice-activated ECSs for their homes,to assist them in tasks that manypeople take for granted.

An ECS is designed for peoplewho have lost the use of their upper-body, specifically their arms andhands.

Farris Hodges, chief, ProstheticTreatment Center at the MemphisVAMC, helps veterans obtain theunit. “The appropriate ECS can meanthe difference between havingaround-the-clock caregivers andliving alone, going to school and/orbeing gainfully employed. Thistechnology can help put meaningback into life.” he said.

The devices, which are approxi-mately 5”x5”x3,” help the veterans toaccomplish tasks such as openingand closing doors, answering thetelephone, adjusting and/or turningon and off lights, ceiling fans,televisions, stereos, air conditioningand heating units, and other electri-cal appliances, such as coffee pots,blenders and even hospital beds.

VA began developing ECStechnology in the early 1970s. Theunits then were functional but notuser-friendly. They required the userto inhale and exhale on a “sip andpuff” pneumatic tube to generateenough air pressure to signal the ECSelectronically to perform presettasks. Even though this older systemcontrolled appliances and fixturesonly in the room in which it wasinstalled, it was a welcome assist.

VA was able to make ECS unitsavailable to SCI veterans whoneeded them through a contract withthe Prentke Romich Company.

Today, VA no longer invests inthe development of the ECS. AfterVA showed manufacturers themarket need for ECS, they built onVA’s work, made improvements and

created an entire industry, accordingto Saleem J. Sheredos, programmanager of the Technology TransferSection of VA’s Rehabilitation,Research and Development Servicein Baltimore.

VA’s primary concern is to ensurethat veterans receiving care at any ofits 23 SCI Units are provided an ECSif they need it.

Today’s multi-functional voice-controlled computerized systems canbe programmed to accomplish tasksfrom any room in the home. Thesesystems range in cost from $7,000 to$11,000.

While still hospitalized in the SCIUnit at the Memphis VAMC, veter-ans learn to use the ECS, which isconnected to the television, radio,lights and bed controls. Their in-structors are from the MemphisVAMC’s Prosthetic Treatment Centerand occupational therapists of theRehabilitation Service.

“Advancements in technologyhave provided a wonderful way toempower people,” said Lisa Johnson,an occupational therapist who worksdaily with veterans in the SCI Unit atthe Memphis VAMC. “The initialhospital rehab is only the introduc-tion — the real test is getting outthere and living. It gives me greatsatisfaction to hear that veterans areactively involved in life, going toschool, working, and interacting withfamily and friends.”

After home needs are identifiedand a unit is installed in the veteran’shome, the veteran receives betweeneight and 12 hours training on howto use the system. Following thisinitial training, the Prosthetic Treat-ment Center staff will again contactthe veteran to ensure that the unit isperforming properly and to deter-mine if further input is required.

For any future concerns orneeded adjustments, Hodges said,“Veterans using these systems knowthat the VA is only a phone callaway.” ❏

By Willie M.T. LoganMemphis VA Medical Center

Home Computers Handle Tasks for VeteransThe Memphis, Tenn., VA Medical Center has one of the country’s firstSpinal Cord Injury units, inheriting that specialty from the old Armyhospital in Memphis that was converted to VA after WWII.

Lisa Johnson, occupational therapist at the Memphis VAMC, discusses the automatedenvironmental control system used by veteran David C. Cantrell in his home.

May/June 1998 5

A utomated prescription fillingis spreading from coast tocoast for VA pharmacies andthe technology is reducing the

number of complaints over prescrip-tion waiting times.

Seven automated VA Consoli-dated Mail-Out Patient Pharmacies(CMOPs) are speeding mailedprescriptions to veterans for 120 VAfacilities. The CMOPS are at theCharleston, S.C.; Bedford, Mass.;Hines, Ill.; Leavenworth, Kan.;Murfreesboro, Tenn.; Dallas andWest Los Angeles VA facilities.

“In addition, VHA is testingATM-like unit-of-use dispensingmachines in ambulatory care clinicsettings and community-basedoutpatient clinics,” said John Ogdon,director of VA’s Pharmacy Service.The units are linked to VA’s database.

Some individual medical centersare also automating to help themwith their unique situations. TheWilkes-Barre, Pa., VA MedicalCenter is the most recent of five VAfacilities to adopt a robotic pharmacy

called the PharmacyBaker 3000 AutomatedPrescription System. Theothers are in Hines, Ill.;Sepulveda, San Diegoand West Los Angeles,Calif.

Wilkes-Barre, withfive outpatient clinics(Allentown, Sayre,Williamsport, SchuylkillCounty andTobyhanna), needed toshorten the waiting timefor veterans picking upprescriptions and toimprove its cost efficien-cies for an increasingworkload.

Fully operational, therobotic system will fill180 total prescriptionsper hour and automati-cally fill a maximum of297 tablets or capsules.The system comesequipped with threeimaging, two filling andthree checking stations.

Its cost, approxi-mately$700,000, isexpected tobe offset bythree full-time equiva-lent (FTE)positions that wereeliminated throughattrition.

Besides providingrobotic dispensing,which automaticallyprocesses and fillsprescriptions, the systemalso provides for remotedata and prescriptionentry through a wide-area network program.This means prescriptionimaging can occur at asatellite location milesaway, and the image canbe passed to the Wilkes-Barre VAMC for filling.

The Wilkes-BarreVA Medical Center’sOutpatient Pharmacy

‘Robotic Pharmacists’ Cut Waiting TimeFor Veterans’ Prescriptions

The robotic arm makes automatic placements on a countingdevice and the correct quantity is dispensed directly into thewaiting bottle on the conveyor belt. The bottle thencontinues to the filling technician who completes the order.

After the Pharmacy Baker 3000 assigns a barcode to aprescription, scans it, generates a label and drops a bottleinto the automatic labeler, the bottle goes into a “puck” onthe conveyor belt. Each numbered white puck has a uniquemicrochip in it to aid in the tracking of the medicationthrough the filling process.

currently fills an average of 1,800prescriptions per day. With mail-orders included, that amount willincrease to more than 2,000 to meetthe demand of the five community-based outpatient clinics underWilkes-Barre’s jurisdiction.

Wilkes-Barre VAMC officials sayautomation enhances the pharmacy’sability to meet the increased pre-scription demand, while allowingpharmacists to focus on one-to-onepatient-education counseling ser-vices. ❏

6 VAnguard

Doctors Make Pronounced Improvements

I f you ever wondered howMeryl Streep could soundlike a native of Poland in“Sophie’s Choice,” then

speak with an Italian accent in“Bridges of Madison County,”Kathryn Donahue, speech-lan-guage pathologist at the Batavia,N.Y., VAMC, can tell you.

It requires a process calledcode switching and a lot of hardwork — and it’s what somephysicians in the VA WesternNew York Healthcare System aredoing to reduce their accents. Acustomer service survey a fewyears ago brought complaintsfrom some veterans that theycould not understand theirforeign-born doctors.

Donahue noticed those responsesafter remembering how much betterher French was understood in Paris afew years before when she made theeffort to switch from an American toa French accent. After that, she took acourse in accent reduction and askedmanagement if she could offer theclass. With an enthusiastic responsefrom the top, a letter offering the

accent reduction course was sent toall physicians at the three medicalcenters of the VISN — Buffalo,Batavia and Rochester.

The need to keep class size smallcaused her to limit the invitation todoctors. Of those who responded,some could not make the commit-ment to the 13-week course becausethey were residents scheduled toleave VA soon, so Donahue had fourforeign-born physicians in her first

class. Their native tongues wereBengali, Hindi, Korean and Spanish.

Donahue’s course uses a structuredeveloped at the Institute of Phonol-ogy in San Francisco. She starts byrecording 66 words, 66 sentences anda reading passage from each student.She translates every accented soundinto a phonetic one. She gets a

baseline of informationthat includes the percent-age of times that thespeaker accents a sound inits position in a word orstring of words. Someone might accentthe r sound 20 percent ofthe time when it is thefirst sound in a word, but75 percent of the timewhen it is the final soundand 100 percent in con-nected speech. Thisinformation helps thespeech pathologist setpriorities for correctionand also can be used to

measure improvement. Donahue hasthis analysis finished before the classbegins.

