Babu, a different breed of diplomat

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.

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.

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.

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.

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.

Babu

As a diplomat in residence, Babu really is 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.

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

Food for thought

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.

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.

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.

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.

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.

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.

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.

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!

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?

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!

But, dengue fever is on the rise, up 15 percent over last week in the city. That will be another story.

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

Almost like coming home

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

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

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

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

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

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

Evaluation season

Job performance evaluations are a normal part of a practitioner’s life. The norm is to be evaluated on our medical work, of course, but this skews a bit when working as a U.S. Foreign Service nurse practitioner. In the Foreign Service, the evaluation season theoretically begins on 15 April and ends a month later, when all evaluations are to be in Washington for processing and review. This year, the already-complex system has been “electronically enhanced” to make the procedure run in a more linear, proficient manner, so, of course, we have to start much earlier. To this end, a human-resources expert came to post to teach us the new system.

Each employee, regardless of her or his actual job, has a rater and a reviewer, selected on the basis of organizational hierarchy. I am the chief of my section—medical—so my rater is the management officer, who is responsible for the embassy’s administrative function. His boss, the deputy chief of mission, who is ultimately responsible for the function of all departments of the embassy, is my reviewer. It should be noted that neither of these great guys has any idea what I do medically.

It is incumbent upon the employee to provide the rater and reviewer with a list of accomplishments that can be highlighted in the evaluation. Most of my nonmedical colleagues can speak in specifics, but I must speak in generalities or risk treading on patient confidentiality. I can offer vague statistics that are medically related or, if something is widely known, such as when the bombing happened in Islamabad, I can offer my rater more specific details. But, usually, my evaluations barely touch on the practice of medicine and I am rated more on administrative issues. There is an exception. Once, during each assignment, a regional medical officer or regional medical manager must submit a supplementary evaluation, which does address medical practice and skill.

On the surface, it might appear that there’s a lack of accountability, but that’s not really true. In Foreign Service lingo, it is called “corridor reputation,” which provides the real scoop on how an employee handles his or her responsibilities, and it has a very real effect on that person’s career. If there are problems, it will be known.

So, back to the training provided by the human-resource specialist. To illustrate how far the Foreign Service has come in performance evaluation, she handed out the single-sheet form used in 1949 for all employees. There were 16 areas of evaluation, each containing only four phrases. The rater was asked to underline the one phrase that was most descriptive and cross out the line regarded as least descriptive. Some of my favorite choices are:

• He talks too much.
• He lacks breadth of view.
• He is careless in his personal habits.
• He is too much of an individualist.
• He lacks aggressiveness.
• He is ingratiating.

And my personal favorite:

• He does not wear well as one knows him better!

I’m grateful to say that the evaluation process has progressed light years from this type of appraisal. One other thing: Note that all the phrases begin with he. In 1949, women did not serve in the U.S. Foreign Service. That change might be the greatest advancement of all!

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

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

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

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

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

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

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

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

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

7) Flowers are important. Prague is a city, but it blooms. Flower shops (květiny) are no more than two blocks away, no matter where you are in Prague. Citizens take great pride in displaying plants and flowers, and bouquets are a common gift. It really adds to the ambiance.

8) Czechs love tea! This was a total surprise to me. The CR is famous for its beer and Budweiser Budvar Brewery, home of the original Budweiser beer, is here, but tea shops with exotic teas from around the world are common. Many restaurants have a special tea menu with dozens of choices. By the way, local beer is often less expensive than tea, coffee or colas!

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

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

Photos:

Top: Astrological clock

Bottom: Tyn Church, Old Town, Prague

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

When personal overlaps with professional

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

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

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

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

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

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

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

A good thing

One of my favorite tasks as a Foreign Service medical officer is to mentor new-hire colleagues. This usually starts with an email from my director, asking if I am available to mentor a new employee, who is being posted to my region. I consider it an honor to be asked and a responsibility to be taken seriously. The purpose is to assist the practitioner in learning the Department of State administrative system, which, as you might imagine, is very different from a typical U.S. medical practice. Most of the mentoring occurs via e-mail or phone but may include a site visit as well.

