By Steve Lewis
NEW YORK – Recognizing the growing number of female veterans and their unique medical needs, a physician at VA New York Harbor Healthcare Center has created a “women-only” examination and treatment room in the emergency department (ED). She also is putting together a multidisciplinary team to help female patients once their emergency needs are met.
“It had become very clear over the last couple of years that the number of women veterans was increasing very rapidly,” says Nancy Lutwak, MD, the Emergency Department women’s health champion at the Manhattan Center. “Not only are there now a lot more women in the military, but they are also in combat areas and other locations where there’s a lot of danger, such as roads where bombs may have been planted.”
Because of this increased exposure to danger, Lutwak added, the literature shows that a growing number of women are experiencing PTSD and depression from combat injuries as well as military sexual trauma (MST).
|Nancy Lutwak, MD|
Women currently make up about 15% of the active U.S. military, compared with 1.4% in 1970, according to DoD statistics. A 2006 VA study found that between 23% and 33% had been MST victims, although more-recent research suggests that the incidence is underreported. An American Legion survey last year found that a majority of female veterans were dissatisfied with VA’s MST screening process; most also called the space and the equipment provided for treatment of women “moderate” or “poor.”
While it addresses a clear need, the project is clearly a labor of love for Lutwak, who has been an emergency medicine physician for almost 21 years. She said she finds her current position extremely rewarding.
“I was very fortunate to come to VA to work and find helping veterans very gratifying, because they have made tremendous sacrifices for this country,” said Lutwak, who was born in Manhattan and has lived in New York all of her life.
It was a combination of her respect and admiration for her patients and what she had come to learn about the challenges faced by female veterans that inspired her to start the project.
Lutwak recalled that she had read several articles about MST and homelessness among women. “There was [one article] in particular by the Department of Labor Women’s Bureau that talked about homelessness,” she said. “Part of it is that a lot of women have had problems with sexual abuse before joining the military, either as children or from being in a relationship with domestic violence, and had joined the military as a way to escape, gain independence and knowledge and to feel better about themselves. When I started reading about it and how they become depressed and turn to drugs and alcohol – and a small group even becomes homeless – I realized this was a large problem that needed to be addressed.”
VA is working very hard to increase and expand services for women, Lutwak added, noting that now many women’s health clinics are in operation and run by female physicians and attached to female social workers.
While Lutwak couldn’t transform the emergency department into a women-only facility, she did the next best thing: take a former observation room and transform it into a private room for women veterans.
“We decided to make it a very nice room for women only,” she said. “We painted it, put up nice prints and also put up curtains to make sure they could have more privacy for getting into their PJ’s and robes.”
Once women are triaged, they are placed in the special room where they can not only be examined in greater privacy but also are able to talk with care providers in a secure location where they can feel comfortable discussing any issue.
“We’re focusing on MST, since the recent literature talks about anywhere up to 40% of the women having experienced it,” Lutwak explained. “You have to keep in mind there is a broad range of things that should be considered – anything from verbal assault, humiliation or inappropriate language up to being pressured into having some sort of sexual contact – including actual physical assault or rape.”
“Under these circumstances, I felt very strongly that being a good physician had to include providing these women a safe haven,” Lutwak said.
While it is not always possible, Lutwak says she tries to have these patients examined by female doctors to make them more comfortable. “If a woman says she would prefer to be seen by a female physician, we are doing that,” she added.
Furthermore, Lutwak has built a multi-disciplinary team which consists of female psychologists and psychiatrists, social workers and clergy, noting, “So they are not only helped by women providers in the room but by a team of all women who can address lots of urgent issues; we get that help for them while they are still in the ER.”
While she continues to recruit staff, Lutwak says the new service has been seeing women for about three months and has been extremely well received.
“The patients absolutely love it,” Lutwak said. “One woman told us she lived in New Jersey, where there are some closer VA hospitals, but she came here because of our private room for women. Others have told me they had been to an ER before, but they find this much more comfortable.”