The Foreign Service Journal, May 2018

THE FOREIGN SERVICE JOURNAL | MAY 2018 13 LETTERS-PLUS A s a fellow Foreign Service par- ent, I couldn’t agree more with Kathi Silva (March Speaking Out) that the Foreign Service provides a rich environment for our kids. Many FS children certainly do bloom— adapting, adjusting and developing in unique and wonderful ways that we could only have dreamed of when we began our careers. As the director of the Bureau of Medi- cal Services, I can say unequivocally that the entire MED team takes our mission to “safeguard and promote the health and well-being of America’s diplomatic com- munity and their family members” very seriously. MED personnel, both in Health Units overseas and our offices here in Wash- ington, work very hard to learn as much as they can about the availability of local health resources at all posts, continually reassessing their quality on the basis of feedback from patients and host-country professional colleagues. At the same time, we strive to fully understand and appreciate each of our patients’ unique health needs prior to and during their time overseas. Our goals, of course, are to ensure that those needs can be met at the assigned mission and that the department, as an employer, does what it can to reduce the health risks employees and family members face in postings where access to quality medical care may be very limited or nonexistent. Meeting our goals is especially chal- lenging when a child’s health and well-being is involved. An adult may argue that they understand the dangers to their health if posted to a medically austere location, and that they accept those risks. But what if the issue, for example, is a family with a child who is two years behind in school potentially being posted to a country with limited services? I can think of few things more heartbreak- ing than to see a child fall further behind in their development, or to have a family curtail after a few weeks at post because the needs of their child could not be met. Our system is designed to prevent families having to face those situations. The department provides more than 1,000 Special Needs Educational Allowances each year to ensure that families receive the services and support they need. Yet in our efforts to avoid outcomes potentially harmful to children we sometimes end up at odds with parents facing difficult choices. One of the toughest tasks for any health care practitioner is sharing hard truths with patients, especially ones that may significantly affect their lives. Patients sometimes fundamentally disagree with their assessments. But in MED we do our best to explain why we feel our adminis- trative decisions are appropriate for each affected family. The daughter I helped raise over the course of three overseas tours didn’t have special educational needs. She did, how- ever, have a medical issue that could have had physical consequences and complica- Response fromMED— Our Commitment to Foreign Service Families BY DR. CHARLES ROSENFARB, MEDICAL DIRECTOR, BUREAU OF MEDICAL SERVICES, DEPARTMENT OF STATE tions. As a physician, I was fortunate to know a great deal about the nature of her condition. But not having served before at the locations I was bidding on and not knowing anything about the quality of the local care at those posts, I realized I was in no position to make an informed decision about where my own child’s health care needs could be safely met. As a parent, I felt fortunate that I could rely on the knowledge and expertise of the staff in MED’s Office of Medical Clearances. Like any bureaucracy, MED can do better. We can—and will—redouble our efforts at communicating proactively and in as timely a manner as possible. We will do more to ensure that our policies and practices are transparent and remain con- sistent as staff change. And we will reaf- firm our commitment to fostering a fully collaborative partnership with patients and families alike. We also pledge to our patients and the department that we will continue to advocate very strongly on behalf of all FS children, and that we will assure to the best of our abilities that those kids have access to the high-quality health and educational services they require to fully flower and grow. As medical professionals first and foremost, advancing the physical and mental health of our employees and family members will always be our singu- lar motivation. n 26 MARCH2018 | THEFOREIGNSERVICEJOURNAL Families with Special Needs Kids Need Support BY KATHI SILVA KathiSilva ismarried toaForeignServiceofficer; theyhave served together in Montevideo,Belgrade,Caracas,Pretoria,ParisandWashington,D.C.Shehas workedasa freelanceeditor,aUSAID contractorandaCommunityLiaison Officeassistantatpreviouspostsand is currently completingamaster’sdegree online.Kathiandherhusbandhave three children, twoofwhomhave ledher intoanewworldof childrenwithdisabilitiesandgivenhermore than15yearsofexperience raisinghappy, resilient, specialneedsdiplokids. R aisingchildren in theForeign Service isa lot likegardening— weprovidea richenvironment forourchildrenwithall the right conditionsandhope theywillbloom.But asgardenersknow, there isa lotofadapt- ingandadjusting towhateverconditions mayarise,andourplantsdon’talways grow inwaysweexpect. Goodgardenersdowhat theycan toestablishstrong roots,providea rich environmentofsupport for theirgrowing plantsandcreateaplanandasystem that responds tounpredictable factorsoutof theircontrol.For familieswithspecial needschildren, thissystem isevenmore important. In recentyears thenumberofchildren in theUnitedStatesdiagnosedwithspe- cialneeds is rising,and this trend isalso seenwithin theStateDepartment.Until a fewyearsago, thanks toapositive rela- tionshipwith theOfficeofMedicalSer- vices (MED,now theBureauofMedical Services)and thesupportandflexibility MEDgaveus to“growourgardens,” the experienceof raisingaspecialneedschild overseaswasmostlyapositiveone. As internationalschoolsbecomemore inclusiveand tele-therapygains inpopu- larity, therearemoreoptions thanever before toaddressspecialneedsoverseas. Thus, thechallenges for familieswith specialneedschildrenoverseasshouldbe increasinglymanageable. Yet for thepastcoupleofyears the experienceofForeignService families withspecialneedschildrenhasbeen the opposite. Why Reduce Support? In the June2016 ForeignService Journal ,MaureenDanzotandMark Evanswrotean importantSpeakingOut columnabout the fact thatparentswere increasinglyhavingahard timeaccess- ingSpecialNeedsEducationAllowance (knownasSNEA) fundsandgettingasay in themedicalclearanceoptions for their children.Since then, therehavebeen numerousactionsonbehalfof,andby, disgruntledparents inaneffort to resolve theseconcerns. Aparentadvocacygroup, theForeign ServiceFamilieswithDisabilitiesAlli- ance,wascreated in2016with thegoal ofprovidingaunifiedvoice for families dealingwithMED issues.When thealli- SPEAKINGOUT ance’ssuggestionswerenotanswered and thenumberand typesofcomplaints wereseriousenough,AFSAgot involved bywritingmemosandattendingmeet- ingswithMED tomediateparents’ complaints. TheStateDepartmentOfficeofCivil Rights isaddressingacomplaint froma ForeignServiceemployeewhoargues thatsomeofMED’scurrentpracticesare disadvantagingForeignServicemembers whosedependentshavespecialneeds. This,hesays, isaviolationof theAmeri- canswithDisabilitiesAct.Thecase is likely toopen thedoor tomanysimilar complaints. OnOct.29,2017,a WashingtonPost articleby JackieSpinner,“StateDepart- mentsupport fordiplomatswithchildren withdisabilities iscontracting,”brought publicattention to the issue.Onemonth later,SenatorsBenCardin (D-Md.)and PattyMurray (D-Wash.)senta letter to the StateDepartmentquestioning the“trou- bling”plans tocutsupport forForeign Service familieswithspecialneedschil- dren.Congresshasalso requestedbrief- ings from theStateDepartment,andMED inparticular,onspecialneeds issues. ThedisenfranchisementofForeign Service familiesbyMED,and theseem- inglyhaphazardway it ishandlingclear- ancesandeducationalallowances forour specialneedschildren,havegonepublic. Morepeopleareawareof theproblem, buthasanythingchanged?Not in the direction familieswerehoping. Speaking Out March 2018