PendlehomeKZ

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…