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Helping mortuary workers cope with grim jobs

DOVER AIR FORCE BASE, Del. — Somebody had to slip off a fallen soldier’s wedding band and take the picture of his little girl out of his helmet. Somebody had to collect the love letters that the Marine wrote but never got to send.

For the last four months, that somebody has been Senior Airman Antonio Daniels.

Back home at Fairchild Air Force Base, Wash., Daniels helped manage the dining hall. He didn’t have any background, any training for his work at the Air Force Mortuary Affairs Operations Center at Dover Air Force Base, Del.

“They chose me and trusted enough of me to return the personal effects to the family with honor,” he said. “Every day, I am sending home a wife’s ring and I’m making a difference in someone else’s life.”

Still, it’s a round-the-clock job that takes a toll, one that Dover officials worry could break airmen unless they know how to cope with the fatigue — and the sad reality of death.

Three months ago, the unit’s commander decided he couldn’t — wouldn’t — let the strain hurt his troops and turned to Maj. Jennifer Burke and Master Sgt. Robin Raine, mental health specialists on rotation from Travis Air Force Base, Calif., who had designed what they call the Resiliency Program.

A holistic approach to wellness, the Resiliency Program helps the mortuary unit’s 165 airmen, soldiers, Marines, sailors and civilians deal with their grim duties from one day to the next. Pressure doesn’t get a chance to build.

Already, the program is getting results. The airmen are genuinely enthusiastic when they talk about it. They insist they look out for each other more now and feel comfortable talking with mental health specialists and chaplains.

The coping mechanisms — social activities, informal counseling sessions, rigorous exercise, wellness classes like yoga — have always been available to airmen, but each by itself, not working in concert.

In the Resiliency Program, for example, a chaplain will attend bowling night, and the mental health specialist will bust out a set of push-ups next to the airman who just unloaded a casket.

“It has never been done this way before,” said retired Lt. Col. David Sparks, the mortuary’s chief chaplain. “The chaplains, mental health, [morale, welfare and recreation], and physical training folks all meet together regularly.”

Burke and Raine came up with their integrated approach after poring over the few studies on the mental health of mortuary workers. Both recognized glaring gaps in the training that prepares mortuary workers, especially young troops, for what they’re going to see on the job.

“Some of these kids are 20 years old and they are intimately involved in working with human remains,” Raine said. “It’s well-documented that the human brain doesn’t fully develop until you are 25. All the images, the sights, the sounds and the smells get packed into a brain that is still forming.”

Just before the commander implemented the Resiliency Program, two airmen had to go back to their home bases early because they couldn’t handle the stress.

Their departure was a tipping point for mortuary commander Col. Robert Edmondson to start the program.

“Our goal here is to help people to be resilient and have the ability to bounce back,” Raine said. ”We call it ‘post-traumatic growth’ as opposed to ‘post-traumatic stress.’”

Of the 165 mortuary workers, 72 are airmen. Fourteen soldiers, as well as two Marines and three sailors, work in the unit. The rest are civilians.

During their three- to six-month deployments — many of them voluntary — the service members do everything from collecting the fallen troops’ personal effects to checking the bodies for explosive devices to carrying the caskets.

Yet, many extend their deployments or return for another tour — often several tours.

“I came back because I want to give dignity and honor to those who have made the ultimate sacrifice,” said Tech. Sgt. Jasmine Hodge, who is on her fifth deployment to Dover. “Since I am not getting sent to Iraq, I want to make sure the soldiers come home to their families respectfully.”

A day off at the mortuary is rare, especially with the increasing number of casualties in Afghanistan. Since April, the remains of 196 troops, as well as those of contractors, foreign nationals and even detainees who die at U.S. bases, have come to Dover, the Defense Department’s sole port mortuary.

A new policy started in April that allows family members and the media to attend the dignified transfers at Dover has put added pressure on those working at the mortuary.

“Sometimes the family is as close as 15 feet away from you and you don’t know the state they’re in. For them to come all the way and see their son or daughter taken into a hearse truck, there is a lot of pressure,” said Staff Sgt. Brandon Brown, who carries the casket from the plane to the hearse. “You hear them crying; it’s very hard to forget.”

