Military

Medical Care Shortfalls for US Personnel in Japan Trigger Push from Lawmakers for Improvements

The American and Japanese flags flying just before sunset at U.S. Marine Corp Base Camp Foster

Lawmakers are pressing the Pentagon to improve medical care in Japan for U.S. military personnel, families and Defense Department civilians amid ongoing concerns that the lack of access to care is forcing service members and federal civilian employees to leave the country.

The move follows efforts initiated last October by U.S. Indo-Pacific Command ^[1] and the Defense Health Agency to improve emergency medical services for Americans covered by a Status of Forces Agreement with Japan.

In a letter to the assistant secretary of defense for health affairs and director of the Defense Health Agency, the bipartisan group that includes the chairwoman of the Senate Armed Services Committee's personnel subcommittee said the issues have not been resolved.

"We appreciate the steps that DHA and INDOPACOM are taking to address these issues. But we continue to be concerned by reports of problems accessing care, and its impact on morale and retention," wrote Democratic Sens. Elizabeth Warren of Massachusetts and Tim Kaine of Virginia, and Rep. Michael Burgess, R-Texas.

They cited examples of teachers who have left their positions at Department of Defense Educational Activity schools and a child clinical psychologist who served military families but had to leave Japan after not receiving timely care for an injury. The psychologist's departure, expected late last year, according to the DoD inspector general, left just one pediatric psychologist in the country to serve military and civilian dependents.

"These numerous reports of problems accessing care show its negative impact on morale and retention, and degrades our nation's readiness," the lawmakers wrote.

U.S. Forces Japan is home to roughly 54,000 U.S. military personnel, 45,000 military family members, and 8,000 Defense Department civilians and contractors.

In December 2022, the Defense Health Agency announced it would treat civilian U.S. employees in military hospitals and clinics in Japan on a space-available basis only and directed those patients to receive medical treatment from local providers if they could not be accommodated.

Following a backlash to the announcement, the DHA clarified its policy, announcing that civilians could continue to receive treatment for chronic conditions at military hospitals but said appointments for acute care would remain on a space-available basis.

Months later, U.S. military medical staff at Kadena Air Base ^[3] began preparing to send pregnant service members, spouses ^[4] and dependents out of the country to deliver their babies as a result of severe staffing shortages at Naval Hospital Okinawa ^[5]. The diversions never came to pass but not before eight DoD civilians requested their assignments be cut short as a result of medical concerns.

A November 2023 DoD inspector general report found significant challenges for using off-base medical resources, such as language barriers, differing approaches to medical care and the lack of availability of certain medications.

In their letter, the lawmakers said they have received complaints as recently as the last few months, and they want to know what steps the DoD is taking to solve the problems.

They cited the military health system's new strategic plan, published in December,^[6] that said the DoD needs to stabilize the system, improve military and civilian staffing, and increase readiness.

"We seek to learn how and when DoD will implement the MHS Strategic Plan and the DoD IG's recommendations, and address ongoing problems with access to health care in Japan and the INDOPACOM region," they wrote.

In an interview with Federal News Network in November ^[7], DHA Director Lt. Gen. Telita Crosland said the agency had "worked through the challenges" of meeting health care demands for civilian employees in Japan and would have a new network structure in place by the end of 2024 that would address the issues.

"'We've unencumbered them to support the 'space-A' population on the same footing they'd previously supported them. We said, 'We really do have some capacity; let's maximize our capacity for all beneficiaries,'" Crosland said.

Navy ^[8] Adm. John Aquilino, who leads U.S. Indo-Pacific Command and wrote the order to improve medical staffing in the country, is expected to testify Thursday before the Senate Armed Services Committee.

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Tomb Guard Makes Last Walk and Earns Badge > U.S. Department of Defense > Story

A soldier in a formal uniform holds a rifle and stands at attention in front of a crowd.

Conducting a final walk at the Tomb of the Unknown Soldier is a high honor for a Tomb Guard assigned to the 3rd U.S. Infantry Regiment, known as "The Old Guard," as is earning the Tomb Guard Identification Badge. However, to do both on the same day is

Tomb Guard Makes Last Walk and Earns Badge

Conducting a final walk at the Tomb of the Unknown Soldier and earning the Tomb Identification Badge are high honors for a Tomb Guard. However, to do both on the same day is an even rarer event.

Pentagon Panel Says Women Should Be Integrated into Marine Platoons as Part of Recruit Training

New U.S. Marines participate in a motivational run

The Marine Corps ^[1] should fully integrate women into platoons and institute mixed-gender drill instructor teams at its recruit depots, according to a newly released report by a Pentagon panel focused on women in the military.

The Marine Corps is the only service that is not gender-integrated at the lowest recruit training level, according to the report released Friday, despite efforts by the service over the last several years to desegregate its training units by gender.

After visiting the recruit depots at both San Diego ^[2], California, and Parris Island ^[3], South Carolina, the Defense Advisory Committee on Women in the Services, or DACOWITS, recommended in its report that platoons at those installations include both men and women "to better prepare male and female recruits as they become Marines, to operate within an integrated operational force, and to better align the Marine Corps with its service counterparts."

The committee also recommended that the Corps integrate mixed-gender drill instructor teams as well, something the other branches are already doing, according to the report.

Currently, the Marine Corps has gender-integrated companies at its training depots, which include separate platoons made up of men and women. The committee argued that those platoons -- where Marines primarily eat, sleep, train, live and learn -- would benefit from integration to normalize inter-gender relationships between Marines before they hit the fleet, where units are integrated anyway.

The committee said that the platoon is the cornerstone of training and serves as the primary learning environment for the 60 to 80 recruits who train in one. At one recruit depot, the committee said that it observed Marines being hindered by the lack of integration, specifically in collective tasks that require teamwork.

Limiting opportunities for the genders to interact with each other affects cohesion and readiness, the committee said. It pointed at physical training as a key component to building teams within the Marine Corps, adding that "gender-integrated training does not cause harm and may actually foster better cohesion." It also said that other branches with fully integrated training have benefited, specifically in better preparing troops for working in their integrated line units.

"To consider training fully integrated, recruits must have an opportunity to interact with opposite-gender peers during these transformational training moments that turn recruits into Marines," the committee report said. "With fully integrated platoons, recruits would participate in all training events as an integrated team, to include training within the squad bay, with the exception of showering and sleeping."

The report recommended that Defense Secretary Lloyd Austin should order the Marine Corps to make the change, which would ensure all services are complying with guidelines passed into law as part of the fiscal 2020 National Defense Authorization Act that mandate the military does "not segregate recruit training by gender."

The committee also argued that gender segregation can cause "unhealthy" perceptions of the opposite gender, including sexism that might carry into the operational force. It said that segregation of training units could promote fear and suspicion of women and reinforce "the stereotype that women need special treatment and protection."

While the Marine Corps has been arguably the slowest service to adopt gender-integration initiatives, it has made progress in getting rid of segregation at higher levels of the training pipeline. Last year, the Marine Corps deactivated the 4th Recruit Training Battalion, a historic formerly women-only training unit at Parris Island.

The Marine Corps did not respond by publication when asked to comment on the recommendations made by DACOWITS.

DACOWITS was established in 1951. It has been at the forefront of several initiatives, to include women taking on different military roles, including combat roles. The report released Friday included dozens of other recommendations for the military overall, like creating a working group focused on women in special operations ^[5] as well as establishing a "more robust" women's health care directory.

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