tag:blogger.com,1999:blog-11842677574772635372024-03-13T13:35:08.594-04:00NP WorldviewAdventures of a nurse practitioner in the U.S. Foreign ServiceUnknownnoreply@blogger.comBlogger72125tag:blogger.com,1999:blog-1184267757477263537.post-24522576276430538302013-07-18T14:13:00.000-04:002013-07-18T15:55:20.621-04:00Prague on my mind<span style="font-family: Times, Times New Roman, serif; font-size: large;">Just my luck! <a href="http://www.npworldview.blogspot.com/2011/06/karachi-here-i-come.html"><b>I leave Prague</b></a>, 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</span><span style="font-family: Times, 'Times New Roman', serif; font-size: large;">’</span><span style="font-family: Times, Times New Roman, serif; font-size: large;">ll be having with you now, in case you want to seek out my favorite places, too.</span><br />
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<span style="font-family: Times, Times New Roman, serif; font-size: large;">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.</span></div>
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<span style="font-family: Times, 'Times New Roman', serif; font-size: large;">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.</span></div>
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: small;">Prague Astronomical Clock</span></td></tr>
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<span style="font-family: Times, 'Times New Roman', serif; font-size: large;">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.</span></div>
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: small;">St. Vitus's Cathedral in Prague Castle (Prasky Hrad)</span></td></tr>
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<span style="font-size: large;"><span style="font-family: Times, 'Times New Roman', serif;">Of the “Big Three,” </span><a href="http://www.hrad.cz/en/prague-castle/prague-castle-tourist-information/visit-of-prague-castle.shtml" style="font-family: Times, 'Times New Roman', serif;"><b>Prasky Hrad</b></a><span style="font-family: Times, 'Times New Roman', serif;"> 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.</span></span></div>
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<span style="font-family: Times, Times New Roman, serif; font-size: large;">Most people identify classical music with Vienna, but Prague is electric with great music every evening of the week. <a href="http://www.classicconcertstickets.com/e-shop/97.html"><b>My favorite concert venue</b></a> 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.</span></div>
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<span style="font-family: Times, 'Times New Roman', serif; font-size: large;">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.</span></div>
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<span style="font-family: Times, Times New Roman, serif; font-size: large;">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 <a href="http://www.obecnidum.cz/en/"><b>Municipal House</b></a> (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.</span></div>
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<span style="font-family: Times, Times New Roman, serif; font-size: large;">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 <a href="http://en.wikipedia.org/wiki/Memorial_to_the_Victims_of_Communism"><b>Memorial to the Victims of Communism</b></a> 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.</span><br />
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<span style="font-size: large;"><span style="font-family: Times, 'Times New Roman', serif;">Even if this monument isn’t to your liking, it sits at the bottom of </span><a href="http://www.pragueexperience.com/places.asp?PlaceID=604" style="font-family: Times, 'Times New Roman', serif;"><b>Petrin Hill</b></a><span style="font-family: Times, 'Times New Roman', serif;">, 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!</span></span></div>
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<span style="font-size: large;"><span style="font-family: Times, 'Times New Roman', serif;">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 </span><a href="http://www.praha-vysehrad.cz/386_GOTHIC-CELLAR-The-historic-faces-of-Vysehrad" style="font-family: Times, 'Times New Roman', serif;"><b>Gothic Cellar</b></a><span style="font-family: Times, 'Times New Roman', serif;">, 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.</span></span></div>
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<span style="font-size: large;"><span style="font-family: Times, 'Times New Roman', serif;">Finally, Prague is famous for its beer (pivo), and there are dozens of boutique breweries all over town. My favorite is located at the </span><a href="http://en.wikipedia.org/wiki/Strahov_Monastery" style="font-family: Times, 'Times New Roman', serif;"><b>Strahov Monastery</b></a><span style="font-family: Times, 'Times New Roman', serif;">, 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.</span></span></div>
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<span style="font-size: large;"><span style="font-family: Times, 'Times New Roman', serif;">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. </span><a href="http://www.praguewelcome.cz/en/travel/travel-in-prague/taxi/" style="font-family: Times, 'Times New Roman', serif;"><b>Take ONLY the recommended cab companies</b></a><span style="font-family: Times, 'Times New Roman', serif;">, 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.</span></span></div>
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<span style="font-size: large;"><span style="font-family: Times, 'Times New Roman', serif;">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 </span><a href="http://www.praguewelcome.cz/en/travel/travel-in-prague/public-transport/" style="font-family: Times, 'Times New Roman', serif;"><b>recommended taxis, the metro or trams</b></a><span style="font-family: Times, 'Times New Roman', serif;">, which provide excellent and inexpensive service.</span></span></div>
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<span style="font-family: Times, 'Times New Roman', serif; font-size: large;">So, colleagues, have a terrific time in this very lovely European capital city. Prague is magical and begs to be savored.</span></div>
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<span style="font-family: Times, 'Times New Roman', serif; font-size: large;">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.</span></div>
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<span style="font-family: Times, 'Times New Roman', serif; font-size: large;">Best wishes to each of you!</span></div>
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<span style="font-family: Times, 'Times New Roman', serif;"><span style="font-size: x-small;">For <a href="http://www.reflectionsonnursingleadership.org/"><i>Reflections on Nursing Leadership</i></a> (<a href="http://www.reflectionsonnursingleadership.org/"><i>RNL</i></a>), published by the Honor Society of Nursing, Sigma Theta Tau International.</span></span></div>
Unknownnoreply@blogger.com5tag:blogger.com,1999:blog-1184267757477263537.post-215881925475114622013-04-16T18:00:00.000-04:002013-04-17T12:20:45.352-04:00Anne of the Foreign Service<span style="font-family: Times, Times New Roman, serif; font-size: large;">On 6 April 2013, <a href="http://www.youtube.com/watch?v=saxAKIDUeYU">Anne Smedinghoff</a>, a 25-year old U.S. diplomat working in Afghanistan, was killed in a car bombing. I never met Anne, but know her well. I know her from my years in the U.S. Foreign Service, working alongside the young—and not so young, but still idealistic and eager—officers who strive to bring the best of America to those outside our borders.</span><br />
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<span style="font-family: Times, Times New Roman, serif; font-size: large;">The Annes of the Foreign Service are crucial contributors to America’s well-being and safety in the shrinking world in which we live. I know I have countrymen who, recognizing that we Americans have problems of our own, believe we shouldn’t be spending our dwindling dollars or our energies on people outside our borders, but my experience leads me to believe that this school of thought is both shortsighted and dangerous.</span></div>
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<span style="font-family: Times, Times New Roman, serif; font-size: large;">The peoples of the world who are poorly educated and have limited exposure to anything outside their local communities know Americans almost entirely by our TV shows, movies and music. The entertainment industry speaks for us—our values, our way of life—more than anything else we do. You might have to think about that for a minute to fully understand how the developing world sees us.</span></div>
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<span style="font-family: Times, Times New Roman, serif; font-size: large;">When I worked in Ghana, West Africa, I frequently had to dispel the very common belief that American life is just like an episode of “Baywatch!” Really! Now, I’m not disparaging “Buffy the Vampire Slayer,” “The Dark Knight Rises,” or the lyrics of our popular music, but we Americans know how much is fantasy and how little is fact. People who only know us by these measures assume they speak a truth about us.</span></div>
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<span style="font-family: Times, Times New Roman, serif; font-size: large;">So, how does this relate to Anne Smedinghoff and the cadre of American Foreign Service representatives who work around the world? They are the true representatives of an American people who are some of the most hardworking, charitable, and freedom-respecting people on the planet. Anne was delivering schoolbooks to a village that had none so that its children could receive an education and have a better future. Her colleagues move out from their respective embassies and consulates daily—in every corner of the globe—to assist, educate, counsel, and affect peace and understanding. Please do not confuse your political views with the aspirations and intentions of the U.S. Foreign Service, which exists to serve the American people through diplomatic means and by being nonpolitical.</span></div>
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<span style="font-family: Times, Times New Roman, serif; font-size: large;">The loss of Anne Smedinghoff is a loss to her family and her country, though most of her countrymen don’t know how much of a loss her death is. We need many, many Annes to demonstrate true American values to the world, and the money, time, and effort we spend doing it is the very best way we can possibly spend those commodities. The future of our children may well depend on it.</span></div>
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<span style="font-family: Times, Times New Roman, serif; font-size: x-small;">For <a href="http://www.reflectionsonnursingleadership.org/">Reflections on Nursing Leadership</a> (<a href="http://www.reflectionsonnursingleadership.org/">RNL</a>), published by the Honor Society of Nursing, Sigma Theta Tau International.</span></div>
Unknownnoreply@blogger.com2tag:blogger.com,1999:blog-1184267757477263537.post-26718554570136139482013-02-19T17:13:00.000-05:002013-02-19T17:44:57.930-05:00Journey to Middle-earth<span class="Apple-style-span" style="font-size: large;"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;">I think the biblical scholars have it wrong when they propose that the Garden of Eden was located between the Tigris and the Euphrates. I’ve just returned from a driving tour of the South Island of New Zealand, and I’m pretty sure that’s the <i>real</i> Eden.</span></span><br />
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<span class="Apple-style-span" style="font-size: large;"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;">I’ve been to the North Island previously and, while I had been told the South was even more beautiful, it was hard to imagine in advance what I actually saw once there. Followers of the movie trilogies, “The Hobbit” and “The Lord of the Rings,” based on books with the same titles by J.R.R. Tolkien, will understand that the </span></span><a href="http://www.newzealand.com/us/home-of-middle-earth/"><span class="Apple-style-span" style="font-size: large;"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;">South Island of New Zealand is “Middle-earth</span></span></a><span class="Apple-style-span" style="font-size: large;"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;">,” as all of the movies have been filmed there.</span></span></div>
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<span class="Apple-style-span" style="font-size: large;"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;">Of course, as all movies do, the videographers have toyed with nature and created imaginary scenes that aren’t really there; but the majesty of the mountains, the purity of the water—and its often-turquoise color—is not video editing. It is a simply amazing place! Top that off with the exciting adventure of seeing fur seals, yellow-eyed penguins, albatross and sperm whales in their own habitats, in nature without fences (other than to keep people <i>out</i>) and it makes for one bang-up trip.</span></span></div>
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<span class="Apple-style-span" style="font-size: large;"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;">It is not easy to get to New Zealand, which may explain how it stays pristine and minimally affected by man, but it is certainly worth the effort to get there. I heartily recommend it to anyone wanting to experience the freshest air, purest water, cleanest towns and friendliest people you are likely to see anywhere on earth.</span></span></div>
