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Friday 22 May 2020

2020-Who is my brother?


                 WHO IS MY BROTHER ?

                                             Eduardo C. Gerding
                                                                                        
                              It isn't what we say or think that defines us, but what we do.
                                                                        Jane Austen in Sense and Sensibility.

Introduction


This article describes the vulnerability of war veterans to SARS-CoV-2 but highlights how, despite adverse circumstances, they have selflessly turned once more throughout the country to help the community by responding to the evangelical call of their brothers. (Matthew 12: 46-50)
At the moment I am writing this article, there are 304,000 deaths from SARS-CoV-2 in the world, 33,998 in the UK and 353 in Argentina (150 are from the Province of BsAs). 27

According to Richard Horton, editor-in-chief of the prestigious medical journal The Lancet, everything that was said in the beginning about this virus producing a mild illness proved to be dangerously false.
Today we know that SARS-CoV-2 attacks all kinds of tissues and organs and leaves sequels even in recovering patients. 7




SARS-CoV-2

Symptoms are experienced 5.1 days after the virus (160 nanometers) enters our body. It can stay 20 days in the airways. 3. 15.7% of the cases are severe, 5% are critical and 2.3% require MRA. 14




The war veteran's vulnerability

Jamie Rowen, Associate Professor of Legal Studies and Political Science, University of Massachusetts Amherst (USA) , published an interesting article pointing out the 8 reasons why war veterans are vulnerable to SARS-CoV-2 . Although this applies to US war veterans it is very easy to extrapolate the data to our national reality. The causes of such consideration are : 30

Age and other Vulnerabilities: According to the New England Journal of Medicine, the first 425 infected average age was 59 years, and we know that case fatalities  increases 50% above patients 50 years old. The latter is due to two reasons: Existence of underlying pathologies (eg: obesity, high blood pressure, COPD, cancer, etc.) and the response of the immune system (reduction in the production of T and B lymphocytes from the bone marrow and thymus and reduction of the function of mature lymphocytes in secondary lymphoid tissues).3. Survivals in elderly patients are exceptional. 12


In 2017, Vietnam war veterans`average age was 58 years old (91% were male). As of April 13, 2020, 241 war veterans had died in US healthcare facilities and 4,000 tested positive for COVID 19.
In the case of the Malvinas conscripts (approximately 23,000 - 4) we speak of an average age of 56 years.

Dangerous residential facilities: Veterans with terminal illnesses, cognitive disorders, or drug addiction are generally found in places where there is a large group of patients. Forty deaths by COVID 19 were registered al Soldier´s Home in Holyoke.
Twenty-nine older adults residing in nursing homes in the city of Buenos Aires died of coronavirus, out of a total of 132 people who had a confirmed diagnosis of Covid-19 in thirteen establishments that house this population. 11

Benefits unfairly denied: In the USA.,the discharge rating (honorable or dishonorable) establishes whether the veteran is to receive social benefits. Many of them suffer from PTSD. This is especially observed Iraq and Afghanistan veterans. Probably this would not be the case for our Malvinas veterans. US war veterans who lost their jobs as a result of the coronavirus can apply for financial aid. In case of being approved they receive U$S 250. 15. There is no survey of unemployed Argentine war veterans.



Diminished access to health care: As a consequence of COVID 19, dental surgeries have been postponed and scheduled worldwide. 14
However, fifty per cent of ICU beds in Argentina have been available thanks to the postponement of scheduled surgeries and decrease in traffic accidents, among other reasons.


Mental health may get worse: Several articles have warned about the impact of quarantine on the psyche. In U.S.A. where currently 20 war veterans commit suicide per day, this situation is expected to worsen.
After the SARS spike registered in 2003, PTSD cases (47.8%) were found in both health workers and in people who self-isolated as part of the lockdown. 13,31
The National Center for PTSD,  in conjunction with the US Department of Veterans of War. promote the use of a free app so that veterans can manage their stress situation. Guidelines for Spanish-speaking war veterans in USA can be read at: https://www.ptsd.va.gov/spanish/COVID_managing_stress_sp.asp  26
British military entities say that 1 in 10 people in jail are war veterans and that this number is increasing due to PTSD. 34
According to the Argentine Public Prosecutor's Office, 58% of ex-soldiers suffer from depression and 3 out of 10 admit having had suicidal thoughts, as an official study indicated in 2012. 33

