When Whitney Brown, a National Guard veteran who lives in Wheeling, West Virginia, needs medical assistance, she must travel to U.S. Department of Veterans Affairs (VA) hospitals in St. Clairsville, Ohio, a half an hour round trip, or Pittsburgh, Pennsylvania, an hour each way. Without outside medical insurance, Brown can only afford to be treated at the VA for any of her physical or mental health concerns. However, care at VA hospitals in Appalachia is not always prompt or easy—particularly for women veterans.

Brown, who was deployed to Iraq for about nine months of her six years in military service, has experienced significant delays on at least two separate trips to her nearest VA hospitals. Once when Brown experienced a “cracking,” wheezing sound in her lungs, she visited a VA emergency room to have her symptoms diagnosed. After some time, the doctor on the floor decided she needed to be admitted to the hospital. However, Brown estimates it took the hospital between three and four hours to finally move her from the emergency room to an inpatient bed.

“They said that they didn’t have any room, but when they wheeled me up in the wheelchair, there were six or seven empty rooms on the way,” she said in an interview with Rewire.News. “So, I don’t know if people just magically discharged themselves or what.”

While Brown cannot say for certain why she experienced such delay, she noted that her father, a Marine veteran, has gotten a room “pretty fast” in the past. Various reasons could explain this delay, but as a woman seeking help regarding a potentially serious medical condition, the wait felt unjustified to Brown. The incident also ignited her anxiety, a mental health condition that has been exacerbated by her military service. “[The situation] irritated me because, along with my anxiety, I get irritated pretty fast,” she said.

For many female veterans like Brown, once their service ends, the challenge of accessing care begins.

Retired Navy Capt. Lory Manning currently serves as the director of government relations for the Service Women’s Action Network (SWAN), a national organization, that, according to their website, strives to “support, connect, and advocate for service women past, present, and future.” According to Manning, one of the lesser-known difficulties female veterans face is simply receiving inpatient treatment at VA hospitals.

As of 2011, women veterans accounted for only 10 percent of the total veteran population in the United States, which means men still heavily outweigh women military personnel. In many cases, the imbalance between male and female veterans’ care can be traced to the Army’s historic gender breakdown.

VA hospitals in more rural areas, like some of central Appalachia, tend to be treatment facilities with a particular, outdated design: fewer wards and rooms filled with more beds. These wards can house multiple patients at one time, which means patients can be treated in a single room—particularly practical at VA hospitals, where, up until the past century, patients were almost exclusively men. Military doctors and nurses could indiscriminately place the men together in a single space.

But these health-care facilities built in past centuries are still in use today, when they may have outlived some of their usefulness. The large ward design has become an issue for VA hospitals as more and more women continue to join the U.S. military. “It’s much easier for male veterans who need inpatient health care to get a slot,” Manning said in an interview with Rewire.News. “Not all VA facilities have slots for women to have inpatient health care.”

Throughout Appalachia, where rurality and economic disparity already affect access to mental health care and other forms of treatment, veterans can sometimes only go to VA hospitals: the only facilities for miles. This is especially the case for veterans like Brown, who do not have outside health insurance.

A 2007 file from the Veterans Health Administration (VHA), cited in the Appalachia Regional Commission’s “Health Care Costs and Access Disparities in Appalachia” report, showed that “military veterans in the Appalachian Region, particularly the central sub-region and western Pennsylvania, were among the highest users of VHA services in the U.S.” Paired with the fact that Appalachians frequently struggle with access to health insurance, many veterans in the region may not have the opportunity to visit alternative clinics or providers.

Little research has been done to compare admittance rates for male and female veterans at VA hospitals throughout the country. In VA hospitals and non-military hospitals alike, it is still a cultural norm in the United States that hospital rooms remain segregated by sex, a measure intended to promote feelings of control and comfort among patients. However, as the number of female veterans increase, women who live in communities serviced by older VA hospitals could experience a delay in care—especially if men already predominantly occupy the hospital rooms.

Hospitals have general protocols they take to ensure female veterans have prompt access to inpatient care. Lauren Winebrenner, public affairs specialist and community outreach program coordinator at the Martinsburg VA Medical Center in West Virginia, said that at the VA where she works, men can be shifted from one room to another in order to give women veterans private rooms.

“For us, if we have to move a man so a woman has a room with a bathroom so she has the privacy she needs, that’s what happens,” Winebrenner said in an interview with Rewire.News. “And I would say that would be true for any facility because we’re not going to ever put men and women together during a hospitalization.”

Renovated facilities like the Martinsburg VA work to serve and treat women by having a women’s health clinic. Furthermore, Winebrenner said that women are always given private rooms with bathrooms when they check into the general medical center. While uncommon, Winebrenner said there have been instances when the hospital had to relocate some male veterans to accommodate women.

“Not frequently, but it does happen on occasion, like during flu season when you have all your beds full,” Winebrenner said. While the move may be inconvenient, Winebrenner said it has never caused a problem.

“We explained that to the [male] veterans and we’ve never had any issues with any veterans who were not willing to do that to accommodate another veteran.”