VI
Motorcycles; Medical Clinics; Mowers
oo0oo
We were walking along a street near our office and not too far from the apartment. It is called Jibek Jolu Avenue, or the Silk Road. There is a street market there which we often frequent as much for the fresh fruits and vegetables as the chance to interact with locals whom we have come to know. The man, his wife and children who always try to give us the best of their offerings; the woman a stall or two away; the young pregnant woman selling the nuts in the inside part of the market. She likes to practice her English and knows exactly what I want and how much of each item. Nuts and dried fruit are sold in bulk and in the open. They are totally unprocessed and very tasty. I mix my own trail mix – cashews, raisins, almonds and pistachios - as a late evening…well, anytime, snack.
Bishkek Bikers
We were almost at the corner where we turn to go to the apartment. There were sirens on Jebek Jolu. We waited to see what was coming; a natural voyeuristic tendency. There was a deafening roar in the distance in addition to the sirens. Within moments the police cars passed and then the large group of motor cycles. It was a rally of some sort and, but for the Kyrgyz flags and Cyrillic writing on signs, it could have been Key West during the poker run. Every shape size and make of motorcycle passed by, except perhaps Harley Davidsons. The riders were as eclectic as any group of riders I ever witnessed in the US, and they appeared to be enjoying themselves to an equal degree. I later learned that it was in fact a rally of bikers from all parts of central Asia who were gathering in Kyrgyzstan for the to-be-annual event. Motorcycle riding as an art form is not so popular in this part of the world as elsewhere. There are scooters and motorcycles in small numbers on the streets of Bishkek, but this was the first time I had seen any riders who were dressed and rode bikes which represented the true biker spirit as we know it. It was an event worth far more than the time taken to watch.
We were almost at the corner where we turn to go to the apartment. There were sirens on Jebek Jolu. We waited to see what was coming; a natural voyeuristic tendency. There was a deafening roar in the distance in addition to the sirens. Within moments the police cars passed and then the large group of motor cycles. It was a rally of some sort and, but for the Kyrgyz flags and Cyrillic writing on signs, it could have been Key West during the poker run. Every shape size and make of motorcycle passed by, except perhaps Harley Davidsons. The riders were as eclectic as any group of riders I ever witnessed in the US, and they appeared to be enjoying themselves to an equal degree. I later learned that it was in fact a rally of bikers from all parts of central Asia who were gathering in Kyrgyzstan for the to-be-annual event. Motorcycle riding as an art form is not so popular in this part of the world as elsewhere. There are scooters and motorcycles in small numbers on the streets of Bishkek, but this was the first time I had seen any riders who were dressed and rode bikes which represented the true biker spirit as we know it. It was an event worth far more than the time taken to watch.oo0oo
I have already discussed my experiences with the dental clinics here. My experience with the public dental clinic was, well, interesting, but I found the dentist to be competent. The facilities are dreadful with the typical long dark hallways lined with worn furniture on which to wait for a turn in the large room filled with ten or more dental chairs each with its own dentist. But I had a root canal at a private clinic which had more of the appearance of a dental clinic as we know them. The dental chairs were older and there is no TV or headphones to listen to your choice of music while the dentist goes about her business, but for about the equivalent of one hundred and fifty dollars, I got a root canal and crown. And it was painless.
I had some gastro-intestinal issues resulting in a painful stomach that did not let me sleep an entire night. I was able to rest by morning and stayed home. That caused the ever watchful office staff to call and inquire as to my well being. When I told the story as un-sensationally as I could, they still insisted that I should go to the doctor. Vladimir and Ermek were at the apartment in a flash. Ermek had called his aunt who worked at the public clinic as a lab technician. Vladimir drove us there. In typical Soviet fashion, the building was long, three stories with the first floor about eight steps from ground level. No ramps, no handicap entrances and no apparent elevator inside anywhere down the long dimly lit central corridor. Ermek’s aunt connected with us and told Ermek where to take me. We went to a rather neat but dated office where a man sat at a desk. A doctor. As we entered and Ermek told him our problem, he put on his lab coat and escorted us to another room where there was a younger doctor already appropriately dressed behind another desk. The room itself was off the main corridor and, like all the others, had a few pieces of old furniture; assorted chairs on which to wait, a couple of porcelain covered metal topped tables and the doctor’s desk. A patient or two came and went as did a couple of nurses with their high topped hats more reminiscent of a chef than a medical professional. The doctor began asking questions and taking notes.