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<b><span class="Apple-style-span" style="font-size: large;"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;">Back here in Karachi</span></span></b></div>
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<span class="Apple-style-span" style="font-size: large;"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;">I don’t consider myself a teacher. I’ve shared information before with colleagues, as we all do, but teaching as an occupation is something I’ve never felt drawn to or suitable for. The consulate has embarked on a program to improve English skills of willing employees, using a combination of professional and volunteer teachers. I am a volunteer.</span></span></div>
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<span class="Apple-style-span" style="font-size: large;"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;">Every Wednesday from 3:30 to 4:30 p.m., two other volunteers and I look into the eager faces of 43 gentlemen with varying English skills ranging from none to minimum, and we try to teach and encourage them. We have a syllabus for beginning English, which seems rather advanced to me, as it assumes some previous introduction to English words. We play games with them to instill the desired idea. For example, we demonstrate walking forward and walking backward, and we try to help them understand the difference between “I am Karachi” and “I am <i>from</i> Karachi.”</span></span></div>
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<span class="Apple-style-span" style="font-size: large;"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;">First, we worked on was greetings. We pointed out, for instance, that the answer to “Good morning” is not “Fine,” which is the common response we receive to greetings given on the compound. It is a particular joy when we can see by our students’ expressions that the light bulb has gone on, and they really get the difference. The excitement is contagious, because local employees seek out English speakers with whom to practice their newfound skills. It has added levity between us that did not exist before and, in a place such as Karachi, where life is mostly tense, this is a very good thing.</span></span></div>
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<span class="Apple-style-span" style="font-size: large;"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;">One of my fellow teachers explained to our class that, in the United States, we do not usually address colleagues using Miss and Mister plus their first name. (She is obviously not from the Deep South.) She encouraged the students to call us by our first names, as we do each other or, if they believed a more formal approach was necessary, to use Miss or Mr. and the last name.</span></span></div>
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<span class="Apple-style-span" style="font-size: large;"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;">A few days later, one of the young members of the class, who is working very hard on improving his English, pulled me aside for a chat. He repeated what the other teacher had said about addressing people and then said to me, “I have respect for you and, because you are an old woman, I must call you Ms. Judie. Is that okay?”</span></span></div>
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<span class="Apple-style-span" style="font-size: large;"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;">Next, I think we will work on political correctness!</span></span></div>
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<span class="Apple-style-span" style="font-size: x-small;"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;">For </span></span><a href="http://www.reflectionsonnursingleadership.org/"><i><span class="Apple-style-span" style="font-size: x-small;"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;">Reflections on Nursing Leadership</span></span></i></a><span class="Apple-style-span" style="font-size: x-small;"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"> (</span></span><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-size: x-small;"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;">RNL</span></span></a><span class="Apple-style-span" style="font-size: x-small;"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;">), published by the Honor Society of Nursing, Sigma Theta Tau International.</span></span></div>
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Unknownnoreply@blogger.com3tag:blogger.com,1999:blog-1184267757477263537.post-12307769333945123092013-01-02T10:54:00.000-05:002013-01-02T10:55:39.112-05:00Happy New Year from Karachi!<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">Several months have passed since my last blog post. For two of those months, I was back in the United States for training and to spend time with my family, but there are two primary reasons I have been unusually quiet: Either there was little to write about or, on the rare occasion when there was a topic of interest that merited a report, writing about it was not possible.</span></span><br />
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<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">This is the second year I spent the holidays in Karachi, Pakistan. Celebrations of Thanksgiving, Christmas and New Year’s require a bit of creativity under these circumstances. Perhaps the biggest issue is that most of my American colleagues go home to be with their families and friends, so those left behind have to fill the void. This year our American presence is about one-third of the normal.</span></span></div>
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<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">There is a young woman among us, however, who is particularly resourceful at creating social opportunities. She set up a Thanksgiving potluck dinner in the lobby of the consulate residence and provided all the usual comfort foods of turkey, mashed potatoes and cranberry sauce, as well as a kickin’ carrot-pumpkin soup that we’ve asked the cafeteria to offer through the cooler months, so we can enjoy it again.</span></span></div>
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<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">Christmas included eggnog tasting, recipe competition and a white-elephant gift exchange. New Year’s Eve featured a progressive-dinner apartment party. We had decorations and a very large tree in the lobby. It looked like Christmas inside the consulate compound, even though there was little sign of it outside the compound.</span></span></div>
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<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">Imagine my surprise when, on Christmas Eve, there was a knock on my apartment door. Outside stood two of our local Islamic guards, one dressed in a Santa suit! Though they did not speak English, they alternated between “Ho, Ho, Ho” and “Merry Christmas” as “Santa” handed me a chocolate. It caused me to reflect on what a strange and wonderful life the U.S. Foreign Service has given me.</span></span></div>
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<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">After that experience, I wondered, “Will Father Time be delivering chocolates on January 1?” Well, New Years’ Day has come and gone and, so far, no chocolates.</span></span></div>
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<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">For </span><a href="http://www.reflectionsonnursingleadership.org/"><i><span class="Apple-style-span" style="font-size: x-small;">Reflections on Nursing Leadership</span></i></a><span class="Apple-style-span" style="font-size: x-small;"> (</span><i><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-size: x-small;">RNL</span></a></i><span class="Apple-style-span" style="font-size: x-small;">), published by the Honor Society of Nursing, Sigma Theta Tau International.</span></span></div>
Unknownnoreply@blogger.com4tag:blogger.com,1999:blog-1184267757477263537.post-55106556891507247142012-07-09T16:16:00.003-04:002012-07-09T17:18:03.252-04:00Where's the billing department?<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">On a recent trip to <a href="http://indushospital.org.pk/"><b>The Indus Hospital</b></a> in Karachi, I was once again amazed by the extraordinary achievement of a few ordinary people. This is a free hospital completely supported by donations. No one who is seen and treated at this hospital is charged. If a patient wishes to donate a sum of money, it is accepted but they are not informed what their treatment might have cost in a different institution, and there is absolutely no expectation of a donation.</span></span><br />
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<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">You might think this is a small, neighborhood operation, but you would be wrong. The hospital staff treats upwards of 300,000 outpatients per year and has admissions of about 11,000. And free doesn’t mean low tech, either. Indus offers invasive cardiology, endoscopy, lithotripsy, hemodialysis and all radiology services except MRI, and that will be in service before the end of this year.</span></span></div>
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<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">Impressed? Well, there is another really amazing fact. Indus is 100 percent paperless! All records and reports—all business—are electronic. Of course, since they have no billing department—<i>can you imagine?</i>—a large need for paper is eliminated right from the start. When one visits a hospital ward at Indus, the robotic medication cart moving down the hall with monitor and keyboard on top should be a quick tipoff. All medications are ordered, tracked and recorded electronically. Every patient service is handled the same way.</span></span></div>
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<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">How did this amazing institution come to be? A group of like-minded medical and business people decided it was needed and would be so—and now it is. The goal was free but excellent treatment for the poor, and Indus provides both.</span></span></div>
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<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">I visited Indus because I will be screening our local staff for tuberculosis this fall. We do this on a four-year cycle, because TB is endemic in Pakistan, and it is important to screen for possible infection and to ensure that people are properly treated. The government of Pakistan has a TB treatment program, and the expert resources in the Karachi area belong to The Indus Hospital. My objective was to arrange a referral path, in case our screening indicated any employee needed further testing and, possibly, treatment.</span></span></div>
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<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">After my tour of the main hospital, I was taken to the TB screening and treatment facility, which is in a separate space from the hospital proper. I really hate to overuse the term “amazed” but, once again, I was. This purpose-built building is ingeniously designed to accomplish infection control.</span></span></div>
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<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">Karachi’s climate alternates between hot and hotter and there is, on average, 7 inches of rainfall per year. That is only 4.5 inches more than Death Valley’s annual average, so this climate is hot and dry. The TB treatment pavilion uses an open-air concept in which shade coverings that resemble boat sails are positioned horizontally to the ground. Every six feet, a bidirectional fan moves air toward the ground, air that is subsequently circulated up and out through the sails. Because the tubercule bacilli are lighter than air, any that might be exhaled from an infected patient are swept up and out with this efficient ventilation system, thus dispersing the bacilli and rendering them ineffective. In Karachi’s hot, dry climate, this ingeniously designed system is very cost effective. As an added safety factor, patients, staff and visitors all wear surgical masks to further reduce the chance of exposure.</span></span></div>
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<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">In addition to this hospital-based TB facility, where patients are diagnosed, counseled, tested and treated, there is an extensive community support program. TB patients are given monthly food items for nutritional support, a monthly travel allowance to treatment centers, daily home visits by treatment supporters to monitor drug compliance—they utilize Directly Observed Treatment, or DOT—and to provide ongoing psychological and social support during the term of treatment. It is all without cost to the patient.</span></span></div>
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<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">Here in Karachi, a city of 20 million in a country with an unstable economy and an average annual wage of approximately $450 per year, ordinary people have come together to do an extraordinary thing. Wow!</span></span></div>
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<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">For </span><i><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-size: x-small;">Reflections on Nursing Leadership</span></a></i><span class="Apple-style-span" style="font-size: x-small;"> (</span><i><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-size: x-small;">RNL</span></a></i><span class="Apple-style-span" style="font-size: x-small;">), published by the Honor Society of Nursing, Sigma Theta Tau International.</span></span></div>Unknownnoreply@blogger.com2tag:blogger.com,1999:blog-1184267757477263537.post-11196293348498409062012-05-30T17:18:00.000-04:002012-05-30T17:24:05.463-04:00Linked in but unhinged!<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">Whoa! Beware of jet lag. It can cause you to act in strange ways.</span></span><br />
