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William Beaumont Army Medical Center’s Child, Adolescent and Family Behavioral Health Services welcomed 17 school-age children to a week-long camp designed to discuss experiences in a safe and supportive environment at Fort Bliss.

The summer camp, dubbed “Camp Wonder,” included four half-day sessions comprised of three counselor-led sessions targeting self-esteem, empowerment, depression, anxiety, behaviors, coping skills and social skills. Children completing kindergarten through fifth grades from Milam, Bliss and Colin L Powell Elementary Schools, were divided into age-appropriate groups to encourage interaction and uniform progression with peers.

“This is a great program for my son to participate in dealing with emotional and socioemotional feelings,” said Ebonie Sanchez, a military spouse at Fort Bliss and mother of three. “I thought it would be really good for him because he is young, so any aspect that can help him with his maturity level and growth, I’m all about it.”

In collaboration with Army Community Services, the camp also engaged parents with workshops addressing behavioral reward systems, medication management, family strengthening, and special education services available at Fort Bliss schools. During the camp, children were introduced to a reward system, earning small prizes for accomplishing daily goals. Parents were encouraged to continue the reward system at home, utilizing leisure activities such as video games and cell phone usage as rewards.

“Since he first found out he was going to the camp he asked question after question,” said Sanchez. “After coming home that first day he was ecstatic, he had so much fun he showed me a reward system they implemented and that gave him motivation to do more positive things to gain rewards.”

“Because school behavioral health is embedded within schools, during the summer they don’t have any children (assigned to programs) so they host camps and groups,” said Lashonda Bogan, outreach coordinator, Child, Adolescent and Family Behavioral Health Services, Department of Behavioral Health, WBAMC. “(The workshops) incorporate parenting classes into what the kids are learning, so (parents could continue to engage at home).”

According to Bogan, the short groups and camps offered during the summer allow eligible children to participate in programs before committing to services during the school year. Programs are aimed at increasing understanding and awareness of special-needs children to better prepare military families for challenges such as deployment of service-members, adding to unit readiness.

The program introduced Sanchez’ six-year-old son, DeAaron, to social settings outside of school while also addressing feelings, bullying and respecting others and themselves.

“It might be their first time being around other kids they could identify with,” said Bogan. “Knowing everyone in the camp (is unique), made campers more comfortable being themselves.”

“(DeAaron) has (Attention-deficit/hyperactivity disorder) so sometimes sitting down and calming down to get all the instructions (at school) is difficult for him,” said Sanchez. “He is learning about being courteous and those life skills parents want them to have to be successful.”

The camp wrapped up with a closed performance for parents featuring children singing as a choir about bullying and respect and swimming at the Fort Bliss Aquatics Training Center.

When asked what he enjoyed about the camp, DeAaron answered “the song,” while also adding he had fun during the camp.

“I’ve seen changes,” said Ebonie Sanchez. “I’m very involved in every aspect of his life, as much as I can be. (Camp coordinators) did have a mandatory meeting for the parents where bullying and coping with certain emotions were discussed, which I felt was a really great aspect of the camp.”

For the soon-to-be first grader, DeAaron says he’ll take what he learned and apply it to school, a goal Sanchez yearns.

“I feel like this was a positive camp that allowed children to work in an environment they felt was fun but also gained the skills of cooperating with others, showing respect and learning about bullying,” said Sanchez. “I look forward to him continuing using the skills he learned here and help him be successful in the next grade level.”

“All of us have our own things that make us different, but we shouldn’t treat anyone differently,” said Bogan.

The summer camp was held June 18 through 22.

Author:  Marcy Sanchez  – William Beaumont Army Medical Center Public Affairs Office

Plastic surgeons at William Beaumont Army Medical Center successfully transplanted a new ear on a Soldier who lost her left ear due to a single-vehicle accident.

The total ear reconstruction, the first of its kind in the Army, involved harvesting cartilage from the Soldier’s ribs to carve a new ear out of the cartilage, which was then placed under the skin of the forearm to allow the ear to grow.

“The whole goal is by the time she’s done with all this, it looks good, it’s sensate, and in five years if somebody doesn’t know her they won’t notice,” said Lt. Col. Owen Johnson III, chief, Plastic and Reconstructive Surgery, WBAMC. “As a young active-duty Soldier, they deserve the best reconstruction they can get.”

The revolutionary surgery has been over a year in the making for Clarksdale, Mississippi native, Pvt. Shamika Burrage, a supply clerk with 1st Battalion, 35th Armored Regiment, 2nd Brigade Combat Team, 1st Armored Division.

In 2016, while returning to Fort Bliss, Texas, after visiting family in Mississippi, a tire blowout changed Burrage’s life in an instant.

“I was coming back from leave and we were around Odessa, Texas,” said Burrage, who was travelling with her cousin. “We were driving and my front tire blew, which sent the car off road and I hit the brake. I remember looking at my cousin who was in the passenger seat, I looked back at the road as I hit the brakes. I just remember the first flip and that was it.”

The vehicle skidded for 700 feet before flipping several times and ejecting the Soldier. Burrage’s cousin, who was eight-months pregnant at the time, managed to only suffer minor injuries while Burrage herself suffered head injuries, compression fractures in the spine, road rash and the total loss of her left ear.

“I was on the ground, I just looked up and (her cousin) was right there. Then I remember people walking up to us, asking if we were okay and then I blacked out,” said Burrage, whose next memory was waking up in a hospital.

She was later told by doctors if she would not have received medical attention for 30 more minutes, she would have bled to death. After several months of rehabilitation, Burrage began to seek counseling due to emotions caused by the accident and its effects on her appearance.

“I didn’t feel comfortable with the way I looked so the provider referred me to plastic surgery,” said Burrage.

“She was 19 and healthy and had her whole life ahead of her,” said Johnson. “Why should she have to deal with having an artificial ear for the rest of her life?”

When explained her options for reconstruction, Burrage was shocked and initially resistant to go through with the total ear reconstruction.

“I didn’t want to do (the reconstruction) but gave it some thought and came to the conclusion that it could be a good thing. I was going to go with the prosthetic, to avoid more scarring but I wanted a real ear,” said Burrage, who is now 21. “I was just scared at first but wanted to see what he could do.”

In order to avoid any more visible scarring, Johnson selected prelaminated forearm free flap, which involved placing the autologous cartilage into the patient’s forearm to allow for neovascularization, or the formation of new blood vessels. This technique will allow Burrage to have feeling in her ear once the rehabilitation process is complete.

