As docents at the National Museum of Health and Medicine (NMHM), Sara and David Handwerker will point out an adult female pelvis in the museum’s “Human Identification” exhibit to visitors. That kind of specimen shares a connection to their own professional histories as doctors: more than 30 years of experience in obstetrics/gynecology and maternal-fetal medicine. NMHM is especially grateful for their volunteerism in October, when women’s health gets special attention in the Military Health System (MHS). NMHM is a Department of Defense museum.
October 2018 is also a service anniversary for the Handwerkers: four years of devoting their time to the medical museum’s visitors. The couple retired from New York City government hospitals several years ago and relocated to the Washington, D.C. metropolitan area to live near family. They joined the museum’s volunteer corps in October 2014, motivated by a love for history and medicine.
The Handwerkers clearly enjoy volunteerism; this spring, Sara received a special pin from the museum and a Bronze Presidential Service Award from the Army Volunteer Corps (AVC) in appreciation for 163 hours of dedication and service at NMHM in 2017, the most time any docent devoted to the museum last year. David also received the AVC’s Bronze Presidential Service Award for providing 104 service hours to NMHM in 2017. They were recognized for guiding tours and assisting with educational programs.
During Women’s Health Month in October, the MHS reminds women to be proactive in addressing their health issues and have regularly-scheduled visits to their health care provider. Both museum volunteers support the MHS message. They encourage women to engage in preventive care and talk with their health care providers; as doctors, they treated women with undiagnosed infections or breast cancer, and women who became ill while pregnant due to untreated conditions.
Scientists say a new treatment is showing promise in the fight against aggressive breast cancer. Three years ago, at age 39, Maribel Ramos was diagnosed with advanced breast cancer. The type was triple negative.
"I was angry and sad," Ramos said. "Because I know that the triple negative is a type of cancer that is really hard to treat."
Ten to 20 percent of breast cancers are called triple negative because they don't have receptors – such as ones for estrogen – that can be targeted by certain medications. Treatment options are limited, and these cancers tend to be more aggressive, with worse outcomes.
In 2016, Ramos entered a trial to test the immunotherapy drug Tecentriq on patients with advanced triple negative breast cancer.
The drug works by targeting proteins found on immune cells and some cancer cells. It's approved for bladder and one type of lung cancer.
Dr. Sylvia Adams of NYU-Langone Health was one of the trial investigators. She says the new drug helps the immune system recognize the cancer.
"There are killer cells already in the cancer present and ready to fight, except that this cancer shields itself from the from the immune attack," Adams said. "So this drug is now able to take the shield down and basically paves the way for your own immune response to kill the tumor."
The trial, at hundreds of sites in 41 countries, followed 902 patients and found the combination of immunotherapy and chemotherapy improved overall survival by nearly four months, (3.7 months) and nearly 10 months for those patients whose tumors tested positive for the targeted protein.
"Hopefully this will actually improve the treatments for many other women with breast cancer as well," Adams said.
"The tumor was getting smaller," Ramos said. "So every time, every four weeks it was getting smaller and smaller and I was so excited."
"The last scan from just last week that shows that she's still completely without any evidence of disease," Adams said.
Three years ago, Ramos worried she wouldn't see her oldest daughter graduate. In June, she did.
General Information About Breast Cancer
- Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.
- A family history of breast cancer and other factors increase the risk of breast cancer.
- Breast cancer is sometimes caused by inherited gene mutations (changes).
- The use of certain medicines and other factors decrease the risk of breast cancer.
- Signs of breast cancer include a lump or change in the breast.
- Tests that examine the breasts are used to detect (find) and diagnose breast cancer.
- If cancer is found, tests are done to study the cancer cells.
- Certain factors affect prognosis (chance of recovery) and treatment options.
Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.
The is made up of and . Each breast has 15 to 20 sections called lobes. Each lobe has many smaller sections called . Lobules end in dozens of tiny bulbs that can make milk. The lobes, lobules, and bulbs are linked by thin tubes called ducts.