Class participants meet weekly atthe Buffalo VAMC for 90 minutesand commit to practicing with audiotapes one hour every day. Two tofour sounds are targeted each class.

Class participants learn that everyaccented sound is due to one of foursound alterations: substitution,omission, addition or distortion.

Donahue calls it “mother tongueinterference.”

For example, in many languagesi is pronounced like ee. Hence thenon-American speaker may substi-tute “seester” for “sister.” In Spanish,many words begin with es which inEnglish begin with s. Hence aSpanish speaker often adds the esound before the s. French speakersoften omit the final consonant inEnglish because the final consonantfor French words often are notpronounced.

Donahue also corrects grammarerrors that she sees in e-mail mes-sages she gets from students; teachespronunciation in sentences that usethe rhythms and phrasing of Ameri-can speech; and explains commonAmerican idioms.

Students ask her why they should“cool their heels” and what’s wrongwith “spilling the beans.” In hersecond class that began in May, shewill emphasize American intonationmore.

And “the proof is in the pud-ding,” so to speak. Measuring fromthe baseline words and paragraphsshe recorded from her students, shefound at the end of the first class a 64percent average reduction in ac-cented sounds.

And, “to top it off,” she says, “Itwas a wonderful experience for all ofus.” ❏

By Jo Schuda

From left, Dr. Cartagena, Kathryn Donahue, Dr. Kim

May/June 1998 7

A s summer begins, VHAprogram directors are well ontheir way to accomplishingthe monumental task of

implementing a revolutionary newhealth-care eligibility law requiringthat veterans wishing to receive VAhealth care apply for enrollment intonew health-care priority categories.The law specifies that the newsystem begins Oct. 1, 1998.

“We know where we have to beOctober 1,” said Kent Simonis,director of the Health AdministrationService. “A lot of people from themedical centers on up are workingextremely hard to make sure we getthere.”

“Getting there” means institutinga new system that will enableveterans to apply simply and quicklyfor enrollment at any VA medicalcenter. That information would thenbe electronically transmitted to theexpanded Health Eligibility Center inAtlanta for certification against databanks maintained by the AustinAutomation Center. The finaldecision on an enrollment applica-tion will be made at VA CentralOffice based on resource projectionsand projections of the number ofveterans VA can care for in the newsystem’s seven priority categories.

Shorter application form usedThe new enrollment process will

begin with the veteran filling out asimple one-page application at his orher local VA medical center. The newone-sheet application form, the1010EZ, is an administrative revolu-tion in itself, according to Simonis.

“This single sheet replaces 11pages of forms currently used todetermine eligibility for care,”Simonis explained. “With this onesheet, veterans will be able to applyfor any type of VA care at any of1,100 locations of care.”

The veteran’s application goes tothe Health Eligibility Center inAtlanta, which certifies the informa-tion against VA records and assignsit to one of seven priority categoriesestablished by the law. That certifiedapplication is then assessed by VHAMedical Administration Service forfinal approval based on its eligibilitycategory and the ability of the VHA

budget to provide health care to thenumber of veterans in that category.

VHA is now in the midst of“auto-enrolling” some 4 millionveterans documented as havingreceived VA health-care servicesbetween Oct. 1, 1996, and Sept. 30,1997. This will ensure that “currentusers” are ready for a seamless entryinto the new system this October.

“This automatic enrollment isbeing done through new and re-vamped information systems,”explained Simonis. “In addition,since last October, we have beenencouraging any veteran interestedin obtaining VA health care after Oct.1, 1998, to apply in advance so wecan develop our enrollment databases and project how many enrolledveterans we can expect.”

Test phase redefinedMisinformation about the nature

of the transition of pre-enrollmentapplication processing swept thenation via Internet in March andApril, giving the issue a sense ofpublic urgency. A message put onthe Internet by a Navy veteranwarning veterans that they had untilOct. 1, 1998, to enroll with VHA orlose their VA health-care benefitsforever rapidly made its way acrossthe country between military andveterans’ web sites.

Calls began streaming into VAfacilities and VA headquarters fromconcerned veterans. VA respondedwith news releases, public state-ments and its own web site clarifyingthe process and explaining thatveterans were being asked to applynow, but could apply anytime beforeor after the Oct. 1, 1998. That VA website recorded more than 25,000 hitsby the end of April, and news mediaacross the country carried the storyof the faulty message and VA’sclarification.

“It is true, of course, that mostveterans will have to be enrolled toreceive VA health care after October1 of this year,” explained Simonis,“but they can enroll any time, evenafter October 1. We can accept anapplication whenever they visit amedical facility.”

Once enrolled, veterans, for thefirst time, will have equal eligibility

for health-care services offered byVA in a benefits package, whetherprovided on an inpatient or outpa-tient basis. That “uniform benefitspackage” will encompass the com-prehensive inpatient, ambulatory,and rehabilitative care servicestraditionally provided by VA, alongwith preventive care services, drugsand prosthetics. VHA has requestedlegislative support from Congress toclarify VA services in “uncertain”areas, such as maternity/newborncare and emergency care in non-VAfacilities.

As E-Day approaches, muchremains to be done. The patientenrollment information system thatwill support the application processand the sharing of eligibility infor-mation among all VA facilitiesthrough the Health Eligibility Centermust be tested and refined. Applica-tions must be encouraged andprocessed. In addition, informationabout this new process must reachVA employees and the veterans whowill be coming to them to apply andask the inevitable questions.

An enrollment “tool kit” isalready on the web at the VHAeligibility and enrollment web site.

VHA has held two nationalteleconferences updating andinstructing medical center staff onenrollment. A VA eligibility reformnational conference will be held inPhoenix July 28-30 to ensure VAmedical administrators across thecountry are on board the enrollmenttrain.

An enrollment education andoutreach contract has been awardedto a private contractor to developcommunications plans and materialsthat will support the enrollmentbeginning in June as VHA sends outits first enrollment decision letters toveterans.

“October 1 will be a landmark forveterans and VA health care,”Simonis said. “We will introduce astreamlined administrative process; acomprehensive, uniform healthbenefits package; and much im-proved customer service. For VAhealth care, this is truly a millenniumevent.” ❏

By Chris Scheer

New Health-Care Eligibility Law Clarified

8 VAnguard

Alternative Healing Works WellFor Navajo Veterans in Phoenix

I magine that you have beenraised in a world where youhave learned to survive inharmony with your surround-

ings. You have called upon the sunto bring you more light, you haveprayed to the rain gods for their dewso that your crops may grow andyou have learned to dance with thewind, to relieve your worries of theday. That environment is quitedifferent from the rigors of war,where a military member may beexposed to death, destruction or thefiring of weapons.

Understanding that typicalAmerican beliefs are different fromthose of Native Americans helpedofficials at the Phoenix, Ariz.,Medical Center decide to offertraditional healing ceremonies forNavajo veterans.

After a successful pilot project,VA signed an agreement April 7 toreimburse Navajo veterans for 12such ceremonies. The agreementcalls for reimbursing $50 when theygo through a Crystal Gazing, StarGazing or Hand Trembling diagno-sis. The diagnosis is then used todetermine which Navajo ceremony

would be best for treating the patient.For example, it may be deter-

mined that a Navajo veteran needs aShooting Way ceremony. Thisconsists of a one and a half-dayherbal treatment plus a five-day,four-night ceremony to address andheal the illness due to the effects ofevil power or war.

Another extensive ceremony isthe Night Way ceremony, which isperformed during the winter months,to address and heal hearing problemscaused by explosion, shock or firingof weapons.

VA will reimburse the Navajoveterans, with fees ranging from $150to $750. The funds are used to payonly the cost of the medicine manand his supplies and not any lodgingor food.

