The VA Pacific Islands Health Care System (VAPIHCS) Women’s Health Program is working hard to expand and provide a more comprehensive range of services to female veterans living in the Pacific Islands.
VAPIHCS does not have a hospital, so many of the gynecological services that female veterans needed were referred to the community. However, in September 2023, board-certified OB/GYN Dr. Ratheany Sakbun was hired as VAPIHCS’ first full-time gynecologist.
“Female veterans receive excellent care that addresses their specific needs at VA clinics on the mainland, and the Women’s Health Program at VAPIHCS is committed to ensuring they receive the same care here,” said Dr. Sakbun. “When we talk about gynecology, people usually think of routine Pap smears, but in reality, there are a wide variety of health issues related to the reproductive organs.”
Dr Sakbun explained that there is a certain stigma attached to women’s menstrual cycles and as a result, it may not be widely known that there are treatment options for women who suffer from abnormal bleeding and menstrual cramps. They may go through life exhausted and anemic, unaware that there are options that could help them feel better. This is because women are often told not to talk about it, so they may not think to ask for help.
“So many women suffer in silence because they think they have to,” said Dr. Sakbun. “And they don’t even have a clear picture of the risks they face. Cervical cancer is talked about a lot, but uterine cancer is more common and you never hear about it. We want to help women get a better picture of what’s normal, what they should be concerned about and what treatment options are available to help them get well.”
In addition to clinical gynecological care, Dr. Sakbun has also started a gynecological surgery program. She is based at Kuakini Medical Center in Honolulu and has begun performing surgical procedures there. Although she has performed fewer than 10 surgeries to date, she says all of her patients have been delighted with the care they received before and after the procedures at Kuakini Medical Center. They are also excited that VAPIHCS can now offer this type of care. The partnership is proving productive.
“What is important is the ability to receive more effective pain management in the hospital,” said Dr. Sakbun. “Women are so often told that proper pain management is not required for gynecological procedures because the pain is not as severe. In fact, procedures such as IUD insertion or cervical biopsy can be very painful for some women and this pain is better managed in the hospital.”
Dr. Sakbun immigrated to the United States with her parents as a child. She completed much of her education in Hawaii, but also attended college on the mainland in Wellesley before returning to study medicine at the University of Hawaii John A. School of Medicine. She completed her residency in obstetrics and gynecology at NYU. She also practiced at a VA hospital in Arizona and in California for a total of seven years.
“Hawaii has given me and my family a lot,” said Dr. Sakbun. “My whole family still lives here, and by coming to VAPIHCS, I’m close to them and I can give back to the place I grew up by bringing all my knowledge here to help female veterans.”
Currently, Dr. Sakbun only performs minor surgical procedures. However, she has experience with all types of gynecologic surgery, including minimally invasive/robotic surgery. She says she has big dreams for VAPIHCS and hopes to offer many more procedures in the coming years. Building such a program takes time and is currently in its infancy. However, it is a welcome and necessary addition to the VAPIHCS Women’s Health Program. With the addition of Dr. Sakbun to our VAPIHCS ohana, the future looks bright for women veterans in the Pacific Islands.
“As you can imagine, I can’t do any of what I do alone,” said Dr. Sakbun. “I am very grateful to Dr. Laura Artabazon, the director of the Women’s Health Program. I am also grateful to Denise Koutrouba and all the staff at the Women’s Health Program and the entire VAPIHCS. Everyone has been helpful, supportive and kind since I arrived.”
Quick facts:
• Some common health problems that are best treated by gynecological surgery include ovarian cysts, fibroids, abnormal bleeding, pelvic pain, polyps, intrauterine scar tissue, and structural problems. A gynecologist may also need to perform dilation and curettage for a variety of reasons related to reproductive health and well-being.
• In the past, all of the attention of the gynecology community was focused on labor and delivery, while there was little research or medical care addressing women’s health and well-being outside of childbirth.
• In the past, women who experienced unusual bleeding or debilitating pain during their menstrual cycle were told that it was normal and not to talk about it. Women are still sometimes told by doctors that lower back pain and other symptoms related to reproductive health are “normal.”
• The stigma that still exists when women talk about their monthly cycles prevents many women from feeling safe to seek help when they are uncomfortable. In the past, women who suffered from extreme conditions such as uterine prolapse were often encouraged by authority figures in their lives to keep it to themselves and not have problems with doctors.
• The death rate from cervical cancer in the United States averages 2.2 deaths per 100,000 women per year. The death rate from cervical cancer in the United States averages five deaths per 100,000 women per year, making cervical cancer more than twice as deadly. Yet cervical cancer screening is only routine.
• Many women experience severe pain during the insertion of intrauterine devices (IUDs). They may also experience ongoing pain and need to have the device removed. However, doctors often tell them that pain is not a reason to use pain management or remove the device. Gynecological surgeons like Dr. Sakbun advocate for appropriate pain management in all gynecological procedures so that women do not suffer unnecessarily.
• A web search for treatment options for endometriosis lists the most popular treatment options as: NSAIDs, birth control, psychotherapy, or alternative medicine such as acupuncture. Although this is considered “common wisdom,” it is completely outdated. Surgical treatment options have far better outcomes than NSAIDs and psychotherapy, but are rarely recommended by doctors who do not specialize in gynecological surgery.
