The Foreign Service Journal, September 2010

20 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 patients, the other to evaluate their fitness for duty. By contrast, “at State, you can’t necessarily trust your doctor. And that’s a problem,” says Hirsch. MED, in its defense, points out that it has a critically important job in evaluating officers’ fitness for duty. Sending officers abroad to places without adequate medical care can put their lives at risk, especially if they have an underlying condition. “We don’t want somebody going to some place where their condition can pose a danger to themselves,” explains Dr. Thomas W. Yun, the office’s med- ical director since early 2008. While Yun focuses his concerns on the well-being of the patients, the State Department must also consider that officers overseas represent the United States and play cru- cial roles affecting U.S. relations with foreign governments and citizens. If they are sick, unstable or unable to per- form their duties, it can hurt U.S. diplomacy. And if they must be pulled from duty and brought back to the States, that costs taxpayers money. Most Foreign Service members who responded to AFSA’s survey said they accepted these facts, and were pleased with the care they received. Some even said that MED had saved their lives. Success Stories One such person is Alex Fleming, who served in nu- merous overseas posts in Asia and Europe during the 1990s and the past decade. In 1999, he was working as a management officer in Guangzhou, the southernmost consulate in China. He came down with a case of sciatica, a compression or irrita- tion of the spinal nerve roots that can cause severe leg pain. He was rushed by car to Hong Kong, a four-hour drive, where he was treated at the Methodist hospital there. Three years later, Fleming was stationed in Vienna, where he was diagnosed with blocked arteries. In need of bypass surgery, he was evacuated toWashington, where he underwent surgery at GeorgeWashington University Hos- pital. He recalls being met at the airport, being taken straight to his hotel and meeting his doctor the next morn- ing. “It was all planned and worked smoothly,” he says. Fleming credits MED with saving his life. And he says that even in non-emergency situations, the bond that’s created by being together overseas makes for better treatment than most Americans receive at home. “I give them top grades,” he says. “All the doctors are well-qualified. They have the human touch, and they really show concern. They know your history far better than your doctor back in the States typ- ically would.” Yun says that while MED per- sonnel are not meant to serve as long-term family doc- tors — that’s supposed to be the physicians that officers see at home — in reality, they often are. Accordingly, the department is working to improve access to medical records by making them electronic and to offer telemed- icine — where patients can have appointments with a MED doctor by video conference — at remote posts. Meanwhile, State is also working harder to make sure that employees can access the type of wellness activities that can help bolster long-termhealth. Last year, American Foreign Service Association President John K. Naland wrote a column for this magazine arguing that MED needed to do more to provide comprehensive wellness services to Foreign Service personnel. The department has already taken some of these recommendations to heart. Late last year, Director General Nancy J. Powell an- nounced that the Human Resources Bureau’s Office of Employee Relations is promoting discounted member- ships at local health clubs and healthy cafeteria food choices. Additional bike racks and more employee shower facilities are being added, as well. Even critics of MED policies who responded to AFSA’s survey acknowledge that they have had many good expe- riences with MED personnel. Hirsch, speaking for many of them, says: “Most of the doctors and nurse practitioners are superb, and if you have some tropical disease you got in Africa or Southeast Asia, you are much more likely to get really good care fromMED than from a hospital in Wash- ington. They’ve seen these things many times, and the vast majority of care providers in MED are highly competent and very dedicated. They are good, old-fashioned general practitioners of the highest order.” And in some ways, MED has become more flexible in the way it handles officers who have chronic conditions or F O C U S There are currently 210 health units at U.S. embassies and consulates, slightly more than half of which are staffed by Foreign Service medical providers.