29 March 2010

A good thing

One of my favorite tasks as a Foreign Service medical officer is to mentor new-hire colleagues. This usually starts with an email from my director, asking if I am available to mentor a new employee, who is being posted to my region. I consider it an honor to be asked and a responsibility to be taken seriously. The purpose is to assist the practitioner in learning the Department of State administrative system, which, as you might imagine, is very different from a typical U.S. medical practice. Most of the mentoring occurs via e-mail or phone but may include a site visit as well.

My current mentee is posted to Kiev, Ukraine, and I recently made a site visit. My colleague is a young mother of two. Spousal employment can be a huge issue for many Foreign Service officers but this is a non-issue for my mentee, as her husband’s work can be done from home via the Internet. However, she is concerned about how overseas life might affect her children, since the lifestyle is so very different from growing up in the United States.

I brought my daughter overseas when she was 14, a terrible age to move a child from the known to the unknown, and we were fortunate it worked out so well. She had a personality that was open to exploration, and she was especially accepting of different cultures. Her first foreign school included a student body representing 34 countries. There is no doubt that it was a learning experience for her, far beyond the actual academic curriculum. Her senior year was spent boarding at a high school in Rome, and my concern that the year would not hold the wonderful memories usually attached to a senior year were unfounded. In fact, her dearest friends, eight years after graduation, are young women she formed a bond with in Rome and who have continued to be central relationships in her life.

I have tried to reassure my mentee that her children will most likely do just fine changing environments every two to three years. Not every Foreign Service child adapts and thrives, but the majority of them do. In fact, Foreign Service kids are some of the most adaptive and confident I’ve ever known. And, as my daughter will attest, the question, “Where are you from?” can make a Foreign Service kid the most interesting person in the room. That is usually a good thing.

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

23 March 2010

The hero whose name I don't remember

In my last post, I mentioned Greg Mortenson, a modern-day hero to the people of northern Pakistan, whose story has been widely publicized. I cannot fail to also tell the story of the Pakistani doctor who is responsible for medical care in the Shigar Valley, where one of Mortenson’s schools for girls is located.

My friend, Debbie, and I walked into the local clinic on a Saturday morning. We visited because, as medical providers, we were curious about the services offered in this very remote area of the mountains of Pakistan, where there are no modern conveniences. Women wash clothes in the river, there is no running water or sewage and electricity is dependent on generators, which means the overwhelming majority of those who live there have no electricity.

We were warmly welcomed in the clinic’s outer waiting area, and an attendant, who spoke no English, hurried off to get the doctor. The physician, probably in his late 30s, invited us into his office and offered us tea. I am ashamed to say I do not remember his name, because it deserves remembering. We explained who we were and he cordially told us—his English was quite good—about his life. Notice, I didn’t say he told us about his practice. That’s because we quickly learned that the practice of medicine is his life—it is clearly not a job.

This man, the government-stationed physician, is responsible for the 15,000 people of his area and the only formally educated medical person in the Shigar Valley. His staff consisted of local people who had received on-the-job training to assist him in caring for his patient load. His wife and children live at the clini
c with him, and he works every day of the year!

While we talked, his assistant brought in patients, who were totally accommodating of our presence. In their language, they told the doctor their complaints. After briefly examining them, he wrote notes on small pieces of paper, which he handed to the assistant. He explained that he was writing down what treatment to give or medicine to dispense. There was a steady stream of people of all ages coming through the door to his office. The nearest hospital is 2 1/2 hours away and inaccessible four to five months of the year, when the roads and mountain passes are closed by heavy snowfall. This doctor takes care of what he can and comforts the patients and families when all he can offer is compassion.

He kindly offered us a tour of the clinic. There were women’s and men’s inpatient wards and treatment rooms for minor surgical procedures or deliveries. There was a small pharmacy and a very basic laboratory. Furnishings were old and meager, but the place was amazingly clean. We asked him if the clinic accepted donations of medicine or medical supplies. No, he said. Needs of government clinics were provided for by the Ministry of Health, and they were specifically forbidden to accept any outside assistance.

