Preparing for the Aftermath: How Navy Medicine Chaplains Fortify the Force

In his book “What It Is Like to Go to War”, American author and Vietnam War veteran Karl Marlantes reflects on the lasting moral and spiritual impact of combat. “Combat is a lot of things, but one of them is that it puts you in a different relationship with eternity … it changes … your sense of what matters and your understanding of what it means to be alive.”

Chaplains have supported the spiritual and moral readiness of U.S. military forces since 1775. According to Naval Medical Forces Atlantic (NMFL) Chaplain, Capt. David Jeltma, the Navy defines spiritual readiness as, “strength of spirit that enables the warfighter to accomplish the mission with honor.”

“Spiritual readiness is not a check in the box or a one-time event,” he said. “It is a constellation of practices that help individuals understand who they are, why their work matters and how they contribute to something larger than themselves.”

As Navy Medicine has shifted its primary mission focus on healthcare delivery to operational capability and lethality—a mission centered on generating ready medical units for combat support—medical staff, like all operators, must be prepared, body, mind, and spirit.

Because of this, Navy Medicine leaders have placed a renewed emphasis on spiritual readiness as a critical component of warfighter resilience. This is particularly important as medical personnel prepare for operational environments where ethical decisions and human suffering can have lasting effects.

Central to the discussion is moral injury, a condition that can occur when individuals experience or witness events that conflict with their deeply held beliefs.

“Moral injury is something all human beings are susceptible to,” said Jeltma. “But in military service, the intensity and frequency of those experiences are amplified.”

Unlike physical wounds, moral injury often stems from ethical dilemmas, perceived failures, or exposure to trauma — including the loss of life—agonizing decisions made under pressure, or witnessing suffering. For Navy Medicine personnel, the risk can be uniquely complex. While medical providers may not be directly engaged in combat, they are routinely confronted with its consequences.

“Our medical Sailors are deeply involved in the aftermath,” Jeltma stressed. “Anguishing decisions about triage, limited resources, or who receives care first can be morally distressing in ways that differ from traditional clinical settings. These experiences can lead to long-term emotional and spiritual strain if not addressed.”

To best address such situations Jeltma emphasizes preparation — not just response — as key to reducing the impact of moral injury. According to him, research and operational experience show that discussing ethical challenges before deployment can strengthen resilience.

“Anticipating scenarios ahead of time is one of the most effective ways to prepare,” he said. “We would not send someone into combat without training them on their equipment. The same principle applies to spiritual and moral preparation, and we can’t just say it’s an individual responsibility.”

In fact, Jeltema believes spiritual and moral preparation is a collective responsibility. He emphasized that Navy Medicine leaders must make this a focus of their unit. This means integrating their chaplain into planning, ensuring spiritual readiness is addressed from the start.

“Marlantes said that the Marine Corps taught him to do maneuver warfare very well but left him unprepared spiritually,” said Jeltma. “And if a medical provider is going into a combat situation, we have to recognize there is great potential something might happen that could be morally troubling, and we must prepare beforehand.” Another way the Navy addresses moral injury is to ensure military chaplains are properly trained to work in medical environments. Currently, every chaplain who works within Navy Medicine receives special training through the Pastoral Care Residency Program. This program is a year-long immersive, full-time healthcare ministry residency with structured clinical supervision, intensive group relations training, and advanced pastoral education.

“This program is designed to help us learn to suspend our personal stories and beliefs, to recognize our conscious and unconscious biases to ensure none of that interferes with the care we provide,” explained Jeltema.

“Our trained Navy Medicine chaplains are some of the finest in the world. This equips them to effectively minister within the complex environment of military medicine, serving the needs of patients, providers, and other military members.”

As Navy Medicine continues to grow their operational role and teams as well as support operational forces worldwide, strengthening spiritual readiness will remain essential to preserving both individual well-being and mission effectiveness.

“Spiritual readiness is a shared obligation.” said Jeltema. “I think we owe it to each other as a force to prepare for these realities together because how we face them as a team matters.”

As Marlantes wrote: “What happens in war is not simply an external event. It becomes part of who you are. The real battle afterward is learning how to live with what you have done and what you have seen.”