Category Archives: MED

US Embassy Conakry Issues Security Message on Ebola Outbreak in Guinea

– Domani Spero

On March 24, the US Embassy in Conakry, Guinea issued the following message to U.S. citizens in the country:

The Government of Guinea has confirmed the presence of the Ebola virus in the Nzérékoré  (Guinee Forestiere) region, mostly in the administrative district of Gueckedou and in the town of Macenta.  Symptoms include diarrhea, vomiting, a high fever and heavy bleeding.  To date over 80 cases have been recorded with 59 recorded fatalities.
The U.S. mission in Conakry strongly recommends that U.S. citizens avoid contact with individuals exhibiting the symptoms described above until further information becomes available.

Ebola Hemorrhagic Fever (HF) is a deadly disease but is preventable.  It can be spread through DIRECT, unprotected contact with the blood or secretions of an infected person; or through exposure to objects (such as needles) that have been contaminated with infected secretions.  The viruses that cause Ebola HF are often spread through families and friends because they come in close contact with infectious secretions when caring for ill persons.  Ebola HF has a high mortality rate and early evidence suggests that the Guinea strain of Ebola is related to the Zaire Ebola strain that carries a mortality rate of 90%. Some who become sick with Ebola HF are able to recover, while others do not.  The reasons behind this are not yet fully understood. However, it is known that patients who die usually have not developed a significant immune response to the virus at the time of death.
During outbreaks of Ebola HF, the disease can spread quickly within health care settings (such as a clinic or hospital).  Exposure to Ebola viruses can occur in health care settings where hospital staff are not wearing appropriate protective equipment, such as masks, gowns, and gloves.

Symptoms may appear anywhere from 2 to 21 days after exposure to Ebola virus though 8-10 days is most common.  A person suffering from Ebola presents with a sudden onset of high fever with any of the following: headache, vomits blood, has joint or muscle pains, bleeds through the body openings (eyes, nose, gums, ears, anus) and has reduced urine.

Since the virus spreads through direct contact with blood and other body secretions of an infected person those at highest risk include health care workers and the family and friends of an infected individual.

For more information on Ebola hemorrhagic fever, please visit the CDC website at http://www.cdc.gov/vhf/ebola

CDC map

CDC map

On 25 March 2014, the World Health Organization provided a status update of the outbreak:

The Ministry of Health (MoH) of Guinea has notified WHO of a rapidly evolving outbreak of Ebola haemorrhagic fever in forested areas south eastern Guinea. The cases have been reported in Guekedou, Macenta, and Kissidougou districts. As of 25 March 2014, a total of 86 suspected cases including 60 deaths (case fatality ratio: 69.7%) had been reported. Four health care workers are among the victims. Reports of suspected cases in border areas of Liberia and Sierra Leone are being investigated.

Thirteen of the cases have tested positive for Ebola virus by PCR (six at the Centre International de Recherche en Infectiologie (CIRI) in Lyon, France, and seven at the Institut Pasteur Dakar, Senegal), confirming the first Ebola haemorrhagic fever outbreak in Guinea. Results from sequencing done by CIRI Lyon showed strongest homology of 98% with Zaire Ebolavirus last reported in 2009 in Kasai-Occidental Province of DR Congo. This Ebolavirus species has been associated with high mortality rates during previous outbreaks.

Doctors Without Borders/Médecins Sans Frontières (MSF) has worked in Guinea since 2001. Its March 25 update indicates that the group is reinforcing its teams in Guéckédou and Macenta, two towns in the south of the country where the virus has spread. Thirty staff members are reportedly on the ground and more doctors, nurses, and sanitation specialists will be joining them in the coming days. According to DWB/MSF, thirteen samples to-date have tested positive for the Ebola virus, an extremely deadly viral hemorrhagic fever. Other samples are currently being analyzed. Suspected cases have been identified in neighboring Liberia and Sierra Leone, but none of these have yet been confirmed by laboratory tests.

The CDC has updated its outbreak page with information from WHO and says that it is in regular communication with its international partners WHO and MSF regarding the outbreak, to identify areas where CDC subject matter experts can contribute to the response.

As of March 25, 2014, WHO has not recommended any travel or trade restrictions to Guinea in connection with this outbreak.

U.S. Embassy Conakry is an extreme hardship post receiving 25% COLA and 30% post hardship differential. Post is headed by Ambassador Alexander Laskaris who was sworn in as the 20th U.S. Ambassador to the Republic of Guinea on September 10, 2012.

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US Embassy Ottawa: Canadian Court Sets Aside FSN Sandra McDonald’s $240K Default Judgment For Now

– Domani Spero

Via Ottawa Citizen, a wrongful dismissal case filed by Sandra McDonald, a former Foreign Service National (local employee) of the U.S. Embassy in Ottawa.

Sandra McDonald, now in her early 60s, worked at the embassy for nearly 30 years as one of its locally engaged staff. She sued for wrongful dismissal after she was fired in early 2011 while on long-term disability with complex regional pain syndrome.

McDonald’s lawyer, Bijon Roy, said she was “very disappointed” with the judge’s decision and that it might force her to fight the case all over again.

In July 2012, Ontario Superior Court Justice Heidi Polowin issued a default judgment in McDonald’s favour after U.S. officials failed to file a statement of defence or contest the case in court. The embassy had been served notice of the case through Canada’s Department of Foreign Affairs and International Trade, and was kept informed of the matter on a regular basis. McDonald’s story also received high-profile coverage from Ottawa media, including the Citizen.

