MARTINSBURG, W.Va. - Doctors at the Veterans Affairs Medical Center in this quiet, bucolic town tucked between coal country and the nation's capital used to go months without treating a female veteran.
Today, they're reporting the beginning of a boom.
Mixed with the Vietnam and World War II-era patients waiting for a doctor are 20-something women who served in Iraq and Afghanistan, reading Allure magazine and, in some cases, coming in for pregnancy tests.
The hospital sees nearly twice as many women it did before the Sept. 11 attacks. Administrators opened a women's clinic and are trying to take female veterans into consideration when deciding everything from the color of the walls to the size of the prosthetics offered. Waiting areas soon will have kid-friendly tables. An onsite day care for veterans with medical appointments is under review.
"It's not the old guys group anymore," said Ann Brown, the medical center director, from her office inside the brown brick hospital not far from Harpers Ferry. "It's women and it's younger, and the younger folks, they need more than just medical care. They've got family issues. They need help reintegrating in how to get back into their jobs."
No one's quite ready for them, but female veterans have arrived in the VA's hundreds of hospitals and clinics. A system long geared toward treating an aging male population is scrambling to care for thousands of female veterans. They are younger, too. Most of the women who served in the recent wars are under age 40.
In the last budget year, the VA saw 281,000 female veterans, a 12 percent increase from two years earlier. Women represent one in 16 veterans in the system, but in 15 years are projected to represent one in seven.
This increase has forced changes in the VA's culture, in addition to its medical system. Not only have VA facilities had to get equipment such as gynecological exam tables, they've had to create a place where women feel comfortable.
In Martinsburg, for example, the hospital recently got a bone density scan machine and had an interior decorator design a warm, neutral-colored room with beach-themed art work to put it in. The door closes for privacy, and there's a hook for hanging up clothes - accommodations that once weren't much of an issue, said Terry Hopper, the nuclear medicine supervisor.
"The older men, you can pretty much do anything," Hopper said. "They are very cooperative with whatever needs to get done. It's definitely a change."
Still, change is not happening fast enough for some women in the VA's system.
The good news is that positive changes are in the works, said Joy Ilem, assistant national legislative director at Disabled American Veterans. But, Ilem said, "They are not at the point where if you go into every VA clinic that you know you're going to get good care if you're a woman veteran."
Beyond Martinsburg, some female veterans said the VA staff didn't believe them when they said they had been in combat. Other women described being mistaken for daughters or granddaughters of male patients.
"You do feel kind of out of place there just because VA hospitals are consumed by Vietnam vets, primarily," Staff Sgt. Meghan Meade, 26, of East Moriches, N.Y. A gunner in the Air National Guard, Meade broke her leg in 2006 while in Iraq and had two years' worth of procedures at the VA in Northport, N.Y.
Meade said any awkwardness was overcome by the good care she received.
"Every time I went there, as dorky as it sounds, I felt so special because everyone knew who I was," Meade said.
Not all women, however, are willing to give the VA a second chance.
Retired Staff Sgt. Karen Boudriault, 49, of Waterboro, Maine, spent 26 years in the military before retiring in 2007. She said she was far from amused when she went to a VA facility in Manchester, N.H., for a post-Iraq deployment physical, and the phlebotomist drew blood to test her prostate - a gland women don't have.
"I pretty much quit using them after they drew blood to check my prostate. ... I just didn't trust them," Boudriault said. "I didn't trust the quality of care."
Reflecting another common complaint, congressional investigators in July said that VA hospitals weren't always providing privacy to female veterans when they bathed and received exams. Investigators found that many VA facilities had gynecological tables that faced the door - including one that opened in view from the waiting room. It also found instances where women had to walk through a waiting area to get to the restroom, even though VA policy requires these restrooms be placed next to an examination room.
Some female veterans have complained that they were turned away from appointments when they showed up with children. In response, VA Secretary Eric Shinseki told a congressional panel in October he issued a directive allowing patients to bring children along for appointments, unless they were seeking mental health care or were in intensive care.
There have been complaints about the inconvenience of having to go outside the VA for many female-specific tests or procedures - even though the VA picks up the tab. That includes all obstetrical services.
Tammy Duckworth, a VA assistant secretary who was a helicopter pilot in Iraq and lost both her legs and partial use of an arm in an attack, said the VA needs to continue to change its programs to better suit women's needs.
As demand for services increases, she said facilities are exploring ways to expand. She said the placement at each site of a women's health coordinator has helped women patients.
"You have to service the most vulnerable member of your population, and if that is the young 18-year-old who experienced traumatic either PTSD or military sexual trauma, she should be able to get exactly the treatment that she needs from VA," Duckworth said. "If we cater to her and she has more requirements, what we do to cater to her is going to help all veterans overall."
Martinsburg opened its women's clinic in 2002 and assigned a women, Dr. Bethesaida Tafari Habte, to it. Four years later, a separate section with its own waiting area opened so women who experienced sexual trauma in the military, and who wished to avoid sitting with men, could do so.
Since September 2001, the number of female patients at the Martinsburg hospital and its outpatient clinics grew from 820 to 1,660. The hospital has women-only networks groups, but administrators would next like to offer women-only group counseling. If demand increases, they'd also like to offer mammograms on site.
The female veterans have noticed the changes, said Su Carroll, 70, who has received care at the hospital since she retired from the Navy in 1991.
"For the young woman who is more private, sometimes you don't want to talk about your problems in front of an audience of men," Carroll said. "Now, we can do it in our own waiting room, and you can talk about anything ... and women do compare notes."
Habte said she's particularly careful to pick up on subtle signs that the women might need mental health help, as many of the female veterans complain of depression and sleep issues.
In recent months, Dolores Doherty, the nurse in the women's clinic, said she's had a few veterans come in for a pregnancy test.
"The shift in the population is really refreshing. They're young, they're getting pregnant. Plus we love our older people, too," Doherty said. "It's just a nice shift."
Michelle Fisher, 43, an Iraq veteran who works at the hospital as a human resources staffing assistant, said she doesn't understand why female veterans wouldn't want to use the care offered.
"They deserve it. They earned it, so why not?" Fisher said. "It doesn't say it's for males. It says veterans, that includes women, also."