One of the public medical clinics in town
A few questions, some universal doctor scrawling on pads and in notebooks, and the doctor, with all the self assurance of the world’s best physician, quickly outlined the additional information he would need to make a proper diagnosis. Within minutes we were off to get blood tests. This was Ermek’s aunt’s area. We went to her lab where, I was told to wait. The lab was a narrow room with one window at the end. A long counter ran down one side and the other had a small table with an oven and gas burner. The burner was used, as best I could tell, more for heating water for tea than anything else. In the corner near the window on another small counter top was an older looking centrifuge. The long counter was cluttered with test tubes. Some were empty others had blood in them to varying levels. After a few minutes, I was told to sit in an old chair near the window. The chair was missing one arm. I was instructed to sit so that my arm would lie on the chair’s remaining arm. The technician put the surgical tubing on my upper arm and began to look for an appropriate vessel to stick the needle. The needle was from a closed package and had a vacuum tube. I always check for such measures. After a bit of familiar poking and pressing with her finger, the technician finally called another woman who came in and within seconds expertly drew a tube full of blood from a vein in my arm. The technician then took the vacuum tube, removed the rubber stopper and poured blood into several other open tubes on a rack on the counter. On scraps of paper she wrote the necessary tests to be performed and wrapped the paper around each tube. I silently hoped that the paper would not fall off or blow away before the tests could be run.
I also had an ultra sound of my stomach. All of these tests in the public clinic are done if fairly rapid succession. I waited for the woman in before me to get up from the table and readjust her clothes. This lab was in a different building in the same complex. This particular complex of clinics is also a teaching hospital. There were numerous students from various countries, most notably, by the kumises of the women in addition to the distinct physical features of the students, India and Pakistan.
All together it was an interesting experience which I had hoped not to repeat. In a day or so we returned to get the results of the tests. Ermek took us to the same floor where the lab was located. At the end of the hall there were several tables and chairs seemingly stored or unused. On one of the tables there were several small cardboard boxes from various types of laboratory supplies. In the boxed were slips containing names of patients and lab test results. The protocol, as best as I could determine from Ermek’s actions and explanation, was find your lab results and take them for your consultation with your doctor. In order to get your results, you would pick up the stack of slips to go through them one at a time until you find the slips with your name on it. After you have your results, you proceed to the office of the doctor who ordered it to get an interpretation of it, or perhaps, but not in my case, a diagnosis.
After several minutes and after going through the stacks at least twice each, Ermek decided that my results were not there. He found his aunt to ask why that was. She, to my relief and embarrassment, had not put my results in the customary pile of results but had delivered them to the doctor. I tend to be a common person with respect for the common man and respect for the people in whose country I am living at any time, but there are times when I am secretly glad that the local people treat foreigners a bit differently than other people. They are particularly sensitive to Americans, thinking that Americans are accustomed to very special treatment. Although we never actually receive the treatment they think we do, it is certainly close to that level in situations such as this. I was grateful for the gesture.
The doctor told me everything I did not have and all about the normalcy of the tests. At some point I mentioned my high blood pressure. He immediately ordered an EKG and ultra sound of my heart, and more blood tests. And, since I did not provide the requisite urine and … other samples, he reordered those. As an American, I am accustomed to leaving my doctor’s office with a specimen bottle in plastic wrap and other appropriate specimen collection paraphernalia. Those things do not exist here. I later learned that people here tend to save certain types of jars and bottles for such contingencies. Even the pharmacies could not understand my request. I scoured the apartment until I found something suitable.
