The Foreign Service Journal, May 2022

20 MAY 2022 | THE FOREIGN SERVICE JOURNAL The reports point to a systemic disregard for women’s health care by MED. calling the medically necessary embryo reduction an “abortion.” Unable to find a provider to perform the procedure in the U.S., Kina was forced to find a doctor in a third country, sched- ule the procedure on her own and fund the travel herself. Instead of supporting her, the health unit told her she “should have known this would happen.” When Kina contacted MED about these issues and then asked how to file a grievance, her emails were ignored. Naomi found herself with an unwanted pregnancy, at four weeks ges- tation, despite having used protection. If she were in the United States, at this early stage Naomi would have been able to get a doctor’s prescription for mifepristone/ misoprostol, a safe, widely available and FDA-approved medical abortion pill. This was not available at her health unit. Abortion was not legal in her country of service. Neither was the health unit willing to medevac Naomi to access these services in the U.S. prior to 12 weeks of gestation. Instead of supporting Naomi with reproductive health choices similar to those available in her home country, the health unit said they could not assist, and Naomi was forced to seek other options. She ended up in a local hospital with internal hemorrhaging. Sharon was facing a risky pregnancy. Because her pregnancy required close monitoring, her U.S.-based OB/GYN did not want her to return to post in light of the civil unrest there. The roads to access any medical facility were being set ablaze daily during violent protests that included gunshots and burning tires. MED declined that recommendation and forced Sharon to return to post. The health unit implored MED to medevac Sharon, again to no avail. Hav- ing returned to post, she experienced inexplicable excruciating abdominal pain but could not access a health facility. Not receiving the support she needed to feel safe, Sharon made the difficult deci- sion to take leave without pay (LWOP) and depart from post on her own dime, getting on the very next flight back to the U.S. Once in the States, Sharon went to the hospital and was told that due to a severe cord prolapse, her baby could have died had she waited any longer. She was immediately hospitalized while doctors determined a treatment plan, which included an emergency C-section. “The whole thing was very traumatic and terrifying,” Sharon told us, “and I am just glad I left when I did.” When Cadence got pregnant, she was ecstatic as she had been trying for some time. However, just weeks into the preg- nancy, she began to bleed and experi- ence pain. Fearing the worst, she reached out to her health unit, where staff confirmed she had likely had a miscar- riage and would need to see a doctor. But there were no doctors in her small post, so MED recommended she drive herself across an international border from a high-threat post, into another high-threat post, to access lifesaving medical care. Instead of authorizing a medevac, or the use of motor pool to facilitate safe passage of a patient who was bleeding, the health unit compelled her to drive herself; and because it was a high-threat post, she was to then walk herself to and from the clinic while bleeding and medicated. In short, she was left on her own to access lifesaving medical care in a crime-riddled, high-threat post with zero support from post. MED’s Failure to Support Other stories we heard include inci- dents in which women did not receive support fromMED: ■ when unable to access a routine Pap smear at post for two years; ■ when suffering an ectopic pregnancy and sent to an inadequate local clinic where the patient almost died; ■ when suffering a miscarriage at one of the most polluted posts in the world; ■ when needing treatment for a urinary tract infection at a priority-service post; ■ when needing comprehensive prenatal care for a complicated twin preg- nancy that was not available at post, but the patient was not authorized for early departure from post to do so; ■ and when being unable to access needed endocrinological testing locally after multiple pregnancy losses. The treatment by health unit staff has also been described as condescending and judgmental when patients sought reproductive health care. One woman requested access to test- ing related to potential early menopause and was told “to go see a [mental health] therapist.” After engaging in an assess- ment on her own, she was found, in fact, to be experiencing early menopause and in need of medication, which she only discovered after going on LWOP due to the symptoms she was experiencing. One individual who was refused mede- vac for a complicated pregnancy was told by a MED professional: “Well, I was eight months pregnant in [a different priority- service post], and I made it out OK.”