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<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">I returned two days ago from R & R in the United States. The time difference is 10 hours, and it always takes me a few days to make the switch. Most of the time, I feel like my brain is still hanging out over the Atlantic Ocean while my body is on terra firma in a strange land. The few days are the worst. Yesterday afternoon, I was absolutely goofy from jet lag and struggling to stay awake. Typically, I surf the Net to kill time.</span></span></div>
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<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">Another time I was jet lagged, this got me in trouble. My laptop DVD drive had conked and, rather than take it to an “iffy” local repair place and expose my personal data to who knows whom, I decided to order an external DVD drive. I took up the quest to find the best bargain on my first day back from leave. A couple days later, I picked up the search again and ordered a drive. A couple weeks after that, my two DVD drives arrived on the same day. TWO? Yes. Though I don’t remember it at all, I had ordered one the first night back when my brain was still on low-function mode.</span></span></div>
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<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">This morning, my e-mail junk folder was particularly full. There were all these “congratulations” messages from people I know about joining LinkedIn. I have to honestly admit that I really don’t know what LinkedIn is and have resisted all offers to join in the past. Further, it seems that anyone I know and correspond with via e-mail has been notified that I’m now part of the fun. How do these things miraculously occur? I am totally baffled.</span></span></div>
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<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">I tried to retrace my steps and, yep, I found a LinkedIn request from my brother-in-law. In my jet-lagged stupor, I must have clicked on the little button that has now opened a new world for me, of what I’m still not sure. But I’m going to embrace this adventure and learn to be linked in and, since Jim Mattson, editor of </span></span><i><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">Reflections on Nursing Leadership </span></span></i><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">(</span></span><i><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">RNL</span></span></i><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">), is also in this pond, I’m sure the sailing will be just fine.</span></span></div>
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<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">For safety’s sake, the next time I return from R & R, I’m going to disable all electronic devices for at least three days. I just can’t trust myself.</span></span></div>
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<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">For </span></span><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">Reflections on Nursing Leadership</span></span></a><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;"> (</span></span><i><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">RNL</span></span></a></i><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">), published by the Honor Society of Nursing, Sigma Theta Tau International.</span></span></div>Unknownnoreply@blogger.com2tag:blogger.com,1999:blog-1184267757477263537.post-75485020552867469062012-04-30T14:08:00.000-04:002012-04-30T14:10:26.542-04:00I’m so VERY glad we had this time together?<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">Cultural idiosyncrasies are some of the most entertaining aspects of living overseas, and let me assure you that we Americans are just as entertaining in our cultural habits as anyone on the face of the earth.</span></span><br />
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<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">Recently, three colleagues of mine—a Pakistani man, a Tanzanian woman and an American woman—were in my office, and the four of us were discussing a work issue. My American colleague was explaining something to our male colleague who, because he would get frustrated by his inability to answer quickly in English, would respond instead in the local Pakistani language of Urdu and have our Tanzanian colleague translate, because she is also fluent in Urdu. As I said, the four of us were discussing a work issue, but it should be noted that I was largely ignoring the entire conversation because I was rapt with the task of clobbering a fly that was bothering me.</span></span></div>
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<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">I don’t know what it is about flies. Mosquitoes find me boring, and fleas refuse to nibble. I don’t think I’ve ever had a tick bite; perhaps a chigger bite or two, but I am honey to a fly. A fly will travel great distances to buzz around my head and drive me out of my mind. They do it at great personal risk, because I am always intent on truncating their already limited life span.</span></span></div>
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<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">So, as the conversation ensued, I was paying attention to my buzzing tormentor, ready for an opportunity to strike with the magazine that was rolled up in my hand. At a particularly opportune time in the conversation, the pesky fly chose to land on the edge of my desk, immediately in front of my Pakistani colleague. I reared back and slammed the rolled magazine down on the desk, at which point my friend jumped up from his chair and grabbed both of his earlobes.</span></span></div>
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<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">There was a moment when the three of us women took in this scene. We each knew I was swatting a fly—actually, I missed—and I was momentarily miffed that my colleague would ever have thought I was aiming at him but, as we looked at him standing and holding his earlobes, we had no choice but to burst into laughter. He joined in but still tightly holding his earlobes.</span></span></div>
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<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">After we caught our breath and wiped the tears; we had to know: Why was he holding his earlobes?</span></span></div>
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<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">Ah, it is cultural. Because he was concentrating on the conversation and the translation that was taking place, he wasn’t paying attention to my hunt for the fly. When I slammed the rolled-up magazine down on the desk, his immediate reaction was to think he had somehow said something wrong or insulting and that I was showing my displeasure. I understood why, to get out of the way of my magazine, should it strike again, he had jumped up, but the earlobes? Turns out it is a demonstration of apology in the Sindhi culture. My friend didn’t know what he was apologizing for but his reaction was instinctive and, given the circumstances, very funny.</span></span></div>
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<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">We have now spent several days adapting this newly learned skill to our toolkit. We’ve decided a mild insult warrants pulling on one lobe, à la <a href="http://www.youtube.com/watch?v=PjQuZCTLAv4"><b><span class="Apple-style-span" style="color: #674ea7;">Carol Burnett</span></b></a>, and that a more serious offense should have both lobes wagging in supplication. My Pakistani friend, on the other hand, has a newfound dislike of flies. Cross-cultural assimilation at its best!</span></span></div>
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<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">For </span><i><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-size: x-small;">Reflections on Nursing Leadership</span></a></i><span class="Apple-style-span" style="font-size: x-small;"> (</span><i><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-size: x-small;">RNL</span></a></i><span class="Apple-style-span" style="font-size: x-small;">), published by the Honor Society of Nursing, Sigma Theta Tau International.</span></span></div>Unknownnoreply@blogger.com3tag:blogger.com,1999:blog-1184267757477263537.post-15169880765301999062012-04-03T13:40:00.000-04:002012-04-03T13:40:03.592-04:00Mr. Wolfe had it right!<span class="Apple-style-span" style="font-size: large;">Thomas Wolfe wrote a novel titled </span><i><span class="Apple-style-span" style="font-size: large;">You Can’t Go Home Again</span></i><span class="Apple-style-span" style="font-size: large;">, and the phrase has become a metaphor for “You can’t recreate the past.” For the last three weeks, I’ve worked in the health unit of U.S. Embassy Islamabad, a place where I spent three of the best years of my career, and I’ve discovered Mr. Wolfe had it right!</span><div>
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<span class="Apple-style-span" style="font-size: large;">I was pleased to receive the invitation to cover for a staffing gap in Islamabad. I still have many friends there, both in the health unit and in the city, and it was an opportunity to renew relationships. I was met at the airport by an embassy driver who remembered me and exclaimed, “Madam, you’ve come home!” It actually felt that way, so familiar and comfortable.</span></div>
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<span class="Apple-style-span" style="font-size: large;">But time has not stood still, and the health unit has grown and become even busier than when I was there. Some of the medical resources have changed, and I had to brush up on new consultants and new facilities. I stopped by a free-standing diagnostic center to see a colleague, and we had a cup of tea and cookies, but it became obvious we really didn’t have much to say to one another. We’ve both moved on and don’t share common ground beyond a past fondness.</span></div>
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<span class="Apple-style-span" style="font-size: large;">The embassy facility itself has changed, and I needed directions to new locations of the various service centers. New construction has greatly changed the layout of the embassy grounds. It was almost the same, but not quite; familiar, yet different.</span></div>
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<span class="Apple-style-span" style="font-size: large;">I was busy. There were lots of patients to see, including three patients to hospitalize, while I was there. That is quite a different pace from Karachi, and I enjoyed the challenge of sweeping out the recesses of my medical knowledge and enjoying a vibrant practice style again.</span></div>
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<span class="Apple-style-span" style="font-size: large;">At the end, I boarded the plane to Karachi with some relief. I have a new home, a new routine, and Thomas Wolfe is right. I really can’t go home again.</span></div>
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For <i><a href="http://www.reflectionsonnursingleadership.org/">Reflections on Nursing Leadership</a></i> (<a href="http://www.reflectionsonnursingleadership.org/"><i>RNL</i></a>), published by the Honor Society of Nursing, Sigma Theta Tau International.</div>Unknownnoreply@blogger.com39tag:blogger.com,1999:blog-1184267757477263537.post-10753005172667581842012-03-09T15:57:00.003-05:002012-03-09T16:11:55.865-05:00For tincture of time, there's no copay.<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">If you follow this blog, you know I’ve been missing for a bit. I am thankful to my buddy, Betty Ulrich, who penned the last entry, and I couldn’t agree more with her description of medical facilities we see in various parts of the world and how fortunate we are to have U.S. medical care.</span></span><br />