Undoubtedly, there will never be a book written about this man, but he is also a hero to the people of northern Pakistan and another fine example of what one person can do. I really wish I could remember his name.

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

15 March 2010

What can one person do?

For diplomats, travel within Pakistan is severely limited. However, the far north region remains secure and, outside of the snow months—November to March, visiting is entirely possible, though not entirely reliable.

It is a one-hour flight from Islamabad to either the northern side of the Karakoram mountain range of the Himalayas and the green Hunza Valley, or to the eastern side of the range and the stark gray beauty of the Skardu and Shigar Valleys, and the raging Indus River. Booking a flight in either direction is easy. Getting on the flight, or getting on a flight back, is the challenge. The planes fly into and out of these valleys by visual means only and, in these high mountains, visibility changes from one hour to the next. I’ve had many colleagues who were stuck on one side or the other for several days, unable to return until the weather cleared. I was never that fortunate.

Both of these areas draw mountain climbers from all over the world, although the security situation in Pakistan has hurt the sport tremendously since 2001. These are not classic tourist areas. There are comfortable—though basic—places to lodge, the air is crystal clear and the food is hearty, although it would not be termed cuisine. Hikers can safely backpack to remote locations and camp and, while very little English is spoken, local people are adept at understanding what a visitor needs and are always willing to assist.

It was on a visit to the eastern side and Shigar Valley that my friend Debbie and I came upon a little school building with a yard full of happy, giggling girls. This tiny village doesn’t see many visitors and the girls were extremely excited by our presence. The head teacher welcomed us to the school and offered a tour. So, in and out of the neat little classrooms we went, looking at artwork and taking note of writing exercises on the blackboards and completed math pages. One young girl offered to read to me from her English book, so we sat on the steps as she expertly read a story. I noticed a photo on the desk of a Western-looking family who, the teacher explained, was the school’s benefactor. It was only later that I understood the significance of that photo.

If you have not read the book, Three Cups of Tea, please do. It is the story of Greg Mortenson, an American RN and former mountain climber who saw a need in the mountains of Pakistan and made it his life’s work to educate the illiterate children, especially girls, of the northern regions. It was one of Mortenson’s schools that my friend and I visited that day, and it is one of the most meaningful memories of my time in Pakistan.

Mortenson’s foundation, Central Asia Institute, strives to promote peace through education and by improving the place of girls in society. In November 2009, Mortenson was awarded the Archon Award by the Honor Society of Nursing, Sigma Theta Tau International at its 40th Biennial Convention. I have read that he has twice been nominated for the Nobel Peace Prize, an honor he surely deserves, as he has more than answered the age-old question, “What can one person do?” As one person, Greg Mortenson has created miracles and changed lives, and is an American hero in Pakistan.

Additional resources:
Convention highlights—Monday, 2 November. (2009). Reflections on Nursing Leadership, 35(4). Retrieved 15 March 2009 from http://www.reflectionsonnursingleadership.org/Pages/Vol35_4_FTS_Convention_day3.aspx

Mattson, J.E. (2009). Through his mother’s eyes: Jerene Mortenson talks about the work of Greg Mortenson. Reflections on Nursing Leadership, 35(4). Retrieved 15 March 2009 from http://www.reflectionsonnursingleadership.org/Pages/Vol35_4_Mattson_JMortenson.aspx

Mattson, J.E. (2009). Wrong turn at the Braldu. Reflections on Nursing Leadership, 35(3). Retrieved 15 March 2009 from http://www.reflectionsonnursingleadership.org/Pages/Vol35_3_Mattson_Mortenson.aspx

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

09 March 2010

Viva Italia!

Today was a beautiful, sunny day—a real treat during this mostly gray-skies time of year in Prague. I took the opportunity to hop a tram, followed by the metro, to go to a distant shopping area and explore that vicinity of the city.

Before I joined the Foreign Service, I spent my entire life in southern United States. Mass transit really doesn’t exist in the South, other than a rather limited system in Atlanta, so being involved with some of the world’s largest and most sophisticated mass-transit systems has been of real interest to me, both in technology and in the culture of mass travel.