The EKG was done immediately and quickly as the line was long. The next blood tests were done by a rather unpleasant nurse who found the vein quickly, stuck the needle expertly, and then did something as she pulled the needle out that was quite painful and left me with a nice black and blue spot on the inside of my elbow for the better part of a week. The ultrasound of my heart was in a separate lab from the prior ultrasound and the cost represented my non-Kyrgyz nationality. Even then, it was very inexpensive; five hundred som or about twelve dollars. The entire costs of all the tests and clinic visits was so small that it was not even worth trying to get some sort of reimbursement from my insurances company, if that would have been possible. Twelve dollars for the older and more prominent doctor, three dollars for the EKG, and so on.
I was quickly becoming frustrated. I was still not feeling well and had not gotten any indication of what I might have. In the meantime and because I knew from prior experiences that early contact was necessary, I contacted MedEx the insurance service that will take you to a better place if you need serious treatment while in developing countries. They initially referred me to a German clinic that we discovered was no longer in business. My confidence in this company was now shaken. They then, however, referred me to another clinic which we had heard about. It is run by a woman doctor named Irina. She works for the Canadian mining company and treats all of their workers including giving them physicals before and after their tours of duty high in the Kyrgyz mountains.
I managed to get test results from all my tests, including the EKG and ultrasound of my heart. I had scheduled an appointment with Irina’s clinic and, at the suggestion of the public clinic doctor, an upper GI endoscopy to be performed at another private clinic devoted mostly to performing tests of various types. I also forwarded all the test results of the tests I had already taken to the MedEx insurance company who, after having them translated, eventually responded with their thoughts on my malady.
The endoscopy was scheduled a day after my scheduled appointment with Dr. Irina. She, as it turned out, was occupied with a dying patient so I was seen by a nice young man – a doctor also – who spoke excellent English and seemed to be knowledgeable. He looked more like a military man than doctor, dressed in green tee shirt with matching trousers folded neatly into high laced black boots. Nonetheless, he was professional in his demeanor and appeared capable in his knowledge. He recommended that I complete the endoscopy and return after.
The clinic where the test was performed was a professional and neat appearing facility. It was necessary to register and I received a patient card for perpetual use. The waiting area was modern, clean and neat. Magazines in Russian adorned the low table in front of the padded seats in the waiting area. My name was called and Julia, Olga and I went to the room where the doctor and nurse were to perform the endoscopy.
The room was small containing two chairs, a small table, an endoscope and computer and a table on which patients laid. We were definitely a crowd, but no one objected, sensitive to the fact that the language barrier itself creates additional apprehension. The nurse said very little, but the doctor seemed to be a nice sincere fellow. He outlined the procedure and, after he reviewed my other test results, the results he expected from the endoscopy.
After a few brief questions translated by Olga and Julia, I was told to open wide. The doctor sprayed an anesthetic into the back of my throat to numb the throat and calm the gag reflex. The nurse placed a plastic circular device into my mouth and told me to bite on it. This was the opening through which the endoscope was to be inserted. I was told to lay on my side and tilt my head back. The part that was missing from what would have been done in the US was the intravenous sedative, apparently considered an unnecessary luxury here.
The doctor fed the endoscope into my throat and down into my stomach. After ten or fifteen minutes of very uncomfortable probing and looking, the doctor pulled the scope out and I was finished. I think the procedure was performed competently in other respects and the doctor told me that other than several spots on my stomach wall that appeared to be healing, everything was fine. He also said that I had a kink of some sort in my small intestine as it exited my stomach, but he was able to un-kink it. Formal results would come later along with a DVD, which in actuality never was produced.
I did return for the results, I returned to Irina’s office and met with the same young doctor as well as Irina. As I said, the entire cost of this marathon of medical clinics and tests cost such a small amount that it was not worth the time to attempt to process a claim. I may have spent, including the private clinics and all the tests, one-hundred fifty dollars. Even if it was two hundred, it was a fraction of the several thousand dollars worth of medical treatment by US standards. I do not think the quality was always the same; In fact, I am disappointed by the quality of the medical care here. I had expected more from the Soviets. I wasn’t necessarily expecting the system to be at the level of Western medicine, but this was basic treatment and I felt that, in my case anyway, they did not deliver. Most of what I have seen in the former Soviet Union is not too bad. Not to the level that they professed for all those Cold War years, but not as bad as we always thought it was either.
