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.

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.