27 May 2010

Only when stressed

One of my responsibilities, using U.S. Department of Transportation guidelines, is to evaluate local employees who drive embassy vehicles. Ninety percent of the drivers evaluated are men who are 100 percent worried that they won’t pass and will be suspended from driving, which rarely happens. Hypertension is usually the biggest health issue that presents in these physicals and, regardless of the actual BP reading, the drivers always blame it on “white coat syndrome.” Most of the time, the initial conversation goes something like this.

Me: I see your blood pressure is a little high today. Do you have high blood pressure?

Driver: No, I’m just nervous to be here.
Me: Really, there is no reason to be nervous. Do you take any prescription medication?
Driver: No, unless my doctor gives me something.
Me: Has your doctor given you anything recently?
Driver: I have those little pills I take when I need to.
Me: What are those pills for?
Driver: For when I get stressed, like now, and my blood pressure goes up, but I don’t have blood pressure problems unless I’m stressed.
Me: How often do you take those pills?
Driver: Well, my doctor told me to take them every day, but I only take them when I’m stressed or I know I’m going to be nervous.
Me: So, you are being treated for high blood pressure?
Driver: Yes.

OK, now we are getting somewhere!

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

18 May 2010

They haven't forgotten

Europeans, especially eastern Europeans, honor pivotal WWII events annually. Allied troops marched into what was then Czechoslovakia in May of 1945 and, under the command of General George S. Patton, liberated the Czechs from Nazi occupation. Even though the Czechs fell under USSR domination after the war was over, they still view American forces with fondness.

The kickoff for the month’s many memorial events held around the Czech Republic for this, the 65th anniversary of the liberation, was held in Prague on Friday, April 30. There was a parade of WWII military vehicles and several dozen Czech citizens dressed in the uniforms of Allied-forces troop personnel. The parade wound its way through Prague and ended in front of the American embassy where a 1940s-style swing band was playing themed music. It wasn’t a huge event; there were perhaps 300 people in attendance. Still, it is gratifying to be an American and experience the appreciation that is still held for Americans who left their shores to defend the freedom of other peoples. It is especially welcome to those of us who serve our government in foreign countries, since there is a fair amount of anti-Americanism overseas, and we are more often on the receiving end of disrespect. The big band music was icing on the cake.

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

13 May 2010

Nine things I've learned since coming to the Czech Republic

I’m in my seventh month in Prague, the weather has warmed to pleasant spring perfection and I’m really enjoying this beautiful European city. I’ve been in the Foreign Service long enough to know each location has its particular culture and individual points of interest, so I’ve been reflecting on what I’ve learned since I’ve been in the Czech Republic.

1) Some people in Prague walk faster than I do. This may seem odd to you, but it is the first place I have ever lived where people on the street routinely pass me. I walk especially fast; not intentionally, it is just what I do. My 6-foot 4-inch son, who has a very long stride, doesn’t walk as fast as I do and asks me to slow down. I have been places where people look at me oddly, wondering where the fire is, I suppose, as I scoot past. Here, I am frequently outpaced, and I love it.

2) Prague is the sixth most visited city in Europe but only about 8 percent of tourists are American. I guess that means Prague is a best-kept secret from Americans but, believe me, other countries’ citizens love to come here. The CR is full of Europeans, South Americans and Asians.

3) Czechs are not friendly until after you say hello. Maybe this is a holdover from the insecure times of communism, but Czechs generally don’t make any eye contact with someone they don’t know, whether on the street or in a store. But the minute the other person says, “Dobrý den (hello),” that reserve melts away and he or she becomes open and friendly.

4) The Czech language is HARD! I think there is a reason only 11 million people speak this language, and it isn’t just because there are only 11 million Czechs! I have learned to get by in Czech when I order a meal or go to the grocery, but I will never be able to hold a simple conversation.

5) Czechs over 30 are not particularly interested in learning English. They were required to learn Russian or German—languages of occupying forces—and they are nationalistic about maintaining the Czech language. Who can blame them? I believe their thinking is, because they live in the Czech Republic and have their own language, foreigners who visit or come to live should make the accommodation to get by in the local language. I agree! We Americans think the same way. I just wish Czech wasn’t so hard.

6) Most Czech women are in the normal weight range. This is probably because almost all Czechs participate in a broad range of sports, but I have a sneaking suspicion it is also because refrigerators are tiny. Keeping the fridge stocked requires several trips a week to the market, on foot. I only feed one person, and I know my physical activity has increased just from grocery shopping. Additionally, once I’ve done the shopping and have lugged the groceries back to my apartment, I’m not too interested in eating.

7) Flowers are important. Prague is a city, but it blooms. Flower shops (květiny) are no more than two blocks away, no matter where you are in Prague. Citizens take great pride in displaying plants and flowers, and bouquets are a common gift. It really adds to the ambiance.
8) Czechs love tea! This was a total surprise to me. The CR is famous for its beer and Budweiser Budvar Brewery, home of the original Budweiser beer, is here, but tea shops with exotic teas from around the world are common. Many restaurants have a special tea menu with dozens of choices. By the way, local beer is often less expensive than tea, coffee or colas!

9) Finally, until 1989, every Czech baby had to be named from an official list of names. Legally, a non-Czech first name was not permitted on a birth certificate, and this tradition had been in place for centuries. Each name—male or female—had a “name” day on the calendar, and name days were celebrated rather than birth days.

No doubt, as I live here longer, I’ll learn more interesting facts about my temporary home. But I think the most important thing I’ve learned about Prague is—I’m happy living here.

Top: Astrological clock
Bottom: Tyn Church, Old Town, Prague

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

03 May 2010

When personal overlaps with professional

I suppose being in practice in the Foreign Service is akin to working in a small town—a very small town. While a few embassy populations are quite large, with more than a thousand staff members and families, most are well below the 500 mark. I am responsible for the occupational health needs of fewer than 200 people in Prague, plus another hundred local staff.

This means my patients are also my colleagues and friends. It is not uncommon for me to have lunch or dinner with someone I treat in the clinic the same week. Rarely are we in a situation where we provide care for people we don’t see frequently outside of the health unit, even if it is just passing in a hallway.

I have always had mixed feelings about this unusual practice environment, as having such a close relationship with one’s patients has both advantages and disadvantages. Under this system, my feeling of responsibility for a patient’s medical outcome is both professional and personal. My medical colleagues and I have to maintain clinical objectivity at the same time we have a very special interest in the people we are treating.

Recently, one of my patients has been very ill and has required advanced medical care within the Czech health system. I am thankful there is such competent care available in Prague, but the length and severity of the illness has cost me many tossing-and-turning nights. I worry and wonder if all the people making decisions in this case—myself included—are making the right decisions. From the beginning, there has been a high chance of complications, and I am acutely aware that, if things don’t go well, my embassy colleagues might look at me with a critical eye. But that isn’t the cause of my fidgety sleep. I have tremendous regard and respect for my patient, and it is that personal connection that causes the angst!

At my first post—Accra, Ghana—I was forced to hospitalize a septic 3-year old. The parents were on their initial overseas assignment and had been in country for exactly one month. The mom was a lovely young lady who stood about 5 foot 2. After admitting the baby to the hospital and initiating IV infusion of the drugs that were going to save her, the mom turned to me, literally grabbed me by the shirt and pulled my face down to hers. “Don’t let my baby die!” she cried.

That was the first time I felt the full force of the responsibility this practice can bring. Unfortunately, it hasn’t been the last time but, in that case, the child did well and left the hospital in less than a week, her mother having never left her side.

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