Idealism Notwithstanding:The Long Defeat in Russia

2007-06-09T13:57:00.000-07:00

Pushistaya Zima Letom - 6/9/07

It is late, and now finally dark. I went for a walk this evening. A faint stain of silver was still visible rising above the Western horizon just before midnight. It is Saturday, but I am staying in. Trying to burn the midnight oil on translating the speech I will be giving this Thursday at the seminar in Saratov. I am both incredibly excited and horribly nervous. I spent all day today alternately thinking about the seminar and writing this speech.

I had a nice moment while writing my speech. I was sitting in my living room, typing on my laptop, when I suddenly looked out the window. I hadn't done so for hours, and I suddenly saw hundreds of thousands of fluff balls rising slowly from the trees like ash from a fire, their cottoney white a stark contrast from the iron storm clouds hanging above the buildings across the yard, stoicly holding back their rain. I came to the window and opened it, and felt the cool air rush in. I looked down and saw that the entire yard enclosed by my building (one of the largest buildings in Samara) was filled with this fluff, hanging in the air. It was as though the whole yard, all it's trees and playgrounds and smaller buildings had just been submerged in some sort of gel, and the second I opened the window, the gel was replaced by cool air, and the little white particles that were previously suspended in the gel just kept on their way as if nothing had happened, slowly floating every which way, to spread the seed.

I went for a jog and saw that this this stuff not only filled the air, but filled every crevice in the asphalt, collected in little dry white puddles. I intentionally stepped in one of these puddles as I was jogging. The fluff quickly flew away as my foot stamped down. A larger-than-life footprint was left in its place.

The air was almost hard to breathe because of this stuff, but each successful breath brought the itch of delight. I felt good jogging, knowing that not only was I making progress on this speech, but that everything around me, all the interesting things I was getting to look at would soon be gone. My time left here is ticking away already, and I feel it all the time. This week is already shot, because I have to spend the whole time preparing for this seminar. When I get back, I'm going on a two day bike trip across the river with my German friend Sören. And then it will be my birthday. I will have one week to say goodbye to everyone and get ready for the arrival of my parents (and for moving back to the States).

I am excited but also sad to go. The heightened nature of everything will have to give way to the hum-drum of being a student. The intense struggle to find meaningful engagement in a community so inaccessible to me, the immense challenge of learning a language on top of the fascinating things I have learned about the interactions of HIV, Russian cultural understandings of health, and local socio-political systems, will all soon be replaced by learning my way around a new academic institution and the memorization of countless biochemical reactions.

But I am thankful for my experiences. Certainly this has been a difficult year. There have been times that I've wanted nothing more than to be at home, surrounded by my English speaking, time-tested friends and working within well-understood and reasonable expectations. But those times have all melded together into a few lessons about what not to do and how to deal with living abroad, and all the miriad rewards are starting to come into view. This has certainly been an irreplaceable adventure and I'm only beginning to be able to apply all the things I have learned. I am now starting to really know what I want to write about when I get back and have the time to sit down and put everything together. The ideas are all there and I just need to put them down and fit them together.

For now, though, I just need to get back to my translation so I can go to bed...

2007-05-30T04:23:00.000-07:00

Summertime and the Livin' is Easy... - 5/30/07

It has been hot here for the last two weeks. Hot. Can't-do-much-but-lie-around hot. Though not too humid, thank God. I've enjoyed a couple days on the beach and a couple bike rides to let the wind through my hair. Mosquitos are biting my feet which are left bare by the tevas I am wearing as shoes. We don't have hot water in our apartment for some reason (apparently, this is part of a 'preventive break' that every Russian apartment gets anually, some time in the summer) so I have to take freezing, little mini-showers and partial showers to wash off my daily sweat. They are actually quite refreshing. I've also taken a couple dips in the Volga to cool down.