Each breast also has and . The lymph vessels carry an almost colorless called . Lymph vessels carry lymph between . Lymph nodes are small bean-shaped structures that are found throughout the body. They filter substances in lymph and help fight and disease. Clusters of lymph nodes are found near the breast in the (under the arm), above the , and in the chest.
The most common type of is , which begins in the of the ducts. that begins in the lobes or lobules is called and is more often found in both breasts than are other types of breast cancer. is an uncommon type of breast cancer in which the breast is warm, red, and swollen.
A family history of breast cancer and other factors increase the risk of breast cancer.
Anything that increases your chance of getting a disease is called a . Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk to your doctor if you think you may be at risk for breast cancer.
Risk factors for breast cancer include the following:
- A of , (DCIS), or (LCIS).
- A personal history of (noncancer) breast disease.
- A of breast cancer in a (mother, daughter, or sister).
- Inherited changes in the that increase the risk of breast cancer.or genes or in other
- Breast that is dense on a .
- Exposure of breast tissue to made by the body. This may be caused by:
- Taking such as estrogen combined with for of menopause.
- Treatment with to the breast/chest.
- Drinking .
Older age is the main risk factor for most cancers. The chance of getting cancer increases as you get older.
uses a woman's risk factors to estimate her risk for breast cancer during the next five years and up to age 90. This online tool is meant to be used by a . For more information on breast cancer risk, call 1-800-4-CANCER.
Breast cancer is sometimes caused by inherited gene mutations (changes).
The genes in cells carry the information that is received from a person’s parents. Hereditary breast cancer makes up about 5% to 10% of all breast cancer. Some genes related to breast cancer are more common in certain ethnic groups.
Women who have certain gene , such as a or mutation, have an increased risk of breast cancer. These women also have an increased risk of , and may have an increased risk of other cancers. Men who have a mutated gene related to breast cancer also have an increased risk of breast cancer. For more information, see the PDQ summary on .
The use of certain medicines and other factors decrease the risk of breast cancer.
- Taking any of the following:
- Less exposure of to made by the body. This can be a result of:
- Getting enough exercise.
- Having any of the following procedures:
Signs of breast cancer include a lump or change in the breast.
- A lump or thickening in or near the breast or in the underarm area.
- A change in the size or shape of the breast.
- A dimple or puckering in the skin of the breast.
- A turned inward into the breast.
- Fluid, other than breast milk, from the nipple, especially if it's bloody.
- Scaly, red, or swollen skin on the breast, nipple, or (the dark area of skin around the nipple).
- Dimples in the breast that look like the skin of an orange, called .
Tests that examine the breasts are used to detect (find) and diagnose breast cancer.
Check with your doctor if you notice any changes in your breasts. The following tests and procedures may be used:
- : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- : An exam of the breast by a doctor or other health professional. The doctor will carefully feel the breasts and under the arms for lumps or anything else that seems unusual.
- : An of the breast.
- : A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a . The picture can be printed to be looked at later.
- : A procedure that uses a magnet, , and a computer to make a series of detailed pictures of both breasts. This procedure is also called nuclear magnetic resonance imaging (NMRI).
- : A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.
- : The removal of cells or tissues so they can be viewed under a by a to check for signs of cancer. If a lump in the breast is found, a biopsy may be done.
There are four types of biopsy used to check for breast cancer:
- : The removal of an entire lump of tissue.
- : The removal of part of a lump or a sample of tissue.
- : The removal of tissue using a wide needle.
- : The removal of tissue or fluid, using a thin needle.
If cancer is found, tests are done to study the cancer cells.
Decisions about the best treatment are based on the results of these tests. The tests give information about:
- how quickly the cancer may grow.
- how likely it is that the cancer will spread through the body.
- how well certain treatments might work.
- how likely the cancer is to (come back).
