I begin to settle in

I met the Rector of the National Medical University on Friday.  The government has merged the Ministries of Health and of Social Development ostensibly to save money and  increase efficiency. In the process they have cut out post graduate training such that there are just two years of what I have been told is a marginal experience at best. Many of the physicians fall into similar habits we have in the US wherein we see a problem and order either an unnecessary and expensive test(s) or obtain consultation(s). As an example, if someone has rectal bleeding they are often referred without exam. Now this happens back home to be sure and is without excuse. Here it is out of fear and poor training. He asked me for my thoughts. I, like he, was stymied. It simply will take time and unwavering commitment.

The National Medical University

"Vazar" Valsartan +/- HCTZ

Class, the gentleman in the front wanted to know my salary.

The Ministry has mandated additional training so that all primary care physicians can provide care for what amounts to the average patient profile of a family physician. As you might expect they aren't enthused. As I led a discussion, they asked me by way of justifying ambivalence what I was paid. I stated that I would rather not discuss that as it would put distance between us (I'm told that the average physician makes 400 USD/mo.). Instead I discussed my role as a physician in Hood River; # pts seen, hours worked /week, inpatient responsibilities, OB and the like. At this point my colleague that was interpreting launched into a bit of a tirade at the docs. She paused to take a breath and informed me that they work only 4hr days. This paradigm is directly inherited from the Soviet style of medicine; do little and make it someones else's responsibility. 

Kazakhstan to its credit invites outside organizations (typically the WHO) to evaluate care on the national level. Remember that this country gained independence less than a generation ago and is to be applauded for simply asking the question. In general the reports point out that there are not enough docs and that the ones that are out there, especially in rural areas, are burned out. As a direct result the best students look outside the national system and are generally vacuumed up by the pharmaceutical industry. I have met some of these folks and have been impressed that they have really drunk the Kool-Aid; asking me if I used this drug or that medical equipment and would I recommend it. My colleagues often give talks for the industry to add income. I have been asked to do the same and can donate any reimbursement (as required by Fulbright) but will really have to wrestle with my integrity.

Meat, and lots of it.

This weekend I visited a farmers market and was again impressed that the national dish truly is meat, About 40% of the stalls were meats of all kinds. One of the most popular items is a variation on Kishka; intsestines stuffed with meat from the ribs of, well.....whatever.

As I was wandering the market I heard what I thought was broadcast music from the steps of the old communist party headquarters. It was very tonal. I assumed it was Chinese and dismissed it. As I got closer to the stage it became clear that the language was Kazakh, it was live, and it was amazing. The band played all of the national Kazakh instruments and the singing was ethereal. I'll try the link again. You'll have to copy and paste. But do yourself the favor.

https://www.youtube.com/watch?v=qQ0c8RBgWtw

All produce is great 

Later that day my friend Kainar took me on a tour of the west side of the city, then to Gorky Park, a beautiful place with amusement rides and outdoor shows for the kids. We ate shashlik (shish kabob) and reminisced. 

One of the many couples going to wed that day that for some reason paddled around the pond

After two weeks I am truly fortunate to have the resources I do. I'm sure month three will look quite different than now, snow and cold for one. For now the newness of this place and the fact that it has somehow disappeared from the collective consciousness of most of the west is very inviting.