Wednesday, September 10, 2014

Military Medicine...Doesn't...Suck...As Much

Jesus, take the wheel.

It's hard to admit that military medicine might not universally suck, and yet yesterday, the best thing that could happen to our family happened. And it happened at the hands of an Air Force doctor.

Some background: Elder sprog has been through the medical system and California's First Five system since he was about three years old. We'd noticed he had delayed speech development, and he was also having difficulty with motor skills and sensory triggers--loud noises would overwhelm him, for example. When we had him evaluated, he qualified for services, but each state we landed in, each school system, and even each new person who saw him came up with a different answer. All agreed he was smart--even his pre-K teachers would constantly bring us over to show us the new pulley system he engineered to put toys away, etc.--but he just wouldn't engage with other kids and certainly couldn't engage in imaginative play.

Nobody could agree on what was wrong with him, so I started researching.

And what I found was Asperger's. It just seemed to fit. So we went to the primary care doctor in Monterey--a civilian, which meant he listened to us, ahem--and got a referral for sprog's evaluation for Asperger's. Tricare sent us to Stanford, which has a great developmental department for kids with autism. We were psyched. Answers, at last! Unfortunately, only one of us could go to the evaluation because we were told it would be an all-day thing and younger sprog had something going on. So husband left and I stayed home to be sure younger sprog got to his whatever-the-hell-it-was.

That night, husband returned home, completely dejected. "They said there's no way it's Asperger's because of his speech delay," he said. "But they said his IQ is 67, and he'll never be able to live on his own."

We were devastated. And confused. Our bright, inquisitive child who already grasped some awesome engineering concepts was intellectually disabled? It just didn't fit. It was during spring break of his homeschool kindergarten year that our request for an IEP for him finally made it to the district psychologist. She took one look at his test scores and the Stanford write-up, and called me. During spring break. She wanted to take her week off to come talk to the sprog and see if she could evaluate him. I agreed, and she spent the week at our house, even bringing another psychologist with her one day.

His IQ, when he was submitted to a language-based exam, was 67. His IQ, when he was submitted to other types of exams, was closer to 160. Imagine that! Language delay...and can't complete a language-based exam. Stunning!

His favorite pastime, mazes, resulted in a moment of ah-ha for all of us. He got a little overwhelmed on one maze, and he was about to spool, so I asked if he could be allowed to finish it with one bit of advice. I showed him where he'd made a wrong turn (about halfway through the maze), he went back to that point and completed it. "Do you know the age that maze was meant to test?" the psychologist asked me. "Fifteen."

Sprog was five.

Alas, they said his language and sensory issues gave a false positive on autism tests, and they didn't think he was autistic. This was largely because he checked off common autism and Asperger's traits, but was missing one or two on each list, disqualifying him.

Apparently, that was key.

Yesterday, sprog finally made it through Tricare's referral system and into a developmental pediatrician's office. We were there well over two hours while a pediatrician evaluated sprog. I was stunned for those two hours because he knew all the right questions to ask and the right ways to phrase them. He continually pulled all the issues sprog has and made them very evident. He was interested in sprog. He was engaged. He built up great rapport with sprog very quickly. He was fabulous...and a military doctor, at Portsmouth Naval.

What the fucking fuck, amirite?

He looked at our evaluations, the teacher evaluations, past tests, current tests, and asked me to complete one more parent evaluation. And when it was done, he gave us a diagnosis and a way forward.

No false positive, he said. Our son is high-functioning autistic, and we are able to nail that definitive diagnosis because the DSM moved all of these diagnoses under the autism umbrella last year. He would be Asperger's, the doc said, but for the speech delay.

Finally, our child, with his various issues that nobody would take seriously (oh, he doesn't require services - he functions just fine! except for these "behavior" problems; we seriously need to get him over that, so please talk to him about appropriate responses) because we didn't have a diagnosis that made sense, has a diagnosis. It makes sense. It fits. And it opens up a world of options for us that we didn't have mere hours before.

We have referrals incoming, and we're going to get EFMP status. We are going to get our sprog help. We have a diagnosis we can take to the school. We have options. It took seven years to get to this point, but by gods we have options.

And we owe this treasure trove of winningness and awesome to an Air Force developmental pediatrician who listened, who gave a shit, who wanted our sprog to be able to find ways around and over his challenges so he can be and do anything he wants in life.

