Spice girl

I have just returned from two weeks in the United States to welcome my newest—and eighth—grandson. He is a great little guy, peaceful and even-tempered, and, considering that his next older brother is a real handful, I hope he stays that way, in deference to his mom.

Lately, I have been corresponding with a couple of people who are interested in what my job entails. I’ve been asked to recount my "typical" day, and I’ve given a great deal of thought about what a typical day is for me. However, there is a big picture to my job, and it can’t be answered as easily as one might think.

First of all, typical, in the sense of the types of patients I see in the clinic, depends a great deal on where that clinic is located. State Department embassy medical units are located worldwide, so health risks differ from location to location. While there might be an allergy or influenza season in any location, acid bug, malaria, dengue or Japanese encephalitis risk only occurs in some locations. However, most patients are seen for basic primary-care causes, just as in a U.S. clinic, but the daily patient load is less, as our responsibilities are broader than patient care.

Patient safety and health issues also vary by location. For example, the risk of gastroenteritis in Southeast Asia, and the community education required to prevent it, far surpasses the risk in Western Europe. When I was in Southeast Asia, evaluation for and treatment of food-borne disease was a daily event. In Prague, I have never discussed food-borne disease with a patient; it isn’t required.

My typical day in some posts might include a visit to the embassy cafeteria kitchen to observe and reinforce proper food storage and preparation practices. Our North American standards of food service are a mystery to food workers in much of the world, and it falls to the post medical unit to enforce the standards we expect.

A frequent task is evaluation of medical resources to use as consultants for the embassy community. In the majority of these cases, a continuing relationship and rapport must be nourished by frequent contact, visits with the consultant and sponsorship of social events. Medical associations in the United States are largely pure business while, in a great deal of the rest of the world, successful business requires social interaction like "tea and biscuits" to keep the relationship active.

In the beginning, I found this very difficult. I was used to calling a consultant and immediately launching into information about a patient. I've learned to be more sensitive to the cultural needs of the practitioners I call, which usually requires discussion of niceties first—"How are you? How is the family? How was your recent trip to X?"—before I launch into the medical conversation.

A typical day for me includes meetings—management, country team, emergency action committee and other committees of various sorts. I may be the medical officer, but my official duties cover many things that aren't medical at all. I admit I’m not a fan of meetings, but they are a necessary part of the job.

If variety is truly the spice of life, I have a very spicy life. Just the way I like it.

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

Small miracle

The Western Hemisphere and most of Europe are gripped by the tragic events unfolding in Haiti. Modern media transports those of us who have televisions to the center of the misery and captures us with heartbreaking and touching stories.

I always considered myself a knowledgeable person, but it wasn’t until I joined the Foreign Service and traveled to the, shall we say, more unusual parts of the world, that I realized how little I really knew about life outside of my sphere. I understood American poverty and I understood the chasm that existed between those who have and those who don’t—in North America. After all, I grew up in south Texas and had visited our neighbors to the south many times. I thought I knew.

What I know now is that the events currently taking place in Haiti are occurring all over the world, on a smaller scale, daily. I don’t just mean earthquakes. I’m talking about desperate circumstances, poor nutrition, unsafe water, lack of shelter, and poor medical care. The World Health Organization estimates that one million African children die each year from malaria. That’s just one continent and one disease. To extrapolate is truly disturbing.

And while I now know, and have seen firsthand, some of the terrible conditions people survive, I have also seen small miracles occur, without international coverage or support, that make life better for these unfortunate people. I’ve already mentioned a few, but I want to tell you another.

When I worked in Conakry, Guinea, I was introduced to six nuns of the Missionary Sisters of Charity—the order started by Mother Teresa—who operated a clinic. I began assisting them in small ways. The clinic usually had a full load of 25 inpatients, mostly children 3 years and younger who had nutritional needs.

One day, I received a phone call asking me to come to the clinic to see a sick child but I was unprepared for what I found. A village woman had come to the clinic with a premature infant. She was the infant’s grandmother. The mother of the child needed to stay in the village with her other children. This baby weighed 1 kilogram. I had no experience with preemies and looking at this little boy was like looking at a tiny, skinny doll. I was afraid to touch him. In spite of his small size, he looked pretty good. He was alert, he was feeding well (breastfeeding mothers at the clinic were pitching in) and he had no respiratory problems. But he was only a few days old, and I couldn’t imagine he would survive. In a developed country, this child would be in the NICU for weeks with all sorts of advanced monitoring and treatments. This baby was in an open crib in a room full of sick children, with just a mosquito net between him and certain malaria. If he needed specialized care, it just wasn’t available. The clinic didn’t even have hot water.

I went to the clinic every other day and watched in amazement as this child survived, developed and eventually flourished. When he was 3 months old, he was a plump, smiling and cooing little boy, and his grandmother took him back to the village. I think of him often and wonder if his miracle continued. He would be 8 years old now. I hope he is.

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