“(The ear) will have fresh arteries fresh veins and even a fresh nerve so she’ll be able to feel it,” said Johnson.

In addition to the transplant, epidermis from the forearm, while attached to the ear, will cover up scar tissue in the area immediately around Burrage’s left jawline.

“I didn’t lose any hearing and (Johnson) opened the canal back up,” said Burrage, whose left ear canal had closed up due to the severity of the trauma.
“The whole field of plastic surgery has its roots in battlefield trauma,” said Johnson. “Every major advance in plastic surgery has happened with war. This was trauma related.”

With only two more surgeries left, Burrage states she is feeling more optimistic and excited to finish the reconstruction.

“It’s been a long process for everything, but I’m back,” said Burrage.

Author: Marcy Sanchez – WBAMC/US Army

A new simulation system at William Beaumont Army Medical Center’s Labor & Delivery Department aims to improve patient care and safety through advanced training simulations.

The state-of-the-art simulator provides WBAMC staff up to various cutting-edge training scenarios which are documented and transmitted to allow for instant feedback on the exercise, increase communication during emergencies, and improve interdisciplinary and clinical performance.

“We have been doing monthly simulation training for years. However, the (new simulation system) is a more advance simulator that will provide feedback to the team regarding their performance” said Maj. Laquincyia Key, clinical nurse specialist, Maternal-Child Health Services (MCHS), WBAMC. ”

The new simulator follows standardized guidelines from the American College of Obstetricians & Gynecologists, which not only provides health care staff with instant feedback from the exercise according to their performance, but also collects and transmits the data to the Defense Health Agency to advance and standardize training platforms. According to Key, the new simulator also meets required DHS’s biennial training mandates.

“The (previous simulation system) needed updating and wasn’t able to collect training data and track clinical outcomes,” said Key. “The (new simulation system) has pre-programmed scenarios with Internet curricula available.

Because most patients at WBAMC’s L&D are low risk, the simulator helps train and prepare staff for emergency cases. Scenarios such as postpartum hemorrhage, umbilical cord prolapse, shoulder dystocia, eclampsia, breech vaginal delivery and operative vaginal delivery are feasible with the simulator to provide staff opportunities to improve obstetric emergency skills.

“Communication and organizational culture are the root causes of most cases of perinatal death and injury,” said Key. “Simulation-based training allows the team to practice high-risk, low-volume obstetric emergencies in preparation for when these events actually occur. They are able to identify areas of improvement and evaluate their team’s performance with non-judgmental debriefing.”

Scenarios also supports WBAMC Simulation Center’s continuing mission to produce measureable outcomes from scenario-based training.

Added features include a medical manikin capable of birthing an infant manikin which allows staff to conduct neonatal resuscitation training. Over 100 newborns are delivered each month at WBAMC.

Author: Marcy Sanchez – U.S. Army/WBAMC

William Beaumont Army Medical Center’s Simulation Center kicked off the first of a series of revamped medical programs for medical students, staff, nurses and physicians at the hospital as part of the recently provisionally accredited center’s goal to achieve outcomes in medical simulation processes implemented at the center.

The center introduced a newly-revised curriculum for suturing and wound closures to students of the hospital’s Interservice Physician Assistant Program (IPAP), one of six Graduate Medical Education programs at WBAMC, during a scenario-based training, March 9.

“A credentialing body wants to see what the credentialing is for. So the more complete the course we can show them is, the better,” said Thomas Soto, simulation technician, WBAMC. “They don’t want to come in and credential random training.”

The step toward standardizing processes in the new curriculum will evaluate students based off scenario-based training, with students required to accomplish objectives during evaluation.

“(Faculty and students) have been (engaged in didactics) but they weren’t covering (scenarios) in detail and putting it into application,” said Joe Lloyd, interim nurse educator, Simulation Center. “Basically this is our (new) policy and we present scenarios and (situations to medical staff and students) where they have to act on the situation.”

The Simulation Center recently presented scenario-based training during an Emergencies in Clinical Obstetrics course aimed at providing OB-GYN staff training on situations from shoulder dystocia, hemorrhage to breech deliveries.

According to Soto, this type of training will not only prepare healthcare professionals for different patient situations but also increase patient safety.

“Whatever (students) end up doing (at the simulation center), when they actually go see the patient they’ll be more prepared for it because they’ve came in here and have done the repetitions,” said Soto.

Aside from increasing patient safety and staff readiness, the center’s upgraded curricula will also minimize the need for training outside of WBAMC. The center expects to recapture training currently performed at other health centers in the region, due to the increased trauma cases at the community hospitals.

“(Medical education programs at the hospital) have to get so many students to perform certain medical procedures, and there isn’t enough patients (requiring those procedures), so they have to do simulation,” said Lloyd. “We have all these different (medical education) programs that want to practice so to give exposure to everyone we have to simulate the environment.”

Future revamped training curriculum is anticipated to continue engaging staff and students throughout all of the medical education programs at the hospital. The center also hopes to incorporate role players in future simulations to educate and evaluate patient engagement and communications.

“(Students) will have to talk to a patient, do their assessment as part of their procedure, and perform that wound closure on a (mock) patient and a simulation model,” said Soto, discussing the IPAP suture/ wound closure scenario in particular. “(The scenario-based training) will improve patient care and make our simulation center premier.”

Author: Marcy Sanchez – WBAMC

William Beaumont Army Medical Center’s Central Simulation Committee Medical Simulation Center recently gained provisional accreditation from the Society for Simulation in Healthcare, an international organization promoting improvements in simulation technology, educational methods, and patient safety.

The Simulation Center at WBAMC supports Continuing Medical Education and Graduate Medical Education (CME/GME) to increase patient safety and practitioner competence. The center provides healthcare professionals with lifelike scenarios aimed at developing and shaping teamwork, communications and critical thinking skills to enhance outcomes.

“(Full accreditation means) we’ll have an opportunity to bring different funding and programs into the organization and have broader opportunities,” said Lt. Col. Olga Betancourt, deputy chief, Education Division, WBAMC. “In turn, these increased opportunities will affect patient care because residents will be able to practice more and conduct different research improving Army Medicine.”