“We know that in medicinespirituality is important, yet weignore the spirituality of people whohave different beliefs,” said MedicalCenter Director John Fears. “This hasbeen a sore point with our Navajoveterans who have served ourcountry well and in times of troublehave volunteered at twice the na-tional rate of any other group.

“They do this because theirculture says they need to defendtheir land, so it’s important we showthat our country supports them aswell,” continued Fears.

For the past 21 months thePhoenix VAMC has been workingwith the Navajo tribes to determinewhat effects such alternative treat-ments might have.

“By furnishing the traditionalservices, we have found that manyare substantially helped and thatwhen modern medicine is necessarythe Native American healer has nohesitation about encouraging thepatient to seek that treatment,” Fearssaid.

The medical center’s surveyshowed that only 20 percent of theNavajo veterans would seek modernmedicine for many of their problemslike PTSD or substance abuse.

As outreach to minority veteranscontinues to expand, the PhoenixVAMC hopes to expand its servicesto other tribes as well. ❏

By Paula PedenePhoenix VAMC

T he Manila Regional Officeand Outpatient Clinic andthe Oakland, Calif., Re-gional Office joined forces to

help the people of Bacolod, Philip-pines, find the relatives of PrivateFirst Class Theodore Vinther, theAmerican WWII hero who savedtheir city.

When Joe Cooley, acting directorof the Manila Regional Office andOutpatient Clinic, traveled toBacolod to meet with the AmericanLegion’s commanders, city officialsasked him to help find Vinther’srelatives. When Cooley asked formore information, they invited himto attend the annual Bacolod Libera-tion Day festivities that coincidedwith the American Legion meeting.

March 30 is celebrated each yearas Liberation Day, when the people

RO Employees Help Find WWII Hero’s Familyof Bacolod recall the story of howVinther changed the course of theirhistory.

On March 29, 1945, the Japaneseknew the Americans were approach-ing and that, if they blew up BagoBridge, they would be able to delaythe advance of the Americans andmake a defensive stand in Bacolod.

Vinther, who was on a scoutingmission with some Philippineguerrillas, attacked the Japanesedetachment of 40 men who weresetting up explosives on Bago Bridge.Many Japanese died, and the rest ofthe surprised detachment fledwithout destroying the bridge. Withthe bridge open, the Japanese garri-son in Bacolod abandoned their planand retreated to the mountains. Thecity of Bacolod did not become abattleground and there were no

civilian casualties. Vinther, though,was killed in the 15 minutes ofgunfire exchange.

This year, the smiles of the peopleof Bacolod, which give the city itsnickname, “City of Smiles,” wereobvious, as they have been for over50 years on Liberation Day.

When Cooley returned to Manilahe found that Vinther was fromBerkeley, Calif., so he contacted theOakland RO. Tony Aponte, theveterans services officer, did somedetective work and located MaureenAnne Vinther, the sister of Vinther.Because she was unable to travelfrom her home in Vallejo, Calif., toattend the Liberation Day festivities,her son may attend next year. ❏

May/June 1998 9

A re you answering the phonecorrectly? You can if youfollow a few principles. Peter Hayman is a counsel-

ing psychologist at Bay Pines, Fla.His experience as a VetCenter counselor hastaught him theimportance of correctphone procedures.In workshops forVA employees, heoffers these tips:

1. Be an activelistener. Use“encouragers”(“uh-huh,” “ please go on”) Payattention to the emotion in thecaller’s voice.

2. Don’t interrupt.3. Take notes.4. Let the caller know you

understand him. Paraphraseand summarize to aid under-standing.

5. Acknowledge thecaller’s feelings.

Beyond these basics are thesubtleties that establish rapport witha caller:

Phone Tips VA Employees Can UseStart out by approximating the

caller’s volume and speed. (“Wow,you are very excited. I can hear it inyour voice.”)

Acknowledge caller’s feelings.(“I can tell you are angry.”)

Obtain and use the caller’s name.

T he Office of ResolutionManagement (ORM), the newequal employment opportu-nity complaint handling

organization, is almost fully staffedand operational. Most of its newemployees have already receivedadditional training, although theyhave EEO work backgrounds.

Ventris Gibson was named bythen Acting Secretary Togo D. West,Jr., as Deputy Assistant Secretary forResolution Management. A Navyveteran, she had been director of theOffice of Human Resources, VeteransBenefits Administration.

Secretary West also selectedRobert Poindexter as District Direc-tor to supervise ORM field offices inthe eastern United States. Poindexteris a retired Army veteran withextensive EEO experience. One otherdistrict director position may befilled. Both the western and easterndistrict offices opened in April at the

Washington, D.C., VA RegionalOffice and are fully staffed with fiveemployees each. Poindexter cur-rently oversees both.

Gibson selected field managersfor all 12 offices nationwide. All aretrained in discrimination complaintprocessing and management. ORMnow has 170 employees out of anexpected total workforce of 258.Gibson said 86 percent of those hiredare veterans, including women anddisabled veterans, and all minoritiesare represented in the staff.

VA awarded a contract to thefirm Booz Allen & Hamilton to assesscurrent complaint handling activitiesby June 1 and to follow up next yearat this time to determine howeffective ORM and the new Office ofEmployment Discrimination Com-plaint Adjudication (OEDCA) havebeen. Established at the same time asORM to review ORM’s findings ofdiscrimination, OEDCA is staffed

Resolution Management Staff Announcedwith attorneys. Both offices werecreated to implement Public Law105-114.

These are the ORM field officelocations, outbased satellite officesand field managers on board byMay 1: Leavenworth, Kan. (Denversatellite) — Charlotte Jones; Lyons,N.J. (Pittsburgh, New York Citysatellites) — Rosa Franco; LittleRock, Ark. (St. Louis, Mo.,Murfreesboro, Tenn.) — AustinLewis; Cleveland, Ohio (Detroit) —Ty Wanna Halstead; West LosAngeles (Long Beach, Calif.) —Dennis Callahan; Washington, D.C.(Fayetteville, N.C.) — Peggy Joyner.

These offices were scheduled toopen between May and July:Vancouver, Wash., James Foster;Bedford, Mass., Deborah Outing;Palo Alto, Calif., Mary Ellen Garcia;Bay Pines, Fla., Malcolm Porter;Hines, Ill., Joan Hansen; and Hous-ton, Texas, Paul Crane. ❏

If possible, find common interestsor experience. (“I know someonewho served in your unit.”)

Use “Selective Agreement”(“You were right to call.”)

Finally, trycomplimenting the

caller. (“I admireyour frankness.”)

Haymanlearned tele-phone tech-niques throughexperience.While at the Vet

Center in Syracuse, N.Y., heestablished a 24-hour help lineand was responsible fortraining volunteer operatorsand reviewing their difficul-ties. Says Hayman: “Themost important point inusing the phone is to be anactive listener and to buildrapport with the caller.” ❏

By Bonner Day

10 VAnguard

C harlotte Roeber, a registerednurse and clinical nursespecialist in the Hines, Ill., VAHospital’s Mental Health

Clinic, is clear as to why she hasembarked on a year-long course ofstudy toward certification as anadult nurse practitioner. Her firstreason is in line with the primarycare goals of the program.

“I am interested in providingprimary care for psychiatric pa-tients,” Roeber said. “Besidesmanaging psychiatric disorders andtreatments, I would like to managetheir other health problems. This willallow me to function more compre-hensively.”

A second motivating factorcomes from individual pride. “I’mhoping to be the first adult nursepractitioner in psychiatry here atHines.” An adult nurse practitionerhas skills uniquely suited for the careof the veteran population, in contrastto a family nurse practitioner whowould be trained to care for children,as well.

The need for more advancedpractice nurses — comprised ofnurse practitioners, clinical nursespecialists and nurse anesthetists —in VA parallels the dramatic transi-tion of the agency in moving towardprimary care.

