A day in the life

Today I gave a presentation titled "Family Medicine in Kazakhstan from the Perspective of an American Family Physician." I gave it to about thirty docs and dentists in a theater type room that has been used since the founding of KazNMU in the early 30's. One of my colleagues, the chair of the Department of Family Medicine here, had lectures in the same theatre as a medical student and told me how they were required to come in on a Saturday and help clean the room. It is rather puritanical in design in that it is so uncomfortable that sleeping during class is impossible.

My presentation was rather provocative (I know, really?) and is a soft indictment of the present system. Currently the health care culture here is more connection based rather than merit based. And everyone knows that. And now they know that I know it. After the presentation I was asked the inevitable question about what I thought the state of Family Medicine here. It's always a bit of a dodge as I want to be honest and politic at the same time. In truth the students are woefully under prepared and compare, barely, to late second or early third year students in the US. My contemporaries are rather disgusted with the present state of ambivalence of the entire student body, of which there are ~13,000 spread over 7 yrs. The notion is that there is a lack of docs out there. So to fill the need there will be more graduates, but they are poorly motivated and trained.

There also is a nostalgia for "Soviet Times" as while the Soviets might have been bastards, at least they were predictable. Numerous people have told me that one didn't (couldn't) look into the future as it was already planned for you and at some level there was security in that. Also those that advanced the Soviet ethos and those that manipulated the system could be rewarded by getting to the "front of the line" for cars, dachas and the like. As to the rest, “we just kept our heads down and hoped for the best.”

1991 marked a time of huge of anxiety as self-determination was granted by default without any instruction or support on how to proceed, somewhat akin to sudden homeless- ness.This of course left a huge vacuum. Apparently the oligarchs became such when infrastructure was simply given or sold at a loss to those that were in the circle of influence or clever enough to manipulate their way into industry. For the rest, the bottom fell out of the economy for two years and then again about 9 years later. There is a pretension about some of the wealthy folks here: fancy cars, arm candy, raising their children in absentia by house keepers and teachers....Nothing new to the western world, but very uncharted here.

Finally folks celebrate the New Year in Kazakhstan rather than Christmas. Most of the high end stores have what we would call Christmas decorations in the windows or on the walks. Add some snow and Almaty becomes familiar, and adds a cozy quiet warmth to my day.