At times like these, eloquence fails. Within the confines of
my moth eaten brain I have begun this post on many occasions only to lose it
once my mind’s eye dwells on the next experience of the day. Perhaps a cliché:
- The days seemed long but the months were short.
Being American and a physician, I hit the ground here ready
to teach and consult. And while I’m slightly embarrassed to admit this, it
became clear that I was in what seemed like a time warp; new language, new pace
to life, new colleagues. This of course has been the status quo for many a
Fulbrighter. In fact it would seem I was one of the more fortunate as I had the
opportunity to teach and mentor throughout my host country. Most of my
Fulbright colleagues from this part of the world were consistently in one
location. Once I was teaching, the weeks flew.
There is a saying in relief work that week 6 is where things
seem to compress and condense into what will characterize your experience. This
was certainly true with all my relief experiences in the past. Here the first
six weeks were ones of relative inertia. I questioned if I was in the
appropriate place, with the appropriate university and faculty. Naturally in a
country where there are something like 120 ethnicities and nationalities there
was miscommunication. In beautiful retrospect, even though my aggravation was
in the red zone, the time spent with little to do was of value. I could gauge
the rhythms, pace, cultures. So in random order:
- First impressions are nothing more than first impressions.
And mine were superficial to be sure. What made this experience most enjoyable was that I had a
chance to have many firsts. Most everyone is employed and while there is little
adult levity on the streets, their children will bring it into the future. Kids
are kids; laughing, teasing, squealing, flirting. They will free their parents
from the sobriety inherited from Soviet times.
- American health care is in chaos.
No news to those of us in the industry (notice I didn't say, “profession"). One gets a valuable opportunity to compare and
contrast when abroad. The US spends twice as much on health care as the UK. Yet
our quality of care ranks 37th in the world by most metrics while
the UK regularly ranks in the top three. Here the US out spends KZ by more than twenty times.
Kazakhstan, while it is still in relative infancy as a nation, is steadily
improving and its health care should be in the first rank by another generation. With a single
payer system there can be rampant corruption as exists here in KZ but access,
prevention, and quality are more efficiently affected and sustained.
As an
American, when I disembark from the plane in Hawaii and am greeted by 80%
obesity and 10% diabetes (worse in Hawaii), I will be at once glad to be back
in what is familiar and will find myself shaking my head thinking, “If only…”
- Personal space is not personal here
In a country where women routinely walk arm in arm, and men
look straight ahead, there is a definite lack of Western culture-type courtesy.
No door holding, queuing, deference. A door will open and people will pour
through. Cars will engage in play where they will come as close to you as
possible and at a very advanced rate of speed when you are crossing a street.
Never mind that you are with the light or in a cross walk. To be fair, this is
true in almost all places I have visited over the years, Vietnam being the
best/worst example. I am not sure why I find it more annoying here. Age? God
forbid.
I set out on the Fulbright process simply thinking that it
would be cool to do one, nothing else. As the process evolved it became clear
that this would be a chance to actually define my legacy, my gift back to
medicine if you will. In false modesty, I feel that I have done so. I have done
some of my best work here. I learned from my experiences in Botswana, and other
places that sustainability is both key and at best fleeting. Kazakhstan is on
the threshold of what seems like a simple binary decision; spending resources
on primary care specifically the most pragmatic of specialties, Family Medicine
or on more sexy and easily attained equipment.
One of the most pressing problems is that Kazakhs live in
what amounts to a benevolent dictatorship. Sure there are elections, the most
recent being in April. But when Nazarbayev won with 98% of the vote one
suspects the fix is in.
There is an intense pride in the heritage of this country.
Kazakhs have asked me what my country was like 500+ years ago whereupon I
confess that most Americans have very little awareness of our indigenous heritage.
Kazakhs celebrate it and are reminded of it daily. Yurts, horse meat, beshbarmak,
kumyz, all of it is ancient and revered.
This is my final day here and not only eloquence by simple
vocabulary seems to fail. The Kazakhs are a kind and gentle people. They can be
out spoken but things don’t escalate as they do in the US. I have never felt as
safe as I do here, even in Botswana. There are thugs to be sure, but they aren’t
armed with hand guns. I have never seen an animated conversation end in anger
except yesterday when I was buying an item and a man was trying to return one
for his money. The sales lady balked and he started to shout. In Louisville
this could rapidly escalate into a confrontation dutifully documented by
countless bystanders on their smart phones. Somehow, people here have the
ability to ignore and feign naiveté. Communication is often through softly spoken
conversation so much so that I strain to hear. The social rhythm here, even after 10 months,
seems undecipherable.
So I will miss Kazakhstan; her people, history, her emergence
into young adulthood in the family of nations. I will return for more master
classes as it is key that outside endorsement of Family Medicine continues.
The
US has all the physical features for which Kazakhstan is famous. I think those
in the US are more grand. We have a “steppe”, huge mountain vistas, remote back country, canyons, and are bordered by four oceans (Alaska). Yet we lack
patience and a kindness of being that is a treasured part of the fabric here.
Many Kazakhs, and all of the medical students, I encountered want to visit or immigrate
to the US. I do my best to disabuse them of this notion. There are more violent
deaths in my home town per year than there are in the entire country here.
People here, like in Botswana, get along because they must. They have social tools to do so, tools so
subtle that I become aware of them only on reflection.
So I leave tomorrow morning, early. As has become my habit I
won’t look back. I will miss friends and colleagues. But those relationships
will cool as they always do in my life when I re-enter the US. Painted with broad of strokes, Kazakhstan has been that kind person who you meet when you
are new to the neighborhood. The one who invites you to share meals, family,
and friends. Who seems to selflessly indulge your needs and guides you through
early assimilation. And who seems to do so with little effort and with a kind
and gentle lightness of being.
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