I contacted MedEx and transferred all information to them as I received it. And, after all that, I was told that I was ok. And in fact after several tortuous weeks of visiting clinics in Bishkek, I indeed improved. I was reminded of the humorous story about cold remedies I have heard in several variations, and of which there is an exact Russian equivalent: Take the remedy for fourteen days and your cold will be cured. If you do not take the remedy, your cold will last two weeks.
A few questions, some universal doctor scrawling on pads and in notebooks, and the doctor, with all the self assurance of the world’s best physician, quickly outlined the additional information he would need to make a proper diagnosis. Within minutes we were off to get blood tests. This was Ermek’s aunt’s area. We went to her lab where, I was told to wait. The lab was a narrow room with one window at the end. A long counter ran down one side and the other had a small table with an oven and gas burner. The burner was used, as best I could tell, more for heating water for tea than anything else. In the corner near the window on another small counter top was an older looking centrifuge. The long counter was cluttered with test tubes. Some were empty others had blood in them to varying levels. After a few minutes, I was told to sit in an old chair near the window. The chair was missing one arm. I was instructed to sit so that my arm would lie on the chair’s remaining arm. The technician put the surgical tubing on my upper arm and began to look for an appropriate vessel to stick the needle. The needle was from a closed package and had a vacuum tube. I always check for such measures. After a bit of familiar poking and pressing with her finger, the technician finally called another woman who came in and within seconds expertly drew a tube full of blood from a vein in my arm. The technician then took the vacuum tube, removed the rubber stopper and poured blood into several other open tubes on a rack on the counter. On scraps of paper she wrote the necessary tests to be performed and wrapped the paper around each tube. I silently hoped that the paper would not fall off or blow away before the tests could be run.I also had an ultra sound of my stomach. All of these tests in the public clinic are done if fairly rapid succession. I waited for the woman in before me to get up from the table and readjust her clothes. This lab was in a different building in the same complex. This particular complex of clinics is also a teaching hospital. There were numerous students from various countries, most notably, by the kumises of the women in addition to the distinct physical features of the students, India and Pakistan.
All together it was an interesting experience which I had hoped not to repeat. In a day or so we returned to get the results of the tests. Ermek took us to the same floor where the lab was located. At the end of the hall there were several tables and chairs seemingly stored or unused. On one of the tables there were several small cardboard boxes from various types of laboratory supplies. In the boxed were slips containing names of patients and lab test results. The protocol, as best as I could determine from Ermek’s actions and explanation, was find your lab results and take them for your consultation with your doctor. In order to get your results, you would pick up the stack of slips to go through them one at a time until you find the slips with your name on it. After you have your results, you proceed to the office of the doctor who ordered it to get an interpretation of it, or perhaps, but not in my case, a diagnosis.
After several minutes and after going through the stacks at least twice each, Ermek decided that my results were not there. He found his aunt to ask why that was. She, to my relief and embarrassment, had not put my results in the customary pile of results but had delivered them to the doctor. I tend to be a common person with respect for the common man and respect for the people in whose country I am living at any time, but there are times when I am secretly glad that the local people treat foreigners a bit differently than other people. They are particularly sensitive to Americans, thinking that Americans are accustomed to very special treatment. Although we never actually receive the treatment they think we do, it is certainly close to that level in situations such as this. I was grateful for the gesture.
The doctor told me everything I did not have and all about the normalcy of the tests. At some point I mentioned my high blood pressure. He immediately ordered an EKG and ultra sound of my heart, and more blood tests. And, since I did not provide the requisite urine and … other samples, he reordered those. As an American, I am accustomed to leaving my doctor’s office with a specimen bottle in plastic wrap and other appropriate specimen collection paraphernalia. Those things do not exist here. I later learned that people here tend to save certain types of jars and bottles for such contingencies. Even the pharmacies could not understand my request. I scoured the apartment until I found something suitable.
