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Fleet Medicine provides comprehensive care to Navy recruits

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Hospitalman Hannah Bonilla, left, front, and Lt. Cmdr. Crystal Aandahl, conduct a class in the Female Wellness Department at USS Red Rover. Sitting left to right are Seaman Recruits Carmen Torres, Sinnah Faitasi, Sage Drummond, Lourdes Vera, Teneiya Walker, and Maci Cecil.

Fulfilling Captain James A. Lovell Federal Health Care Center’s mission of “Readying Warriors and Caring for Heroes” remains a high priority for USS Tranquillity’s Recruit Evaluation Unit and the USS Red Rover Clinic Female Wellness Department.

Military staff at both Recruit Training Command (RTC) clinics are assigned to Navy Medicine Readiness and Training Command (NMRTC) Great Lakes, which is located at Lovell FHCC. The combined military and civilian teams have made it a top priority to continue growing above and beyond their scope of practice, ensuring Navy recruits – “the warriors” – are being properly cared for, not just while they are at the Navy’s only Boot Camp at Naval Station Great Lakes, but in other parts of the community as well.

The USS Tranquillity Recruit Evaluation Unit’s (REU) focus over the past few years was on “access to care being received by recruits, and expanding our efforts surrounding awareness of stress inoculation, resilience, and retention,” said Recruit Evaluation Unit Department Head Dr. Michael Brennan, Psy.D., assistant.

Brennan said, “Both the military and civilian team members working in USS Tranquility are top notch. They are always up for the task no matter what is thrown their way.”

USS Tranquility REU now has eight distinct programs or clinical areas. This includes locations at Lovell FHCC, Recruit Training Command, and Lake Behavioral Hospital located in Waukegan, Ill. 

“The work we do throughout the clinic spaces far exceeds the realm of an evaluation unit as our focus is now on preventative and proactive care, risk mitigation, and assessment,” Brennan said.

The programs focus on recruit needs at different points during Boot Camp. For example, “Ship 1 Moment of Truth” brief focuses on stress inoculation and normalizing recruit experiences during the first few weeks of Boot Camp. The resiliency program addresses motivation and continued engagement when recruits are injured and temporarily can’t continue their training.

Another of the eight programs focuses on mental health and increases recruit access to care and consultation as far forward as possible in every area of operation at RTC, Brennan said.

“Each program has a unique fit that addresses mental health problems and concerns that have been noted as problems throughout the past,” he said. “Our current team has compiled a strategic response in order to address them and implement interventions with the intention of increasing motivation while mitigating risk.”

In January of 2022, the REU combined its efforts with Lovell FHCC Outpatient Mental Health to create the mental health consultation phone line. The phone line provides recruit support staff and leaders consultation and mental health support by providing recommendations, information, and resources to address immediate problems within the training environment.    

As a result of the joint effort between the REU and Outpatient Mental Health, Brennan said, “Over 81 percent of the more than 900 calls received had been diverted from the Lovell FHCC Emergency Department and handled more intimately by staff, leading to an increased level of care, expansion of caller retention, and a decline in overall cost and avoidance measures.” 

The USS Red Rover Female Wellness Department also has been working equally hard for the 9,000, on average, female recruits who complete entry-level training annually at RTC. The Female Wellness Department has concentrated its efforts on ensuring Boot Camp becomes the model location, rightfully focused on health promotion, and education, ensuring female recruits have the ability to make informed decisions surrounding services such as contraceptive care, and sexually transmitted infections or STI screenings.

In 2018, a Navy Personal & Professional Choices survey found half of all female sailors felt as though no matter their duty station, access to care was the biggest hurdle experienced when it came time for making wellness and reproductive decisions.

According to the CDC, unintended pregnancies most often occur in the 18- to 24-year-old age group – the group most recruits fall into – and these pregnancies often are associated with worse psychological and physical health factors compared to planned pregnancies.

During the height of the 2020 pandemic, the complications of access to care became even more alarming. Lt. Cmdr. Crystal Aandahl, officer in charge of USS Red Rover’s Female Wellness Clinic, looked at the data and noticed a significant decline in the number of female recruits during training who received their requested Long-Acting Reversible Contraception methods (LARCs) – the most effective reversible method of contraception for prevention of unintended pregnancy. LARCs also are reliable and easy to use.

“The gap in care delivery was likely the result of reduced staffing, consolidated services, and a shortened recruit training cycle due to COVID-19 mitigation strategies,” Aandahl said.

When Recruit Training Command instituted a 10-week training cycle, “we knew that was our opportunity to offer recruits more comprehensive contraception education and more convenient access to their preferred contraceptive methods,” Aandahl said. “We wanted to be able to find a way to provide access to care during those first feasible opportunities while possibly eliminating barriers that could otherwise occur once recruits begin attending A School (Accession Training) or even at their next duty station.”

The Female Wellness Department reallocated existing resources to change the process. A pilot program was rolled out that helped establish the importance of offering female wellness services to recruits five days a week, and with walk-in services. With the help of Aandahl and the support of Navy leadership, a first-of-its-kind, walk-in contraceptive clinic (WICC) was created at USS Red Rover.

The WICC is an optional clinic for female recruits that provides standard education on each short- and long-acting reversible contraceptive method including risk, benefits, effectiveness, and alternatives. After receiving education, recruits meet individually with a healthcare provider to discuss individual contraceptive priorities and questions. Finally, recruits are provided same-day access to prescriptions for short-acting reversible methods and procedures for long-acting reversible methods.

During its first few months of operation, the program was remarkably successful. “Shortly after implementation, we noticed that around 56 percent of female recruits were returning to the WICC during training, requesting a variety of short- and long-acting reversible contraceptive methods,” Aandahl said. “Equally as impressive, staff felt assured that the more comprehensive education was empowering recruits to consider health promotion and take responsibility for their own healthcare decisions.”

Unprompted, the WICC also received ample positive feedback from recruits. Comments included, “Great service, and staff was great and made me feel comfortable.” “The process was fast and painless. Easy day,” and “The staff was extremely helpful and patient when answering questions.”

Aandahl praised the dedication of the Female Wellness team – nurse practitioners, nurses and Navy hospital corpsman – a team that recognized the impact of the change. “Their efforts will undoubtedly produce long-lasting effects, improving and empowering the health of the service members and overall readiness of the Fleet.”

Both the REU and Female Wellness Department continue to prioritize the health and well-being of recruits, making their access to much needed care a first concern moving forward. By permanently turning challenges into life-changing actions, the staff at USS Tranquillity and USS Red Rover compassionately provide the best patient-centered care to the Navy’s newest sailors.

Erica Noel works in the Lovell FHCC Anesthesia Department, in Surgical Services, and is a contributing writer for this story.