18 July 2013

Prague on my mind

Just my luck! I leave Prague, and the Honor Society of Nursing, Sigma Theta Tau International (STTI) schedules its 24th International Nursing Research Congress there. As I spend my days in Karachi coveting my colleagues’ enjoyment of beautiful Prague and her fabulous culture, I will be remembering my very favorite places while I lived there. And, because I hold no rancor for my “missed opportunity,” I will share the thoughts Ill be having with you now, in case you want to seek out my favorite places, too.

Everyone will tell you that the Charles Bridge, the Prague Astronomical Clock and Prague Castle (Prasky Hrad) are must-sees, and they are. If you have time to visit only the Big Three, don’t miss them.

The clock, which is in Old Town Square, is the third oldest astronomical clock in the world, dating from 1410, and the oldest one still functioning. On the hour, it strikes, and the show begins: a series of bell tones, trumpet blasts, and figures of the Apostles appearing in small doorways just above the clock face. Go early, as it will seem that everyone in Prague is waiting to view this hourly exhibit, and it can be difficult to find a good place to take photos.

Prague Astronomical Clock
The Charles Bridge dates from 1357 and is named after the Holy Roman Emperor, King Charles IV. Over several hundred years, carved statues were added to the bridge. The current statues are copies, and the originals are displayed out of the elements elsewhere, but the effect is the same. Note: The bridge is frightfully busy during a good part of the day and early evening. If you want a magnificent experience, get up early and be at the bridge before 7 a.m. If you are really lucky, there will be fog on the Vltava River, which gives the bridge an amazing otherworldly effect, unspoiled by the presence of people.

St. Vitus's Cathedral in Prague Castle (Prasky Hrad)
Of the “Big Three,” Prasky Hrad is my favorite. The castle complex, which marks the old walled city of Prague, has been around in enlarging forms since the 10th century. Once inside, opt for the audio guide, because it provides excellent information, and it assures you a no-wait line to get into St. Vitus´s Cathedral, where there are many treasures to enjoy. I am a fan of stained glass windows, and the window I love most in the world is here. So, when you are standing before the window designed by the famous Czech artist, Alfons Mucha, in his distinctive Art Nouveau style, think of me.

My favorite stained-glass window.
Most people identify classical music with Vienna, but Prague is electric with great music every evening of the week. My favorite concert venue was a very old church, St. Martin in the Wall, located in New Town, just off of Narodni. There are concerts there every Friday and Sunday at 6 p.m. sharp! You can purchase tickets online or at the door, but don’t be late because, once the concert begins, to prevent disturbance of the performance, you will not be admitted.

If St. Martin’s is inconvenient, don’t hesitate to find a venue more to your liking. Most Czech churches have been decommissioned as places of worship and have been turned into tourist and concert venues. The art within is often on par with the finest museums, and you won’t be disappointed in the music selections. Signs out front advertise the evening’s program, time of performance, and the price of tickets. If you happen upon a venue just before concert time, and you are interested in attending, ask for a price discount. Chances are good you will save a few koruna (crown), but don’t haggle too hard. The music will be worth the price of admission.

With its more than one thousand years of history, Prague is an architectural or art student’s delight. One of my favorite places is the Municipal House (Obecni Dum), located in central Prague. Following a major overhaul about 100 years ago, the present décor is predominantly Art Nouveau. Dine in the first floor French Restaurant or Café, or make your way to the basement to dine in the American Club. The food is fine, but the ambiance and tile mosaics are marvelous.

Monuments abound in Prague. You can’t help but pass them on any major street. But the one dearest to me also happened to be located next door to the apartment building where I lived in Prague. The Memorial to the Victims of Communism is of 21st-century design and pertains particularly to victims in the Czech Republic. It took me a good bit of processing before I decided how I felt about it.

Memorial to the Victims of Communism
Even if this monument isn’t to your liking, it sits at the bottom of Petrin Hill, a wonderful green space with excellent walking trails to explore. Just follow the trails up the hill, and you will eventually reach the Czech version of the Eiffel Tower and great views of the entire valley. About halfway up the hill are a couple of lovely restaurants with quite decent food and amazing views. Sit out on their patios, and enjoy!