In court this week, embassy officials, seeking to overturn the default judgment, said they had “explicable and plausible” reasons for not having responded to McDonald’s lawsuit, and a “good defence” to be made against it. According to court documents, the Americans claimed that they’d “lost the documentation”, “could not open the email attachment”, that the documentation was “inadvertently directed to the wrong office at the State Department”, and that it was “not indexed correctly”.

Superior Court Justice Timothy Ray questioned how U.S. State Department officials could claim not to have been aware of McDonald’s default judgment. “Its embassy apparently failed to see the front page of the Ottawa Citizen (on) Sept. 11, 2012,” the judge commented.
[...]
Ray said he would set aside Polowin’s default judgment on conditions the embassy pay McDonald’s legal costs and put the $240,000 award in a court trust within the next 60 days.

Read in full: U.S. Embassy wins bid to set aside wrongful dismissal judgment.

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Former Foreign Service Kid Writes About Dad With Severe PTSD

– Domani Spero

In 2012, we blogged about a retired FS employee, William “Tony” Gooch who was sentenced to 12 years in prison – the maximum he faced under a plea agreement in a Nov. 7, 2010 episode, in which he reportedly rammed a Jeep into his estranged wife’s home before setting it ablaze. (See Former FSO William Anthony Gooch: No Mercy for Broken Men?).  Colorado Spring’s The Gazette covered the hearing in 2012.

We recently received a note from his son, Andy Gooch (he was referencing our blogpost below):

I came across this article the other day while searching to see if there was anything out there on my father, William Gooch (Tony). He is currently incarcerated and subjected to the brutality of prison life. He was in fact diagnosed with severe PTSD, depression, and substance dependence after serving State Department which the court system neglected to take into consideration. This whole situation frustrates me everyday. In fact, I clearly remember like it was yesterday after I told the judge my little amount of overseas experience. “This sounds like something out of a Jason Bourne movie,” stated the judge. It was as though he was calling not only my statement, but my fathers career a fabricated story.

Anyway, since then, my father and I have published a book on Amazon about his life. It’s called “My Mind, A Different Place.” If you are interested in his story, please look into it. Below is the hyperlink.

http://www.amazon.com/My-Mind-Different-Place-familys-ebook/dp/B00IHOCAC2/ref=sr_1_1?ie=UTF8&qid=1392741948&sr=8-1&keywords=my+mind%2C+a+different+place

It’s unfortunate how the path of one’s career is often times vulnerable to acquiring PTSD, yet others don’t see/understand the reality.

Thanks,
William Gooch (Andy)

News report said that Tony Gooch’s career with the State Department ended with a medical discharge after he suffered a breakdown during an assignment in Kingston, Jamaica. On the prologue of the book, Andy Gooch writes that he moved to Centennial, Colorado in 2004 to live with his father  who was then retired from the State Department.  “It took me all these years to understand him, and to see what he was going through. At that time, my ignorance was bliss. Had I known then what I know now, I would have done a lot more to help my dad, ” he writes.

According to Andy , his father is not getting the mental health treatment he should be getting and his physical condition is deteriorating.  Due to this, he said his family is “currently filing action against the state.”  Andy also said that his father is allowed to accept some items like books and magazine through the mail writing,  “He is so isolated from the outside world I’m sure anything from anybody would be great.”

If you want to help, you may send cards, books or magazines to William “Tony” Gooch’s address below:

William Gooch #157833
AVCF Unit 4-B
12750 HWY 96
Ordway, CO 81034

Andy Gooch graduated from Virginia Commonwealth University in 2012 and is a second lieutenant in a Field Artillery Battery with the Army National Guard.

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Drowning in Smoggy Delhi: There’s No Blue Sky, So Where’s Blueair? (Updated)

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– Domani Spero

In December last year, Hindustan Times reported on how air and water pollution plagued Indian cities:

One in three people in India live in critically-polluted areas that have noxious levels of nitrogen dioxide (NO2), sulphur dioxide (SO2) and lung-clogging particulate matter larger than 10 micron (PM10) in size. Of the 180 cities monitored by India’s Central Pollution Control Board in 2012, only two — Malapuram and Pathanamthitta in Kerala — meet the criteria of low air pollution (50% below the standard).

The NYT also reported in February last year  that “The thick haze of outdoor air pollution common in India today is the nation’s fifth-largest killer.”

NASA image courtesy Jeff Schmaltz, LANCE MODIS Rapid Response

NASA image courtesy Jeff Schmaltz, LANCE MODIS Rapid Response
Photo from January 11, 2013
(click on image to read more)

The State/OIG report from 2011 says that the health environment for US Embassy employees in India is “challenging, punctuated by frequent respiratory and gastrointestinal illnesses.”  That’s putting it mildly.  Reports about the air pollution in India is nothing new but has not been as widely reported as the “fog” in China. That’s probably because we have @BeijingAir monitoring crazy bad air in China and no @DelhiAir to report on India’s bad air.  NYT reported this week that “The United States does not release similar readings from its New Delhi Embassy, saying the Indian government releases its own figures.” Click here to see NYT’s follow-up report why.

The Times of India notes that “Lately, a very bad air day in Beijing is about an average one in New Delhi” and cites disturbing comparative numbers between the two cities:

Clean Air Asia, an advocacy group, found that another common measure of pollution known as PM10, for particulate matter less than 10 micrometers in diameter, averaged 117 in Beijing in a six-month period in 2011. In New Delhi, the Center for Science and Environment used government data and found that an average measure of PM10 in 2011 was 281, nearly two-and-a-half times higher.

Of course, FS folks have been living and hearing about this for years.  Haven’t you heard — “If you have asthma or other breathing issues, think long and hard before committing to New Delhi?”  Last year, an FS member said, “Very unhealthy, especially for young children, during winter when dung, garbage, and everything else is burnt for warmth, and smog traps it within Delhi.”  In 2010, somebody assigned to New Delhi warned that “Asthma and skin disorders are on the rise.

