We put in the paperwork to renew her medical clearance at the beginning of June, three and a half months ago. Seven of us got cleared with a worldwide, class 1, clearance within a week. Sophia, obviously, did not.
Having a worldwide medical clearance is a very good thing to have in the State Department. It means that you don't have any medical issues that can't be dealt with by the local medical unit. I have hypothyroidism, but that's taken care of easily with blood tests and a Synthroid prescription.
In the last few years, the definition also got changed to include chronic conditions that you can take care of yourself, even if the local medical unit can't help you with them. I have a friend who had cancer, but was allowed to go to her next post after she arranged to meet with a doctor in Europe for the follow-up appointments.
Having a class 2 medical clearance is not such a great thing. It doesn't mean that you are absolutely banned from going anywhere other than first world countries, but it does mean that you have to be approved for specific posts. It can be a real pain when bidding on jobs because you have to research the medical capabilities of every post you're thinking of bidding on and convincing State's med bureaucrats that those posts can take care of your issue. It adds another complicated step to an already complicated thing.
So, back in June, I crossed my fingers when we turned in Sophia's medical clearance, hoping that she'd get a class 1 clearance. After all, it's not like ADD is a particularly difficult issue to deal with. She doesn't need any special school accommodations and she's on a stable dose of Ritalin, which can be prescribed by the doctor at post - just like my Synthroid is prescribed by the doctor at post.
Unfortunately, my finger crossing didn't work and Sophia's clearance paperwork got passed on to another office within MED. After spending a week making multiple phone calls and emails, we finally got in touch with the case worker who was reviewing her case. We talked on the phone and she laid out the issue, "I need to know that you have a way to get Sophia's Ritalin. She doesn't have a current prescriber, and I need to know that you have one before I'll clear her to go to Tashkent."
We had been working with the doctor at post to get Sophia's Ritalin prescription while we were in Dushanbe and it had worked quite well. But then the regional psychiatrist (RMO/P) went to her next post and a new RMO/P showed up. When I needed a new prescription for Sophia, the doctor at post, also new, told me that I had to have the RMO/P refill the prescription. I emailed her about refilling Sophia's prescription in March, and she told me to set up a digital video conference for her to meet with Sophia before refilling the prescription.
We left before we could do that. So when I told the case worker about the RMO/P being willing to prescribe, she told me that we just had to get a new DVC set up and Sophia would be cleared to go to Tashkent. Which was a good thing to hear, because we were less than a week from our departure date.
This is when things started going sideways. I duly emailed the RMO/P and asked for the DVC. She replied saying that she had no interest in meeting with us about Sophia - we were supposed to have Sophia meet with our pediatrician. We replied that we had met with Sophia's pediatrician and what else did she need us to do? Then she stopped responding to our emails.
At this point, the case worker had decided that, since the RMO/P didn't show any indication that she would prescribe, and we couldn't get Ritalin locally in Tashkent, we were going to have to find a country where Sophia could get Ritalin. This decision was reached on July 5 - the day before we were supposed to leave for Tashkent.
We got in touch with people at the embassy in Tashkent and let them know of the the problem. This wasn't good news to them because they were expecting Brandon to show up to work the following Monday and fill a hole that had been empty for several months already. A few hours later - around two in the morning - we got an email from the HR officer at the time telling us to go ahead and come to post. Sophia could come without a medical clearance, but that meant that she couldn't use any medical resources. The email implied that they had worked things out with the RMO/P and that a resolution would come quickly.
That was not the case.
We made it to Tashkent and settled in to our new home. A couple of weeks after we arrived, Brandon got called into the DCM's (second in command) office. "Did you know," he asked, "that your daughter doesn't have a medical clearance? I got a personal email from the RMO/P telling me that I needed to know that you were here at post with a child who wasn't cleared." Brandon let him know the situation, and assured him that it was only an issue with a Ritalin prescription and nothing serious. The DCM was relieved and commiserated about tangling with MED. After you have been in the foreign service long enough, everyone has horror stories about tangling with the medical office.
Brandon went straight from his office to the medical unit. The PA who runs the unit said that she had gotten in contact with the RMO/P about prescribing Sophia's Ritalin, and the RMO/P had told her in no uncertain terms that she was not allowed to prescribe Ritalin herself. When the PA asked what we should do, the RMO/P didn't have any reasonable solutions. Or any solutions at all.