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</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">So where have I been? Well, I went home for a few weeks to see my family, and then I attended a medical conference before returning to Karachi. Since then, I’ve been in somewhat of a funk! Is that word still used, or am I dating myself?</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">This is a very common problem in the Foreign Service (FS). We call it “culture shock,” but I think the name is a bit misleading. There is a period of time, usually three to six months after transfer to a new post, when an individual feels somewhat disconnected to the new environment, perhaps longs for the city and friends he or she has left behind and experiences anxiety or doldrums. Clinically, people show up on my doorstep complaining of insomnia, gastric disturbances, lethargy or nervousness. Symptoms are nearly always nonspecific, and a treatment of benign neglect is all that is warranted. I advise a person to eat well, exercise, get a good night’s sleep, do something that interests them in off hours and, usually, that is all it takes. “Tincture of time,” we call it.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">No one is immune, no matter how many times the moving process is experienced. Early in my FS career, I was sure I would reach a point when culture shock didn’t occur. I was wrong. It has manifested itself in very different ways, depending on the circumstances, but it has always happened.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">When I left Ghana, I really missed the friendships I had created and the many local people I had grown to love. When I left Guinea, I pined for the islands offshore that were such a wonderful place of respite. When I left Afghanistan, I had a haunting feeling of things left undone. When I left Pakistan (the first time), I was plagued by concern for the colleagues that remained.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">This time, I think the hardest thing is being away from my children and grandchildren, and this only became an issue with this latest visit home. My grandson Cade, <a href="http://npworldview.blogspot.com/2010/02/grandma-in-box.html">the little guy who used to describe his grandmother as living in a box</a>, because he most frequently saw me on the computer screen via Skype, has the part of Michael in the community theater’s presentation of Peter Pan. I won’t be there, and I’m still deciding if that is acceptable to my vision of who a Nana should be.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">When I knew I wouldn’t have the mindset to blog for a while, I wrote to Jim Mattson, editor of <a href="http://www.reflectionsonnursingleadership.org/"><i>Reflections on Nursing Leadership</i></a>, the magazine for which I write this blog. I told him I was suffering from jet lag, a cold and a bad attitude, and we both agreed the first two would resolve quickly, but the last malady could present a problem. I think the cure is near.</span></span></div><div><br />
</div><div>For <i><a href="http://www.reflectionsonnursingleadership.org/">Reflections on Nursing Leadership</a></i> (<i><a href="http://www.reflectionsonnursingleadership.org/">RNL</a></i>), published by the Honor Society of Nursing, Sigma Theta Tau International.</div>Unknownnoreply@blogger.com4tag:blogger.com,1999:blog-1184267757477263537.post-7141794708889919102012-01-30T16:56:00.002-05:002012-01-31T11:07:58.703-05:00Reflections from stateside<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><i>I've asked my colleague, Mary E. "Betty" Ulrich, MSN, RN, ANP-BC, FNP, to write a guest post. A nurse practitioner with the U.S. Foreign Service, Betty, a retired U.S. Army major and a member of the Honor Society of Nursing, Sigma Theta Tau International, is presently stationed in Kabul, Afghanistan. — Judie Pruett</i></span></span><br />
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</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">Upon my return to the United States from Kabul, Afghanistan for a little R & R (rest and relaxation), I spent some time in a U.S. hospital system when my sister required a biopsy. As a nurse practitioner who has practiced in many places in this world, including Africa, Asia, Europe and the Caribbean island of Haiti, I sat in wonder of the U.S. medical system I had taken for granted.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">To my colleagues who also work in remote places, I say, imagine a hospital with clean floors, medications available when the health care provider orders them, an efficient administrative staff, air conditioning in the summer and heat in the winter, a safety-conscious environment, meals delivered to your patients’ rooms, clean linen, disposable gloves, patient call buttons and access to mammography before a lump is palpable. These are all items normally available at U.S. hospitals. Life under these circumstances would be heavenly for those of us in the “field.” Understand that these benefits are not the norm in many hospitals around the world.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">In Africa, most hospitals require families to provide meals and perform daily bathing and changing of linens. There are too few nurses to take care of too many patients.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">Morocco has recently started encouraging women to get mammograms. Unfortunately, the service is not affordable for most women. In Casablanca, the <i>Institut Pasteur</i> reports that the pathology department is seeing more early-stage tumors. In previous years, most tumors were stage 4 specimens. It’s a sign of progress.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">In Hungary, local nurses told me that, historically, disposable gloves were washed on the night shift and reused, as there was no money to purchase additional gloves. Poor funding of public hospitals in pre-European Union days demanded adjustments in techniques. The public hospitals do good work under severe budget restraints, but only privately funded hospitals can afford to comply with all the regulations and recommendations.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">In Liberia, a nurse told me she thought piped-in oxygen was a wonderful idea but did not expect to see this modern equipment during her lifetime.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">In many hospitals around the world, when a medication is prescribed to an inpatient for PO or IV use, the family must go to the pharmacy, purchase the drug and bring it back to the hospital for the ward nurse to give to the patient.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">I remember my African housekeeper asking for extra money to treat her malaria. When I questioned her about the results of her tests, her remarks stayed with me a long time. “We can’t afford both the tests and the medicines, so we buy the medicine when we get the fever.” Education comes in many forms.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">I do not want to convey an unwritten message of “Don’t get sick outside the USA.” I have seen many doctors around the world, with excellent skills and little technology, who perform some pretty impressive diagnoses. When X-rays aren’t available, listening to a chest with a stethoscope takes on different intensity. When the nearest CT is 100 miles away or in the next country, a well-performed abdominal exam by an expert physician is held in extremely high esteem.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">In many countries, very little high technology is available to doctors who take care of the common man or woman. Consequently, physicians have honed advanced ultrasound skills seldom seen elsewhere.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">While I am only days away from ending this R & R and returning to Afghanistan, I am gently reminded that, even though our system isn’t perfect, I am grateful that it does struggle for continuous improvement.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">For </span><i><a href="http://www.blogger.com/goog_2106127343"><span class="Apple-style-span" style="font-size: x-small;">Reflections on Nursing Leadership</span></a></i><a href="http://www.blogger.com/goog_2106127343"><span class="Apple-style-span" style="font-size: x-small;"> (</span></a><i><a href="http://www.blogger.com/goog_2106127343"><span class="Apple-style-span" style="font-size: x-small;">RNL</span></a></i><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-size: x-small;">)</span></a><span class="Apple-style-span" style="font-size: x-small;">, published by the Honor Society of Nursing, Sigma Theta Tau International.</span></span></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1184267757477263537.post-8902825294396981602012-01-05T10:00:00.004-05:002012-01-05T10:06:20.991-05:00Do you know TED?<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">I’ve been in Karachi over the holidays, and I admit to enjoying the quiet. Many of my colleagues went to the United States during this time, and others used the decreased workload as an opportunity to take a regional vacation. I used the quiet time in the office to do those work things I view as a chore and won’t do, unless I have nothing else on which to focus my attention. So, today, I feel rather proud of myself for starting the new year with a clean slate—no nagging odd jobs to complete.</span></span><br />
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</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">Not having many people around the compound meant extra quiet time on my “off” hours, too. I admit I have hermit tendencies, so being alone in my apartment with my books, TV and computer is really quite all right for me. Over the years, I’ve perfected the ability to entertain myself when there is nothing else to do.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">One of the things I enjoy most is going to the <a href="http://www.ted.com/"><b>TED</b></a> website and catching up on all the amazing things that are happening in the world. Do you know <a href="http://www.ted.com/"><b>TED</b></a>? “<b>T</b>echnology, <b>E</b>ntertainment, <b>D</b>esign: Ideas Worth Spreading,” is an amazing site of information. Check it out for yourself. I guarantee you will find something that catches your interest. These short 5- to 20-minute videos are perfect for my equally short attention span, and the information is often cutting-edge stuff.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">My parents always told me that what you do on New Year’s Day, you do all year long. If there is truth to this, my 2012 will be excellent. I am rested and healthy. I’ve enjoyed Skype visits with my family, watched a good movie, visited with TED and spent the evening with friends. I hope your January 1st was equally as satisfying.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><br />
</span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">For </span></span><i><a href="http://www.blogger.com/goog_246126025"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">Reflections on Nursing Leadership</span></span></a></i><a href="http://www.blogger.com/goog_246126025"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;"> (</span></span></a><i><a href="http://www.blogger.com/goog_246126025"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">RNL</span></span></a></i><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">)</span></span></a><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">, published by the Honor Society of Nursing, Sigma Theta Tau International.</span></span></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1184267757477263537.post-70329351130763585932011-12-20T14:21:00.001-05:002011-12-20T14:28:11.406-05:00The babies of Karachi beach<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">I never expected my tour in Karachi to present me with a once-in-a-lifetime opportunity, but it has. It turns out that the beaches of Karachi are among the top seven hatching grounds in the world for green sea turtles, so when we learned that the Sindh Wildlife Department had offered to provide a turtle experience for the consulate staff, I was eager to sign up. I’ve never seen a sea turtle outside of an aquarium or a movie and, although I grew up on the beaches of south Texas, turtles don’t visit there. I’ve seen lots of land turtles, of course, but this is different.</span></span><br />
<div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">Late one night, a group of us were driven to a secluded beach outside the city to view turtle egg laying. We were told there were no guarantees. It isn’t like the turtles make an appointment to crawl up on the beach to lay their eggs. While this is the busier season for egg, there are nights when no turtles arrive, or they come later than we are allowed to stay.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">After reaching our destination, the rather long, bumpy ride getting there quickly faded in memory when the scientist running the facility informed us that this was a special night. Not only was there a mama turtle digging her laying hole right then, but a group of turtle eggs had just hatched and we would be able to see them before they were released to the sea. It was like winning the turtle jackpot, since the hatchlings have to be in the water in less than two hours after hatching.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">This facility, part of the Pakistan wildlife conservation effort, has been in operation for 30 years. It was easy to discern that it is run on a shoestring budget, but the commitment of the scientists and facility employees was impressive. We were led into a shell of a building about 50 feet from the water’s edge. It was pitch black, except for the flashlights our hosts carried. Inside, we were shown a PowerPoint presentation about the two types of turtles that come to this beach to lay eggs, and given information about various endangered turtle species around the world, the predators they face—humans are the most dangerous— and the destruction of their habitats by pollution and the spread of dwellings onto their spawning grounds.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">To prevent the extinction of these majestic creatures, their newly laid eggs are dug up and transplanted to nurseries where they are protected until they hatch, approximately two months later, from the elements and from poachers—both two- and four-legged. Once the eggs are hatched, their caretakers deliver them to the water’s edge and hope for the best. It is estimated that less than .01 percent of the hatchlings will actually grow to adulthood and complete their natural lifespan of around 100 years.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><div class="separator" style="clear: both; text-align: center;"><a href="http://4.bp.blogspot.com/-hQo_eTy5FG4/TvDhfym2L7I/AAAAAAAAAxE/_0gFCEhw12M/s1600/CIMG0060_hatchling_SFW.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="640" src="http://4.bp.blogspot.com/-hQo_eTy5FG4/TvDhfym2L7I/AAAAAAAAAxE/_0gFCEhw12M/s640/CIMG0060_hatchling_SFW.jpg" width="480" /></a></div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">My group was first introduced to the new hatchlings. Why are all babies cute? That must be some type of universal law, and the hatchlings were no exception. Their tiny flippers were in full motion swimming vigorously in the air and, after we each had the incredible opportunity to hold one and get a very close look, into the sea they went.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">Next, we were escorted down to the beach and to the laboring turtle. The only light allowed was one dim flashlight aimed at her growing pile of eggs deposited in the 3-foot deep hole she had dug. While she largely ignored us, we were told that lights would confuse her and she would stop laying and return to the sea, and that would not be good. We stood watching this incredible act of nature until the turtle indicated it was over and began to use her hind flippers to cover the hole.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/-WHO2eiiHYPg/TvDhtcNXmLI/AAAAAAAAAxM/b3yBe_A9i8A/s1600/CIMG0078_egglaying_SFW.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="640" src="http://3.bp.blogspot.com/-WHO2eiiHYPg/TvDhtcNXmLI/AAAAAAAAAxM/b3yBe_A9i8A/s640/CIMG0078_egglaying_SFW.jpg" width="480" /></a></div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">Four men then gently picked her up and moved her away from the hole so the eggs could be retrieved, but she didn’t seem to notice the ride. Her back flippers just kept scooping sand. She would do that for the next couple of hours until some instinct told her it was enough, and she would then return to the sea. The eggs were carefully removed, measured, weighed and taken to the nursery for reburying, and this amazing experience was over.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><br />