Although the simulation program at WBAMC is vastly focused on supporting the GME mission at WBAMC, CME is also profiting from the Sim Center’s various programs designed to educate and refine nursing skills and training requirements, as well as honing the skills of Soldiers preparing for deployment. After documenting outcomes for two continuous years, the center will be eligible to reapply for full accreditation from the organization.

In preparing for the accreditation, staff members developed curriculum to evaluate detailed processes for each scenario presented to GME residents.

“Everything we do here is to assist in (GME residents’) training development and to provide medical simulation for their respective programs,” said Thomas Soto, Simulationist, WBAMC. “So when residents actually conduct a procedure for the first time, it isn’t on a patient. It’s training hands on with high-fidelity Manikins.”

According to Betancourt, a native of Philadelphia, one of the first steps toward accreditation was formulating a multidisciplinary strategic plan to welcome creativity and collaboration thus developing the center’s programs to benefit training.

“It’s not just about doing the training but providing the curriculum that backs that training up such as what are the objectives, who’s the target audience, and developing scenarios for different training events,” said Soto, the simulation center’s only dedicated simulationist. “Simulation isn’t just providing a simulation the technician wants to show. This is targeted to residents and providers that are going to (or already) working on real patients and going out in to the community and performing these skills. It’s very specific and really detailed.”

Simulation programs at the center range from endoscopic surgery to neonatal care, benefiting all new healthcare professionals training at WBAMC from general surgery residents to the Army’s junior enlisted medics.

“There’s a lot of programs that are currently using the simulation program,” said Betancourt, who also supervises operations in the simulation center. “One of the rooms we created within the sim center is a patient room, a lot of the students will actually come into the room and actually work with a (simulated) patient in the room.”

Future plans include expanding the center’s capabilities to include laparoscopic surgery, spinal fusions, and robot-assisted surgery simulations.

In addition to current capabilities, the center is also an approved Fundamentals of Endoscopic Surgery site, meaning residents may be evaluated on their fundamental knowledge, clinical judgement and technical skills at the center required in endoscopy, a requirement for most surgery residents in WBAMC’s GME programs.

“We have the equipment and the site for designation which they need before graduating,” said Soto, a native of Aransas Pass, Texas. “We’re saving the Army money, getting residents trained and what they need to be credentialed.”

Future developments with full accreditation will also provide the necessary training physicians may require, eliminating the need to travel to other medical centers or hospitals to conduct training.

Simulation center staff credits WBAMC’s chief of education, Col. Susana Argueta, with initiating the accrediting process and collaborating with WBAMC leaders to develop program curriculums. Full accreditation across all Army Medicine simulation centers is also a goal to improve overall Army readiness.

Author: Marcy Sanchez – WBAMC /US Army

William Beaumont Army Medical Center held an assumption of responsibility ceremony during which Command Sgt. Maj. Janell Ray assumed responsibility as WBAMC’s command sergeant major.

Ray, a native of Fort Hood, Texas, previously served as command sergeant major of U.S. Army Medical Department Activity (MEDDAC) and Ireland Army Health Clinic at Fort Knox, Kentucky.

“Welcome to a great command sergeant major,” said Col. Erik Rude, commander, WBAMC. “As soon as the (command sergeant major list) came out, my phone blew up. Not enough people could call me to tell me about how great (Ray) is.”

A unit’s command sergeant major is the top enlisted advisor to the commander and an advocate for enlisted Soldiers.

During the ceremony Rude performed the traditional passing of the unit colors to Ray, a symbolism of assumption of responsibility and authority of the incoming command sergeant major.

“I’m truly humbled and honored to serve as the command sergeant major for the Soldiers, civilians and families of WBAMC,” said Ray. “Over the past 25 years I’ve been fortunate enough to serve with some great outstanding leaders and soldiers. I’m forever grateful and appreciative for their mentorship and guidance because it’s them who prepared me to take on the responsibility of what I perceive as the most challenging but rewarding job in my entire career at this point.”

According to Rude, while Ray’s peers discussed her strengths and knowledge with medical operations, both in and out of Military Treatment Facilities, their biggest emphasis was her love and caring for Soldiers.

“The success of this organization lies with each and every one of you doing your part as a member of an outstanding winning team,” said Ray. “Continue striving to be better tomorrow than you are today, so we can take our organization to the next level.”

Since July, 18 2017, WBAMC’s top enlisted position was filled by interim Command Sgt. Maj. Michael Fetzer, previously serving as command sergeant major, Troop Command, WBAMC.

“(Fetzer is) outstanding,” said Ray. “I’ve always appreciated his candid leadership and guidance. Because of his leadership, WBAMC is better today.”

WBAMC is dedicated to increasing Army Readiness through patient-friendly access to high-quality healthcare.

“We’ll continue to guide this extraordinary organization into the future of Army Medicine,” said Ray.

The ceremony was held at the Fort Bliss and Old Ironsides Museum, on Fort Bliss, December 19, 2017.

Author & Photographer: Marcy Sanchez – WBAMC/US Army

In 2016, Sherita Kelly, despite being in the best shape of her life, was diagnosed with stage three breast cancer, an advanced stage of breast cancer extending beyond the immediate tumor region but not yet invading other organs.

After her 40th birthday, Kelly, a military spouse and native of Columbus, Georgia, was recommended and requested a mammogram through her Primary Care Manager (PCM) even though she regularly performed self-exams and never detected abnormalities. The American Cancer Society recommends annual mammograms for women ages 40-44.

Once her mammogram was completed and she was informed of the diagnosis, Kelly didn’t know what to do next.

“I had multiple tumors but I never felt them,” said Kelly. “I didn’t know where to go or who to see.”

William Beaumont Army Medical Center has operated a cancer program fully approved by the American College of Surgeons, Commission on Cancer since 1954. Recent reports from the Commission on Cancer highlight WBAMC’s adherence to standardized guidelines on cancer screening and treatments.

“We can treat most cancer patients, except those requiring inpatient chemotherapy which we can’t (logistically) support,” said Dr. Warren Alexander, staff physician, Hematology/ Oncology Clinic. “As part of the Commission on Cancer, we do make a concerted effort to participate in screenings, not just for malignancies but for other (issues) to make the quality of life of our patients a little bit better.”

Over the past few years, WBAMC’s cancer treatment has been above the national average for administration and reporting radiation and chemotherapy after diagnosis, according to the Commission on Cancer, a program dedicated to improving survival and quality of life for cancer patients through standard-setting, prevention, research and education.

