The potholes that litter the side alleys are bursting at the edges, full of brown water, so it seems easier to step on the recent bed of fallen autumn leaves at the side that leads from the house to the office. The cars veer wide of the large potholes, occasionally jolting into one. The weather has changed and it has rained for the last two weeks, with the temperature dropping to single numbers. The atmosphere is grey and the colour has slowly disappeared from the city, leaving even the grandiose presidential palace looking insignificant. Irony is that for the last 24 hours, while the roads are almost flooded, our water supply was cut off. When it came back on, the electricity switched off, the fuel which heats up the water, and so basically nature has beaten me and the only place to stay warm is the office!
With little to do outside, there is an opportunity to learn the ancient language of Tajik so I may eventually get to know this world and speak to the kids in the hospital. The letters are so foreign to me, that they hurt my eyes and being a slightly impulsive student, the frustration of the poor understanding is even more evident. My teacher is a young Tajik lady who cannot understand why I cannot pronounce the words properly. The language sounds like a mix of urdu and mandarin to me, the latter bringing a smile to my attempt at Tajik. The alphabet is the beautiful Cyrillic alphabet which has shape and music to every letter. Well not quite, there are some sounds which are guttural and I have to practice them in front of the mirror to see where the tongue lies! They say the language is poetic and there is a lot of folktale and theatre here but until I have a basic foundation, the nuances of the language are just a dream.
The guards help me a lot here in the office. One guard is Rasul and he is a tall man worthy of a Tajik medal. He offers me bread, an offering that one must never refuse, and patiently teaches me. I like his style: he smile and teaches me with lots of repetitions. The basic greetings are to the gods and health, generally followed by a hand to the heart and a bow of the head (I love it). Any further conversation is a mix between Hindi, Spanish and English in the hope that one of the languages associates with Tajik, and with an innocent smile, I start listening to the words. They slowly start to spring to life, a joy which is difficult to suppress, because slowly, things start to make sense.
The kids in the hospital giggle at any attempt to speak Tajik, so I decide to hold an English class, as a pay-back for giggling. I enter the school/dining room. The low tables are coloured red and the small hand-made wooden seats are the only objects that suggest this might be a small school. The children here are not considered to be infectious to others and are generally quite well.
There are four children who are infectious. They are housed in a separate area, and fall victim to other consequences of this consumptive illness, the separation from normality, from play and learning and helping the others. The two 15 years old girls and two 13 year old girls do not receive any education and spend the cold days in the rooms, mostly sleeping. It is hard to imagine their boredom, but they never complain. This worries me – why are they so accepting of their fate? Is this cultural or the role of poverty that determines the freedom to express one’s wishes? Do the children and families receive an informed view of their health and if not, does it matter in this culture? Or should culture be ignored and should MSF serve to enhance the view of the child more? The problem, I feel, is that a western construct of childhood is different to that of another culture and without a good understanding of what Tajik culture is, it is very difficult for me to implement our slightly two dimensional standardized view of how to serve the interests of these children.
I speak to the teacher, a lady of mature years with laughter lines running down her eyes. She has worked as a teacher for 40 years and in the hospital for 4 years. The children love her classes because they can practice their singing and although as yet I have not heard their songs, I look forward to listening to their dulcet (and not so dulcet) tones. There is nothing to draw or write with and the white walls speak of hygiene, but not of stories or messy hand prints and colour. The children, however, are noisy and eager to learn so I ask the teacher if I could teach them the body parts (I feel as a doctor, I know something about body parts). The lesson begins: there is the creek of the small wooden chairs unceremoniously dragged across the floor in two lines and the noise makes me shiver. There are more children than chairs, so those who are able to speak generally have the better seat (the under 2′s group themselves on the side and the boys in the back row). I sing ’’head, shoulders, knees and toes’’ and there are glazed expression. I repeat ‘’head, shoulders, knees and toes, knees and toes, and eyes and ears and mouth and nose, head, shoulders, knees and toes, knees and toes’’. There is movement, but the expression is still of confusion. I repeat the song with accompanying gestures remembering that language is easier to learn through gesture and here we go, we are getting somewhere, and once I get over the image of me looking like a monkey as I place my hand neatly cupped over my head, there is an imitated response. The girls are generally the better at the words but the boys don’t do too bad considering the horror that they are subjected to. We continue for another 10 minutes before the lesson terminates and lunch is served
I learn through experience not to promise too much to children because the disappointment they show is quite palpable and makes you feel quite sick. Still, I’m sure a few notebooks and a blackboard could be managed, without too much problem and I promise at least to myself that we can buy this. It is the kids in the positive ward that worry me more.