Capt. Vondray Sanford, who is in charge of dignified transfers, admits he struggles with the images of death. Before he left his job in force support with the 31st Intelligence Squadron at Fort Gordon, Ga., Sanford said he did his homework to try to prepare himself to handle human remains.

“I talked to as many people and tried to find out as much information as I could because I didn’t want to be surprised,” he said. “Just like going out to the desert — I had to prepare myself.”

When Hodge first came to the mortuary, she dreamt of the bodies she saw each day, she said.

“I was a little nervous not knowing what I was going to see and be able to handle it,” said Hodge, who dresses and wraps the fallen. “At first, I had dreams of angels.”

Edmondson, the commander, didn’t want to wait for these vulnerabilities to catch up with those at the mortuary, Sparks said. He approved the Resiliency Program to make sure the smallest problem is addressed the moment it comes up.

“We’re even hoping that our airmen go home from this deployment better than when they came,” Sparks said.

Airmen enter the program the moment they arrive at the mortuary. They’re screened to determine what job they can handle.

Are they better equipped emotionally to deal with carrying caskets or opening body bags? A series of progressively graphic pictures of casualties and a conversation helps the mental health specialists and commanders decide.

“The good thing about it is they ask you directly if you can deal with a body or not,” Daniels said.

Raine then hands a binder to each worker. Inside are facts about the Dover area; a self-care booklet with sections on adapting to life at Dover, the symptoms of stress, communication tips and the stages of grief; ways to keep track of activities; and information about the program.

The program has strict rules, such as a mandatory counseling session for every worker every 30 days, but also features lighthearted social activities such as a watermelon-eating contest the airmen call “mandatory fun.”

The airmen said they needed a push to get to know their co-workers better and to relax, even if an ice-cream social or a pizza party seems a bit childish.

“It’s just a boost of morale and unity,” said Daniels, the food services specialist from Fairchild. “You feel happier. Everyone gets to know each other and it’s on a first-name basis.”

Senior Airman Rochonda Hicks, deployed from the 459th Air Reserve Wing at Andrews Air Force Base, Md., now goes in to work on her off days just to get a slice a pizza.

The calendar is packed. There is rock climbing, weekly bowling and even a dance night. All the events aren’t mandatory — as the airmen contend — but attendance is “highly encouraged,” said Edmondson, the commander.

“At first, I could tell not everyone was happy about it, but now I don’t think I even have to make it mandatory,” Edmondson said.

He said he goes to as many of the activities as he can, and the mortuary’s 16 chaplains and mental health technicians go to them all. In fact, Sparks and the chaplains conduct “Pizza and Conversation,” a session of pizza-eating and sharing to make airmen feel more at ease with the spiritual and mental health staffs. “I noticed right off the bat that people come to me on a regular basis now,” said Tech. Sgt. Karlus Madison, a mortuary psychological health advocate technician. “It started out that it was a leery thing to do.”

The fitness program truly is mandatory — and tough. Tech. Sgt. Gail Reed-Harmon, the unit’s PT leader, runs 10 training sessions a week. Airmen must attend three of them, no matter how busy their schedules get.

“On the carry team, sometimes you don’t have time at all to go to PT because we are getting off work at 3 o’clock in the morning,” Mercedes McCoy-Garrett said. “We fit in ours whenever we can. Sometimes we do it twice a day. But when she is screaming at us, everything that just happened is not on your mind anymore.”

A relaxation room has a place for silent meditation, aromatherapy, a Bose sound system and even a $3,000 massage chair.

“If sitting in that chair for an hour takes the stresses out of one of my airmen, it was certainly worth it,” Edmondson said.

Pictures of trees line the walls of the small room. A waterfall drips down the front of a mirror. It’s a momentary escape from the grim realities of war. But even in that room, these airmen can’t truly escape it.

The relaxation room sits directly next to the mortuary’s crematorium.

“How about that?” said Raine as she pulled away the painting that covers up the window that looks into the crematorium. “It’s something about this place. We do the best we can to help, but there is only so much you can do when these young kids have to deal with death every day.”