I'm in the Brig!

So...it never occurred to me that military women's health care also includes the inmate population! I know women commit crimes; it's not as if active duty women are exempt from bad behavior...but still, as an an active duty provider- am I really going to treat women in jail? Yes, particularly you Navy folk. The brig over at Miramar Marine Corps Air Corps Station is the military's only long term institution of confinement for active duty women prisoners. They can be held there for up to 10 years. If the sentence exceeds 10 years, then they are transferred to a federal prison. Most are there for murder as a result of IPV (Intimate Partner Violence). So, there I was on Friday morning...doing speculum exams...on a prisoner...in the brig. My preceptor shared with me that this experience is actually very similar to providing care for women in the deployed setting. A lot of abnormal menses [change in diet/exercise/stress; close proximity of many women living closely together (syncing of cycles)]; along with BV and candidiasis d/t changes in hygiene patterns and hygiene products. I had to do paper charting, we had to bring our own supplies- including speculums, and there is no microscopy. If it smells like BV, you treat for BV. If it looks red and inflamed w/itching to the vulva and inguinal intertriginous folds, you treat for candidiasis- you get the picture. As a military FNP, there is such a wide range of what care in austere environments means.

Can anyone say TBI???

22yo female G1 P1 seen in OB clinic for 6-wk PP visit and questions about contraception, spec. Mirena. During the initial introduction, my preceptor noticed a bump on the pt's left forehead and inquired about it. Pt explained that in 2008 she had injured herself playing soccer when she and another player headbutted each other. She stated that it had never truly resolved, although it was much better. During the course of my interview, I found out that she and another player (300lb with glasses) had run full steam toward a soccer ball both with the intent of head-butting it to wherever. Instead, they collided in midair and were each thrown about 5 feet back. The other player broke his glasses and had a few minor cuts to his face, where my pt had lost consciousness for 2-3 mins, regaining it when she was being driven to the hospital. She had difficulty recalling name, place, date, etc. in the ER, but finally regained her memory. Fast forward to post-delivery 2010...pt now complains that she feels like her "center of gravity" is off and has tripped and fallen down her stairs x2 since delivery. She denies any vision changes (doesn't wear glasses/contacts), denies hearing difficulties or any hx of BP issues. She was negative for PIH, GDM or any other complications (except PUPP) during/post pregnancy. After discussing risks/benefits of contraceptive types (incl. Mirena) and performing necessary cultures prior to IUD insertion, pt was instructed on when to return for IUD placement and a NEURO CONSULT was initiated immediately. I thought this case was particularly interesting b/c of what we have learned about TBI in school/SIM center and that TBI can affect anyone at anytime...including 22 yo post-partum females.