Vyšehrad Cemetery
I enjoy cemeteries in a very nonmorbid way, and the Vyšehrad Cemetery is a real treat. Not only is it the final resting place of some internationally famous people—Alphonse Mucha and Antonín Dvořák—but it is also a place full of beautiful mosaics, sculptures, and interesting monuments. Immediately adjacent to the cemetery is the Church of Sts. Peter and Paul with its beautifully painted wall scenes, casements containing original Charles Bridge monuments, and the Gothic Cellar, which is a museum of interesting medieval artifacts. To get there, take trams No. 3 or 16 to Výton, south of New Town, or take Metro line-A (green) to Vyšehrad Station, and walk about 15 minutes up the hill. I always took my visitors to Prague to the Vyšehrad, and it never failed to please.

Finally, Prague is famous for its beer (pivo), and there are dozens of boutique breweries all over town. My favorite is located at the Strahov Monastery, located at the top of the hill above the Prasky Hrad. The monastery has much more to see than the brewery, and I recommend a leisurely stroll around the grounds, through the church, the art gallery, where there are rotating exhibits, and the library, recently beautifully restored.

And finally, advice from my experience in Prague. When you fly into Prague airport, pay attention to the signs, located where you collect your luggage, identifying taxi companies recommended by the city government of Prague. When you exit the building, there will be a line of taxi cabs. Do not be fooled into thinking you must take the first cab in line. Take ONLY the recommended cab companies, and if you like the driver, ask for his card and call him again. Your hotel will arrange proper taxi service to your destination, but you will need to call for a returning taxi. One of the recommended taxi companies has stands around town that are usually reliable.

Just know that hailing a taxi in Prague, as a foreigner, is a very risky business, and you are much less likely to be dissatisfied if you take the recommended taxis, the metro or trams, which provide excellent and inexpensive service.

So, colleagues, have a terrific time in this very lovely European capital city. Prague is magical and begs to be savored.

On a personal note, I am retiring from active practice in a few months and, sadly, this is my last post for “NP Worldview.” I am returning to the United States to bone up on my grandmother skills, and I can’t wait. My career in the U.S. Foreign Service has been an amazing experience, and I do hope I’ve been able to share some of the best of it through my blog.

Best wishes to each of you!

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

16 April 2013

Anne of the Foreign Service

On 6 April 2013, Anne Smedinghoff, a 25-year old U.S. diplomat working in Afghanistan, was killed in a car bombing. I never met Anne, but know her well. I know her from my years in the U.S. Foreign Service, working alongside the young—and not so young, but still idealistic and eager—officers who strive to bring the best of America to those outside our borders.

The Annes of the Foreign Service are crucial contributors to America’s well-being and safety in the shrinking world in which we live. I know I have countrymen who, recognizing that we Americans have problems of our own, believe we shouldn’t be spending our dwindling dollars or our energies on people outside our borders, but my experience leads me to believe that this school of thought is both shortsighted and dangerous.

The peoples of the world who are poorly educated and have limited exposure to anything outside their local communities know Americans almost entirely by our TV shows, movies and music. The entertainment industry speaks for us—our values, our way of life—more than anything else we do. You might have to think about that for a minute to fully understand how the developing world sees us.

When I worked in Ghana, West Africa, I frequently had to dispel the very common belief that American life is just like an episode of “Baywatch!” Really! Now, I’m not disparaging “Buffy the Vampire Slayer,” “The Dark Knight Rises,” or the lyrics of our popular music, but we Americans know how much is fantasy and how little is fact. People who only know us by these measures assume they speak a truth about us.

So, how does this relate to Anne Smedinghoff and the cadre of American Foreign Service representatives who work around the world? They are the true representatives of an American people who are some of the most hardworking, charitable, and freedom-respecting people on the planet. Anne was delivering schoolbooks to a village that had none so that its children could receive an education and have a better future. Her colleagues move out from their respective embassies and consulates daily—in every corner of the globe—to assist, educate, counsel, and affect peace and understanding. Please do not confuse your political views with the aspirations and intentions of the U.S. Foreign Service, which exists to serve the American people through diplomatic means and by being nonpolitical.

