Operational Obstetrics & Gynecology

The Prisoner of War Experience

Colonel Rhonda Cornum, Ph.D. MD
Medical Corps, United States Army

Prisoner of War

We all hope that no American serviceman, male or female, will be taken prisoner. Historically however, the risk of capture is small but real in all conflicts. Treatment of repatriated POWs has been discussed exhaustively, but has focused on men. Women have represented a very small percentage of the military, and until recently, an even smaller percentage of prisoners. Most of the information is probably equally applicable to female as to male repatriated POWs, but there has been nothing written specifically about the repatriation of women ex-POWs.

As the only woman ex-POW still on active duty, I would like to share my views on the repatriation process.

Sexual Abuse

The primary concern of many health care providers, when caring for a returning female POW, seems to be the possibility of sexual abuse. I believe this emphasis on female sexual abuse is primarily cultural. I further believe this emphasis is derived from concerns about potential psychological after-effects of sexual abuse, and that it is based on the model of civilian women. It is vital to recognize that sexual abuse in the context of the POW experience is very different, for several reasons.

• Women in the military are not necessarily representative of the "average" American woman. A military career is still not considered a traditional path for women, and women who choose a military career may have a different "willingness to take risk" than women in the general population. They may not react like the "average" woman in the civilian setting.
  
• Most women in the military recognize that they are engaged in a high-risk occupation, and accept that there is a small but real risk of death and capture.
  
• Women in the military may have different priorities. For example, I was captured after being wounded by small arms fire and involved in a very significant aircraft shoot-down. My primary concerns were first, those that were life threatening (bleeding and internal injuries), followed by those that could result in permanent disability (multiple long bone fractures in my case). While I was subjected to an unpleasant episode of sexual abuse during my captivity, it did not represent a threat to life, limb or chance of being released, and therefore occupied a MUCH lower level of concern than it might have under other circumstances.

It is my opinion that sexual abuse should be considered just one of many potential physical and psychological torture techniques, whether the subject is male or female.

The Total Soldier

Importantly, the health care provider encountering repatriated POW’s should evaluate their total condition, and not focus on any single aspect of their condition unless it is obvious (broken bone, diarrhea, pregnant, etc).

The repatriated soldier (it is important to avoid the term "patient") will tell you his or her primary concerns, and the health care system should respond to those needs if at all possible.

Pre-deployment Planning

On a practical level, deployed women may find it valuable to use a method of birth control that does not require either daily input (the pill) or voluntary use (condoms or diaphragms). I recommend the IUD, Norplant, or Depo-Provera, particularly for women at higher risk, especially aircrew.

It is important to introduce this concept before deployment, as it can be a social problem for monogamous women to suddenly begin a contraceptive program if their spouse does not understand the risk issue.

The Typical Repatriated Soldier

Because the circumstances of captivity are so different, it is difficult to describe a "typical" repatriated soldier.

Some have been subjected to prolonged isolation and others not. Some have been physically abused and others not. Some have been held captive for a very long time, while others have been held only a short time. Clinically, they should be approached as individuals, with unique experiences and clinical needs.

Stresses of Captivity

While individual experiences vary, many common stresses of captivity may need to be addressed. Among these* are the physical stresses of:

Crowding Diarrhea Epidemic diseases Exhaustion Forced labor Infectious organisms Injuries

Medical experimentation Nutritional deprivation Sleeplessness Torture Weather extremes Wounds

…and the psychological stresses of:

Boredom Close long-term affiliation Confinement Danger Family separation

Fear/terror Guilt Humiliation Isolation Threats Unpredictability

* Textbook of Military Medicine, Office of the Surgeon General, United States Army, The Prisoner of War, P. 435, 1995

Recovery

Most former POW’s will fully recover from these physical and psychological stresses. Many will find a lasting emotional strength from their experience.

Contents -  Introduction -  Medical Support of Women in Field Environments -  The Prisoner of War Experience -  Routine Care -  Pap Smears -  Human Papilloma Virus -  Contraception -  Birth Control Pills -  Vulvar Disease -  Vaginal Discharge -  Abnormal Bleeding -  Menstrual Problems -  Abdominal Pain -  Urination Problems -  Menopause -  Breast Problems -  Sexual Assault -  Normal Pregnancy -  Abnormal Pregnancy -  Normal Labor and Delivery -  Problems During Labor and Delivery -  Care of the Newborn

This web version of Operational Obstetrics & Gynecology is provided by The Brookside Associates.  It contains original contents from the official US Navy NAVMEDPUB 6300-2C, but has been reformatted for web access and includes advertising and links that were not present in the original version. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense. All material in this version is unclassified.

This formatting C. 2006 Brookside Associates, LLC.
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