“We have evidenced-based information that proves we are consistently above other Commission on Cancer sites when you pull all the data,” said Alexander, a San Francisco native. “Quarterly reports look at data and administration of radiation (therapy) after breast cancer therapy as well as mastectomy, we’re almost across the board 100 percent.”

According to Alexander, other measures also includes recommended treatments following the Commission on Cancer’s standardized guidelines, of which WBAMC is reported at 100 percent compliance.

“Even as guidelines change, we adapt,” said Alexander, who was recently recognized as one of the top specialty-care doctors in the Army. “(WBAMC) is above the national average in surgical outcomes. When you adhere to the guidelines you have a tendency to have good outcomes.”

Because of WBAMC’s proactive approach to recommended screenings, which incorporates everyone in a patient’s line of care, Kelly’s persistent PCM’s recommendations for a mammogram led to detecting Kelly’s cancer before it metastasized to stage four breast cancer, considered to be incurable.

“I was diagnosed in July, had a right mastectomy in September and started chemotherapy on Oct. 6,” said Kelly. “From the very first time I walked into the office, the physician explained everything. (Treatment) was difficult but the staff here made it easier, compared to how it could have been.”

After 28 treatments of radiation therapy, Kelly’s cancer went into remission.

Because of her experience during her battle, Kelly, already a registered nurse specializing in emergency medicine, is hoping to pursuit an education to also specialize in oncology. With the assistance of outside organizations, Kelly began initiated and began volunteering in the hospital’s Survivorship Group, a group aimed at comforting and educating other patients diagnosed with cancers.

“Once you’re diagnosed, your life completely changes. It’s always in the back of your head, how do I live without constantly thinking about whether it’s going to come back again,” said Kelly.

In addition to a full-team approach, WBAMC’s access to care and the military’s comprehensive health care which covers retirees and family members, also played a vital role in Kelly’s treatments.

“Having a team effort is important to be able to push patients from one clinic to another to include primary care,” said Alexander. “If you need a colonoscopy, mammogram… you can get one versus in the private sector where there may be a cost that may prohibit you from doing so. (WBAMC screenings) are free, (patients) just have to get it.”

Through adherence to guidelines and proactive screenings, WBAMC’s cancer program continuously contributes to Army readiness through patient-friendly access to high-quality healthcare.

Author: Marcy Sanchez – WBAMC

Earlier this year, William Beaumont Army Medical Center doctors performed the first Transcatheter Aortic-Valve Replacement (TAVR) in El Paso at WBAMC.

The procedure is a minimally-invasive alternative to open-heart surgery for patients with severe Aortic Stenosis (AS), a condition involving the narrowing of the heart’s aortic valve which minimizes or blocks blood delivered to the aorta resulting in limited blood flow throughout the body.

The TAVR procedure is revolutionary not only as an alternative to traditional means of treating AS but also as a solution for patients who may not have had an option two years ago.

“It (is) a feasible way to save patients who are not good candidates for surgery,” said Maj. Ryan McDonough, interventional cardiologist and chief of cardiology, WBAMC. “There are patients who are not good surgical candidates but are excellent candidates for a percutaneous approach due to comorbidities, illnesses and previous surgeries.”

Because blood flow is limited in patients with AS, it makes the heart work harder to pump blood through the body, resulting in symptoms such as chest pain, fatigue and difficulty breathing.

Similar to a stent placed in an artery, patients are implanted with self-expanding valves via a catheter usually entering the body through the femoral artery in the groin. The minimally-invasive procedure results in reduced operating and recovery time when compared to traditional open-heart surgery procedures which usually demand for a sternotomy (opening of the sternum) to treat AS.

According to McDonough, as new as the procedure is to medicine, there are two Food and Drug Administration-approved devices available to patients for the procedure: self-expanding and balloon-expanded valves. While both have similar functions, the WBAMC patients were implanted with the self-expanding to minimize risks.

“The valve is stented on a self-expanding metal that reacts to heat. When exposed to heat it expands to a predesigned form and the catheter slowly comes off the valve and expands,” said McDonough, a native of Port Jefferson, New York. “You don’t have to balloon expand or pace (regulate the heartbeat by means of an artificial pacemaker), (the valve) is recapturable and repositionable. The valve deploys to 80 percent first, allowing us to assess whether it’s position and functionality is correct before fully deploying.”

The self-expanding valve also conforms and seals to non-circular aortic valve annulus (passages) and may be safer to use than other TAVR devices due to decreased potential to rupture tissue, decreasing mortality risk.

For 75-year-old Daniel Mooneyhan, the second patient to be implanted with the valve in El Paso, the valve provided relief after suffering with AS for two years.

“I was walking one day and I had to stop and hold on to a tree at a park. I was having a lot of heaviness, a little chest pain here and there,” said Mooneyhan, a 75-year-old retired Army first sergeant.

After a series of tests and exams, Mooneyhan was informed that his aortic valve was failing. Due to previous ailments along with reluctance to open-heart surgery, Mooneyhan didn’t prove to be a good surgical candidate for a bioprosthetic valve, which must be sewn into place during open-heart surgery, occasionally taking hours to complete.

“I didn’t want to be cut open. If I had to be cut open just forget it,” said Mooneyhan.

While this was a first at WBAMC, it wasn’t new to Mooneyhan, who had been researching treatment options for his condition.

“I watched hundreds of videos (regarding the procedure) and talked to the specialists,” said Mooneyhan. “They (perform the procedure) in Tucson, Albuquerque, Lubbock, Dallas, Indianapolis, San Antonio, so why can’t we do this here in El Paso?”

After McDonough spent three years supporting and training for the use of the TAVR device, the device was approved for treatment at WBAMC.

“It’s awesome,” said McDonough, who along with an interdisciplinary team of surgical professionals performed both treatments. “I felt very comfortable with our team doing this procedure and it’s very much a collaborated team approach. It’s not the technical part of deploying the valve, it’s the process.”

On Nov. 15, Mooneyhan received a call to be admitted for treatment at WBAMC the following day. Less than a week later, Mooneyhan was back home, feeling relieved.

“I’m sleeping better, I’m getting a full breath, I’m feeling good and have no scars or anything,” said Mooneyhan, just 10 days past the TAVR procedure. “There’s people here in this city, in this county who probably need this procedure, I think this is the future.”