What each of these roles has incommon is that the practice is based

on the nursing model and philoso-phy of care that stresses a client-centered approach. It builds on thestrengths of the client and fosterseducation, independence and self-care.

Nurse practitioners are viewed asa resource for basic primary health-care delivery and are charged withconducting nurse-managed clinicsand/or primary care patient manage-ment for a defined patient popula-tion.

Often described as employing aholistic approach, the advancedpractice nurse attends to the fullrange of the patient’s needs inrelation to his or her environment.This nurse uses skills in both physicaland psychosocial diagnosis, treat-ment, evaluation, coaching, commu-nication and community referral.

According to Dr. Nancy Valen-tine, Ph.D., chief consultant, VHA’sNursing Strategic Healthcare Group,this holistic model of curing as wellas caring is what contributes to ahigh level of client satisfaction.

Previously, care was providedaccording to an inpatient model thatrelied more on specialty care ratherthan the current focus of primarycare and preventive medicine.

Today’s veteran, however, oftenrequires extended care and long-termbasic care rather than acute, episodiccare. Primary health-care delivery

also improves access to care, main-tains quality of care and improvesprovider accountability for patients.

Consequently, VA Under Secre-tary for Health Dr. Kenneth W. Kizermandated a 200 percent increase inthe number of primary care provid-ers systemwide over a two-year spanas a more efficient way of deliveringprimary care.

VA and the Department ofDefense Uniformed Services Univer-sity of the Health Sciences (USUHS)are training 38 VA clinical nursespecialists to become adult nursepractitioners through an 18-monthlong-distance learning program.

The accredited program began inOctober 1997 after a successful two-month pilot.

Using two-way video teleconfer-encing, the USUHS faculties teachfrom the campus in Bethesda, Md.The signal is transmitted through theVA national telephone system bridgeat Martinsburg, W. Va., to VAparticipants at eight sites: BronxVAMC, Baltimore VAMC, San Diegoand West Los Angeles, Calif.,VAMCs, Fayetteville, N.C., VAMC,Atlanta VAMC, Charleston, S.C.,VAMC and Leavenworth, Kan.,VAMC. When participants concludethe 18-month program, they will beeligible to take the national nurse

(continued on page 11)

Primary Care Nurses Assume More Roles

Mary Ann Noonan, an assistant professor in nursing at Loyola University Medical Center and a family nurse practitioner, teaches the nursepractitioner course to nurses at Hines and throughout VISN 12 via videoconferencing.

May/June 1998 11

practitioner certification exam.Unlike other distance learning

programs, this nurse practitionerprogram has no requirement forstudents to spend four to six weeksin residency at the teaching campus.Rather, each facility provides oneclass coordinator and several clinicalpreceptors to supervise studentpractice.

At Hines, there are already about10 nurse practitioners throughout thehospital.

The VISN 12 initiative is a “grow-our-own” program to prepareregistered nurses holding a clinicalmaster’s degree in nursing as nursepractitioners. The program is inconcert with the VHA Nurse Man-aged Care Initiative. Partial fundingcame from the VA Health Care StaffDevelopment and Retention Office inNew Orleans.

The program was developedbetween Loyola University School ofNursing and VISN 12 VAMCs. Themaster’s degree nurse practitioner

programs at Loyola are accredited bythe National League for Nursing,and students who complete therequired course work are eligible fornational certification as a nursepractitioner. By providing coursework to employees who alreadyhave master degrees in nursing, theprogram completion time is just oneyear.

The VISN 12 multi-pointvideoconference system is used totransmit classroom activities —conducted at Hines by Loyolainstructors — to other VISN 12 sites.VAMCs at Madison, Wis., NorthChicago and Chicago (West Sideand Lakeside divisions) provide aclassroom, library, clinical learningsites and preceptors for employees.

Ten nurses are participating inthe VISN 12 program. Four are fromHines, four are from the VA ChicagoHealth Care System and one each isfrom the North Chicago VAMC andthe Madison, Wis., VAMC.

VA and some HMOs (health

maintenance organizations) areamong the first health-care systemsto recognize the importance of non-physician providers in primary care.Non-physician providers includenurse practitioners, clinical nursespecialists and physician assistants.

By achieving quality and cost-effective outcomes, these practitio-ners will assist VA in achieving theperformance indicators outlined inthe Under Secretary for Health’sVision for Change, Prescription forChange and Journey of Change.

One of the greatest barriers to beovercome is physician acceptance ofthese roles. As outcomes of thisalternative model to those tradition-ally employed in the department areboth experienced and measured,acceptance will grow rapidly,Valentine predicts. ❏

By Gary RobertsHines, Ill., VAMC

G one are the days of shufflingpapers and looking formissing documents at theAtlanta and St. Louis Educa-

tion Regional Processing Offices.Now The Image Management

System (TIMS) “takes pictures”ofpaper documents and converts theminto electronic images. This docu-ment capture and managementsystem gives vocational rehabilita-tion counselors access to a veteran’sentire folder with a touch of a button.

TIMS houses electronic versionsof all the documents in a veteranseducation claim folder. It is used inthe processing of Montgomery GIBill education claims but could beexpanded to handle other VA benefitprograms.

TIMS also allows multiple usersto view a particular veteran’s foldersimultaneously, eliminating “foldercompetition” between employees.

Schools can transmit documentsdirectly into the TIMS system via faxor the VA Certification (VACERT)computer program. This eliminatesthe scanning process and makes for atotally paperless claim.

The system was installed in theAtlanta and St. Louis sites in fall1997. Plans are for the other twoeducation regional processing

Imaging Speeds VBA Document Processing

offices (Buffalo and Muskogee) tohave TIMS soon. ❏

High resolution scanners copy veterans’ handwritten letters, enabling VARO employees tocreate less cumbersome electronic files. More than 60,000 pieces of correspondence arescanned monthly at the Atlanta Regional Processing Office.

12 VAnguard

Veterans’ Spirits Soar at Winter Sports Clinic

“I have new respect for the wordsteep!” Those are the words of anovice disabled skier after finishinghis first run down the slopes of Mt.Crested Butte, Colo., at the 12th Na-tional Veterans Winter Sports Clinic.

Open to any veteran with anyphysical disability, the Winter SportsClinic this year hosted more than 300disabled veterans who were ready totake up the challenges of downhilland cross-countryskiing. Included inthe ranks ofparaplegic, quad-riplegic, visuallyimpaired andamputee skierswere 40 percentnovice skiers, manyof them newlyinjured. Thesenovice skiers sharean absolute terroron the first trip upthe mountain, andunrestrained joywhen they arrivesafely at thebottom. Said one ,“Being able to ski— just using yourupper body —makes you feel likeyou can do any-thing!”

The Winter

Clinic is jointly sponsored by VA andthe Disabled American Veterans(DAV), with support from dozens ofcorporations.

“The Winter Sports Clinic hasopened up a new world of freedomand independence for me,” saidBailey King, a Navy veteran fromSan Francisco. “When I get into theski, I leave behind my wheelchairand all of the physical barriers and

confinements.Gone are thecurbs, stairs,and closeddoors —swallowed upby sheerexuberance!

“We comehere and ski,but the eventreally isn’tabout skiing,”said SandyTrombetta,VA Clinicfounder anddirector. “Thevets come hereand challengethemselves.This eventmakes eachvet get moreout of theirlives — not

because they are skiing, but becauseof what skiing has taught them abouthow to handle adversity.”

These lessons in skiing and in lifewould not be possible without theski instructors. More than 190instructors, the best who are certi-fied to teach skiing to the disabled,come from around the nation, mostat their own expense.

Instructor Sue Marcote offeredthis insight: “Someone asked mewhat the hardest thing was aboutthis Clinic. I decided it was trying toremember what ‘disability’ someonehad. I’d go out and ski with peopleand could never remember the rest.”

