With six new occupational specialties and more than 13,000 new positions opening to women – positions that will be co-located with direct combat units, as well as battalion-level positions with combat units – more women than ever before will be serving along the front lines, often in small, isolated locations, without access to running water or many hygiene products.
That’s especially true of another group of women, who are already blazing a new trail: the female Soldiers assigned to special operations female cultural support teams. This includes female medics and nurse practitioners, who are often the first medical professionals some women in Afghanistan have ever seen.
“They’re really serving as role models. They’re able to actually help with leader development,” noted Lt. Gen. Patricia D. Horoho, the Army’s surgeon general. “There’s been a lot of work in both Iraq and Afghanistan of female clinicians, both on the enlisted and officer side. … They’ve helped with women’s health issues. They’ve helped with perinatal care. They’ve helped with basic female hygiene and child care types of things.”
It’s an opportunity, but one that has the potential to affect women’s health and women’s bodies in ways that male Soldiers will never need to worry about.
It is something that Horoho understands, however. She’s not only the first female Army surgeon general, she is also the first surgeon general who is a nurse, not a medical doctor.
Horoho has spoken to a number of female Soldiers about women’s health issues, and while she said they are generally very happy with the care they receive, she also noted that “we have anatomical differences” that the Army has to consider, that “there are certain areas we can definitely improve upon.” She created a women’s health task force “to really look at what are those unique women’s health issues that we can … support, either through policy changes or being able to adjust the care that’s provided to ensure that they’re healthy and they’re ready?” Army Medical Command, she added, is currently going through this process, and is considering suggestions from female Soldiers.
Infections are a common problem. According to a 2009 study by Col. Peter E. Nielsen, chief of clinical operations and obstetrician/gynecologist consultant to the surgeon general, Western Regional Medical Command, rates of urinary tract infections among deployed women range between 10 and 18 percent, while National Institutes of Health statistics show civilian rates are usually around 11 percent. “The symptoms,” Nielsen and his team speculated, “could be caused by poor access to bathroom facilities, deliberate dehydration by Soldiers to avoid the need to use bathroom facilities and infrequent hygiene opportunities.” Increasing access to the female urinary device, which allows women to urinate while standing via a funnel-like cup, should help reduce the risk of infection, especially among women at small, remote bases or on long convoys, Horoho explained.
And because female Soldiers indicated that they don’t always feel comfortable going to their units’ physician or medic to receive treatment for a yeast infection, Horoho said MEDCOM is considering issuing female Soldiers a kit to treat basic infections “so they don’t have to go and see a provider, so they’re able to just get the medication that they need,” she said. “We’re trying to break down whatever those barriers are for females who want to seek care when they’re with small teams out in remote areas.”
Avoiding menstruation during deployment is also possible if female Soldiers are given medication at least six months before deployment. Horoho said this comes down to educating providers so they know to offer the option early in the predeployment process, and educating Soldiers so they know to ask for it.
The Army is partnering with the Department of Veterans Affairs to look at women’s health care, Horoho continued, and has done a lot of work with pregnancy. She credited Public Health Command’s Pregnancy Postpartum Physical Training Program, which helps pregnant and postpartum Soldiers stay fit safely and then return to physical readiness. It can also, according to PHC, promote a healthy pregnancy, reduce the stress of labor and provide new moms with some much-needed encouragement.
Horoho went on to discuss the additional support some female Soldiers need in the redeployment process, especially when it comes to dealing with guilt. Horoho said female Soldiers sometimes feel guilty because they found their roles as deployed Soldiers in combat to be more fulfilling than their roles as wives and mothers. They may feel guilty because they can’t pick up their lives exactly where they left off or as quickly as their children and husbands might expect. They may feel guilty because they’ve missed large portions of their children’s lives. They may feel angry that their families moved forward without them. They may feel a combination of some or all of these, or have an entirely different set of feelings.
So, Horoho explained, they need “a forum (where) they feel comfortable sharing that … and where they’re not being judged.” They need “the right support system to help them as they reintegrate.” She went on to say that providing this support could be as simple as customizing the Comprehensive Behavioral Health System of Care. The CBHSOC is a MEDCOM initiative designed to standardize and improve behavioral health programs across the Army force generation cycle. This includes prevention, intervention, treatment and follow-up care.
“It’s very easy to tailor that to make sure that females then have the opportunity to see a behavioral health provider if that’s what they’d like, or to see a chaplain,” Horoho continued. “They’re also looking at support groups, and this is for males and females, because some people find that being part of a support group is how they can work through those issues. Others prefer to have it one on one, so it’s making sure that we don’t have a one-size-fits-all, and then sometimes it’s also marrying up our females with other servicemembers, even going back to the Vietnam War who … have gone through the same experiences. … And then we’ve had females say that they’ve had online chats, that they’ve found that to be very beneficial. So I think it’s looking and saying, ‘What are all the tools out there and how do we make those tools readily available for our female Soldiers so that they can utilize them?’”
Both men and women need support systems, she stressed, but they often process information and experiences differently. Women, for example, often “want to just share their feelings and concerns and not have someone fix it. Part of their healing is being able to talk about it. Males tend to want to solve things. So sometimes I think male and female Soldiers, although experiencing the same experience, they handle it differently and they process and work through it in different ways.”
That kind of flexibility, she continued, is one of Army medicine’s greatest strengths, and her goal is to transform the Army health care system, focusing on “those behaviors that are outside of the health care system so that we can really improve the readiness of the force, both mentally, physically and spiritually, and doing that in a collaborative manner of partnering with our sister services, as well as academia and civilian leaders. The ability to improve health will allow us to optimize health care, improve health care outcomes and drive down costs.”