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 I’ll 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.

Almost like coming home

I’m here—back in Pakistan—and it is almost as if I never left. There is so much that is familiar about Karachi: food, crowded streets, tuk-tuks, sounds and smells. The past two years in Prague have started fading away, which is sort of sad, as I enjoyed them so much. But I find I am glad to be back; almost like coming home.

I joined the U.S. Foreign Service with the intent to live and work in places I would never visit as a tourist. My goal was to really get to know people and cultures that were different from the life I had always known, and I have been true to that goal. Even living in Prague, in the Czech Republic, which is in many ways similar to the United States, was very different from my pre-Foreign Service life in the American South. Americans and Europeans are pretty savvy about health and wellness issues. At least, they know a good deal about it, even if they don’t follow good health practices. But Southeast Asians are often not well educated about safety and health issues. Many of the home remedies and first aid applied in this region are traditions passed down from one generation to another, and they are not always effective traditions.

For instance, during my previous tour in Pakistan, one of our gardeners sustained a deep gash on his lower leg from a chainsaw accident. In an effort to stop the bleeding, his co-worker doused him with the gasoline mixed with oil that was used to power the chainsaw. We rushed him to the hospital for definitive care and, after the surgery, the surgeon called me to ask what that oily substance was in the wound that required such pains to debride?

As a result of that incident, a program was created to train some of the local employees to teach all of the other local employees, in their language and on a regular basis, about basic first aid. I’m pleased to say that the program is still ongoing in Karachi and is taken quite seriously by the workers. I am hearing stories of how family members and neighbors have been helped through the program.

Sharing information about health and safety practices to poorly served populations around the world is one of the most important things we can do. It follows the “teach a man to fish” philosophy, and small successes are really great triumphs.

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

Getting my eyes Czeched

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.

The appointment started off in the opposite direction I had hoped for when I was told the ophthalmologist with whom I had the appointment was not in and that his associate would see me. After a few minutes wait, a lovely young woman came in to speak with me and asked questions about my medical and visual history. I thought she was the nurse. She was the associate.

A few minutes later, I was ushered into the examination room where the young doctor did an eye exam. She quickly informed me that LASIK would not help me, and I needed to meet with her colleague. She thereupon personally walked me up to the next floor, where I met an equally young and lovely lens implantation specialist. In spite of the fact that I’m a medical provider, I can be a bit slow on the uptake. I was still of the mindset that we were talking about improving my vision which, in my mind, was a simple matter of loss of visual acuity due to aging.

The second ophthalmologist told me all about this wonderful multifocal lens that would improve my ability to read, without the Dollar Store readers I’ve used for years. “Yea!” I thought. I would love to ditch the readers. She then took me into her examination room and started with the same basic eye exam I had one floor below.

At some point, I threw out the question, “I guess LASIK would not work for me?”

“No” she said, “it will not correct the cataract.”

Cataract! What? Where did that come from? I immediately said, “I’m too young for a cataract!”

“Obviously not,” came her reply.

I was still trying to absorb this information when the young lady, now peering into my dilated right pupil, said “Oh!”

I do medical examinations and, as hard as I try, sometimes that “Oh!” just slips out. It usually isn’t good.

Now, the doctor is speaking Czech to her assistant. Next, the assistant is on the phone, and then we are moving hurriedly to another office. I asked what the “Oh!” was about. The doc tells me she thinks she sees a hole in my retina, and I’ll need retinal laser surgery.

“When?”

“Now!”

My goodness, the Czechs move quickly! This time, the retinal specialist is a rather ordinary-looking man who, though quite pleasant and reassuring, does mean things to my eyeballs as he looks for holes. After about 10 minutes of misery, he announces that my retinas are not perfect, but they are good enough and—drum roll—NO HOLES! “No laser today,” he says.