My current mentee is posted to Kiev, Ukraine, and I recently made a site visit. My colleague is a young mother of two. Spousal employment can be a huge issue for many Foreign Service officers but this is a non-issue for my mentee, as her husband’s work can be done from home via the Internet. However, she is concerned about how overseas life might affect her children, since the lifestyle is so very different from growing up in the United States.

I brought my daughter overseas when she was 14, a terrible age to move a child from the known to the unknown, and we were fortunate it worked out so well. She had a personality that was open to exploration, and she was especially accepting of different cultures. Her first foreign school included a student body representing 34 countries. There is no doubt that it was a learning experience for her, far beyond the actual academic curriculum. Her senior year was spent boarding at a high school in Rome, and my concern that the year would not hold the wonderful memories usually attached to a senior year were unfounded. In fact, her dearest friends, eight years after graduation, are young women she formed a bond with in Rome and who have continued to be central relationships in her life.

I have tried to reassure my mentee that her children will most likely do just fine changing environments every two to three years. Not every Foreign Service child adapts and thrives, but the majority of them do. In fact, Foreign Service kids are some of the most adaptive and confident I’ve ever known. And, as my daughter will attest, the question, “Where are you from?” can make a Foreign Service kid the most interesting person in the room. That is usually a good thing.

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

Viva Italia!

Today was a beautiful, sunny day—a real treat during this mostly gray-skies time of year in Prague. I took the opportunity to hop a tram, followed by the metro, to go to a distant shopping area and explore that vicinity of the city.

Before I joined the Foreign Service, I spent my entire life in southern United States. Mass transit really doesn’t exist in the South, other than a rather limited system in Atlanta, so being involved with some of the world’s largest and most sophisticated mass-transit systems has been of real interest to me, both in technology and in the culture of mass travel.

Most of my metro/tram experience has been in Europe, but I was also a frequent rider of the Mexico City metro, while serving in that post. Frankly, most of my colleagues wouldn’t ride the Mexico City metro, for fear of pickpockets or of being squashed to death. The latter was a real possibility, as I quickly discovered one rush hour when I witnessed a young woman trying to exit the train and be literally picked up by the oncoming rush of people and pushed back into the car. I hoped she was able to get off at the following stop.

My favorite thing about living in Moscow was the metro system. This system is HUGE! It is dependable, inexpensive and has the most artistic stations I’ve ever seen. I spent many weekends just traveling the metro and taking pictures of station decorations, which was strictly forbidden but not enforced. There are tours of the Moscow subway stations—I took one just to learn more about the history—and coffee-table picture books of the most ornate.

The culture of mass transit in Moscow is interesting. There is a set etiquette for travel, and it includes being straight-faced and, preferably, quiet. If one must speak to another passenger, it is to be done at a whisper and as quickly as possible. And one should never ever smile, nod or make eye contact with other travelers.

In contrast is travel on the Rome metro, where jabbering travelers might be entertained by a fellow commuter(s) who breaks out in song—usually opera—for a few minutes, and then finishes to raucous clapping. While Rome stations are not particularly ornate, in comparison to Moscow stations, their displays of Roman antiquities are a real plus.

In Bucharest, I sometimes traveled on the new and modern metro, usually with only a few other passengers. The line is rather limited, but so expensive that most people couldn’t afford to travel. Sure kept those cars clean and shiny, though.

In Budapest, the stations were underground shopping malls with food courts, stores, flower shops and travel agencies—sort of one-stop shopping while going to or from home. I mostly used the trams in Budapest, and I don’t think I was ever on one that wasn’t standing-room-only, which became an issue when tram police jumped on to check tickets. People without tickets would start pushing to the other end of the car, hoping to get off at the next stop before getting caught and fined. It was great entertainment, if I could get out of the way.

The metro and trams in Prague are modern and quite utilitarian, and the system is widespread. The most important thing is, they are punctual with a great frequency schedule. Unlike our neighbors to the far northeast, people happily chat and smile at each other, though not so much to strangers. On my tram ride back home today, our car was serenaded by a group of three young men—visiting Italians!

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

Grandma in a box

I live in a computer. At least, that’s what my 18-month-old grandson, Price, thinks. Yesterday, my daughter in Orlando sent me a precious video of Price standing in front of the computer monitor, pointing and saying, “Nana!” It is there, in that small square, that he sees me the most. I play tickle with him by waving my fingers at the webcam and blowing kisses his way. He leans in to hug the monitor and then looks confused that it looks like me, but isn’t me. I want to reach out and grab him, but we aren’t at the “Scotty, beam me up” phase of our scientific progress yet. Webcam is definitely the next best thing.