We understand that you don’t get to see the blue sky for a couple of months. In 2011, somebody called it, “the worst in the world.”

This past weekend, Yale Center for Environmental Law & Policy and Columbia University’s Center for International Earth Science Information Network released its 2014 Environmental Performance Index (EPI) at the World Economic Forum Annual Meeting in Davos, Switzerland.   The Environmental Performance Index (EPI) ranks how well countries perform on high-priority environmental issues in two broad policy areas: protection of human health from environmental harm and protection of ecosystems.

The announcement made special mention of improvement in India’s overall performance but cites dramatic declines on air quality. The announcement notes that “India’s air quality is among the worst in the world, tying China in terms of the proportion of the population exposed to average air pollution levels exceeding World Health Organization thresholds.

India ranks 155th out of 178 countries in its efforts to address environmental challenges, according to the 2014 Environmental Performance Index (EPI). India performs the worst among other emerging economies including, China, which ranks 118th, Brazil, at 77th, Russia, at 73rd, and South Africa at 72nd.
[…]
In particular, India’s air quality is among the worst in the world, tying China in terms of the proportion of the population exposed to average air pollution levels exceeding World Health Organization thresholds.

“Although India is an ‘emerging market’ alongside China, Brazil, Russia, and South Africa, its environment severely lags behind these others,” said Angel Hsu of the Yale Center for Environmental Law and Policy and lead author of the report.“ Very low GDP per capita coupled with the second highest population in the world means India’s environmental challenge is more formidable than that faced by other emerging economies.”

This is not a health hazard that just showed up yesterday. So we were surprised to hear that at a town hall meeting at Embassy New Delhi, a medical professional reportedly said that none of the government issued embassy purifiers at the mission do the fine particles.

Wait, the US Embassy in New Delhi issued air purifiers that do not work for the  finest particles — the particles that do the most damage?

How did that happen?

Some folks apparently are now buying their own air purifiers. A mission member reportedly spent $1600 for purifiers to allow a breath of clean air inside the house.

Dear US Embassy India, we would have liked an official comment, but your public affairs ninja ignores email inquiries.  Call me, maybe — we’d like to know which smart dolt spent all that money for decorative air purifiers.

On a related note, early this month, China Daily reported that in December last year, the US Embassy in Beijing ordered 2,000 air purifiers  for its employees in the country from Blueair, a Swedish manufacturer:

The cheapest model from Blueair, the Blueair 203, costs 3,590 yuan ($591) from Torana Clean Air, Blueair’s official seller in Beijing, while it sells for $329 on the Best Buy and Amazon websites in the US.  The order placed for air purifiers by the US embassy was handled by the Swedish company’s American supplier, and the unit price was not disclosed.

We don’t know what types of purifiers were issued at US Embassy India.  Popular brands like Blueair, Panasonic, Daikin, Sharp, Yadu, Honeywell are compared here as used in China via myhealthbeijing.  There is also a review of air purifiers by the Consumer Report that should be worth looking into; the report is only available to subscribers.  Or check with MED which should have this information available.

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State Dept Regional Psychiatrist William Callahan, 53, Dies in Cape Town

– Domani Spero

We previously posted about the December 12 death of a U.S. Embassy Accra employee while visiting Cape Town, South Africa. (See US Embassy Accra Employee Falls to Death on South Africa’s Table Mountain). We subsequently learned the identity of the employee but decided not to publish his name as we could not confirm independently that the family back in California has been notified.  His hometown newspaper had since identified him in a news article as William E. Callahan Jr., 53, a prominent psychiatrist in Aliso Viejo, California.  He was the State Department’s Regional Psychiatrist covering West Africa. Below is an excerpt from OCRegister:

Callahan had left his private psychiatry practice in California last year to join the U.S. State Department as a Regional Medical Officer and Psychiatrist based out of the U.S. Embassy in Accra, Ghana, said Kenneth Dekleva, Director of Mental Health Services at the U.S. Department of State in Washington, D.C.

Dekleva said the news came as a shock to him and his department last Friday when he found out Callahan’s body had been recovered by South African authorities near the Table Mountain Range.

“His death has touched many people: my phone hasn’t stopped ringing since Friday…we lost one of our own,” Dekleva said. “It’s a huge loss for our organization. He represented the best in psychiatry in my opinion. We’re very proud to have known him and to have had him as part of our team.”

Dekleva said that the investigation surrounding the circumstances of Callahan’s death is ongoing in South Africa.

Memorial services are planned in Accra on Wednesday. Services in Greenfield, Mass. and Laguna Beach will occur in early 2014, the State Department said.

 

Dr. Callahan joined the State Department in July 2012.  Our source told us that “he was an avid outdoorsman and in great shape.  He was well-liked in Accra and at the other embassies he covered in West Africa.”

According to his online bio, he was a Special Forces flight surgeon turned psychiatrist.  “With the constant deployments in my military unit on clandestine missions, I observed how stress in a family member can jump from person to person and lead to physical illness as well.  After 5 years of active duty and 9 of total service, I left the military to get the training to become a board certified psychiatrist.”

He was previously the president of the Orange County Psychiatric Society.  For 15 years prior to joining the State Department, he  provided a two hour a week, free, open-to-the-public group for families dealing with a mental illness called Interactive Solutions.

Dr. Callahan’s service in the military included a general surgery internship at David Grant Medical Center at Travis AFB, CA followed by assignment to the 8th Special Operations Squadron as a flight surgeon, at Hurlburt Field, FL.  He served in both the First Gulf War and Panama Wars,  and received two Meritorious Service Medals. He was the 1988 Flight Surgeon of the Year within the First Special Operations Wing.