By now, I am so relieved I don’t have a hole in my retina I don’t even care that I have a cataract. Back we go to the second office, where the informed consent for cataract surgery and several bits of paperwork for pre-surgery testing are prepared. Alas, I am told that, because my retina is not perfect, I can only have the monofocal lens and will still have to rely on readers. They scheduled me for cataract surgery in three weeks, and I left the office with the typed medical report in my hand, just two hours after I arrived in the ophthalmology department.

Beat that!

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

The sign of the comet

I’ve often said it is the variety in my U.S. Foreign Service job that keeps me enthralled, especially since I seem to have a rather short attention span. In my career, no two posts have even been similar, much less the same. The Czech Republic has been a huge change from my previous developing-country assignments and, with a more typical list of medical complaints, I admit I was getting a bit soft.

Then, the mites arrived! One of our young officers came to me with a profusion of itchy, whelped, pink bites on her posterior thighs. Honestly, I didn’t know what the cause could be, and since the bites were in a defined location, it didn’t seem like a major issue. That was in the morning. When she returned in the afternoon, the bites were weeping, enlarged and had taken on a purple hue. My comfort level dropped to zero, and we arranged for her to see a dermatologist immediately.

The dermatologist was less concerned, because she knew what the cause was—a severe reaction to mites! Mites? Where did they come from, and why now? It is winter in Prague. Do mites attack in winter? A bit skeptical, I forwarded photos to a dermatology consultant in Washington, D.C. His reply was, “Yep, mites.” The dead giveaway was the “comet sign” coming off one of the lesions. (A comet sign is a red streak leading away from the central area). The two dermatologists disagreed on the source. One believed the mites were related to birds, and the other thought they were connected to woodborers, but both were certain the lesions were caused by a severe reaction to mite bites.

This is where my job gets really interesting. If I was in a usual practice in the United States, I would refer my patient to a dermatologist, who would prescribe treatment, and we would be finished with the issue. Not so in the Foreign Service. The ongoing saga of investigating why there are mites in this officer’s home, determining which chemicals are safe—and OSHA approved—to treat the infestation, photographing and cataloging new bites as they have appeared, discussing with various embassy offices about what’s best to do—all have involved me.

I know more about mites today than I knew three weeks ago and more than I ever thought I would need to know. It is fascinating, really! And to the long list of “jack-of-all-trade” tasks the Foreign Service has required of me, I can now add exterminator!

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

I'm sure I am where I am!

My hard drive crashed. That’s a major headache for anyone, but add the oddity of being overseas, and it becomes a major migraine.

Fortunately, my computer is still under warranty. I called the company, which is U.S. based but has an offshore service center. The technician, a very nice man, put me and my blue-screen computer through several diagnostic procedures and then announced that my hard drive had, indeed, crashed and would have to be replaced. The company would send me a new one, and within 10 days of its arrival I needed to return the old one. If I didn’t return the defective drive within 10 days, I would receive a bill for the new one.

I explained that, although I have a U.S. address, I don’t live in the United States and, thus, it takes more time for me to receive mail. Besides, the East Coast was in the middle of several storms, which always slows military-diplomatic mail. Even after I explained it several times, the young man had no idea what I was talking about. He kept repeating that I was giving him a U.S. address, so I could not be in Europe. Finally, we both called a truce and ended the conversation.

Three days later, the phone calls began. I have Skype and a U.S. telephone number that rings on my computer in Prague. A company representative—not the technician I spoke with originally—began calling daily to see if I had received the new hard drive. I explained the situation to him and, no, I had not received the disk. He repeated the U.S. address where the package had been delivered and signed for. Yes, I said, but that is a forwarding address, and now the package gets forwarded to me in Europe. He repeated the address again and reminded me that the package had been signed for, but finally agreed he would give it a day or two and check back.

For the next several days, I came home to voice mails from him—at least it was the same guy—reminding me that the package had been signed for at the address I had provided and that I should call the 800 number and leave a message. I did, once again leaving a detailed message about how this mail-forwarding business works.