Based on WHO recommendations, several papers have been published depicting measures to protect mental health of those who observe quarantine in their homes. 8


Complications for homeless veterans and those in the justice system: In the US on any given night there are 45,000 veterans on the streets and 181,500 in jails. There is no survey of homeless Argentine war veterans.
There are 2,820 British war veterans in jail  which constitutes up to 3.5% of the total prison population. It is estimated, that in England and Wales war veterans are 30% less likely to be than those who are not veterans. 32
According tothe  US Department of Justice Statistics, during 2011-2012 there were 181,500 war veterans in jail representing 8% of the entire prison population. 9. Half of them revealed mental disorders. 19. The three main reasons why veterans end up in jail would be: 1) Alcoholism and drug addiction, 2) Inability to adapt to civilian life and 3) Economic Problems  (eg: homeless) .28

In Argentina, between 2013 and 2019 the prison population rose 55%  and reached 63,094 . This figure refers to prisoners within the Federal and Buenos Aires Penitentiary System, services which represent 69% of the country's total the prison population. 22. Overcrowding prisons is an Argentine priority concern. 29


Disability benefits delayed: In the US, 75,000 veterans wait at least 125 days to get their benefits.
After the 1982 South Atlantic conflict, 301 conscripts from the Argentine Army were left with disabilities (36 wounded with  disabilities greater than 66%), 53 officers and 297 non-commissioned officers (33 with a disability due to injuries greater than 66%). In the Argentine Navy, 46 conscripts, 80 officers and NCOs were left with disabilities. The Argentine Air Force had 25 Officers and NCOs with disabilities. 20

In our country there is Law 22,674 (BO 16 November 1982) that regulates an extraordinary subsidy for disabled Malvinas ex-combatants. Its Art 2 establishes that the amounts to be settled will be those that result from multiplying the monthly credit of the rank of Lieutenant General or equivalent, in force on the date of the settlement, by the coefficient TEN (10).

Obstacles to getting stimulus checks: In the case of the USA this is due to cumbersome forms to be completed by those veterans who are exempt from taxes. Argentine war veterans are exempt from some taxes (eg: income tax, automobile patent, real estate tax, etc.) but there are no obstacles to collection. 10
As of March 2020, the benefit received by the Malvinas war veterans will be $ 47,674.40 (U$S 381) 2

Donations
The Argentine Army donated field kitchens to a groups of war veterans. Each kitchen, originally fueled by firewood, has the capacity to provide 250 servings, and on its side it carries a 73-liter container for hot chocolate, coffee or mate.


Los veteranos de Malvinas de todo el país se movilizan para enfrentar la pandemia-https://www.infobae.com/sociedad/2020/04/16/los-veteranos-de-malvinas-de-todo-el-pais-se-movilizan-para-enfrentar-la-pandemia/   25



The Reconquista group donated an infusion pump for the intensive care area of ​​the local hospital, valued at 120 thousand pesos.
Globally, some cases have been extraordinary, such as 99-year-old British war veteran Tom Moore (Captain, Yorkshire Regiment who served in India and Burma) who walks with the help of a walker and helped collect £ 16m for health workers fighting the COVID 19 pandemic. 1

Background to solidarity actions of war veterans

In 1998, a single fire devastated 37,000 square kilometers of the Brazilian Amazon. This fire, which started in January 1998 and lasted until the rains began in early April, affected the state of Roraima, on the border with Venezuela and Guyana, and reached the Yanomani tribe reserve. Here our war veterans participated. 17
For 15 years, war veterans of Rosario, Daniel Britos, Raimundo Villagra, Roberto Sosa, Eleuterio Cardozo, Oscar Cabral and Baciliano Cháves distribute hot food to homeless from Monday to Friday with a truck . Every day, at sunset, these veterans meet to cook in a shed in Cafferata and Avenida del Rosario. Britos says that they do a bit of everything: noodle stew, yellow rice, and lentils, among other viands. They have the support of the Municipality which provide the food they cook and fuel for the 1983 Mercedes Benz 608 truck that was donated by the Argentine Post. 6
In Mendoza, war veterans collaborate in solidarity in the towns of San José, Gualtallary, Cordón del Plata, Villa Bastia, Zampal and La Arboleda. The products they deliver (coffee, pancakes and bills) are contributed by the veterans themselves, although they also receive the collaboration of some people and entities. 18



How Argentine war veterans help during the pandemic 24,25

-They make mask faces

In Santa Fe, in the towns of San Javier, Esperanza, San Carlos Centro, San Justo, Gálvez, Rufino, Villa Ocampo and Laguna Paiva, they distribute mask faces in coordination with NGOs. In Corrientes, they make mask faces in 3D printers for medical personnel and distribute them as well fre in Paso de la Patria and Ituzaingó. 


