Availability and usefulness of health services. Another implementation challenge was variation in availability and usefulness of health services. Family doctors had the potential to be helpful, but after-hours clinics were critical for timely care for all women, especially for those without providers. But having a provider was not enough. For example, survivors reported fatigue or difficulty sleeping, depression, anxiety, and chronic pain as the issues most detrimental to their daily functioning. Providers often discounted these problems, especially when unaware
of abuse and trauma. registered nurses helped women to be heard by providers, by writing letters to validate health problems and coaching women about abuse disclosure and ways to frame symptom patterns, severity and consequences. “I was procrastinating about seeing the doctor; the nurse pushed and pushed and when I went, he had the nurse’s letter. It was amazing.”