4=3 and 2=1

4th year student (L) testing on X-rays

Last night I arrived home from a two week stay in Astana where I gave master classes in primary care at Astana Medical University. I stayed in a hotel across the street from the university that had rooms for rent in 12hr increments. I am informed that romantically inclined couples often live with extended family such that there is very little discretion available thus contributing to rather apparent public displays of affection. Parks, malls, even buses seem to be where affection is demonstrated; quite innocent by western standards but remarkable for a Muslim culture. We in the West joke about how a couple should “get a room!” and indeed many couples obtain a flat or a room for half a day for some needed intimacy that is either within an existing relationship or purchased. Oh and the elevator uses a different logic than I have experienced wherein one pushes "4" for the 3rd floor and "2" for the 1st.

The iconic Bayterek ("tree of life") tower.

For the first time in my sojourns I asked to have my room changed as the afternoon sun baked the interior, a good thing when it is -40C outside but the weather last week was temperate and the heating hadn’t been turned off at the hot water generating plant. (Here in post-Soviet Kazakhstan domestic heat is either “on” or “off”. You can have as much heat as you want as long as WHAT you want is what is available. No individual control is offered, thereby assuring state control.) Opening the window was pointless as it was stuck (all too common), the breeze was blowing away from the room and the air conditioning hadn’t been turned on yet. So I asked if there was another one available. I knew there was as I was the only one registered at the time. I pointed to some that were out of the evening sun and was told that these were too noisy. “Noisy?” “Yes from the people on the floor below”. In short order the room change was sorted out only to have a knock on the door wondering if I wanted a “massage”. I thought, “Aren’t you supposed to be on the floor below?” It would seem that one can also buy a room, and love, by the hour.

Every city has at least one
statue of Abay

I have stayed in some real sketchy places over the years. Full disclosure, I have generally sought them out as after I get used to the rhythmic thumbing and moaning one wall away, the morning brings out kids and the greater community that is gestated by affordable hotel rooms. Folks will cook outside, sit and chat, and if I am lucky, invite me to partake in the food. The palate of colors in these places is generally welcoming. If I am asked what I do, I quickly find I am holding “community rounds”, something I find I enjoy and for which there a desperation borne of a need to be reassured that the perceived problem is minor and self-limited.

Cranes bristling over the EXPO 2017 site, none of which
were moving.

Astana, translated ”capital”, is a boom town, capital city of Kazakhstan relocated from Almaty in the late 1990's. Conventional wisdom holds that the location is more central to the country, thus invigorating the economy and not in an area as seismic as Almaty. Interestingly the town that was there previously was Alqmola or “white grave”. Astana is the Houstonian equivalent of a town without an identity. New construction adds capacity to a population that is too small to fill it. If all the new apartments truly are, or were, needed there would be general grid lock. There isn’t. Yet the town is in the shade of about 70+ construction cranes that spike the horizon. Centralized parks seem lightly used. Astana’s soul is either evolving, or truant.

Nur Astana Mosque, a gift from Qatar

Some of the unique architecture

Along the river front

Presidential palace

Astana will play host to an Expo in 2017 https://expo2017astana.com/en/ and is constructing a square kilometer sized “village” purported to be environmentally green and very modern, at least on paper. It is across the street from a couple of new hospitals and clinics where I did some consulting. I counted about 30+ cranes in this location alone. Curiously, few were moving, few trucks were going through the gates, and I could see activity on only few of the planned structures. To be sure the architecture in Astana is beautiful and avant garde, especially for the CIS. But I just don’t see how the office buildings could be occupied more than, say, 25%. I was on the central avenue of the new area of Astana at the end of the work day and there wasn’t a stream of people coming out the doors headed for home.

Astana is like a teenage daughter. She isn’t sure who she is or will become but feels pressured to keep pace, if not set it, with her cohort. She seems to want to be like Almaty and at the same time shun it. So she understandably becomes consumption oriented, big time. Astana has no history dating back past the late 90’s so almost everything is without context. Old is painted over, sided with faux marble, disguised as new.  It seems there is no true sense of community in Astana (it has yet to exist for a generation) yet it is populated by the entire spectrum of ethnicity and circumstance. In fact I saw the first openly gay couple there. True women hold hands and walk arm in arm here but this couple was just different, refreshingly so, in their demonstration of affection and bravery.

 

There are four malls, each within walking distance of the other. The food courts there are populated by the usual outlets of local food, both near and central asian. But each has a KFC, Hardees, and several have a Burger King. There are numerous other outlets of the above three dotting the avenues throughout Astana. Apparently all are owned by one individual who is purported to be the second richest person in Kazakhstan.

One of my favorite presentations is on Diabetes Type 2. I open with asking the students regarding their favorite food and many will enthusiastically shout “KFC!!” We explore why it so enjoyed, the amount of calories in a four piece meal, the nutritive value of the accompanying Coke and fries. We discuss exchanging a diet rich in lean meat and root vegetables for one of lesser quality calories that is at the same time more calorically dense. I point out how this will become a huge public health problem in their generation of physicians as diabetes is a hugely expensive disease. This is met with a shrug as no one here is used to campaigning for the greater good, there isn’t a protocol, or a manual to provide a sense of how engage for change.

XXXL does not refer to an adult movie
house. It is the Wal Mart of Astana and
a window into the possible future 

I’ve commented on this in previous posts but I bears repeating. I find I have become more protective of the innocence and naiveté here. The novelty that first defined my stay has worn to an ever thinning veneer. I am amazed how Kazakh culture defines itself as both ancient and modern. Any celebration will include singing of traditional Kazakh songs and dancing by young women in traditional dress.

Pride is displayed in histrionic relief through statuary dramatically posed with  forward looking figures, especially on this the 70^th anniversary of the victory over Germany. And yet progress seems to be at least in part defined by how closely Kazakhstan culture has progressed, superficially, toward the US. Many identify with the West when they eat American fast food. Walking down the street in Almaty I recognize America in the sixties, before the super-size generation.

I have had more photos taken of me in the last 10 months than the last 63 years. It’s interesting to me to see the evolution of my appearance. I have lost some weight here but have lost height as well due to stooping at the computer desk and when discussing cases with much shorter students and colleagues. With the advent of Spring I find I am less stooped as the weather is brighter and I now am aware of my slovenly posture. 

Notice the slumped and round shouldered posture.
Ugh, gotta fix that

And in just two hours Lynne arrives! We plan a short holiday in the central east of KZ, then to Astana for a night, then to Semey for two. It seems to me now that I have seen some of the country that Semey has more of the “old Kazakhstan” than other places, probably because when it was Semipalatinsk it was a relatively closed community due to atomic testing.

I leave here in just seven weeks. I know I remarked how most here seem to look straight ahead without smiling or acknowledgement. It seems I just didn’t know where to look. I feel secure here. There are few guns. There is a tolerance that is at once annoying (there is no awareness of personal space) and refreshing. Folks here seem use laughter to disarm, similar to Botswana but more reserved. Patience hasn’t been sacrificed for digital screen time. Yet. 

I will return to the US quite a bit older in appearance as I will have not enjoyed exercise for what will be close to a full year. I will follow Kazakhstan as she emerges not unlike the worried parent who acknowledges that after nurturing she will need to learn from her failures.