Tests include the following:
- : A test to measure the amount of and in cancer tissue. If there are more estrogen and progesterone receptors than normal, the cancer is called and/or . This type of breast cancer may grow more quickly. The test results show whether treatment to block estrogen and progesterone may stop the cancer from growing.
- : A to measure how many HER2/neu genes there are and how much HER2/neu is made in a sample of tissue. If there are more HER2/neu genes or higher levels of HER2/neu protein than normal, the cancer is called . This type of breast cancer may grow more quickly and is more likely to spread to other parts of the body. The cancer may be treated with that target the HER2/neu protein, such as and .
- : Tests in which samples of tissue are studied to look at the activity of many genes at the same time. These tests may help predict whether cancer will spread to other parts of the body or recur (come back).
- : This test helps predict whether or that is estrogen receptor positive and will spread to other parts of the body. If the risk that the cancer will spread is high, may be given to lower the risk.
- : This test helps predict whether stage I or stage II breast cancer that is node negative will spread to other parts of the body. If the risk that the cancer will spread is high, chemotherapy may be given to lower the risk.
Based on these tests, breast cancer is described as one of the following types:
- (estrogen and/or ) or ( and/or ).
- HER2/neu positive or .
- (estrogen receptor, progesterone receptor, and HER2/neu negative).
This information helps the doctor decide which treatments will work best for your cancer.
Certain factors affect prognosis (chance of recovery) and treatment options.
- The of the cancer (the size of the tumor and whether it is in the breast only or has spread to lymph nodes or other places in the body).
- The type of breast cancer.
- Estrogen receptor and progesterone receptor levels in the tumor tissue.
- Human epidermal growth factor type 2 receptor (HER2/neu) levels in the tumor tissue.
- Whether the tumor tissue is triple negative (cells that do not have estrogen receptors, progesterone receptors, or high levels of HER2/neu).
- How fast the tumor is growing.
- How likely the tumor is to recur (come back).
- A woman’s age, general health, and menopausal status (whether a woman is still having ).
- Whether the cancer has just been or has recurred (come back).
October is Breast Cancer Awareness Month, a perfect time to remind women Veterans about the importance of mammograms and early detection.
According to the National Cancer Institute, there were an estimated 266,000 new cases of breast cancer so far in 2018 and over 40,000 deaths.
A more encouraging statistic is the percentage of breast cancer patients surviving five years after treatment: almost 90%. (For the years 2008-2014.)
Approximately 12.4 percent of women will be diagnosed with female breast cancer at some point during their lifetime, based on 2013-2015 data.
In 2015, there were an estimated 3,418,124 women living with female breast cancer in the United States.
What is breast cancer?
Breast cancer is cancer that forms in the breast when abnormal (unusual) cells turn into cancer. Breast cancer can spread to other parts of the body.
Talk with your doctor or nurse if you notice any of these changes:
- A lump or an area that feels very firm in the breast or armpit
- A change in size, shape, or feel of the breast
- Fluid (called discharge) coming out of a nipple
- Skin on the breast that is itchy, red, flaky, or dimpled
What if the doctor finds something wrong with my breast?
Mammograms let the doctor or nurse look for lumps inside your breasts that can’t be felt. If a lump is found, you may need other tests to find out if it’s cancer or not.
The doctor or nurse may take a small bit of tissue from the lump for testing, a biopsy.
At each VA Medical Center nationwide, a Women Veterans Program Manager is designated to advise and advocate for women Veterans. She can help coordinate all the services you may need, from primary care to specialized care for chronic conditions or reproductive health.
Woman Veterans who are interested in receiving care at VA should contact the nearest VA Medical Center and ask for the Women Veterans Program Manager.
Women currently comprise approximately 16 percent of the United States military. As of 2016, service women are permitted to serve in any military position for which they meet the gender-neutral performance standards and requirements. These expanded roles have increased the cadre of responsibilities that service women have, as well as increased their potential challenges. As such, it is more important than ever for military leadership, researchers, and health care providers to understand women’s health.