The damp has settled in the bones but after the two weeks, the sun came out for two days. A group of children make a fire out of the nearby fallen twigs and the groups of men and groups of women wander in the streets to celebrate the holiday. Last night, it all changed and the wind returned to Dushanbe. By the morning, there was fresh snow and now there is a foot of thick snow. Earlier than expected, the women are still in their high heel stilettos – a scenario that is always amusing in the slippery surface. I hear a boy shout “mama”, when his poor mother slips on the damp snow. I turn around and she smiles hopefully realizing the impracticality that she puts herself in. The snow was dense and lasted for two days before the sun emerged and melted it rapidly, making it fall on unsuspecting foreigners. The pot holes are full again of dirty water. The leaves had fallen prematurely and the hospital grounds have a thick carpet of unwithered leaves, that should have fallen and become crisp from autumn. I returned to the hospital, where the day is beautiful and most of the kids are out. The older ones are at work clearing the fallen leaves in the tarpaulene left over from construction work. And they look healthy today, not cramped away inside the hospital. It also means that I do not have to wear the respirator (mask) as the natural ventilation will rapidly take away the cough particles. The children are relaxed , those that are deemed to be not infectious, but once again, the kids in the positive ward are left to watch what appears to be a normal day outside from within.
Kartik, thanks for putting your thoughts and experiences into words. It does put a lot of things into perspective for the rest of us and is inspiring. Thoroughly enjoyed the insights and moved by the plight of the children. Keep up the good fight!
Kartik – I loved reading your blog – you write beautifully. The work you are doing in Tajikistan is inspirational. Please look after yourself – we are thinking of you. Bxx
Thank you for the messages – it is so good hearing from all of you. I will respond individually:
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Sara, I completely agree with you – this culture is fascinating and you slowly get drawn into it (I eat a lot of bread and choi with the local staff)! What is the name of the book you mentioned. Another good book to read is William Darylrimple’s ‘’In Xanadu’’.
Claude, lets have a coffee next to the Nelson Mandela statue in Waterloo next time I see you.
Victor and Douglas, thanks for your kind words.
Ipsi, it seems a far cry away from the haunts of Northwick Park Hospital. The TB here is active disease rather than what we saw in Northwick Park. Good to hear from you – how is Amartya Sen?
Xenobio, I was at LST&H and you are right – it is a great place to study. There is supposed to be good coverage for BCG but as always, sometimes, the poorest do not always receive the vaccine. The vaccine is generally good for the under 5s to prevent disseminated TB.
Alina, where did you work with MSF and what were your experiences?
Heather, with regards to your son, the standard treatment for lung TB is 6 months. When he was 2.5 years old and was thought to have TB, he would have been started on this standard TB treatment and should have completed the course of treatment – by the end, he should have put on weight and any symptoms should have disappeared, and the disease would have been cured. If he were resistant to the drugs, you might not have seen an improvement. If he is well now at the age of 8, I would say that he is cured and there would be no need to worry unless he is exposed (like any other child) to TB. A test (the mantoux skin test) can be done now – it will tell you that he has been exposed to TB in the past (i.e. latent TB) but it does not tell you that you have active disease on its own. The ‘typical’ symptoms of TB in children are considered relatively chronic (>2-3 weeks) without improvement following other appropriate therapies such as conventional medications: a persistent cough and not improving, weight loss, fever +/or night sweats . Children tend to be infected from close contacts such as someone living in the same house. He should have had his BCG.
