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Currently, only 37% of the VA's 144 medical centers have a gynecologist on staff. And an audit published this spring by the Government Accountability Office found that of 19 health care facilities surveyed, only two provided tampon or sanitary-napkin dispensers in public bathrooms. Not a single facility was fully compliant with regulations governing women's privacy. Some of the clinics had no locks on bathroom doors, raising concerns that a male patient or staff member could barge in. Other facilities placed gynecologic-exam tables facing doors; in one room, the stirrups were in the line of sight of the mixed-gender waiting room.
Some of female veterans' health care needs pap smears, mammograms, etc. are more obvious than others. Treatment for mental-health issues, autoimmune disorders and even high cholesterol can be hampered by a doctor who is not accustomed to female patients. At VA facilities nationwide, the average male patient is 61, and when it comes to treating young women, doctors may be "rusty," says Dr. Laura Herrera, the VA's national director of women's comprehensive health, a position created in 2008. Women and men don't react the same to certain medications, they develop some diseases at different rates, and they may display varying symptoms. Women may also have a different reaction to dry desert heat: some 34% of female vets evaluated at a VA health care facility from 2002 to 2008 returned from Iraq and Afghanistan with urinary-tract infections, reproductive-system problems, and other genitourinary issues which may be brought on by dehydration, among other factors compared with just 8% of male vets.
Disorders aside, even women's routine health needs often go unmet. In 2004, when Tammy Duckworth returned from Iraq where her legs were blown off after a rocket-propelled grenade hit the helicopter she was piloting the Army outfitted her with prostheses and helped her walk again, but the VA couldn't give her a common form of contraception. "I remember thinking, 'Really? This is like a caricature,'" says Duckworth, who is now an assistant secretary at the VA. "Why do you have Viagra but you don't have the birth-control patch?"
About 66% of female Iraq and Afghanistan veterans using VA health care are under 30, prime childbearing age. But it wasn't until this May that the VA was authorized to care for newborns; obstetric care is outsourced except in emergencies. Salt Lake City's 58-year-old VA hospital, where the average patient is 78 and male, made headlines in October for delivering its first baby. Mom showed up in bad enough shape that there was no time to transfer her. She gave birth to a healthy girl. But the next day, doctors still didn't know how much the infant weighed. The hospital didn't own a baby scale.
Starting a family or returning home to one presents unique challenges to women. Female soldiers on active duty are nearly three times as likely to get divorced as their male counterparts are. As of March 2009, some 30,000 single mothers had deployed to Iraq and Afghanistan. Female veterans are also at least twice as likely as civilian women to be homeless. And, says Pete Dougherty, head of the VA's homeless programs, the percentage of homeless female veterans is on the rise even as the overall number of homeless veterans is dropping.
Hospitals can sometimes add to the trauma. Some women report getting catcalled by fellow patients as they walk down hospital hallways. Others speak of staff members struggling to comply with a VA rule that requires female veterans to be given the option to have a female attendant present at any exam performed by a male doctor. Anuradha Bhagwati, executive director of the Service Women's Action Network, a female veterans' advocacy group in New York City, recalled the ham-handed manner in which a male gynecologist, upon being told by a patient that she had been sexually assaulted, left the exam room and presumably to beckon a female staff member yelled down the hall, "We've got another one!"
Bhagwati, a former Marine, recounted this story during her testimony before the House Committee on Veterans' Affairs last July. The purpose of the hearings was to help eliminate barriers to female veterans seeking benefits and health care. In 2008 the VA tasked all its medical facilities with offering comprehensive women's health care, creating one-stop shopping for women's primary and mental-health care. But the department has yet to issue a timetable for the change, and some officials reported to the GAO that they don't know what steps are needed to bring their own clinics in line. "The VA needs to catch up, fast," says Bhagwati. "I don't think our male patients are treated well, but our female patients are treated even worse."