The EKG was done immediately and quickly as the line was long. The next blood tests were done by a rather unpleasant nurse who found the vein quickly, stuck the needle expertly, and then did something as she pulled the needle out that was quite painful and left me with a nice black and blue spot on the inside of my elbow for the better part of a week. The ultrasound of my heart was in a separate lab from the prior ultrasound and the cost represented my non-Kyrgyz nationality. Even then, it was very inexpensive; five hundred som or about twelve dollars. The entire costs of all the tests and clinic visits was so small that it was not even worth trying to get some sort of reimbursement from my insurances company, if that would have been possible. Twelve dollars for the older and more prominent doctor, three dollars for the EKG, and so on.
I was quickly becoming frustrated. I was still not feeling well and had not gotten any indication of what I might have. In the meantime and because I knew from prior experiences that early contact was necessary, I contacted MedEx the insurance service that will take you to a better place if you need serious treatment while in developing countries. They initially referred me to a German clinic that we discovered was no longer in business. My confidence in this company was now shaken. They then, however, referred me to another clinic which we had heard about. It is run by a woman doctor named Irina. She works for the Canadian mining company and treats all of their workers including giving them physicals before and after their tours of duty high in the Kyrgyz mountains.
I managed to get test results from all my tests, including the EKG and ultrasound of my heart. I had scheduled an appointment with Irina’s clinic and, at the suggestion of the public clinic doctor, an upper GI endoscopy to be performed at another private clinic devoted mostly to performing tests of various types. I also forwarded all the test results of the tests I had already taken to the MedEx insurance company who, after having them translated, eventually responded with their thoughts on my malady.
The endoscopy was scheduled a day after my scheduled appointment with Dr. Irina. She, as it turned out, was occupied with a dying patient so I was seen by a nice young man – a doctor also – who spoke excellent English and seemed to be knowledgeable. He looked more like a military man than doctor, dressed in green tee shirt with matching trousers folded neatly into high laced black boots. Nonetheless, he was professional in his demeanor and appeared capable in his knowledge. He recommended that I complete the endoscopy and return after.
The clinic where the test was performed was a professional and neat appearing facility. It was necessary to register and I received a patient card for perpetual use. The waiting area was modern, clean and neat. Magazines in Russian adorned the low table in front of the padded seats in the waiting area. My name was called and Julia, Olga and I went to the room where the doctor and nurse were to perform the endoscopy.
The room was small containing two chairs, a small table, an endoscope and computer and a table on which patients laid. We were definitely a crowd, but no one objected, sensitive to the fact that the language barrier itself creates additional apprehension. The nurse said very little, but the doctor seemed to be a nice sincere fellow. He outlined the procedure and, after he reviewed my other test results, the results he expected from the endoscopy.
After a few brief questions translated by Olga and Julia, I was told to open wide. The doctor sprayed an anesthetic into the back of my throat to numb the throat and calm the gag reflex. The nurse placed a plastic circular device into my mouth and told me to bite on it. This was the opening through which the endoscope was to be inserted. I was told to lay on my side and tilt my head back. The part that was missing from what would have been done in the US was the intravenous sedative, apparently considered an unnecessary luxury here.
The doctor fed the endoscope into my throat and down into my stomach. After ten or fifteen minutes of very uncomfortable probing and looking, the doctor pulled the scope out and I was finished. I think the procedure was performed competently in other respects and the doctor told me that other than several spots on my stomach wall that appeared to be healing, everything was fine. He also said that I had a kink of some sort in my small intestine as it exited my stomach, but he was able to un-kink it. Formal results would come later along with a DVD, which in actuality never was produced.