Again we spoke, and he told me 10 days had passed since my receipt of the drive, because he had confirmation of delivery, and he wanted to know if I was experiencing any trouble. He seemed very suspicious when I told him I didn’t have the drive, because it had not yet arrived. I went back over my story about the mail-forwarding process. He countered that I had called and left a message for him from a U.S. phone number. The unspoken charge? I could not be in Europe because I have a U.S. address and a U.S. phone number that I both answer and call from. Clearly I am in the United States!

Uncle!

PS: I now have the new hard drive and the phone calls have, mercifully, stopped.

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

Home sweet shipping container

I have had a steady stream of visitors since I’ve been in Prague. To be fair, I haven’t worked many places people were eager to visit, and Prague is the crème de la crème of my locations, so it is understandable that this would be a popular place to visit me.

I anticipated visitors, a bit more spread out perhaps, but I messed that up when I announced that my tour in Prague would be two years rather than three. (I will depart Prague in June of 2011.) That added pressure to tell those who want to visit me and share this beautiful city to “come on.” Luckily, I have a second bedroom in my apartment, so there is a place to house visiting friends.

Housing is an interesting subject in the U.S. Foreign Service. In almost all posts, we are assigned housing based on family size, seniority and job requirements. Some of my colleagues must entertain contacts in their homes, so that may net them a larger place. There are firm rules concerning housing assignments at post and a housing committee ensures that the rules are followed. I have served on those committees several times.

Housing assignments can be disputed and there are often solid reasons why someone should be allowed a housing change. However, my favorite memories of housing disputes are from Afghanistan. At that time, all housing consisted of repurposed metal shipping containers—a single room 7 feet wide by 20 feet long. Each resident had a 3-foot wide bathroom, a metal bunk bed, a student desk with chair and a dorm-sized microwave and refrigerator. The walls were plastic and the floor vinyl. This is what everyone had regardless of rank or position.

Ah, but it was the location that became the disputed issue. People would jockey for housing (called hooches) depending on what location was most important to them. A person might prefer to be closer to the cafeteria or nearer the embassy, while others wanted to be on the back of the property and away from the noise. Personally, I considered myself fortunate to be close to the laundry trailer, especially during inclement weather.


















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

Thumbs up for the Scots

One of the things I like most about Prague is that it surprises me! I can’t think of a month that has passed without some occasion or insight that has either surprised or delighted me. I’ve already written about many of them and, now, men in skirts!

While I’ve never been to Scotland, I have seen men in kilts before, rarely, and usually in association with a parade and bagpipes. But this past week, I noticed an abundance of men in skirts on the streets. Some were walking alone, some were in groups and, over a couple of days, the numbers grew until I thought there must be some kind of national Scottish holiday these men were honoring. Finally, I asked my buddy at the Irish pub where I frequently eat lunch, “Why all the men in kilts?”

He explained that there was a futbol—soccer to us Yanks—game in Prague between the Czechs and the Scots, and all these fine men in kilts were here to cheer on their team. A visiting friend was lucky enough to see a group of these fans as they hung out on the famous Charles Bridge—the perfect photo op!

They are gone now. The Czechs won the match 1-0 and are now second behind Spain in their group, competing toward the semifinals of the 2012 European Futbol Championship. I’m glad the Czechs won, as this is my adopted home for now, but I give a huge thumbs up to the Scots who were so supportive of their team that they outnumbered the Czechs two to one at the match. That is a terrific fan base. I will miss seeing them around.

Photo by Marianne Drain

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

See the USA in a Chevrolet ... wait a minute, this is Prague!

Even though I live on the third floor of an apartment building located on one of Prague’s main streets, traffic noise is usually like white noise to me, excepting the occasional ambulance. But when I heard the successive revving engines, I immediately recognized it as something unusual. I looked out my window to see—a long line of Corvettes.

Corvettes? One after the other they came up the street and, when it continued for several minutes, I realized this was not just a quirky occurrence. Down to the street I went to see—as far as I could see in both directions—Chevrolet Corvettes!

