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Star-Telegram.com

Veterans Affairs addresses growing demand of women needing care

Posted Monday, Jun. 20, 2011

By Chris Vaughn

cvaughn@star-telegram.com

Roughly 6,000 female veterans in Dallas-Fort Worth get medical care from Veterans Affairs.

They represent 6 percent of the patients in the Fort Worth outpatient clinic and Dallas hospital, but the trend is definitely heading north. The VA expects to serve 18,000 North Texas women within five to 10 years, in part because Texas has the second-most female veterans of any state.

The growing number of female veterans, including many with combat experience and some with debilitating injuries, has led the Veterans Affairs Department to re-engineer some of its services to a population that was largely unfamiliar to the VA system in the past.

The Fort Worth outpatient clinic, for example, opened a women's clinic, led by a female internist, in its new building last fall and has integrated cervical exams, mammography and sexual trauma therapy into its clinical options.

"Certainly there is demand," said Assistant VA Secretary L. Tammy Duckworth. "For the first time in our nation's history, we have combat veterans giving birth. We have found that women veterans of Iraq and Afghanistan use the VA at far higher rates than any other demographic group. ... We've come a long way in the last two years. We have a lot more work to do, but we've made tremendous progress."

Duckworth, 43, herself is Exhibit A of the changing face of the warrior and veteran. She flew UH-60 Black Hawk helicopters in the Illinois National Guard and was grievously wounded in Iraq in 2004 when a rocket-propelled grenade struck the cockpit. She had both legs amputated and lost partial use of one arm.

She was in North Texas last week for a national VA conference on equal employment and spoke with the Star-Telegram for about 40 minutes.

More on the agenda

Duckworth and her boss, VA Secretary and retired Army Gen. Eric Shinseki, make a point of asking about women's programs as they visit VA facilities, occasionally dragging a hesitant local director along on the issue, she said.

"More than once I've embarrassed someone at a VA health clinic, especially when I first came on board," Duckworth said. "I've put hospital directors on the hot seat. It's about personally reaching out and communicating our dead seriousness that this is an important issue."

For all the good the VA is accomplishing in ramping up women's access to care, retired Air Force Col. Kim Olson of Weatherford would like it to happen faster. Olson, executive director of the nonprofit Grace After Fire, characterizes the VA as "great, but it's such a huge bureaucracy that it's difficult to move quickly."

"If the VA still takes the stance of 'build it and they will come,' they will never get the numbers," said Olson, who receives VA care. "They've got to build a rock-solid outreach program with this generation. If you take that old VA approach and wait, these young women will never try the VA. The VA needs to step it up. These women need help yesterday."

Vicki Fulwiley, a Navy veteran who lives in Fort Worth, illustrates that point.

She only found out about the clinic a month ago, after having been told about it through the Texas Workforce Commission.

"I didn't even know this was here," she said.

Average age lower

Fourteen percent of the active-duty military and 17 percent of the National Guard and reserves are women. Although they are still barred from infantry and armor jobs, they are far from strictly rear-echelon support personnel. In Iraq and Afghanistan, 140 women have died, compared with eight during the Vietnam War.

Within the VA system this startling dichotomy reflects the times: The average male veteran who receives care is in his early 60s; the average age of female veterans is close to 40.

Some of those women want separate entrances and waiting areas for their clinics. Others, like Duckworth, would prefer to be in the mix with men. She said the VA is trying to listen to women as they make their wishes known. She said the VA has hired a women's health coordinator at every location nationwide to "advocate, listen and coordinate" care.

The Fort Worth clinic handles many gender-specific tests and exams in-house but contracts out for obstetrics services to civilian providers.

"We used to get three [pregnancies] a quarter, but I've had three this week," said Kim Rice, a registered nurse who is the acting women's program manager. "When the veterans are young like those we're getting now, they're continuing their families."

Group therapy

One of the biggest differences between the genders may well be in post-traumatic stress. A VA Office of Inspector General report in January discovered that women returning from Iraq and Afghanistan are more likely to be diagnosed with mental-health conditions than men, yet men are far more likely to receive financial benefits for those problems.

Because of the overwhelming demand for counseling and a shortage of therapists, the VA conducts much of its therapy in group sessions. But Olson said that won't work for many women.

"I'm painting in generalizations, but group therapy doesn't work for women," she said. "You think a woman is going to go into a room full of men and say, 'Hi, I'm Sally and I ran over a child trying to get out of the kill zone.' Women veterans want one-on-one counseling, not to mention that it usually takes a woman an hour to get to the point of her problem. Therapy needs to be different for gals."

Duckworth said female veterans can ask to see a female therapist, attend a women-only group session or, in some cases, request to be seen by a civilian provider paid by the VA.

"The key is listening and providing those services and understanding that it may be different," she said. "It's about being flexible. ... We don't want women to walk through the doors and turn on their heels and leave. Because once they leave, it's 10 times more difficult to get them to come through a second time."

Chris Vaughn, 817-390-7547

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