“Once the valve is in and it’s functional, their heart is fixed,” said McDonough. “The only reason we keep the patient is to make sure they don’t develop conduction abnormalities (electrical impulses which cause the heart to beat), a potential need for a pacemaker and to monitor the access site.”

While WBAMC has already scheduled another pair of TAVR procedures, the success and benefit of the treatment made an emotional impact on Mooneyhan.

“There’s people out there who need this, who are dying,” said Mooneyhan. “To those guys that are retired and any veteran who needs this, they need to come (to WBAMC). These doctors are awesome, they’re good doctors.”

Author –  Marcy Sanchez – WBAMC / U.S. Army

From adolescence to beyond menopause, midwives offer a broad scope of practice tailored to women’s preference of care. To celebrate their holistic approach and contributions to the medical community, midwives are being recognized October 1 – 7 as part of National Midwifery Week.

At William Beaumont Army Medical Center, a team of Certified Nurse-Midwives (CNMs) provide around-the-clock care, the only medical center in El Paso to do so, ranging from well-woman exams to postpartum care.

“I love being a nurse and being a midwife,” said Maj. Noelle Dove, nurse midwife, Department of Women’s Health Services, WBAMC. “(Being a midwife) is about being able to offer more to the patient and increasing the opportunities that (CNMs) can be involved in.”

According to the American College of Nurse-Midwives (ACNM), in 2014, 8.3 percent of all U.S. births were delivered by CNMs. Furthermore, statistics show a steady rise in CNM-attended births in the U.S. since 1989.

The growth in opting for CNM-attended births may be attributed to CNMs’ commitment to evidence-based practices which continuously introduces options for women not just during labor but also within their primary care practice.

“Women’s bodies are pretty amazing,” said Capt. Merry Fontenot, nurse midwife, WBAMC. “As midwives, which means ‘with women,’ we also provide our patients the tools to make decisions. We don’t make the decision for them on a regular basis; we empower them to make the best decision for themselves.”

While some patients may not be familiar with the profession, CNMs and Obstetrician-Gynecologists do have a shared goal of promoting safe women’s health through evidence-based models. Such evidence-based models are a staple at WBAMC’s Labor & Delivery Unit where CNMs have introduced a variety of modalities to broaden women’s options during labor such as hydrotherapy, wireless monitoring and are currently looking into other alternative pain management techniques such as Nitrous Oxide, better known as laughing gas.

“Labor can be a long process and sometimes women need all sorts of options to get them through it,” said Dove, a native of Woodbridge, Virginia. “We’re going to let women go on and have their babies in the way that their bodies and babies are dictating and sometimes that could take a couple of days. So offering (nitrous oxide) can get them through the pain of labor in the early and late stages and starts working in a few minutes and can stop working in a few minutes.”

In addition to providing clinical diagnosis during low-risk interventions, midwives also emphasize prenatal education and pain-mitigating techniques for moms during pregnancy, labor and birth.

“The actual practice of midwifery extends back to the beginning of time,” said Valerie Miller, nurse midwife, WBAMC. “It’s a practice that has an amazing culture of promoting women having their babies in a safe way and a way they want to do it.”

Nurse midwives’ roles also expand beyond the exam rooms to WBAMC’s group prenatal care sessions where they provide expecting and

new moms a group setting to discuss concerns, pain management, expectations, birthing plans and a health check-up during two-hour-long sessions.

“We do a lot of education and provide good quality care to our patients while letting them own their own experience,” said Fontenot. “It’s really their choice how they want their care. If they do or don’t want a medicated labor, we’re there with them. We’ll be there while they’re breathing and laboring through the pain if that’s the experience they want. It’s their choice and we’re there to support them and allow them to make the best decision for themselves, it’s their time.”

WBAMC’s group prenatal care sessions are where first-time mom, Susan Molina, was introduced to the profession.

“This is my first experience with a midwife and I didn’t expect it to be so awesome,” said Molina, a military spouse whose daughter, Veronica, was delivered at WBAMC on Sept. 19. “The experience was definitely more personal and felt like a closer connection.”

According to Molina, a 28-year-old native of Westchester, New York, the midwife care she experienced made her pregnancy and labor easier. So much so, during labor Molina was nervous and anxious but felt relieved once Miller, the midwife on duty, came into the room before delivering her baby.

While WBAMC midwives focus on OB care, they are capable of providing well-women exams, gynecologic, family planning and menopausal care.

“Patients have a choice,” said Fontenot. “Our end goal is healthy mom, healthy baby.”

Author: Marcy Sanchez – WBAMC

In the United States there are approximately 72,000 Clinical Nurse Specialists (CNS) and approximately 2.7 million nurses. That’s one CNS to every 37.5 nurses.

What is a CNS you may ask?

Clinical Nurse Specialists are Advanced Practice Registered Nurses (APRNs) who not only provide patient care but specialize in mentoring, educating and progressing clinical practices in specific patient populations. Sept. 1 – 7 marks the annual National CNS Recognition Week.

“They’re not the same as other (APRNs),” said Col. Gayla Wilson, chief nursing officer, William Beaumont Army Medical Center. “They focus on their clinical areas. They’re spectacular in what they do. One of the key roles, as educators, is bringing the latest and greatest evidence-based practices to the fight.”

Clinical Nurse Specialists are one of four APRNs which include nurse anesthetists, nurse midwives and nurse practitioners. While CNSs in a civilian capacity are capable of diagnosing and prescribing medication, Army CNSs focus on progressing Army Medicine as a whole and employing best-practice in their respective specialties.

“I think the biggest difference (for Army CNSs) is shifting focus from single patient care to advancing the care of all patients,” said Lt. Col. Patrick Marlow, CNS, Emergency Department, WBAMC. “While others work full time with patient care, (being a CNS) gives us the education and time to implement programs and efforts (to advance their clinical areas).”

Recently, Marlow, a Milwaukee native, was instrumental in implementing an Emergency Department program which decreased wait times for beneficiaries while increasing primary care engagement with active-duty service members. Although CNSs do take an active role in patient care, their greatest impact is improving overall proficiency and efficiency of their units.

“(CNSs) create strong foundations for the staff,” said Wilson. “I don’t have to depend on the (officer in charge of a unit) to carve time out of their day to make sure all of their staff understand the latest practices.”