-Influenza vaccination

The Center for former South Atlantic combatants of Atlantic of Santiago del Estero participate in the home flu vaccination campaign for vulnerable PAMI members. Patients (whether veterans or not) with diabetes, hypertension, heart diceases and disabled are included in this assistance. War veterans are also in charge of bringing medications to ex-combatants at risk who cannot approach pharmacies. All expenses are borne by the local war veterans`center.
Alicia Reynoso (65) is a nurse who, during 1982, carried out her work as Air Force personnel at the mobile hospital in Comodoro Rivadavia. 21,24.She Works at the II Paraná Air Brigade and actively participates in the influenza vaccination campaign for older adults in the Grapschental village, a small town founded in 1886 by Germans from the Volga in the province of Entre Ríos. There are about 30/40 families, with many vulnerable elderly people.

-Nonperishable food

In the province of Buenos Aires war veterans carry out various solidarity and assistance actions, in coordination with the Buenos Aires Veterans Federation . In Mar del Plata the Malvinas Defenders Veterans Association delivers non-perishable food to dining rooms in different neighborhoods.

-Bags of food

The Neuquén veterans  provide a daily distribution of food bags whose products are  purchased from their own pockets.



Vía Malvinas- War veterans carry out solidarity tasks against hunger  6
https://viapais.com.ar/malvinas/1066097-excombatientes-realizan-tareas-solidarias-contra-el-hambre/



It should be noted that every Thursday for a period of six weeks, with food provided by the Municipality, members of the Argentine Army Pigüé Base prepare 250 hot lunch rations for people in need. 16

-Lodging people in risky situations.

In Tierra del Fuego, the president of the Center and also of the Malvinas Foundation, Conrado Zamora, transferred their facilities from the center to a coordination office for line 107 of emergency ambulances. The foundation's facilities were adapted and accomodation was provided for vulnerable people.
                  
-They provide vehicles for the local authorities 


In Misiones, war veterans provided their 22 owned vehicles to the the government thus helping to transport people, carrying medicines or food.

Safety, health, cleaning and garbage collection tasks

The Agrupación 2 de Abril (Malvinas Combatant Former Soldiers Center) in Tucumán, together with the United Neighborhood Center for San Andrés, collaborates in safety, health, cleaning and waste collection tasks, and they are also the ones who provide mask faces to older people.

-Vehicles control

187 kilometers from Santa Fé capital, on the way to the west, is the city of El Trébol. There, ex-combatants  coordinated by Osvaldo Martínez and Oscar Scaglia  collaborate with the municipality in the controls of entering vehicles. To do this, they perform rotating three-hour shifts, controlling drivers´ personal data and temperature.

-At institutional level

The symbolic daily raising of the flag in the historic monument in the city of Rosario could not be interrupted just because the employees in charge had to comply with the mandatory lockdown. Thus, Malvinas war veterans, after obtaining permission from the authorities, organized rotating shifts to raise and lower the flag of the main mast of the monument every day.


Acknowledgements

-Adolfo ¨Fito¨ Schweighofer-President of the National Commission of Former Malvinas Combatants of the Ministry of the Interior.Province of Santa Fé-(former conscript at the ARA Piedrabuena destroyer which rescued cruiser ARA General Belgrano´s survivors).

-Roberto Barrientos-Representative of the Ministry of Labor, Employment and Social Security before the National Commission of Former Combatants of the Malvinas.( Company of Combat Engineers 601-Argentine Army).