The loss of Anne Smedinghoff is a loss to her family and her country, though most of her countrymen don’t know how much of a loss her death is. We need many, many Annes to demonstrate true American values to the world, and the money, time, and effort we spend doing it is the very best way we can possibly spend those commodities. The future of our children may well depend on it.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

19 February 2013

Journey to Middle-earth

I think the biblical scholars have it wrong when they propose that the Garden of Eden was located between the Tigris and the Euphrates. I’ve just returned from a driving tour of the South Island of New Zealand, and I’m pretty sure that’s the real Eden.

I’ve been to the North Island previously and, while I had been told the South was even more beautiful, it was hard to imagine in advance what I actually saw once there. Followers of the movie trilogies, “The Hobbit” and “The Lord of the Rings,” based on books with the same titles by J.R.R. Tolkien, will understand that the South Island of New Zealand is “Middle-earth,” as all of the movies have been filmed there.

Of course, as all movies do, the videographers have toyed with nature and created imaginary scenes that aren’t really there; but the majesty of the mountains, the purity of the water—and its often-turquoise color—is not video editing. It is a simply amazing place! Top that off with the exciting adventure of seeing fur seals, yellow-eyed penguins, albatross and sperm whales in their own habitats, in nature without fences (other than to keep people out) and it makes for one bang-up trip.

It is not easy to get to New Zealand, which may explain how it stays pristine and minimally affected by man, but it is certainly worth the effort to get there. I heartily recommend it to anyone wanting to experience the freshest air, purest water, cleanest towns and friendliest people you are likely to see anywhere on earth.

Back here in Karachi
I don’t consider myself a teacher. I’ve shared information before with colleagues, as we all do, but teaching as an occupation is something I’ve never felt drawn to or suitable for. The consulate has embarked on a program to improve English skills of willing employees, using a combination of professional and volunteer teachers. I am a volunteer.

Every Wednesday from 3:30 to 4:30 p.m., two other volunteers and I look into the eager faces of 43 gentlemen with varying English skills ranging from none to minimum, and we try to teach and encourage them. We have a syllabus for beginning English, which seems rather advanced to me, as it assumes some previous introduction to English words. We play games with them to instill the desired idea. For example, we demonstrate walking forward and walking backward, and we try to help them understand the difference between “I am Karachi” and “I am from Karachi.”

First, we worked on was greetings. We pointed out, for instance, that the answer to “Good morning” is not “Fine,” which is the common response we receive to greetings given on the compound. It is a particular joy when we can see by our students’ expressions that the light bulb has gone on, and they really get the difference. The excitement is contagious, because local employees seek out English speakers with whom to practice their newfound skills. It has added levity between us that did not exist before and, in a place such as Karachi, where life is mostly tense, this is a very good thing.

One of my fellow teachers explained to our class that, in the United States, we do not usually address colleagues using Miss and Mister plus their first name. (She is obviously not from the Deep South.) She encouraged the students to call us by our first names, as we do each other or, if they believed a more formal approach was necessary, to use Miss or Mr. and the last name.

A few days later, one of the young members of the class, who is working very hard on improving his English, pulled me aside for a chat. He repeated what the other teacher had said about addressing people and then said to me, “I have respect for you and, because you are an old woman, I must call you Ms. Judie. Is that okay?”

Next, I think we will work on political correctness!

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

02 January 2013

Happy New Year from Karachi!

Several months have passed since my last blog post. For two of those months, I was back in the United States for training and to spend time with my family, but there are two primary reasons I have been unusually quiet: Either there was little to write about or, on the rare occasion when there was a topic of interest that merited a report, writing about it was not possible.

This is the second year I spent the holidays in Karachi, Pakistan. Celebrations of Thanksgiving, Christmas and New Year’s require a bit of creativity under these circumstances. Perhaps the biggest issue is that most of my American colleagues go home to be with their families and friends, so those left behind have to fill the void. This year our American presence is about one-third of the normal.

There is a young woman among us, however, who is particularly resourceful at creating social opportunities. She set up a Thanksgiving potluck dinner in the lobby of the consulate residence and provided all the usual comfort foods of turkey, mashed potatoes and cranberry sauce, as well as a kickin’ carrot-pumpkin soup that we’ve asked the cafeteria to offer through the cooler months, so we can enjoy it again.

