Speaking Out

BY JULIET WURR

Fading in and out of awareness, I curled up on a gurney in the hospital emergency room in Hyderabad, India, in November 2010. For the previous five days, I’d been feverish with a splitting headache. I couldn’t sleep, yet felt listless and weary. The consulate’s local doctor had no answers, but said the obvious culprit, dengue fever, wasn’t evident in my blood—yet.

Days later, I ended up in the emergency room. Embassy New Delhi’s American doctor, who was fortuitously in Hyderabad on his quarterly visit, asked me to name the current U.S. president. “Roosevelt?” I offered. That afternoon, I was medivaced to Singapore. After 10 days and numerous medical tests in Glen Eagles Hospital, the doctors concluded I had indeed contracted dengue fever, with encephalitis as a bonus.

There’s no telling where the mosquito came from that infected me. Dengue is endemic in India, and I wasn’t the only American at our new consulate to become ill from it. But I definitely had the worst case of anyone I knew.

Coming to Grips with a Lifelong Illness

Over the next year, first in Hyderabad and then in Washington, D.C., I discovered and then struggled to cope with the repercussions of my illness. My doctor concluded that my now-unreliable memory, constant drowsiness and cognitive impairment were all the result of my encephalitis. I knew that my Foreign Service career had come to an end.

I spent months trying to find an individual or office at State designated to help me. Surely there was compensation or some kind of assistance, I thought, though I wasn’t sure what kind. So I was aghast when, time and again, I was told that no one had a mandate to help. Employees in the Office of Medical Services and the Bureau of Human Resources were kind and welcoming, but eventually they admitted they had nothing to offer me.

Was I at fault? Should I have taken out disability insurance? The idea would have seemed preposterous when I entered the Foreign Service 20 years ago. With the bravado of youth, I would have laughed and proclaimed, “But I never get sick!” Like most of my peers, I would have assumed that if an illness left me with huge medical and pharmaceutical bills, the State Department would share the burden of those costs and mitigate the loss of income from a career cut short.

After all, hadn’t I volunteered for hardship assignments, including some severe hardship posts, throughout my career? Hadn’t the department and my insurance company covered two hospitalizations already? So surely they would help me now.

Or so I thought.

The truth was that no one at State had a mandate to offer assistance to an employee with compromised abilities and bills for an illness contracted while serving at a hardship post. Blue Cross/Blue Shield paid a certain percentage of my costs, but I was dismayed to discover how much still had to come from my own pocket—as it will for the rest of my life.

Passing the Buck

The Foreign Affairs Manual assigns responsibility for assisting Foreign Service members who have contracted life-changing illnesses overseas to the Department of Labor’s Workers’ Compensation Program. However, this worthy government assistance program was originally designed for blue-collar laborers who toiled in America’s factories, not white-collar workers living and working overseas.

Instead of dragging its feet, State should implement new policies to assist employees who return to the U.S. with life-changing illnesses or injuries.

I duly submitted my application with its inch-thick stack of supporting material in October 2012. My application was denied because the DOL adjudicator failed to recognize that dengue fever was endemic in India—and that my job required me to be there. Undaunted, I reapplied three months later, presenting more doctors’ letters and explanations. The result was the same: I could not convince Labor that my illness was caused by being in India as an employee of the Department of State.

I have one more appeal to DOL left, and this time I’ve hired a lawyer.

To apply successfully for disability, another program we all contribute to through our paychecks, I must stop working with no guarantee I’ll receive compensation. And I must use a considerably smaller income than I’d expected for costly medications and frequent visits to specialists for the rest of my life.

The Department of State insists it has met its legal responsibility by referring me to the Workers’ Compensation Program, managed by the Department of Labor. In a series of meetings with MED and HR, I was told that workers’ comp is the only avenue for receiving compensation to cover my medications and medical bills. MED noted that its ability to advocate for me is extremely limited, but did give me a letter attesting that, as a requirement of my State Department employment, I worked in an area where dengue fever was endemic.

Several years ago, Iraq returnees sounded off about their frustration with the inadequate treatment of Post-Traumatic Stress Disorder. A similar outcry will be heard as more Foreign Service employees find that State does not value the physical sacrifices they have made.

Helping State’s “Wounded Warriors”

Instead of dragging its feet, State should implement new policies to assist employees who return to the U.S. with life-changing illnesses or injuries. This should include assistance, both in terms of applying to the Labor Department for workers’ comp and within the department itself. DOL obviously does not understand or appreciate the inhospitable environments in which Foreign Service personnel work all over the world. Accordingly, State should aggressively educate DOL adjudicators about the realities of service abroad and advocate on their behalf.

State could also offer low-cost disability insurance—or at least publicize other avenues for obtaining it—and educate its employees, especially new recruits, about the limits of the assistance it can offer. Information about disability insurance for federal employees is actually just a click away on the Internet, but how many people know it exists or that they need it?

Another idea would be for State to use employees’ contributions to fund its own workers’ compensation program, rather than contributing to the Labor Department plan.

State could offer low-cost disability insurance, or at least publicize other avenues for obtaining it.

Better still, State should emulate the Department of Defense’s approach to assisting employees who have been disabled by injury or illness incurred overseas. DOD’s congressionally mandated “Wounded Warriors” program makes injured soldiers’ care a priority. Shouldn’t State recognize that the injuries and life-changing illnesses of its own employees are equally worthy of care and compensation?

Let me note a valuable resource with great potential to aid Foreign Service personnel in my situation. With an infusion of staff and funding, the Employee Consultation Service could play a welcome role as advocate and adviser for those suffering from illness or injuries. The department’s new, congressionally mandated creation of a Post-Combat Case Coordinator is another step in the right direction.

Sadly, though, it is not only war and captivity that cause life-changing illness and injury. To ignore the plight of Foreign Service members who serve on the “front lines” is wrong, especially those left with something as severe as a brain injury.

Sending the Wrong Message

One of the lowest points in coming to terms with my illness was the realization that the agency I’d so loyally worked for was unwilling to help me in my time of need. MED, HR and other bureaus I asked to help me often had consoling words, but none were able to offer me what I sought: compensation for my medical bills and recognition of the sacrifices I’d made in serving abroad. An illness I’d contracted while serving my country denied me six years of a career that I loved, yet I was no one’s Wounded Warrior at the Department of State—even though I had served and excelled at some of its most difficult posts.

If the department does not start taking the health and welfare of its returning overseas employees more seriously, it will send the wrong message to all its employees—especially its talented and eager new hires. Unless it consistently demonstrates that commitment, it will quickly find the goal of recruiting and retaining the best employees becoming more and more difficult.