He graduated from Deerfield Academy (1978), Tufts University (1982), Tufts Medical School (1986) and did General Surgery Internship at Travis AFB, CA (1987), and his Residency in Psychiatry at UC Irvine (1994).

R.I.P.

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State Dept’s Bureau of Neglected Disease – Dengue+Encephalitis, What Help Is There?

– By Domani Spero

She joined the Foreign Service over 20 years ago.  Among her overseas postings were New Delhi, Damascus, Alexandria, Northern Iraq, and Beirut.  In 2009, she opened the new Consulate’s PD shop in Hyderabad.  In 2010, she contracted dengue fever. And encephalitis. She was medevaced to Singapore and spent 10 days at a hospital there.  That was not her only hospital confinement.

In the November 2013 issue of Foreign Service Journal, FSO Juliet Wurr writes:

“Over the next year, first in Hyderabad and then in Washington, D.C., I discovered and then struggled to cope with the repercussions of my illness. My doctor concluded that my now-unreliable memory, constant drowsiness and cognitive impairment were all the result of my encephalitis. I knew that my Foreign Service career had come to an end.”

The CDS describes Dengue (pronounced den’ gee) as a disease caused by any one of four closely related dengue viruses (DENV 1, DENV 2, DENV 3, or DENV 4). The viruses are transmitted to humans by the bite of an infected mosquito. The CDS says that with more than one-third of the world’s population living in areas at risk for transmission, dengue infection is a leading cause of illness and death in the tropics and subtropics. There are reportedly as many as 100 million people infected yearly.   In September this year, the NYT reported about India’s dengue problem.  In October, the Raw Story called it New Delhi’s “mysterious dengue fever epidemic.

Click on image to see an interactive Dengue map of the word.

Click on image to see an interactive Dengue map of the word.

Dengue is an endemic illness in India, the second-most populous country in the world.  Anecdotal reports suggest that the U.S. Embassy in Delhi has about half a dozen dengue cases among mission members this year alone. We’ve requested information on current mission-wide dengue cases and medevaced cases but have not heard anything back.

A separate report in the Indian Critical Care Medicine notes that “Encephalopathy is a very common neurological complication of dengue fever. Dengue encephalopathy is usually secondary to multisystem derangement like shock, hepatitis, coagulopathy, and concurrent bacterial infection.”  Encephalitis is the irritation and swelling of the brain that can be mild and short and results in full recovery. Or it can be severe with permanent impairment or death as a possibility.  For more on encephalitis, see the National Institute of Health.

In an email to this blog, Ms. Wurr writes:

“I think there is a huge gap in what State can do statutorily and what morally they should do.  If employees and the public realized this I think they would be outraged.  I want to do all I can to publicize because there are simple changes they can do that don’t depend on legislation.  I am retiring six years earlier than expected.  State refuses to advocate for me with Department of Labor Workers Comp.  I am receiving no compensation for my $500+ medical bills each month or for wages lost.”

Ms. Wurr said that she had been to the Office of Medical Services and the Bureau of Human Resources, who “were kind and welcoming, but eventually they admitted they had nothing to offer me.” She had also been to the Office of Casualty Assistance twice, and told this blog, “They said there was nothing they could do.”

She had filed a claim at the Labor Department’s Office of Workers’ Compensation Programs last year. It was denied. She had refiled that claim, it was denied for the second time. The reason for the denials, “I could not convince Labor that my illness was caused by being in India as an employee of the Department of State.”

She’s up for a third filing, and has now hired a lawyer.

If this story sounds familiar, it’s because it happened before.

Remember Frank Pressley who was wounded in the East Africa bombing and had filed for permanent disability? The  Office of Workers’ Compensation Programs and the State Department’s Office of Casualty Assistance (OCA) both made the news:

Compensation claims examiners questioned the precise percentage of Pressley’s handicap. Two non-government doctors administered tests and said the arm was 78 percent disabled, permanently. The Office of Workers’ Compensation Programs said it was only 40 percent disabled.

Hoping to minimize runarounds, he contacted Kendall B. Montgomery, director of the State Department’s Office of Casualty Assistance, which was established in 1999 in response to the embassy bombings.

“I get no assistance, no options, no real help,” he e-mailed last summer. “I’m afraid that nothing is going to happen unless I get a lawyer. That would be very sad for me. I trust the system, my country.”

“Frank, I understand — and share — your frustration,” Montgomery told him in a December e-mail. The federal workers’ compensation program “is just not meeting its obligations to you and many others. The system is broken, but there is no will to fix it.”

After The Washington Post inquired about the status of Pressley’s disability compensation, government officials including the State Department’s Office of Casualty Assistance suddenly got their Minute Maid:

The State Department’s Kendall Montgomery vowed she would push for “speedy approval” of medical treatments for injured employees mired in the federal compensation system.

“We’re putting a very high priority on it,” she told The Post while a public affairs official monitored her words. “We’re once again trying to start a new round of discussion between ourselves and the Department of Labor. . . . We do hope they’re fruitful discussions.” 

Soon after, the Department of Labor stopped disputing Mr. Pressley’s claim to a 78 percent disability in his left arm and paid up.

But whatever “fruitful discussions” the State Department conducted with the Department of Labor back in 2002, the result is clear.  We sent email inquiries to the Office of Casualty Assistance (OCA) and the Family Liaison Office (FLO) asking what type of assistance their offices provide to cases like Ms. Wurr’s in ensuring that sick/injured employees mired in the federal compensation system are not stuck there. We also wanted to know more information about the State Department and specifically OCA’s role in advocating for cases before DOL’s Office of Workers’ Compensation Programs.

