Military Medicare | The VA’s Woman Problem
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15 Aug The VA’s Woman Problem

16thorpe-master675On Sept. 11, 2001, Desma Brooks was a single mother in her mid-20s who served part-time in the Indiana Army National Guard. Watching the attack on TV, she wondered if she might be called up. She had three kids, so maybe she would be assigned to some kind of support role on the home front. Instead, she served two yearlong deployments, the first to Afghanistan, the second to Iraq. During the second, while driving a military vehicle that was guarding a supply convoy, she hit a roadside bomb. Ms. Brooks returned home with a mild case of traumatic brain injury and a serious case of post-traumatic stress disorder.

Of the almost 22 million veterans in the United States today, more than two million are women, and of those, over 635,000 are enrolled in the Department of Veterans Affairs system, double the number before 9/11. Women are the fastest growing group of veterans treated by the V.A., and projections show that women will make up over 16 percent of the country’s veterans by midcentury.

Like Ms. Brooks, many female veterans are returning home with PTSD — the No. 1 complaint among women seeking treatment at V.A. health facilities. Hypertension and depression are the next two largest diagnostic categories for women. And one in five female veterans treated by the V.A. reported having experienced military sexual trauma.

Unfortunately, these veterans aren’t always getting the care they require from a system originally designed to serve mostly men. Women have health care needs that are distinct from men; cardiovascular disease, for example, plays out differently in the female body, and particular expertise is required when providers see women in their childbearing years. “For too long, the V.A. has essentially ignored many of the most pressing needs that our women veterans face,” Senator Richard Blumenthal, Democrat of Connecticut, said during a hearing held by the Senate Armed Services Committee earlier this year.

Women’s clinics at Veterans Affairs facilities are sometimes located in basements or obscure corners of the buildings, without adequate signage. V.A. facilities still usually do not offer some of the services that women require, such as prenatal care or obstetrics, and very few do mammograms.

Disabled American Veterans, an advocacy and assistance group, recently issued a report called “Women Veterans: The Long Journey Home,” which includes a list of recommended changes. Among them are establishing a culture of respect for women, providing access to peer support networks, requiring every Veterans Affairs clinic to have a gynecologist on staff, removing barriers to mental health services, and adding gender-sensitive mental health programs aimed at women. “One of the most perplexing problems is a culture in V.A. that is not perceived by women as welcoming, and does not afford them or their needs equal consideration,” said Joy J. Ilem, the group’s deputy national legislative director, at this year’s Senate hearing.

Part of the solution is simply explaining that female veterans exist. “We are invisible,” says Kathryn Wirkus, the founder of Women Veterans of Colorado. “Women vets come home and we blend back in. We go back to being mothers, wives, schoolteachers, nurses, doctors, whatever. We don’t hang out at bars wearing funny hats that say ‘World War II vet.’ We aren’t easily identified by our haircuts or the clothing that we wear. If I walked into a room, nobody would think I was a veteran.”

Once, when Ms. Wirkus sought treatment at a V.A. facility in Colorado, she was approached by a male veteran who asked what she was doing there. “I was like, ‘What the hell do you think I’ve been sitting here for 45 minutes for?’ ” she said. “They don’t think you’re a veteran. They think you’re somebody’s spouse, there to pick up meds for somebody else.”

Ms. Wirkus spoke with a woman who had been the victim of military sexual trauma and was suffering from PTSD, and who was told to participate in group therapy, even though the group consisted mostly of men and she was not comfortable in that setting. Congressional staff members on the Senate Committee on Veterans’ Affairs worked with a veteran who had a brain tumor that caused various health complications including weight gain, yet her condition was incorrectly diagnosed and referred to a weight loss clinic, rather than the specialist she needed to see. Only when she went outside the V.A. system did she receive help. Either because they do not believe the V.A. can offer them the care they need or because they do not understand that they qualify for the benefits, eligible women have been approximately 30 percent less likely to enroll in the system than eligible men.

Veterans Affairs has been working to respond. It has hired more providers with expertise in women’s health, relocated space to make room for women’s clinics, and offered a mini-residency training program to get its providers ready to administer breast exams, gynecological exams and Pap smears, and to understand which medications can put a fetus at risk for birth defects.

The problem is not will, it’s money. The V.A. has to care for all living veterans, and has encountered increased demand on every front, from nursing home beds to mental health care. The demographic challenge is daunting: dealing with a large population of aging Vietnam veterans just as over one million veterans are making the transition from the military back into civilian life, most after serving in Iraq and Afghanistan. “Yes, increased funds will be needed,” says Dr. Sally Haskell, the V.A.’s deputy chief consultant for women’s health services. “We need to work to make sure that women veterans are being taken care of.”

But leaders of the V.A. have to choose between competing priorities. This summer, for example, they obtained extra funds to provide new drugs for hepatitis C, which is rampant among Vietnam veterans, after threatening to close facilities unless the dollars came through. They did not employ the same strong-arm tactics to obtain additional funding for new services for the young women who served in Iraq and Afghanistan.

Desma Brooks eventually did get the help she needed. Recently, she spoke on a panel about PTSD at the V.A. facility in Indianapolis, and described how regular therapy helped to reduce her hyper-vigilance. She showed the audience that it was not only men who returned from combat zones with hidden injuries. And when, like Ms. Brooks, the veteran is a mother, the well-being of her children is deeply affected by the question of whether she is able to heal from trauma.

As we put more women in peril, we have to get better at welcoming all veterans back home. We have to make sure the V.A. can treat men and women equally.

New York Times August 15, 2015