The Departments of Veterans Affairs (VA) and Defense (DOD) collaborated to host the National VA/DOD Women's Mental Health Mini-Residency Aug. 28-30 in Arlington, Virginia. This mini-residency brought together more than 150 VA and DOD mental health providers so they could gain knowledge and skills in the provision of gender-sensitive care to women Veterans and service members. Specific topics included:
- Complex trauma
- Safety planning
- Suicide prevention
- Compassion fatigue
- Sexual functioning
- Impact of health conditions
- Ostracism, and many others
During the mini-residency, attendees developed an action plan to disseminate these best practices and facilitate practice change at their local facilities -- to optimize women's mental health care in VA and DOD. Requests from DOD mental health providers to attend in person far exceeded the number of spots available, so we posted all DOD presentations and posters on the mini-residency website for you to read, download and share with colleagues.
Today also marks the start of Women’s Health Month, a time to highlight women’s health, to include the mental health of service women. Throughout the month, we will showcase some of the exciting presentations from the mini-residency through our Clinician’s Corner blog series.
Dr. Nancy Skopp, PHCoE research psychologist, will describe the impact of gender stereotypes on diagnosis and treatment. Dr. Laura Miller of the Hines Jr. VA Hospital in Hines, Illinois, will highlight mental health across the female lifespan, and Dr. Margaret Altemus of the Yale School of Medicine in New Haven, Connecticut, will discuss perinatal and postpartum depression. Dr. Lauren Messina of the Consortium for Health and Military Performance will discuss a total force fitness approach to physical and mental health, which can help women and men improve their emotional health and manage symptoms of mental health disorders.
For updated research and resources, be sure to check out our Women’s Mental Health webpage and follow us on Facebook for more women’s mental health-related posts and resources. Like, comment and share on your channels so we can promote women’s health awareness, and particularly the importance of women’s mental health, during October.
The Veterans of American Legion Post 204 ― the “Service Girls” ― as they’re known in their Pacific Northwest home, are speaking out about the American Legion’s membership policies, which currently exclude the spouses of female Veterans in every branch of their organization.
The former commander of Post 204 and 35-year Army Veteran Carrol Stripling is getting ready to file a third resolution with the American Legion since 2015. Her first two resolutions were denied. Stripling said the denials were representative of a culture that hasn’t always respected the needs of female Vets.
“We don’t want our service undervalued any longer,” Stripling said at a June 23 meeting in Bothell, Wash.
Founded in 1946, Post 204 is one of the few all-female American Legion posts across the country. Located in Washington state, the post is open to any female service members who’d like to join.
“We call ourselves Post two-zero-four ― never two-oh-four ― because it makes [people] remember our name and who we are,” said Sandy Cooper, a retired Air Force Veteran and the first female USAF fire chief.
“As a woman Veteran, you can’t be average. You have to be better than the men to get respect,” Cooper continued.
Respect is why Post 204 came into being. Born out of what the women said was a need for sharing in a way only female Vets can understand, the service members said they support each other in and out of meetings without judgment.
But they said they also have a looming concern about the organization that has come to offer them so much comradery: they want the same benefits their male counterparts are offered. They want their husbands to have a place within the American Legion organization.
Elizabeth Bissett, retired Army Veteran, echoes the concerns of the other members. “I want to be able to have a male auxiliary … all of us are in the same boat and we don’t have an official auxiliary,” Bissett said.
The American Legion history
Since it was chartered by Congress in 1919, the American Legion, or The Legion, is the largest wartime Veterans’ nonprofit organization.
According to The Legion’s website, it was developed by “war-weary Vets from World War I” and it quickly grew into a unique reprieve for service members to connect.
The organization offers a network for Vets to grow friendships, bonding over volunteering events and activities, as well as unifying members through shared experiences. The Legion prides itself on patriotism and support for its 2.4 million members across the nation, according to its mission statement.