</span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">For </span></span><i><a href="http://www.blogger.com/goog_826879935"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">Reflections on Nursing Leadership</span></span></a></i><a href="http://www.blogger.com/goog_826879935"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;"> (</span></span></a><i><a href="http://www.blogger.com/goog_826879935"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">RNL</span></span></a></i><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">)</span></span></a><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">, published by the Honor Society of Nursing, Sigma Theta Tau International.</span></span></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1184267757477263537.post-6499916767063961152011-12-05T17:49:00.006-05:002011-12-06T11:33:16.837-05:00No, a fish pedicure was NOT on my bucket list!<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">One goal I will never attain is to work in East Asia. The opportunity has just never arisen for me and, since this is my last post, I’ve accepted that it’s not going to happen. So when a friend of mine invited me to visit her in Kuala Lumpur, Malaysia and I discovered there are direct flights from Karachi to Kuala Lumpur, it was too good an offer to let pass.</span></span><br />
<div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">This past month, in the same week we celebrated the U.S. holiday of Veteran’s Day, several local holidays were also strung together. As a result, only one day of actual office time was required of me that week and thus seemed the perfect time to hop a flight.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">When I arrived, I was surprised to find my friend was hospitalized, with discharge still a couple of days away. It gave me the opportunity to learn a bit about the local medical system and how care is delivered.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">My friend had an attending physician and several consultants who visited her daily for examination and updates on her condition. The hospital itself might have been in any downtown U.S. city, complete with a Starbucks on the first floor. The only thing that set the Malaysian nursing staff apart from their American counterparts was that they have retained the custom of the nurse’s cap, a tradition I was very happy to see dropped in the United States. The only thing I noticed that was very different, at least from the hospitals I’m familiar with, is that each time a patient leaves the room, the door is locked until his or her return. Otherwise, everything was very familiar and that was a comfort to my friend. It isn’t easy to be in a hospital in a foreign country with no family present. Familiar looking surroundings are a real bonus.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">After a couple of days, I brought my friend back to her apartment, and we basically became couch potatoes for the rest of my visit. I did take one day to use the hop-on, hop-off bus that ran through the city so I could get a taste of this peninsular nation. Wherever I travel, I try to use these buses when available, as they usually provide a great overview and an efficient way to cover the highlights of the city I’m visiting.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">At the central market, I hopped off the bus to participate in something that has peaked my curiosity since the first read of it several years ago. I had a fish pedicure! I dangled my feet in a large vat of water while small, sardine-size fish hungrily attacked dead skin everywhere they found it.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">The first two minutes were almost unbearable, not because it was uncomfortable, but because of the freakish sort of tickle. But after the initial shock, the sensation diminished and it was quite pleasant. A half-hour later I was done, evidenced by the few fish still paying attention to me.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">Each time another person came to the tub, however, it was like a feeding frenzy. (Maybe we have different flavors.) The fish would swarm to the new feet and do their thing, then eventually lose interest and disperse.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">I can declare two things. This was by far not the best pedicure I’ve ever enjoyed, but it sure was the most unusual, and I have a photo to document it.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><br />
</span></div><div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/-vVVOypz1erw/Tt1MPspjETI/AAAAAAAAAwc/SXFsIFRqOZg/s1600/CIMG0019_SFW.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="492" src="http://1.bp.blogspot.com/-vVVOypz1erw/Tt1MPspjETI/AAAAAAAAAwc/SXFsIFRqOZg/s640/CIMG0019_SFW.jpg" width="640" /></a></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">For </span></span><i><a href="http://www.blogger.com/goog_91782454"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">Reflections on Nursing Leadership</span></span></a></i><a href="http://www.blogger.com/goog_91782454"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;"> (</span></span></a><i><a href="http://www.blogger.com/goog_91782454"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">RNL</span></span></a></i><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">)</span></span></a><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">, published by the Honor Society of Nursing, Sigma Theta Tau International.</span></span></div>Unknownnoreply@blogger.com2tag:blogger.com,1999:blog-1184267757477263537.post-82570793840829685462011-11-14T16:10:00.001-05:002011-11-14T17:09:44.202-05:00Babu, a different breed of diplomat<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">I am typically amused when I see diplomats represented in the movies. The character, who is good looking, tanned, expensively dressed and dealing with international intrigue, is frequently shown attending a cocktail party or driving a convertible down a curved mountain road, hair blowing in the breeze. These people don’t seem to have actual jobs, families or concerns outside of their glamorous lives. In short, they are depicted as living a life of travel and comfort and, if there is an element of danger, it is portrayed as adventure.</span></span><br />
<div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">That is diplomacy in the movies, of course. In reality, the scene is very different. In real life, diplomats are fairly ordinary people who slog through fairly ordinary jobs, many times under different, if not difficult, circumstances. We do choose this life, of course, and it suits a particular type of person, I think. Not many people would be fond of picking up their lives and relocating every two to three years. But the constant for most U.S. Foreign Service officers is their family. The family is the force that keeps us centered, normal and able to do our chosen jobs well.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">Family is defined in many different ways in the Foreign Service. Many officers have the traditional spouse and, perhaps, children. For other officers, family is a parent or partner who travels with them and, for many of my colleagues, family is a pet. For me, an absolute necessity is a reliable Internet connection. I require video chats with my children and grandchildren to keep me on solid ground, and I would not accept a post where that is unavailable. The point is, we U.S. diplomats need a sense of home and a grounding of reality, no matter where in the world we might live and work.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">We have a few posts—Karachi is one—where the ability to have that sense of home is compromised. Karachi is an “unaccompanied” post, meaning spouses or other members of one’s household are not allowed. To make matters even harsher, pets are not permitted here, either. People assigned to these posts are literally removed from most of what is normal in their lives, and it is a particularly difficult stress to manage. As the medical officer, I frequently see the physical reactions this stress causes.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">Respite from that stress is provided, however, in one small but very significant way. One of our officers, through unexpected circumstances, arrived in Karachi with her Chihuahua, Babu. There was nothing to do but let him stay, and he has become the mascot of the compound. Babu is a very friendly fellow, adored by all who meet him. He considers every person his friend, and he is quite willing to accept petting and scratching from all who wish to give it. When Babu is out for a walk, people come from all directions to speak to him and give him some love, which he happily returns with nuzzles and wagging tail. It is impossible not to smile and get a warm fuzzy feeling when Babu is present.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://1.bp.blogspot.com/-SW1EHA9YhvQ/TsGDaOm-iZI/AAAAAAAAAvU/jCiBq3LQJDQ/s1600/Babu_blog.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="640" src="http://1.bp.blogspot.com/-SW1EHA9YhvQ/TsGDaOm-iZI/AAAAAAAAAvU/jCiBq3LQJDQ/s640/Babu_blog.jpg" width="508" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">Babu</span></span></td></tr>
</tbody></table><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">As a diplomat in residence, Babu really <i>is</i> living the good life. He has plenty to entertain him, lots of admirers and, when his mistress goes for a swim at the compound pool, Babu hangs out on a boogie board catching some sun. If he could learn to drive a convertible, I’m sure Hollywood would have him star in a movie.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">For </span></span><i><a href="http://www.blogger.com/goog_453997168"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">Reflections on Nursing Leadership</span></span></a></i><a href="http://www.blogger.com/goog_453997168"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;"> (</span></span></a><i><a href="http://www.blogger.com/goog_453997168"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">RNL</span></span></a></i><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">)</span></span></a><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">, published by the Honor Society of Nursing, Sigma Theta Tau International.</span></span></div>Unknownnoreply@blogger.com3tag:blogger.com,1999:blog-1184267757477263537.post-19030282228844502212011-10-28T16:38:00.010-04:002011-10-28T17:19:58.733-04:00Er, Doctor, would you wash your hands, please?<div><span class="Apple-style-span" style="font-size: large;">Global Handwashing Day was October 15, so, in keeping with the Southeast Asian time scheme, we celebrated it on October 21. Things are always a bit slower in this part of the world. Anyway, my health unit was asked to “participate” in a program sponsored by the consulate and our public affairs office. We were told there would be presentations to an audience of nursing students selected from various hospitals around the city.</span></div><div><span class="Apple-style-span" style="font-size: large;"><br />
</span></div><div><span class="Apple-style-span" style="font-size: large;">The time was set for Friday morning and, since that is the time I routinely supervise vegetable sanitizing—not to mention that I don’t speak the local language—Mehroon, my Urdu-speaking colleague, volunteered to represent our office. We only heard about this event a week before it was scheduled and, three days before it was to happen, we were told the presentation—now singular—was us!</span></div><div><span class="Apple-style-span" style="font-size: large;"><br />
</span></div><div><span class="Apple-style-span" style="font-size: large;">Mehroon and our computer-whiz administrative assistant put together an amazing PowerPoint presentation, complete with videos from Centers for Disease Control, to drive home the point that hands spread germs and germs make people ill. The presentation especially focused on hand washing prior to touching patients in the hospital and how microbes can be spread from one patient to the next by staff members who are not particular about hygiene.</span></div><div><br />