Christmas included eggnog tasting, recipe competition and a white-elephant gift exchange. New Year’s Eve featured a progressive-dinner apartment party. We had decorations and a very large tree in the lobby. It looked like Christmas inside the consulate compound, even though there was little sign of it outside the compound.

Imagine my surprise when, on Christmas Eve, there was a knock on my apartment door. Outside stood two of our local Islamic guards, one dressed in a Santa suit! Though they did not speak English, they alternated between “Ho, Ho, Ho” and “Merry Christmas” as “Santa” handed me a chocolate. It caused me to reflect on what a strange and wonderful life the U.S. Foreign Service has given me.

After that experience, I wondered, “Will Father Time be delivering chocolates on January 1?” Well, New Years’ Day has come and gone and, so far, no chocolates.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

09 July 2012

Where's the billing department?

On a recent trip to The Indus Hospital in Karachi, I was once again amazed by the extraordinary achievement of a few ordinary people. This is a free hospital completely supported by donations. No one who is seen and treated at this hospital is charged. If a patient wishes to donate a sum of money, it is accepted but they are not informed what their treatment might have cost in a different institution, and there is absolutely no expectation of a donation.

You might think this is a small, neighborhood operation, but you would be wrong. The hospital staff treats upwards of 300,000 outpatients per year and has admissions of about 11,000. And free doesn’t mean low tech, either. Indus offers invasive cardiology, endoscopy, lithotripsy, hemodialysis and all radiology services except MRI, and that will be in service before the end of this year.

Impressed? Well, there is another really amazing fact. Indus is 100 percent paperless! All records and reports—all business—are electronic. Of course, since they have no billing department—can you imagine?—a large need for paper is eliminated right from the start. When one visits a hospital ward at Indus, the robotic medication cart moving down the hall with monitor and keyboard on top should be a quick tipoff. All medications are ordered, tracked and recorded electronically. Every patient service is handled the same way.

How did this amazing institution come to be? A group of like-minded medical and business people decided it was needed and would be so—and now it is. The goal was free but excellent treatment for the poor, and Indus provides both.

I visited Indus because I will be screening our local staff for tuberculosis this fall. We do this on a four-year cycle, because TB is endemic in Pakistan, and it is important to screen for possible infection and to ensure that people are properly treated. The government of Pakistan has a TB treatment program, and the expert resources in the Karachi area belong to The Indus Hospital. My objective was to arrange a referral path, in case our screening indicated any employee needed further testing and, possibly, treatment.

After my tour of the main hospital, I was taken to the TB screening and treatment facility, which is in a separate space from the hospital proper. I really hate to overuse the term “amazed” but, once again, I was. This purpose-built building is ingeniously designed to accomplish infection control.

Karachi’s climate alternates between hot and hotter and there is, on average, 7 inches of rainfall per year. That is only 4.5 inches more than Death Valley’s annual average, so this climate is hot and dry. The TB treatment pavilion uses an open-air concept in which shade coverings that resemble boat sails are positioned horizontally to the ground. Every six feet, a bidirectional fan moves air toward the ground, air that is subsequently circulated up and out through the sails. Because the tubercule bacilli are lighter than air, any that might be exhaled from an infected patient are swept up and out with this efficient ventilation system, thus dispersing the bacilli and rendering them ineffective. In Karachi’s hot, dry climate, this ingeniously designed system is very cost effective. As an added safety factor, patients, staff and visitors all wear surgical masks to further reduce the chance of exposure.

In addition to this hospital-based TB facility, where patients are diagnosed, counseled, tested and treated, there is an extensive community support program. TB patients are given monthly food items for nutritional support, a monthly travel allowance to treatment centers, daily home visits by treatment supporters to monitor drug compliance—they utilize Directly Observed Treatment, or DOT—and to provide ongoing psychological and social support during the term of treatment. It is all without cost to the patient.

Here in Karachi, a city of 20 million in a country with an unstable economy and an average annual wage of approximately $450 per year, ordinary people have come together to do an extraordinary thing. Wow!

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

30 May 2012

Linked in but unhinged!

Whoa! Beware of jet lag. It can cause you to act in strange ways.