Today, we received a one-sentence response to our email and a non-response to our questions from Kirk A. Leach, the director of the State Department’s Office of Casualty Assistance.

“The Department is fully supportive of Ms. Wurr’s case and is actively engaged in advocating her position with the Department of Labor’s Office of Worker’s Compensation.”

That’s the same office, who according to Ms. Wurr, gave this response: “They said there was nothing they could do.” After learning of  OCA’s response to our inquiry, Ms. Wurr was surprised.  If they are working on her behalf, she said, “they kept it secret from me.” LOL!

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What to do when different voices start delivering multiple démarches in your head?

-- By Domani Spero

 

Below is the State Department’s High Stress Assignment Outbrief Implementation Guide – the FSI/MED Model.

Background of the High Stress Outbrief Program via fbo.gov

The High Stress Assignment Outbrief program was developed after the first groups of employees began coming back from assignments to Iraq and Afghanistan in 2002 and 2003 – posts that would have beenin evacuation status in more normal times. Returnees asserted that coming back from those posts wasn’t at all like coming back from a regular foreign affairs community assignment – that theDepartment needed to help with this particular transition in some way. Med’s Office of Mental Health Services asked the Foreign Service Institute’s Transition Center to assist in the development of a prototype training event, which was piloted in 2003. MED/Mental Health convened an Iraq Out-briefing Conference on July 29 & 30, 2004 at the Foreign Service Institute. The Outbrief program was reviewedand discussed by the full cadre of RMO/Ps, Dr. Robert Ursano and Dr. James McCarroll, from theUniformed Services University for Health Sciences, Dr. Carol North, Washington University (St. Louis),with guest presentations by (then) Director General of the Foreign Service Amb. Robert Pearson and others.

The program was endorsed by MED leadership and has run as a partnership between the FSI’sTransition Center and MED/Mental Health Services since then. All subsequent Directors General of the Foreign Service have mandated that all returnees from Iraq (and later Afghanistan) who have served for 90 days or longer be required to attend either a group or individual Outbrief upon return to CONUS.The realities of the Foreign Service assignment system brought complications – many officers had TDY-ed to Iraq or Afghanistan and were returning directly to their former posts. Others PCS-ed directly to follow-on assignments around the world. Clearly, a purely Washington-based program would not be effective in providing the service to all of our employees. Furthermore, many participants did not fit traditional Foreign Service employee profiles – special hiring authority hires (3161s), civil service employees, and third country nationals all stepped up to serve in those war zones. RMO/Ps were instructed to deliver Outbriefs at posts or during post visits, and to communicate the name of the Outbrief participant, date, and place back to the Transition Center for entry into the Department’sofficial training registration database to certify compliance.

Read more below:

 

I’ve requested help in understanding the usefulness of the Outbrief session and received a few responses below:

Comment #1: (from a twice-deployed employee)

“I have taken that half-day course twice in 2009 and 2013.  The class was almost the exact same.  They basically tell you to get sleep and try to adjust back and if needed, see someone.  The class I took in 2013 was 8 months after I returned because HR would not pay to send me to DC before home leave then I was in language training for six months.  If it was really important, HR would allow people to take it as early as possible otherwise, it must not be that important.”

Comment #2 (a State Department employee who served in Iraq and Pakistan)

“The description of the outbrief program seems reasonably accurate – although it’s been a while since I attended (in 2008 after Iraq, but not subsequently after Pakistan).  There’s a certain value to spending a bit of time (three hours?) with people that have been through similar experiences – probably including someone that you knew or at least shared acquaintances with.  It gives you a chance to talk with people who better understand your experiences.   It’s possible that some of our feedback made it back to decision makers in aggregated form.  For example, one of the themes of our discussion was that the Department (USG?) was doing itself no favors by sending warm bodies that lacked core qualifications (e.g. basic competence and a desire to be there.)  I think that the Department is now requesting 360s [360 degree feedback] for everyone that they send – although that may just be part of the general trend towards requesting 360s.  My memory is a bit hazy, but I think a key element was describing what other resources (e.g. clinical/therapeutic) might be available for those that needed them.”

Comment #3 (somebody once posted in Iraq— added at 6:48 am PST)
The high stress outbrief  is, as you noted, just an example of CYA– look, we have a program! A couple of voluntary hours with some contractor at cozy FSI with no follow-up, and especially no mandatory individual session is worthless. Many symptoms of PTSD evolve over time, and many returning-to-DC-stresses only become apparent after you have in fact returned to work and gotten the lay of the land in a new office. Speaking out in front of a group is not a core FS trait, and not something any person with real problems does easily. Imperfect as it is, the military does require formal screening and a brief one-on-one session with a counselor. Follow up care (imperfect) is available. At State, you’re told to “get help” without much help in getting it. After all, MED is not responsible for healthcare in the U.S.
 
Still not sure? Check with officers who were MEDEVACed for anything, not necessarily PTSD, and see if any of them got any follow-on from MED other than a new, career-crushing clearance status.

One of our readers commenting on mental health support suggested the following:

“While I know it wouldn’t solve everything, I think that anyone coming out of a post with danger pay should have some sort of mandatory sessions with some sort of licensed therapist. That would take away the stigma of the therapy and maybe get some people some help before they take out their PTSD on themselves or someone else.”

 

Remember the US Embassy Malta road rage meltdown that made the news? (US Embassy Malta Gets a Viral Video But — Not the Kind You Want).  We don’t know this individual nor his story, or which post he previously came from. But assignments to European posts like Malta have typically gone to employees who did tours in Iraq, Afghanistan and Pakistan.   We don’t know if this individual came from an AIP posts. Even if he did, it’s not an excuse for such a behavior, but it might help us understand his demeanor.  American diplomats normally do not go around looking for a fight.

