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The Path to Female-Friendly Care
So what's the solution? Advocates point to some bright spots in the landscape of care for these women. One of them is the Women's Prevention, Outreach and Education Center (WPOEC) in Menlo Park, Calif., where Morrison, Moss and Smith have been receiving treatment on an outpatient basis. Flanked by courtyards dotted with flowering trees and stone benches, it is staffed almost entirely by women, and its doors are locked to keep out uninvited visitors.
The center offers sessions with psychologists like Natara Garovoy, a willowy blonde who, when she was nine months pregnant in February, was still clicking around the clinic in stilettos. She knows that regulations prohibiting women from serving in combat don't keep them from carrying guns or facing down insurgents in wars with no front lines. She knows how hard it is for female vets to prove their injuries stem from combat in order to qualify for disability benefits. And she has worked with enough female veterans that when she tells a rape survivor she can help, the woman believes her.
One floor above Garovoy's office, her colleagues nearly all women give the same kind of care on an inpatient basis. The Women's Trauma Recovery Program, which fields enough demand to fill its 10 beds nearly twice over, mostly enrolls veterans who are not from the area. They board two to a room, and they can connect, if they want to, with other women in similar straits. The activity room has many couches, some exercise equipment and a sewing machine.
These clinics are outliers. Together with a major VA hospital a short drive away in Palo Alto, these facilities make up the VA's first and only Center of Excellence for Women's Health. But it's not very big, treating just 6,000 women a year. And even at the epicenter of female-friendly VA care, Morrison says, it's easy to feel out of place. She recalls once being wheeled into a room at the Palo Alto VA hospital, which was filled with elderly male veterans who looked far more in need of care than she did. "It almost makes me feel guilty about going in there," she says.
Still, it's a start, and it's the kind of care veterans may see much more of if some ambitious initiatives take root. The VA is ramping up women-only treatment centers like the one in Menlo Park and adding all-female therapy groups, especially for sexual-assault survivors. Last year the VA finished installing a full-time women's veteran program manager at each of its 144 hospitals. These managers help coordinate care and sometimes direct women to private clinics, which often are geographically more convenient but may cost the government more: a 2008 audit by the VA's Office of Inspector General found that better monitoring of outsourced care could save the VA nearly $50 million over five years.
In May, the Veterans Health Administration published a new handbook that updates and standardizes the guidelines for women's care, including privacy requirements. To increase clinical staff's proficiency in women's health, the VA has trained more than 400 health care providers in the past two years through mini-residencies featuring two and a half days of presentations from women's-health experts on such topics as contraception, cervical-cancer screening and sexually transmitted infections. The VA has also earmarked nearly $220 million in its 2011 budget for gender-specific care of female veterans, an increase of almost 10% from 2010. Among the initiatives the money will help fund is a 24/7 call center and a social-networking site for female combat veterans.
A bill spearheaded by Washington Senator Patty Murray and signed into law in May goes even further, authorizing, among other things, a report to Congress on the effects the wars in Iraq and Afghanistan have had on female veterans' physical, mental and reproductive health. "Women veterans have earned their stripes. They have earned their benefits," says Murray. "They shouldn't have to feel like they're asking for a handout."
In July the VA will hold a forum at Arlington National Cemetery to discuss the quality of care for female veterans and ways to improve access. Meanwhile, a national outreach campaign is using mailings, posters, videos, Facebook and Twitter to increase awareness of the benefits available to female veterans and encourage women to take advantage of them.
For now, too few women have figured out how to navigate the byzantine system. But the lucky ones, like Moss, show what could be possible if bold new plans are backed up by the resources and the political will necessary to make them stick. These days, Moss works in chaplain services at the Palo Alto hospital, a job that's conveniently close to the VA clinic where she sees a therapist once a week. She says she no longer feels, as she did when she first got home from Iraq, "like a shell of a person." She hugs her kids again. She enjoys lunch at Olive Garden and what she calls "me time" at the hairdresser. She's even getting married in August, to a former Marine who, as she puts it, "understands PTSD." "It's not just being brave on the battlefield," she says of being a veteran. "You have to be brave in civilian life too."