This went on for weeks and weeks. The PA would contact the RMO/P, who wouldn't reply or offer vague answers or put her off. Then there would be silence for a few weeks. The PA would try to re-open the issue and the RMO/P would go through the whole cycle again. Brandon didn't feel that we should contact the RMO/P personally because he thought that she was angry at us for coming to post without her blessing. Weeks turned into months and we still didn't have a medical clearance for Sophia. When we went off to our first horseback riding lesson, Brandon told Sophia not to break anything because she couldn't get any help from the embassy.
In early September, we got a notice that the RMO/P would be visiting Tashkent personally. I emailed about making an appointment and the PA asked if it was allowable for the RMO/P to meet with Sophia, even though Sophia didn't have a clearance and didn't have access to medical resources. The RMO/P said no. So I made an appointment for myself. I figured that she couldn't refuse to answer me if I was sitting in the office looking at her and we could finally get everything straightened out.
At the same time, Brandon was putting in a request to extend in Tashkent. Since Tashkent is a hardship post, you only have to stay for two years. If you want to stay for three, you have to request to stay for the third year. We try and stay wherever we are as long as possible, so extension wasn't even a question. It was an assumption.
Everything seemed to be just fine for him to extend. His boss was fine with it, the HR officer was fine with it, and the DCM was fine with it. It was a happy party of agreement.
Bidding season was getting ready to start and Brandon was already getting several emails a day about his position, as it was listed as becoming vacant in summer 2020. Brandon let them know that he was planning on extending, so it wouldn't be a good idea to get their hopes up. But he had to get his extension in before bidding ended otherwise his job would be given away.
Then the DCM called Brandon in to his office (again). "I can't approve your extension," he told Brandon, "until your daughter has a medical clearance. So see if you can get that cleared up and I'll be happy to send the memo to the ambassador."
The next day, the PA let us know that the RMO/P had finally given her a straight answer about prescribing - and the answer was no. That afternoon we got an email from DC letting us know that Sophia was not cleared for Tashkent.
I reached out on Facebook for advice and heard from several other people who had had similar (or exactly the same) experiences with the RMO/P. She flatly refused to prescribe any maintenance medication - stating that her job was only a "stop gap measure" and that "primary care comes from US-based physicians." Which, as every single person on the thread agreed, was complete nonsense. The job, according to the State department website, of an RMO/P "is a local resource available to help manage a child or adolescent’s mental health needs." Our previous RMO/P had had no problem providing Sophia's prescription initially and then had no problem letting the local med unit write the refills.
It was very frustrating to finally understand that the RMO/P had never had any intention to refill Sophia's prescription and that she took three months to tell us that. We had spent months waiting for some sort of resolution and praying that Sophia wouldn't get sick or injured. We had waited and waited and waited for any kind of communication, even if it had been a no. But instead we just waited on someone else's whims, someone who knew what her answer was from the very beginning and never intended to tell us. I hope that we never are posted in the same country as this woman because I would have a very hard time
So we were left scrambling for another solution and under a very pressing deadline. I reached out to our former RMO/P, who also refused to manage the prescription. Then I reached out to our pediatrician in the US, who wonderfully, mercifully, thankfully agreed to help. I never thought that getting a prescription for a mind-altering substance could bring me so much joy.
The next day I turned in a new provider form, one that said that our pediatrician was willing to manage Sophia's medication, and copied every single person I had ever interacted with at MED. The next day I followed up with promises to make personal phone calls. That got a 'don't bother me - bother her!!!' email with the finger pointed at our original case worker. So I emailed her, called her multiple times, called her the next day, tattled to the office manager about not getting a response, and emailed her again. That finally got us a response, and the response that we wanted - the only reasonable response that it could be. 'Yes, she's fine. I'm approving her for Tashkent [now leave me alone].' I have learned through long experience that sometimes the only way to get the job done is to be the most annoying person ever so people will do anything to get you to leave them alone.
Our quest almost done, I got a message from a wonderful friend who had just gotten a job in the medical office the week before. She offered to help move the rest of the process along, and did an admirable job of it. A week after we had the first denial, Sophia was cleared for post. Brandon and I celebrated for thirty seconds and then he started bugging everyone about getting his extension finalized.
This whole experience has shifted my view of people, ever so slightly, towards Brandon's. I've always felt that people are reasonable and, if approached the right way, would work with you in a decent fashion. He sees other people as entities dedicated to doing everything in their power to make your life miserable. After the last three and a half months dealing with the RMO/P, I'm willing to concede the point. At least when it comes to Dr. D.