21 December 2009


H1N1 has arrived in the Czech Republic. This is a bit more complicated for my clinic than for a clinic in the United States. For one thing, I don’t have H1N1 vaccines. They were ordered months ago for the Foreign Service, but only a tiny fraction has actually been delivered to the Department of State for its overseas staff. I have 20 people who fall into the CDC’s high-risk group and should be vaccinated; some of them are anxious because the vaccine is not available.

The Czech Republic has vaccine only for a limited number of their residents, and they have purchased Pandemrix, which is not FDA approved, so I wouldn’t be able to use it anyway. I do have Tamiflu and Relenza and use them when appropriate. Although we have had employees diagnosed with H1N1, so far, none have been serious, and we are doing our best to keep it that way.

We’ve been busy educating all staff members at the embassy, including local employees who fall under the Czech health system. I’ve tried to impress on everyone that this is a public health issue and not just a private health concern. I’ve delivered information in e-mails, handouts and personal group sessions with the different offices, but the most successful campaign has been the use of a video prepared by the Virginia Department of Health. Whoever thought this up is a genius!

In 2007, when “bird flu” was all the rage, the U.S. Embassy in Islamabad, Pakistan was seeing a large bird die-off on the embassy compound. My clinic arranged for some of these birds—all crows—to be evaluated at a poultry lab and, sure enough, they died of H5N1. At that time, there had been no animal-to-person transmission of avian influenza in Pakistan, but having these multitudes of bird carcasses around the compound was unsettling to people, and a minor crisis was evolving.

Our facilities manager called me one afternoon to announce that a sick hawk was on the compound and asked me what to do. “Leave it alone,” was my sage advice. For the next three hours, I received update calls as this poor bird experienced his death throes! When he finally did expire, he was refrigerated and sent to the poultry lab for diagnosis. He tested negative for H5N1, so they performed an autopsy! Cause of death: pathogenic E-coli. If Mr. Hawk had come to the health unit for his check-in orientation, he would have known to boil it, cook it, peel it or leave it, essential food sanitation advice in Pakistan, and he might still be soaring in the skies!

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

11 December 2009

We got something right!

One of my responsibilities, when moving to a new post, is to assess local medical resources. Most cultures are more formal than the American culture, so there are official introductions, sometimes the exchange of small gifts, often tea or coffee, and polite chatting before we get down to the business of me asking, “What can you do for the official Americans in your country?” Not in those words, of course, but that is the real purpose. I will visit the hospital or clinic and ask nosey questions to determine if the facility is acceptable to me, and those I serve.

I continue to be surprised by the hidden jewels I find in the most unexpected of places around the world. I remember the husband-wife MD team—Harvard residencies—working in a truly backwater clinic in Rwanda and, in Guinea, the tropical disease expert from Germany. I have never served anywhere that I couldn’t find at least a few excellent physicians.

Nursing is another matter. Frankly, most of the countries in which I have worked undervalue the nursing discipline, and a few—Guinea and Afghanistan come to mind—don’t recognize the discipline at all. Nursing in these places is an OJT technician job with little formal training and no respect. In more modern countries, nursing usually requires formal education but falls short of the critical thinking required in countries with the highest standards of nursing care.

I recently had dinner with a German nurse who was lamenting that nurses in her country, while highly educated, were underutilized as integral members of the health care team. She was intrigued by advanced practice nursing and commented on the ways in which the German system could benefit from such a program. Finally, she said, “You Americans have really got it right!” Now, there’s a comment I never hear. I usually have to listen to all the things we Americans have wrong.

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

03 December 2009

Assimilation in progress!

Encountering a different culture as a tourist doesn’t require true commitment to adaptation. A person on vacation eats in foreigner-friendly places, shops for souvenirs in stores where staff do not view the customer as a “bother,” and learns polite words (please, thank you, etc.) in the language of the country visited, but little else.

Not so for the expatriate who has come to a foreign country to live and work. We are more than guests of our new home country and are expected to assimilate as much as possible. In some countries, going to the grocery store is often more of a nightmare than an adventure. When I was in Russia, where I had no prior language training, I would only purchase things that were visible in the package or that had a picture I recognized. The writing was not only Russian, but in the Cyrillic alphabet, and completely unintelligible to me.

Once, an American co-worker, also a non-Russian speaker, and I decided to lunch in a particular restaurant because they had an English menu. Most restaurants will have a line item in the local language followed by a translation immediately below it in other languages. This establishment, however, had two separate menus, one in Russian and one in English. Our server spoke no English, so my friend and I found what we wanted on the English menu and then located items in the same positions on the Russian menu and pointed out our choices. Ah, you see what’s coming, don’t you? It’s true; the meals we ordered were not at all what we were served. It never occurred to us that the two menus, other than being in different languages, would not be exact duplicates of each other.

I’ve been in the Czech Republic for five weeks now and I’m learning to assimilate. At least the Czech language uses the Roman alphabet and I had seven weeks of language training to give me the bare necessities of communication.

I was in the butcher shop a few days ago and asked, in Czech, for the items I wanted. The lady behind the counter understood me and began preparing my order. I burst with pride when the woman standing next to me turned and said something in a long Czech sentence that I did not understand, but I knew she spoke to me because she thought I could understand. I smiled and nodded, to what I do not know, and she was satisfied.

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