The strong relationship goes bothways. Bud Klepps, of Camp Dou-glas, Wis., says, “They feed, houseand treat you like a king here. Butit’s the instructors like Dave whoreally make the difference. He reallyopened my eyes to the potentialthat’s there. Someday, I want to beable to ski as well as Dave.”

“After my first day on the slopes,I couldn’t sleep,” said Klepps. “All Icould think about was what Davehad told me, how to move to makemy turns, and I was twitchingaround in bed practicing. And Iactually did better the next day.And, the next night, I fell asleep andskied all night in my dreams.” ❏

By Bob KlearDavid Farris, one of about 200 volunteerinstructors

Mt. Crested Butte, Colo., site of the National Veterans Winter Sports Clinic

May/June 1998 13

R ecipients of the Secretary’sAward for Excellence in Nurs-ing include: Penelope (Penny)Abegglen, R.N., of the Fort

Harrison, Mont., VA Medical andRegional Office Center; Estella M.

Reynero, licensed vocational nurse,at the Temple Integrated ClinicalFacility of the Central Texas VeteransHealth Care System; and DorisConley, certified nursing assistant, atthe Chillicothe, Ohio, VA MedicalCenter. Director of the Fargo, N.D.,VA Medical and Regional Office

CenterDouglasM.Kenyonis therecipientof theSecre-tary’sAwardfor theAdvan-cementofNursingPro-grams.

Penny Abegglen was creditedwith implementing the mechanicalventilator care map used to enhancequality of care for patients requiringmechanical ventilation.This care map has

become the prototype.She developedtraining criteria fornurses in intensivecare units and isconsulted by manydisciplines for col-laborative treatmentplanning. She alsoserves as an Ad-vanced Cardiopulmo-nary LIfe Support(ACLS) instructorand teaches EMT,respiratory care anddefibrillation for theAir National Guardand Eagle Ambulance Service. Estella M. Reynero demon-

strates professionalism andcompassion for all patients. She isan effective patient advocate forHispanic patients in Central Texasbecause of her fluency in speakingand understanding Spanish. Shefrequently assists other staffmembers in reviewingperioperative procedures andprovides reassurance to anxious

patients, oftenaccompanyingthem duringintravenoussedation andsubsequent proce-dures. Doris Conleycan be counted onto interact wellwith patients,whether in groupsor on a one-to-onebasis. She is anastute observer ofchanges in patients’conditions and herinput often leads tomodifications ofthe interdiscipli-nary treatmentplan. She orients patients success-fully to their environment andexpectations of the treatment pro-grams.

Four Earn Award for Nursing ExcellenceDouglas M. Kenyon initially

established nursing as a clinicalpractice discipline at the seniorexecutive level. The Nurse Execu-

tive is responsible for the deliveryof care, excluding medical services,with an interdisciplinary focus.This includes sharing in the respon-sibility for overall hospital manage-ment, policy determination andimplementation strategies. Kenyondemonstrates a strong commitmentto the full professional role ofnurses and efforts to foster theircareer growth and development.He strongly supports community

activities, highlighted by hisleadership during the spring 1997floods that ravaged the Red RiverValley. ❏Douglas M. Kenyon

Doris Conley

Estella M. Reynero

Penelope Abegglen

14 VAnguard

A s VA teams continue to findbetter, less costly and moreefficient ways of doingbusiness, they have received

more VA Scissors Awards fromDeputy Secretary Hershel Gober.Here are some recent Scissorswinners:

In moving the VA Forms andPublications Depot from Alexandria,Va., to the VA Service and Distribu-tion Center at Hines, Ill., the HinesForms and Publications Teamtransferred more than 14,000 formsand publications with no disruptionin service and a savings of $908,000in rent.

They reengineered all processes,and, with fewer staff, incorporatedthese changes, saving $296,000. Thethe cost of warehouse functionsdropped from $487,000 to $262,000,by employing patients in Compen-sated Work Therapy, administeredby the Hines VA Hospital.

Team members continued theirreengineering through audits, fillingorders faster, reducing paper, andestablishing a document controlsystem that can locate an order anytime, anywhere, and provide itsstatus to the customer in minutes.

The Buffalo, NY, Medical CenterRemanufactured Equipment Teamused benchmarking best practicesand bought remanufactured equip-ment for the cardiac catheterizationlab, saving almost $500,000. The teambenchmarked with private health-care facilities, toured vendor sites,and developed contracts defining“high quality, factory rebuilt to newequipment performance specifica-tions.” This best-value situation hasbecome standard practice for theVISN.

The Denver Regional Office ofPublic Affairs coordinated theefforts of 13 facilities to reach veter-ans with the VA toll-free phonenumber through a one-of-a-kind,first-ever federal communicationsproject.

The Public Affairs Team pro-moted VA services to some 2.9million veterans and 31.6 millionAmericans in 13 states, using road-side billboards, retail outlet newspa-per ads, paper and plastic shoppingbags, coupon books and even the

cover of a metropolitan telephonebook. Walk-ins to one VA facilityincreased by 12 percent and phone-ins at all facilities increased, withsome more than doubling. Thisapproach publicized the toll-freenumber at no cost to VA, and themedia placement value was esti-mated at $1 million.

Columbia, Mo., VA MedicalCenter cardiothoracic surgery andcardiology services formed a Cardio-vascular Services Team to providebetter continuity of care, shorterhospital stays and reduced cost. Thetwo programs were fully integratedby January 1997 into a “center ofexcellence.” Since then, increasedteamwork has saved almost $400,000annually.

The Hines, Ill., VA HospitalDrug and Pharmaceutical ProductManagement Team partnered withVA’s National Acquisition Centerand developed a method for stan-dardizing the selection, prescription,contracting, and procurement ofhigh-use drugs.

The method facilitates integra-tion of drug requirements in eachVISN and helps to identify drugitems for potential national standard-ization and centralized nationalprocurement.

To compete these pharmaceuticalitems on a national level, VA’sNational Acquisition Center began abusiness strategy with VHA. To date,national contracts awarded followingthis process have saved and esti-mated $71 million annually for VAand an additional $20 millionannually for other federal govern-ment customers. This team devel-oped clinical and business criteria forevaluating offers. Front-line, practic-ing clinicians guide the selectionprocess.

The VA Community NursingHome/Multi-State Contract Team(VACO/field) consolidated nursinghome contracts nationwide, whichled to a simpler, more cost-effectiveprocess and improved quality ofcare.

VHA and the Office of Acquisi-tion and Materiel Managementpartnered to reinvent the process.The team developed a competitiveprocess using only seven multi-state

contracts, down from 465, and morethan doubling the number of avail-able nursing homes. Placement innursing homes now occurs withintwo days of referral. Instead of on-site evaluations, certification isexamined in each state on-line.

The Bath, N.Y., VA MedicalCenter Accounting Handbook Teamdeveloped an accounting handbookto address new products neededbecause of nationwide conversion ofthe CALM Accounting System to theFinancial Management System(FMS). It is now widely usedthroughout VHA.

The Philadelphia VA RegionalOffice and Insurance Center Fi-nance Division Team improved theprocessing of payment invoices toschools and vendors who provideservices to veterans in the vocationalrehabilitation program.

The team reduced the averageprocessing time from 30 to 20 days —an improvement rate of 33 percent.The team developed a program toimprove workload control andreduce the number of hand-offsinvolved in inquiries associated withinvoices. Vocational Rehabilitationand Counseling representatives haveaccess to this data and can replydirectly to inquiries from schools andvendors.

John Dietrich of the Roanoke,Va., VA Regional Office, while withthe Baltimore VARO Loan Guar-anty Division, changed the wayhome sales listings reach customersby developing Fax on Demand.

Every month’s listings weremanually collected and mailed,many times reaching the customertoo late because mail was slow andoffice hours too short. Printing wascostly, and requests continued toincrease.