“We are considered expert clinicians at the bedside but one of our more significant roles is to help guide and mentor newer nurses,” said Maj. Maria Pescatore, CNS and officer in charge, Medical-Surgical Unit, WBAMC. “CNSs help improve new nurses’ skills and critical thinking while increasing their capabilities and development, breaking them out of a novice role to an advanced one.”

While CNSs continuously research for best practices in their fields, their expertise goes beyond clinical practices as they play a role in improving safety measures in their units as well. Wilson also points out this year’s CNS Week theme “Leading Changes to Healthier Living,” is embodied by WBAMC CNSs in their vigilant staff education including raising awareness of proper patient lifting techniques, increasing communication among staff and building resilience.

“My favorite part (about being a CNS) is being with the new nurses and mentoring and guiding them through their nursing practice,” said Pescatore, a native of Binghamton, New York. “The best part is to watch them grow; it reinvigorates why we do what we do.”

One unique challenge WBAMC CNSs face is preparing to transition to the Fort Bliss Replacement Hospital, which is slated to open in 2019, by providing input regarding development of clinical areas to maximize best practices by healthcare professionals. Additionally, Wilson states CNSs are active in mitigating costs by researching and endorsing more efficient equipment and supplies.

“(CNSs) improve efficiency, competency and throughput capabilities by going with the best product and educating staff on utilization of the best product,” said Wilson. “(CNSs) are definitely moving us in the right direction and moving us as a team.”

There are currently six CNS roles at WBAMC covering the hospital’s Critical Care Unit, Medical and Surgical Units, Perioperative Nursing Services, Maternal Child Health Services and Emergency Services. As WBAMC transitions from Level III Trauma Center designation to Level II, their roles are crucial as subject-matter experts to train and educate nursing staff on efficient practices to prepare for more comprehensive or definitive care.

Because of the continuous advancements CNSs provide to clinical practices, their actions sometimes require an interdisciplinary approach to formulate changes which improves overall patient care at WBAMC.

Over the course of this year’s CNS week WBAMC CNSs educated beneficiaries and fellow staff members as to how the role they have in the hospital impacts patient care and readiness for service members.

Author: Marcy Sanchez – WBAMC

Growing up in war-torn Nicaragua in the early 80s, 1st Lt. Lizamara Bedolla vaguely recalls the sounds of heavily-armored vehicles driving past her front door.

It was after the violent ousting of Nicaraguan dictator, Anastasio Somoza DeBayle, followed by the deaths of tens of thousands of Nicaraguans caused by rebel fighting that Bedolla’s parents decided to flee the country for the safety of their family.

After fleeing the country at the age of four, Bedolla, now an Army nurse who was recently promoted to first lieutenant, was raised in Houston after her family applied and was granted family-sponsored visas. While Bedolla has led a rewarding 16-year Army career, the road to commission hasn’t been easy.

“It was very dangerous,” said Bedolla, of the war in Nicaragua. “Sometimes we would have propane and electricity, sometimes we wouldn’t and it wasn’t safe.”

As refugees traveling to the U.S., Bedolla and her family were stalled in Mexico, spending several months waiting for their visas to arrive. Refusing to wait any longer, Bedolla’s father decided it would be safer crossing the border on their own.

“My dad tried to have us cross the border by travelling underground through (cross-border) tunnels in the nighttime,” recalls Bedolla. “We could hear (U.S. Customs and Border Protection officers) up above yelling ‘We know you’re down there’.”

As the group of immigrants travelled through the tunnels, Bedolla recalls singing in the manmade passages.

“I was singing throughout the whole journey, it was an adventure,” said Bedolla. “(Other refugees in the group) would tell my mom to tell me to stop singing… We ended up getting detained.”

As Bedolla and her family waited at a border detention facility, their visas arrived and they were granted legal entrance into the U.S.

After entering the U.S., the family rented a two-bedroom Houston apartment which later welcomed the addition of Bedolla’s two younger sisters. Away from the dangers of her native country, Bedolla began school. As a young child, Bedolla recalls watching a U.S. Army commercial on the family’s 13-inch black and white television and expressing to her mom, “That’s what I wanted to do when I grow up.”

A model student, Bedolla was seeking a break from school and felt that if she didn’t take an opportunity to explore the world, she wouldn’t get that chance again. As she neared high school graduation, Bedolla enlisted in the Army and shipped off to basic training soon after graduating.

As a young enlisted Soldier, Bedolla received training as an Operating Room technician and soon after deployed with the 10th Combat Support Hospital in support of combat operations during the initial invasion of Iraq in 2003.

“It was a high-stress environment,” said Bedolla. “There was nothing there, everything was literally tents and pallet floors.”

Following the deployment Bedolla served for a total of 12 years as an enlisted Soldier, gaining U.S. citizenship in 2005 and reaching the rank of sergeant before applying for the Army’s Enlisted Commissioning Program.

“One of my biggest drives was that I always told my mom I would finish my degree,” said Bedolla. “My initial plan wasn’t to become a nurse. When I started taking courses I wanted to get a general degree.”

According to Bedolla, the longer she served as an enlisted Soldier in the medical field the more she realized nursing was what she was looking for in a career.

“I loved the medical field, it’s dynamic, there’s always something to learn and you grow every day,” said Bedolla, now a wife and mother of two. “I had such great nurses (as an enlisted OR technician) that it pulled me to want to know more of that side of the medical field.”

After 16 years in the Army, Bedolla is now a staff nurse at William Beaumont Army Medical Center’s Surgical Ward, with temporary assignment as the officer in charge of the hospital’s Neurology Clinic.

“From her (noncommissioned officer) roots she understands Soldiers and what it means to take care of Soldiers,” said Maj. Tanisha Currie, officer in charge, Surgical Ward, WBAMC. “Her team player efforts and work ethics are part of the reason she was selected to fulfill the role at the Neurology Clinic.”

Although Bedolla has only served as a nurse for just over two years, Currie describes her as a rock-solid, very mature and poised Soldier.

“My experience as a nurse has been more than I could hope for,” said Bedolla. “(Nursing) has helped me gain much more empathy and sympathy than I thought was possible. Whatever my idea of empathy was 16 years ago, has completely grown while serving in the Army.

“There’s such a myriad of people that I’ve encountered and that’s one of the biggest things I’ve learned,” said Bedolla. “The Army has taught me a lot about tolerance, self-awareness, patience and has opened my eyes to the different people that are all over this country and abroad.”

