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At Your Own Risk
By Shannon Jamison
This article originally appeared in the Winter 1997 issue of the Spouses Underground Newsletter (the SUN). Foreign Service Lifelines thanks the author and the SUN for allowing us to reprint it here.
"In the course of looking into the possibility of an assignment to another post, I have heard that nine members of the rather small American embassy community at the post have come down with cancer over the last few years, and that six were cases of breast cancer. This seems an extraordinarily large number. What could cause so many cancers in a small community in one place over a few short years? What advice would you give to someone considering such a post or to those currently or recently posted there?"
--Ask Dr. Rigamer, State Magazine, June/July 1996, page 24.
The post is the U.S. Embassy, Bucharest, Romania. It is a roughly 45-position post, if you include State, USIS, DOD, AID, and the Peace Corps staff. We served there TDY in 1991 and then on a regular assignment from 1992 to 1994. Of the people we knew serving there during those three years, 11 have developed cancer, including eight cases of breast cancer. Two of those 11 are now dead.
You should read Dr. Rigamer's answer for yourself. He notes that a variety of factors-genetic and environmental-can cause cancer. He states that the numbers quoted above "may seem unusually high," but "such reports are not rare." He concludes that, "cancer touches nearly every family in our aging population and has a high public priority." His answer is full of true statements, full of medically correct facts, full of accurate information. It is also completely empty of reassurance.
It does not say that the Office of Medical Services is thoroughly investigating the possibility of cancer-causing conditions in Bucharest. It does not say that MED has recommended or authorized follow-up examinations for anyone recently posted to Bucharest. It does not say MED has recommended that the statistics on cancer victims from Bucharest be made clear to anyone bidding on a Bucharest assignment. It does not even say that MED was aware of the problem until someone decided to ASK DR. RIGAMER.
I wish that the Office of Medical Services would do all of the above, yet my purpose is not to attack MED for failure to do these things. I want to make it clear to any Foreign Service spouse of employee out there who still thinks that "they wouldn't send (or house) us there if it weren't safe" that you AND YOU ALONE are responsible for your health and well-being. Do not-please do not-trust that Medical Services (or any other part of the bureaucracy) will actively pursue your good health and safety, and do not assume-ever-that U.S. standards and safeguards apply in anything done by the U.S. Embassy. Each of us individually must seize responsibility for our lives and our medical care overseas because it can literally be fatal not to do so.
What do I mean by seizing responsibility for our own medical care?
Know your body. Know what it feels like healthy, or at least functioning normally, and know what signs indicate problems. Every woman should know the warning signs for breast cancer. And every Foreign Service family should make themselves knowledgeable about the diseases prevalent in their new post and be aware of the warning signs.
Don't ignore problems in the hope that they will go away with a new assignment, a new country, etc. Particularly in the case of breast cancer, early detection and treatment can save or prolong your life indefinitely.
Don't be bullied, gently or otherwise, into accepting a diagnosis you don't believe. If you feel there is something wrong, find a doctor who believes you-even if that requires going outside the Health Unit, outside State MED, or outside the country. Trust yourself and act aggressively on your own behalf.
Do as much as you can to control the quality and consistency of the care you receive in spite of the highly mobile Foreign Service life. That might mean doing annual exams at home on annual leave to see the same, trusted doctor regularly. In the case of breast cancer, consistency is particularly important in the administration and reading of mammograms. Done at the same place and compared with previous visits, mammograms can be invaluable in spotting lumps too small to be felt.
Practice prevention. Have regular exams monitor your health. Take what
sensible precautions you can about your food, your home, and your working
conditions. Try as best you can to exercise, eat right, and maintain a
positive mental attitude.
Above all, do not be lulled into a false sense of security about your
environment overseas. It is dangerous, and it can be lethal-as evidenced
by the deaths of Foreign Service personnel of carbon monoxide poisoning
or pesticide exposure. Your housing is not "safe" simply because
the U.S. Embassy put you there. Your diplomatic status will not shield
you from radiation or toxic air pollution or disease-infested food. The
Embassy is not guarding you from those hazards; the Office of Medical
Services is not protecting your. The dangers-from cancer-causing agents
to debilitating diseases-are real and we must all recognize that our only
true guardians are ourselves.
Bid on Bucharest at your own risk.
Shannon Jamison is currently stationed in Nagoya, Japan with her husband, the director of the American Cultural Center. She reports that since the time that she wrote the article, the only change to the situation described has been that one more person has died.