Police had stopped the traffic so the spectacle could continue, unimpeded, to its destination, wherever that might be. People lined the sidewalks, pointing at various vehicles that impressed them and taking photos. For a full 20 minutes after I arrived at street level, they passed. There were vintage models and new ones, hardtops and convertibles, of every imaginable color, driven by men and women, some with a passenger and others alone. All the drivers and passengers looked rather serious and largely ignored the curious crowds on the sidewalks. Except for the drivers who were compelled to rev up their engines and jerk their vehicles forward by a foot or two, it was more like a funeral procession than a parade.

The scene was quite surreal. First of all, I am absolutely sure I have not seen any Corvettes traveling around Prague since I’ve been here. Secondly, the mighty Corvette, symbol of American automotive ingenuity and the most “macho” of sports cars, really stood out when contrasted to Prague’s cobble-stoned streets and ancient buildings. And, of course, despite the fact that this vehicle is distinctly American, here, in the heart of Europe, were a couple hundred of them passing.

I have since learned that the 10th International Corvette Meeting is this weekend, when proud Corvette owners from all over Europe come together to flex their engines and share their pride of ownership. I am still smiling from this unexpected treat.

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

Fans, fountains and fruit

Prague is in the middle of a heat wave. The temperatures have been in the mid 80s for a week and, for a city with an average summer temperature of 74 degrees, I guess that is a bit warm. Air conditioning is virtually unknown in Prague. The few establishments that have it proudly display large, bold “Air-Conditioned!” signs to draw in wilting visitors. Fans and open windows are the methods most used to cool businesses and homes, and most restaurant dining is done alfresco, on any patch of outdoor space available.

Just across from my apartment is a very nice fountain. As I walked home from work a few nights ago, I saw many people in bathing suits—adults, not children—sitting in the fountain basin and lying around on the surrounding grass. I had to look twice to be sure I was really seeing that. Odd, I thought. The next day, same thing, and it has continued.

I can think of no water fountain that I’ve seen in the southern United States where citizens are allowed to frolic in the basin. To be fair, these Czechs weren’t frolicking, either. They were either sitting in the water, or dipping in and then going back to the grass. It was purely a method to cool down.

In thinking back over the many countries I have worked in and those that had fountains, I could only recall one other country where I’ve seen people inside a fountain. In Mexico City, the U.S. Embassy is just down Reforma Avenue from the fountain of Diana the Huntress. This is a quite large and very beautiful fountain and, for reasons I never understood, protesters for various causes would frequently come to the fountain, completely disrobe and splash around as a form of civil defiance. We would receive notices the day before these planned demonstrations and be advised to stay away from the fountain area, but there was never any violence or police action—just a bunch of nude people cavorting around Diana’s statue. Perhaps municipal fountains should be open to citizens to enjoy the cooling waters on a hot summer day, just not in the nude.

Strawberries, cherries and peaches. Oh, my! Summer has enveloped the local market with wonderful fruit. I returned to the United States in May for several weeks and left behind in Prague the sweetest, most succulent strawberries it had ever been my pleasure to enjoy. Sad was I that they would be gone on my return, as I assumed a short strawberry season as in the United States. Surprised was I when I realized there were still scads of strawberries to be had upon arriving back in Prague. So I asked, “When does the strawberry season end?” September! Because the Czech Republic has a cooler clime, strawberries grow all summer long. Yeah! I’m in paradise. The cherries are abundant right now, as are plums and peaches. Those, of course, do have a finite season, so I’m eating all I can while I can. Just one more reason to love living in Czech land!

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

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.

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.

Photos:

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.

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.

Too much of a good thing

Unfortunately, the spring equinox did not bring warm weather to Prague, but we are having sunny days and there is no more snow, so I’m quite happy. It is windy and there are scattered showers. I’m not very fond of wet, windy and cold weather but, if the sun shines, it is tolerable, and I was so ready for sun.

