The Foreign Service Journal, September 2010

18 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 1 0 not limited to, Foreign Service gen- eralists and specialists —have expe- rienced some sort of medical ailment. (The study did not define such ailments, but the fact that 90 percent of the group sought treat- ment for them indicates some de- gree of severity.) The State Department’s Office of Medical Services, familiarly known as MED, is the first line of defense against illness for For- eign Service employees, including those from other for- eign affairs agencies, and their family members. It is charged with making sure employees are fit for duty when they are hired, when they leave for their assignments and when they come home, and for treating them when they are abroad. In Washington, MED provides travel-related medical services, such as immunizations, and will assist pa- tients in emergencies. But otherwise, Foreign Service em- ployees rely on their private physicians when they’re in the United States. Foreign Service medical providers stationed overseas provide primary care, including mental health services, to the U.S. Foreign Service community at post. Many also cover other posts in their regions through visits, e-mail and phone. They assess local health threats and evaluate local medical facilities and consultants to ensure that patients can access the best local care possible. (MED arranged for more than 800 hospitalizations overseas last year.) And when employees require urgent or emergency medical care that isn’t available at post, MED approves their evac- uation to the nearest medevac center overseas, or back to the United States if necessary. Since 2002, the patient population the office serves has doubled to about 50,000, while the number of ap- pointments at overseas health units per year has nearly tripled over that same period, from about 80,000 to more than 200,000 today. The number of Foreign Serv- ice employees evacuated from posts for medical reasons has doubled from 600 a year in 2002 to about 1,200 per year in 2009. The number of mental health evacuations it oversees has grown at a similar rate over the same pe- riod, from 38 to 74. (The highest number to date was 123 in 2007.) Who Is MED? With few exceptions, MED’s employees are either Foreign Serv- ice members or locally hired. Like other Foreign Service personnel, they rotate and are assigned ac- cording to Foreign Service rules. There are currently 210 health units at U.S. embassies and con- sulates throughout the world. Slightly more than half of these, 115, are staffed by 172 Foreign Service medical providers. Their ranks include 49 Regional Medical Officers (physicians); 92 Foreign Service Health Practitioners (nurse practitioners or physi- cian assistants); 21 Regional Medical Officer/Psychiatrists and 10 Regional Medical Technologists. (The remaining 95 health units are staffed by locally engaged medical per- sonnel, mostly nurses.) These caregivers provide medical care to U.S. government employees under chief-of- mission authority and their families, as well as occupational health services to Locally Engaged Staff. InWashington, D.C., MED’s exam clinic provides both initial and periodic medical clearance examinations. The three travel, health and immunization clinics in the Wash- ington, D.C., area offer advice and immunizations for those who are traveling or assigned abroad. Cleared for Duty The Office of Medical Services wields immense power over Foreign Service careers. While a Class 1 clearance is unrestricted, a Class 2 medical clearance — which limits Foreign Service personnel to posts where they can receive treatment for a medical condition — can impede career growth and promotional opportunities. MED’s determinations can also have a big impact on the pocketbook. If a Foreign Service employee is deemed too ill to return to post, for instance, he or she will be med- ically curtailed, rather than evacuated — potentially in- curring expenses related to follow-on care and travel. One way FS personnel qualify for medical evacuation is when their condition can’t be treated locally and it is too se- rious to wait until the next time they are scheduled to leave the country. For example, if someone is stationed in Kigali and finds a breast lump, she’d likely be evacuated to Lon- don or Pretoria. If an evaluation there found that the lump was cancer- ous, requiring months of treatment, the employee’s as- F O C U S Most AFSA members who responded to a recent survey said they are pleased with the medical care they’ve received. Shawn Zeller, a regular contributor to the Journal , is a free- lance writer in Washington, D.C.