Prague on my mind

Just my luck! I leave Prague, and the Honor Society of Nursing, Sigma Theta Tau International (STTI) schedules its 24th International Nursing Research Congress there. As I spend my days in Karachi coveting my colleagues’ enjoyment of beautiful Prague and her fabulous culture, I will be remembering my very favorite places while I lived there. And, because I hold no rancor for my “missed opportunity,” I will share the thoughts I’ll be having with you now, in case you want to seek out my favorite places, too.

Everyone will tell you that the Charles Bridge, the Prague Astronomical Clock and Prague Castle (Prasky Hrad) are must-sees, and they are. If you have time to visit only the Big Three, don’t miss them.

The clock, which is in Old Town Square, is the third oldest astronomical clock in the world, dating from 1410, and the oldest one still functioning. On the hour, it strikes, and the show begins: a series of bell tones, trumpet blasts, and figures of the Apostles appearing in small doorways just above the clock face. Go early, as it will seem that everyone in Prague is waiting to view this hourly exhibit, and it can be difficult to find a good place to take photos.

Prague Astronomical Clock

The Charles Bridge dates from 1357 and is named after the Holy Roman Emperor, King Charles IV. Over several hundred years, carved statues were added to the bridge. The current statues are copies, and the originals are displayed out of the elements elsewhere, but the effect is the same. Note: The bridge is frightfully busy during a good part of the day and early evening. If you want a magnificent experience, get up early and be at the bridge before 7 a.m. If you are really lucky, there will be fog on the Vltava River, which gives the bridge an amazing otherworldly effect, unspoiled by the presence of people.

St. Vitus's Cathedral in Prague Castle (Prasky Hrad)

Of the “Big Three,” Prasky Hrad is my favorite. The castle complex, which marks the old walled city of Prague, has been around in enlarging forms since the 10th century. Once inside, opt for the audio guide, because it provides excellent information, and it assures you a no-wait line to get into St. Vitus´s Cathedral, where there are many treasures to enjoy. I am a fan of stained glass windows, and the window I love most in the world is here. So, when you are standing before the window designed by the famous Czech artist, Alfons Mucha, in his distinctive Art Nouveau style, think of me.

My favorite stained-glass window.

Most people identify classical music with Vienna, but Prague is electric with great music every evening of the week. My favorite concert venue was a very old church, St. Martin in the Wall, located in New Town, just off of Narodni. There are concerts there every Friday and Sunday at 6 p.m. sharp! You can purchase tickets online or at the door, but don’t be late because, once the concert begins, to prevent disturbance of the performance, you will not be admitted.

If St. Martin’s is inconvenient, don’t hesitate to find a venue more to your liking. Most Czech churches have been decommissioned as places of worship and have been turned into tourist and concert venues. The art within is often on par with the finest museums, and you won’t be disappointed in the music selections. Signs out front advertise the evening’s program, time of performance, and the price of tickets. If you happen upon a venue just before concert time, and you are interested in attending, ask for a price discount. Chances are good you will save a few koruna (crown), but don’t haggle too hard. The music will be worth the price of admission.

With its more than one thousand years of history, Prague is an architectural or art student’s delight. One of my favorite places is the Municipal House (Obecni Dum), located in central Prague. Following a major overhaul about 100 years ago, the present décor is predominantly Art Nouveau. Dine in the first floor French Restaurant or Café, or make your way to the basement to dine in the American Club. The food is fine, but the ambiance and tile mosaics are marvelous.

Monuments abound in Prague. You can’t help but pass them on any major street. But the one dearest to me also happened to be located next door to the apartment building where I lived in Prague. The Memorial to the Victims of Communism is of 21st-century design and pertains particularly to victims in the Czech Republic. It took me a good bit of processing before I decided how I felt about it.

Memorial to the Victims of Communism

Even if this monument isn’t to your liking, it sits at the bottom of Petrin Hill, a wonderful green space with excellent walking trails to explore. Just follow the trails up the hill, and you will eventually reach the Czech version of the Eiffel Tower and great views of the entire valley. About halfway up the hill are a couple of lovely restaurants with quite decent food and amazing views. Sit out on their patios, and enjoy!

Vyšehrad Cemetery

I enjoy cemeteries in a very nonmorbid way, and the Vyšehrad Cemetery is a real treat. Not only is it the final resting place of some internationally famous people—Alphonse Mucha and Antonín Dvořák—but it is also a place full of beautiful mosaics, sculptures, and interesting monuments. Immediately adjacent to the cemetery is the Church of Sts. Peter and Paul with its beautifully painted wall scenes, casements containing original Charles Bridge monuments, and the Gothic Cellar, which is a museum of interesting medieval artifacts. To get there, take trams No. 3 or 16 to Výton, south of New Town, or take Metro line-A (green) to Vyšehrad Station, and walk about 15 minutes up the hill. I always took my visitors to Prague to the Vyšehrad, and it never failed to please.