Even if the weather is not cooperating, there are plenty of other signs that spring is in the air. Europeans are known for being great lovers of dogs, and the sidewalks have suddenly come alive with dog walkers. The downside is that not all dog owners are responsible, and I have to watch my feet as carefully now as I did when ice was on the sidewalks. It also makes me wonder where all these dogs were during the winter months?

The sidewalks have become treacherous for another reason, too. Preschool kids are out en masse on their wheeled toys, and most moms are less than attentive about where the kids are going or whom they are running over. I literally had to jump sideways this week when a tot whirled his vehicle around, right into my path. It was jump or fall right over him, and I was pretty sure hitting the cobblestones would do me a lot more damage than it would him. I hollered, “Prosim!” (please), which his mother totally ignored as she walked right past me and shooed him forward.

The local eateries have put café tables out on the sidewalks, and the street and park benches are full of people soaking up the sun. A few crocuses are peeking their heads through the barren ground. The park behind my apartment has suddenly burst with activity as people enjoy the outdoors. This includes the young—and not so young—lovers, who seem to be on every street corner and doorway, and in the back of each tram. They are, as my dad would have said, “Makin’ whoopee!” I’m no prude but I ask you, Is it safe to make out on an escalator in a department store?

But the biggest change—one I’m fairly sure portends the first thing I won’t like about living in Prague—is the throngs of tourists. There were tourists when I arrived in October and there were lots of them over the Christmas holidays, but now. Oh my, are there tourists! They are everywhere, even on my street, which really isn’t a tourist area at all. On any given day, I wonder if Italy or Spain has closed their doors, because I’m reasonably sure all the Italians and the Spanish are in Prague.

Walking home after work has become a challenge, because the sidewalks are filled with strolling people who obviously have all the time in the world and believe they’ve rented the pavement for the day. The tourist areas of the old city are impossible to maneuver, as I discovered this past Friday when it took me 45 minutes to make a 20-minute walk to my dentist’s office. Local colleagues tell me that every Praguer who is able to do so leaves Prague in August, because vacationing Germans flood the city. I’ve already started perusing the city map to plan which areas of the suburbs I’ll be discovering for the next six months, as I endeavor to stay clear of the maddening crowds.

Ah Prague, the better to know ye!

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

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.

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.

How do YOU spell relief?

The snow has been falling intermittently in Prague for two months. The streets and sidewalks are rife with patches of ice that threaten all who trod there. I’ve been doing quite a bit of slippin’ and slidin’ myself, and I’ve had a number of patients come to the medical unit that have been injured from falls. Some have been referred to our local emergency departments or orthopedists for treatment.

This brings me to the topic of pain and, more precisely, pain control. Americans, probably more than any other society on earth, are interested in pain control. We don’t like to hurt, and we believe that unnecessary pain is a violation of our human rights. We have laws that govern pain control measures, and we have developed pain measurement scales to assist providers in properly assessing the level of pain or pain relief.

Many other societies accept pain as incidental to injury and, while they may offer measures of relief, they are not committed to pain eradication whenever possible. Of course, there are many areas of the world where pain medication just doesn’t exist, or it is reserved for the truly severe cases, so pain tolerance is expected.

I’m discovering that the philosophy in the Czech Republic, as in much of Europe, is that pain is to be dampened by using the most moderate means available. That usually means no narcotics. Europeans love NSAIDS (ibuprofen-type medications) and are really slow to suggest narcotics. They also rely on nonpharmacological methods such as ice, heat, breathing techniques, muscle relaxation, music, massage therapy, and the list continues. These important adjuvant measures are used in the United States, too, but usually not for short-term or immediate pain control.

In West Africa, I took a patient with an injured leg to the local emergency department. The X-ray showed a displaced fracture and the orthopedist was called to do a closed reduction. I asked the doc, “What are you going to give her for pain?” He looked puzzled for a moment, then turned to the nurse and said, “Please prepare some tea!”