Most of my metro/tram experience has been in Europe, but I was also a frequent rider of the Mexico City metro, while serving in that post. Frankly, most of my colleagues wouldn’t ride the Mexico City metro, for fear of pickpockets or of being squashed to death. The latter was a real possibility, as I quickly discovered one rush hour when I witnessed a young woman trying to exit the train and be literally picked up by the oncoming rush of people and pushed back into the car. I hoped she was able to get off at the following stop.

My favorite thing about living in Moscow was the metro system. This system is HUGE! It is dependable, inexpensive and has the most artistic stations I’ve ever seen. I spent many weekends just traveling the metro and taking pictures of station decorations, which was strictly forbidden but not enforced. There are tours of the Moscow subway stations—I took one just to learn more about the history—and coffee-table picture books of the most ornate.

The culture of mass transit in Moscow is interesting. There is a set etiquette for travel, and it includes being straight-faced and, preferably, quiet. If one must speak to another passenger, it is to be done at a whisper and as quickly as possible. And one should never ever smile, nod or make eye contact with other travelers.

In contrast is travel on the Rome metro, where jabbering travelers might be entertained by a fellow commuter(s) who breaks out in song—usually opera—for a few minutes, and then finishes to raucous clapping. While Rome stations are not particularly ornate, in comparison to Moscow stations, their displays of Roman antiquities are a real plus.

In Bucharest, I sometimes traveled on the new and modern metro, usually with only a few other passengers. The line is rather limited, but so expensive that most people couldn’t afford to travel. Sure kept those cars clean and shiny, though.

In Budapest, the stations were underground shopping malls with food courts, stores, flower shops and travel agencies—sort of one-stop shopping while going to or from home. I mostly used the trams in Budapest, and I don’t think I was ever on one that wasn’t standing-room-only, which became an issue when tram police jumped on to check tickets. People without tickets would start pushing to the other end of the car, hoping to get off at the next stop before getting caught and fined. It was great entertainment, if I could get out of the way.

The metro and trams in Prague are modern and quite utilitarian, and the system is widespread. The most important thing is, they are punctual with a great frequency schedule. Unlike our neighbors to the far northeast, people happily chat and smile at each other, though not so much to strangers. On my tram ride back home today, our car was serenaded by a group of three young men—visiting Italians!

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

01 March 2010

Interesting people

I continue to visit medical and dental clinics in Prague, as required by my Washington superiors. The purpose is to know options for care that are most in line with our American medical philosophy. This information benefits Americans who work here in an official capacity as well as visiting Americans who call the consular office for our list of medical consultants. I’ve had the opportunity to hear interesting stories along the way, and I frequently find the unexpected.

From 1948 to 1989, the Czechs were under a communist political system. One practitioner I know completed his medical education in Prague in the late 1960s and then defected to the west, eventually ending up in Canada, where he practiced for more than 20 years. He returned to Prague a few years ago to work and reclaim the home of his youth. His story is fascinating as he tells of his struggle to learn English, pass the medical examinations required in Canada and begin a life completely cut off from the rest of his family, who remained in what was then Czechoslovakia. He made huge sacrifices to live a life free of political domination.

I met a physician born in the United States to Czech parents, who defected from communism. He completed his medical education around the time the Czech Communist Party was abolished and decided to come to the Czech Republic to help build the new medical system. He has spent the last 20 years with his foot in both societies. He has a practice in Prague and maintains an attending staff position at an Ivy League teaching hospital in the United States, working at the U.S. location several times a year. Medical residents from the U.S. program have the opportunity to rotate through a linked curriculum he administers in Prague for an overseas study semester.

My young dentist in Prague is an American who married a Czech woman. They met in the United States, where they married, lived and worked but, when their child was born, they decided to move to the Czech Republic to be near her parents. His story is equally interesting because it is the reverse tale. Although he wasn’t escaping a totalitarian government, he did have to learn Czech—a very difficult language—to pass the certifying and licensing examinations. In fact, he was the first English-speaking dentist to achieve licensing in the Czech Republic. And, of course, he had to adapt to a very different medical environment. He has great stories to tell about his experiences; in fact, they all do. Meeting these interesting people and hearing their histories is one of the most interesting parts of my job.

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