Our concern is simple. We are sending people out to the war/danger zones.  The State Department touts its mandatory High Stress Outbrief, an educational program that only requires presentation/delivery skills from whoever delivers the program.  Less than 60 percent of returnees attend the program, and there are no consequences for non-compliance.  Who does the follow-up? Anybody?

Is it fair to say that the State Department does no follow-up beyond the Outbrief session and expects employees to simply self-report any mental health issue? And because no one fears the social stigma of seeking mental health help and nobody suffers from the fear of losing one’s security clearance over a mental health issue, everyone in the Service can be counted on to self-report if/when different voices start delivering multiple démarches in one’s head?

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Filed under Afghanistan, Diplomatic Life, Foreign Service, FSOs, Functional Bureaus, Govt Reports/Documents, Huh? News, Iraq, Leadership and Management, MED, Mental Health, Org Culture, Pakistan, State Department, War

State Dept’s Suicide Prevention Resources — A Topic So Secret No One Wants to Talk About It

—By Domani Spero

This blog has been running almost uninterrupted for over five years now.  We have heard just about everything there is to hear about the worldwide available universe. While we don’t get shocked very often anymore, there are days when running this blog becomes heavy on one’s soul.

In the last few months we have heard allegations of sexual harassment, workplace bullying and an attempted suicide. All these have two things in common. One, the alleged perpetrators were senior officials in the Foreign Service who appeared able to skirt accountability.  And two, the informers all prefer to remain anonymous for personal and professional reasons.

The allegations are troubling and disturbing given how often we’ve seen officers get recycled to other posts when trouble comes calling.  A person who harasses one or more person at Post A is probably a serial harasser who will not stop when you move him to Post B at a different geographical location.  A person who routinely bullies subordinates probably think he/she is doing hands-on management and do not have the self-awareness to recognize his/her negative impact at post.  He or she rotates to the next post and do the same thing all over again to miserable consequences.   Yes, there are rules, but those apparently are quite useless when people look the other way.

Below is an excerpt from one of our correspondents:

“How many Foreign Service Officers have attempted suicide, and named [Senior FSO X] as the reason?  I personally know of at least one officer who did this.”

“[T]his attempt, PRECISELY BECAUSE of” Senior FSO X’s  “treatment/management of that officer.”

“Why is there only accountability for those who are new in their career, or who do not have the unwavering support of a career ambassador?”

The note was sent anonymously but there was nothing anonymous about the pain that leapt across the screen.  It kept me awake for days.  What happens when one feels suicidal while in an overseas posting?

Suicide is not unheard of in the Foreign Service.  In 2007, Colonel Thomas Mooney who was then with US Embassy Nicosia went missing, and after four days was found with reportedly self-inflicted wound.  In May 2012, Caribbean news reported as “apparent suicide” the death of RSO George Gaines of the US Embassy in Barbados.

Two cases too many.  What we don’t know is how many suicide attempts have occurred behind the embassy walls.  We have so far been unable to confirm that an FSO working for Senior FSO X attempted suicide.  According to save.org, there are an estimated 8 to 25 attempted suicides to 1 completion.  That’s an estimate for the general population, what is it in the foreign service?  When we asked around, our question was answered with another question by a blog pal –

What FSO is going to risk losing their security clearance by going to MED and saying they are thinking about suicide?” 

We know of one documented case of an attempted suicide:  an FS employee accused of raping his maid in Bangkok, Thailand.  The employee reportedly maintained the sex was consensual but aggressive interrogation techniques by DS agents allegedly drove this employee to jump off a hotel window.

[A]fter “being told he would end up in a Thai prison, his wife would lose her job and his children would be pulled out of school, [the man] attempted suicide by jumping out of the 16th-story window at a hotel in Bangkok … The man was flown back to Washington for in-patient psychiatric care, where the agents continued to harass him, the union charged. The rape charges were ultimately dropped.

Psychology Today explains that “the thought of suicide most often occurs when a person feels they have run out of solutions to problems that seem inescapable, intolerably painful, and never-ending.”

“Of all motivations for suicide, the two found to be universal in all participants were hopelessness and overwhelming emotional pain.”

We wrote to the State Dep’t’s Family Liaison Office (FLO)  inquiring what resources or material on suicide prevention are available to FS employees and spouses.

FLO’s response: “Please direct them to the Employee Consultation Service (ECS) here is a link to their website http://www.state.gov/m/dghr/flo/c21952.htm   They provide in-person and phone counseling.”

We wrote to the Employee Consultation Service at MEDECS@state.gov, with the same inquiry and received a response from one Pollenetta P. Douglas: “Good morning, Are you or your family member employed by the State Department?”

After being informed that we are writing about suicide prevention resources available to employees and family members, we never heard from Ms. Douglas again. You’d think that they would want that information widely disseminated.  But no, apparently, suicide prevention is a topic so secret no one wants to talk about it.

The State Department does have a “Do You Need Help?” page that says:

If you are feeling suicidal or homicidal, it’s important that you let someone know. You should seek help immediately by calling 911 or going to the closest emergency room.

It did not say what an FS employee/family member should do if one is in a foreign country where there is no 911 to call or no ER.  Perhaps that’s because the text of that web page is cribbed from DOD’s afterdeployment.org without attribution.