</div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-ZPTjsRYdbV4/TqsbYDPYOoI/AAAAAAAAAuM/hUn5BtRkGf4/s1600/Mehroon_handwashing_SFW.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="278" src="http://4.bp.blogspot.com/-ZPTjsRYdbV4/TqsbYDPYOoI/AAAAAAAAAuM/hUn5BtRkGf4/s400/Mehroon_handwashing_SFW.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">Mehroon teaches proper handwashing technique.</span></span></td></tr>
</tbody></table><div><span class="Apple-style-span" style="font-size: large;">Mehroon strongly encouraged the nursing students to remind family members, hospital staff and—gasp!— physicians to remember to wash hands or use hand sanitizer between patients. Evidently, there was a bit of worried discussion about the latter suggestion. Sure, it is reasonable to instruct families and other staff members might be amenable, but the physician? The students were absolutely sure that offering this suggestion to the physician would not be tolerated.</span></div><div><span class="Apple-style-span" style="font-size: large;"><br />
</span></div><div><span class="Apple-style-span" style="font-size: large;">I’ve been in medicine for a long time, and I remember those days—not that they are completely gone—when physicians were at the top of the heap, and no one dared to suggest or question. Most of the docs I know now think that type of isolated existence is lonely and not very safe, and they welcome rapport with the health care team. It is a worthy concept, and I hope some of these nursing students take the dare and mention what they learned for Global Handwashing Day, maybe even to a physician.</span><br />
<div><div><div><br />
</div><div><span class="Apple-style-span" style="font-size: x-small;">For </span><i><a href="http://www.blogger.com/goog_2112304657"><span class="Apple-style-span" style="font-size: x-small;">Reflections on Nursing Leadership</span></a></i><a href="http://www.blogger.com/goog_2112304657"><span class="Apple-style-span" style="font-size: x-small;"> (</span></a><i><a href="http://www.blogger.com/goog_2112304657"><span class="Apple-style-span" style="font-size: x-small;">RNL</span></a></i><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-size: x-small;">)</span></a><span class="Apple-style-span" style="font-size: x-small;">, published by the Honor Society of Nursing, Sigma Theta Tau International.</span></div></div></div></div>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-1184267757477263537.post-71502281578641502772011-10-14T14:08:00.003-04:002011-10-14T14:16:49.076-04:00Go fly, kite!<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">I grew up amongst seagulls; a noisy, messy bunch, but not at all threatening, even when they came in large groups searching for treats. Once I left Texas, I was largely removed from groups of flying critters, except for occasional swooping pigeons, but living overseas has changed all that.</span></span><br />
<div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">In Africa, swarms of fruit bats filled the sky at dusk, darting in and out of the trees and, sometimes, flying so close to me as I walked I could hear the “swoosh” of their giant wings.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">In Islamabad, we had crows. To discourage them from roosting, we hung fake owls in the trees—owls are evidently a natural enemy of crows—along with shiny strips of twirling metal. It didn’t work. The crows would foul the ground below the trees and make a terrible racket at both dawn and dusk. The worst was when they became infected with H1N5 (avian influenza). Dead birds, scattered by the dozens around the grounds of the embassy, caused a minor panic.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">Karachi has kites, black kites to be exact. These large, rather intimidating birds soar and swoop in groups all day long, not unlike vultures waiting for carrion to appear.</span></span><br />
<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://2.bp.blogspot.com/-KK2QtlEaneY/Tph8WiIZsOI/AAAAAAAAAt8/8qeS9E_Rnx4/s1600/Black_Kite_SFW.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="226" src="http://2.bp.blogspot.com/-KK2QtlEaneY/Tph8WiIZsOI/AAAAAAAAAt8/8qeS9E_Rnx4/s400/Black_Kite_SFW.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">Black kite</span></span></td></tr>
</tbody></table><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div class="separator" style="clear: both; text-align: center;"></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif; font-size: large;">My apartment has a very nice balcony with some lovely teak furniture. It might be a nice place to sit and read a book. I say might because I will never know. The kites like to land on the balcony rail and sit on the arm of the teak chair, and they are aggressive. I got a good look at a kite perched outside my window, and that thick, curved beak and the menacing talons were enough for me. My balcony belongs to the kites. I will never venture there.</span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">For </span></span><i><a href="http://www.blogger.com/goog_774723318"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">Reflections on Nursing Leadership</span></span></a></i><a href="http://www.blogger.com/goog_774723318"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;"> (</span></span></a><i><a href="http://www.blogger.com/goog_774723318"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">RNL</span></span></a></i><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">)</span></span></a><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">, published by the Honor Society of Nursing, Sigma Theta Tau International.</span></span></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1184267757477263537.post-5268133328207237112011-10-03T11:32:00.011-04:002011-10-03T11:45:12.561-04:00It's just my southern hospitality!<span class="Apple-style-span" style="font-size: large;">If you have had even a passing interest in world news, you know that the United States and Pakistan are in an ongoing spat, and a number of issues this past year have caused dissatisfaction on both sides. This past week, the most recent political upheaval inspired a peaceful protest march to the U.S. consulate in Karachi. The consulate was informed there would be a protest of possibly a few hundred people, but that the protesters would not be allowed to actually reach the compound.</span><div><span class="Apple-style-span" style="font-size: large;"><br />
</span></div><div><span class="Apple-style-span" style="font-size: large;">I should explain that the consulate in Karachi is in a self-contained compound surrounded by a high wall and is under tight security. Our office building, where all the work takes place, is about 150 yards from the residential building, where we all live. Between the two is a totally open area of sidewalks and palm trees but, since the wall is so high, it is impossible to look into the compound from the street. Or so I thought.</span></div><div><span class="Apple-style-span" style="font-size: large;"><br />
</span></div><div><span class="Apple-style-span" style="font-size: large;">As I was leaving the consulate, one of the security officers cautioned me to go straight to the residence as the protesters had been allowed, in spite of what we had been told, to move up the street outside the compound and they were gathering right then. I moved on through the entrance and began my walk to the residence. I was about a third of the way when I heard the music and shouting. It wasn’t threatening shouting, and it wasn’t cheering. It was just lots of noise coming from the area outside the wall and, when I looked in that direction, I was absolutely shocked to see people—lots and lots of people—standing above the level of the wall.</span><br />
<div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"> </span></span><br />
<div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/-D6fjff2qAaA/TonWCFvI9KI/AAAAAAAAAtY/-ix2z03gtXA/s1600/2011-09-Karachi-rally.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="417" src="http://1.bp.blogspot.com/-D6fjff2qAaA/TonWCFvI9KI/AAAAAAAAAtY/-ix2z03gtXA/s640/2011-09-Karachi-rally.jpg" width="640" /></a></div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif; font-size: large;">So there I am in the middle of the otherwise deserted area between the two buildings, looking at these folks who are looking right back </span><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif; font-size: large;"><i>at</i></span><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif; font-size: large;"> me. Many of them were waving their arms, and it seemed to me they were waving at me. I didn’t feel threatened at all, but it certainly ran through my mind that this was a situation I had not anticipated and with which I was not completely comfortable. While I saw no indication of hostility, I also know it only takes one person with ill intent to turn a situation violent.</span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">I quickly considered my options. I didn’t want to turn around, as that would put my back to the crowd. Instead, I did what every good southern woman from the United States would do in that situation. I smiled my biggest smile, waved at the crowd and kept moving forward to the residence, reaching it without incident.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">Later, I learned that the crowd came with buses and people had climbed on top of the buses to see into the compound, thus giving me the impression they were standing above the wall. And the initial estimate of several hundred turned out to be several thousand, though that was not obvious from the numbers I saw levitating above the wall.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">I have caught a lot of ribbing from my colleagues for waving at the protesters, and more than a few have suggested that the “waving” I perceived was, perhaps, less than friendly. I choose to remember my version of the event. It is the southern way.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">For </span></span><i><a href="http://www.blogger.com/goog_1461218706"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">Reflections on Nursing Leadership</span></span></a></i><a href="http://www.blogger.com/goog_1461218706"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;"> (</span></span></a><i><a href="http://www.blogger.com/goog_1461218706"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">RNL</span></span></a></i><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">)</span></span></a><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">, published by the Honor Society of Nursing, Sigma Theta Tau International.</span></span></div></div>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-1184267757477263537.post-67584773925261965592011-09-22T15:05:00.002-04:002011-09-23T12:36:44.573-04:00Food for thought<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">One of the things I love most about working in the U.S. Foreign Service is the variety of health issues I have to deal with. Each new post brings a fresh challenge, a new opportunity to learn and, frankly, a different way to make changes that have a lasting influence. Most of us choose a nursing career to have a positive impact on the lives of others, and my job offers very creative ways to fill that need.</span></span><br />
<div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">I am the first Foreign Service medical officer to be assigned to Karachi. There is a wonderful RN who has been here for years and has done an amazing job of getting the needed accomplished but, as a sole practitioner, she was limited in the projects she could attack. I am now in the office, as well as an administrative assistant, and we are on the prowl to stamp out common health problems.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">One of the major issues at this post has been food-borne illness. Kitchen checks and food-handler classes failed to make a significant dent in the number of people with GI complaints. For the past six weeks, a small part of my day—each day—is looking at food safety issues. This is not new. Almost every Foreign Service medical officer has responsibility for food safety at his or her post, but the depth of responsibility differs vastly, depending on the post’s location and size.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">I have five commercial-style kitchens to evaluate and approximately 30 food workers spread among them. Despite my previous experience, which I considered advanced, I’ve turned over a whole new leaf in food safety, pun intended! There is a mantra that Foreign Service people recite: Wash it, peel it, cook it or don’t eat it. And that is good advice, but not the whole picture. I bet most people have never thought of the many opportunities food has to make a person ill.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">I have to consider where the food comes from and how it has been handled prior to purchase. If the meat is fresh, there is possible contamination, such as salmonella for chicken and eggs, E. coli for beef and vegetables or, more commonly, vegetables contaminated with the protozoa Giardia.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">Once the food is purchased, our kitchens are expected to clean it with the intent to rid the food of harmful organisms. In this part of the world, this is usually done with salted water, but our standards do not accept that as sufficient, so cultural sensitivity is required when asking our cooks to do something different than they do in their own homes.