A very quick and tense conversation followed regarding pain control in this patient, who was now terrified as well as hurting. It was finally decided that I would scurry to my clinic to bring an appropriate pain medication to the hospital for my patient, as all the doc could provide was an NSAID. My patient had pain medication prior to the closed reduction and casting and, while the procedure was still a bit uncomfortable, she did quite well. Oh, yes. She also had tea!

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

Unpacking history

Today is moving-in day for me. I arrived in Prague in October but my HHE (household effects) were just delivered. I had a much smaller shipment that arrived from Islamabad in October, so I’ve been perfectly content living with what I have, and I have dreaded this day for several months now. I need to give you the background on the problem.

Allow me to introduce you to one of the oddities of Foreign Service life. We move—a lot! Our standard tours are one to three years, depending on the difficulty of the location. While our housing is provided, and almost always furnished, personal items, household goods, kitchenware, books, etc. move with us. Some posts are in areas where standard goods are difficult, if not downright impossible, to buy. If we are moving to one of those “hardship” posts, we are also granted a consumables allowance, which is an additional weight to use for products we will need while we are at that post and are not likely to find locally.

In 2001, I transferred to Conakry, Guinea in West Africa. Conakry is one of those “hardship” posts where a consumables allowance is essential. Guinea is a country incredibly rich in resources with a long-standing corrupt government that has kept the people in abject poverty. Fortunately, people don’t usually starve there because food grows abundantly, but the people are starved for everything else. As a result, goods and services are largely unavailable.

I was supposed to be in Conakry until 2004 and I brought with me ample goods to see me through. I’ve learned that I do quite well on local food, so most of my consumables are things such as paper products and cleaning supplies. One can really tell a lot about a person’s preferences from seeing what is chosen for consumables. Let your imagination be your guide: disposable diapers, wine and beer, ethnic foods, various canned goods, etc. For me, it is American paper products. They can’t be beat! If you have ever used non-American toilet paper, you know what I mean.

Unexpectedly, I was offered a move to Kabul, Afghanistan for the spring of 2003, more than a year before I was supposed to leave Guinea. I jumped at the opportunity and began the preparation of moving. But there was a catch. Housing in Kabul consisted of a 17-foot by 8-foot metal shipping container, and I was only allowed to ship 500 pounds of goods and bring two suitcases. So everything I had in Guinea that was non-perishable was put into storage for me by the Department of State.

My plan was to do the one-year tour in Kabul and then go to another regular post, but again I was offered my dream job—worldwide rover. My things stayed in storage for the second and third year while I worked temporarily in nine different locations, filling in staffing gaps. In fact, the things I had shipped to Kabul were now in storage, too, as I was down to two suitcases—period!

As providence would have it, for my next posting I chose Islamabad, again one of those limited-household-effects posts, and all I was able to move was the stored goods from Kabul. I stayed in that one-year post for three years! This brings me to today. This morning the belongings that have been stored since 2003 were delivered to my apartment.

I have been opening boxes all day, discarding things I wondered why I packed at all, trying to find a place in my limited storage space for other things I know I don’t need. I’m even getting nostalgic over a few items. When I opened a box filled with dinnerware my son gave me years ago, I choked up. And when I came across a couple of items that had belonged to my daughter, I sat down for a good cry. Perhaps nearly seven years of not having my real life with me was too long. I need reminders of my history to reassure me and help me remember who I really am and where I came from, not just things that chronicle where I’ve been.

Some of the boxes have been real surprises with contents I actually don’t remember at all. Several times today I have said, to no one present, “Where did this come from?” Fortunately, I like most of what I’ve found.

And then I came upon the consumables. I won’t bore you with the details, but I will tell you this. For the rest of my life, I will never again have to buy paper towels.

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

Culture shock

Culture shock is a well-known, expected phenomenon in the Foreign Service community. It doesn’t happen to every person with every transfer, and there are degrees of effect, but it is something we warn our patients about whenever they relocate. I am in culture shock.

