Karachi, here I come

Four young, beefy guys just left my apartment and, while I know this must sound intriguing, there is a simple explanation: They are movers. Once again, it is time to pull up stakes and move somewhere else in the world. For my next adventure, I’m going to Karachi, the largest city in Pakistan and the main seaport on the Arabian Sea.

If you have followed this blog, you know I previously spent three years in Islamabad, the capital of Pakistan, located 710 miles north of Karachi. There is a complex reason why I chose Karachi as my final post, but one important element is that I honestly like the people.

This usually comes as a shock to people who have never been there, especially Americans who interpret the troubled relationship between the United States and Pakistan as anti-Americanism of the Pakistani populace. I’m not a political person, despite the fact I am employed as a diplomat, but I can say with certainty that the problem between the average American and the average Pakistani is that they each know the same thing about the other, which is to say almost nothing. Both groups have formed opinions based on rumors and sensationalized news stories, and the reality is far different from the perception.

Please note I did say average Pakistani, because there is no denying there are radical factions at work in Pakistan, as in many countries. Fortunately, I need only interact with people who are just trying to get through another day, as am I, with no ill will toward anyone else. I can honestly say that, in my previous three years in Pakistan, I never met a single person who was anything less than welcoming and friendly to me. I hope I never do.

This moving ritual that we Foreign Service employees participate in always brings up the question of “Which post did you like best?” I can never really answer that question, because I’ve found something to like about all of them and comparison between embassies is very much an apples-and-oranges dilemma. But I can say what I liked best about each post:

Accra, Ghana was my first taste of Africa, as well as my introduction to Foreign Service life. It was an excellent beginning, as Accra has a vibrant culture, the provincial travel possibilities were marvelous and I developed friendships that are still important to me.

Conakry, Guinea is the place people mean when they say “the end of the earth!” In spite of the poverty and lack of opportunity for the citizens, I met some of the kindest people I have ever known in Conakry.

Kabul, Afghanistan is the zenith of my Foreign Service experiences. I’ve explained why in previous blogs. To summarize, it is where I experienced great professional purpose and enormous pride in American assistance to others in need.

A two-year “roving” tour that took me to nine different countries over four continents during which I learned a person can live for an extended period of time with only two suitcases of material goods. I also had one of the most amazing experiences of my life in Rwanda, as I climbed through a bamboo forest to watch mountain gorillas in their habitat.

I appreciate Islamabad, Pakistan for the art, food and generous hospitality of the people. I also have to say the work-team environment was as close to perfect as I will ever have.

Prague, Czech Republic is a gift of beauty at the foot of Cinderella’s castle. It is almost a fantasy to walk down these cobblestone streets and enjoy the spectacular architecture. I’ve been on a two-year vacation, but shhhh, don’t tell my bosses, okay?

I will depart Prague this week, and I have several weeks of vacation and a couple of weeks of training before I report to Karachi. Please be patient while I take a break. I will be back.

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

Pink backpacks in Kabul

I have been fortunate enough to serve in 14 embassies with the U.S. Department of State for periods of time ranging from one month to three years (Ghana, Guinea, Afghanistan, Nicaragua, Sierra Leone, Mexico, Uzbekistan, Hungary, Russia, Kosovo, Rwanda, Romania, Pakistan and Czech Republic). I am often asked which of these was my favorite posting, a question impossible to answer. In truth, each has given me memories I cherish, friendships I continue to enjoy and experiences I value. But, if pushed to name one post that was a pivotal experience for me, it would be Kabul, Afghanistan.

I spent 14 months in Kabul in 2003-04 and it was, I think, the best time to be there. The Afghan people were full of hope and promise, the Taliban were weakened and had retreated, and much needed money and skilled personnel were flowing into the country to rebuild the economy and improve living conditions. I was there when the girls were permitted to return to school. On the first day of the term, the streets were full of nicely groomed girls holding hands, smiling and walking briskly toward their classes. I remember a profusion of pink backpacks as I sat in the rear seat of the embassy vehicle, sobbing at the sight.

The city of Kabul was relatively safe then, and I was allowed to meet civilian medical colleagues from other missions and military medical colleagues from the International Security Assistance Forces (ISAF) and the North Atlantic Treaty Organization (NATO), both at secure locations and even at approved restaurants in town. Truly, one of the great delights of my career was the opportunity to collaborate with so many American and foreign military medical professionals. I came out of that experience with an unshakeable regard for the military and utmost respect for the sacrifices they make for us.

U.S. Aid for International Development (USAID) made a commitment to build primary care clinics throughout Afghanistan so that physicians, midwives and community health educators could begin to pull the health system up from the ruin that years of war had created. I was invited to attend the opening of the first such clinic at a village some distance from Kabul.

The citizens of the little village were proud of their new clinic and the medical personnel the government had sent to staff it. I was proud of the U.S. government for making this dream a reality, and honored to be there to witness the villagers’ delight.

After the dedication speeches, the village imam came to ask the USAID representative for another favor. “The children need a school,” he said, through an interpreter. “May we have a place for our children to learn and books to teach them?” I was really struck by this old man and his humble request. Isn’t that what we all want for our children—good health and a future? Is there really anything else that matters, regardless of where on earth you live?

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

Question to ponder

In my previous posting, I mentioned the guide, Danny, who took me to the Mountain Gorilla Reserve in Rwanda. There were just the two of us in his Land Rover on the three-hour trip each way, so we had plenty of time to get to know one another. On the return drive, I asked Danny about the 1994 genocide where more three quarters of a million people, mostly Tutsi, were slaughtered. The rivers literally ran red with blood. Danny is a Tutsi and he told me a story of great courage.

In 1994, he was in his early 20’s with a wife and a 2-year-old daughter. He lived in Kigali but the rest of his family lived in rural Rwanda. On the night the radio instructions to kill Tutsi’s was broadcast, Danny’s neighbor, a Hutu, came to his house and told him he wanted to hide Danny’s family to protect them. Danny’s family went with this man to his cornfield and they hid there for three months. Every few days, the neighbor brought them food and water, at great risk to his own safety. When they were finally able to go home safely, Danny learned that, other than a teenage cousin who was away in Uganda when the genocide began, his entire family and his wife’s family were dead—more than 20 men, women and children.

Following the genocide, Danny had worked hard to build a successful business and give his three children a good life. When I asked him what he had told his children about the genocide, I was surprised to learn he had not spoken to them about it at all. He said they learned the history in school, but that he was waiting for the time when his children were “ready” to hear the worst of his story and mature enough to consider the question he would put to them.

Danny remembered that hundreds of thousands of ordinary people were faced with a choice. One choice was to comply with instructions and do something terribly wrong—kill innocent people, including family members and neighbors. The other choice was to acknowledge the evil and refuse to participate. Danny said there were many people he considered good people who picked up their machetes and went out and murdered as instructed, because they feared for their own lives or the lives of their family if they did not follow the order. There were also people, like his Hutu neighbor, who refused to do what they knew was wrong and many of them were killed for helping the Tutsis or for resisting the genocide.

So the question Danny said he will put to his children is, “If faced with a decision such as this in life, which person will you be?” Danny believed most people think they would be on the side of good but, until this decision actually faces a person, one cannot know for sure!

I will remember our conversation for a lifetime and I tell it often. Danny’s story is the most heartrending example I know of how ordinary people can do extraordinary things—for good or evil!

For Reflections on Nursing Leadership (RNL), 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