So it is with great regret that I rescind my statement that all military doctors suck. Not all military doctors suck. Apparently, the Air Force has some really specfuckingtacular ones.

Thank you, Air Force doctor. You have turned 2014 into an automagically amazing year. This is the year we felt hope.

Friday, June 27, 2014

The Sad State of Military Medicine

It looks like the Army and the Navy are recapturing Tricare Prime members and forcing them back to MTFs. I can't say I'm surprised to read this since there's so much wanking about health care costs for service members and dependents. But still. This is fucking infuriating.

The article touches on one reason -- despite the claim that a significant percentage of appointments go unfilled, it's nearly impossible to get an appointment, especially not a same-day.

I've encountered this issue at the Boone clinic in Virginia Beach. I call the appointment line to ask for an appointment today or tomorrow - first available, please, because a sprog or I cannot breathe/eat/get a temp down/stop screaming from pain and haven't been able to for X many days/hours. Each time, I'm transferred (usually unsuccessfully) to the clinic's direct line.

And nobody picks up.

So I call back to the appointment line, and they say I should call at 7am tomorrow because that's when the openings will be filled. So we wait out another several hours of coughing/puking, fever hallucinations/screaming, and straight up at 7am, I call the clinic.

And nobody picks up.

So I call back. And call back. And call back. And nobody picks up. I get the husband to call the appointment line. And voila. We get an appointment. In three days.

The point is there are no appointments. Since we moved from Champus to Tricare, it's been impossible to get a timely appointment. In most places we've lived, we're told to head to the MTF's ER if we have same-day needs. Now I'm curious about these "unfilled appointments" they're apparently paying double for. How many of those were no-shows? How many of those were set aside for same-days that were somehow unneeded? How many were left empty for late patients or emergencies or long appointments? How many of these appointments are truly unfilled for lack of patients?

The other issue the article doesn't touch on is the fact that MTFs exist to treat service members. Families aren't just secondary priorities. We're considered a burden on the system. We get appointments only if no service member needs one. We get treatment only if there's room and time and money. And this makes sense. The military can't function if all their medical staff is focused on family when service members need attention. But at the same time, we rely on the insurance covering our family, and if our only option under that coverage is to be seen at an MTF whose command doesn't include us as anything more than a tertiary morale issue for the service member, how valuable is this insurance?

I remember when Tricare was born, and Champus died, and Balboa in San Diego was trying to convince everyone to go Prime. All the "prime" appointment times went to Prime members, even if we were dependents. They had special parking close to the entrance for Prime. Even dependents. But nowadays, that's gone. Standard members have freedom Prime members don't--they have to pay a small copay, but they can be seen by civilian doctors (though, to be fair, the number of docs is dwindling because Tricare doesn't pay for shit, and doctors have bills to pay) and still take their civilian prescriptions to the MTF pharmacy, which means their meds are free. They aren't part of the MTF cattle call, and they don't get the shit medical care that Prime members pay extra to be subjected to.

I'm starting to wonder if this isn't how the Pentagon slides the bulk of its healthcare burden into the service members' hands. Prime seems to cost them money, considering the restrictions and the aim for 100% appointment fill and the increasing cost passed to the service members. So are they trying to incentivize Standard?

One of the interviewees in the article mentioned she was losing a doctor she'd had for six years and would now have to start over with a new doctor who doesn't know her. What isn't mentioned is that doctor will have max 2 years with her. And then s/he will PCS. So continuity of care and a healthy patient-doctor relationship don't exist when you're treated at a MTF.

And we won't even get into the standard of care that MTFs have. For more information regarding my feelings on that issue, just look under the "navy medicine" label on this blog and check out my experiences at Pendleton's hospital.

This is sad news for all dependents, and it bodes ill for our medical future.

Monday, June 16, 2014

Working in Belgium

So, with the news of our impending doom PCS on the distant horizon, I've begun the research and the making of plans and the realization that hoo-boy this is gonna fucking suck.

You might recall I used to be a software engineer. We went to Bahrain, where I did good and fun things and totally biffed my career trajectory because it was all under the auspices of system administration rather than any kind of programming. When I came back to the States, the only jobs I was getting calls for were sys admin--not my cuppa because I hate dealing with people (especially when they're freaking out because they don't know how to reboot their computer). So I went back to school and got a Master's degree in something I figured would help me attain a portable career -- creative writing. This degree would enable me to write better, teach college (where I'm allowed to be an asshole), or edit books.

