More impressions. Warning, no pics

I’ll journey a little deeper into my hippocampus to further explore my impressions of Kazakhstan over the last five months. I’ll do this in bulleted format as it seems better suited to streams of consciousness. Formatting the blog on this site is awful so please bear with me.

• People here are kind and gentle. I have yet to see even a hint of hostility. In Botswana there was laughter and broad smiles that would disarm any conflict. Here it seems to simply be an unwritten part of protocol and seems to be deeply imbedded into the culture. The Russians can be cranky but in the main seem to behave and get along.

• I had mentioned early on how that there aren’t a lot of smiles on the street here. Well that was a very superficial and uniformed observation. Kids smile all the time, adults dote on their kids endlessly. Grandparents do a lot of the child care here and are quietly and extremely patient. And the smiles are there, I just need to offer my own to see them.

• I haven’t observed any one raise their voice to a child here and haven’t seen any tantrums. And I have been in many environments where I would expect it.

• Kids are bundled up in this weather such that they are round on all their corners. They still are placed in buggies in -10C weather but all seem to fall fast asleep with the warm against the cold. I can appreciate that. I leave my window open in -20C weather and like it that way.

• Homes get quite crowded as people of numerous generations and familial iterations call the same flat “home”. So much so that privacy to say nothing of intimacy is difficult to find. Thus one can walk down the street and see sales persons hawking furnished apartments for rent by the hour, cheaper than a hotel here. It can also come with your very own concubine, your chioce of gender, should you be so inclined.

• I pay 1000USD here for my apartment. Compared to the ones of other expats it seems about right. Some are far and away nicer and less expensive and are either subsidized or away from downtown. I live in what is known as the “golden rectangle” wherein there are numerous bars, restaurants, high end stores, and expat hangouts. I live just up (south) of a good grocery store where I have slowly become known as the only non-Russian speaking regular. So all the staff know to simply point. I will sometimes go with a list of items in Russian which makes everyone smile.

• There seems to be little sense of personal space here. I have been to numerous places over the years and this is not unique to KZ. Still lines are not 'lines" in the western sense, one does not “wait” for someone else to go first through a door or climb on or off a bus, etc. One just does moves. Were you to try that in the US it would cross numerous lines of propriety and angry words would be exchanged. The Vietnamese were the absolute worst at this. To each culture its own, and, while I don't (and will never) fully understand this one at least, again, there aren’t guns on the street.

• People use their horns almost as an alternate mode of communication here. But angry glances are rare. Road rage is unheard of in a city that now has approximately twice the number of cars it did 10 years ago. That is of course unless you are stuck in traffic with an American who needs to get to the airport and discover the cause of said jam are the French (see previous blog posted 12 December). I am chuckling about that epic experience even now.

• Medically it has become frustrating in that I see where things are and have the perspective to foresee the consequences of some of the decisions, many of them political, that can affect availability and quality of care for the next several decades.  Here, as in many of the places I have been, way too much lab is generated. This is a particular bone with me in the US as there really is no excuse for the added cost and risk if the lab isn’t going to influence care. Here so much inappropriate and extraneous data is generated that you become your lab results. And the forest (you) becomes lost for all the trees (the lab data). I have yet to see an abdominal ultrasound that doesn’t make diagnoses that have no correlation to clinical circumstances. People are told they have “changes in the liver”, “pancreatitis”, “pyelonephritis”, “cholecystitis” and the like all without any clinical circumstances that would indicate either the need for the test or that the test results were accurate. And, with props to Eli, I will state to the students or those that I mentor: “You can fish or you can hunt. Which is a better idea in this case.” I have said it so often that the students will finish it in broken English whereupon we all dissolve in laughter!

• There is very little precision to history or physical taking, a big sore point with this Luddite masquerading as a physician. I find myself getting hoarse, so often have I repeated the mantra, “If you don’t ask the right questions, you won’t get the right answers”. Folks think nothing of interrupting a patient encounter, no knock, excuse me, nothing. It annoys me to the point of TUMS, but it is the status quo. This happened in Bots, and a lot in other places but I don’t remember it having been as problematic. Maybe it’s age (mine), maybe the lack of endorphins (jeez I am out of shape), who knows. Again I harken back to my personal yogi master, Bethany: “Smile and nod, Papa. Smile and nod.”

• Men ask directions (!) here all the time. Sometimes of me and when I inform them I don’t speak Russian, they smile and move on.  

• There is little sarcasm here.

• People don’t say “I’m like, and then she’s like….” I like that. No vocal frying either. All the voices are melodic and genuine.

• As I walk down a busy sidewalk I see lots of black hair belonging to people of all ages. There is no gray hair here, everyone dyes it. And no one is bald. Ah, would that I had those genes.

• Like all the other places I have been there are a lot of medically unexplained symptoms here. In Botswana it was waist ache, dizziness, and generalized body weakness. In Vietnam it was general malaise, InTurkey it was always cough, same in Albania. Each had its own set of contextual and cultural concerns but it made for a long day for this doc. These symptoms are put forward as the individual feels a need for medical care since she has something similar to one of the maladies a family member or neighbor had who then was informed that they had  “XYZ”, received treatment, and 'recovered'. In short we are our own worst example with this craziness and we seem to reinforce this modality worldwide. Here it is tachycardia or bradycardia. 

•  I was whining about this to our Bethany, an ER nurse with an enviable intuitive sense of medical circumstances, and she replied that at least I didn’t have to deal with “patients with chronic fatigue syndrome and fibromyalgia with metastases to the eyelashes!” True that and then I thought about it. There is literature that states the above diagnoses occur where ever it has been studied. But I have yet to see it anywhere other than in the US. Just sayin’.