There are phases to culture shock. The first is the honeymoon, where the new location is pleasing and exciting. Prague is certainly beautiful—amazingly beautiful—but the aspect of Prague that impressed me most in the weeks after I arrived was my ability to walk through the city and have no one pay attention to me. My last three years were in Islamabad, Pakistan. It was too dangerous to freely walk around the city and, in those few places we were allowed to go, a tall, gray-haired (head uncovered), fair-skinned woman walking about was always met with curiosity. Everyone stared! So, for the first six weeks in Prague, I walked for a couple of hours after work—more on the weekends—just because I could and no one would care. It was absolutely liberating.

The second phase of culture shock is negotiation. That's where I am. In this phase, the new living circumstances may cause frustration, anxiety and even anger over differences in language, cultural ethics and available food choices. This is a time of comparison between what was one’s life in contrast to what is one’s life and may lead to mood disturbance or even depression, in extreme cases.

Life in Pakistan was life on the edge, especially the last two years. Somehow, being in the middle of it conferred a sense of control. Now that I have moved on, I am beset by concern for those I left behind, especially my Pakistani friends who are less protected than the diplomatic residents. I feel helpless to do anything but worry, so I worry. I watch the news. I fret when a new incident happens. Recently, the Navy Yard gate in Islamabad was attacked and people were killed. The Navy Yard was one of my favorite places to shop and I felt safe there. In Prague, I feel safe everywhere. That is a very good thing, but now I also feel guilty for enjoying this safety and freedom in Prague when my former colleagues don’t share it.

The final phase is adjustment. When I get to that phase, life in Prague will feel normal to me and Pakistan will be a memory. It isn’t that I will lose my concern for my colleagues who remain in Islamabad, but I will accept that my focus is my life and work in the Czech Republic.

Foreign Service employees may also suffer reverse culture shock when they reenter the United States for a long visit or for a work tour. Returning to the U.S., especially from a country that is very different, can be mind-boggling.

Many years ago, I came home for the birth of my first grandson. I was living in Ghana at the time and, while it is a pleasant country and I enjoyed living there, food choices were quite limited. On my first day back in Mississippi, my daughter sent me to the grocery store with a list that included corn flakes. I stood in the aisle at Kroger looking at what seemed to be dozens of choices of corn flakes—different brands additives and sizes. I simply could not choose because I had grown accustomed to buying the one option available to me, if there was any available at all. Having so many choices was overwhelming! I was forced to call my daughter and request that she name a particular corn flakes item so I could continue shopping. And, yes, she thought I was completely wacky!


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

Win-win

It has been the holiday season in Prague and, as in most northern European cities, numerous small log-cabin-type buildings have been erected at most major plazas, and merchants have been selling crafts and Christmas goods. Originally, I thought this was the purpose of the markets, but I now know better. The real reason for the markets is to drink beer, grog and mulled wine and to eat pastries and sausage. The shopping is just for entertainment during eating and drinking rest breaks.

Recently, I visited an interesting specialty hospital in Prague. This hospital specializes in adult cardiac, neurosurgical and planned abdominal, vascular, orthopedic and GYN surgery. They have no conventional emergency department and they don’t accept trauma cases. The hospital is also heavily involved in surgical research.

My intent was to quickly view the outpatient diagnostic departments and perhaps see a med/surg floor, but the executive office, which had advance notice of my visit, arranged a presentation in the cardiac catheterization lab. Specifically, I was ushered into the electrophysiology lab, where a patient was undergoing right-atrial mapping for prospective ablation therapy.

I had atrial ablation in 2005, so I was interested in comparing the facility in Prague with the U.S. facility that treated me. The Prague lab is super high-tech with robotics and a magnetic catheter-guidance system that has just become available in the United States. I do believe my electrophysiologist in Memphis would be drooling over this lab set up.