I quickly found a job editing. I've been working for this company since I graduated three years ago. Huzzah!

But when I researched Belgium, I kept coming across warnings about getting a work permit and restrictions on jobs. When I dug down, I found some pretty fucking dire info: only jobs on base (read: commissary clerk, admin assistant, teacher, etc.) are allowed under the NATO SOFA. Not to diss on those jobs--they're just not for me. You might notice a trend there...dealing with people. Also, aside from teaching, none of these jobs has a really clear or stable career trajectory, which is key for me. I need a job that pushes me to learn and do more than I thought I could, to constantly improve myself, study, experiment, etc. Also, a retirement fund would sure as fuck be nice since I'm not earning one being a pearl-polishing wifey.

Anyway, I did more research because this is some bullshit info. And I kept finding the same thing: limited jobs qualify under the SOFA (the only European country with this kind of sploogetastic 50s throwback shit), and for the rest, you have to relinquish your SOFA status and become a Belgian resident. WTF?

I finally dug up a number for a military law office yonder and, after being spoken to by a very loud French speaker, I was connected with a very French-speaking Belgian lawyer who, I shit you not,

advised me on how best to break the law.

I'm not lying.

So I have to give up the editing gig. This portable job I pursued because it's portable and mil-friendly is not actually portable into Belgium. It's most definitely going to cost me hardcore to maintain, in both taxes and SOFA status, and making these meetings when I'm 6-7 hours ahead of East coast time and 8-10 hours ahead of company headquarters...yeah, no.

But even my backup plan is dangerous. "You will not be a high priority for the Belgian government," she said about a writing career because with this, at least, I would not be taking a job away from a European, and my income would be laughably low enough that I would not be depriving Belgium its due taxes. I just have to make sure I pay my American taxes and keep to American laws so "if the worst happens" (jail time? deportation?) I can show a "good faith effort" to be all legal in some way. O.o

She gave me a tiny glimmer of hope, though: there are American companies with Belgian offices that can employ Americans under the SOFA. The only thing is, they have to be willing to fill out egregious amounts of paperwork and file applications with NATO, the Belgian gubmint, etc. and possibly sacrifice a few goats (which is cool because apparently all their veg is fried in animal fat or doused in dairy, so no big on the goats because harvest time).

This means I have some planning and prep to do. I can write covertly and chance deportation/jail/community service, which in Belgium is probably forced friendliness and most likely entails system administration work, but I should establish that career post haste to show that this was something I brought with me. I can get some certifications to rejuice my not-very-portable software engineering mojo, in hopes (maybe, possibly, because I can't find much with my google-fu) there are Amurrican companies in Belgium that are happy to hire cantankerous Amurrican milspouses and do all that jazzy paperwork shit. But then I'd have to be okay with our next PCS dropping us somewhere there are--once again--no jobs to build up my career. Or I can settle in with the whole housewife thing and pretend to like putting my whole fucking life on hold--yet again--for my husband's career.

If you need me, I'll be in the corner.

Plotting revenge.

Thursday, May 22, 2014

The Portable Job

We milspouses know how important it is to find a portable career, something you can take with you no matter where you go. A lot of these jobs end up being home-based businesses or telecommute situations. And these work great for a lot of people. You have the opportunity to build up time with a company, build up experience, build up networking contacts via a job that you can maintain no matter where you land.

Unless, apparently, you're going to Belgium.

While I was researching our new home to get a feel for things, I looked at the information about jobs in the area. In short: you're fucked. Unless you want to work at the commissary an hour away...or the quickie mart on base...or similar. thanks. It's a fine job for people who have the ability to not hate people and screaming babies, but I'm allergic to assholes and badly behaved children, and commissaries etc. tend to be et up with those.

