Department of Veterans Affairs healthcare system struggles to adapt to changing population

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May 3, 2011 - 7:00pm

Ann Thieman joined the army right after high school, at the tail end of the Vietnam War. She retired from the army as a sergeant first-class, E7, after six years on active duty and 11 years as a reservist. She was stationed in Germany during the Beirut conflict, working as a chaplain's assistant.

Thieman's father, stepfather, uncles, grandfather and great-grandfather all served in the military; she was the first woman in her family to enlist.


Photo by Hilary Stohs-Krause

Former staff sergeant Ann Thieman has been receiving treatment at the Nebraska-Western Iowa VA Healthcare System in Omaha since 2000. She said the system's transition to caring for female veterans hasn't always gone smoothly.

Chart courtesy of the
Department of Veterans Affairs

A chart showing the projected veteran population of Nebraska through 2036, broken up by gender.

Graphic created by
Hilary Stohs-Krause with Wordle

A map showing the prevalence of words in a 2010 report from the Department of Veterans Affairs Advisory Committee on Women.

"I just got that bill today, then I had a surge of nausea just hit me, and I'm like, Oh my gosh. My stomach, it's like the typical panic thing,'" Thieman said during a recent appointment with her psychiatrist at the Nebraska-Western Iowa VA hospital in Omaha.

Her psychiatrist mentioned that it'd been a while since she'd had an anxiety attack.

"Yeah, it has," Thieman said. "(But) today, it's really bad."

Shifting demographics

The number of female veterans has doubled since the Vietnam War, and the population is set to double again in the next decade. But when it comes to healthcare, the system is struggling to adjust to increasing numbers of women entering the military - and its hospitals.

Women now comprise 15 percent of active duty military and 18 percent of reservists and the National Guard, according to the U.S. Department of Veterans Affairs, and Thieman's experiences form a textbook example of the difficulties they face.

Women soldiers are younger than men - the average age of female veterans is 48, compared to 63 for male veterans.

They're also at greater risk for mental health issues: female veterans have twice the rates of PTSD and depression as male veterans. One in five female VA patients has experienced sexual harassment or assault, known as military sexual trauma, compared with one in 100 men.

"I don't want to get into a lot of detail about it, but just the remarks, and the insinuations and some inappropriate touching here and there," Thieman said in the lobby of the VA hospital after her appointment. "And you know, at that point, it was usually people above me in rank, so I was afraid to react. You don't fight it, is what we were taught

"You know, they even had these rape prevention seminars when I was in, because it was the Women's Army Corps when I first went in. So they told you, Don't fight, don't fight just take it.'"

Thiemann didn't know who to turn to, so she internalized her experiences. For a long time, she said she felt like a dishonored veteran. She felt damaged.

"It got to a point where I thought, If this is all I'm good for, I want to die,'" she said. "And I actually did try to commit suicide once, in the army. But I was not successful, fortunately."

Emphasis on awareness

One of the national VA's key goals is letting female veterans know about the services they offer, said Patty Hayes, national chief consultant for women veterans health. Hayes has worked for the VA for nearly 30 years.

"One of the things that we've (paid) a lot of attention (to) is changing the culture of the VA to be more inclusive of women," she said, "because of the fact that women have been fairly invisible."

One of the ways the VA is trying to combat this is by using new technologies to not only reach female veterans, but treat them. Hayes said the VA is exploring the use of telemedicine - or for women, telegyny, as she called it. Telegyny is being piloted in several cities and states, including Colorado.

"For example, if you needed to see a gynecologist, you might meet the gynecologist over this secure framework," she explained, "so that by the time you go to the main facility, you're ready for the surgical procedure or the outpatient procedure. You don't make three trips just to have that one visit or that one outpatient procedure accomplished."

Other issues plaguing the system are lack of female healthcare providers and understanding the different challenges men and women veterans face. For example, Hayes said, women are often "squeezed" between their work and family responsibilities, including caring for not only children but perhaps elders or other family members.

"So they don't necessarily take time out for their own healthcare," she said. "We need to make sure that our hours are flexible, that we recognize that they can't come back many times to get their care accomplished."

Courtesy photos

Hope DaCosta, a former staff sergeant now teaching elementary education in Lincoln, had a hard time transitioning back to civilian life after her second tour overseas.

According to the national VA Office of Policy and Planning, the top three diagnostic categories for women treated by the VA were PTSD, hypertension and depression.

Recognizing that they're veterans, too

Cindy Niemack-Brown oversees and administers the women veterans program for the Nebraska-Western Iowa VA system. She says women have served since the Revolutionary War, but even today, many don't think of themselves as veterans or, conversely, they're not seen as veterans by VA staff.

"I just get looks when I go there," said 26-year-old Lincolnite Hope DaCosta with a laugh. The petite, freckled elementary school teacher and former staff sergeant E-5 served two tours overseas, driving trucks between Kuwait and Iraq.

"I don't really feel quite comfortable when I'm (at the VA hospital)," she continued, voice growing somber. "I do feel like an outcast."

For DaCosta, transitioning back to civilian life was much harder the second time around. Her first tour, she left while attending college and then came back to college. But for her second tour, she graduated right before leaving for Iraq and when she came back, her life was completely different.


Click here for information on military sexual trauma from the National Centers for PTSD

Click here for a 2007 report on women veterans from the Department of Veterans Affairs Office of Policy and Planning

"In the military, everything's so black and white," she said. "You're told what to do, when to do it. You don't have to pick out your clothing. You don't have to make too many decisions.

"And then when you come here, when you come back you're faced with thousands more, on top of 17 little faces (saying), Miss DaCosta, can I do this?' Miss DaCosta, can I do that?' It was just really overwhelming."

DaCosta took a two-month leave of absence from work and received treatment from the Omaha VA. She says she finally feels like herself again, adding that the treatment she received at the VA was really beneficial. She encouraged other veterans to seek help if they need it.

An ongoing struggle

The VA acknowledges there's work to be done, especially as the percentage of women in the military continues to increase. Female veterans cite privacy issues, distance they have to travel for services and lack of gender-specific options as barriers to care.

Jennifer Bos, the Nebraska Veterans of Foreign Wars Women's Chairperson, said those changes won't come easily.

"I think it's just a whole mentality issue, where it's been strictly old men in the VA hospitals and the VA clinics and everything, and it's going got take time for everybody to adjust to that," she said.

Thieman suggested that young female veterans unsure about the VA healthcare system contact their local VFW or American legion office and ask for a woman veteran who could help them get started. Additionally, every county has a veteran service officer who can provide more information and answer questions.

Thieman started receiving treatment at the Omaha VA in 2000. She still struggles with anxiety, but says she's doing much better.

"I feel like I'm not alone anymore," she said. "I almost feel like an advocate, like I need to let other women know, 'You're not the only one, and there's help out there. And go get it. Don't suffer in silence, because that's what I did for a long time.'"



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