Using equipment purchased in1995 for other purposes, Dietrichbegan offering sales listings via fax in1996. Today, 3,000-plus customersreceive timely information via Fax onDemand at no cost to the regionaloffice. The customer calls from a faxmachine and pays for the call andprinting. The service is available 24hours a day. ❏

$nip, $nip — the Sound of Red Tape Falling

May/June 1998 15

Central Office Hosts Youth Town Hall Meeting

Veterans Warm Up to Visiting Pets

W orld War II veteran ShepMooney welcomes a nuzzlefrom a llama named Elvira,one of Little Rock, Ark., VA

Nursing Home Care Unit’s favoritevolunteers. Veteran Bobby Enwrightbrings Elvira not only to visit VApatients, but also to spend time atarea nursing homes. Little Rock VAMC has a widevariety of pet therapy programs. Petsare interviewed and approved by theAssociate Chief Nurse for theNursing Home Care Unit, BettyCarr-Richards.

Clinical studies have shown thata person’s blood pressure dropsbelow the point of resting whenpetting an animal or watching fish inan aquarium. ❏

A Lake BraddockHigh Schoolstudent fromBurke, Va., makes

her point about racerelations at a VA CentralOffice Youth Town HallMeeting of 65 studentsfrom the Lake Braddock,Georgetown PreparatorySchool, The BridgesAcademy and ThePotomac School.

VA White HouseLiaison Heyward Bannis-ter, left, facilitated thestudents’ dialog on race,along with Ellis JonesHodges, director of VAAffirmative EmploymentService, and ThomasBarritt, VA trainingofficer.

VA Assistant Secre-tary for Human Resources andAdministration Eugene Brickhousehosted the event and Deputy Secre-tary Hershel Gober made openingremarks.

The VA Central Office YouthTown Hall Meeting invited thestudents to discuss issues of race inAmerica based on their experience

and understanding. The studentsfocused on ways to overcome racialdivisiveness, such as respect,education, community involvement,dialog, honesty and self-assessment.

Deputy Secretary Gober sharedsome of his observations andexperiences and encouraged stu-dents to discuss the issues openly.

Facilitators posed questions andthemes and the students took it fromthere.

The students gave the town hallhigh marks, and one teacher said helooked forward to future VA pro-grams like this involving moreschools. ❏

16 VAnguard

MEDICALadvances

Cerebral Malaria PossibleCause of Medical,Psychological Problems

Cerebral malaria may be the causeof neurological and psychologicaldifficulties that are often attributed to post-traumatic stressdisorder (PTSD) or exposure to Agent Orange, research at theIowa City VA Medical Center has found.

Dr. Nils R. Varney, reporting in the November issue of theJournal of Nervous and Mental Disease, compared the psychi-atric status of 40 Vietnam combat veterans who contractedcerebral malaria between 1966 and 1969 with that of 40 whowere wounded but did not have the disease. Participantsunderwent various tests for sensory, cognitive and behavioralsymptoms. The veterans who contracted malaria had moreproblems with depression, subjective distress, auditory informa-tion processing, memory, emotional instability and seizure-likesymptoms.

Estimates indicate that up to 250,000 Vietnam veteranssuffered cerebral malaria, which is contracted from mosquitoes.The disease causes an inflammation of the brain and candamage cerebral nerve tissue.

“I would suspect that doctors who treat Vietnam veteranswith unexplained neurological and psychological problemswould find a significant number of them with a history ofmalaria,” Varney said. “Now we may be able to move thesepatients into a category where their problems make sense —and where they are treatable.”

Signals from Fat CellsInfluence Food Intake

Although diet and exercise remain critical in determiningbody weight, scientists are beginning to understand how fatcells use the chemical leptin to tell the brain how much a personshould eat. Researchers, including Dr. Michael Schwartz of theVA Puget Sound Health Care System in Seattle, recentlyreported that in many overweight people a communication glitchdisrupts the signal to stop eating.

Speaking February 12 at the annual meeting of the Ameri-can Association for the Advancement of Science in Philadel-phia, Schwartz explained that leptin is supposed to tell the brainthat energy reserves are high and food consumption shouldstop. When heavy people cut calories and lose weight thenumber of fat cells and leptin levels decline, telling the brainthat energy reserves are declining, he said. The body thenbegins to conserve energy and stimulate appetite, making itdifficult to maintain weight loss.

Scientists have found in animal studies that activatingalternative communication pathways can make the brain moresensitive to leptin. Schwartz thinks such advances may lead tobetter obesity treatments in humans.

“If I had said just a few years ago that fat cells send signalsto your brain telling it how much you should eat, no one wouldhave believed it,” he said. “But that appears to be just what ishappening.”

Research Places CholineAmong EssentialNutrients

Research at the Durham,N.C., VA Medical Center is

among a number of studies that have led the Institute ofMedicine to advise adding choline to the government’s list ofessential nutrients.

Dr. H. Scott Swartzwelder, who conducts neuroscienceresearch at the VA medical center and Duke University, foundthat rats whose mothers consumed extra choline duringpregnancy were better able to find their way through mazes andto retain the skill over time. He believes that choline — acompound found in liver, eggs, peanuts, whole milk, and otherfoods — may prove to be helpful in developing humans as well.

In research published in the April issue of the Journal ofNeurophysiology, Swartzwelder and colleagues found that theimproved learning and retention in offspring occurred only whenthe rats received extra choline between the 12th and 17th daysof their pregnancies. He said a similar opportunity may exist inhuman development.

“We have found that manipulating a single nutrient for a fewdays during gestation has a lifelong effect on how brainsfunction,” he said. “In theory, we could develop ways tosignificantly reduce age-related memory deficits.”

Vitamin C and AlcoholMay Help Fight Gallstones

A vitamin C supplement and regular, moderate drinking ofalcohol may reduce rates of gallbladder disease in postmeno-pausal women, according to research conducted at the SanFrancisco VA Medical Center.

A team of investigators led by Dr. Joel Simon reported inthe March issue of the Journal of Clinical Epidemiology on theirsurvey of the dietary habits and incidence of gallbladderdisease in 2,744 women between 44 and 79 years old. Theresearchers reported vitamin C supplementation produced nosignificant reduction in disease among nondrinkers, but it waslinked to a 50 percent reduction in incidence of disease and a62 percent decrease in gallstone removal among those whosaid they had at least one alcoholic drink in the month beforethe survey.

Simon and associates said it is unclear how vitamin C andalcohol interact to lower the prevalence of disease. Preciselevels of consumption of the two substances by study subjectscould not be determined, and the researchers said public healthrecommendations should not be made until the best dosagesbecome clear. ❏

By Dan Bruneau and Pat ForsythVA Research Communications

May/June 1998 17

HONORSand awards

Dr. William Monacomoved from Oklahoma toWashington, D.C., to becomeVHA’s chief of optometry.Before he left the “SoonerState,” he was recognized byCongress and the state for hisservice. Congressman Dr.Tom A. Coburn honoredMonaco for being part of hisCongressional Medicare/Social Security AdvisoryCommittee. The statelegislature issued a citationrecognizing Monaco for hisservice as dean of the Collegeof Optometry at NortheasternState University of Tahlequah,Okla.

William R. West, Jr.,Beverly, N.J., NationalCemetery foreman, receivedthe state of New JerseyDistinguished Service Medalin recognition of his combatservice in Vietnam with theU.S. Marine Corps. To receivethe state medal, a New Jerseyveteran must have beenawarded the Bronze Star,Silver Star or other medalsrecognizing individual heroicaction in combat, or thePurple Heart for woundsreceived in combat action.West was seriously woundedin 1969 while on a reconnais-sance patrol in Vietnam.

Miami VA Medical CenterRegistered Nurse BessieGarrett received the “Individu-als of Merit” award from theGreater Miami Chamber ofCommerce at its 1998 HealthCare Heroes Award luncheon.She received a Waterfordcrystal bowl mounted on awood base with her nameinscribed on it. She washonored for her consistent

display of excellence in herwork and inspirationalcommitment to her professionand community. As a nurseeducator for immunology,Garrett conducts AIDSworkshops at VA and in thecommunity. She also partici-pates in and supports healthoutreach initiatives to Miami’s“at risk” population.

