It was early in the morning, on a train to Shymkent...

The scene:

1:00am, a four bed compartment in coupe car on a train to Shymkent.

A friend, who is an ex-Fulbrighter, and I were travelling to Shymkent, in the south of Kazakhstan, where he did his Fulbright to see old friends and for me to get a guided tour. Shymkent is a little like Texas in that you either drink the “look, we really aren’t part of the US (Kazakhstan), we’re just playing along” Kool Aid or are looked upon with contempt. But I digress. I was asleep on the bottom bunk, Bill the ex-Fulbrighter, on the upper one. A woman traveler was on the bottom of the bunks across from us. There is banging on all the doors along the car with some commotion following, then on ours. It is slid open and there stands a cartoon caricature of a guy ready to continue partying. He has on a short, tight shirt that doesn’t quite cover his hairy belly and sweat pants that are a touch too tight such that the ick factor slides up from ones stomach. Reminds me of when Lynne saw Mitch McConnell, our illustrious Senator from KY, in a local deli in Louisville; sports clothing too tight leaving little (and she does mean "little") to the imagination. She won’t ever be able to “un-see” that one. Again, I digress.

Vlad, Vlad, Vlad what has the world come to when you are in a mosaic on the side of a crumbling apartment bldg

He slaps Bill on the back and roars in Kazakh, "Vodka, Russian vodka!” and holds a half empty bottle up as if to prove he was telling the truth. Now I was dreaming about Lynne being along on the journey (no, really) and was in a semi-awake state when he decided to sit down on my bunk and slap at me. Nope, ain’t gonna happen, not with Lynne in the next bunk. So I used my foot to shove him to the floor and sternly said “Don’t touch me”.  What went unsaid was “you drunken SOB!” The guy starts to posture, holds up his dukes and the fight was on. I am now wide awake and realizing the mistake of my ways. Shit… OK, I guess I’ll duke it out with this guy in a berth that is 6x8 feet with two other people. I was well on the way to being righteously pissed anyway.  No punches thrown, just a lot of American WTF?! and shoving on his part. I side stepped his lunge and he fell onto my bunk. Shit twice. It was the fates telling me to act my age. The woman does the sensible thing; gets up and runs to the conductor’s berth and comes back with this guy who is five foot nothing and maybe 90 lbs straight out of the shower. Somehow he de-escalates the situation and we close and now lock the door.. He was escorted out into the hall by the conductor. All we heard was loud cussing in Kazakh and “Americanski” every two sentences. Bill asked if I had the first clue about what I was going to do with this guy. “Sure did”. Right, Mike.

A park celebrating the 20th anniversary of Kazakhstan as an
independent nation.

It was cold and grey in Shymkent made more so by the sm/fog and concrete apartment buildings. But we had a great time in the 30 hours we were there. We visited an American Corner in a local library where Bill met some of the kids he taught and a teacher of English who had these kids, about fifty of them, entranced. American Corners are located in many local libraries here in Kazakhstan where one can read, study, or converse in English about the US. I have taught at the one here in Almaty.

Seems everyone wanted me to notice the wee willie. So I took

a photo already

Shuzhuk, small intestines stuffed with horse meat and fat, then 

boiled. It should be remembered that Kazakhstan is just two 

generations removed from a highly nomadic society where one wasn't 

sure about their next meal and Tupperware hadn't yet made it

to Central Asia. Hence the high fat diet, boiled, which chased

bacteria, and "stored" in intestines. And the "pantry" was grazing 

just outside the yurt.

Beef heart in the foreground, horse to the right and sheep in the back

The large fat tails come from central asian sheep. I have seen numerous
ones in Afghanistan

As an aside, the construction here is typically cinder block walls where a 90 degree angle comes at a premium and re-bar is maybe there maybe not. The wall is finished with faux marble that is glued onto wire supports.. Again right angles are a thing of speculation. This leaves a large gap of air between the walls such that the marble is often missing or caved in due to some vandalism. It was very much the same in Gaborone, Botswana.
We visited a new park that was touted as a shrine to the people of Shymkent and the President, and was truly beautiful until I looked closely at the facade of marble, it was already failing. Also the steps there  had no consistent rise or run so anyone with compromised vision would struggle to anticipate the next step.

