20 December 2011
05 December 2011
14 November 2011
28 October 2011
|Mehroon teaches proper handwashing technique.|
14 October 2011
03 October 2011
22 September 2011
12 September 2011
17 August 2011
15 June 2011
31 May 2011
23 May 2011
For some months now, I’ve noticed my vision becoming less sharp. I finally decided to see if a bit of LASIK surgery might be a possible solution and scheduled an appointment with Prague’s premier LASIK center at a local hospital.
05 May 2011
I have just returned from two weeks in the United States to welcome my newest—and eighth—grandson. He is a great little guy, peaceful and even-tempered, and, considering that his next older brother is a real handful, I hope he stays that way, in deference to his mom.
Lately, I have been corresponding with a couple of people who are interested in what my job entails. I’ve been asked to recount my "typical" day, and I’ve given a great deal of thought about what a typical day is for me. However, there is a big picture to my job, and it can’t be answered as easily as one might think.
First of all, typical, in the sense of the types of patients I see in the clinic, depends a great deal on where that clinic is located. State Department embassy medical units are located worldwide, so health risks differ from location to location. While there might be an allergy or influenza season in any location, acid bug, malaria, dengue or Japanese encephalitis risk only occurs in some locations. However, most patients are seen for basic primary-care causes, just as in a U.S. clinic, but the daily patient load is less, as our responsibilities are broader than patient care.
Patient safety and health issues also vary by location. For example, the risk of gastroenteritis in Southeast Asia, and the community education required to prevent it, far surpasses the risk in Western Europe. When I was in Southeast Asia, evaluation for and treatment of food-borne disease was a daily event. In Prague, I have never discussed food-borne disease with a patient; it isn’t required.
My typical day in some posts might include a visit to the embassy cafeteria kitchen to observe and reinforce proper food storage and preparation practices. Our North American standards of food service are a mystery to food workers in much of the world, and it falls to the post medical unit to enforce the standards we expect.
A frequent task is evaluation of medical resources to use as consultants for the embassy community. In the majority of these cases, a continuing relationship and rapport must be nourished by frequent contact, visits with the consultant and sponsorship of social events. Medical associations in the United States are largely pure business while, in a great deal of the rest of the world, successful business requires social interaction like "tea and biscuits" to keep the relationship active.
In the beginning, I found this very difficult. I was used to calling a consultant and immediately launching into information about a patient. I've learned to be more sensitive to the cultural needs of the practitioners I call, which usually requires discussion of niceties first—"How are you? How is the family? How was your recent trip to X?"—before I launch into the medical conversation.
A typical day for me includes meetings—management, country team, emergency action committee and other committees of various sorts. I may be the medical officer, but my official duties cover many things that aren't medical at all. I admit I’m not a fan of meetings, but they are a necessary part of the job.
If variety is truly the spice of life, I have a very spicy life. Just the way I like it.
15 April 2011
If you have been watching the health news, you may have seen statistics released by the World Health Organization for stillbirths across the globe. Congratulations to Finland, which has the lowest rate at one per 1,000 births. Pakistan, a county I have lived in, has the second highest rate at 47 stillbirths per 1,000 births.
In 2008, I was invited to join a group of USAID (United States Agency for International Development) staff traveling to Kashmir to oversee a women’s health project. I jumped at the chance, even though it required traveling in a helicopter (I hate them), because we are not usually allowed to go to Kashmir. As disputed territory between Pakistan and India, it is not considered “secure.” So, the opportunity to see part of this district was too good to pass up.
The purpose of the project is to strengthen essential obstetric care in the district of Bagh, where 64 percent of deliveries occur without skilled attendants. There was no obstetric physician in all of Bagh, a district of 2 million people, until USAID paid to locate one—yes, that is ONE—there. To provide pre- and postnatal care to the mothers of the Bagh district, local nurses are trained to be professional midwives. They are located in rural areas where the preponderance of unattended births occur. One in every 74 deliveries is fatal for a mother in Pakistan versus 1 in 4,800 in the United States, so the program has tremendous potential. This is a two-year education program and very professional. I visited two rural health clinics, one where training was in process that day on how to prevent and treat post-delivery hemorrhage.
These clinics, housed in prefab buildings, have no running water. Hand washing stations were created using a system comprised of metal jugs, and instrument sterilization is done by boiling or by soaking the instruments in disinfectant. In addition to providing a place to deliver babies, these clinics, which were amazingly clean and tidy, provide health care to the general population.
Operating at low cost and with high return, such programs are fiscally efficient. WHO’s recent release of stillbirth statistics emphasizes the need for continued education in maternal-child health care in the poorest parts of the world. I do hope that cost cutting proposed by First World countries to tackle their budget problems does not include decreasing these effective, fiscally efficient programs. I’ve seen first hand the benefit they provide.