Samantha Frost has been getting acupuncture to relieve pain from a neck injury she suffered while a security officer in the Air Force.
Jennifer Hubbard gets inhalers for an asthma-like condition from her days as a Marine Corps welder.
Cherrilyn Pugh, who had a 20-year military career, comes in for regular checkups at the U.S. Department of Veterans Affairs McClellan women's clinic.
Increasingly, they are the face of the VA, joining Greatest Generation retirees and grizzled Vietnam vets. The ranks of female veterans are mushrooming in large measure because of our wars in Afghanistan and Iraq. Already, 100,000 and counting have returned from the war zones and left the military. Now, nonprofits and government agencies alike the VA medical system in particular are grappling with that surge.
One fact that sets the wars apart is how many women have been close to combat. Another truth about our current wars is that most of us have not been called on to make any real sacrifices. The least we can do for those who have served is to help make sure they're made whole when they come home.
Janelle Adams grew up in Sebastopol and, like many Americans, was drawn to the military after 9/11. She served as an Army intelligence analyst for four years, including tours in Iraq and Afghanistan.
Now, she relies on the VA for all her health care, including treatment for migraines and other concussion-like symptoms from a vehicle wreck in Afghanistan. She was riding in a Suburban speeding from Bagram Air Base to Kabul when it flipped over rounding a curve, throwing her out.
Once she left active duty, it took six months of paperwork to become eligible for benefits, she says. "It's a slow start getting in."
She received more support at California State University, Sacramento, where she plans to graduate next spring with a biology degree. On campus, there's a veteran success center and an active student group for the 1,200-plus veterans, more than a quarter of them women.
"It's made the whole thing easier," says Adams, 29. "There are a lot of people willing to help."
She is among the nearly 250,000 women deployed to Iraq and Afghanistan, 11 percent of all forces. Officially, they are excluded from combat, but there are no clear front lines, either. They have been in the middle of firefights and in convoys blown up by roadside bombs. More than 100 women have been killed and more than 600 injured.
Typically younger than male vets, they come home with all the wounds, visible and unseen, that men do. Some succumb to the same demons of depression and suicide.
About one in five female vets have been diagnosed with post-traumatic stress disorder, according to VA data. Until recently, women had a higher burden of proof to get benefits since they were not supposed to be in direct combat.
It's frightening and disgraceful how many are dealing with "military sexual trauma." Nearly one-fifth of returning women report abuse, but the real number could be much higher because many are afraid to speak out.
More than half the women returning from war zones have gone to the VA for health care, a primary reason why the number of female patients has doubled since 2004 to about 255,000 and is expected to double again by 2015.
The VA, which only began providing expanded services to women in 1992, is ramping up to offer comprehensive care tailored for women, including gynecological services, mammography and mental health treatment.
"People think it's still their grandfather's VA, but in 2011, it's a whole new ballgame," says Dr. Scott Gale, a gynecologist who is medical director for women's health in the VA's Northern California health care system.
It's a work in progress.
While the VA has made significant strides for instance, there are now advocates and social workers whose job is to help female veterans it takes time to change the male-dominated culture of such a sprawling bureaucracy.
There are precious few places like the VA's Menlo Park complex. It includes a residential recovery program for post-traumatic stress and an outpatient counseling center for emotional well-being. As the VA's first and only "center of excellence for women's health," it is held up as the gold standard.
Dr. Natara Garovoy, a psychologist and program director of the Women's Prevention, Outreach and Education Center, says it is distinguished by the early funding it received and the intensive mental health treatment it offers. In its first three years, however, only about 500 female veterans have gone through the outpatient program.
"My hope is that all women no matter where they show up will be given access to the care that they need," she says. "My other hope is that there's an understanding that women do need targeted services. They do have unique needs."
Chandra Banks, a research fellow at Iraq and Afghanistan Veterans of America, calls the Menlo Park complex "phenomenal," but says, "That's the exception, not the rule."
More common are Sacramento County's two VA women's clinics, which offer many of the same services, but in more modest surroundings. The women's clinic occupies a corner of the VA's outpatient center at McClellan, the Air Force base turned business park. There's a separate waiting room where brochures on breast and bone health vie for attention with those on sexual trauma; a conference room for female-only group counseling sessions; and a half-dozen exam rooms. In the one with ultrasound machines, there's a poster with pink and lavender baby booties and the slogan: "A healthy pregnancy should be the first gift you give your child. Let VA help."
At the Sacramento VA Medical Center in Mather, the women's clinic is housed in a trailer. While there's a design for a 3,000-square-foot permanent clinic slightly larger than the one at McClellan, there's no money to build it.
Most places in California, and across the nation, female veterans have to search longer and harder for all the help they need. "You can find the services. The issue might be the distance that you might have to travel to get to the services," says Barbara Ward, deputy secretary of the state Department of Veterans Affairs.
Gale says his "biggest challenge" is the size of the Northern California VA system, which stretches from the Oregon border to Sacramento and from the Sierra to the East Bay. Even with a mobile clinic, telemedicine and a 10th clinic soon to open in Yuba City, female vets in outlying areas are at a disadvantage.
California has the most female veterans of any state, about 167,000 of 1.8 million nationwide. With about 10,000, Sacramento County has the third most of any California county.
Among the most pressing needs is child care. Thousands are single moms, or divorced while deployed, and some miss medical appointments because they have to stay with their kids.
Another gap is more gender-specific programs, such as women-only counseling sessions for post-traumatic stress and sexual abuse.
Those were among the recommendations last fall from a national VA advisory committee on which Ward serves. Many of those shortcomings were also highlighted in an August 2009 state report commissioned by state Sen. Lois Wolk, D-Davis, and the California Commission on the Status of Women.
Since the report, there are more programs aimed toward women and those with post-traumatic stress are being taken more seriously. But there are still not enough female clinicians and staffers, and insufficient assistance for female veterans who have children or are caring for parents or older relatives, Wolk says.
"We have a good ways to go," she says.
State Veterans Affairs Secretary Rocky Chavez says he wants to improve services to female veterans who have children and who may be homeless. Female vets are at greater risk of being homeless than their male peers. While the VA has a goal to end homelessness among veterans by 2015 and funds about 500 homeless shelters, not many house women with children.
Ward and Chavez say they also want to better coordinate the benefits and services available to female vets from government agencies and nonprofits, so they can fill in the gaps and avoid duplication. It needs to be easier to navigate the maze of programs.
For that to happen, outreach to veterans is essential. Gov. Jerry Brown originally proposed to cut $9.9 million from veterans' services, ending state support for county staffers who help veterans claim benefits and for Operation Welcome Home, started last year by Gov. Arnold Schwarzenegger to help veterans successfully transition to civilian life.
After strenuous objections from officials including Rep. Jerry McNerney, a Pleasanton Democrat on the House Committee on Veterans' Affairs who in a letter urged Brown not to "balance our state's budget on the shoulders of our nation's veterans" the governor and the Legislature restored the state's $2.6 million contribution for the staffers.
That will help, but Chavez says the state can do more for veterans, men and women, returning from war zones.
"What we're doing here in California is OK," he says, "but it's not where it needs to be."