The Foreign Service Journal, September 2003

32 F O R E I G N S E R V I C E J O U R N A L / S E P T E M B E R 2 0 0 3 rom a medical point of view, as a family physician in the Foreign Service, much of what you see in the patient population is the same in New Delhi as it would be in Des Moines,” says Dr. Brooks Taylor, Regional Medical Officer for Embassy New Delhi, “except that Delhi is a very unhealthy place to live.” New Delhi is one of the most polluted cities in the world, and air pol- lution causes respiratory problems for many resident Americans. Disabling diarrhea, also known as “Delhi belly,” is a constant threat. The Embassy New Delhi health unit staff spend a lot of time teaching people how to reduce health risks from local food and water, and how to avoid diseases common to the area, such as typhoid, dengue fever, salmonella, rabies, and malaria. Providing primary health care overseas gives Foreign Service medical practitioners — physicians, nurse practi- tioners and physician’s assistants, psychiatrists, and medical technologists — unique challenges and opportunities, and affords their patients unique benefits. Brooks, 49, tells us that “the wonderful thing about practicing medicine in the Foreign Service is that I don’t have to charge patients, I can see them the day they call for an appointment or immediately for an emergency, and I can spend as much time as I need to with any patient. Those things are unheard of in the managed-care milieu of the States.” There are about 29 Regional Medical Officers (called RMOs) and about 54 Foreign Service health practitioners and physician’s assistants posted overseas. In addition, there are 12 regional psychiatrists and nine regional med- ical technologists. At some large embassies, several practi- tioners are co-located. Embassy NewDelhi has one of the largest health units in the Foreign Service, with five Foreign Service medical personnel on staff: two RMOs, one psychiatrist, one medical technologist (who runs the health unit laboratory), and one health practitioner. In addition, the unit has three part-time nurses, a full-time Foreign Service National pharmacist (the only one in the Foreign Service), and four other FSN employees. Embassy and consulate health units vary from post to post, depending on the size of the mission, local medical capabilities, and the needs of the community. Many embassies have Foreign Service health practitioners prac- ticing solo. Smaller embassies have only a locally hired nurse in their health unit. A few embassies hire local physicians on contract to see patients in the health unit. The RMO supervises all the practitioners serving U.S. mis- sions in the region and ensures the quality of care provid- ed. The RMO manages the entire medical program in his or her region, including efforts to maintain a healthy work- force by focusing on preventive health care through com- munity education and periodic health screening exams. The RMO also facilitates and oversees the medical care patients receive from local specialists and hospitals. When a patient faces a medical problem that cannot be handled locally, the RMO authorizes and facilitates a medical evac- uation to an appropriate health-care facility. There are regional medevac centers in Singapore, London, Pretoria, and Miami. The Delhi health unit takes care of about 500 offi- cial U.S. government employees and family members, as well as 132 “unofficial” Americans — schoolteachers and USAID contractors. Embassy Delhi is staffed by almost 1,000 Foreign Service Nationals, who also have access to the health unit when they are injured or ill at work. The health unit not only covers the embassy community in New Delhi, but also the consulate com- munities in Mumbai, Chennai and Calcutta, and the embassy community in Colombo (although there are plans to staff Colombo with a Foreign Service medical practitioner soon). F O C U S O N F S S P E C I A L I S T S S AY A H : R EGIONAL M EDICAL O FFICERS IN A CTION B Y S HAWN D ORMAN “ F