It's been a month

In fact exactly four weeks since bidding beloved family and friends farewell. These milestones, always seem an appropriate time for reflection. For me the first month is always intimidating as I don't speak the language and, for that matter, don't do well in crowds or large cities. And yet I find I have adapted rather well. I smile more and marvel as to how the Kazakhs seem to morph and move through their universe here. I imagine awakening on 16 Dec 1991, finally out from under decades of oppression and timidly wondering, "Now what?" I'd be at once terrified and filled with ecstatic.

While there isn't much smiling here nor back home for that matter there is a lightness of being and a simultaneous resignation that I initially found contradictory. Now I simply accept is for what it is..life in a former Soviet state.

It seems as if the whole region has a communal case of PTSD; the reluctance of my generation to completely embrace the ability to be spontaneous, or perhaps more to he point, of my profession to embrace medical excellence while discarding anecdote/don't rock the boat medicine. Yet in my small corner there is a gradual awakening that pride of position is truly в порядке (OK). As my dad would say (I think) "Not enough people have died yet" for change to be complete and it's true.

Yesterday I attended a small conference sponsored by a pharmaceutical enterprise at the Intercontinental Hotel. For those of you considering a visit be assured that there are first rate accommodations here in Almaty. The conference was per usual; first rate buffet lunch including horse, mutton, and the like. The meeting was hosted by some regular types from Astana but also a contingent of reps that were straight out of central casting; the typical young slightly aggressive high heeled career woman or slick suited, spit polished man both of whom unfortunately have become somewhat of a cartoon caricature of the industry world wide. During the conference there was a slide indicating the rank order of pharmaceuticals prescribed here. In the US they vary by region and season but the number one medication is generally an antibiotic. Here the first three are:

• "Actovegin": a homeopathic remedy, highly diluted, (one sure as hell hopes) from calf's blood, given IV to facilitate movement of 02 across membranes. People get this IV and a nap at same time. Small wonder it "works". Lance Armstrong used it so how bad could it be??!
• "Kreon": In the US it is "CREON", a group of replacement enzymes that are given for pancreatic dysfunction as in chronic pancreatitis, resection, cystic fibrosis and the like. Here it is given to people that are vomiting or have diarrhea. No dose adjustment for kids.
• Vitamins of course.
• Third generation cephalosporins: a class of antibiotics that have a broad spectrum of activity when what we try is to give one that will kill a specific bug.

All of the above is of course heavily steeped in anecdotal experience and is driven by both habit and the pharmaceutical industry where it would seem there is no investment in what is medically appropriate or cost effective, despite claims to the contrary.

To be fair, about 10 years ago there was study on the No.1 revenue producer at CVS pharmacies; echinacea. Yep that stuff for which there isn't a shred of decent evidence as to its efficacy or safety. There were something like 20 different varieties sold. Each was tested for content and the findings were telling. Some of the capsules had the stated amount, some had no echinaciea and still others had up to 2x the stated amount. So sure I judge, just in both directions. And here as everywhere, folks get really puckered if they aren't getting what they think they need from us.

At this point in the journey I like to contemplate what I do and don't miss about home as I have time, lots of it when I don't speak the language, to contemplate my circumstances. 

What I miss: Well the obvious for starters. Lynne's warm embrace, my life's inspiration, companion, and side kick. Eli, Amber, Sam and "?" . My biking and swimming homies who have so generously invited me into their collective lives, Breadworks, Horton's, Southern Indiana from a bike, Zombie rides, any ride for that matter, swim workouts by Nate, clean(er) air, much more.

What I don't miss: This runs the risk of offending but I try to be relatively transparent with these blogs. I don't miss the gun culture. You know what I mean. The "any gun is a good gun" and "we just need to be better armed to protect ourselves from the bad guys". Guns are definitely not on the streets here and it is more of a relief to me than I would have ever expected. I am surprised that I was preoccupied as much as I was with the "Jimmjoeraybobs  with a Budlite" that would shoot if a car (or bike) cut him off. I don't miss the vocal fry, I know, a little too brittle, contrary, and curmudgeon-like. Definitely not politic. But it find it really annoyed me more than I thought or was willing to admit. Here the voices are lilting and lack pretension.  Oh and the liver rattling bass tones that sidle up beside me at a stop light, nope don't miss it. I wish the whole pants on the floor thing would wear itself out, don't miss it.

Tomorrow is my first Russian lesson, an instructor at USAID for the last 21 years.