From a small Nicaraguan city torn by conflict to living a childhood dream, Bedolla’s journey from refugee to Army officer is telling of the unique opportunities the Army provides. Bedolla’s plans for the future include serving in the Army as long as she can and continuing to set an example for her younger sisters, and children.

“I’m grateful for the opportunities I’ve had and proud of what I do,” said Bedolla.

Author: Marcy Sanchez –  William Beaumont Army Medical Center

William Beaumont Army Medical Center was recognized as the first Military Treatment Facility (MTF) in the state of Texas to be qualified for the Immunization Action Coalition’s (IAC) Hepatitis B Birth Dose Honor Roll.

According to the IAC’s website, WBAMC is also the first Army Medical Center to be recognized and the second DoD MTF to qualify. From June 2016 through June 2017, 96 percent of infants born at WBAMC were vaccinated with the hepatitis B vaccine following birth.

“We’re promoting excellence to our infants and military families,” said Maj. Laquincyia Key, clinical nurse specialist, Maternal-Child Health Services (MCHS), WBAMC. “We ensure they are educated before they leave our hospital by providing them the most up-to-date information so they can make an informed decision regarding the Hepatitis B vaccination.”

The IAC launched its Hepatitis B Honor Roll initiative in 2013 to recognizing hospitals and birthing centers for attaining high rates of hepatitis B vaccines at birth.

One of the main efforts leading to WBAMC’s successful hepatitis B vaccination program is due to the MTF’s whole-team approach to educating patients on the benefits and risks of vaccination.

The chances of an infant acquiring hepatitis B, through transmissions such as sexually-transmitted diseases and sharing syringes, are low so some parents delay vaccinations, said Key, a native of Jeanerette, Louisiana. The WBAMC MCHS staff takes it upon themselves to educate parents so they understand the risks involved.

“If the nurse is told ‘no,’ it’s elevated to the pediatrician. The pediatrician then counsels the patient and makes sure that the patient understands the risks of not receiving the vaccine after birth,” said Key, who spearheaded the efforts toward recognition. “It is common practice but they have the option to not vaccinate or wait for a follow up appointment.”

According to the Centers for Disease Control and Prevention, hepatitis B is caused by a virus that attacks the liver which can cause lifelong infection, cirrhosis of the liver, liver cancer, liver failure and even death. Furthermore, the World Health Organization (WHO) claims hepatitis B resulted in 887,000 deaths in 2015 with an estimated 257 million people living with the virus.

Because the risk of chronic infection is higher for infants and children, WHO recommends all infants receive the hepatitis B vaccine as early as possible after birth, preferably within 24 hours, followed by a two or three-dose schedule.

In addition to educating patients, MCHS staff also began to educate within their ranks to equip staff with the knowledge necessary to inform patients and improve communication within the unit.

“We’ve always educated, now we’re just streamlining the education process and having everybody saying the same thing, everybody is getting the same information,” said Key.

Prevention of a perinatal transmission, when a mother is infected with the hepatitis B Virus (HBV), requires the administration of the hepatitis B vaccine and immune globulin to the infant within a 12-hour window after birth. To reduce the probability of perinatal transmission, the Maternal-Child staff ensures the mother’s original hepatitis B test results are present at time of delivery to prevent possible human error and ensure infants are treated properly.

William Beaumont Army Medical Center averages 150 births per month and provides high-quality, evidence-based newborn care with around-the-clock pediatricians. The hospital is in the process of receiving baby-friendly recognition as part of the World Health Organization and United Nations Children’s Fund Baby-Friendly Hospital Initiative, while aiming to provide immediate skin-to-skin contact after delivery.

The facility was honored on Thursday, August 10, 2017

Author: Marcy Sanchez – William Beaumont Army Medical Center

William Beaumont Army Medical Center was recently recognized as an Army Safety and Occupational Health Star site, becoming the first Army Medical Center in the Continental United States to receive the title.

In 2012, U.S. Army Medical Command adopted the Occupational Safety and Health Administration’s Voluntary Protection Program, a program promoting effective worksite-based safety and health, into its own Army Safety Management System (ASMS).

Shortly after, WBAMC rolled out ASMS to empower employees to take charge of safety in their area by self-identifying hazards; allowing staff to become a part of the hazard analysis process.

Organizations achieving the ASMS Star are recognized for the development, implementation and continuous improvement in the prevention and control of occupational safety and health hazards.

Because of the organization’s size, achieving a culture of safety was no easy task, said Henry Ford, safety manager, WBAMC. In order to engage more than 4,000 employees at 52 geographically-separated facilities, the WBAMC’s safety plan included implementing Additional Duty Safety Officers (ADSOs) as representatives for the safety office and to streamline safety concerns within the organization.

WBAMC’s safety philosophy also integrated every staff member into the role of safety officer. Not only did employees become responsible for safety in their workspaces, they underwent training to understand how to recognize, identify and react to unsafe work environments.

Strides toward star recognition also involved improved accessibility to filing safety concerns through the inclusion of a “safety button” on each computer desktop in the hospital while increasing transparency of previous safety reports in order to encourage best practices in resolving reoccurring conflicts.

Other steps included mandatory leader walkthroughs, on-the-spot recognitions for safety excellence and creating friendly safety competitions within WBAMC.

The Rusty Star Award (literally a rusty star on rebar Ford mounted to a two-by-four) is one way the safety office has encouraged safety best practices, said Ford. The award is presented to the most active department submitting safety discrepancies or concerns through the MTF’s safety portal.

Proactive safety measures leading to the recognition also included updating Job Hazard Analysis (JHAs) to determine risks associated with individual occupations.

Not all occupations pose the same safety risks to the employee, said Ford. WBAMC has supply technicians who operate heavy machinery which face different risks than Medical Support Assistants who assist patients.

Author: Marcy Sanchez – William Beaumont Army Medical Center

Only six months on the job and a nurse with William Beaumont Army Medical Center’s Orthopaedic Clinic is being recognized for her tireless attention to detail, possibly saving a patient’s life earlier this year.

Megan Jackson, a licensed vocational nurse and native of Oxnard, California, was recognized for her efforts in treating a patient who was suffering from a Pulmonary Embolism (PE), a life-threatening blockage to one of the pulmonary arteries in the lungs caused by blood clots.

The patient had recently undergone knee surgery, but had recovered well. Following a short stay at the hospital the patient was discharged but a few days after began feeling delusional.