The American Legion Auxiliary (ALA), developed the same year as The Legion, is a club for spouses of male Veterans, as well as daughters of Veterans.
Essentially, it’s a place for women to lend support for each other and their service members.
The ALA offers similar kinship and events, offering “support to The American Legion and to honor the sacrifice of those who serve…” according to the ALA mission.
Likewise, The Sons of the American Legion (SAL) is an organization that offers membership to sons of Veterans.
While these organizations have independent rules and statutes which dictate membership eligibility, all are inclusive to most relatives of Veterans. But none offer memberships to spouses of female Veterans, despite a growing concern.
Female membership in the military
In 1948, the Women’s Armed Services Integration Act was passed by Congress, allowing women to have a permanent place in the military. But long before it was a law, women have inserted themselves in military efforts dating back to the late 18th century.
Today, women represent 16 percent of all enlisted service members and 18 percent of officers. These numbers are up from 1973, when women represented 2 percent and 8 percent, respectively.
The influx of female armed service members over the last 40 years are not reflected in the American Legion’s membership policies, which haven’t changed since it began in 1919, despite The Legion’s declining membership numbers.
While there are more active female Legion members today, there’s still no place for their spouses to gather in support of their service.
“You know, my husband has said to me, ‘if there were other husbands here that I had a way to network with, we could go out and have a golf outing or we could do this or that,' so there is a need and an interest in networking,” Cooper said.
Membership eligibility and the American Legion Auxiliary
The complicated issue of changing policy to include male spouses of female Vets in the ALA is determined by different factors. These factors dictate how and if the constitution of the American Legion Auxiliary can be amended.
ALA National Secretary and Executive Director Mary “Dubbie” Buckler released a statement in 2015 on the subject: “The American Legion Auxiliary is a separate corporation, incorporated as an all-female organization with our own Tax Identification and our own IRS Group Exemption independent from The American Legion. As such, we cannot amend our American Legion Auxiliary bylaws to change membership eligibility because our Articles of Incorporation filed with the government already prohibits it.”
She went on to say: “The American Legion Auxiliary is both incorporated and constituted as an all-female organization and our national governing documents cannot conflict with The American Legion’s governing documents. The American Legion National Constitution Article 13, Section 2 specifically limits membership in the American Legion Auxiliary to females, as specified consistently in everything published stating membership eligibility criteria. Therefore, any changes to membership eligibility in The American Legion Auxiliary would first require a constitutional amendment to both the Legion and ALA constitutions and an amendment by the federal government to the IRS Code, which is considered very unlikely.”
The Vets of Post 204 say the long explanation is an excuse by the American Legion and the Auxiliary so they won’t lose their standing as a federal charter.
“They’re worried about losing their federal charter. If you leave [the tax code] the way it is, nobody can mess with it,” Stripling said. “Before we went to Panama and Grenada, the Legion went to the IRS and said, ‘You know, we are all dying, we will have no members … so let’s let some of those Cold War Veterans in’ and the IRS said, ‘Sure.’ … So you can see it’s a misnomer.”
Another explanation came from the American Legion Frequently Asked Questions Guide in a 2013 document citing that the need for male spouses to have a separate auxiliary would be arbitrary.
In direct response to the question of why female spouses don’t have a separate organization, the document read: “Over the last few years, Internal Affairs has had a few resolutions on male spouses of female Veterans (either to join SAL or to establish a separate male auxiliary) that were considered by various Convention Committees and all were rejected … it was unanimously decided that the American Legion is a wartime Veterans’ organization and not a social organization. Each of the three organizations has specific requirements for membership with specific purposes and to add spouses either male or as defined by specific states would not add value to our organizations.”
American Legion Auxiliary headquarters did not respond to further questions on the subject of membership eligibility.
What comes next?
Master Sgt. Kacie Chiappini, a current Air Force reservist from the Youngstown Air Reserve Station in Vienna, Ohio, said she joined the American Legion because it was a way to bond with her WWII Veteran grandfather.