I returned two days ago from R & R in the United States. The time difference is 10 hours, and it always takes me a few days to make the switch. Most of the time, I feel like my brain is still hanging out over the Atlantic Ocean while my body is on terra firma in a strange land. The few days are the worst. Yesterday afternoon, I was absolutely goofy from jet lag and struggling to stay awake. Typically, I surf the Net to kill time.

Another time I was jet lagged, this got me in trouble. My laptop DVD drive had conked and, rather than take it to an “iffy” local repair place and expose my personal data to who knows whom, I decided to order an external DVD drive. I took up the quest to find the best bargain on my first day back from leave. A couple days later, I picked up the search again and ordered a drive. A couple weeks after that, my two DVD drives arrived on the same day. TWO? Yes. Though I don’t remember it at all, I had ordered one the first night back when my brain was still on low-function mode.

This morning, my e-mail junk folder was particularly full. There were all these “congratulations” messages from people I know about joining LinkedIn. I have to honestly admit that I really don’t know what LinkedIn is and have resisted all offers to join in the past. Further, it seems that anyone I know and correspond with via e-mail has been notified that I’m now part of the fun. How do these things miraculously occur? I am totally baffled.

I tried to retrace my steps and, yep, I found a LinkedIn request from my brother-in-law. In my jet-lagged stupor, I must have clicked on the little button that has now opened a new world for me, of what I’m still not sure. But I’m going to embrace this adventure and learn to be linked in and, since Jim Mattson, editor of Reflections on Nursing Leadership (RNL), is also in this pond, I’m sure the sailing will be just fine.

For safety’s sake, the next time I return from R & R, I’m going to disable all electronic devices for at least three days. I just can’t trust myself.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

30 April 2012

I’m so VERY glad we had this time together?

Cultural idiosyncrasies are some of the most entertaining aspects of living overseas, and let me assure you that we Americans are just as entertaining in our cultural habits as anyone on the face of the earth.

Recently, three colleagues of mine—a Pakistani man, a Tanzanian woman and an American woman—were in my office, and the four of us were discussing a work issue. My American colleague was explaining something to our male colleague who, because he would get frustrated by his inability to answer quickly in English, would respond instead in the local Pakistani language of Urdu and have our Tanzanian colleague translate, because she is also fluent in Urdu. As I said, the four of us were discussing a work issue, but it should be noted that I was largely ignoring the entire conversation because I was rapt with the task of clobbering a fly that was bothering me.

I don’t know what it is about flies. Mosquitoes find me boring, and fleas refuse to nibble. I don’t think I’ve ever had a tick bite; perhaps a chigger bite or two, but I am honey to a fly. A fly will travel great distances to buzz around my head and drive me out of my mind. They do it at great personal risk, because I am always intent on truncating their already limited life span.

So, as the conversation ensued, I was paying attention to my buzzing tormentor, ready for an opportunity to strike with the magazine that was rolled up in my hand. At a particularly opportune time in the conversation, the pesky fly chose to land on the edge of my desk, immediately in front of my Pakistani colleague. I reared back and slammed the rolled magazine down on the desk, at which point my friend jumped up from his chair and grabbed both of his earlobes.

There was a moment when the three of us women took in this scene. We each knew I was swatting a fly—actually, I missed—and I was momentarily miffed that my colleague would ever have thought I was aiming at him but, as we looked at him standing and holding his earlobes, we had no choice but to burst into laughter. He joined in but still tightly holding his earlobes.

After we caught our breath and wiped the tears; we had to know: Why was he holding his earlobes?

Ah, it is cultural. Because he was concentrating on the conversation and the translation that was taking place, he wasn’t paying attention to my hunt for the fly. When I slammed the rolled-up magazine down on the desk, his immediate reaction was to think he had somehow said something wrong or insulting and that I was showing my displeasure. I understood why, to get out of the way of my magazine, should it strike again, he had jumped up, but the earlobes? Turns out it is a demonstration of apology in the Sindhi culture. My friend didn’t know what he was apologizing for but his reaction was instinctive and, given the circumstances, very funny.

We have now spent several days adapting this newly learned skill to our toolkit. We’ve decided a mild insult warrants pulling on one lobe, à la Carol Burnett, and that a more serious offense should have both lobes wagging in supplication. My Pakistani friend, on the other hand, has a newfound dislike of flies. Cross-cultural assimilation at its best!

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.