Drexel’s College of Nursing and Health Professions and Department of Defense Advance Understanding of Gulf War Illness for Veterans and Health Care Providers

A collage created by a Gulf War Veteran about their perspectives of life with GWI and their health care experiences. Credit: Girija Kaimal, EdD

More than 200,000 veterans are affected by Gulf War Illness (GWI), with symptoms including respiratory, gastrointestinal and skin problems, as well as fatigue, pain and mood alterations. Despite the conflict occurring more than 30 years ago, health care providers lack clear guidelines about how to best treat veterans with this illness. Researchers from Drexel University’s College of Nursing and Health Professions, with support from the Department of Defense, have started the process of clarifying guidance for health care providers.

Through the Gulf War Illness Research Program, a Qualitative Research Award Grant from the Department of Defense, researchers from the Creative Arts Therapies department in the  College of Nursing and Health Professions, published two studies validating the experiences of veterans with GWI and health care providers, which led to the creation of newly available education materials for health care providers to reduce misconceptions about GWI, provide an increased knowledge about the illness and improve health care options.

There has been a large gap in understanding the illness, as there had been no studies prior to 2017 that focused on the perceptions and unique experiences of veterans with GWI. Girija Kaimal, EdD, assistant dean for the Division of Human Development and Health Administration and an associate professor, and Rebekka Dieterich-Hartwell, a postdoctoral scholar, both in the College, led a qualitative study to understand the human experience of Gulf War veterans suffering from GWI.

Kaimal noted that veterans with GWI have fought for recognition of the illness, their experiences with it and an inadequate health care response.

“By understanding and sharing the perspectives of veterans with GWI, we sought to increase awareness of this illness and the wide-ranging impact on their lives and the care they receive. There are efforts underway to help these veterans,” said Kaimal.

Another collage created by a Gulf War Veteran about their perspectives of life with GWI and their health care experiences. Credit: Girija Kaimal, EdD

Kaimal and her colleagues focused on veterans’ experiences of GWI symptoms, physical health, cognitive functioning, quality of life and the quality of care they received. In collaboration with Bryann DeBeer, PhD, at Department of Physical Medicine and Rehabilitation at the University of Colorado, Anschutz Medical Campus, 40 Gulf War Veterans were interviewed and created collage portraits about their perspectives of life with GWI and their health care experiences. In addition, 10 health care providers across the U.S. were also interviewed about their experiences with veterans with GWI and were asked about what resources would be helpful for treatment.

An additional study from Kaimal’s lab analyzed collage-making with 14 veterans to understand their Gulf War Illness experience. Bani Malhotra, lead author of the study and a graduate student in the College, noted that the use of art therapy, such as the collage creation, is increasingly being accepted as part as integrative and clinical care for veterans. The artwork created during art therapy becomes tools to address a variety of issues, such as identity, grief, and loss, and to communicate inner experiences that are often difficult to verbalize.

A third collage created by a Gulf War Veteran about their perspectives of life with GWI and their health care experiences. Credit: Girija Kaimal, EdD

“In this study, we presented the contributions of using collage as a graphic elicitation method, informed by art therapy practice, to build a deeper understanding of GWI compared with the use of verbal interviews alone,” said Kaimal.

Following the two studies, the development of an educational resource for health care providers is intended to convey the perspectives and lived experiences of veterans living with GWI to their providers. The four-unit course is available on the College of Nursing and Health Professions website here.

Kaimal and her colleagues in the Gulf War Illness Research Program hope that their research highlighting the veterans’ voices and experiences and the resulting educational materials will improve awareness and education of GWI, and importantly improve health care for patients with GWI. 

This work was supported by the Assistant Secretary of Defense for Health Affairs, through the DOD Gulf War Illness Research Program, under Award No. W81XWH-18-1-0271. Opinions, interpretations, conclusions and recommendations are those of the author and are not necessarily endorsed by the Assistant Secretary of Defense for Health Affairs.