A unique center provides health care services for our nation's heroines

By Lisa Fratt

Although women have served in the armed forces throughout the 20th century, veterans' medical care has not always been gender-sensitive. In fact, the federal government didn't support distinct VA women's clinics until the end of the last century.

In 1994, a federal mandate provided both a structure and funding to support care for women veterans at the local level.

The federal mandate helped the VA develop a better program that was more sensitive to gender issues, according to Kathy Breunig, MN, RN, ANP. She and her colleagues at the Women's Health Clinic of Clement J. Zablocki VA Medical Center and Clinics in Milwaukee provide comprehensive, gender-based medical care for female veterans of all ages.

Expansion of Care

Today, every VA medical center has a women veterans' program manager, a role Breunig fills at the Zablocki Women's Clinic. That person serves as an advocate for women veterans; she helps them enter the system, navigate the bureaucracy and access needed care.

All women's VA clinics provide care for female veterans beginning at the time of military discharge when the woman may have critical needs based on injuries and conditions sustained in conflict. The clinics continue to serve women veterans throughout their lives, meeting specific health care needs at every stage.

Breunig has been part of the Zablocki Women's Clinic since its doors opened in 1994. Today, she is part of an interdisciplinary team providing primary and gender care to about 900 Milwaukee-area veterans. The clinic oversees five community-based outpatient clinics, and patients at those clinics bring the total female veteran population to approximately 2,500.

The patient population includes women who served in the armed forces in World Wars I and II, the Korean and Vietnam wars, and the first Persian Gulf conflict. The staff also is starting to see the first veterans of the current Iraqi crisis trickle into the center. Meeting the comprehensive and gender-sensitive medical needs of this diverse population is a challenging, but rewarding, undertaking.

One-Stop Shopping

"Our women's clinic offers one-stop shopping to women veterans," Breunig explained. This means women veterans visit the clinic to receive both gender and primary care. On-site gynecological care includes annual screenings, contraceptive care, maternity care (covered by a fee-for-service arrangement), fertility evaluations, menopausal management, hormone replacement therapy and osteoporosis screenings.

Gynecological surgeries, including hysterectomies, laparotomies, laparoscopies and Leap therapy procedures, along with breast surgeries, also are performed at the center.

Providers at the clinic also provide primary care and help patients manage chronic health problems like hypertension, diabetes and heart disease. Breunig said the clinic staff tracks current medical research related to their patients. For example, after evaluating the recent research on women and heart disease, the nursing staff developed a program to educate women veterans about heart disease in women.

Clinic services also include disease management. For example, if a patient is newly diagnosed with diabetes, a staffer will provide extensive teaching and oversight for the patient.

"That's because we now know that the success or failure of an intervention depends on the patient's ability to make lifestyle changes [to manage the disease]," Breunig said.

Female veterans are susceptible to every health concern present in the non-military female population–Alzheimer's disease, thyroid problems, stroke, heart disease, and breast, uterine and ovarian cancers. To help patients manage these diseases, the clinic maintains consulting relationships with a range of VA specialists such as endocrinologists, breast specialists and geriatricians.

Social workers and a psychologist round out the comprehensive care team at the Zablocki Women's Clinic. A number of women veterans use the mental health services offered at the medical center.

"Our patients face all the same problems encountered in the general society," Breunig noted. This includes drug and alcohol problems, domestic violence and homelessness. The clinic provides an annual screening that assesses for issues, such as financial problems and family stress, which may affect mental health for all veterans.

A Changing Face

The reality of the current military state of affairs, coupled with the increasing presence of women in the military, means the face of the female veteran is changing. The new vet is younger; many may require care for conflict-related conditions in addition to ongoing primary care.

"It used to be that the bulk of our patients were in the 60- to 70-year-old age group, but now we're seeing more younger veterans," Breunig said. "This includes women who participated in the first Persian Gulf conflict, those who served military tours during the 1990s and recently were discharged, and the first vets from the current Iraqi War."

The VA has kept pace with younger vets by providing services targeted to their needs, including maternity care, fertility evaluations and contraceptive services. While comprehensive, ongoing gender-based care is important, an increasing number of women veterans require posttraumatic services.

"Since earlier this year, we've provided a screening program for all Iraq and Afghan combat veterans who have served since 9/11," Breunig said. "We look at mental health issues, including posttraumatic stress disorder and military sexual trauma, as well as physical concerns."

Some patients require ongoing care for musculoskeletal injuries and the chronic pain associated with them. Skin problems and gastrointestinal problems are other common complaints.

Breunig and the rest of the staff also are beginning to prepare to meet the needs of women veterans returning from the current crisis in Iraq.

"Their needs are just beginning to be defined, but we are anticipating a range of issues," she admitted. This includes dermatologic issues and orthopedic problems. Other VA centers have reported seeing Iraq war veterans with chronic infectious diseases endemic to Iraq and Afghanistan, such as enteric infections, malaria and leishmaniasis, an infection transmitted to humans by bloodsucking sand flies. These can present after a veteran returns to the United States. As women veterans enter the VA system, the staff is assessing them for these issues.

Breunig also anticipates seeing women veterans with gender-specific problems relating to chronic dehydration. Dehydration, which can be an issue in the desert environment, is associated with urinary tract infections and menstrual problems.

Still, the most critical needs of women veterans may not be physical but emotional. "Mental health will be a tremendous need," Breunig stressed.

The Zablocki staff is preparing to meet the wide variety of anticipated needs by tapping into online teaching modules, including evidence-based clinical approaches for treating veterans following deployment, developed by the U.S. Department of Veterans Affairs.

The changing needs of female veterans are a challenge for the staff at the Zablocki Women's Clinic, but one which they look forward to meeting. The rewards of coordinating and providing comprehensive care for this diverse patient population are simple, said Breunig. "The VA historically had been a man's domain, but women aren't an extension of men. Seeing women veterans get good care is my reward."

Lisa Fratt is a freelance writer from Ashland, WI.