As of the end of January I will have been at this Fulbright gig for 5 months, half way through. I thought I would use this entry to try to thematically summarize the experience thus far.

Us and the FSPs at a local waterfall

By far the most fun was to surprise Lynne in Hawaii. I had cleaned my pad and had dinner and then rotted my brain on the web until it was time to call a cab and leave for the airport. The flight left at 2405 and it always takes a while to slide through customs and various check points. As I was waiting in yet another line a group of Chinese guys came through in full stereotypic (regrettably) form: talking loudly and belligerently, moving as a tight group. They had just come from the bar area and thought that I wouldn’t think anything of it if they cut in front. I had pretty well had it by then. I stood tall, squared my shoulders walked up to the closest guy, too close perhaps, and tapped him on the shoulder. He turned around and looked at me right in the chest, slowly moving his gaze to my face on which was a “WTF do you and your mates think you’re doing?” stare affixed to it. He melted (thankfully) and motioned to his guys that oops they needed to queue up at the back of the line, now some 25 deep. One guy wanted to stay put and I again straightened and sent him over “the look”. He went to the back and about 10 people applauded (!).

Jama, Cora, Asher, Grandpa, Judah, Malachi

I arrived a day ahead of Lynne so had a chance to get good and anxious. Forrest and his family took me to the airport where we bought leis and lay in wait. The FSPs spied her as she walked down the hall to baggage claim. Forrest motioned me to come out from around a wall and as she was glancing down, I slipped into view. The reunion was priceless. It was a good thing there was wall she could collapse into. We embraced a long and knowing embrace borne of 44 of relationship and all seemed right. It was 13 days of delight.

Getting in a birthday and farewell hug

The return was through Beijing. I spent the evening in a lounge with a bed and a shower one rents by the hour, cheap at twice the price.

I have been welcomed and embraced by an ancient, kind, gentle, and proud culture. Almaty is safer than Louisville-no guns. I was surprised at how that made such a psychic difference to me but it did and does. I live in a classic Soviet style apartment complex, on the top floor. The construction in that era didn’t include much reinforcing of the concrete so when the much discussed earthquake for which we are imminently due strikes I can ride it down.

I have made several home visits and can say that ALL the apartments of that era are virtually identical. I have learned how the Soviets controlled the Kazakhs at so many levels, large and small. Still many Kazakhs of my generation long for “Soviet times” as all the streets were clean, parks were beautiful and most services were free. Self-determination is tough when one awakens on December 17, 1991 to the realization that one campaign is over but the struggle continues; how does one govern, survive one devastating depression, then another, and protect that which is uniquely Kazakh. And here it is less than a generation later. Almaty is becoming a world hub.

Today in the mountains. That's Bill Shuey, a former Fulbrighter.

Health care struggles to become reliable. It suffers from “Soviet times” in that most doctors are of the generation where ambivalence reigned along with bribes (so called “informal payments”) as did bad anecdotal medicine. Children are still admitted to hospital for two weeks with a simple fever where they will receive twice daily injections of an antibiotic that is toxic to the kidneys, but only if the parents can and are willing to pay the bribes.

Evidence is slowly creeping into the lexicon of medicine here. I give a presentation (they prefer the term “lecture” which I resist) on colds and appropriate use of antibiotics. To my surprise, when the students are polled, not one is willing to use antibiotics in this case. It will take at least a generation go bring medicine into the rank of western nations. Kazakhstan has moved from somewhere near #120 to 60 in outcomes and other parameters measured worldwide. The US is stuck with devoting more than twice as much of its GDP on health care per capita than the next country in rank and, wait for it, it ranks 37^th. It is as scandalous as it is tragic.

I have fallen in love with this nation. The vistas are no more expansive than in Montana, the mountains no more beautiful than the Cascades, the cold no worse than Madison, WI with which Almaty shares latitude. It is of course the Kazakhs, like the Dinka, like the Tajiks of Afghanistan, the Kosovars, the Yazidis of Sinjar, the Kurds, and the Batswana that make this such a unique experience.

 

After a 900 stair climb to the top of a retention dam
that will  prevent a mud slide from inundating Almaty.

I have found that the evolution of Kazakh Family Medicine is about where we were in 1970; rigidly drowning in anecdote and territoriality. A primary care physician makes less than 500USD a month. A pharmaceutical rep makes 8050USD a month with a car, expenses, and living allowance. Of a class of 3000 graduates, less than 20 might be practicing medicine in 5 years. If they are paid more and are held accountable with less draconian consequences things will turn. There is little horizontal integration where one sees a physician within an ongoing relationship and no vertical integration where one visits a specialist (the term is used very loosely here) and returns to their primary care doctor for review and context. I contend, and think I am fairly accurate, that all the polyclinics could be condensed down and around to a handful of Family Physicians.  

I have made some lifelong friends here; colleagues in medicine in the public sector, private practice, and at the consulate. I get to practice enough medicine through consults to scratch that ever present itch. And my ideas are always welcomed, perhaps hotly debated (a good thing) and a consensus is arrived at which seems to satisfy my colleague, the students, the patient and myself.

More later this week.