The opposite end of this scale would be the National Cardiothoracic Centre in Accra, Ghana. It was my privilege to meet the founder of this, the first cardiac surgery program in all of West Africa, while I was posted to Ghana. Frimpong Boateng, MD, left his native Ghana in the 1970s to study surgery in Germany. After 10 years abroad, he returned to his home country to offer life-saving cardiac surgery where there had been none and, in 1989, with considerable support from members of the German medical establishment, opened the National Cardiothoracic Centre in Accra. For 20 years, he has struggled to keep his life’s work moving forward and has survived insufficient facilities, a dearth of funding and even occasional loss of electrical backup during surgery. The center regularly accepts patients from neighboring countries and primarily repairs valvular and congenital heart disorders for persons who would have no options if the center didn’t exist.

I have not been to this hospital in many years but I am confident that Boateng and his group of dedicated colleagues continue to provide valuable health care under the most difficult of circumstances and without all the fancy bells and whistles I saw this week. Don’t misunderstand. I am as impressed by the potential of the high-tech interventions and the practitioners who advance our knowledge through research as I am by the surgeon who is saving lives under stringent circumstances. Ultimately, in both cases, the practice of medicine benefits and lives are bettered. I think we call this win-win.


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

Prologue to my blog

The advertisement in the nursing journal said, “Deliver primary care to U.S. government employees working in embassies overseas.” That was enough to catch my attention! I was a 40-something single mother with a great nurse practitioner job in Biloxi, Mississippi, but I had a nagging suspicion that there was more to be had if I looked for it. Soon, I was going through the long and frustrating process of applying for the position of foreign-service health practitioner with the U.S. Department of State.

That was 10 years ago and, in subsequent years, I have enjoyed long assignments in Ghana, Guinea, Afghanistan and Pakistan with shorter tours to Mexico, Russia, Hungary, Uzbekistan, Rwanda, Kosovo and Honduras. I am assigned—with consideration of my preference—to a U.S. embassy community to deliver patient care in the medical unit, usually as the sole provider, but sometimes with a State Department physician. The patient load is the run-of-the-mill primary care stuff with some interesting twists along the way. Some are location-specific, such as parasites, malaria, or “acid” bug burns. Some are scary acute-care problems (MIs, cancers and orthopedic nightmares) that my clinic diagnoses, stabilizes—using local resources, when available—and transfers to a medevac center or to tertiary care in the United States.

It isn’t all direct patient care. I am responsible for testing embassy water quality, evaluating food sanitation practices of embassy kitchens, scrutinizing local public health issues that might affect our embassy population, emergency preparedness, health education of the embassy staff and a variety of issues that are in some way related to the health and well being of embassy personnel. It is never boring and I marvel at the range of knowledge I have acquired since taking this job.

The off-work possibilities are boundless. I’ve spent New Year’s Eve in Red Square, ridden horseback to Egypt’s Great Pyramids, climbed through a bamboo forest to photograph mountain gorillas and been a lazy bum on some of the most beautiful, and isolated, beaches in the world.

I’ve met amazing people at every location and learned that, no matter the region or the language, we are all more alike than we are different. I have also seen the poverty, lack of education and poor health care the majority of the world suffers. It devastates me, but I have been able to offer small assistance by volunteering at a children’s center or supporting a local hospice.

Of course, there are some negatives to this employment. While I have attended the major events in my grown children’s lives, such as weddings, I’ve missed just about all of the daily life events. Webcams and Skype phone calls help my seven grandsons remember my face and voice between visits home, but I miss not being with them more often. My youngest daughter traveled with me until 2003, when she returned to the United States for university. Now, I live and travel unaccompanied and sometimes feel out of touch with the U.S. culture, and my family and friends. Still, I know how truly fortunate I have been to reside and work in the world at-large. It isn’t for everyone but it has been a dream-come-true for me.

I recently completed a three-year assignment in Pakistan, an amazing experience. After returning to Washington, D.C. for two months of language training, I’ve now moved to my new assignment, Prague, the capital of the Czech Republic. The past 10 years have taken me to mostly rough, medically underserved locations. For the next three years, I will be in the heart of Europe, and I wonder what that assignment will hold for me. In this blog, I will share my discoveries and adventures and reflect on past ones. I hope you’ll join me.

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