Finally, Prague is famous for its beer (pivo), and there are dozens of boutique breweries all over town. My favorite is located at the Strahov Monastery, located at the top of the hill above the Prasky Hrad. The monastery has much more to see than the brewery, and I recommend a leisurely stroll around the grounds, through the church, the art gallery, where there are rotating exhibits, and the library, recently beautifully restored.

And finally, advice from my experience in Prague. When you fly into Prague airport, pay attention to the signs, located where you collect your luggage, identifying taxi companies recommended by the city government of Prague. When you exit the building, there will be a line of taxi cabs. Do not be fooled into thinking you must take the first cab in line. Take ONLY the recommended cab companies, and if you like the driver, ask for his card and call him again. Your hotel will arrange proper taxi service to your destination, but you will need to call for a returning taxi. One of the recommended taxi companies has stands around town that are usually reliable.

Just know that hailing a taxi in Prague, as a foreigner, is a very risky business, and you are much less likely to be dissatisfied if you take the recommended taxis, the metro or trams, which provide excellent and inexpensive service.

So, colleagues, have a terrific time in this very lovely European capital city. Prague is magical and begs to be savored.

On a personal note, I am retiring from active practice in a few months and, sadly, this is my last post for “NP Worldview.” I am returning to the United States to bone up on my grandmother skills, and I can’t wait. My career in the U.S. Foreign Service has been an amazing experience, and I do hope I’ve been able to share some of the best of it through my blog.

Best wishes to each of you!

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

Anne of the Foreign Service

On 6 April 2013, Anne Smedinghoff, 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.

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.

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.

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.

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.

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.

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

Journey to Middle-earth

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 real Eden.

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 South Island of New Zealand is “Middle-earth,” as all of the movies have been filmed there.

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 out) and it makes for one bang-up trip.

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.

Back here in Karachi

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.

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 from Karachi.”

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.

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.

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?”

Next, I think we will work on political correctness!

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

Happy New Year from Karachi!

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.

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.

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.

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.

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.

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.

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

Where's the billing department?

On a recent trip to The Indus Hospital 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.

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.

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—can you imagine?—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.

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.

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.

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.

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.

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.

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!

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

Linked in but unhinged!

Whoa! Beware of jet lag. It can cause you to act in strange ways.

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.

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.

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.

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 Reflections on Nursing Leadership (RNL), is also in this pond, I’m sure the sailing will be just fine.

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.

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

I’m so VERY glad we had this time together?

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.

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.

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.

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.

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.

After we caught our breath and wiped the tears; we had to know: Why was he holding his earlobes?

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.

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 Carol Burnett, 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!

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

Do you know TED?

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.

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.

One of the things I enjoy most is going to the TED website and catching up on all the amazing things that are happening in the world. Do you know TED? “Technology, Entertainment, Design: 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.

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.

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

The babies of Karachi beach

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.

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.

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.

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.

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.

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.

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.

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.

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

Er, Doctor, would you wash your hands, please?

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.

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!

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.

Mehroon teaches proper handwashing technique.

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.

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.

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

I’m ba-a-ck ... I think

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.

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.

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.

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.

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 not fit all!

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

Six days in Malta

I have just returned from six days in Malta. It would be a great spot to vacation, but I was there strictly for work. The U.S. Department of State Office of Medical Services, known in governmentese as MED, sent a psychiatrist and me to support Americans being evacuated out of Libya. Before they could be evacuated to Malta, 300 of these evacuees spent two harrowing days aboard a ferry anchored in the port of Tripoli, while they waited for seas calm enough to travel. This group included children, pregnant women and elderly people, all of whom were at higher risk for such travel. They slept on the floor three nights, ate mostly snack food and had no shower facilities.

On the third day, they were finally cleared to travel to Malta and then motored through high seas and rough water. Most were seasick and exhausted when they, at last, arrived. Still, considering that experience and all they went through prior to reporting to the ferry, when tensions in Tripoli were high and the situation was increasingly dangerous, they all looked remarkably good.

I believe the emotional trauma was the worst of the suffering. People left their homes and nearly everything else behind, perhaps never to see them again. They left Libyan friends and colleagues to an uncertain future. They left beloved pets that were not allowed to travel on the ferry. I heard of at least one family that witnessed people being shot in the street. Their children were clearly distressed. The psychological healing will take some time.

Fortunately, there were no serious illnesses or injuries on the vessel. The physical complaints were mostly the effects of exhaustion, seasickness and the benign, nonspecific physical symptoms that follow the decrease of stress hormones after they have been elevated for an extended period of time.