Three VA researchinvestigators — P.A. Ubel, J.Shea and D.A. Asch — areco-winners, along with J.F.Merz, of the Nellie WestermanPrize, a national honor fromthe American Federation forMedical Research for the bestpaper discussing an issue inthe ethics of clinical research.The research that won theprize, is titled, “How Prelimi-nary Data Affect People’sStated Willingness to Enter aHypothetical RandomizedControlled Trial.”

Dr. Walter Rivera,director of the PerioperativeCare Line at the VAHealthcare Network UpstateNew York, Albany, has beenappointed state surgeon forthe New York Army NationalGuard, making him thehighest ranking medicalauthority within that organiza-tion.

Six VA North TexasHealth Care System regis-tered nurses were named tothe 1998 “Great One HundredNurses” sponsored by theDallas-Fort Worth HospitalCouncil. They include Joy A.Law-Brennan, Wanda SueRose, Nan Saage, JawelWest, Jeanie Zelanko, andMichael E. Zelanko. Great

One Hundred Nurses arechosen based on contribu-tions to profession andcommunity.

Kimberly A. Rude,Medical Service secretary atthe Fargo, N.D., VAM&ROCreceived the 1997 VA AlumniAssociation ExemplaryService Award for the GS-1through 8 category. She wasselected from applicantsnationwide for demonstratedpotential for increasedleadership and managerialresponsibilities.

Frampton Ellis, III,formerly at VA Central Office,was a 1998 finalist in theIntellectual Property Owners(IPO) National Inventor of theYear Awards program. Anindependent inventor, Ellisinvented Adidas “Feet YouWear” sport shoes featuringnaturally contoured soles.Designed to avoid anklesprains, the invention origi-nated with Ellis’s observationthat a tilted bare foot is morestable than a tilted conven-tional shoe. It is estimatedthat six to seven million pairsof the shoes will be sold thisyear.

The Black Hills, S.D.,Health Care System’sAssociate Chief of Staff forMental Health, RobertPhares, Ph.D., has beenselected as Psychologist ofthe Year by the South DakotaPsychological Association. Hehas worked with VA for 19years.

Long Beach, Calif., VAMedical Center ChaplainRabbi Sidney S. Guthmandelivered the prayer for theU.S. Senate May 14.

Joan Furey, director ofthe Center for WomenVeterans at VA Central Office,received the Common CausePublic Service AchievementAward. The nonpartisan

citizens’ lobby honored heras one of five who “by force ofimagination, initiative andperseverance have made anoutstanding contribution to thepublic interest.” She alsoreceived the 1998 AnnualNational Public ServiceAward, sponsored by theAmerican Society for PublicAdministration and theNational Academy of PublicAdministration. The awardgoes to public servicepractitioners who haveexhibited the highest stan-dards of excellence over asustained period of time.

Veterans Services OfficerTed O’Brien, Hartford, Conn.,VA Regional Office, is awinner in this year’s FTSAwards program sponsoredby the General ServicesAdministration. He wasrecognized for his contribu-tions to development of theNew England Connectiontelephone initiative thatincreased workload flexibilityand improved client access inBoston, Hartford and Provi-dence.

A team of researchinvestigators at the New YorkVA Medical Center wereselected as finalists in the“Windows World Open” — aninternational competition thatawards innovators for use ofthe Microsoft Windowsplatform in solving problems.The New York VA teamdeveloped the VA PedorthicCAD/DAM System forcomputer-aided design andmanufacture of customorthopedic footwear forveterans and other patientssuffering injury and biome-chanical disorders of the footand ankle. The project wasone of three finalists in thecompetition’s health-caredivision. ❏

18 VAnguard

In the spirit of “One VA,”employee survey results areavailable on a VA Intranet site(http://152.125.190.53/qm/start.htm). Through thetechnical expertise andcooperation from VHA’s Officeof Performance and Quality(10Q), VA employees with aweb browser and access toVA’s Intranet may now obtaincomparative analysis of thesurvey results for VHA, VBAand BVA. The interactivenature of the site allowsselection of two variables tocreate custom cross-tabulations. Those accessingthis data should note that,although VBA and BVA dataare found under the samelink, the data have not beencombined. Analysis of somedemographic groups of lessthan 10 employees will berestricted for privacy consider-ations.

Dr. Inder Perkash, chief,Spinal Cord Injury Center, VAPalo Alto Health CareSystem, spent 18 days inIndia in March as a memberof the American Team forSpinal Injuries Consultation inIndia. The visit was sponsoredby the National Institute on

Mr. Harold E. “Speedy” Wilson, former employee atthe Regional Office in Columbia, S.C., died March 29.

Mr. Wilson, Medal of Honor recipient and a retiredchief warrant officer of the Marine Corps, was buriedwith full military honors on April 1 in Lexington, S.C. Hehad retired from VA in 1989.

His medal recognized his bravery during a nightattack in the Korean War, when he rallied troops,delivered ammunition and administered first aid,despite wounds to the arm, leg, shoulder and head.

Volunteer greeters at Richmond, Va., VAMC —readily identified with bright green vests — answerquestions, offer directions and drive the parking lotshuttle. Volunteers in the new greeter program include(from left) Donald Wright, Shyleen “Charlie” Bradshaw,Ollie Wright, Tom Reid, Loyce “Tex” Walker, FlorenceScott, James Shipmon, James O’Neill.

Disability and RehabilitationResearch (NIDRR) andsanctioned by the U.S. StateDepartment under the Indo-U.S. Collaboration. The teamprovided consultation to thenew Indian Spinal Cord InjuryCenter in New Delhi andtrained staff in regional spinalcord injury centers elsewherein India. Perkash, who holdsthe Paralyzed Veterans ofAmerica Professorship inSpinal Cord Injury Medicine,also lectured at workshops.Under the auspices of theNIDRR, the team also workedtoward developing academicresearch projects to collectepidemiologic data and tostudy certain medical prob-lems in India.

Visiting a hospital isn’t fun,especially for children.Charleston,S.C., VAMCpolice noticed this anddecided to donate toys andstuffed animals to give tovisiting children to keep thembusy and make their hospitalvisit a little happier. QualityManagement staff joined theeffort, and last year more than80 children received toys andstuffed animals duringhospital visits.

The West VirginiaLegislature over the past twoyears has purchased 16 vansfor use at VA medicalcenters in West Virginia andVA medical facilities inPittsburgh, Pa. For thepurchase, the legislatureappropriated $300,000. In1997 alone, 37 drivers at theBeckley, W. Va., VAMC

volunteered about 7,600hours to transport nearly2,000 veterans 196,293 miles.

The partnership betweenLoma Linda VAMC andSouthern California Edisonto reduce energy costs andprotect the environment isexpected to yield over$1,312,000 in annual energysavings. Recognizing themedical center’s initiatives,Edison rewarded the facilitywith a cash award of $280thousand.

VBA has reached amilestone: Of the $1.7 billioncompensation and pensionbenefits paid monthly, 68percent is going to VA

Harold E. “Speedy” Wilson

you heardHAVE

customers through electronicfunds transfer (EFT). Thismilestone surpasses thegovernment-wide average of65 percent. Social Securitymay be leading the EFT effortgovernment-wide, but VBA ishot on their heels.

Detroit VA Medical CenterDirector Carlos B. Lott, Jr.,

had his hands full afteraccepting the presentation of a$1 million check from theestate of Peter P. Burda. Theveteran’s will left the money tothe medical center, whichplans to use it for scholarshipsto train employees in scarcespecialties of which themedical center has particularneed.