The figure is a "shanyrak" a revered symbol signifying

the top of a yurt, something that ties all of the supports together. It refers

to family and nation.

The symbol is literally everywhere. On much of the signage on
Shymkent, on small shields that are on the fence surrounding
the medical university where I teach, everywhere.

We went to a small Uzbek village, Sayram, where Bill met more of his students and taught some games. It was truly a blast. We had classic Uzbek “plov”, what we would call rice pilaf, that was amazing. A tradition here, one that I struggle with, is to fill a plate or glass if a guest has emptied it. So we had one toast after another with vodka, another, then another, then….. then back on the train to sleep the sleep of the dead but for the three year old in the adjacent berth who just wanted to play, or scream, or pee.

Finally, the mother lode! No bikes, just parts.

Not sure how I could be intoxicated AND hung over at the same time. Oh well another first.

The construction in Sayram is mud brick with mud facing. You will see from the photos that it can be very attractive. I don’t understand how it can hold up so well in a seismic area but apparently it does.

Some random observations. I think I have related how there is very little grey hair here as almost all the women and men of Kazakh origin dye it. People of Russian or Caucasian descent allow hair to go grey.

Spring seems around the corner. The ice has melted and walking is easier. I see couples walking hand in hand, and younger ones making out in the parks as they often live in a two room apartment with three generations of relatives. They sit on benches along the walks and seem oblivious. Somehow it seems sweet and not a little quaint. And we now have song birds for the first time since I arrived. It is so beautiful to wake up  to them. I'm disappointed that I took them for granted in Louisville.

The scale is poor but the crack is about 1-2 inches
wide and extends the length of a two story building.

A minaret, now about half the size, that is over
1500 years old and is on the campus of a
the school where Bill taught. You can see the crack
on the right near the base so don't go up and lean left.

And breaking news! I have been active in trying to acquire baseball equipment for a friend who is resurrecting Little League here in Almaty. It is a bit of a long story but suffice it to day that it is a most noble endeavor. I had written all over Louisville; to the Bats, Louisville Slugger, all the local Little League teams and finally to Little League headquarters asking for used equipment. Finally  Little League headquarters referred me to Pitch in for Baseball, a non-profit in Pennsylvania. They have sent used and new baseball and softball equipment all over the world and will outfit our teams with used equipment or new that they purchase at a 50% discount. So we have all we need. There is some fine print but wow, done.

It seems that patient encounters here are always interrupted by other patients (who open the door to see how the queue is moving or looking for someone) or drug reps. It annoys me (really Mike, you?) and the other day a colleague became so as well. I gave her permission to lock the door and blame me. She did so with a look of pure relief and things quieted down, we could concentrate, and the patient even thanked us.

Sanitariums are still very popular here. People will visit a physician to get a prescription to go to one much like we would go to a spa. But ours aren’t government funded. Once there they receive numerous injections and IV’s as the medicine isn’t any good unless it is injected or infused. They often leave refreshed if not with a sore butt and bend in the elbow.

All for now. I’m basking in the afterglow of the Little League equipment. My friend Timur, vice president of Little League Almaty, asked if we could go drinking after we hear the official news on Monday. I said sure to which he replied, “Mike, can I drink whiskey?” Uh sure, why not? “Good because my doctor said no and you’re a doctor.”

Preparing to depart Shymkent

 YOU try squatting on that commode..in a moving train.. at 2am...
with a touch too much vodka swimming around in your brain.

It's started. They invade by causing the populace to think that
their brand is innocent. Then....
BTW I wish McD's DID selldoner. Beats a Big Mac and
already has fries on the inside.

I am slowly becoming less intimidated. I dislike expat places but find myself there on occasion as it is just easier to get a beer and a burger. My diet is now exclusively vegetarian except canned tuna and the odd meat fest when I eat out. But my gut goes into full on protest afterward. So here I am in a state where the national dish is meat and I get a gut ache when I eat it. 

Still I try, although I am reluctant to get meat here as I see it handled by hands that are, well, bloody and filthy. I used to eat sausage but thought about all the parts in there that were like wise handled so though better of it. The produce is good and I can wash it. Mind you there isn’t epidemic gastroenteritis here but I’m just not in the mood to risk it. Rather unlike me come to think of it.

Even in the high end area of town this is just so.....wrong.