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">The food is now properly cleaned. Are we done? Not on your life, pun intended. Now it has to be stored at the proper temperature. That means assuring freezers register no more than 4 degrees Fahrenheit and refrigerators no more than 38 F. But what about a place where the electricity is unstable and power fluctuates between the grid and a generator, sometimes multiple times a day. This is murder to a motor and the fridge that was functioning properly yesterday may be at 60 degrees today. We require cooks to record the temperature of these units daily, but think of how difficult it is to understand the concept of proper cold storage when you don’t have cold storage in your home? I recently found a freezer where the worker had dutifully recorded the temperature of 27 degrees for three days running but didn’t understand the significance of this “danger zone” temperature and hadn’t notified Maintenance of the problem.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">OK, so we have properly functioning storage and now the food is prepared into meals. Am I twiddling my thumbs at this point? No, I’m out there with my handy-dandy, infrared thermometer, truly one of the coolest inventions on earth, checking to be sure the salads are being served cold and the hot foods are hot. So now, sigh, my job is finally done!</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">Hmm, what about the flies? What about the hygiene of the dinnerware, glassware, tableware? What about the hands of the servers? Are any of the staff workers ill with a communicable disease? Is the lassi (a lovely local drink) really made with pasteurized yogurt, or did some raw tuberculosis-tainted yogurt sneak in?</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">I’m sure I have colleagues who would say they did not go into medicine to focus on food safety issues, and I never imagined this as part of my forte, either. We really take this for granted in the Western world. But I don’t live and work in the Western world, and I have to tell you, I am struttin’ my stuff right now. I haven’t had a bad belly come through my health unit door in about 10 days, and my staff and I are kings of the consulate! No pun intended!</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">But, dengue fever is on the rise, up 15 percent over last week in the city. That will be another story.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><br />
</span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">For </span></span><i><a href="http://www.blogger.com/goog_856710146"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">Reflections on Nursing Leadership</span></span></a></i><a href="http://www.blogger.com/goog_856710146"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;"> (</span></span></a><i><a href="http://www.blogger.com/goog_856710146"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">RNL</span></span></a></i><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">)</span></span></a><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">, published by the Honor Society of Nursing, Sigma Theta Tau International.</span></span></div>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-1184267757477263537.post-46614974922009413462011-09-12T14:27:00.002-04:002011-09-12T14:29:48.777-04:00Almost like coming home<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">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.</span></span><br />
<div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">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. </span></span><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif; font-size: large;">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.</span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">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?</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">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.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">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.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"></span></span><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">For </span></span><i><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><a href="http://www.blogger.com/goog_1821674089"><span class="Apple-style-span" style="font-size: x-small;">Reflections on Nursing Leadership</span></a></span></i><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><a href="http://www.blogger.com/goog_1821674089"><span class="Apple-style-span" style="font-size: x-small;"> (</span></a></span><i><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><a href="http://www.blogger.com/goog_1821674089"><span class="Apple-style-span" style="font-size: x-small;">RNL</span></a></span></i><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-size: x-small;">)</span></a><span class="Apple-style-span" style="font-size: x-small;">, published by the Honor Society of Nursing, Sigma Theta Tau International.</span><span class="Apple-style-span" style="font-size: large;"> </span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1184267757477263537.post-47496350897832655102011-08-17T10:24:00.001-04:002011-08-17T10:35:44.939-04:00I’m ba-a-ck ... I think<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">I hurt all over! No, it isn’t flu, it is “crash and bang!” There are several postings around the world where U.S. Foreign Service personnel are at an increased risk for things, such as mob mentality, kidnapping or targeted terrorism. If we are assigned to such a post, we are tasked to complete a defensive driving course, the idea being that we out-drive the threat and get to safety. My Pakistan assignment requires me to take this course.</span></span><br />
<div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">We are taken to a racetrack in the boonies to drive worn-out police cars way too fast. I probably wouldn’t complain if it was just speeding, though I am truly a granny driver. No, we have to drive through water so we can skid and try to stop the inevitable donut-spin that comes if you don’t brake absolutely correctly! We must ram an almost done-for vehicle into the front, then the back, of a totally done-for vehicle, to move the thing out of our path.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">Then there is the exercise of driving forward at about 40 mph, stopping as quickly as possible, backing up using mirrors and doing a rapid Y-turn so you are going back the way you came. I don’t get motion sickness easily, and I’m not a whiney person, but I am sure whining over this experience.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">The requirement is 100 percent participation, so when I place my hand over my stomach and turn my green face toward the instructor, he simply asks, “Do you need to hurl before we continue?” Considering that my abdominal contents are unsure which way to face forward and that’s it’s 100 degrees,, yes, that is exactly what I must do.</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">My three days of vehicular terror are over. I had such a nice weekend planned, but now it consists of moving from the tub of hot water, where my very sore muscles are trying to un-spasm, to the couch, where I lay quietly, trying to convince my stomach that life is back to normal. Before this experience, people would tell me “crash and bang” was great fun. Just goes to prove, once again, one size does </span></span><i><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">not</span></span></i><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"> fit all!</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">For </span><i><a href="http://www.blogger.com/goog_1836280676"><span class="Apple-style-span" style="font-size: x-small;">Reflections on Nursing Leadership</span></a></i><a href="http://www.blogger.com/goog_1836280676"><span class="Apple-style-span" style="font-size: x-small;"> (</span></a><i><a href="http://www.blogger.com/goog_1836280676"><span class="Apple-style-span" style="font-size: x-small;">RNL</span></a></i><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-size: x-small;">)</span></a><span class="Apple-style-span" style="font-size: x-small;">, published by the Honor Society of Nursing, Sigma Theta Tau International.</span></span></div>Unknownnoreply@blogger.com3tag:blogger.com,1999:blog-1184267757477263537.post-79771878601023155652011-06-15T09:34:00.005-04:002011-06-15T09:52:11.179-04:00Karachi, here I come<!--StartFragment--> <p class="MsoNormal"></p><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">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.</span></span><div><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">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.</span></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">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.</span></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">Please note I did say </span></span><i><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">average</span></span></i><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"> 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 </span></span><i><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">never</span></span></i><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"> met a single person who was anything less than welcoming and friendly to me. I hope I never do.</span></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">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:</span></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"><br /></span></span></div><div><b><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">Accra, Ghana</span></span></b><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"> 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.</span></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"><br /></span></span></div><div><b><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">Conakry, Guinea</span></span></b><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"> 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.</span></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"><br /></span></span></div><div><b><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">Kabul, Afghanistan</span></span></b><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"> 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.</span></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"><br /></span></span></div><div><b><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">A two-year “roving” tour that took me to nine different countries over four continents</span></span></b><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"> 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.</span></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">I appreciate </span></span><b><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">Islamabad, Pakistan</span></span></b><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"> 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.</span></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"><br /></span></span></div><div><b><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">Prague, Czech Republic</span></span></b><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"> 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?</span></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">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.</span></span></div><div><span><span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></span></span></div><div><span><span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:small;">For </span></span><i><span class="Apple-style-span" style="font-family:'times new roman';"><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-size:small;">R</span></a></span><span class="Apple-style-span" style="font-family:'times new roman';"><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-size:small;">eflections on Nursing Leadership</span></a></span></i><span class="Apple-style-span" style="font-family:'times new roman';"><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-size:small;"> (</span></a></span><i><span class="Apple-style-span" style="font-family:'times new roman';"><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-size:small;">RNL</span></a></span></i><span class="Apple-style-span" style="font-family:'times new roman';"><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-size:small;">)</span></a></span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:small;">, published by the Honor Society of Nursing, Sigma Theta Tau International. </span></span></span></span><p class="MsoNormal"><o:p></o:p></p> <!--EndFragment--> </div>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-1184267757477263537.post-37369248866640215602011-05-31T11:47:00.006-04:002011-05-31T11:54:55.676-04:00Eye witness<!--StartFragment--> <p class="MsoNormal"></p><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">I have recently been on the receiving side of patient care. My cataract surgery was a complete success, and I am surprised—no, <i>amazed</i>—how much brighter my world looks now.</span></span><div><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">I reported to the eye clinic at a local hospital one morning last week. My ophthalmologist, who looks like she belongs in high school rather than a hospital, did a quick eye exam to determine if I was an acceptable surgery risk and then sent me off to the outpatient surgery section. There, I was met by two lovely young nurses, Petra and Jane, who explained that they each spoke a little English and that, together, would get me ready.</span></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">They were so helpful and pleasant I was sorry I caused them extra effort with my language requirements. I changed into scrubs, had my name plastered on the front of my shirt on a piece of tape so they wouldn’t forget who I was, and was led into the surgery-suite waiting area. There, one of them appeared every 10 minutes to put different medicated drops in my eye.