“My grandfather was the last WWII [Veteran] still living that was a member at our post and we would meet him there a lot before he passed away. He loved it there … but it was mostly [him] that got me going there,” Chiappini said.
Like the women of Post 204, Chiappini shares concerns over why her husband can’t join the club where she’s had so many fond experiences.
“To me, it’s mostly principle,” Chiappini said. “It needs to change.”
Chiappini brought the issue up to her commanding officer Lt. Col. John Boccieri. Boccieri is a also a member of the American Legion and a former U.S. congressman in Ohio’s 16th District.
“I, too, was startled by the fact that the American Legion will not permit spouses of female service members to join the auxiliary organization. Permitting a family to honor all Veterans in such an esteemed organization as the American Legion can only strengthen the respect we pay to all Veterans, whether male or female,” Boccieri said.
The movement for change is in early stages as more female Vets question the policies of The Legion.
However, the women of Post 204 want Vets like Chiappini, and every other female service member, to have the opportunity for a male auxiliary in support of their service in the near future.
Stripling, Cooper and Bissett shared their frustrations over previous efforts to file resolutions and how their voices, seemingly lost before having a chance to use them, may not be enough to spark the necessary measures of change.
“These resolutions we filed, they go to committees, but sometimes they don’t even reach the committees because the staff pulls them,” Stripling said. “The committees are appointed, but you don’t know which committee sees the resolution.”
In the coming months, Stripling will file a third resolution with the American Legion, hoping this time it will make a difference.
“I just think that changing the culture of The Legion will help change the whole culture in the military. That’s what we’re here for,” Stripling said.
The women say they won’t stop until The Legion recognizes the need for a male auxiliary in support of female Veterans, whose service is just as valuable as their male counterparts.
“We’re gonna fight. And we’re eventually gonna get it,” Bissett said.
There are far more men than women Veterans in the VA system. For this reason, many women Veterans are not aware of resources offered just for them. Many women Veterans prefer treatment with other women.
Research shows that people often do better in treatment with others that are more like them. As a result, mental health services just for women are offered in many VA’s across the country.
VA Women Veterans Program Managers
Every VA Medical Center in the country has a Women Veterans Program Manager. This person is your advocate. She can help you get to VA services and programs, state and federal benefits, and resources in the area where you live.
If you need help:
- Call your local VA and ask to speak to the Women Veterans Program Manager
- Learn more about the VA Women Veterans Health Care program
- Find helpful information on the VA Center for Women Veterans website
If you have questions about your VA care, you should first go to your Women Veterans Program Manager. During normal business hours, you can also contact:
- The Department of Veterans Affairs Center for Women Veterans at (202) 273-6193
- The Veterans Health Administration Women Veterans Health Strategic Health Care Group at (202) 461-1070
Types of VA programs for women
The following list describes some of the mental health service programs offered by VA for women Veterans. To find out more, see VA PTSD Treatment Programs. The fact sheet links to a list of VA PTSD treatment programs. The list includes programs for women, with contact information. For other help locating a program or service, you should ask your Women Veterans Program Manager.
- Women's Stress Disorder Treatment Teams (WSDTTs). WSDTTs are special outpatient (not live-in) mental health programs. They focus on treatment of PTSD and other problems related to trauma.
- Specialized inpatient and residential programs for women. These are live-in programs for women Veterans who need more intense treatment and support. While in these programs, women live either in the hospital or in a residence with other women. For help locating a program, ask your Women Veterans Program Manager.
- Cohort treatment or separate wings for women. These programs are like the live-in programs discussed above except these programs accept both men and women. Some programs accept women in groups that start treatment together on a certain date. Sometimes the program has a space set apart for women.
- Women Veterans Comprehensive Health Centers. Complete health centers for women Veterans are located in many VA's around the country. Many of them provide outpatient mental health services to women Veterans. Check with your local Women Veterans Program Manager to see if there is a women's health center that provides mental health services near you.