But something else I saw made my Scooby ears go "Rurh?" Something about needing a work permit to work off base. So I dug a little deeper. And this is what I found (emphasis mine):

We've seen some questions lately about running a home-based business while being stationed in Belgium. Here's a summary of what we've learned about that issue. "US personnel cannot have both NATO SOFA status and be engaged in a commercial activity. US dependents engaging in a commercial activity lose their NATO SOFA status and are immediately treated as an ordinary resident in Belgium. Please note that you will still retain most of your privileges as they come from your sponsor. This distinction between having NATO SOFA status or being considered an ordinary Belgian resident applies regardless of the type of commercial activity you are involved in (i.e., self-employment or employment with a off-post non government affiliated company) or where the business takes place (in US owned/leased housing or in privately leased housing or building)."

And what I found as far as the requirements were thusly:

  • A work permit costs 140 euros to apply for, and it's not guaranteed you'll get approval. No refund if you're denied. Sucker. 
  • Refusals are common and often are due to the pay being insufficient. You can appeal, but you need your boss to write a letter about why it's important for you to work for less than what Belgium considers sufficient pay. If you're self-employed...not sure how this works.
  • You must pay nearly 1000 euros per quarter MINIMUM in just unemployment insurance. There are other taxes you also owe.
  • On top of this, you will be a Belgian resident. I don't know what this means as far as protections from random Belgian laws that you might find objectionable, as NATO claims you'd still have *some* protections via the service member. There's not a lot of detail about this.
In short, if your darlingest is stationed in Belgium, kiss your job--and possibly your career--goodbye. Even if you're drowning in student loan debt from that one time when you got a degree that would help you score a portable career.

Welcome to the 1950s, baby. This is Belgium.

Wednesday, May 14, 2014

Just when you thought it was safe...

Looks like this here blog is about to be resurrected. Well, about to be...sometime this year or next.

It's PCS time (in a year), and we have word we're headed to northern Europe. As in where there's fucking permafrost and shit. Maybe not that far north, but godsdamned close. The climate is just like my most favoritest place ever--Monterey, where I was so fucking sick for two straight years that I ended up with a lovely autoimmune illness.

Oh. Fucking. Joy. I cannot fucking wait to be sick all the time again. I wonder if it'll actually kill me this time? Maybe. According to my doctor, Monterey very nearly killed me, so it's not outside of the realm of possibilities.

I did NOT want these orders. Like, I would rather have gotten the orders to Seoul. I'd rather go to fucking Guam or Diego Garcia. I hate the cold. I hate damp. I hate not being close to family. One of the things I have LOVED about being in Virginia has been proximity to my mom.

And even though I'm pretty fucking flamingly liberal, I cannot abide a nanny state. Jesus fucking wept, the shit you have to have in your car and on your bike there. Jesus. Fucking. Wept.

The cost of living? Would make a Southern Californian cry.

The housing? Would make a shack look palatial.

The employment opportunities? Ha! If I want to engage in fisticuffs over the thankless administrative assistant job that doesn't even pay a living wage, SURE. Opportunities motherfucking ahoy!

Meanwhile, we hear the only good thing about the job is when you get sent to Afghanistan. No, I'm not fucking kidding.

And holy shit, everyone who's said, "OMG so jealous of you!" I've asked them all what they liked about Europe. The only answer: the travel! And this is me holding my breath that there will ever be an opportunity to travel. Ever. Because the military. I've danced this fucking chicken dance mandated by the Navy for nearly 20 years now, and I know what comes after the cluck-twist-clap portion--a gigantic shaft up the ass sans lube and no reacharound.

I truly can't even. We had some time today where we thought this was off, that we were going to stay here in Virginia. My sprogs would get to finish elementary school here. They'd have this gigantic yard and the lovely cul-de-sac to ride bikes and skateboard and skate and all that shit. And then a writing conference was announced that's next year, and I thought *maybe*.

Nope. Hopes dashed. And on top of dashed hopes went the ashy remains of the hope we'd end up on base instead of in a city far, far away from the nearest base and the commissary and exchange and medical and all that shit. Far. Far. Away.

So...just fucking kill me now. Or else geobach. I don't know. Three years separated is a long fucking time, but so is three years living in the frozen hellmouth.

Wednesday, March 12, 2014


I saw on the Facebooks today that CNN has a new interactive on their website called The Uncounted. It's all about military dependent suicide.

What's the big deal? Nothing new in our world, right? We've been watching this happen year after year. We even had a suicidal ideation comment on Left Face a couple of years ago, which was scary and awful and incredibly sad. Authors across the mil-sphere have tried to bring this to public attention, but it hasn't really caught on.