“The patient came in saying he did not feel well,” said Jackson. “He was a little out of it, sweating a lot, had a fever and chills.”

Jackson’s first steps were to check the patient’s vital signs.
“All vitals were fine except for O2 (blood oxygen levels),” said Jackson. “He was a young gentleman and doesn’t smoke so it was very alarming.”

Normal oxygen levels range from 95 to 100 percent, the patient’s levels were fluctuating between 79 and 92 percent, which raised red flags for Jackson.

While below-normal blood oxygen levels may be a sign of hypoxemia, one of the underlying problems in hypoxemia cases is related to circulation. Jackson immediately called for a doctor who ordered an ultrasound and CT scan for the patient. While the ultrasound didn’t show anything of concern, the CT scan images revealed the PE.

“(Following surgeries) we watch out for deep vein thrombosis (DVT),” said Carmen Salcedo, head nurse, Orthopaedic Clinic. “DVTs can lead to a PE.”

According to the Centers for Disease Control and Prevention, while the number of Americans affected by PE is unknown, it is estimated 60,000-100,000 Americans die from PE each year. Approximately 25 percent of those figures are sudden deaths where the cause of death, a PE, is first discovered.

Because of the post-operation risks associated with surgeries, the Orthopaedic Clinic has an open-door policy for post-operation patients feeling any kind of excruciating calf or lower extremity pain, both of which are early signs of DVT. One mistake post-operation patients may make is remaining sedentary for long periods of time following surgery, a common cause for DVTs and other blood clots.

“We want (post-surgery patients) to move, they need to keep the blood flowing,” said Salcedo. “We try to remind patients that pain is a good sign as long as they’re not suffering.”

Thanks to Jackson’s instincts, the patient was treated and recovered fully. Jackson credits her training and tenacity in helping the patient in what could have been a fatal oversight.

“When I was at nursing school I didn’t think it was for me until I had an actual patient,” said Jackson, a mother of two. “I just knew (what to do) and went by my gut feeling. If I think about it I start to second guess myself.”

Jackson’s knack for caring is evidenced by her reluctance to discharge a patient if they still have concerns.

“If someone says they don’t’ feel well, (Jackson) will hold them in the room all day, if she has to, in order to get them seen,” said Salcedo, also Jackson’s supervisor. “In the (PE) case that’s exactly what she did, she held on to the patient until a doctor came to see him. Nurses with her (tenure as a nurse) may have dismissed it, (LVNs) may not have thought critically like that. For a lot of nurses it can take them years to get to that point.”

Jackson, who has been an LVN for just over a year, has also broadened her experience beyond the Orthopaedic Clinic. Jackson’s participation in WBAMC’s nursing float pool has provided her with experiences in other wards throughout the hospital.

“I worked every chance I was able to,” said Jackson.

“(Jackson) knows what each (Orthopaedic Clinic provider) likes and it’s helpful for her to go up to the floors and assist,” said Salcedo. “(Jackson) has earned a reputation in the hospital and any (hospital ward) would be happy to take her.”

Author: Marcy Sanchez – WBAMC

William Beaumont Army Medical Center’s Neurology Clinic is taking a different approach to beneficiaries suffering from neck pain.

Neurosurgeons at the clinic are combating cervical disc disease, a common condition among the military population, by performing cervical disc arthroplasty (CDA), or disc replacement surgery, on beneficiaries who may be experiencing the painful effects of the wear-and-tear condition.

“I believe in the procedure because it promotes faster recovery, and reduces the chance of degenerating the disc above and below,” said Dr. Pedro Caram Sr., senior neurosurgeon, WBAMC.

The joint replacement surgery involves replacing damaged cervical disc(s) with prosthetic disc(s). The treatment may provide relief for patients by decompressing or relieving pressure on the spinal cord or nerves and restoring stability and alignment.

Other symptoms from a degenerative disc may include increased pain in shoulders, arms and in some cases may even lead to migraines.

“I’ve treated people with what they thought were migraines but really their necks were causing the problem,” said Caram, a native of Houston. “(Staff) examines patients very carefully in the clinic. I don’t let them get away without an exam and look to find out what they’ve done from a conservative (management) standpoint, find out if they’ve had any trauma and go over medications.”

The initial examination also includes a look over pain history, spasms and a test of strength, the results of which alarms most patients.

“(Caram) proved I was a lot weaker strength-wise on my first visit,” said 1st Sgt. Joseph Phillips, C Company first sergeant, 1st Battalion, 6th Infantry Regiment, 2nd Brigade Combat Team, 1st Armored Division. “The pain limited my ability to do pushups, sit-ups, wear body armor for long durations, it would hurt.”

When he began noticing a consistent pain in his neck and shoulders, Phillips, a native of Prince Frederic, Maryland, began seeking medical attention and was eventually referred to the Neurology Clinic. Phillips was also suffering from tingling of the hands, numbness of the arms and the aforementioned loss of strength.

“It was pretty consistent, everyday all day like a five or six (on a pain scale of one to 10),” said Phillips.

After a visit with Caram, Phillips, an 18-year Calvary Scout veteran, was recommended for surgery.

Caram favors CDA over the traditional treatments which may lead to delayed recovery.

In 2007, the Food and Drug Administration approved CDA as an option for treating cervical disease. In 2009, Caram spearheaded the procedure at WBAMC and has since performed dozens of surgeries.

According to an article Caram and colleagues published in the Journal of Surgical Orthopaedic Advances, in a study of 34 single-level CDA patients, 30 returned to duty with an average 8.5 weeks of recovery time. In a multilevel cervical disc disease study with a hybrid approach to treating the disease, meaning CDA and cervical spinal fusion applied, out of 30 patients, 24 were able to return to active duty with an average 15.6 weeks of recovery.

For Phillips, a 37-year-old father of two, results were immediate following his multilevel hybrid cervical disc arthroplasty.

“I had no more issues, no more tingling and my strength came back immediately,” said Phillips.

Prior to the surgery, Phillips would struggle to throw a ball and play with his two daughters, said Phillips. Six weeks into his post-operation recovery, Phillips is able to participate in more physical activities at home than before.

“It proves that us older guys should have got fixed a lot sooner, we should have paid a little more attention to our bodies over the last 18 years,” said Phillips.

“(Phillips) will be fit for duty. That’s what our goal is: to make them fit for duty,” said Caram.

Author: Marcy Sanchez – WBAMC / DVIDS