Bibliography


1-99 Year-Old WWII Veteran Raises $16 Million for U.K. Health Workers Amid COVID-19 Pandemic-TIME-April 16, 2020.
https://time.com/5821467/war-veteran-uk-coronavirus-fundraiser/
2- A partir de marzo los veteranos de Malvinas cobrarán más de 47 mil pesos.21 de febrero 2020.
https://tn.com.ar/sociedad/partir-de-marzo-los-veteranos-de-malvinas-cobraran-mas-de-47-mil-pesos_1036716
3-Adler, Sara Elizabeth-Why Coronaviruses Hit Older Adults Hardest-Health-March 14, 2020.
https://www.aarp.org/health/conditions-treatments/info-2020/coronavirus-severe-seniors.html?intcmp=AE-HLTH-TOENG-TOGL
4-Balza, Martin-¿Quiénes son veteranos de guerra?-INFOBAE-2 de abril 2020.
https://www.infobae.com/opinion/2020/04/02/quienes-son-veteranos-de-guerra/
5-Bär, Nora-Coronavirus en la Argentina: afirman que el 50% de las camas de terapia intensiva están disponibles-La Nación-26 de abril de 2020.
6-Brandariz, Silvia- Excombatientes realizan tareas solidarias contra el hambre-
 Vía Malvinas-
7-Bethge, Philip-What the Coronavirus Does Inside the Body-Spiegel International-15 May 2020.
https://www.spiegel.de/international/world/what-the-coronavirus-does-inside-the-body-a-03651b1c-3fd4-441b-aac8-fa49fdeacbd6?sara_ecid=nl_upd_1jtzCCtmxpVo9GAZr2b4X8GquyeAc9&nlid=bfjpqhxz.
8-Brewer, Kirstie- Coronavirus: How to protect your mental health-BBC News-16 March 2020.
https://www.bbc.com/news/health-51873799
9-Brooks, Christina-Why are our Nation’s Military Veterans in jail?-Texvet-
https://www.texvet.org/blogs/pjefferies/why-are-our-nation-s-military-veterans-jail
10-Comisión AFIP de Ex Combatientes de Malvinas-AFIP.
http://www.afip.gob.ar/malvinas/legislacion.asp
11-Coronavirus: 29 adultos mayores murieron en geriátricos de Buenos Aires-
La Voz-8 de mayo 2020.
https://www.lavoz.com.ar/ciudadanos/coronavirus-29-adultos-mayores-murieron-en-geriatricos-de-buenos-aires
12-Coronavirus: War veteran Albert Chambers recovers from Covid-19.BBC News-10 April 2020.
https://www.bbc.com/news/uk-england-south-yorkshire-52244704
13-Covid-19 pandemic could cause an increase in prevalence of PTSD.
 Pharmaceutical Technology-28 Apr 2020.
https://www.pharmaceutical-technology.com/comment/ptsd-covid-19/
14-COVID Recomendaciones generales para directivos y jefes de servicios hospitalarios-Ministerio de Salud de Argentina-1 de Abril de 2020.
http://www.msal.gob.ar/images/stories/bes/graficos/0000001890cnt-covid19-recomendaciones-para-directivos-y-jefes-de-servicio-hospitales.pdf
15-COVID Unemployment Relief-Florida Veterans Foundation-
16- El Ejército Argentino comenzó a cocinar en Salliqueló-Veradia.com. 10 de abril 2020.
https://www.veradia.com/nota.php?id=15171
17- El incendio de la Amazonía es de los más devastadores junto al de 1998-El Comercio-Perú.
https://elcomercio.pe/mundo/actualidad/amazonia-brasil-incendio-amazonia-devastadores-1998-noticia-nndc-668658-noticia/
18- En Tupungato, veteranos de Malvinas recorren el departamento con acciones solidarias-El Cuco Digital-Mayo 7, 2020.

