Monday, February 19, 2007

Back in Action – 2/19/07

It is a quiet night here in Samara. Dark and cool. Stepping out for a quick trip to the store, I could hear the snow squeaking under the heels of my boots. Stopping for a moment, I could hear the faint kiss of miniscule snow flakes brushing against the collar of my coat on their way to the ground to join their infinite neighbors. Behind me, my footprints revealed the black ice that lies beneath the fresh frosting of snow, reflecting the night's darkness.

I arrived today from my long journey back to Samara. After the 9 hour flight, the 6 hours killed in Moscow and the 14 hour train ride here, I made it just in time to go to my Russian lesson. Walking to the tram to go to my lesson, the sun came out a bit and I could see blue sky through a thin, rippled veil of white. In the glowing sun, the snow, ice and mud that covers the ground in packed layers seemed to sparkle.

My Russian lesson was just as it always is: I arrive late, my teacher, Valentina Alexandrovna, gives me a bit of a hard time about it, but then says she's glad to see me, we sit down and chat for an hour and a half, moving from one random theme (my trip, a conversation I had, the etymology of a new word) to another (the departure of our mutual Brazilian friend, the biochemistry of Seasonal Affective Disorder, the upcoming fast of the Russian Orthodox faithful), occasionally we might do a language excercise.

This lack of structure is usually a source of frustration for me. In general, it does not feel a ton more helpful than chatting with my Russian friends, who do not charge me money (but also are less likely to discuss Russian etymology). However, today, it served as a valuable anchor. I have been gone quite a bit in the past two months, between my two weeks traveling through Siberia and Mongolia, my week at the Fulbright midterm conference in Moscow, and my two weeks in the States for med school interviews. It has all felt like a huge interruption, and I fear that everything I have been doing here has ground to a halt and scattered to the floor. Coming back is a bit jolting, because I have to look around and pick up the pieces.

On the other hand, traveling this much has given me a fair amount of time to reflect on this first five and a half months in Samara and to put what I have and have not accomplished into perspective. To be blunt, my work with the case management program has fallen so far short of the ideal I came with, that, in the shadow of that ideal, it appears as nothing. To date, I have given only one training and sat in on only one session with a client. I have prepared another training and am hoping to develop more, but when all is said and done, I think this all may be a fool's errand – the intersection of a) my overzealous desire to help (that often oustrips my capabilities), b) a lack of committment on the part of the program managers to making the case management model work and c) miscommunication about expectations for my Fulbright year. Taking into account my serious lack of institutional backing, my lack of additional resources to contribute to the program (including sufficient language facility), and the lack of interest on the part of the program managers, it is a wonder I have managed to make anything happen at all.

However, as we all learn eventually, time slithers by like an eel in dark waters and it is gone before you know what touched you. In the blink of an eye, this next four and a half months will be gone, packed away in suitcases and memories, and the people I am trying to work with here will live on in this town as if nothing happened. Their lives may be different, but in ways only perceptible by that slithering infinity, by the stars that watch unblinkingly from far away. People here will go on becoming infected with HIV, people infected will go on living in a bewildering, inhuman system, and those trying to combat the virus will go on trying to squeeze water from stones.

I, on the other hand, will have been changed in enormous ways. I have already learned an incredible amount, about people living with HIV/AIDS here in Samara, about Russian language and culture in general, about my self. My worldview has been challenged and challenged again, broadened and deepened in inexpressable ways. After five and a half months, I see and understand the world in new and different ways. This ineffible growth may well slip through my fingers like anything else that happens in a time and a place and lives on only in memory, washed away by compelling new scenery and change in focus. But ultimately, despite my best efforts, it may well be that the sum total of this experience is personal – the memories I take back with me and the new understanding I get to keep of Russia and the world.

This possibility brings up the mixed feelings I have about my work in the Bronx as a case manager. Looking back on the thirteen months I spent working in the Bronx community, I know that I got what I wanted out of my experience there, but I have no way of knowing if my clients got what they needed. Sure, I can point to a handful of clear successes and a vast number of tiny minor obligations fulfilled, but I had so many clients with so many needs unmet. It is impossible to know if another person could have done better or would have done worse.

On the other hand, no one else is trying to do exactly what I'm trying to do here in Samara, so we may never know. What is important, I suppose, is to squeeze the most out of my remaining time here as I can, either for the local community, or for my own personal development.

I will continue doing my trainings with the case management program, and hope that in some way, somewhere down the line, they make at least a ripple. I will also see if I can't make myself useful to some other organizations in the area. But most importantly, I would like to make what I'm learning here stick a little better. As I feel less and less confident in my ability to help realize case management here, I am becoming more and more drawn to the idea of turning my personal learning and growth into the thing called 'research.' I'd like to write some articles that put some of the things I'm thinking together so that someone else might be able to pick up where I left off. I think what I am gaining, useful or not, is a strong sense of what is being tried here in Samara and how the different cultures of different parts of Russian society affect those efforts. Sounds like medical anthropology to me. I'm hoping it's not just to me, but who knows. If you know, please let me know.