</span></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">I’ve traveled a good bit of the world and one thing I’ve always marveled at is, no matter how friendly a society is or is not toward Americans, everyone—and I do mean <i>everyone</i>—likes American music. So there I am sitting in this room, surrounded by several Czechs waiting for eye surgery, and I’m listening to American country music.</span></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">After I completed several rounds of eye drops, I was transferred to the operating room, positioned for surgery and draped out. I have a bit of claustrophobia. It isn’t one of those run-screaming-out-of-the-room things but rather a nervous tension. I knew I was going to have a drape over my face, and I was a little concerned about this, but I shouldn’t have been. I only had a moment to worry about being covered up before the instruments started coming toward my eye. For the rest of the short procedure, I gave no thought to being enclosed. I was too focused on the needles and the sucker thing I was watching attack my eyeball.</span></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">I readily admit there was </span></span><i><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">no pain</span></span></i><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">! And, to prepare me, my ophthalmologist explained everything that was happening. The nurses were great, comforting and reassuring me, and one even held my hand. It was not a bad experience; it was a </span></span><i><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">strange</span></span></i><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"> experience! I’ve never had eye surgery before, but I have had surgery in the United States and I can honestly say that the surgeon, staff and facility met any expectation I would have had at home. I would not hesitate to recommend them.</span></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">I’m now in the recovery phase, which has been surprisingly easy. I had no post-operative pain at all, only a patch on my eye for 24 hours. The patch came off and—</span></span><i><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">voilà</span></span></i><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">—bright, clear vision! I’m channeling Bob Marley lately as I sing, “I can see clearly now.”</span></span></div><div><span><span><span class="Apple-style-span" style="font-family:'times new roman';"><br /></span></span></span></div><div><span><span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:small;">For </span></span><i><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:small;">Reflections on Nursing Leadership</span></span></a></i><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:small;"> (</span></span></a><i><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:small;">RNL</span></span></a></i><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:small;">)</span></span></a><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:small;">, published by the Honor Society of Nursing, Sigma Theta Tau International.</span></span></span></span><p class="MsoNormal"></p> <!--EndFragment--> </div>Unknownnoreply@blogger.com2tag:blogger.com,1999:blog-1184267757477263537.post-14315032828100558112011-05-23T12:13:00.007-04:002011-05-23T17:27:55.980-04:00Getting my eyes Czeched<!--StartFragment--> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span class="Apple-style-span" style="font-family:'times new roman';"></span></p><span><span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">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.</span></span></span></span><div><span><span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"><br /></span></span></span></span></div><div><span><span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">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.</span></span></span></span></div><div><span><span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"><br /></span></span></span></span></div><div><span><span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">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.</span></span></span></span></div><div><span><span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"><br /></span></span></span></span></div><div><span><span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">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.</span></span></span></span></div><div><span><span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"><br /></span></span></span></span></div><div><span><span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">At some point, I threw out the question, “I guess LASIK would not work for me?”</span></span></span></span></div><div><span><span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"><br /></span></span></span></span></div><div><span><span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">“No” she said, “it will not correct the cataract.”</span></span></span></span></div><div><span><span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"><br /></span></span></span></span></div><div><span><span><i><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">Cataract!</span></span></i><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"> What? Where did that come from? I immediately said, “I’m too young for a cataract!”</span></span></span></span></div><div><span><span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"><br /></span></span></span></span></div><div><span><span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">“Obviously not,” came her reply.</span></span></span></span></div><div><span><span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"><br /></span></span></span></span></div><div><span><span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">I was still trying to absorb this information when the young lady, now peering into my dilated right pupil, said “Oh!”</span></span></span></span></div><div><span><span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"><br /></span></span></span></span></div><div><span><span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">I do medical examinations and, as hard as I try, sometimes that “Oh!” just slips out. It usually isn’t good.</span></span></span></span></div><div><span><span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"><br /></span></span></span></span></div><div><span><span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">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.</span></span></span></span></div><div><span><span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"><br /></span></span></span></span></div><div><span><span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">“When?”</span></span></span></span></div><div><span><span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"><br /></span></span></span></span></div><div><span><span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">“<i>Now!</i>”</span></span></span></span></div><div><span><span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"><br /></span></span></span></span></div><div><span><span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">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.</span></span></span></span></div><div><span><span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"><br /></span></span></span></span></div><div><span><span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">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.</span></span></span></span></div><div><span><span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;"><br /></span></span></span></span></div><div><span><span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">Beat that!</span></span></span></span></div><div><span><span><br /></span></span></div><div><span><span><span class="Apple-style-span" style="font-size:small;">For </span><i><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-size:small;">Reflections on Nursing Leadership</span></a></i><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-size:small;"> (</span></a><i><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-size:small;">RNL</span></a></i><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-size:small;">)</span></a><span class="Apple-style-span" style="font-size:small;">, published by the Honor Society of Nursing, Sigma Theta Tau International. </span></span></span><p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height: normal"><span style=" ;font-size:12pt;"><o:p><span class="Apple-style-span" style="font-family:'times new roman';"></span></o:p></span></p> <!--EndFragment--> </div>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-1184267757477263537.post-36035468268671098162011-05-05T11:24:00.005-04:002011-05-05T11:32:13.445-04:00Spice girl<!--StartFragment--> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt"><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">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.</span></span></p><p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt"><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">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.</span></span></p><p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt"><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">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.</span></span></p><p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt"><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">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.</span></span></p><p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt"><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">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.</span></span></p><p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt"><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">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.</span></span></p><p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt"><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">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.</span></span></p><p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt"><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">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.</span></span></p><p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt"><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">If variety is truly the spice of life, I have a very spicy life. Just the way I like it.</span></span></p><p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt"><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">F</span><span class="Apple-style-span" style="font-size:small;">or </span></span><i><span class="Apple-style-span" style="font-family:'times new roman';"><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-size:small;">Reflections on Nursing Leadership</span></a></span></i><span class="Apple-style-span" style="font-family:'times new roman';"><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-size:small;"> (</span></a></span><i><span class="Apple-style-span" style="font-family:'times new roman';"><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-size:small;">RNL</span></a></span></i><span class="Apple-style-span" style="font-family:'times new roman';"><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-size:small;">)</span></a><span class="Apple-style-span" style="font-size:small;">, published by the Honor Society of Nursing, Sigma Theta Tau International.</span></span></p> <!--EndFragment-->Unknownnoreply@blogger.com3tag:blogger.com,1999:blog-1184267757477263537.post-16469347826726811602011-04-15T12:57:00.010-04:002011-04-15T13:38:21.780-04:00Not the place for cost cutting<p class="MsoNormal"><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">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.</span></span></p><p class="MsoNormal"><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">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.</span></span></p><img style="float: right; margin: 0pt 0pt 10px 10px; cursor: pointer; width: 400px; height: 267px;" src="http://1.bp.blogspot.com/-oH3OOk2GTqc/Tah7Y-sPkhI/AAAAAAAAAhE/2HuDbIffiXY/s400/CIMG0374_LR.jpg" alt="" id="BLOGGER_PHOTO_ID_5595858206083486226" border="0" /><p class="MsoNormal"><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">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.</span></span></p><img style="float: right; margin: 0pt 0pt 10px 10px; cursor: pointer; width: 400px; height: 267px;" src="http://4.bp.blogspot.com/-jSE3doZC5nA/Tah7MimDDII/AAAAAAAAAg8/1OSt3k1WAqo/s400/CIMG0377_LR.jpg" alt="" id="BLOGGER_PHOTO_ID_5595857992382876802" border="0" /><p class="MsoNormal"><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">T</span></span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">hese 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.</span></span></p><p class="MsoNormal"><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:large;">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.</span></span></p><p class="MsoNormal"><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:small;">For </span><i><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-size:small;">Reflections on Nursing Leadership</span></a></i><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-size:small;"> (</span></a><i><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-size:small;">RNL</span></a></i><a href="http://www.reflectionsonnursingleadership.org/"><span class="Apple-style-span" style="font-size:small;">)</span></a><span class="Apple-style-span" style="font-size:small;">, published by the Honor Society of Nursing, Sigma Theta Tau International.</span></span></p> <!--EndFragment-->Unknownnoreply@blogger.com0