If you or somebody you know needs help, please –

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If you have thoughts of suicide, these options are available to you (via save.org):

  • Dial: 911
  • Dial: 1-800-273-TALK (8255)
  • Check yourself into the emergency room
  • Call your local crisis agency
  • Tell someone who can help you find help immediately.
  • Stay away from things that might hurt you.
  • Most people can be treated with a combination of antidepressant medication and psychotherapy.

For FS folks overseas, this can get even more complicated. In some places, there is no 911.  In most cases, for language, logistical or other reasons, one may require the help of the mission’s MED or Health Unit to visit the ER.  Which means the incident could be reported up the embassy’s chain of command.  And certainly if one is at a post with very few foreigners, showing up at an Emergency  Room would probably be big news.  A medical evacuation is always an option but realistically, despite what officials say, there are ongoing concerns about security clearance and mental health issues, not to mention the stigma for people who have a mental health condition. That fact alone is enough to preclude people who needs help from asking for it.

Given the expanding number of people who served/are serving in the war zones or in unaccompanied, dangerous assignments, we suspect that there is a good number of people suffering quietly with PTSD, depression and other related issues.  Secretary Kerry needs to pay attention to this.  Asking for help while overseas is particularly complicated.  Secretary Kerry can make a difference by ensuring that people who needs help can get it without fear of jeopardizing their security clearance or their jobs. And he needs to do something about State’s recycle program.

In the meantime, we hope the following is helpful:

If you’re overseas and need help but do not want to call the ECS, please call the Military Crisis Line (1-800-273-8255 and Press 1), online chat or text (838255). In Europe call 00800 1273 8255 or DSN 118*. This is available for veterans, active duty/reserved service members, and family members and friends of service members. We recently used the online chat and we’re told that help is available even if you’re in the Foreign Service.  You do not have to give your name or other personal information. See the FAQs here.

Below are some common misconceptions about suicide (via save.org):

“People who talk about suicide won’t really do it.”

Not True. Almost everyone who commits or attempts suicide has given some clue or warning. Do not ignore suicide threats. Statements like “you’ll be sorry when I’m dead,” “I can’t see any way out,” — no matter how casually or jokingly said, may indicate serious suicidal feelings.

“Anyone who tries to kill him/herself must be crazy.”

Not True. Most suicidal people are not psychotic or insane. They may be upset, grief-stricken, depressed or despairing. Extreme distress and emotional pain are always signs of mental illness but are not signs of psychosis.

“If a person is determined to kill him/herself, nothing is going to stop him/her.”

Not True. Even the most severely depressed person has mixed feelings about death, and most waiver until the very last moment between wanting to live and wanting to end their pain. Most suicidal people do not want to die; they want the pain to stop. The impulse to end it all, however overpowering, does not last forever.

“People who commit suicide are people who were unwilling to seek help.”

Not True. Studies of adult suicide victims have shown that more then half had sought medical help within six month before their deaths and a majority had seen a medical professional within 1 month of their death.

“Talking about suicide may give someone the idea.”

Not True. You don’t give a suicidal person ideas by talking about suicide. The opposite is true — bringing up the subject of suicide and discussing it openly is one of the most helpful things you can do.

If you or somebody you know is contemplating suicide, please call the numbers above or contact one of these hotlines before you do anything else.

⛅ ⛅ ⛅

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Filed under Americans Abroad, Foreign Service, FSOs, Hall of Shame, Leadership and Management, MED, Mental Health, Realities of the FS, State Department

Friends of Kelly Hunt Start Online YouCaring.com Fundraiser for Hunt Family

State Department Public Diplomacy Officer Kelly Hunt was wounded on the April 6, 2013 suicide attack in Qalat, Afghanistan. About a week after the incident that killed five Americans and seriously wounded Ms. Hunt as well as three others, and as she was moved to a hospital in Germany, her friends back home, Brian DeNicola, Regan Hildebrand, Becky Reindel, Jen Vinci, Beth Doyle-Hudson & Valerie Cizl decided to organize a fundraiser to support Ms. Hunt’s family.

“Becky met Kelly at work.  Brian and Regan met her through rowing.  Jen, Beth and Valerie knew her from elementary school.  She touched our lives in many ways and the last few days have been difficult for everyone.” 

On June 8, Regan will be climbing Mt. Rainier in Seattle, Washington.  He was originally going to climb the mountain for fun.  In light of Kellly’s accident, he’s now climbing Mt. Rainier for her and will stand on the summit on June 12 for Kelly. 

The fundraiser located at you caring.com - http://www.youcaring.com/medical-fundraiser/climbing-for-kelly/52529 - had $1,000 for its original funding goal. As of this writing, the fund has raised $7093 from 114 supporters across the Foreign Service, EPA, colleagues in Afghanistan, folks from the University of Tennessee and the News Sentinel newsroom, and from friends and friends of friends.

Screen Shot 2013-04-13

Over in FB,  the Kelly Hunt’s Road to Recovery page also put together by friends provided a link to the fundraiser with the following note:

We have been contacted by so many wonderful people across the world who are interested in donating to Kelly’s family in order to help ease the costs associated with traveling to see her when she arrives at Walter Reed, and other costs that arise during this time. Please visit the page below if you would like to contribute financially. All proceeds will go directly to the family. Thank you!  

Ms. Hunt’s mother, Dinah told us that the help organized by friends “will allow us to be with our daughter.”  If you are want to help, check out the youcaring page here.  If you want to send messages of support to the Hunt family and/or follow her recovery, you can check the Kelly Hunt’s Road to Recovery in Facebook where her mother provides regular updates on Kelly’s condition including the following:

I know that people in the DC area are eager to see Kelly, however, it won’t be possible for quite awhile. She’s in intensive care right now.  I want to thank everyone for their prayers and words of encouragement. They are definitely helping our family to cope. This is a marathon; not a race sprint and I appreciate your support.

