Far forward gynecologic care of the female soldier.
OBJECTIVE
To evaluate the value, unit cost and medical effectiveness of providing specialized obstetric and gynecologic care far forward, at echelon III, the combat support hospital (CSH), in the operating theater of Afghanistan during Operation Enduring Freedom (OEF), rotation 5.


METHODS
Between April 2004 and September 2004, records were reviewed from the outpatient gynecology clinic at Bagram Air Field (BAF), in Afghanistan, through an approved protocol request. Cohort analysis was performed on all gynecologic patients. Significant differences in distribution of clinical factors were determined by Student's t test.


RESULTS
A total of 62 cases were extracted for analysis over the 6-month period. Fifty-seven total patients were seen at echelon III, the CSH at BAF, while 5 were sent to level IV or V echelon care in Landstuhl, Germany. The average distance traveled for the patients coming to BAF was 158 km, while those sent to Germany averaged 5,204 km. The mean travel time in days was significantly lower among patients seen at BAF, 0.5 versus 7 days for patients sent to Germany. The time to appointment was also significantly lower among those patients seen at BAF: 0.04 versus 13 days for patients sent to Germany.


CONCLUSIONS
We devised and implemented the concept of far forward specialized gynecologic care for women participating in OEF. This substantially decreased the woman-hours lost by their individual units. The far forward availability of gynecologic care and the supplies to evaluate and treat abnormal Pap smears should be considered by all military services in their plans for providing health care for the modern female soldier.
Farley
John H
JH
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Tripler Army Medical Center, 1 Jarrett White Road, TAMC, HI 96859-5000, USA. john.farley@us.army.mil
Alexander
Alma
A
Zahn
Christopher
C
Harrison
Terry A
TA
Nielsen
Peter
P
Branch
Walter
W
Larsen
Wilma
W
Homas
Dallas
D
D000346:Afghanistan; D003695:Delivery of Health Care; D005260:Female; D005831:Genital Diseases, Female / Q000191:economics / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008887:Military Medicine / Q000592:standards*; D008889:Military Personnel / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D014481:United States; D014857:Warfare; D014932:Women's Health Services / Q000592:standards*; D014931:Women, Working / Q000706:statistics & numerical data