In 2011, Maj. Gen. (P) Patricia Horoho deployed to Afghanistan as the International Security Assistance Force Joint Command Special Assistant for Health Affairs to conduct an assessment of theater Health Service Support with a multidisciplinary team of experts varying from information technology to combat casualty care and women's health. Upon return from deployment, this group of professionals wrote a series of reports that comprised a comprehensive Health Services Support Assessment (HSSA) completed in May 2012.
The Women's Health Assessment Team composed a White Paper entitled "The Concerns of Women Currently Serving in the Afghanistan Theater of Operations (ATO)," which was subsequently integrated into the HSSA. The Women's Health Task Force was established in December 2011 to address concerns identified in the HSSA. Twenty-six tasks were identified as specific to women's health. They were centered on six broad categories and operationalized into eight functional teams. Since its inception over three years ago, numerous personnel have dedicated significant time and resources to follow the tasks through to completion.
Some highlights from the Women's Health Task Force (WHTF) include providing better female health education, advocating for better body armor for females with Program Executive Officer (PEO)- oldier, creating clinical practice guidelines for use by medics and providers, and to provide better visibility of the Female Urinary Diversion Device (FUDD). Other areas of work included addressing the psychological needs of Families when Service members deploy, addressing Sexual Harassment and Assault Response Prevention, addressing the psychological effects of women in combat, and examining the feasibility of a 12-month postpartum deployment deferment.
Education was a central theme in many tasks. Women's health content was introduced into Basic Combat Training for recruits. Working with U.S. Army Training and Doctrine Command (TRADOC) and the Army Medical Department Center & School (AMEDDC&S), the WHTF crafted a class focused on female-specific readiness issues for leaders in noncommissioned officer (NCO), officer and pre- command courses. In an effort to combat barriers to seeking care, the WHTF developed a program of instruction that addresses patient confidentiality and privacy in austere settings.
Another item used to break down barriers to seeking care was the development of algorithms for both medics and providers with limited female healthcare experience. In the end, algorithms developed for providers and for medics included "Evaluation and Treatment of Abnormal Uterine Bleeding," "Urinary Incontinence," "Evaluation of Sexual Transmitted Illness (STI)," "Pelvic Inflammatory Disease Treatment Protocols," "Menstrual Cycle Control," "Emergency Contraception" and when to consult gynecological and inpatient services.
Medic-specific assessment protocols included "Vaginal Bleeding," "Vaginal Discharge," and "STI Concerns." While currently available on the U.S. Army Public Health Command Women's Health Portal, they are also being incorporated into the new Army pamphlet, Algorithm Directed Troop Medical Care (ADTMC).
The WHTF promoted efforts already underway with PEO-Soldier to improve women's gear. Body armor that was designed with men in mind resulted in ill-fitting body armor due to women's anatomical differences. Females traditionally have wider hips, narrower shoulders and shorter frames. Without these differences accounted for during the design of the body armor, most females had to obtain a best fit in one to two sizes larger. Therefore, their armor chafed hips, made seating a weapon in the shoulder difficult, and had a protective plate that hung low and would bang against legs. PEO-Soldier's redesign helped address those issues and the armor is being tested by women today.
Another item that the task force worked with was the FUDD. An anatomically correct funnel that sits against the perineum, it has an attached tube that allows women to void when standing or during a tactical pause. This is designed to decrease the need of women to hold their bladder while on mission or sacrifice hydration, both of which can lead to urinary tract infections. While it is available for order in the supply system, the task force is still working to make this a Rapid Fielding Initiative so deployed women would all receive one. In the meantime, it has become an essential packing item for females attending Ranger School.
Over the life of the task force, dozens of persistent team members have valiantly strived to bring changes to women's health in the deployed setting. Many of these issues will continue to be relevant as operations tempo decreases and we transition back to a garrison based environment. Programs established to help educate healthcare providers, Soldiers, and their leaders will continue to increase female readiness and those advancements in behavioral health will continue to help children and Families.
To ensure continuity, the Women's Health Service Line will adopt the remaining tasks from the WHTF, seating them in their operational line of effort to ensure completion, relevance, and perform updates as needed.
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