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.