Bina and Urvina – good to see you can laugh at seeing your brother looking like a monkey
Caelan, I miss you so much – I can’t wait to cycle with you when I return. Kartik mama
Ana, gracias por el mensaje. Te echo de menos mucho y nos vemos en Barcelona y tomamos unas cervecitas!
Paul, so good to hear from you again. The Tajik has improved and I am able to form a sentence (hoooraaah)! If you are ever in Dushanbe, lets meet.
Tamara, como siempre, me alegro de tener noticias tuyas. Que nos vemos en Barcelona o Canada, me encantaría. Besos.
Jane, I could do with your company here in Tajikistan – the bureaucracy is nuts but the culture is pretty cool – I think you would like it.
Priti, I am definitely coming to Kenya!
Kartik – this link came up on my home page. What an absolute delight to have read this. I’m really happy to hear that you are still getting involved in such work… I believe it was your calling.
Coincidentally, I’m planning to travel to Kyrgyzstan next year (and perhaps beyond). My father had a book on Central Asia, given to us by my Godfather – a doctor who’s family originated from Russia, and migrated to Tabriz in northwest Iran. I remember flicking through the book as a child, and being captured by the scenes of the local herdsmen, the mountain back drops and the wild horses. And now I feel a sort of magnetism drawing me there.
Your experiences sound fantastic, and I’m certainly impressed with your work efforts and enthusiasm
Please do keep in touch and I hope to meet with you again in the not so distant future… maybe over a coffee, or a round of yoga.
From the dusty streets of Colombo,
Sara (Your old class mate at CIHD)
)
Kartik, you are an inspiration to us all. I love reading your blog. Keep strong, your friends here in England love you and are very proud of all you are doing xxxx
Keep up the good work sir and Thank You.
It is a great pleasure to read your words. Keep up the good work!
hey kartik saw you on msf facebook update.. how cool is this.. all the best. take care
ipsi
My father almost died of TB when he was small. God bless you for taking care of these kids, or good luck and best wishes if you’re not religious. Did you go to LSHTM? It sounds like an awesome place to study infectious diseases.
Do they have the BCG vaccination in Tajikistan by the way?
Kartik, Thank you for taking the time to blog. I too worked with MSF and had every intention of blogging…But somehow, times slips away. I thoroughly enjoy reading about your experiences. They paint a beautiful picture. Well wishes.
When we adopted my son from Ethiopia, he had TB. He was on a small cocktail of drugs for about 6 months and then they just said, OK he is better now. But I wonder… what if for some reason he had drug resistant TB and we didn’t know it… Or would we?? He is 8 years old now and was just 2 1/2 at the time of adoption. How do I know he is really rid of the TB?
It brought aear to my eye. How touching! Monkeys eh? That doesn’t surprise me! Somethings never change!
I read a small chunk of your blog. It was funny and touching. Hope it gets easier.
Brought a tear to my eye! How touching! Can just imagine you looking like a monkey! Somethings don’t change!
Kartik your writing is so so good very interesting. When reading it I feel like I am there X
Kartik, tus palabras son muy muy bonitas, las entran directamente a la corazon. Estas haciendo un trabajo increible!! Cuidate!
Ever considered becoming a writer? I felt your pain and joy. How lucky we are here! Take care of you and speak soon.
I’m trying to learn Persian at the moment which is allegedly very similar (Tajik is said to be a dialect of Persian).
Stick with it, it’s not as difficult as you may first think.
have a look at:
http://www.indiana.edu/~celcar/language.html
Regards Paul
Kartik I have really enjoyed reading your blog. You have transported me there somehow. You are very generous and brave to help these kids. Cuidate mucho – te quiero – Ta x
You write so beautifully Kartik. It’s great to hear what you’re up to. Wrap up warm! xxx
http://www.ibtimes.com/articles/249829/20111115/kenya-somalia-refugee-cholera-camp-dadaab-famine.htm
When you are finished there, come to Kenya – we need you too!