Final exam on the final day.

I have had the same translator both times I have been to Semey. She is an extraordinarily gregarious woman who is also a colleague and a member of the faculty in the Department of General Medicine. She has a round open face with an easy smile. Hers life is a struggle as she is caring for her husband who has renal failure and is now on dialysis three times a week, her teenage son (always a break even endeavor at best) and her demented elderly father-in-law. She is a MD/PhD and is paid a pathetic salary from the national government. And yet she refers to her situation with a wonderful joie-de-vivre.

Consulting

When I am giving master classes in Semey I lobby hard to visit local polyclinics so as to mentor docs there. Semey is one of just two locations in Kazakhstan where Family Medicine has a foothold. None of the docs are trained in Family Medicine per se but all act with a level of creativity and integrity that equals and often surpasses many of us in the U.S.

The class, my last after two weeks, was a final exam of sorts. Per the last post you know that the head in phone thing really gives my chain a hard yank. So I wrote a very complex case presentation with some obvious gaffs. Then split the class into eight groups of ten or so. I stated that “Those in your group are no longer your friends. They are your colleagues, your true professors. Learn from them.” Then had them participate in what amounted to a grand rounds- M&M-case presentation and a hard one at that. It incorporated all the topics of the previous two weeks into four patients, all members of the same family. Family Medicine. Get it?

Introducing the subject of the "exam" It's a big hall.

Testing for Rhomberg

Conferencing before demonstrating

These poor interns sweated bullets and held each other to account. There was lively discussion, laughter when they discovered my “mistakes” and coaching from all corners when they were asked to demonstrate how to examine various regions of the body. They still acted for the most part like high schoolers but this time the power struggle was tabled for some real life learning. I’d ask a pointed question, would of get both a “Da” and “Hey (nyet)” and then ask them to defend their choice. I kept emphasizing that this was the best place to really screw up as there were no consequences and very slowly I became trusted and, as happens in these classes, all spoke at once. Somewhere in there the answer was given and we would laugh and proceed.

Testing for Cranial Nerves 3,4,6

Cardia exam team. Almost got it right.

At the conclusion I thanked them all and challenged them to practice evidence based medicine. Then about twenty of them lined up to copy my presentation onto a USB key. I think that was one of the better complements of my experience in Semey.

Then off to SCAT Airlines to hope and pray that it stayed in the air long enough to get back to Almaty. It did and as I walked to the terminal, for the first time since I have been in Almaty, I could see clearly the close proximity of the Tien Shen Mountains. The temp went from -6C in Semey to +22C here. I can see green, no jacket or vest for the first time since late October. Nice.