19-From enlisted to incarcerated: Why some veterans end up behind bars-Prison Fellowship-
https://www.prisonfellowship.org/2018/11/why-some-veterans-end-up-behind-bars/
20-Gerding, Eduardo C.-El conflicto del Atlántico sur: Sus secuelas.
International Review of the Armed Forces Medical Services-Vol. 75/2-2002 p 84-94-Belgium.
21-Gerding, Eduardo C.-Nuestras enfermeras-El Grupo Nottingham-Malvinas: Los primeros 10 años-Editorial 1884
22-La población carcelaria de Argentina creció un 55% en seis años-Perfil-178 de noviembre 2019.
https://www.perfil.com/noticias/policia/cantidad-presos-en-argentina-subio-55-por-ciento-en-seis-anos.phtml
23-Morales, Fernando- Los veteranos de Malvinas manifestaron su malestar por la eliminación de la movilidad jubilatoria-INFOBAE-20 de febrero de 2020.
https://www.infobae.com/politica/2020/02/20/los-veteranos-de-malvinas-manifestaron-su-malestar-por-la-eliminacion-de-la-movilidad-jubilatoria/
24-Pignatelli, Adrián-La enfermera de la guerra de Malvinas que cuida adultos mayores en tiempos de coronavirus- INFOBAE-14 de abril, 2020.
https://www.infobae.com/sociedad/2020/04/14/la-enfermera-de-la-guerra-de-malvinas-que-cuida-adultos-mayores-en-tiempos-de-coronavirus/
25-Pignatelli, Adrián-Los veteranos de Malvinas de todo el país se movilizan para enfrentar la pandemia-INFOBAE-16 de abril, 2020.
https://www.infobae.com/sociedad/2020/04/16/los-veteranos-de-malvinas-de-todo-el-pais-se-movilizan-para-enfrentar-la-pandemia/
26-PTSD: National Center for PTSD-US Department of Veterans Affair.
 https://www.ptsd.va.gov/covid/COVID_managing_stress.asp
27-Récord de muertes por coronavirus en Argentina y Chile en un día-BAE Negocios-14 de mayo de 2020.
https://www.baenegocios.com/sociedad/Record-de-muertes-por-coronavirus-en-Argentina-23-fallecidos-20200514-0055.html
28-Rice, Sheena-3 reasons returning US veterans end up in prison-Futurity-
https://www.futurity.org/military-veterans-prison-1535212/
29-Rivas Molina, Federico-La sobrepoblación pone en riesgo a las cárceles argentinas-El País-12 de junio 2019.
https://elpais.com/internacional/2019/06/12/argentina/1560302394_095427.html
30-Rowen, Jamie-Associate Professor of Legal Studies and Political Science, 
 University of Massachusetts ,Amherst-8 ways veterans are particularly at risk from the coronavirus pandemic. The Conversation, Apr 16, 2020.
https://theconversation.com/8-ways-veterans-are-particularly-at-risk-from-the-coronavirus-pandemic-135619
31-Stieg, Cory- Could you get PTSD from your pandemic experience? The long-term mental health effects of coronavirus-Make it-Apr 18, 2020.
https://www.cnbc.com/2020/04/17/long-term-mental-health-ptsd-effects-of-covid-19-pandemic-explained.html
32-UK veterans and the criminal justice system-The Royal British Legion-
https://www.britishlegion.org.uk/docs/default-source/campaigns-policy-and-research/litrev_uk_vets_crim_justice.pdf?sfvrsn=6e0c84bf_2
33-Veteranos de Malvinas: piden que el derecho al cobro de pensiones sea imprescriptible-Perfil-1 de junio de 2019.
https://www.perfil.com/noticias/politica/veteranos-guerra-de-malvinas-piden-que-derecho-cobro-pensiones-imprescriptible.phtml
34-Wooding, David-Squaddies in cells- One in ten jail prisoners is an Armed Forces veteran as number rises due to PTSD-The Sun-1 sept 2019.

Published May 22nd, 2020 at The Nottingham-Malvinas Group:
https://malvinasnottingham.blogspot.com/2020/05/2020-quien-es-mi-hermano.html#.XsghgTozZdg

Saturday 8 February 2020

2020-The War within a Military Veteran








THE WAR WITHIN A MILITARY VETERAN - A QUESTIONNAIRE BASED STUDY ON INDIAN VETERANS


Dr.V.S.Srikanth, Dr.Shruthi Rajkumar 1,Dr.(Col)Vishal Marwaha 1, Dr.M.Gopalakrishna Pillai 1, Dr.ValsrajMenon1,  Anuja Anil 1, Anupama Kurup 1, Anuja Jayan 1, Aparna Chandrababu 1, Anna Mariyam1, , Arfaz Nazer1, Andrea Susan 1, Maj.Priyank Yadav 2, Col.Shri Kumar 3  

1)Amrita institute of Medical science and research Centre, Affiliated to Amrita Vishwa Vidyapeetham, Kochi, 2) Indian Army, Hisar  3)Indian Army,  Anandhapur 





Published at the International Review of the Armed Forces Medical Services ,December 2019-Vol 92/4

Abstract

Veteran is the title earned by those citizens who have scarified their youth and life for their motherland serving in the Armed Forces, in this study we have focused on the life of veterans post retirement assessing their physical and mental wellbeing.