I did return for the results, I returned to Irina’s office and met with the same young doctor as well as Irina. As I said, the entire cost of this marathon of medical clinics and tests cost such a small amount that it was not worth the time to attempt to process a claim. I may have spent, including the private clinics and all the tests, one-hundred fifty dollars. Even if it was two hundred, it was a fraction of the several thousand dollars worth of medical treatment by US standards. I do not think the quality was always the same; In fact, I am disappointed by the quality of the medical care here. I had expected more from the Soviets. I wasn’t necessarily expecting the system to be at the level of Western medicine, but this was basic treatment and I felt that, in my case anyway, they did not deliver. Most of what I have seen in the former Soviet Union is not too bad. Not to the level that they professed for all those Cold War years, but not as bad as we always thought it was either.
I contacted MedEx and transferred all information to them as I received it. And, after all that, I was told that I was ok. And in fact after several tortuous weeks of visiting clinics in Bishkek, I indeed improved. I was reminded of the humorous story about cold remedies I have heard in several variations, and of which there is an exact Russian equivalent: Take the remedy for fourteen days and your cold will be cured. If you do not take the remedy, your cold will last two weeks.
oo0oo
Sharon in one of the parks
The parks in Bishkek are nothing less than plentiful and beautiful. Flowers are planted and roses tended. There are statues and fountains everywhere. The mayor proudly announced that he had repaired all fountains in the city as well as all the park benches. The lovers, most of whom have no cars, use the parks as a place to meet and court. Parents walk children in strollers, older citizens simply enjoy.
The mountains are on the south side of Bishkek and the city slowly slopes to the north. This geographic characteristic allows for the easy distribution of mountain water for irrigation to the dry city all summer. Every street is flanked by concrete troughs through which water flows at various times as determined by the city’s irrigation schedule. When driving to the mountains, the larger aqueducts can be seen along the road carrying water to the city. This system of irrigation sustains the many parks filled with trees and flowers.
The parks in Bishkek are nothing less than plentiful and beautiful. Flowers are planted and roses tended. There are statues and fountains everywhere. The mayor proudly announced that he had repaired all fountains in the city as well as all the park benches. The lovers, most of whom have no cars, use the parks as a place to meet and court. Parents walk children in strollers, older citizens simply enjoy.The mountains are on the south side of Bishkek and the city slowly slopes to the north. This geographic characteristic allows for the easy distribution of mountain water for irrigation to the dry city all summer. Every street is flanked by concrete troughs through which water flows at various times as determined by the city’s irrigation schedule. When driving to the mountains, the larger aqueducts can be seen along the road carrying water to the city. This system of irrigation sustains the many parks filled with trees and flowers.
Two boys racing in a fountain
The only thing that detracts from all of this beauty is the lack of mowing of the grass. The grass grows as it wishes and no one seems to be bothered by it except me. I noticed it last year when I first arrived and this spring, it was nearly unbearable. I walk past Gorky Park every morning on my way to work. It was painful. I have complained to Ermek, one of our translators, about this issue. He had no solution other than to say that they indeed do have mowers, but no one here would want to spend their energy to mow grass.
The only thing that detracts from all of this beauty is the lack of mowing of the grass. The grass grows as it wishes and no one seems to be bothered by it except me. I noticed it last year when I first arrived and this spring, it was nearly unbearable. I walk past Gorky Park every morning on my way to work. It was painful. I have complained to Ermek, one of our translators, about this issue. He had no solution other than to say that they indeed do have mowers, but no one here would want to spend their energy to mow grass.Lawn Rangers taking a break
But then, one morning in June, when the grass was actually too long to cut properly with a mower, there, in Gorky Park, were nine – nine - mowers, each one manned by a knowledgeable if not competent operator. They have returned at least once since then. I have seen this noble battalion of lawn rangers in other parts of the city and I congratulate the mayor on his sensitivity to my concerns about the parks. They really do look much better.
But then, one morning in June, when the grass was actually too long to cut properly with a mower, there, in Gorky Park, were nine – nine - mowers, each one manned by a knowledgeable if not competent operator. They have returned at least once since then. I have seen this noble battalion of lawn rangers in other parts of the city and I congratulate the mayor on his sensitivity to my concerns about the parks. They really do look much better. Until Next Connection,
Dan