I have worked through crisis situations before, but never an evacuation. I was extremely impressed with its planning and execution. The staff of the American embassy in Malta really did their homework, and I don’t believe they left a single contingency unexplored. In addition, the Maltese government provided relief workers, ambulances and supplies, and the Maltese Red Cross provided personnel and equipment for escort. The whole episode was a finely tuned operation that went off without a hitch, which was very encouraging since the American-chartered vessel was the first to arrive. Other followed that evening and in succeeding days.

PHOTO: U.S. Ambassador to Malta Douglas W. Kmeic welcomes evacuees from Libya as they exit the ferry. Michael Avina, photographer.


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

I'm sure I am where I am!

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

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

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

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

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

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

Uncle!

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

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

You’re going where?

I've asked my colleague, Mary E. "Betty" Ulrich, RN, MSN, ANP-BC, FNP, to write a guest posting for today's blog entry. Betty, also a member of the Honor Society of Nursing, Sigma Theta Tau International, is a retired U.S. Army major who wasn’t through with public service and brought her considerable experience and expertise to the U.S. Foreign Service. — Judie

I don’t know how folks functioned in the U.S. Foreign Service before the advent of the personal computer. Every year, about a third to half of embassy staff members prepare to rotate to the next blue horizon. That goes for the medical crew, as well. We bid on a job list that is anxiously awaited every year and then get down to the business of learning geography all over again. Not every U.S. embassy has a health unit, so we are not in tune to every country, but we don’t do too badly.

I was working for the State Department about a year before it dawned on me that we don’t bid on country assignments but capitals. So, when you are looking at a list and it says, Yaoundé, you’d better look it up before you put it on your list. Many of you will know Berlin, Rome, Frankfurt and Beijing, but what about Lilongwe, Antananarivo, Ulaanbaatar, Chisinau, Quito or Cartagena? Okay, you may know Cartagena, if you are a Michael Douglas “Romancing the Stone” movie fan.

So, every year, the medical folks help those who are bidding on jobs—sometimes on the other side of the world—to assure that medical assets required by the bidder’s family are available at the new posting. Easier said than done! Over the years, a system of evaluating and writing down medical contacts and sources of excellent care has evolved into a massive worldwide I’ve-got-you-covered list. So Jamie, who has asthma and wants to go to an air-polluted environment, will need a very good pulmonologist who, by the way, speaks English well enough so that her mother, whose native tongue is French, will understand.

This whole topic evolved as a patient—and friend—walked into the office the other day and said her husband had gotten the job of his dreams in Lusaka.

“Great!” I said. “Hmmm,” I was thinking quietly, “where in the world? Okinawa? Japan? Southeast Asia?” No, my friends, none of the above. It’s the lovely country previously known as Zambia.

Now, what part of Africa is that in? Get out the maps, which a seasoned Foreign Service officer has bookmarked on the desktop. The usual thoughts race through the old gray cells: Malaria? Yellow fever? Diarrhea? Food sources? Typhoid? Etc, etc.

Well, this is going to take some education to pull off the medical-advice portion of a briefing for Lusaka. Like I said, I don’t know what medical providers did before the computer!

— Betty Ulrich, U.S. Foreign Service NP, medical rover, Washington, D.C. (for now)

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

Thanks, Jim!

I rarely get to go to the United States for holidays and this Thanksgiving was no exception. But don’t feel too sorry for me because, while there was no turkey and dressing, I spent my holiday playing with friends in Paris. Three other Foreign Service ladies and I met in Paris for the long weekend, arriving on Wednesday and returning to our respective posts on Sunday.

I’ve been to Paris previously but this was an opportunity to see things I had not seen before and to do something I’ve long thought about. I spent seven hours one day at the Louvre, even eating lunch there. For those of you who have been to the Louvre, you know that seven hours isn’t enough time to see all of even one section—and there are three sections! But I was alone, and that meant I did not have to compromise. I saw exactly what I wanted and spent as much time as I needed to thoroughly check out my interests. I didn’t even go by the Mona Lisa. Heresy!

But what I did do, something that had been lurking in the back of my mind for some time, only took a few minutes and still has me smiling—and singing—days later. My friend Judy and I found our way to the Père Lachaise Cemetery, a veritable maze of tombs, monuments and cobblestone paths leading to hidden treasures of history, some a millennium old, and the very nondescript grave of James Douglas Morrison, better known as Jim Morrison of the Doors.

A small group of gawkers was there, very quiet and respectful. I was seized with an uncontrollable desire to sing “Come on baby, light my fire,” and most of the others joined in. Truthfully, I went there with this plan in mind but almost chickened out when I saw other people. But there I was, standing at the feet of Jim, and breaking into song seemed appropriate, even necessary. It was a great, if short, moment and the memory is still tickling my fancy days later.

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