Methods

This pan Indian study was conducted on 220 veterans attending ECHS clinics in Kerala, Andhra Pradesh, and Haryana. SF 36 questionnaire applied to survey the health status & asses the wellbeing score, where the results are reliable and correlates with the outcome. The scores for different categories under SF 36 were calculated and the data tallied in Excel sheet.

Results

Overall health status score of our study population is positioned as ranging from Moderate Health Status to Progressing towards Good Health. High Quality of Life with individual parameters scoring minimum of 54 points .Comorbid conditions included COPD, CLD, SHTN, CAD, DM, Cancer, and Osteo Arthritis.  Younger age habituation to alcohol and smoking Parameters like physical health, emotional problems, energy failure, emotional wellbeing, pain scare, general health have a score of > 63, which indicated that the veterans were towards good health.

Conclusion

 Our study indicates the overall well-being & health status of our veterans is quite positive & Good SF-36 score. The scores can further increased with life style and family support.

INTRODUCTION

Veteran is the title earned by those citizens who have scarified their youth and life for their motherlandand stood against all odds to see their flag fluttering high. They have faced the scroatching heat of the desert, freezing colds of the glaciers for protecting their country. They are the ones who stood guarding even the tallest mountains and deepest of the oceans of a nation bearing all odds. As a whole, transitioning out of the military can be a very difficult experience, contrary to the common illusion of “everything being gravy in the civilian world.” The reality is that the civilian world abides by many standards that are seemingly opposite of those of the military (1)
Once retired, most of them find it difficult to reunite with the civil world, as the functioning is not as orderly as in the defense forces. Prime part of lifetime spent away from the family and the familiesalso get adjusted to such a life style without their presence in person, many of them find it difficult to re-establish the family bond immediately after retirement.
Being in combat and separated from your family can be stressful. The stress can put service members and veterans at risk for mental health problems. These include anxiety, post-traumatic stress disorder, depression and substance abuse. Suicide can also be a concern (2).To face the obstacles of post retirement reality alcohol and smoking become crutch to cope with, while readjusting to the civil life.
In a study done by Linda et al, showed Comprehensive literature review found limited knowledge about how to integrate veterans into a new workplace (3).   This is one of the few studies, which deals with the quality of life, post retirement from defense forces. In this study, we looked into psychological and common morbid condition, which the veterans develop, so that it can be tackled at the root level.

OBJECTIVE
To understand the quality of life post retirement in Indian veterans by assessing the physical social and mental wellbeing and to develop preventive strategies if there is any problems faces by the veterans.
METHODS
This Pan Indian study was conducted on 220 veterans attending ECHS clinics in Kerala, Andhra Pradesh, and Haryana. Informed consent was obtained, following which demographic details, history, comorbidities and questions to assess the general well-being
SF 36 questionnaire applied to survey the health status & asses the wellbeing score, where the results are reliable and correlates with the outcome (4,5). The scores for different categories under SF 36 were calculated and the data tallied in Excel sheet.
Quality of Life and Wellbeing scores were assed as per SF-36 questionnaire with maximum score of 100 indicating high quality of life and good health and Low score (< 40) indicating poor health status .Data analysis done using IBM - SPSS statistical tool

Inclusion criteria
Veterans attending ECHS clinics in Kerala, Andhra Pradesh, and Haryana where the study conducted. All age groups irrespective of their service period
Exclusion criteria
Terminally ill patients who could not participate in direct information collection and patients receiving psychological and psychiatric treatment.


RESULTS


Data collected using SF 36 questionnaire recorded and analyzed using SPSS tool. The results observed are presented here in the graphs in Fig1 to Fig 6 under various categories.


















