Portal de Periódicos da CAPES

Deadline in Dushanbe

2007; Wiley; Volume: 9; Issue: 1 Linguagem: Inglês

10.1576/toag.9.1.070.27305

1744-4667

James Drife,

African studies and sociopolitical issues

Many people enjoy flying. Thanks to low-cost airlines, you can pop over to Prague for the weekend or even spend a few days shopping in New York. This is not my idea of a good time. I dislike airports, with their stone-faced immigration officials and their offensive assumption that I'm wearing explosive shoes. In the plane I brood about what could go wrong – missed connections, thromboembolism, acute psychosis on the flight deck – and prepare for the worst. Believe me, I'm not a cheery travelling companion. When I reach my hotel, though, I lighten up, particularly if it is in an exotic city never before visited by anyone from Leeds. Such places are few. When I remarked last month to a midwife that I was going to Bishkek she replied that Kyrgyzstan is beautiful and she loves the Silk Road. Well, I'm writing this in Dushanbe, Tajikistan and I hope you're impressed. If you're thinking ‘That's where our team lost 2-0 against Locomotiv Tajik and we had that iffy curry’, please don't say so. I'm here with the World Health Organization (WHO), whose initials are less global than you think. In French they are OMS (Organisation mondiale de la Santé) and in Germany the Weltgesundheitsorganisation is, presumably, known as ‘W’. Our team (an Italian, a Dane, a German and myself) communicate well enough in English but doctors here speak Russian. Our interpreters do an amazing job (surely it's neurologically impossible to listen in one language while speaking in another) and add a touch of romance to our talks. ‘Accoucheur’ and ‘reanimator’ sound far grander than ‘obstetrician’ and ‘intensivist’ and wouldn't any surgical team prefer to be a ‘theatre brigade’? We arrive at meetings laden with laptops, memory sticks, CDs, extension leads and mysterious Cyrillic handouts of our presentations. In the past, lecturers turned up with a flip chart or a box of slides. Now we're starting to look like a Rolling Stones world tour, though our budget does not extend to roadies. A local technician silently connects our computers to his projectors and once we start speaking, the audience put on their headphones. This means they don't notice when their mobile phones go off. Even here, Mozart and Strauss are big in the ringtone business. Despite the technology, countries in the south of the former USSR are horribly poor. Doctors' salaries are $20 per month, so ‘informal’ payments by patients are normal in some specialties, particularly ours. There is a brain drain to Russia and Kazakhstan (which, whatever Borat says, is comparatively well off). But some problems are more familiar. Ministries rigidly control clinical practice with unhelpful diktats. Professional organisations are weak or non-existent. Doctors are terrified of disciplinary procedures. If you want to see where the NHS is heading, come to Central Asia…but not as a patient. Our hosts are astute people and generous. Last night at a PECTOPAH (restaurant – I worked it out) the meal was punctuated by toasts while a band in the corner played The Beatles. Toasts here are for real. If you fail to drain your glass of vodka you are benignly chided. It's a good system for making friends. When you're the eighth diner to make a speech, there is no place for irony. You extol your colleagues, their patients, their country and world peace with deep sincerity, all the while hoping you don't slide off your chair before you finish. At the weekend we flew from Bishkek to Dushanbe—2 hours over snowy mountains, near the highest peak in the former Soviet Union. We had been told that the airline was banned from Europe on safety grounds so you can imagine my mood of sunny good humour as we joined the queue to board the elderly Russian aeroplane. I spent the whole flight watching the propellers. Dushanbe turned out to be a pleasant city with trees, boulevards and neo-Mogul style buildings. Tajiks originally came from Persia. Women wear vibrant colours and people are gentle and reserved, even in the markets. We liked the place immediately. Nevertheless, Tajikistan is at the bottom of the region's health league, so let's hope this week's workshop on maternity care goes well. This is no time to relax, folks. It's only a few days until the flight home and oh no, it's starting to snow.