In a state with one of the two highest per-capita populations of veterans in the country, a legion of volunteer drivers works year-round to help vets overcome the logistical challenges of Montana’s wide-open spaces to get the health care they need
Story by Myers Reece | Photography by Greg Lindstrom
IN the early 1980s, while serving as an air scout for the U.S. Army’s 6th Air Cavalry Brigade in Amman, Jordan, Robert Phillips was in a helicopter descending at night amid a blinding glare from nearby lights. When the pilot thought he had positioned the aircraft roughly four feet above ground, the recommended distance, Phillips and another passenger jumped. After an 18-foot fall, Phillips shattered his tibia and fibula, while his comrade broke his back.
Thanks to the vigor of a youthful body and the intrepid spirit of youth itself, Phillips went on to pursue an adventurous post-military life of odd jobs and travel throughout the Mountain West, undeterred by a limp. But three years ago, at age 50, Phillips was waiting tables in Ennis when a wound on his injured leg broke open and wouldn’t close.
Doctors diagnosed him with a venous stasis ulcer, which occurs when poor circulation, in this case caused by trauma, produces an open sore. Since then, Phillips has endured a whirlwind of regular medical appointments, constant compression on his leg and various kinds of treatment to promote skin growth. The wound is slowly but surely closing.
Phillips, who doesn’t have a car, can’t afford to miss any checkups and must routinely travel from his apartment in Whitefish to Kalispell. That’s where the volunteer-powered Disabled American Veterans (DAV) transportation network fills the gap. Phillips depends on transportation services from Colorado to Alaska, wherever his work and wanderlust take him, but he says unequivocally that Montana’s program is the best he’s seen.
“I’ve never seen one coordinated so well,” Phillips says while sitting in the passenger seat of a DAV van en route to a checkup. “Solid people. It’s just really slick for a volunteer organization.”Veterans of all ages are drawn to and hail from rural areas at a high rate, away from big cities. Montana and Alaska have the most per-capita veterans in the nation, followed closely by Maine, with vets representing roughly one out of 10 people in those three states, which in Montana means nearly 100,000 veterans out of 1 million total residents. That figure is one out of 20 in New York and California.
According to the U.S. Department of Veterans Affairs’ Office of Rural Health, a quarter — 5.2 million — of the nation’s veterans reside in rural communities, and 33 percent of veterans enrolled in VA services are rural. Accordingly, the VA allocates 32 percent of its health care expenses to rural veteran care. By comparison, 19 percent of the country’s overall population is rural, even though 97 percent of its land qualifies as such.
The Office of Rural Health lists a multitude of reasons for veterans favoring lower-population regions: closer proximity to family, friends and community; open space for recreation, with many enjoying hunting and fishing; more privacy; lower cost of living; and less crowded towns and schools. There can also be more complex psychological reasons at play: Both veterans and those who work with them frequently use a variation of the phrase, “They just want to get away.”
Whatever their individual motives are, veterans face logistical dilemmas when living in sparsely populated regions. The Office of Rural Health cites a number of challenges: fewer options for housing, education, employment and transportation; higher poverty rates; limited broadband internet; higher uninsured rates; greater geographic and distance barriers; and difficulties in accessing health care.
“While they may enjoy the benefits of rural living,” the Office of Rural Health states, “these veterans may also experience typical rural health care challenges that are intensified by their combat-related injuries and illnesses.”
But Terrie Casey, chief of voluntary services for the Montana VA Health Care System, offers a flipside to rural living that she says is one more factor in Montana’s draw for veterans: smaller waiting lists and lines for health care, and more personalized care and tight-knit networks.
“We’re smaller, and they like the personal touch,” Casey says. “We get to know our veteran patients by sight.”
To be seen, however, veterans first have to get to their appointments. For those who can’t drive, don’t own a car or prefer not to drive, Montana offers limited general public transportation programs. Meanwhile, there’s the VA’s Veterans Transportation Service, which covers both ambulatory and non-ambulatory veterans — those confined to wheelchairs or restricted in other ways — but has a limited fleet of vehicles and paid drivers and only one dispatch for a 147,000-square-mile state.
All of which makes the DAV transportation network “essential,” Casey says, in a state with wide-open spaces and endless highway miles. Stan Rube, Flathead County’s DAV local area coordinator and a disabled Army vet, says many veterans using the program wouldn’t have any other way of getting to the doctor, aside from depending on family, friends or neighbors, which isn’t ideal for either side and leads to missed appointments. Veterans’ health and quality of life, and perhaps their life itself, is at stake.
“A family member would have to take off work,” Rube says. “It just doesn’t always work. A lot of them couldn’t even make it to the local appointments, and then some have to go all the way to Fort Harrison. They need the rides.”
The DAV’s volunteer transportation service emerged in 1987 following changes to funding levels for the VA’s Beneficiary Travel program. Disabled American Vets, a nonprofit charity established in 1920 that provides a range of services, recognized that numerous veterans subsisting on fixed low incomes lived many miles from the nearest VA hospital. So the organization created the transportation network to offer free rides.