Living overseas has many challenges. Maintaining a family life with those in the United States is one of them. When I joined the Foreign Service in the late 1990s, technology—especially communication technology—was still very basic. There was email, of course, but no Facebook, blogs, webcam or Voice over Internet Protocal (VoIP). The special-occasion phone calls were very expensive and mail (via the U.S. diplomatic pouch system) was slow. The only thing that has remained the same is the pouch.

Another significant change for me is my family framework. During the early years, my four older children were all single and in university. They didn’t have much time to communicate and, frankly, not a lot of interest. If I managed to talk to them every other month and saw them once a year, that was OK. We were all busy with our individual lives and, because my youngest child was with me overseas, I still had a family core.

Then, in quick succession came the weddings, followed by the change that rocked my world—grandchildren. The birth of each little boy—there are seven now—tugged my heart a bit more and, I believe, gave my grown children a different perspective about staying in closer touch with me, too. The difficulties of frequent communication became more apparent to us all, and while webcams had become available by then, I didn’t have computer access that could support one.

When I moved to Islamabad in 2006, I could finally sign up for VoIP and use a webcam. My then youngest grandson, Trevor, who previously would have nothing to do with me on home visits because I was a stranger to him, learned who I was and would happily babble to me over the Internet. Now, when I would visit, he came to me easily. When my next grandson, Caden, was born, he grew up seeing me on webcam and never viewed me as a stranger at all. His mother would announce as I was leaving from a visit, “Nana is going back into her box!” and the transition was smooth. Little ones are amazing like that.

I fully understand how much this advance in technology has helped me stay satisfied with my Foreign Service career and life out of the United States. I feel like I am part of my children and grandchildren’s lives on a more personal level and, as a result, any guilt I might have of choosing to be so far away is largely assuaged. It is a tough choice to move to the other side of the world from one’s family and friends. I am very grateful to have the benefit of technology to bridge the distance.

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

Unpacking history

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

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

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

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

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

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

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

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

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

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

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

H1N1

H1N1 has arrived in the Czech Republic. This is a bit more complicated for my clinic than for a clinic in the United States. For one thing, I don’t have H1N1 vaccines. They were ordered months ago for the Foreign Service, but only a tiny fraction has actually been delivered to the Department of State for its overseas staff. I have 20 people who fall into the CDC’s high-risk group and should be vaccinated; some of them are anxious because the vaccine is not available.

The Czech Republic has vaccine only for a limited number of their residents, and they have purchased Pandemrix, which is not FDA approved, so I wouldn’t be able to use it anyway. I do have Tamiflu and Relenza and use them when appropriate. Although we have had employees diagnosed with H1N1, so far, none have been serious, and we are doing our best to keep it that way.

We’ve been busy educating all staff members at the embassy, including local employees who fall under the Czech health system. I’ve tried to impress on everyone that this is a public health issue and not just a private health concern. I’ve delivered information in e-mails, handouts and personal group sessions with the different offices, but the most successful campaign has been the use of a video prepared by the Virginia Department of Health. Whoever thought this up is a genius!

In 2007, when “bird flu” was all the rage, the U.S. Embassy in Islamabad, Pakistan was seeing a large bird die-off on the embassy compound. My clinic arranged for some of these birds—all crows—to be evaluated at a poultry lab and, sure enough, they died of H5N1. At that time, there had been no animal-to-person transmission of avian influenza in Pakistan, but having these multitudes of bird carcasses around the compound was unsettling to people, and a minor crisis was evolving.

Our facilities manager called me one afternoon to announce that a sick hawk was on the compound and asked me what to do. “Leave it alone,” was my sage advice. For the next three hours, I received update calls as this poor bird experienced his death throes! When he finally did expire, he was refrigerated and sent to the poultry lab for diagnosis. He tested negative for H5N1, so they performed an autopsy! Cause of death: pathogenic E-coli. If Mr. Hawk had come to the health unit for his check-in orientation, he would have known to boil it, cook it, peel it or leave it, essential food sanitation advice in Pakistan, and he might still be soaring in the skies!

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