A day in the life of a Foreign Service Nurse Practitioner

I’m only 6 weeks in, but here are what my day’s look like so far….

The day begins with Motorpool picking me and Chotu up in the morning. We drop him off at school and then head to the embassy. Motorpool is our temporary ride service until we buy a car. The driver’s are locally employed staff that work for the Embassy. It doesn’t have to be temporary, there are plenty of people that never buy a car and use motorpool for their entire tour- it’s available 24/7 and free for the first several weeks then there is a small fee ($1.50 daily to come home from work- so pretty reasonable).

When we arrive at the Embassy we enter through a security gate where the engine is turned off and the car is searched for any shady paraphernalia. I have to show my badge and then we are let in.

Funny story about this. The car actually pulls in between two gates for this check- so you can’t reverse or go forward. For some unexplainable reason, I thought I had to get out of the car and get searched. So on my first day, I climbed out of the car prepared to get frisked. The driver and security guards were so confused. I mean, in my defense- it was my FIRST TIME going to an embassy- I don’t know the protocol! After the driver looked at me like I was crazy, I just climbed back in- and embarrassingly mumbled to myself

The clinic sits inside of the embassy, and it is staffed by me and two RN’s. We also have a local doctor that comes in part time. It looks like your normal run of the mill clinic. Waiting room, exam rooms, supply room, nurses station. Bonus, is that I have my own office (with windows and a view!). There is a small pharmacy with commonly prescribed medications. This allows us to hand out prescriptions instantaneously, since meds can take a long time to arrive and one’s on the local market can sometimes be unreliable and counterfeit. It’s a pretty small pharmacy meant to treat urgent things like infections and malaria. So we have all your common antibiotics, along with steroids, anti-fungals etc. If patient’s need their daily chronic medications then we refill those through an online portal and it gets mailed to post.

On the topic of unreliable meds- check out this article about a banned Chinese birth control that is STILL being sold in Kenya! This oral birth control has 40 X the recommended dose of levonorgestrel and 100 X the estradiol dose!! (hello blood clots).

The other unique part of being a medical provider in the FS is that you often care for your own family. We all recently got ill with strep throat and it still felt like I was “breaking the rules” when I had to prescribe Chotu’s amoxicillin. I’m sure with time this will normalize.

Within the clinic we have a small lab with some pretty cool capabilities. We can do rapid malaria tests using just a finger stick-only takes 15 minutes. There is a machine to do a CBC, chem panel and the coolest of them all is the Biofire machine. This machine can run a respiratory and GI panel in one hour! The respiratory panel can check for COVID, flu, RSV, pertussis and many more- all from one nasopharyngeal swab! The GI panel is equally as cool and can check for everything from ETEC, Shigella and Cholera to parasitic infections. SUPER necessary as we see quite a bit of infectious diarrhea.

There is no lab tech (some larger posts do have their own dedicated lab technician) but here in the Buj, these tests are run by me and the nurses.

Patient’s can make appointments, but since our embassy is so small we mostly function on a walk-in basis.

In a typical day, I will see anywhere from 2-4 patient’s. This can be any embassy employee- so Americans (and their family members) or Locally employed staff. Fun Fact: the majority of the foreign service staff around the globe are actually local staff!

In talking with my colleagues from orientation it seems this patient load is somewhat the norm- of course differs by the size of the post. As a point of reference at my previous jobs in Family Practice we would see anywhere from 18-24 patient’s a day.

What kind of things do I see? A lot of urgent care stuff like: Diarrhea, UTI, URI’s and fevers (Malaria until proven otherwise in these parts). I do a fair amount of driver’s physicals since everyone that drives a government vehicle needs one. We also do a health unit check-in for all new staff at the embassy. This is like an establishing care appointment. I’ve heard from my colleagues at bigger posts that they are seeing a lot of pediatrics and well child visits- not the case here as there are just not that many kids at this post. We are expected to provide prenatal care, and may manage pregnant patient’s until they are sent home for delivery around 34 weeks.

The day’s are slower with patient care, but there is still plenty to do and I manage to stay busy.

On top of being the only full time medical provider (our local doctor see’s only local staff, this is not the universal norm just how it functions at our clinic) I’m essentially the clinic manager. So I have the added responsibilities of managing and hiring staff (we are in the process of hiring a third nurse). Additional duties are managing supplies- we just went through our inventory and identified medication, vaccines and supplies that we don’t have and need to order. We have emergency supplies and AED’s from DC that need to be inventoried and checked for expiration. Everything that has a lithium battery needs to be sent to post by ship- so you can imagine we have to order WAY in advance and prepare for those needs.

We received our COVID and flu vaccines and are in the midst of setting up a walk-in vaccine clinic. In more exciting news- the Ebola outbreak in neighboring Uganda rages on. I’ve been on disaster preparation calls with other’s in the region on how to prepare for this should it come to Burundi. I think the global health and infectious disease aspect of this job is truly fascinating and something I am really enjoying learning more about.

Did I mention, endless meetings and so many emails!

My mornings are usually spent seeing patients and afternoons tend to be heavier on meetings. There are meetings with the Bujumbura embassy staff and management as well as with MED back in DC.

I made my first visit to the local hospital to check out their lab. Forming relationships with local providers and health facilities is a fun and truly unique part of the job. This is where the diplomacy really comes in.

I’m acutely aware that on these visits I’m representing the American government and people. It is strange to feel like the red carpet is being rolled out for you on these site visits.

Next up I will be meeting with a local GYN and pediatrician, as well as getting a tour of the emergency room at our partnering hospital. In general, specialty care is limited here and anything complicated would be sent to our Medevac point for management, but it is nice to know that there are some local options if I’m really in a pinch.

Are we really on-call 24/7?

This is probably what made me most nervous about this job and the short answer is it really depends. We have a 24-hour duty phone that we take turns manning. I had it for two weeks, and received only one phone call after hours- it did result in me making a home visit to check on someone. I think this is really post dependent. Larger posts and posts with more children seem to have a busier duty phone.

I suppose I am always on call because even if i don’t have the duty phone if there is a true emergency I would be expected to meet the patient at the hospital and/or coordinate a Medevac. Luckily these situations are pretty rare.

For the most part, I leave work everyday on time and I feel like I have a better work like balance than I did in my previous jobs. It’s nice not being in the grind of rushing through patient’s every 15-20 minutes. It somehow feels less stressful- although I haven’t yet had an emergency Medevac so stay tuned….

Another plus is we get local and American holiday’s off so there are quite a few long weekends. This allows for local travel and weekends away. We have our first trip coming up, and I’m so excited to get out and explore a neighboring city! I mean let’s be real- this is the real reason we go into the FS- to travel and explore.

Other questions about the job or lifestyle? Are you at another post and things are a bit different? Drop a comment below!

A Day in the Life of a Foreign Service Nurse Practitioner