Now, though, we have a major news network placing the series front and center on their website. Families who struggle--spouses, parents, siblings, sprogs--do count. They do matter. But we've been told through the inaction, inattention, and disinterest of military brass, that we don't count. We remain uncounted.

Thinking about this subject today took me through a windy brain-journey that ended with memories of speech after speech where the CO thanks us, the spouses. "You have the hardest job in the Navy," they've told us year after year. "Keeping the home front secure is tough, but your support helps our sailors focus on their important and often dangerous jobs."

This has always bugged me, but this morning, I realized why, exactly, these moments of faux gratitude are so damaging.

It's because of the message underneath the thanks.

It's because these little love notes are actually reminders of what our jobs really are.

Keep the home front secure. Take care of all the financials so service members can focus on the job that really matters.

Keep the home front secure. Be the only parent, functionally a single parent, for kids who miss their deployed mom/dad and might be acting out. Even though you aren't financially doing it on your own, you need to function as if you've got all the bases covered so service members can focus on the job that really matters.

When shit goes sideways, don't whine to your deployed spouse about it. Because s/he has a bevy of more important issues to worry about on that ship. That job is important, and they can't be distracted.

Keep the home front secure. It's a tough job, but it's your job to do.

Your job is support. And anything that distracts you from this job--your own career (which we don't actually want you to have, or else we wouldn't PCS you out of state every two fucking years), friends that don't understand what comes first in your life (the home front), interests that require your spouse take leave (while he's stationed on a ship? HA! Good fucking luck)--is to be avoided because it weakens the home front.

This might not be too awful if the job weren't compulsory or if there were compensation. But there is no compensation. All the money and benefits go to the service member. Only if you've given ten fucking years of your life to military marriage do you qualify for half of the service member's retirement (should s/he make it to retirement). And only if the worst happens do you ever receive benefits directly to your bank account. Because the employed person is the service member.

We don't fill out a W-2. We don't earn benefits or retirement of our own. Yet here we are with the "toughest job in the Navy." Lucky us.

Friday, January 17, 2014

A Modest Proposal

A serious issue in the US military, one that has taken years to slowly percolate, has recently become a central point of concern and contention. It is one that most definitely needs to be addressed, as it affects military readiness. But finding a solution has been difficult as politicians and those representing service members butt heads over how best to define the issue and remedy the problem.

The issue: how to pay for all the things.

The solution, according to Congress, the President, and four gregarious taintgrenades, is "entitlement reform."

Which is a fun way of saying, "take away money earned from people who don't legally have the voices to complain and call it *fair*." It is the most popular solution according to most members of Congress and a whole lot of taintgrenades.

I would like to propose a modest solution that will solve many issues. It requires only three actions:

  1. Congresscritters earn extremely generous entitlements for a quarter of the time served of military personnel. Clearly, it's only fair that they, too, share in the pain as the country learns fiscal responsibility. Instead of earning a generous retirement when they come into their political positions after having already established a career, and able to resume that career after their political terms have ended, and since they also have a very clear ability to earn a living from speaking engagements after their terms are over, they don't really need that retirement. Instead, this money should be forfeited in order to ensure we can balance our budget.
  2. Retired generals and admirals have typically given thirty years of service or more when they retire. Those who go on to earn metric fucktons of cash through defense contractor work or "think tank" employment might have only ten years of retirement before they earn their full COLA. To be fair, they won't miss any of their retirement, as they were part of a minority (as officers of high rank) able to easily secure employment built on their military experience. For those ten years, until they reach age 62, their entire retirement could likewise be used to balance the budget. Extrapolating on the logic of Congress, service and earned entitlements are inversely proportional; therefore, those who've served longer deserve the entitlements less.
  3. The staff of USA Today, Reiham Salam, Michael Moffett, Senator Hagel, Rep. Paul Ryan, and their cohorts have a flavor reminiscent of tea and crumpets. We should eat them. They would provide excellent sustenance during the months of unemployment. Warning: they're not vegan.
This proposal, which I offer with all modesty, could either ensure service members might have the COLA they were promised when they agreed to serve...or it could be a show of solidarity from those who believe military personnel are greedy bastards who got into this fucked up shitshow of a career path for the money.