The VA is retooling health care (WOMENSENEWS)–Tammy Duckworth heard the rattle of bullets, then saw a golden fireball unfurl.

A helicopter pilot stationed in Iraq, Duckworth was shot down near Baghdad in 2004, sustaining massive wounds, shattering her right arm and mangling both her legs, which later had to be amputated.

"The treatment I received at Walter Reed Army Medical Center in Washington was excellent and saved my life," says Duckworth, who is now director of the Illinois Department of Veterans’ Affairs. "But the comfort package I received contained men’s Jockey shorts, and the local VA hospital carried Viagra but not my birth control."

Monday marked the fourth anniversary of the U.S. invasion of Iraq, a war that has put a record number of U.S. servicewomen in military hospitals designed to treat male soldiers.

Alhough some female recruits have had trouble getting gender-appropriate care, many problems they faced earlier in the war–such as those Duckworth cites–have since been addressed. And despite the recent disclosure of problems with outpatient care at Walter Reed, the majority of women returning from the war zone report they are satisfied with their medical treatment, according to the Department of Veterans Affairs, which declined to provide details.

The Department of Defense, which provides health care to active duty soldiers, and the Department of Veterans Affairs, which offers medical treatment to vets, have both seen a dramatic spike in their number of female patients since the beginning of the Iraq war.

Just as women represent a record number of casualties in this conflict–to date, 82 women have been killed; 11 in Afghanistan and 71 in Iraq–they also represent a higher-than-ever portion of troops (11 percent). More than 470 servicewomen have been wounded in action: nine in Afghanistan and 461 in Iraq.

Expanded Roles, Greater Risk

The rise in deaths and injuries stems in part from the 1994 retraction of a rule barring women from positions "with a substantial risk of capture." Female soldiers are prohibited from fighting in combat or supporting combat troops, but they are now qualified to fill 90 percent of military jobs and stand at greater risk of physical harm.

Tammy Duckworth

Although Kevlar helmets and body armor help recruits of both sexes survive injuries that were previously fatal, women are three to four times more likely than men to be injured in battle because of differences in bone structure, aerobic capacity and upper-body strength, says Elaine Donnelley, president of the Center for Military Readiness in Livonia, Mich.

"The nature of the conflict in Iraq and Afghanistan also boosts women’s risk," says retired Brig. General Evelyn Pat Foote, president of the nonprofit Alliance for National Defense in Alexandria, Va. "There is no combat zone with set boundaries, so women are targeted just as if they were in direct combat. With no warning, they can be hit with improvised explosive devices and suffer head injuries and amputations that in the past were usually sustained just by men."

Bomb attacks are the top cause of injury in Iraq, and never knowing when they will strike is exposing female soldiers to unprecedented emotional trauma.

"In the field in this war, any loud noise can make you jump and you can never get a good night’s sleep," says Megan O’Connor of Venice, Calif., a former Army captain who served in Tikrit and Ramadi.

Last year, Army studies found 24 percent of female soldiers, compared to 19 percent of males, suffered from mental illness such as post-traumatic stress disorder (called PTSD and marked by insomnia, headaches, depression and other symptoms).

Meeting Needs of Servicewomen

At the beginning of the war, say female soldiers, the military health care system didn’t always meet their needs. Hospital gowns were man-sized; tampons, sanitary napkins and drugs for menstrual cramps were scarce.

"By late 2004, when fighting intensified, military hospitals were seeing the largest population of female wounded in our nation’s history," says Duckworth. "To meet this need, they had to play catch-up."

Women currently represent 15 percent of the active military and 5.5 percent of veterans, and those numbers are expected to double by the year 2020.

Research indicates only 57 percent of female vets realize they are eligible for government-sponsored health care. And according to Irene Trowell-Harris, director of the Washington-based Center for Women Veterans, only 37 percent of the 70,000 women discharged between 2002 and 2006 have signed on for this coverage.

The Defense, Veterans Affairs and Labor departments say they are working to change this by boosting their advertising of VA services to female vets.

Now, at the urging of female patients, facilities carry medications such as birth control pills, which are currently available at all veterans’ care centers.

At the suggestion of Dawn Halfaker, a former military police officer who lost her right arm in a grenade attack in Iraq, the Wounded Warrior Project, a Jacksonville, Fla., nonprofit that supports wounded soldiers, has provided female patients in military hospitals with packs containing cotton rounds, a nail file, shaving cream, tampons and women’s underwear since 2005.

Addressing Top Health Complaints

Researchers identified–and worked to treat–returning female soldiers’ top health complaints: musculoskeletal disorders (such as back pain from carrying 40-pound packs); mental health issues (such as readjustment problems); and digestive complaints (such as diarrhea from stomach bugs caught overseas).

Scientists began studying female soldiers to see how their physical needs and experience of PTSD differ from those of men, research that continues today.

Health advocates beefed up services for female vets, which now include residential trauma programs in Cincinnati, Palo Alto, Calif., and Bay Pines, Fla.; a women’s psychiatry unit in Brockton, Mass.; a transitional housing and treatment program in Boston; and six women’s health centers and four women’s stress disorder programs across the United States.

Psychiatrists discovered that a third of women seeking care through the veterans’ system had suffered sexual trauma and worked to help these victims of harassment and rape.

All the while, military doctors provided women with the care needed by soldiers of both sexes: plastic surgery for shrapnel scars, prosthetics to replace missing limbs and counseling to address nightmares in which comrades die and bomb blasts reverberate.

Last month, a Washington Post series described mice, mold, cockroaches, long waits for treatment and substance abuse problems in outpatient facilities at Walter Reed, which led to the ouster of Walter Reed’s director and the resignation of the Army’s top medical officer. Congress launched hearings into the scandal, and President Bush created a task force to identify gaps in medical coverage.

"Injured women soldiers get magnificent first-tier care," says Foote. "But as the recent Walter Reed disclosures show, we still need to improve outpatient and long-term care."

Molly M. Ginty is a freelance writer based in New York City.

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