The widow of a World War Iveteran bequeathed $50,000to the Sheridan, Wyo., VAMedical Center. The bequestcame from the estate of MarnaM. Kuehne, a lifelong resi-dent of Campbell County. Mrs.Kuehne’s family homesteadedin the area in the early 1900s.She continued operating the

May/June 1998 19

Juel E. Marifjeren

It is with much regret and sadness that I report to youon the events of Tuesday, May 19, 1998. Juel E.Marifjeren , a Service Center Division Team Coach at theChicago Regional Office, was shot to death as he leftwork and entered the subway adjacent to the FederalBuilding. Mr. Marifjeren, an Army veteran, was a valuedand respected employee of the Department of VeteransAffairs for some 26 years. He is survived by his wifeKathy, his daughter Elizabeth, and son Steven. We aretaking every step possible to assist his family in their timeof grief. We are also assisting with the personal needs ofour employees by making counselors available to them,on request. We will make every effort to share informa-tion on this tragic event as it becomes available. I believeJohn McCourt, Acting Director of the Chicago RO, spokefor us all in his statement to the Media, and I quote, “VAto many, is more than just an employer, it is afamily…..We have surely lost a member of our family withthe death of Juel.”

From Under Secretary for Benefits Joe Thompson

The Augusta, Ga., VAMC hosted a visit from PhilNiekro, former pitcher for the Atlanta Braves. The April 29visit was through the MCI/Veterans Canteen ServiceHeroes to Heroes Tours. Neikro talked with roughly 500people, visiting in patients’ rooms, signing autographs andposing for photographs. Fifteen former sports figures visitedmedical centers through the Heroes to Heroes Tours.

family ranch after her hus-band died in 1949. MaureenHumphrys, the hospitaldirector, said the moneywould be used to assistdisabled veterans.

A national disasterresponse drill was heldrecently by the VA NorthTexas Health Care System.At a command center set upat the Dallas VA MedicalCenter, coordinator BillBossert practiced collectinginformation on the types andlocations of available hospitalbeds. Then he directed thetransport of casualties tospecific hospitals. In a truenational disaster, VA hospi-tals, working with the U.S.Public Health Service and theDefense Department, wouldcoordinate the disposition ofcasualties. The casualtieswould be transported on AirForce planes to CarswellNaval Air Station Fort Worthor to Dallas-Fort WorthInternational Airport. The drill,the first for the VA team inTexas, is scheduled to be anannual event.

Many Yavapai Countyorganizations assisted thePrescott, Ariz.,VAMC whenthe Traveling VietnamMemorial, “The Wall ThatHeals,” came to Prescott.The traveling memorial is areplica of the VietnamVeterans War Memoriallocated at the ConstitutionGardens in Washington, D.C.An estimated 10,000 visitorsviewed the traveling memo-rial. Volunteers assisting inhost duties included an AirForce ROTC unit and thefollowing veterans organiza-tions: Vietnam Veterans ofAmerica, Marine CorpsLeague and American Legion.

The new NationalPrisoner of War Museum inAndersonville, Ga., dedi-cated April 9, honors thenation’s estimated 800,000

Americans who have beenheld as POWs. Money for the$5.8 million project was raisedby the sale of commemorativecoins, private donations andappropriations by the federaland Georgia governments.Exhibits include narratorsreading from the letters ofPOWs and videotapedinterviews with modern-dayPOWs, including U.S. Sen.John McCain, former vicepresidential candidate JamesStockdale and U.S. Ambassa-dor to Vietnam Pete Peterson.

For 12 years the nursingstaff of the VA MedicalCenter in Washington, D.C.,has held an Easter Basketcontest to benefit the Hospitalfor Sick Children, St. Anne’sInfant and Maternity Homeand the Chi Child Care Centerfor Boarder Babies. Thisyear’s baskets were filled withclothes, toys and practicalgifts donated by the nurses.

What a month! That isabout the amount of time thatthe John D. Dingell VAMC(Detroit) had to prepare tohost Vice President Gore and

Secretary Togo D. West, Jr. –not to mention the guest ofhonor, Congressman Dingell,Senator Carl Levin, Congress-men David Bonior, JohnConyers, Sander Levin andCongresswoman CarolynCheeks Kilpatrick at thenaming ceremony. Theinvitation list came to almost

600 people. It was like havinga month to plan a hugewedding, only at weddingsyou usually don’t invite thesecret service. Thanks to thehelp from almost everyone,the event was a positiveexperience. Even employeeswho were not directly workingon the ceremony helped outby filling in for those whowere.

Veterans Health Admin-istration recently establisheda $1 million Quality Achieve-ment Recognition Grant. Thegrant will be awarded annu-ally to any Veterans Inte-grated Service Network(VISN) that achieves trulyoutstanding performanceleading to exceptionaloutcomes and demonstratingexemplary processes.Additional grants of $500,000and $300,000 may beawarded to promising VISNs.VHA staff are preparingapplication materials andexpect to have these “on thestreet” by early June. Duedate for submission of appli-cations this year is Nov. 1.

20 VAnguard

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Secretaryof VeteransAffairsTogo D.West, Jr.Sworn In

Togo D. West, Jr.,received Senateconfirmation asSecretary of VeteransAffairs April 28 andwas sworn in by VicePresident Al GoreMay 5 at the WhiteHouse, with Mr. West’swife, Gail Berry West,at his side.

Linda Waldrop, licensedpractical nurse at North TexasHealth Care System(Bonham), teamed up withOld Glory to save lives at anautomobile accident shecame across near Telephone,Texas. Four people wereinjured, one was four monthspregnant. Waldrop was first atthe scene and immediatelytriaged the injured, using whatwas available to controlbleeding. She found a 5’x8’American flag in herhusband’s truck she wasdriving and used it to cover avictim going into shock. Shecontinued to assist afterparamedics arrive. Later, sheand her husband properlydisposed of the bloodied flag,knowing it had been put tomost honorable use.

Wilkes-Barre, Pa., VAMedical Center police officer

Alan D. Magliaro was drivinghome on a busy four-lanehighway. As he rounded adangerous blind curve, henoticed a smoking, overturnedcar on the other side of theroad. He stopped on theshoulder, crossed four lanesof highway and a concretedivider and assisted theshaken driver out of the car,providing comfort until anambulance arrived. He alsohelped with traffic control toprotect the medical crew frompossible danger.

Jenny Urban, R.N.,Central Texas VeteransHealth Care System (Waco),was driving home fromexercise class when shecame upon a collisionbetween a gasoline tankertruck and a car carrying threepeople, one a 15-month-oldgirl. Arriving just as an

ambulance pulled up, sheidentified herself as a nurse. Amoment later anotherparamedic yelled out, “Whereis that nurse?” He took her tothe baby who was notbreathing. She began mouth/nose CPR breathing for thechild and then used theparamedic’s pediatric ambu-bag to continue respiration.As she worked, the paramed-ics put a neck brace on thetoddler and placed her in aninfant wrap. Police said thechild was flown by helicopterto Cook Children’s MedicalCenter in Houston and laterreleased. Urban credited hereffectiveness to her VAClinical Education Depart-ment, which offers employeesinstruction and certification inCPR and infant/child CPR.

Professional follow-through by Ann Arbor, Mich.,VA Medical Center policeofficer Terry Campion resul-ted in the closing of a 20-year-old unsolved Detroit murdercase. Campion responded toa disturbance in the medicalcenter endoscopy unit wherea patient had threatened a

physician. After escorting thepatient back to his inpatientunit, Staff Sergeant Campiondecided to run a Law Enforce-ment Information Networkcheck on the person in light ofthe threats he had made. Thecheck revealed that the manwas wanted on a 20-year-oldmurder arrest warrant.Campion contacted Detroitpolice who came and took thepatient into custody.

Omaha, Neb., VAMedical Center police officerJeff Garrett respondedquickly and professionallywhen a veteran parking hiscar at the center for anoutpatient appointmentmistakenly stepped on theaccelerator instead of thebreak, plunged down a steephill, crossed four lanes oftraffic, knocked over a lightpole and crashed into a houseacross the street. Garrettadministered first aid whileawaiting the rescue squad,instructed bystanders to avoiddowned power lines, andguided emergency vehicles tothe scene.

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