An Awl in My Ass (Travel Photos!!) - 12/14/06

So, this weekend, I took a quick trip with a couple friends to Kazan', a city of about 1.1 million people four or five hundred kilometers north of here. My friends I all took the overnight train Friday evening, leaving us in Kazan' Saturday morning at around 6 in the morning. We began our day there with a sleepy walk down the street lamp-lined canal that runs down the middle of the old town, draining Canal's lake into the nearby Volga.


Kazan' is the capital of Tatarstan, one of Russia's "autonomous" ethnic republics. They are something like a cross between a Native American reservation (in that they enjoy relative autonomy under federal jurisdiction) and a state (they are generally the size of states and are rarely contained within other regions). Tatarstan is home to the majority of Russia's Tatar population (you may have heard of steak tartare or tartar sauce -- tartar sauce was invented in France to be served with steak tartare which supposedly comes from the Tatars). The Tatars are an ancient Sunni Muslim ethnic group that dates back the Turkic Ural-Altayans of Southern Siberia and Central Asia that were brought Westward by the Mongol invasion of the 13th Century (thank you Wikipedia!). Their traditional Muslim culture was somewhat supressed in the Soviet era and is now experiencing a revival. In that vein, the city of Kazan' has invested a great deal of money into rebuilding the Kul Sharif mosque (pictured below), which was destroyed by Ivan the terrible upon his defeat of the Kazan Khanate (a medieval Tatar state).


Kul Sharif is the largest mosque in Russia and, supposedly, also in Europe [Look at the tiny little people to the right of the picture below]. I can also tell you from experience [pictured above] that it is too heavy to lift.

The mosqe is contained within the walls of the city's kreml' (the word Russian word kreml' or kremlin as we say in English actually just translates to fortress), which was built in the 16th century on the ruins of the Kazan Khanate's own fortress

The walls have all been rebuilt since the 16th century, of course, but it is still a beautiful site to see, looking out over the Volga.

In addition to the kremlin and the mosque, we saw the city's main pedestrian drag, which is all being refurbished and developed. This town is a happening place.

They even have a new Basket-Kholl (Basket Hall, it is a play on words, both of which are merely transliterations from the English). Kazan's team is called the Unics. I could not for the life of me figure out how they got that name and my Russian friends couldn't explain it to me.

Other highlights of the day include a tiny nationalist demonstration...

...and car tires being sold through a wheel shaped hole in the wall.

Kazan' is a beautiful city. I really recommend going there to anyone who might visit Russia. The beauty of the city, the fun of traveling (even if to a place to which I've been before), and especially the fascinating intersection of Russian/Soviet culture and Sunni Muslim culture [see right] all gave me a strong urge to travel more. There was a museum in the first floor of the mosque on worldwide Islam that had beautiful pictures of the ancient mosques in Samarkand and Bukhara Uzbekistan. By the end of the trip, I had made up my mind: in April, I'm going to take a trip to central Asia and see those mosques for myself.

On the train back to Samara, I told my Russian friends that I had the travel bug, and tried to explain what it was, without knowing the Russian word for bug. It got through to them, though, and they told me the Russian equivalent of the term: in Russian, I would say I have a shylo v popke (an awl in my ass). Meaning, I can't sit down. I'm now entertaining myself by planning my upcoming trip to Siberia/Mongolia and the springtime daydream in the Kyrgyz Republic and Uzbekistan, and probably Glorious Nation Kazakhstan too.

Back in the USSR - 12/7/06

I have been back in Russia now for about a week and a half. It has been a difficult readjustment. Becoming accustomed to life here is a lot more difficult without the constant positive glow of novelty to balance out the constant negative frustration of dealing with culture shock, language difficulties, ubiquitous bureaucracy, community dishevelment and the ever-present mud. I spent the first week getting over jetlag, fighting off a viral infection and strongly craving the comforts of home. I am still often doing that last one.

I went for a walk this evening. The streets are wet and shiney. Streams of red and white lights reflect off of them from the cars that pour by, their drivers all on the hunt for slow pedestrians crossing in front of them. The water that made the streets into black mirrors is not falling from the sky, but just hanging somewhere between the earth and the tops of buildings. It has already been cold and snowed and warmed up again, so the snow that was packed into icey trails on the sidewalks only remains as gritty, brown slush pancaked out over the ridges of the uneven concrete. The pits and holes are filled in by liquid dirt. If music were playing to match my mood, it would be Frank Sinatra; but since I am in modern day Russia, it would be a loud, obnoxiously sped up techno version of Frank Sinatra. Walking by a well-lit entryway to a dormitory, I heard the loud, bulbous roiling of the Russian language being spoken by a smoking pack of boys, laughter and bad words echoing through the alleys. I couldn't help but stare at the light.

Trying to get back in the swing of the work I am doing here, I felt enormously frustrated, almost hopeless. Two days ago, I had a meeting with the head of the program I am working with – a meeting I had been looking forward to for some time. Among other things, I was hoping to finally discuss with her my idea for implementing some kind of reassessment (common procedure for any case management program I've ever seen), in order to address the utter lack of any longitudinal follow up of the client's progress (two meetings with a client does not a case manager make). I had done a lot of thinking and writing to prepare my thoughts before hand, had even charted out all my ideas, how I would present them. In the end, all of it was for nought. The program director did not seem interested in this idea, or at least as far as I could tell – she changed the subject to another problem that I couldn't resolve, funding. It reminded me of when I brought up the washing machine my landlord here promised us three months ago and she changed the subject to the mess she saw on the dining room table when she was last in the apartment, quickly shifting sideways to avoid facing the problem head on.

