Regarding your cover story on veterans problems in getting care in rural areas (Medicine off the battlefield, Nov. 5, p. 6): Our Department of Veterans Affairs medical center has responded to the challenges of providing rural healthcare for veterans by establishing four community-based outpatient clinics linked by telemedicine, telepsychiatry and in-home care coordination, the kinds of services described in your article. This is a major improvement in access to VA services that should not be underestimated. Those of us who live in rural America are accustomed to traveling long distances for medical and specialty services. Most residents of our small community travel 180 miles for cardiac surgery, and we only have one psychiatrist serving 50,000 people. Our local hospitals dont want veterans admitted as patients because many require such complex care that private physicians cannot recover sufficient fees to cover time and costs. What critics of the VA often do not recognize is the level of training given all VA staff that uniquely prepares us to serve veterans who have post-traumatic stress disorder and other complex medical and psychiatric problems. Veterans referred for an eye examination to the clinic where I work are treated in a manner that reduces anxiety and fosters a multidisciplinary therapeutic approach, while honoring their service to our country. We assess and refer veterans to other services such as medicine, social work, mental health, audiology and clinical pharmacy, and we assist with transportation and durable medical equipment. The VA is Americas thank you to our men and women in uniform, and VA employees express that gratitude daily. Veterans often appreciate meeting other veterans, because even when 40 years separate their periods of active duty there are certain experiences that unify them. Rural healthcare is an enormous challenge, and the VA is actively developing innovative strategies, technology and outreach to meet the needs. Well get there, because our goal is to deliver the right care, safely, at the right time, at the right place and for the right cost for our heroes and our nation.
Barbara HetrickChief of optometry Jonathan M. Wainwright Memorial VA Medical Center Walla Walla, Wash.