We understand that a separate hometown fundraiser was also done by several friends of Ms. Hunt last April 20 at the Deja vu Nightclub in Lorain, Ohio (thanks JA!).

– DS

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Filed under Afghanistan, Foreign Service, MED, Realities of the FS, State Department

Zabul Attack: Walking But Not Lost, More Details But Not Official; Plus Update on Kelly Hunt

On Friday, April 12, the AP citing a senior State Department “not authorized to speak to the news media” reported that the initial reports that members of the group were in vehicles, as well as subsequent media reports that they were lost, are incorrect.

The official reportedly provided the details on condition of anonymity.  This report contradicted the eyewitness account of an Afghan reporter cited by McClatchy news on Wednesday, April 10.

You may read the full AP report here.

Last weekend, The Skeptical Bureaucrat  (TSB) posted about this here:

It’s quite bad enough already, judging by the details that have come out so far. Let’s see … the book donation visit to the Sheik Baba Metti school by a team from the U.S. Embassy and PRT Zabul was announced to the press one day in advance. But, despite that lack of operational security, the team was allowed to walk to the school from the PRT’s base at FOB Smart rather than use protected vehicles. The roughly 100-meter long route to the school evidently wasn’t swept before the team’s walk, or blocked to traffic during the movement. The team’s military escort didn’t know which gate to use to enter the school – a school that the PRT itself funded and regularly visited – which required the team to double back to FOB Smart and further expose themselves to attack.

Lastly, the attack reportedly involved a roadside bomb as well as a suicide driver in a bomb-laden vehicle. If that’s true, it means that the Taliban were able to plant a command-detonated bomb in the street immediately outside FOB Smart despite the surveillance that street was undoubtedly under by both the U.S. and Afghan military.

There is reportedly an ongoing FBI investigation. The FBI investigates bombings in the U.S. and overseas where incidents were acts of terrorism against U.S. persons or interests. But this is the war zone. Was there also an FBI investigation on the suicide bombing that killed a USAID officer and wounded an FSO in Kunar Province last year? (Update: We’re told by a blog pal in Afghanistan that the FBI investigates a lot of different incidents in Afghanistan and that there is “nothing unusual” with them investigating the April 6 attack.  Was also asked about an ARB for Camp Bastion.  Camp is under military control so that’s a clear exception to ARB regs; nothing to keep DOD from pursuing its own inquiry but we haven’t heard anything moving on that direction. Read this piece by Rajiv Chandrasekaran on the Taliban attack that resulted in the deaths of two Marines and the largest loss of allied materiel in the 11-year-long Afghan war).

No way to tell right now if there will be an Accountability Review Board. As TSB pointed out, there is a limited exception for convening an ARB if the security incidents involving serious injury or loss of life occurs in Iraq or Afghanistan. We found an exemption for incidents between October 1, 2005-September 30, 2009. In December 2009, that exemption remained in effect through September 30, 2010.

Following the findings of “accountability” from the ARB on Benghazi, we are not holding our breath on an ARB on this latest incident. After not seeing any ARBs convened for several attacks on embassy properties with significant damages last year, we’re starting to think that an ARB in its current authority is not the best use of time/resources to assign accountability.

The notion that an ARB is convened to investigate security incidents that result in “serious injury, loss of life, or significant destruction of property” and then keep the result secret and the interviewees secret is absurd. Add to that the fact that the Secretary of State did not even convene an ARB for all the mob attacks last year which resulted in significant destruction of embassy properties, makes one think that the ARB on its present form is not as useful or effective as it should be.  It also leaves the recommendation on whether or not the Secretary of State should convene an ARB on the hands of the Permanent Coordinating Council in the State Department, staffed by people who answer to their chain of command.

So - we’d much rather see the FBI conduct these investigations.

Also last Thursday, Lt. Col. Justin Kraft, the Zabul Provincial Reconstruction Team commander released the following statement via FB:

We recently lost three of our nation’s finest warriors. They were sons, brothers, one was a father, and all were men who lived, served and died with honor. They gave to their country and their brothers and sisters in arms the last full measure of their courage. 

We are less for this loss. 

Please keep their families in your thoughts and prayers at this difficult time.

DOD identified the three soldiers killed in the April 6 attack but to-date the identity of the DOD civilian who perished in the same attack had not been released. Who was he/she? Did he/she leave behind a family?

On April 14, Staff Sgt. Chris Ward was buried at Oak Ridge. According to knoxnews.com, Maj. Gen. Jeffory Smith, commander of Fort Knox, Ky., presented  the Purple Heart and the Bronze Star to Ward’s mother. The passing of these casualties was heartbreaking  to their loved ones, fellow soldiers and largely ignored by the public. The death of  three  soldiers in the battlefield of Afghanistan … not much was said.

On April 18, knoxnews.com also reported that Kelly Hunt, the State Department employee wounded in the attack arrived earlier this week at the Walter Reed National Military Medical Center in Washington.  Friends of Ms. Hunt at her home state are organizing a fund-raiser online to help the family.  You can check it out here. We have been looking but have not been able to find a contact email for the organizers.  The family Friends of Ms. Hunt have also put up a Facebook page – Kelly Hunt’s Road to Recovery , it includes updates from Dinah Hunt, Kelly’s mother.

 

– DS

 

Updated on April 22@1720 PST with info on ARB

Updated on April 22 @21:41 PST with FB page correction; page put up by friends not family.

 

 

 

 

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Filed under Afghanistan, Foreign Service, FSOs, MED, Realities of the FS, Skeptical Bureaucrat, State Department, U.S. Missions, War