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Texas, with 84,000 women veterans has the 3rd largest population of women veterans. The South Texas Veterans’ Health Care System (STVHCS) has approximately 10,000 women enrolled. Throughout this system there are Women’s Health Programs at each facility. Women are eligible to receive women’s health care through their primary care provider or through a specialty Women’s Clinic. The Frank M. Tejeda Outpatient Clinic (FTOPC) has the Woman’s Place and the Kerrville Division has the Women’s Health Program. At each hospital, there are nurse practitioners employed as Women Veteran Program Managers who are responsible administratively and clinically for the provision of comprehensive women’s health care. I am the Women Veterans’ Program Manager for the Kerrville Division. Each of the 5 satellite clinics has provided women’s health care services. Each Outpatient Clinic (OPC) has a Woman Veteran Liaison to ensure women veterans’ needs are met.

The women veteran population has unique issues that we have identified and addressed. Among the unique issues that VA is faced with in the women veteran population includes screening and treatment for military sexual trauma and clear access to women’s health care. Women in the military have not seen VA as a system willing and able to care for women patients. In talking with women veterans, I have been surprised to hear that in too many cases, women do not consider themselves veterans and in those cases they certainly do not consider themselves eligible for health care at VA. They are surprised and pleased to find that the VA has services that equal or surpass the women’s health care offered in the private sector.

Another priority issue in the women veteran population that we have faced is the screening and treatment of women with military sexual trauma. As you know, victims of sexual abuse often do not report this crime. Women delay disclosure of sexual abuse until after departure from active duty perhaps in fear of retaliation or rejection or the fear of the negative consequences the accusation will have on her career.

This reluctance presents challenges to VA in the delivery of care and availability of services. Many victims of sexual trauma are not eligible for services other than sexual trauma counseling. In this system, we have been able to coordinate and collaborate military sexual trauma services within VA and the Vet Center. For many years this system has worked collaboratively with the Vet Center to provide counseling services to women veterans. For those veterans who live in remote areas, we have worked with private counselors to provide needed counseling. Women veterans are seen in the Mental Health Clinic, The PTSD Care Team, within the Women’s Clinic, and through the Vet Center for military sexual trauma counseling. For the past three years, the Kerrville Division Women’s Health Clinic has collaborated with the San Antonio Vet Center to offer military sexual trauma counseling locally. We have also collaborated to offer a retreat to women veterans involved in military sexual trauma group therapy. This has been a tremendous success with women veterans expressing that this has been the most successful therapeutic experience they have received.

VA is eager and able to provide care to women veterans; however, getting that information to them has been a challenge. We have met this challenge in many ways. For the past 13 years we have offered the Salute to Women Veterans in Kerrville. The purpose of this program has been to honor the role of women veterans and to increase community awareness of the role that women have served while in the military. The Salute to Women Veterans has reached women throughout the entire system and has heightened awareness of women veteran issues and healthcare services. In addition it has heightened public awareness. The Women’s Place has held women’s health fairs at a local San Antonio community college. A representative from the Women’s Health Program presents weekly at the local military bases TAPS briefing to apprise military women of services that they are entitled to. In November 2002, the Kerrville Division collaborated with a local theater group to produce the play A Piece of My Heart to women throughout the system. This play is a moving depiction of the role of women veterans in the Vietnam War. This served the purpose of increasing awareness of the issues of women veterans and to honor women veterans. Regularly, the Women Veterans Program Managers meet with the media in television, radio and newspaper regarding women veterans’ issues and stories of interest.

The FTOPC has two primary care physicians, two nurse practitioners and a gynecologist providing women’s health care. The Kerrville Division has one nurse practitioner providing women’s health Care. At the Audie L. Murphy Division (ALMD) women can choose to receive their care in their primary care team or they can choose to be referred to the Women’s Place at FTOPC. At the satellite clinics, patients receive women’s health care with either a nurse practitioner or a physician. Throughout the system, for complex women’s health care issues, patients are referred to the Women’s Place to be seen by the gynecologist. We have a collaborative relationship with University Health Systems for gynecological surgical procedures. These are done at the University Hospital. For obstetrical care, we have contracted with local private providers as well as with Wilford Hall. Both have been well received. Since the VA began providing obstetrical care in 2001, we have delivered 63 VA babies. Sixteen additional babies are expected this year.

I was also asked to discuss the role of Nurse Practitioners in the STVHCS. Nurse practitioners have been instrumental in providing care to all veterans but have been especially effective with women veterans. Women veterans generally expect holistic care, which means care for their emotional and spiritual needs, as well as their physical needs. Women in America tend to be the primary person in the family responsible for health care needs. Women expect detailed information prior to making health care decisions. Nurse practitioners are uniquely able to meet this need with training in both medical science and nursing science. Nurse practitioners are trained to assess from a holistic perspective in a caring manner. There are 24 Nurse practitioners in our system where they are utilized in the hospitals and within the outpatient clinics. Nurse practitioners can be found throughout the system in long term care, in primary care clinics, in triage and in specialty clinics.

As a nurse practitioner, who has practiced in both the private sector and within the VA, I am in a unique position to evaluate the best of both private and public health care. I feel that the STVHCS has met the challenges of caring for women veterans well. In this environment, the health care that women veterans receive surpasses the services that I am able to receive as a non-veteran in the private sector. In 2002 the STVHCS received the Clinical Program of Excellence in Women’s Health award. We were one of six VA facilities to receive this award. I am honored to serve in the capacity of the Women Veterans Program Manager. I feel that I have learned as much from veterans I care for both women and men as that I have imparted to them.