- Women Veterans Homelessness Programs. The Women Veterans Program can help you find shelter if you are homeless or at risk of being homeless. Certain VA locations have programs for homeless women Veterans and homeless women Veterans with children. Contact your Women Veterans Program Manager for resources near you. You can also contact the Social Work Services department at your local VAMC. For more information, go to Homeless Veterans.
For more information
To learn more about women and traumatic stress, please see this section of materials Specific to Women.
The proportion of women who experienced serious complications while giving birth in U.S. hospitals rose 45 percent between 2006 and 2015, according to a report released today by the Agency for Healthcare Research and Quality (AHRQ).
The analysis, based on data from AHRQ’s Healthcare Cost and Utilization Project (HCUP), explored overall trends in severe maternal morbidity and mortality while identifying areas of particular concern. The new report indicates, for example, that rates of acute renal failure, shock, mechanical ventilation use and sepsis at delivery all more than doubled during the 10-year period.
“This report provides an essential update to our understanding of an urgent public health issue,” said AHRQ Director Gopal Khanna, M.B.A. “With these data in hand, State and Federal agencies, patient safety experts and health systems can evaluate maternal morbidity trends in greater depth, a vital step before addressing the challenge.”
AHRQ’s new statistical brief, “Trends and Disparities in Delivery Hospitalizations Involving Severe Maternal Morbidity, 2006-2015,” provides detailed statistics on complications involving labor and delivery:
- The rate of severe complications increased 45 percent overall during a 10-year period, from 101 per 10,000 delivery hospitalizations in 2006 to 147 per 10,000 in 2015.
- Some severe conditions involved medical procedures. In 2015, for example, blood transfusions occurred with more than half of deliveries among mothers who were in shock, had an amniotic fluid embolism, were experiencing a sickle cell disease crisis or had disseminated intravascular coagulation (the formation of blood clots throughout the body). One-third of deliveries with shock had a hysterectomy.
- In 2015, rates of severe maternal morbidity were highest among poor mothers, for those over the age of 40, or uninsured or on Medicaid or lived in large urban areas.
The report also underscored racial and ethnic disparities among women who experienced severe complications. For example, although deaths decreased overall, black women were three times more likely than white women to die as a result of delivering a baby in 2015 (11 versus 4 deaths per 100,000 delivery hospitalizations, respectively). Compared with white women, severe maternal morbidity was 110 percent more likely among black women, 40 percent more likely among Hispanic women and 20 percent more likely among Asian/Pacific Islander women in 2015.
To help hospitals reduce the occurrence of severe maternal morbidity, AHRQ developed the Safety Program for Perinatal Care to improve communication and the quality of care of labor and delivery units to reduce maternal morbidity and neonatal adverse events. The toolkit builds on knowledge gained from AHRQ's Comprehensive Unit-based Safety Program (CUSP), TeamSTEPPS® team training system and patient safety and medical liability initiative demonstration grants.
In addition, AHRQ is working with colleagues at the HHS Health Resources and Services Administration to integrate key components of teamwork and safety culture training strategies into The Alliance for Innovation on Maternal Health program’s maternal safety bundles.
AHRQ is the lead Federal agency charged with improving the safety and quality of America’s health care system. AHRQ develops the knowledge, tools and data needed to improve the health care system and help Americans, health care professionals and policymakers make informed health decisions. Learn more about the Agency at www.ahrq.gov.
ASHEVILLE, N.C. (WLOS) — A Candler Veteran who was trying to get medical treatment through Veterans Affairs found out the agency has declared her dead.
"I said, 'I look pretty well preserved for being dead for 26 years,'" Judith Herren, an Iraq War Veteran, said.
Herren said the problem started back in November when she decided to consider getting treatment at Charles George Veterans Affairs Medical Center in Asheville.
"They couldn't process anything because I was listed as ‘deceased’ in September of 1991," Herren said.
