@StateDept’s Blackhole of Pain Inside the Bureau of Medical Services (MED)

April 5, 2018 By domani spero in Congress, Foreign Service, FSOs, Functional Bureaus, MEDical, Mental Health, Realities of the FS, SFRC, State Department, Trends, U.S. Missions Tags: A/DGHR, Bureau of Medical Services, Charles Rosenfarb, Kathy Gallardo, State/MED

Posted: 12:46 am PT
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We previously blogged about the ongoing problems encountered by Foreign Service families with special needs children when dealing with the State Department’s Bureau of Medical Services (MED) (see @StateDept’s Mental Health Services Drive Employees with Special Needs #FSKids Nuts). Note that as employees prepare for the summer job rotation, MED will be reviewing the medical clearances of employees and family members in preparation for their transfer. Whatever is the number that is now stuck in MED’s labyrinth, expect that number to go up with the upcoming rotations as kids with special needs are snared in the system that is supposed to help but instead has caused so much disruption and pain.

We understand that medical clearance decisions can be appealed to a panel of three doctors. But we’ve been informed that one of the three in this review panel is the reviewing officer of the the other two. We’d like to know how many cases that come before this review panel are decided in complete agreement by all panel members, and how many cases are decided by the two panel members against the decision of the third panel member/rating official? Perhaps something for the congressional oversight panels to look into? Or something to FOIA if this is going the class action route.

Congress should also look into State’s Medical Services perspective on risk. Would it surprise us all if State/MED doesn’t want to take any? State/MED’s mission is “to safeguard and promote the health and well-being of America’s diplomatic community.” Does that mean keep everyone with the slightest issue inside the United States instead of sending them on overseas assignments? Bad things can happen just the same in the United States – but of course, MED won’t be responsible when employees are on domestic assignments. It is responsible once employees/family members are overseas. So again, what is State/MED’s perspective on risk, and how much does this inform its decision on the medical clearances issued to FS employees, spouses and their kids?

FP’s Robbie Gramer recently had a lengthy piece on FS families in State’s medical labyrinth. It is quite a read, and don’t miss the quotes.

On #WorldAutismAwarenessDay, read my deep-dive into how the State Department is tearing apart families of diplomats who have children with autism, down syndrome, other special needs, mental health issues https://t.co/v3cMFP7Rsj

— Robbie Gramer (@RobbieGramer) April 2, 2018

When a diplomat based overseas fought to have his youngest daughter brought to his post, he received veiled threats about the future of his career at the State Department. https://t.co/C4TqzS6WyA pic.twitter.com/5qWC0Rxf9R

— Foreign Policy (@ForeignPolicy) April 2, 2018

What are we doing to our diplomatic corps, jeez https://t.co/PNrRifipO5 pic.twitter.com/O8WjoZY68q

— Kelsey D. Atherton (@AthertonKD) April 2, 2018

US Embassy Cuba: New Mechanism For Brain Injury From an “Exposure of Unknown Origin”

February 16, 2018 By domani spero in Diplomatic Attacks, Foreign Service, MEDical, Realities of the FS, Spectacular, State Department, Technology and Work, U.S. Missions, WHA|Western Hemisphere Tags: Bureau of Medical Services, Center for Brain Injury and Repair, clinical findings, Cuba, mystery illness, reports, sonic attacks, University of Pennsylvania, US Embassy Havana

Posted: 12:39 am ET
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The University of Pennsylvania’s Center for Brain Injury and Repair was selected to coordinate the evaluation, treatment and rehabilitation of 21 government personnel (11 women and 10 men) identified by the State Department and evaluated an average of 203 days following exposure to reported sound (described as “buzzing,” “grinding metal,” “piercing squeals” or “humming”) and sensory phenomena (described as pressure-like or vibrating and likened to air “baffling” inside a moving car with the windows partially rolled down) at the US Embassy in Havana, Cuba in late 2016.

“It’s like a concussion without a concussion.”

“Of the 21 individuals assessed at Penn, 17 reported cognitive or behavioral problems such as difficulty remembering, concentrating, or both. “It’s not that any patient can’t do a given task, but it requires way more effort,” said coauthor Randel Swanson, DO, PhD, a brain injury rehabilitation specialist at the University of Pennsylvania’s Center for Brain Injury and Repair. “They don’t have as much cognitive reserve.”

The author and his coauthors signed a nondisclosure agreement with the State Department, “so they cannot discuss whether they know more about what happened in Havana than has already been made public.”

The study concludes that “The unique circumstances of these patients and the clinical manifestations detailed in this report raise concern about a new mechanism for possible acquired brain injury from an exposure of unknown origin.”

