The Foreign Service Journal, January 2011

8 F O R E I G N S E R V I C E J O U R N A L / J A N U A R Y 2 0 1 1 many hoops just to get their foot in the door. I’m sure there are many people at State and other departments who would like to try working for one of the other foreign affairs agencies. They, too, would be welcomed with open arms, but are blocked by the same lo- gistical and financial disincentives. Any improvement, even temporary; that AFSA can achieve by developing an interagency hiring program will benefit not only the to-be-hired indi- viduals, but all Foreign Service mem- bers and our country’s foreign affairs agencies’ work as a whole. Steve Bennett FSO, USAID Embassy Dakar Training MED Reading the September article on the Office of Medical Services (“To Your Health,” by Shawn Zeller) was both enlightening and disheartening. While the State Department has scores of competent doctors, nurse practitioners and physicians’ assistants working all over the world, the article fails to mention that there are also State Department health professionals who lack the knowledge or experience to diagnose and treat certain diseases or recognize when a person needs to be medically evacuated. Health care for all Foreign Service personnel —both generalists and spe- cialists — serving overseas is impor- tant, but particularly so in ThirdWorld countries where the quality of local doctors, hospitals and testing is sub- standard. We rely on our embassy health care professionals to be proac- tive. Yet I’ve seen too many real-life cases overseas where medical practi- tioners take a “wait and see” approach. Let me cite a few cases I know about. (Though I acknowledge I don’t have medical expertise, I am still com- fortable saying that these cases were not handled professionally.) For ex- ample, a burst appendix became sep- tic while the Regional Medical Officer would not medevac the patient before London saw the lab work (and imme- diately acted). The patient was near death, lost 40 pounds, and had to spend six weeks recovering in London, away from his family. Other examples: a lump found under an arm did not lead to immedi- ate medevac and ultimately resulted in a radical mastectomy. A young boy was treated for anemia for eight months but not tested for the leukemia that he actually had. A man was sick for four months, lost 30 pounds, and was finally medevaced, too weak to stand, and di- agnosed with colon cancer. Another man with falciparum malaria, the most deadly type, was drowning in his own fluid, but the health practitioner would not medevac him “unless he got worse.” This last case was my spouse. I had to contact the ambassador, who had been told he was doing okay, and get authorization for a medevac. My husband spent three days in London in the intensive care unit before stabilizing. This traumatic experience was fur- ther exacerbated by MED’s refusal to take responsibility. When I wrote a let- ter reporting the incompetence and malpractice that nearly took my hus- band’s life, I received a very conde- scending reply stating that the practi- tioner did everything right, and blam- ing my spouse, the locally employed nurse, the air ambulance service and the local doctors for the situation. I am disturbed that MED appar- ently cannot admit error, and take cor- rective action. Why do medical per- sonnel overseas wait for some cases to reach a critical stage before doing any- thing? Is it State Department policy to do so? If so, this policy is detrimental to personnel serving in difficult post- ings with little or no health care. Or is the department simply not training health care personnel to work in diffi- cult environments? The State Department has many competing needs, but providing the best health care possible to employees should be among its first priorities. Quality health care is priceless, yet over and over the subject of money comes up: Outside testing will cost at least $500. Certain malaria pills are very ex- pensive. This medevac costs $100,000. So what? Are we putting a price tag on human lives? If so, then all of us are at high risk of losing our lives while serv- ing overseas. We are always told how important our work is and how valued we are. But tragic real-life cases tell a different story. For the department, taking care of its people should mean giving them the highest-quality care in a timely manner, particularly when they are serving in difficult environments where medical facilities are deficient or nonexistent. Such a policy would reduce overall medical costs and min- imize the number of positions left va- cant due to illness that could have been prevented. The September article paints a rosy picture, but does not show that there are deficits in the knowledge of de- partment health professionals. State must train its medical personnel so that they can save lives, or at least instruct them to recognize when they can’t pro- vide adequate help and when it is time to proceed to an evacuation. They should not be taking risks with other people’s lives, and there should be no L E T T E R S