I have mastered the buses here to the extent that that is possible for a non-Russian speaker. For the most part there are just two speeds; too damn fast and stop. So the buses which are often jammed and one sneeze away from a major measles outbreak, lurch and stop such that it takes a while to get one’s land legs back. Most of the drivers here have been doing so for less than 10 years so it is no surprise that moderate acceleration and braking are for the most part a novelty.

The last week I have been teaching third year students how to do a quick screening neurologic exam. It begins with a case that I generally make up on the spot. The students then engage in a history and “physical”. It is here we discuss when to do the neuro exam. I find I seem to repeat the same tired refrain from the days in Botswana to Hilo to Rustaq to Hue to Skoder to…..”if you don’t ask the questions you won’t get the answer” So I lead these poor little lambs to the didactic slaughter only to rather sternly advocate for excellent patient histories and physicals, citing how “in my country we often hear headache and order a CT scan”! The presentation involves lots of interaction and playful shenanigans and is met with laughter and, I hope, retention. They are all engaging and eager at this point in their careers. And by the time they are in the 7^th course (last year of a two year internship) things stand to change dramatically in the health care sector here.

Testing for visual fields

There was this one woman however…who made the mistake of having head-in-cell-phone and was giving me eye rolls whenever we did an exercise. At the beginning of each seminar I inform the students that I consider it an insult to refer to mobile phones for anything less than translation. And that they are of course adults and can make their own choice, just do the phone thing outside and once you have left please don’t return. She gave a deafening eye roll and, well, it was a bad time on a difficult day, so she and her enabling side kick (a man) were soundly chastised to the point of head hanging. They bowed and returned to their seats. 

After class I pulled them aside and through an interpreter let them know that I knew that they could do the work, they just needed to care about it. The woman sniffed and said that the only reason she was here was because her parents wanted her to be. This is a very common refrain and while not unique to KZ (I see it often in the States) it seems accepted with a shrug by faculty. The thing that I am starting to appreciate is how the old Soviet system is really the only contextual framework that remains after less than a generation of independence.

YOU try to test pupils on some one a full 1/2m taller than you

People long for “Soviet times” as the parks were beautiful and there was order to daily life. I often imagine what it would have been like to awaken on Dec. 17, 1991 and realize that this was the first day of autonomy. One uses, and still does, what one is used to…..an autocratic protocol, wherein ones first concern on arising in the morning is not how to improve situations under one’s purview but how to be off the radar or at least to be a target not worth shooting. Ambivalence reigns.

Checking relfexes

I realize that seems harsh but the interns at least are rarely, if ever, all present and all on time. There seems to be little accountability and the physician pay is so poor that many admit that after they satisfy their parents they are out of medicine.

Now that I am not exercising other than walking I seem to feel older and heavier. The photos seem to bear that out. I look forward to getting back in the pool and saddle.  I still take stairs two at a time and living as I do on the 5^th floor “helps”. I have had a bad cold and am down to one lung, having coughed up the other and strained my damn chest. Everyone asks very kindly what I am taking for this. They have every right to ask as they have patients or relatives who have coughed like this and had Tb or died of pneumonia. Mine is a stupid lingering cough that is on the wane, still truly embarrassing and not a little painful. No antibiotics for Mikey, just patience. Like I have a lot of THAT…

The classes were held on the grounds of an old Soviet hospital

that has not been maintained. Never the less it would seem that

there are still patients there. It reminded me of Albania.

An old well

No clue except the tree is younger than the icons

Al Farabi, a beloved philosopher.

Nikolay Ivanovich Pirogov- Russian physician and
teacher

A walk the down Kabanbai batyr Street, about 6km. Warning: no narrative

Really not sure what to make of this

This type of quality graffiti is present everywhere

All the flats are the same floor plan the outside is the only space
one can control

Chicken heads for soup

It seems that all the old wood construction is dyed blue

snow soccer

Baptism Eastern Orthodox style

Almaty Medical college

Built during the Kazakh CCP

Russian Orthodox church

Icons

Russian Orthodox church

Pharmacy

The Rixos

Not really sure about this but it shares the same intersection as
the Rixos, the best hotel in town

Never had the guts to try one as by the time I would eat one

it would have been handle by hand at least four times

Very high end shoe store near hone

A Subaru purchased in USA. There must be a story