Take a closer look at the study focused on neurological symptoms among U.S. diplomats in Cuba with @LVHN's Steven L. Lewis, MD and our own Christopher C. Muth, MD: https://t.co/oz8fmw2Cju #Neurology pic.twitter.com/SB3nL7mspe

— JAMA (@JAMA_current) February 15, 2018

Neurological Manifestations Among US Government Personnel Reporting Directional Audible and Sensory Phenomena in Havana, Cubahttps://t.co/VQwbzJN15D

— Diplopundit (@Diplopundit) February 16, 2018

The mystery of the Cuban diplomatic malaise endures. Neurologists see concussion-like symptoms but can’t pin down a cause. https://t.co/Nx8th4NqwB

— Carl Zimmer (@carlzimmer) February 15, 2018

Watch / listen to @JAMA_current podcast re the #Cuba sonic attacks on US diplomats:
“Medical Findings From U.S. Government Personnel in Cuba” https://t.co/0lrDepbxpl

— diplomattitude (@diplomattitude) February 15, 2018

Ruling Out 'Sonic Attack,' Docs Still Mystified by Brain Damage in US Staff in Cuba https://t.co/j4pjAv6uCZ pic.twitter.com/TeFYerAl5O

— Live Science (@LiveScience) February 15, 2018

@StateDept Seeks Foreign Service Social Workers For Afghanistan, Iraq, Pakistan–Closes 11/15

November 4, 2016 By domani spero in Af/Pak, Iraq, MEDical, Mental Health, Realities of the FS, Staffing the FS, State Department, U.S. Missions Tags: Afghanistan, AIP, Bureau of Medical Services, Iraq, LNAs, Pakistan, Psychiatric Social Workers, State/MED 1 Comment

Posted: 1:17 am ET
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The State Department is seeking Social Workers on Limited Non-Career Appointments (LNA) for jobs in Afghanistan, Iraq and Pakistan. The job announcement opened in November 2 and closes on November 15. The jobs are FP-0185-02/02 and pays $83,173.00 to $122,142.00/year. The LNA appointment is restricted by statute to a maximum of five years.

The State Department’s Bureau of Medical Services (MED) maintains and promotes the health of employees and their accompanying family members who represent United States government (USG) agencies abroad. Foreign Service (FS) Medical Officers, Medical Officers/Psychiatrists, Medical Providers, Social Workers, and Laboratory Scientists are assigned to selected posts overseas. Many of these posts have significant health risks and local medical care that is inadequate by U.S. standards. The incumbent of this position serves as a Social Worker on the Mental Health Programs staff and as a resident professional counselor providing services for employees at FS posts. The Social Worker will have multifaceted responsibilities at post which include but are not limited to the following: assessments of psychiatric problems, including substance abuse; Post-traumatic stress disorder counseling, job stress counseling, cross-cultural adjustment issues counseling, crisis management consultation, conflict mediation/resolution, consultation on violence in the workplace, and crisis management training for employees assigned to hardship posts.

Individuals must be willing to serve worldwide, primarily high threat locations. Limited Non-Career Social Workers (SWLNA) presently serve at unaccompanied posts in Afghanistan, Iraq, and Pakistan. Family members are not permitted to accompany SWLNAs to post. However, at some locations, adult eligible family members (EFMs) may be approved to accompany the SWLNA to post if they will fill certain mission-critical positions. EFMs must be employed/hired in the mission before traveling to post.

Duties

Serves as a psychiatric Social Worker for posts such as Afghanistan, Iraq, and Pakistan. Provides crisis intervention, problem assessment, and brief counseling for employees under Chief of Mission authority. Coordinates efforts with Regional Medical Officer/Psychiatrist.

Provides crisis management training for employees. Provides supportive counseling and debriefings to employees.

Coordinates service provision with the Bureau of Medical Services’ Family Liaison Office, Office of Casualty Assistance, Regional Bureaus, and Human Resources.

Serves as technical expert on troubled employees and provides clinical guidance to post management on sensitive situations such as interpersonal relations on the job, job stress, violence in the workplace, medical illness, medical disability, and family problems.

Mediates job performance issues and disputes between employees and supervisors. When indicated, coordinates resources within the State Department to provide further assistance.

Advises and counsels employees of the possible administrative consequences of activities adversely affecting job performance caused by personal problems. Refers such employees for consultations with the appropriate office responsible for effecting disciplinary actions and explaining appeal processes and rights.

Maintains liaison and provides expert assistance to specialists responsible for the administration of other specific employee programs including, but not limited to, disciplinary actions, leave administration, reasonable accommodations, conduct/suitability, disability retirement, and career development.

Participates as a Family Advocacy Team member reviewing and giving advice and counsel on cases of spouse abuse.

Provides support services, including hospital/home visits as needed to patients.

Facilitates support groups in the workplace for employees with cancer, employees dealing with elderly relatives, single parents, and other groups, as requested.

Designs, facilitates, and conducts appropriate training activities, such as orientation for employees under Chief of Mission authority, Community Liaison Officer training, and supervisory training. Works with managers on an ongoing basis to develop leadership skills.

Develops educational outreach programs to ensure an awareness of the benefits of Mental Health Services. Offers outreach in the form of videos, workshops, panel discussions, and health fair presentations. Maintains handout literature and a lending library on mental health, stress management, parenting, aging, and other issues of interest to employees.

Performs other duties as requested by M/MED and M/MED/MHS.

Performs all duties with scrupulous regard for confidentiality and with the goal of assisting employees to maintain effective work performance.

Read the full announcement here: SWLNA-2017-0002 https://www.usajobs.gov/GetJob/ViewDetails/455056400.

For more information in the Foreign Service selection process, please visit http://careers.state.gov/work/foreign-service/specialist/selection-process.

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