A North Bethesda organization says it is waging a battle against the “emerging but silent epidemic” of traumatic brain injury in postwar Iraq.
A little over a year ago, employees of JBS International, a firm of government contractors, traveled to Iraq to help physicians treat a nation and populace beset with trauma from war.
According to Eileen Elias — a former mental health commissioner for Massachusetts, who went on the trip — the goal was to take on traumatic brain injury.
The condition refers to the brain being injured by an external force. The most common causes are traffic accidents, falls and violence.
The World Health Organization considers TBI to be a leading cause of death and disability worldwide.
Jerri Shaw, a co-owner of JBS, said the effects of TBI in many victims in Iraq are compounded by other stressors.
“There’s a ripple effect. There are lots of consequences of brain injury,” she said.
At that meeting in Iraq, physicians put together a strategic plan to deal with traumatic brain injury.
Then, U.S. troops and aid workers left the country, and “the strife has just intensified,” Shaw said.
Now, she finds herself fighting a battle few people are noticing.
“Most people will say to me, ‘If there’s no money, why are you paying attention to this issue?,’” Elias said. “I continue to say, ‘We were there. We have stepped out. There continue to be problems.’”
The fighting in Iraq has made traveling there too dangerous. A lack of support from other organizations means little progress has been made, she said.
Elias said she first began working on TBI issues in Massachusetts about 20 years ago, when she was mental health commissioner.
With JBS, she proposed a project to work with soldiers returning from Iraq with TBI, she said. She and others realized this was a serious problem for Iraq’s civilian population, as well.
She, Shaw and others say they feel some responsibility. “It’s a war we went into, it left a lot of people questioning, ‘What did we accomplish?’” Elias said.
“We have not finished our work,” she said.
From a distance, she and others communicate with counterparts in Iraq electronically and hope for a respite in the violence.
Elias and her colleagues have been doing their work pro bono since they first proposed focusing on the issue nearly five years ago.
Shaw, Elias and others are trying to find low-cost ways to help physicians in Iraq treat TBI, despite being thousands of miles away. They create digital data archives with the latest research on treating TBI or link Iraqi doctors with American doctors who can be mentors.
“One of the reasons we built the company was because we wanted to do things like this that no one else was doing but needed to be done,” Shaw said.
“TBI is increasingly being recognized as an emerging but silent epidemic,” said Capt. David Tarantino, a military doctor who served at Marine Corps headquarters as director of the Marines’ medical programs, which cover TBI.
“TBI is a huge challenge for Iraq, as it is for any developing country or any country undergoing security issues,” he said.
It’s also a significant issue in the U.S.
Mark L. Ettenhofer, a professor at the Uniformed Services University of the Health Sciences, said 1.7 million people in the U.S. suffer traumatic brain injuries every year. Of those, about 50,000 are fatal, he said.
Roughly 1.4 million people who suffer injuries are treated and released. An additional 275,000 injuries are moderate or severe and require hospitalization.
Those numbers do not account for people who do not seek treatment, he said.
In moderate to severe cases, traumatic brain injury affects memory, attention, speed of processing and higher-level reasoning, Ettenhofer said. “It’s also common for people to have some sorts of emotional difficulties related to the brain directly,” he said.
In Iraq, from 2000 to 2013, there were about 288,000 TBIs of all severities among American servicemen and women, Ettenhofer said. Numbers for the Iraqi population are not known.
But “being active duty in a combat zone is a big risk factor for a TBI,” he said.
The condition has been widely featured in the news in the U.S. among professional and high school football players who have died or been seriously injured by concussions.
“There’s not enough awareness domestically ... that TBI happens here — when kids fall off bikes, car accidents, just in the normal process of living — and needs treatment,” Shaw said.
In Iraq, the condition has become a secondary, lurking menace, Elias said.
“It’s not the one trauma. It’s repetitive,” she said. “It’s one of those hidden cognitive disorders, yet its impact is huge.”