The meeting left me with me with a horrible feeling. It was as though we were in different rooms, trying to communicate through a wall. The wall was composed not just of language and culture, I think, but also of investment in progress and change. She did not seem truly interested in hearing how the program could be improved, it seemed, so much as entertaining the impression that she was. I felt that I was, in fact, a small child to this woman, cute and entertaining, but starting to pester her with my questions. Certainly this feeling was very much amplified by my anxiety about my language skills, by the culture shock I am still experiencing, and by the ambivalence I have about being back here, after having such a good time being home for a couple weeks.

Ultimately, we decided I would continue with my trainings on psychological themes, though we did not hammer down a time-frame for my next one. I was invited to come to yesterday's monthly "supervision" meeting (the last one, apparently was the training I gave). At this one, a narcolog [addiction doctor] was invited to give a lecture on drug slang. He proceeded to read off the definitions on a list that he got from a book and handed out the list to everyone at the end. He did not seem to have much experience using or hearing the terms, though, at least not as much as the leader of the local support group for people living with HIV/AIDS in attendance, who is himself a byvshchiy narkoman (former drug user). He would occasionally clarify or add a term, as we went through them alphabetically

At the end of the meeting, as I was speaking with the leader of the local support group about working together on some trainings, I was told that if I wanted, I could stick around and get to see the case managers in action. As it turned out, a client was coming in that evening, and I would be able to observe the client's first appointment with one of the case managers. Two months ago, the case managers told me they would call me next time they knew they had a client coming in, and then reaffirmed this at the last training. However, until yesterday, I had just been waiting, so I happily agreed.

The client came in and, after introducing myself and asking permission, I sat down and started observing, taking notes, paying attention to impotant verbal and non-verbal indicators: did she close the door (no), is she looking him in the eye (yes), is she explaining the purpose and the process of what they do together (purpose but not process). The client, it turns out, was an undocumented immigrant from Tajikistan, who had come to Samara six years ago to work. He was recently diagnosed with HIV and didn't know where to turn or what to do. The situation was so familiar, as most of my clients in the Bronx were undocumented. A major difference, however, was his understanding of HIV. My clients in the Bronx had, with few exceptions, all been counseled extensively by doctors and social workers about HIV/AIDS. They knew how it was transmitted, they knew the difference between HIV and AIDS, they knew about treatment options, usually they even knew what CD4+ count and viral load tests were. This client knew that HIV was a virus, AIDS is the illness awaiting for him and that he got the virus from having sex.

As the session went on, it became clear to me that the case managers were not going to educate the client about his infection. I was unclear, however, about the ethics of my role as the uninvolved observer. I did not want to take away from the authority of the case managers or break the rhythem of their work (after all, I could have been wrong: the counseling part could have been yet to come). At the same time, I did not want to let the client leave the office without what might be the only chance for any sort of decent HIV counseling.

Finally, the client himself asked the case managers, "is there a cure for this?" The case managers seemed a little puzzled about how to answer the question. Suddenly they turned to me and said something like, "we should ask our foreign consultant, who has worked with many people with HIV." And suddenly, I was discussing treatment options for HIV. And then, together with the linguistic aide of the case managers, I was counseling him about clinical latency, HIV transmission, the disease progression of AIDS, etc.

It felt good to be working with a client again, to be talking about the things that matter most to a person. Even if it is only for a moment, and not always so sweet, the intense intimacy of the counseling session is so fulfilling. It is worrisome, that I attempted to counsel this young man in my third language, without preparation or extensive knowledge of the Russian healthcare system. But, it is more worrisome that this could have been the best he could get. The two women working as case managers are intelligent people. But for both of them, this is their second job (maybe third). They are both "social pedagogues." One works with the children of alcoholics mainly and the other with disabled children. They seem very dedicated to the work that they do in their primary jobs. The most excited I've seen them was when they asked me if I'd come hang out with the activity group of the children with disabilities and I agreed.

However, I can tell that they do not really like this work. After working with the client I met, they told me this was the first client they met who actually wanted help, who wasn't addicted to drugs. From what I have been told, they have only had one or two trainings on HIV/AIDS and it was a year ago. In watching them work with this client, it became clear to me that I need to work with them on things that I would consider somewhat basic: structuring time with a client, explaining both the purpose and the process of what they are doing and obtaining consent before so doing, asking questions that involve the client in the counseling process, using instruments to guide these questions, rather than treating them like more forms to fill out, etc.

In finally seeing the work that is actually being done, I was both pleased and disquieted. The program is even less developed than I had thought and the services being provided more rudimentary. But, I was also able to see more clearly what I need to do, what my next steps are. Here I was trying to teach them how to evaluate a person's readiness to change and I had misevaluated their own readiness for what help I wanted to provide them. Though the pinciple concepts I introduced in my training on the client-centered approach were easy to understand, the case managers far from being at a place where they could put them into practice. I hope that watching me in action (not that I am such a prime example), at least gave them more of a sense of what I was talking about. I'm looking forward to my next training which will be on framing a counseling session for maximum client involvement, or something like that.

More imminently, tomorrow I am taking a one day trip to Kazan' to look around with some friends. I am greatly looking forward to that.