S E P T E M B E R 2 0 1 0 / F O R E I G N S E R V I C E J O U R N A L 33 F O C U S O N T H E O F F I C E O F M E D I C A L S E R V I C E S A U NIQUE P RACTICE oreign Service Health Practitioners are either Nurse Practitioners or Physician’s Assistants. Though the two specializations differ in terms of medical education backgrounds, they arrive at essentially the same knowledge and skill set. We are often called “mid-level” medical providers to in- dicate a responsibility less than the pinnacle (physicians) and more than the base (everyone else). But I don’t like that term, because it makes me imagine I am hanging in space with no firm grasp in either direction. I am a nurse practitioner, and my comments reflect that discipline. When I joined the Foreign Service in 1999, I had no idea what I was getting into. I had enjoyed a successful pri- vate practice in a hospital setting with a group of gen- eral/vascular surgeons, but I wanted something else in my middle-aged life, and the Foreign Service seemed exotic and adventurous. It has been long enough ago that I no longer remember exactly what I expected, but clearly my expectations were way off the mark. On the other hand, I can’t imagine that anyone could join the medical branch of the Foreign Service and fully re- alize what lies ahead. This is a unique medical practice set- ting, and it isn’t for everyone. I have watched colleagues leave, usually because of family issues, but some because they just could not adapt to this unusual milieu. A Wide Range of Issues I am usually posted to countries whose medical services are substandard to those available in the American model. This reality usually removes the option of fancy diagnostic tools or subspecialty consultants and requires falling back on the basics of diagnosis: a good patient history and phys- ical exam, plus common sense. It also means staying cur- rent on all the options that the First World can provide and our standard of care requires. I deal with a much wider range of issues than my col- leagues in an American practice ever will. It isn’t just the variety of diseases — what is a nice girl from Mississippi doing treating malaria, leishmaniasis and myiasis? — but food and water safety, biochemical threats, emergency pre- paredness, civil unrest, mental health issues ... and the list goes on. Though many of these issues have a direct effect on my patients, they are not patient-centered, and this has P RACTICING MEDICINE IN THE F OREIGN S ERVICE IS AKIN TO WORKING IN A SMALL TOWN — A VERY SMALL TOWN . B Y J UDIE P RUETT F Judie Pruett became a Foreign Service Nurse Practitioner in 1999. She currently serves in Prague, following assignments to Accra, Conakry, Kabul and Islamabad. She also spent two years as a worldwide rover for the Office of Medical Serv- ices. Prior to joining the Foreign Service, she worked as a hospital-basedNurse Practitioner for a private surgical prac- tice in Biloxi, Miss. She blogs for the Society of International Nursing Scholarship at http://npworldview.blogspot.com/.