Cheryl Hansen, RN, MSN, a U.S. Air Force Vietnam-era veteran, remembers when her female colleagues, many of them nurses, returned from Vietnam seeking healthcare and other veterans services. There wasnt very much for them, she recalls.
Hansen, who serves as the Women Veterans Program manager for the Northport Veterans Affairs Medical Center on Long Island, has seen a lot of change since then, and she has been part of it. Women, who were primarily nurses, advocated to bring about services that would be equal to those provided to male veterans, but it didnt happen overnight, she says.
Hansen has been in her position since 1995, and since then there have been many changes, both in the female patient population that visits Department of Veterans Affairs facilities and in the programs available to serve them.
As weve moved forward, weve made dramatic changes to benefit women, not to get more services or elevate them above men, but emphasizing equality of services, provided in a dignified and private manner, Hansen says.
More Women Returning From Combat
Roughly 1.8 million of the nations 23 million veterans are women. Some 65,116 of them live in New York and 28,438 in New Jersey, according to VA statistics. In recent years, with the involvement of the U.S. in conflicts in Iraq and Afghanistan, the profile of the average female veteran seen at VA facilities has changed, and the VA is changing along with it, modifying programs to meet the needs of a growing population of younger female patients. Many of these young female veterans are of childbearing age and in need of reproductive services, and many have experienced military sexual trauma during their service.
Laurie C. Zephyrin, MD, MPh, MBA, FACOG, the VAs first director for reproductive health, began her job in September 2009. She says that while the average age of female veterans nationally is 48 (compared with 61 for male veterans), some 80% of the women returning from Iraq and Afghanistan who seek care at VA facilities are younger than 40.
The creation of Zephyrins job last fall is one sign of the VAs commitment to step up its womens reproductive health services. Zephyrin is spearheading efforts such as making sure women with abnormal mammograms receive follow-up care, tracking cervical cancer trends among female veterans, educating VA providers and staff about maternity issues and tracking birth outcomes among female veterans.
Our goal is that the VA can be a leader in the provision of healthcare for women veterans, she says. One of our major priorities is to ensure women are receiving comprehensive primary care, with privacy, safety and specificity to their gender-specific needs.
Reaching OutCheryl Hansen, RN
In 1995, female patients seen at the Northport VA medical center were, on average, in their mid-60s, Hansen says. Today they are in their mid-40s. At the James J. Peters VA Medical Center in the Bronx, the average age of female patients is younger than 30, says Angela Crafton-Murray, LCSW, manager of the centers Women Veterans Program. To reach out to these women, many of whom are returning from Afghanistan and Iraq, Crafton-Murray and her team attend post-deployment events, where they provide female veterans with information about available VA healthcare services.
Once these veterans are in the system, they receive follow-up calls and letters reminding them when theyre due for mammograms, Pap tests and other routine gender-specific care. Software programs help the care teams access information about each patient, track results and easily analyze trends in womens health issues. Crafton-Murray says the software also produces reminder letters to be sent to veterans about recommended follow-up care.
In the realm of tracking cervical cancer screening, the VA leads the private sector, Zephyrin says. More than 90% of female patients treated at VA facilities are screened for cervical cancer annually, she says, and such screening and tracking is considered a key quality measure and priority at the VA.
The VA also is doing what it can to cater to women who work, who have young children or who need help with transportation to healthcare-related appointments. The program at the James J. Peters VA Medical Center, for example, makes it convenient for female veterans to receive birth control injections and human papillomavirus vaccinations without having to set up appointments each time, says Cheryl Adams, NP, BC, a womens health nurse practitioner at the center and a retired colonel in the U.S. Army. Prescriptions are written for both birth control injections and the HPV vaccine for the whole year, so the patient can return to see a nurse for follow-up injections without having to get a new prescription and set up an appointment each time. The womens program also has early morning and late afternoon hours to make it easier to fit appointments into work and child care schedules.
At the Northport VA center, where mammograms are not offered on site, female veterans are eligible for free transportation to appointments at facilities in their communities, Hansen says. Pregnant veterans also are covered for maternity care at non-VA facilities through the VAs fee basis program. Maternity care, in fact, is one area that is likely to benefit from a new telehealth program the Northport VA is implementing, Hansen says. The center recently received approval to start a program in which veterans can be monitored remotely and communicate daily with a group of nurses and a nurse practitioner.
Part of the reason for wanting this and putting it into practice is that so many of the women who use maternity care at the VA are high risk, Hansen says. So many of our patients not only have physical issues and liabilities, but also mental health issues, PTSD, depression, anxiety disorders. You can only imagine how when somebody is pregnant how these issues can be exacerbated.
The VA also is moving aggressively to address the issue of military sexual trauma, Hansen says. While the problem is by no means confined to women, about 50% of female veterans report they have experienced some form of military sexual trauma, she says, although the percentage is likely even higher because not everyone who experiences it reports it.
VA nurses are trained to look for signs and ask questions about the possibility of such trauma during a patients intake and to develop a care plan that is unique for each patient, Hansen says. The veteran does not have to prove theyve had any kind of trauma by documentation or witness, she explains. They just have to report it and ask for services and they will be able to get counseling. Usually this counseling is one on one, and therapists are available in the evenings to help women fit it in around work schedules.
At the Bronx VA center, the military sexual trauma coordinator is usually available for one-on-one consultation at short notice and is setting up a group tailored specifically to women who have experienced military sexual trauma, Adams says.
As veterans themselves, Hansen and Adams can relate to the young women they see entering their medical centers for care. I really believe in what were doing, Hansen says. Its not just a matter of job, its a matter of heart.
Adams, who served as a director of health affairs in Iraq and helped Iraqi armed forces set up their own medical program, explains that having a personal understanding of what these female veterans are going through helps her connect with them. She can explain and understands firsthand how difficult it can be to normalize upon returning from combat situations. Its also a selling point when patients see her coming and going from her own healthcare appointments at the VA.
I utilize the VA, she says. And I think I get exceptionally good care.