The program has since grown exponentially, nationwide and especially in Montana, which consistently ranks in the top 10 nationally in miles driven and veterans carried. In fiscal year 2017, roughly 200 volunteer drivers statewide in 35 vans took a total of 15,478 trips covering 788,000 miles. All told, they volunteered 62,339 hours. The program’s drivers account for 40 percent of the VA’s 500 total volunteers statewide, who fill roles ranging from information desk greeters to honor guards for funerals.
Despite the program’s name, veterans do not have to be disabled or members of the DAV to get rides, although many have disabilities, ranging from visible physical injuries to psychological wounds such as post-traumatic stress disorder (PTSD). Nor are there financial requirements.
The lone stipulations are that the veterans are enrolled in the VA system, their medical appointments are VA-approved and they have no other transportation. Appointments include those at the agency’s Fort Harrison hospital in Helena and other local clinics, but also a wide range of non-VA providers. For example, Phillips goes to Kalispell Regional Healthcare’s wound center.
The state DAV, with matching funding from its national counterpart, purchases the vehicles, relying on private donations and grants. The vehicles are then donated to the VA, which licenses and insures them and then returns them to the DAV for operation and management. The VA pays for gas and maintenance, but the DAV must recruit and maintain the volunteer manpower. That’s a constant dilemma for local area coordinators like Rube, who is always looking for more drivers.
“I could very easily use another 10 volunteers,” he says.
Rube is one of nearly 20 volunteer local area coordinators in Montana, each covering a specific jurisdiction, as well as two paid hospital service coordinators in Billings and Fort Harrison. The 16 drivers in Rube’s jurisdiction are based out of Flathead County but travel to appointments elsewhere, including to Missoula and regularly to Fort Harrison, nearly four hours away. That means, to make a 10 a.m. appointment, a driver has to pick up the veteran and be on the road by 6 a.m. Counting the wait during the appointment, a driver might have a 10- to 12-hour day.
Last year, Rube’s drivers volunteered 6,463 hours, covering 81,888 miles and carrying 1,745 veterans.
“My drivers are very dedicated,” Rube says. “I’ve never heard any driver complain that the day was too long.”
Most of the drivers are retired, although Rube’s daughter is an exception. Safety is prioritized, so drivers won’t drive in dangerous conditions, but they still have to deal with Montana’s usual weather elements, including winter’s surprises. There are two types of vehicles: a Ford Flex SUV and a larger van. Ford sells the vehicles at a discount.
John Babb, a local driver and veteran, and his two siblings donated $5,000 apiece to purchase a van, giving Rube’s district a fleet of four vehicles.
Prospective drivers must contact Casey’s agency, the VA Voluntary Service, and complete an application packet that includes a handbook and protocol addressing issues such as safety and privacy. They must also get background checks, take a physical exam and tuberculosis test, get a flu shot and meet other criteria, such as proof of a driver’s license and insurance.
In November, Lake County’s DAV transportation program out of Ronan was shuttered due to lack of drivers. The vehicles were still there, waiting for volunteers, and Rube was scrambling to resolve the issue.
“The one thing I hate is telling a vet I can’t do it,” Rube says. “I do everything I can to help these vets.”On a sunny October afternoon, Jan Sharp steered her DAV van into a Columbia Falls driveway that she had visited many times before. Colleen Ross, a U.S. Air Force veteran, greeted her outside. The two women embraced like old friends, which they are by now.
Sharp has been a volunteer driver for more than six years, and her husband Jim, a veteran, also drives. Sharp has transported countless veterans, ranging in age from early 20s to late 80s, and has managed to only get stuck in the snow once. Her longest day was 16 hours, during which she drove 700 miles.
Sharp picked up Ross immediately after dropping off Robert Phillips at the wound clinic. On the drive between Columbia Falls and her medical appointment in Kalispell, Ross told the story of undergoing a botched laser eye surgery in 1974 in Europe, where she was stationed and serving on the staff of the U.S. Air Force’s Judge Advocate General’s Corps. She was granted disability status and a medical retirement from the military.
Although her eyes were damaged, Ross continued trying to go about her normal post-military daily routines, including driving, until Christmas Eve in 1988.
“I nearly killed myself driving,” she says. “That was the last time I ever drove.”
The loss of her mobile independence left her “at a loss.”
“I had these doc appointments and no way to get to them,” she says. “Then somebody introduced me to the DAV.”
The introduction changed her life. Ross, who is beset by other health problems in addition to her vision difficulties, has been regularly using the transportation service ever since, and she now speaks of the program in terms of “we,” a family of sorts that she’s eternally thankful to have.
“It’s a fabulous program,” she says. “It filled a big void in my life.”
Ross, who uses a cane to help navigate her surroundings, underwent cataracts surgery in February, and although she still has poor vision, her world has been flooded with clarity.
“What was so profound was the new light and how bright colors were,” she says.
But it doesn’t take good eyesight to know where her friend Sharp is, directly across the middle console, behind the steering wheel, where Ross can always count on her to be.
“Jan is my buddy,” she says, smiling at Sharp. “I just love her. Let me tell you, life is good. Life is so good.