Herren served in the military for eight years -- four in the Army and four in the National Guard, where she found herself in Iraq.
"We were the first units in Desert Shield and Desert Storm, and we really didn’t know what to expect," Herren said.
What she also didn’t expect is having to prove she was alive when she came back.
"I finally got listed as ‘non-deceased’ back in April of this year," Herren said.
But then another problem came up.
"It took another three months to get my ID card,” Herren said. “Because I was listed as ‘deceased’ on that system, too."
Which leads us to now, where Herren said she wasn't able to renew her 12 daily prescriptions because she was also listed as "deceased" on that system.
"It shouldn't have happened the first time, much less three times," Herren said.
Herren said she is thankful for all the help she’s received from Charles George VAMC employees.
This is a statement sent to News 13 by Armenthis Lester, Public Affairs Officer at Charles George VAMC, regarding Herren's case:
"The issue Ms. Herrin is having originated with the Health and Eligibility Center in Atlanta, GA. This is a national office separate from Charles George VA Medical Center. However, our administrative office staff worked with the Health and Eligibility Center to assist this Veteran, and as of Monday, August 27, 2018, her issue is resolved. We honor Ms. Herrin's service to this country and our desire is for Veterans to get the care they need, when they need it."
News 13 also reached out to the Health and Eligibility Center with the VA to find out what initially led to the problem. We're still waiting to hear back.
Treating women Veterans
Patty Axtell, RN, and Suzanne Rainforth, LPN, (pictured above) practice pelvic exam supply setup with instructor Jonna Brenton, RN, at Grand Island VAMC. The number of women Veterans is increasing rapidly. Consequently, the number of women Veterans receiving health care from VA tripled from between 2000 and 2016, growing from 160,000 in 2000 to 475,000 in 2016, driving an increase in need for high-quality, gender-specific health care.
As of May 2017, 26 percent of enrolled women Veterans lived in rural and highly rural areas. These are areas in need of more trained primary care providers designated as Women’s Health Primary Care Providers (WH-PCPs) and nursing staff trained in women’s health.
Since 2008, the Women’s Health Services (WHS) has developed and delivered a comprehensive education and training model for clinical staff, called the Women’s Health Mini-Residency, to address gaps in knowledge and skills in women’s health topics. This training is traditionally a three-day, face-to-face program offered 1-2 times per year in Orlando, Florida.
Although more than 3,500 PCPs and 1,200 primary care nurses trained in this mini-residency model, additional training needs persist, including for staff in rural VA facilities.
WHS understands that rural VA clinics, with fewer staff, may face challenges sending staff off-site for training without disrupting normal clinic operations. Travel from rural areas also means more time away from clinical care.
Bringing the training to clinic sites
To better support women Veterans’ long-term health and well-being, address staff training need and minimize the burden on the clinic and staff, WHS, funded by the Office of Rural Health (ORH), launched a blended learning approach to the Women’s Health Mini-Residency intended for providers and nurses at rural Community Based Outpatient Clinics (CBOC) and VA medical centers (VAMC) by bringing this training program directly to clinic sites. This modified mini-residency includes:
- Core women’s health courses on topics such as abnormal uterine bleeding, contraception, breast issues and intimate partner violence offered via the Veteran Affairs’ Talent Management System (TMS) and done independently in advance of the one-day training delivered directly at clinic sites
- Tailored one-day on-site training includes interactive portions of the program such as facilitated case discussions, simulation equipment for hands-on activities, videos of gynecologic procedures and exams, and live models for breast and pelvic exam instruction
Patient-Aligned Care Team (PACT) providers and nurses train side-by-side in this inter-professional training program, which aligns with how care is provided. In all, each provider and nurse will receive more than 18 hours of accredited medical training. Launched June 2018, in partnership with ORH, WHS will provide this mini-residency for rural providers and nurses in up to 40 rural clinical sites per year to support the highest level of care for women Veterans in rural areas.