DISCUSSION
This is one of the few studies, which assessed both health and mental status of the veterans
The Age wise spread of our population had mean age of 59 year and Median age of 61 years with Min age being 36 &  Maximum age being 89 .Common Comorbid conditions faced by veterans of study included COPD,CLD,SHTN,CAD, DM , Cancer & Osteoarthritis of which the most common  were diabetes and systemic hypertension.
On evaluating the quality of heath with SF-36 scoring system which asses both physical and mental wellbeing wherephysical wellbeing is assessed based on the scores obtained from parameters of (Physical function, Role of limitation of physical health, Role limitation emotionalproblems, Fatigue) 
Mental Welling was assessed based on by (Emotional wellbeing, social functioning, Pain, General Health) .Where higher the score less is the disability. Where < 40 is poor functioning, 40-60 were moderate functioning and the above 60 score falls in the good range.
Parameters like physical health, emotional problems, energyfailure, emotionalwellbeing, painscare, general health have a score of > 63, which indicated that the veterans were towards good health. This can be correlated to Regular exercise, high pain tolerance, and strong mental makeup, which they develop during the service
Overall health status score of our study population is positioned as ranging from Moderate Health Status to Progressing towards Good Health & High Quality of Life with individual parameters scoring minimum of 54 points.
Due to younger age habituation to alcohol and smoking, veterans are more prone for development of co morbid conditions. This leads to decrease in physical function and energy levels at later years of life. The result of our study co related well with results of study done by Jenni et al where they found veterans demonstrate high rates of SUD in American Army (6, 7, 8 ).
In our assessment, we had found that the veterans had overall all mental well-being because of “Better health care schemes for veterans by the armed forces like Ex-servicemen Contributory Health Scheme (ECHS), played an important role delivering timely heath care services (9,10).
Veteran housing colonies help to live in a mutually supportive environment provided a platform for veteran’s emotional and psychological support by peers and community
Emotional wellbeing & Social functioning show more positive reflections in veterans of higher age group Strong mental makeup and development of self-sustainable skill and training their social functioning and emotional independence post retirement can be related to this fact.
CONCLUSSION

Our study indicates the OVEALL well-being & health status of our veterans is quite positive & Good SF-36 score, thanks to various measures provided to care for their healthy life.
In order to improve the scores further, we suggest few additional measures as follows
Periodic follow up ofthe physical and mental veterans every quarter for immediate couple of years post retirement in a medical facility .The score could be reassessed and necessary psychological and timely psychiatric guidance can be provided on need basis.
Provide sufficient counselling sessions prior to retirement for a seamless / stress free integration in to civilian society.Counselling Sessions for Rehabilitation: inorderto support for withdrawal of Alcohol andSmoking.
Assist them in finding opportunities to use their skills and find placements to absorb them in right positions and keep them engaged.
The study can be extended to cover wider band of veteran population across the age groups and demographics in order to understand the applicability of SF-36 scores and customise the measures. Providing quality life and Pride filled engagement of Veteransin their post service lifetime is one of means by which civilian society can pay as gratitude to their service.

An important message what we also wanted to convey from our study is that 


- Its responsibility of every citizen to value our veterans who stood awake in the frontiers guarding our borders so that they could sleep peacefully at home and support then with love , honour and pride  





CONFLICT OF INTEREST

There is no conflict of interest in this study 

REFERENCES

3)   Linda Van Til,  Deniz Fikretoglu et al, Work Reintegration for Veterans With Mental Disorders: A Systematic Literature Review to Inform Research. Physical Therapy, Volume 93, Issue 9, 1 September 2013, Pages 1163–1174,https://doi.org/10.2522/ptj.20120156
4)   Wilma M. Hopman et al., Canadian normative data for the SF- 36 health survey CMAJ. 2000 Aug 8; 163(3): 265–271. PMCID: PMC80287
5)    Ronan A. Lyonset al., Measuring health status with the SF-36: the need for regional norms. Journal of Public Health Medicine. Vol. 17, No. 1, pp. 46- 50
6)   Jenni B Teeters, et al, Substance use disorders in military veterans: prevalence and treatment challenges Subst Abuse Rehabil. 2017; 8: 69–77. Published online 2017 Aug 30. doi: 10.2147/SAR.S116720 ,PMCID: PMC55871
7)    Seal KH, Cohen G, Waldrop A, Cohen BE, Maguen S, Ren L. Substance use disorders in Iraq and Afghanistan veterans in VA healthcare, 2001–2010: implications for screening, diagnosis and treatment. Drug Alcohol Depend2011;116(1–3):93–101
8)   Hoggatt KJ, Lehavot K, Krenek M, Schweizer CA, Simpson T. Prevalence of substance misuse among US veterans in the general population. Am J Addict2017; 26(4):357–365.
http://ksb.gov.in/education-of-Children-Widows-of-esm.htm