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.

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.

The sign of the comet

I’ve often said it is the variety in my U.S. Foreign Service job that keeps me enthralled, especially since I seem to have a rather short attention span. In my career, no two posts have even been similar, much less the same. The Czech Republic has been a huge change from my previous developing-country assignments and, with a more typical list of medical complaints, I admit I was getting a bit soft.

Then, the mites arrived! One of our young officers came to me with a profusion of itchy, whelped, pink bites on her posterior thighs. Honestly, I didn’t know what the cause could be, and since the bites were in a defined location, it didn’t seem like a major issue. That was in the morning. When she returned in the afternoon, the bites were weeping, enlarged and had taken on a purple hue. My comfort level dropped to zero, and we arranged for her to see a dermatologist immediately.

The dermatologist was less concerned, because she knew what the cause was—a severe reaction to mites! Mites? Where did they come from, and why now? It is winter in Prague. Do mites attack in winter? A bit skeptical, I forwarded photos to a dermatology consultant in Washington, D.C. His reply was, “Yep, mites.” The dead giveaway was the “comet sign” coming off one of the lesions. (A comet sign is a red streak leading away from the central area). The two dermatologists disagreed on the source. One believed the mites were related to birds, and the other thought they were connected to woodborers, but both were certain the lesions were caused by a severe reaction to mite bites.

This is where my job gets really interesting. If I was in a usual practice in the United States, I would refer my patient to a dermatologist, who would prescribe treatment, and we would be finished with the issue. Not so in the Foreign Service. The ongoing saga of investigating why there are mites in this officer’s home, determining which chemicals are safe—and OSHA approved—to treat the infestation, photographing and cataloging new bites as they have appeared, discussing with various embassy offices about what’s best to do—all have involved me.

I know more about mites today than I knew three weeks ago and more than I ever thought I would need to know. It is fascinating, really! And to the long list of “jack-of-all-trade” tasks the Foreign Service has required of me, I can now add exterminator!

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.

Home sweet shipping container

I have had a steady stream of visitors since I’ve been in Prague. To be fair, I haven’t worked many places people were eager to visit, and Prague is the crème de la crème of my locations, so it is understandable that this would be a popular place to visit me.

I anticipated visitors, a bit more spread out perhaps, but I messed that up when I announced that my tour in Prague would be two years rather than three. (I will depart Prague in June of 2011.) That added pressure to tell those who want to visit me and share this beautiful city to “come on.” Luckily, I have a second bedroom in my apartment, so there is a place to house visiting friends.

Housing is an interesting subject in the U.S. Foreign Service. In almost all posts, we are assigned housing based on family size, seniority and job requirements. Some of my colleagues must entertain contacts in their homes, so that may net them a larger place. There are firm rules concerning housing assignments at post and a housing committee ensures that the rules are followed. I have served on those committees several times.

Housing assignments can be disputed and there are often solid reasons why someone should be allowed a housing change. However, my favorite memories of housing disputes are from Afghanistan. At that time, all housing consisted of repurposed metal shipping containers—a single room 7 feet wide by 20 feet long. Each resident had a 3-foot wide bathroom, a metal bunk bed, a student desk with chair and a dorm-sized microwave and refrigerator. The walls were plastic and the floor vinyl. This is what everyone had regardless of rank or position.

Ah, but it was the location that became the disputed issue. People would jockey for housing (called hooches) depending on what location was most important to them. A person might prefer to be closer to the cafeteria or nearer the embassy, while others wanted to be on the back of the property and away from the noise. Personally, I considered myself fortunate to be close to the laundry trailer, especially during inclement weather.


















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

And this is a SLOW week!

Another week has ended and, because it is summer vacation time and post transfer season, my clinic has been operating at a slower pace. I enjoy the occasional slumps, because they give me time to accomplish administrative work I’ve been putting in my “round tuit” file, catch up on journal reading and reflect a bit on what I’m doing.

Today’s reflection highlighted the virtual practice, of which I am part, and the global resources I enjoy. In my former U.S. practice, if I wished to discuss a case, I usually walked down a hall to speak with a fellow medical provider. Occasionally, I would phone a colleague about a particular patient but, almost certainly, that colleague was someone I would see face to face within a short time to continue the collaboration.

Most of my postings with the U.S. Foreign Service have been as a single provider, so when I require consultation, I pick up a phone to call medical staff people in Washington, D.C. or in another country. For example, this week I’ve collaborated by phone or e-mail with colleagues in Washington, Budapest and Kyiv. I’ve also discussed medical-supply problems with colleagues in Islamabad, Pretoria and Abu Dhabi, and worked through an administrative question with my counterpart in Bucharest. And this is a slow week!

I admit I am impressed with how truly universal and “virtual” this form of practice is. I take it for granted that the diabetes expert I rely on is in Jakarta, the neurologist is in Frankfurt and the pediatric guru is in Budapest. And, like a city toss, next year we could all be in a different location, but still readily available to each other and the patients we serve.

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