The organization that describes itself as the nation’s largest health- maintenance organization is trying to show that it’s serious about improving care for the 2 percent of its patients who are female.
Last year the Veterans Administration treated nearly 300,000 women nationwide.
This year Congress appropriated $7.5 million for expanded VA services under the Women Veterans Health Programs Act of 1992.
In Washington, Dr. Susan Mather, who is in charge of women’s health for the VA, says there were so many good proposals from VA hospitals that wanted a share of the allocation “that we went ahead and asked for additional funding for ’94.”
The first appropriation was spread among various programs, but $3 million went to create four Women’s Veterans Comprehensive Health Centers, one in each of the VA’s U.S. medical regions, each with a different focus. “They will be prototypes for other hospitals,” Mather says.
Mather calls the one in Minneapolis a “preventive care model.” It is concentrating on such things as screening women for cancer and osteoporosis and educating veterans about both. It will help patients stop smoking, watch their cholesterol or start an exercise program, taking what Mather calls “sort of a wellness approach” to women’s health.
The staff at the health center at the VA hospital in Tampa focusescancer, with emphasis on early detection of ovarian and breast cancer.
The “center” in the northeast is really four facilities in the Southeast Pennsylvania Network. VA medical centers in Coatesville, Lebanon and Philadelphia, Pa., and one in Wilmington, Del., are trying to improve the “network” approach to health care. The three small hospitals in Lebanon, Coatesville and Wilmington have women’s clinics run by nurse practitioners, with physicians on call, Mather says. Any patients who can’t be handled locally will be sent to the big VA hospital in Philadelphia.
The VA hospital in San Francisco set up a clinic in 1988 to provide preventive care such as breast exams and deal with what doctors call “ambulatory gynecology”-menstrual disorders, vaginitis, sexually transmitted diseases-in addition to handling ailments that afflict women as well as men. To help women with non-gender-specific conditions, the hospital is building a women’s area rather than assigning women to private rooms scattered throughout the facility.
The clinic was partly a response to a survey about six years ago indicating that women veterans who visited the San Francisco facility were not getting appropriate gender-related care, such as Pap smears and mammograms.
Dr. Deborah Grady, who organized the clinic, says: “Because the percent of women in the (VA’s) general practice is small, providers naturally don’t feel comfortable doing stuff like breast exams. Most of our physicians don’t get enough experience in quality women’s health care to make them really expert.
“About 4 percent of all veterans are women,” she says, “but only about 2 percent of all patients” at VA facilities are women, a disparity she blames on several causes. Generally, women veterans have better outside health care coverage than male veterans do, and they use it instead of the VA, she says.
Veterans with service-related disabilities or low incomes are eligible for VA care. Because women have been excluded from combat roles, fewer of them suffer disabilities. And on average, Grady says, women entered the military with more education than did men, and were more likely to get good jobs when they left the service, the kinds of jobs that carry higher wages and medical coverage.
But part of the reason women don’t take advantage of VA facilities, Grady and other officials acknowledge, may be the atmosphere. The VA calls itself “the nation’s largest HMO,” and its patients have the typical HMO complaints about the amount of time it takes to get an appointment and the amount of time you sit around waiting, even with an appointment.
Grady says women who visited a VA facility 15 years ago “probably got good care, but it wasn’t always fun. It’s a place where the patients are 97 to 98 percent men, and it could be an unpleasant experience.”
Now, she says, “things have changed.” During a recent interview, Grady pointed to a stack of paper and said, “Just today I got this thing from central office detailing all of the various things that each VA has got to provide, and it’s very detailed, right down to having women’s hair-care products in the VA service stores.”
Mather, who’s responsible for those detailed instructions, says “women who come to our hospitals have told us that they’re not very user-friendly for women, that they’re very masculine.” She says VA facilities send out a “non-verbal message in a canteen service that has only stuff for males.” Hospital pajamas, she says, “are government issue, all green or brown, and they were made for men.” Women were just given the smallest size.
Of the $7.5 million appropriated by Congress this year for women’s programs, $1.5 million went to those storefront veterans centers to provide counseling for women vets suffering sexual trauma.
Grady says she sees women with post-traumatic stress disorder in her clinic. “When we first started dealing with PTSD, people thought, `Well, you had to have actually been in combat,’ which is clearly not true. The nurses in Vietnam saw terrible things and clearly had problems related to that.”
But the counseling programs are not just for PTSD or military-related experiences, Grady says, “but also any kind of non-military experiences from any kind of trauma or violence. So they’re designed to include problems with domestic violence, child abuse, PTSD and sexual harassment.”
The hospital’s AIDS program, Grady says, “is very active, of course, because we’re in San Francisco.” Women at Grady’s clinic are eligible for everything the San Francisco VA hospital offers the approximately 600 men in the program, including participation in tests such as an AIDS clinical trials group at the University of California at San Francisco. AIDS testing is also available.
The VA also has a program for homeless veterans, and it sends its female clients from the San Francisco area to Grady’s clinic.
Grady says her women’s clinic is unlike those set up at civilian hospitals because “most women’s programs focus on young, reproductive-age women and their problems. If we have a focus, it’s more on the medical care of older women. These women have many more problems. Our typical clinic patient is menopausal and older, in fact, sometimes a lot older.”
