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.

No, a fish pedicure was NOT on my bucket list!

One goal I will never attain is to work in East Asia. The opportunity has just never arisen for me and, since this is my last post, I’ve accepted that it’s not going to happen. So when a friend of mine invited me to visit her in Kuala Lumpur, Malaysia and I discovered there are direct flights from Karachi to Kuala Lumpur, it was too good an offer to let pass.

This past month, in the same week we celebrated the U.S. holiday of Veteran’s Day, several local holidays were also strung together. As a result, only one day of actual office time was required of me that week and thus seemed the perfect time to hop a flight.

When I arrived, I was surprised to find my friend was hospitalized, with discharge still a couple of days away. It gave me the opportunity to learn a bit about the local medical system and how care is delivered.

My friend had an attending physician and several consultants who visited her daily for examination and updates on her condition. The hospital itself might have been in any downtown U.S. city, complete with a Starbucks on the first floor. The only thing that set the Malaysian nursing staff apart from their American counterparts was that they have retained the custom of the nurse’s cap, a tradition I was very happy to see dropped in the United States. The only thing I noticed that was very different, at least from the hospitals I’m familiar with, is that each time a patient leaves the room, the door is locked until his or her return. Otherwise, everything was very familiar and that was a comfort to my friend. It isn’t easy to be in a hospital in a foreign country with no family present. Familiar looking surroundings are a real bonus.

After a couple of days, I brought my friend back to her apartment, and we basically became couch potatoes for the rest of my visit. I did take one day to use the hop-on, hop-off bus that ran through the city so I could get a taste of this peninsular nation. Wherever I travel, I try to use these buses when available, as they usually provide a great overview and an efficient way to cover the highlights of the city I’m visiting.

At the central market, I hopped off the bus to participate in something that has peaked my curiosity since the first read of it several years ago. I had a fish pedicure! I dangled my feet in a large vat of water while small, sardine-size fish hungrily attacked dead skin everywhere they found it.

The first two minutes were almost unbearable, not because it was uncomfortable, but because of the freakish sort of tickle. But after the initial shock, the sensation diminished and it was quite pleasant. A half-hour later I was done, evidenced by the few fish still paying attention to me.

Each time another person came to the tub, however, it was like a feeding frenzy. (Maybe we have different flavors.) The fish would swarm to the new feet and do their thing, then eventually lose interest and disperse.

I can declare two things. This was by far not the best pedicure I’ve ever enjoyed, but it sure was the most unusual, and I have a photo to document it.

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

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.

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.

Go fly, kite!

I grew up amongst seagulls; a noisy, messy bunch, but not at all threatening, even when they came in large groups searching for treats. Once I left Texas, I was largely removed from groups of flying critters, except for occasional swooping pigeons, but living overseas has changed all that.

In Africa, swarms of fruit bats filled the sky at dusk, darting in and out of the trees and, sometimes, flying so close to me as I walked I could hear the “swoosh” of their giant wings.

In Islamabad, we had crows. To discourage them from roosting, we hung fake owls in the trees—owls are evidently a natural enemy of crows—along with shiny strips of twirling metal. It didn’t work. The crows would foul the ground below the trees and make a terrible racket at both dawn and dusk. The worst was when they became infected with H1N5 (avian influenza). Dead birds, scattered by the dozens around the grounds of the embassy, caused a minor panic.

Karachi has kites, black kites to be exact. These large, rather intimidating birds soar and swoop in groups all day long, not unlike vultures waiting for carrion to appear.

Black kite

My apartment has a very nice balcony with some lovely teak furniture. It might be a nice place to sit and read a book. I say might because I will never know. The kites like to land on the balcony rail and sit on the arm of the teak chair, and they are aggressive. I got a good look at a kite perched outside my window, and that thick, curved beak and the menacing talons were enough for me. My balcony belongs to the kites. I will never venture there.

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

It's just my southern hospitality!

If you have had even a passing interest in world news, you know that the United States and Pakistan are in an ongoing spat, and a number of issues this past year have caused dissatisfaction on both sides. This past week, the most recent political upheaval inspired a peaceful protest march to the U.S. consulate in Karachi. The consulate was informed there would be a protest of possibly a few hundred people, but that the protesters would not be allowed to actually reach the compound.

I should explain that the consulate in Karachi is in a self-contained compound surrounded by a high wall and is under tight security. Our office building, where all the work takes place, is about 150 yards from the residential building, where we all live. Between the two is a totally open area of sidewalks and palm trees but, since the wall is so high, it is impossible to look into the compound from the street. Or so I thought.

As I was leaving the consulate, one of the security officers cautioned me to go straight to the residence as the protesters had been allowed, in spite of what we had been told, to move up the street outside the compound and they were gathering right then. I moved on through the entrance and began my walk to the residence. I was about a third of the way when I heard the music and shouting. It wasn’t threatening shouting, and it wasn’t cheering. It was just lots of noise coming from the area outside the wall and, when I looked in that direction, I was absolutely shocked to see people—lots and lots of people—standing above the level of the wall.

So there I am in the middle of the otherwise deserted area between the two buildings, looking at these folks who are looking right back at me. Many of them were waving their arms, and it seemed to me they were waving at me. I didn’t feel threatened at all, but it certainly ran through my mind that this was a situation I had not anticipated and with which I was not completely comfortable. While I saw no indication of hostility, I also know it only takes one person with ill intent to turn a situation violent.

I quickly considered my options. I didn’t want to turn around, as that would put my back to the crowd. Instead, I did what every good southern woman from the United States would do in that situation. I smiled my biggest smile, waved at the crowd and kept moving forward to the residence, reaching it without incident.

Later, I learned that the crowd came with buses and people had climbed on top of the buses to see into the compound, thus giving me the impression they were standing above the wall. And the initial estimate of several hundred turned out to be several thousand, though that was not obvious from the numbers I saw levitating above the wall.

I have caught a lot of ribbing from my colleagues for waving at the protesters, and more than a few have suggested that the “waving” I perceived was, perhaps, less than friendly. I choose to remember my version of the event. It is the southern way.

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.