When I was growing up I was given a little battery operated toy Dune Buggy that I would play with for hours on end in our kitchen at home. This little buggy would propel itself towards the skirting board of the kitchen and on impact it would flip itself over and head in the opposite direction with ease. Occasionally, there would be times where it was caught right in the corner of the room and would then find itself flipping backwards over and over again endlessly without a way out. At that point I would then have to intervene, repositioning the buggy back on course for it to continue its journey.
The story of the Dune Buggy is not too dissimilar to what many commanders face with their subordinates. Intervention is required at times to re-align their journey so they are better able to negotiate the tight corners of life and the many obstacles that life in the Defence may offer.
Unfortunately, it is a sad truth that many of the people that serve in the Defence Force will at some point in their career suffer an injury. Now we are not going to dive into the mechanisms of injuries here, I am merely stating a fact that there is a high propensity for injury in the nature of what we do for a living.
It requires a multidisciplinary approach when it comes to rehabilitation and reconditioning from an injury or illness and it needs to be aimed at maximising a soldier’s potential for restoration to their pre-injury or pre-illness physical, occupational, social, and educational condition.
The Trainee Rehabilitation Wing (TRW) was originally raised in 2003 and was located in a rather primitive facility at Moorebank NSW as a sub-unit of the School of Military Engineering. The aim was to create a positive environment for the rehabilitation of Army Initial Employment Trainees (IETs) from Combined Arms Training Centre training establishments. This was achieved by centralising injured trainees allowing for a concentration of rehabilitation assets and support systems. TRW has now opened its doors to all of Army’s IETs and has become an essential Forces Command asset.
In 2011, TRW relocated to a $28 million purpose built facility at Holsworthy Barracks adjacent to the Holsworthy Health Centre, which is capable of providing on hand clinical and rehabilitation support. Geographically, Holsworthy Barracks is close to some of Australia’s top surgeons located in the Sydney region that are able to provide the best surgical intervention and care as needed for the trainees. TRW has the capacity to accommodate up to 84 live-in trainees at any one time and the average length of stay is usually 3-6 months depending on the complexity and rehabilitation requirements of the soldier.
The TRW complex at Holsworthy
As the Officer Commanding (OC) of TRW for the past three years, I have seen my fair share of young soldiers suffering injuries that at times require extensive rehabilitation. Unfortunately what many people don’t understand is that when an individual suffers an injury there is always going to be an element of residual scar tissue. Whether that is musculoskeletal scar tissue, psychological scar tissue or even both, one needs to be prepared that they will never be exactly the same person that they were prior to their rehabilitation journey.
I’d like to focus more around the psychological aspect of being injured in this article as opposed to the physical. I’m sure the reader can directly relate to being physically injured; however, the psychological aspect and a soldier’s emotions frequently get overlooked and rarely get discussed. I’m going to caveat that I am not a psychologist, I am merely a General Services Officer (GSO) Medical Officer with a Physical Training Instructor background and these are my observations as a commander of wounded, injured and ill trainees.
I have personally witnessed on numerous occasions the psychological journey that a soldier will endure throughout their rehabilitation process demonstrating various emotional attributes. Every single person is different and they will cope with their injuries in their own unique way; however, initially I quite often see denial as the first emotional reaction. Denial that the injury is really that bad and that they still have the ability to soldier on without intervention. Once they realise that their injury is quite serious and will require extensive rehabilitation, we then may see remorse and blame. ‘What was I thinking, I shouldn’t have done that’, or ‘They had no right to make me do that activity and I deserve to be compensated’.
When a soldier finally sees their medical specialists and possibly undergoes surgery, we may see the soldier going through a mourning process. They often mourn for the loss of the ability to do the things that they once did, or mourn for the loss of a particular career path that may no longer be an option due to their injury. This is also the most difficult time for commanders, knowing how to assist their soldier who was once so positive and full of life with goals and aspirations, who now appears 'down' and struggles to see the light at the end of the tunnel. As a commander we will try our best to keep them engaged with positive psychosocial and community based activities attempting to demonstrate to them their sense of worth to our organisation and their true potential regardless of their condition; however, there are some that will not respond to this and this is when we encourage the soldier to have psychological intervention to assist them with some coping mechanisms and to help them to set some new goals.
We quite often also see the complete opposite to the last emotion where a soldier demonstrates excitement post-surgery. They’ve had their surgery and now they can see a light at the end of the tunnel demonstrating great excitement and motivation. Unfortunately, this is also another time that we as commanders need to step in and heavily monitor and observe this process and it has the propensity to go very wrong in a very short time.
Around Holsworthy Barracks we have numerous sets of speed bumps which are purposely placed there to slow down the traffic and ensure we stick to the speed limit. If one is in a hurry and approaches the speed bump too fast, there is a strong possibility that they could damage their vehicle, therefore, extending the length of time of their journey. A similar process happens with rehabilitation, there are soldiers who at times push too hard too fast and end up re-injuring themselves and quite often make their original injury worse and lengthen their rehabilitation process.
Unfortunately what many don’t understand is that rehabilitation is a fine balance between stimulus and rest. The rest component quite often gets neglected with soldiers that want to speed things up by adding more to their rehabilitation thinking they will achieve a better result, whereas, less is usually best when it comes to stimulus for acute injuries.
As stated previously, everybody is different and they will respond to rehabilitation in their own unique way. As a rehabilitation provider, we often find it quite difficult to get the exact balance of stimulus and rest for each of these soldiers. This is why we need to remain flexible as an organisation and engage with our soldiers frequently to ensure that we are on the correct path and providing the best care that we can within our scope.
The soldiers that we care for here at TRW are our future generation of leaders. I personally believe we have a duty of care to ensure they are set up for success either in their new Army career or even those who unfortunately need to separate from the Army as a result of their injury need to be established with a greater sense of independence and self-reliance.
I desire that we as a professional military organisation will one day eradicate some of the nasty stigmas that many of us have possibly experienced and endured as a result of injury of illness. I would hope that we can achieve a generational shift in attitude where those who have had a positive rehabilitation experience earlier in their career (in particular those who have spent time at TRW) will one day, when they are in a leadership position, treat their subordinates with the respect, compassion and empathy that they deserve.