I am now finding it extremely difficult to do the things I want to get done now that I have less than a month left. The main project, above all others, is to write an essay about case management and translate it into Russian. I must do this as it will be the opening speech for my two day seminar on the subject in Saratov, June 14th and 15th. I also have to fine tune my previous trainings and develop some new materials for a couple new sessions I'm planning. But in this weather, with my time here running out, I just... can't... quite get myself to do it. I've been spending days taking my time waking up, making myself leisurely fanciful breakfasts and then reading all the news that's fit to print.

The worst part of my truancy, though, is that I haven't been able to enjoy it. It just brings back all the anxiety and depression that I've felt countless times throughout this experience. I suspect that part of the problem in actuality is that, at base, I've lost interest in case management as an intellectual pursuit. In general, I don't have the experience, the education or the cultural background to really make a significant impact on moving it forward here in Russia, and the energy and ideas I had a year and a half ago when I wrote the grant application, have pretty much all been spent (albeit haphazardly).

When it comes down to it, I think all of my frustrations with this experience have stemmed with the difficulty of trying to be an amateur everything. In the last couple years, I've been alternately: an amateur social worker, an amateur tour guide, an amateur cook, amateur international consultant and amateur ethnographer. I'm starting to really look forward to starting the next phase of my life when I get back, where I will be learning how to do something from beginning to end before I start doing it for money. I think it will be much more satisfying to be a professional something, at least. Now I just have to wait this month out, which will go by far too quickly, make sure I don't embarrass myself and my colleagues, and make sure I enjoy being around all the wonderful friends I have made here in Samara.

I have been discussing the status of my research project with my colleague in Tajikistan and she has pointed out that even if I had managed to accomplish a serious survery with a large sample, I would have had problems publishing my results because I never had a human subjects ethics committee. She suggested I move in the direction of writing something more like a suggestion of an area for further research based on the preliminary work I have done in the form of participant observation and unstructured interviews. This seems a little more like what I should expect from myself. When all is said and done, I think I take myself just a little too seriously. I probably would have had a much better time here if, from the get-go, I had the same low expectations of myself that the Fulbright program had for me - that I'd learn descent Russian, get a general feel for my subject, and maybe help a couple people in minor ways along the way, the minor ways that have nothing to do with what I'm trying to do with my work.

Oh well, Saratov here I come.

2007-05-15T06:26:00.000-07:00

Various and Sunny Sundry - 5/17/07

Spring has finally sprung for real in Samara, and with it has returned not only the full, green leaves. With the air warm enough to enjoy its presence and the days long enough to forget the winter, I have regained some of the hope and enthusiasm I originally felt about my time here. The stale hopelessness and grinding boredom I felt through the winter, no matter what the level of my activity, has attenuated to a thin nagging anxiety. My depression of the last couple of weeks has lifted and I'm ready to finish this grant period with a bang... really, I am... I swear..

There have been a number of things I've wanted to blog about lately, what with all this talk of a new cold war and all the crazy events surrounding Estonia. I've simply been either too busy or too lazy (or both) to sit down and blog about them. Well, there's no time like the present.

I've been trying to gauge the general opinion among my friends of the recent movement by the Estonian government of a Soviet-era memorial to fallen Soviet soldiers in WWII, and the near-violent reaction by Russian pro-establishment youth group, Nashi [meaning literally, "our", but assumed to mean "our people"]. Most of the friends I've asked about it seem to tacitly agree with the Russian media's portrayal of the move by the Estonian government to transplant the memorial from the center of Tallinn to a cemetary for WWII veterans as support for the defeated Nazi government and for fascism in general, though as one friend put it, "it's hard for most Russian people unless they can read English, because they can only get media controlled by the president."

On the eve of Den' Pobedy [Victory Day], sitting in front of a mangal [open grill for shish-ka-bobs] at my friend's dacha, I discussed the Estonia question with a friend of mine who works high up in the local Nashi organization as a tim-bilder [team-builder], who seemed to genuinely share the outrage of Moscow and the Nashi organizers. She felt that Estonians were clearly stating their support of fascism. When she asked me my opinion, I said that firstly, I thought it was a different country, so not really something I would say concerns Russians (who have enough memorials to WWII), and that secondly, from what I'd read, it didn't have to do with support of Fascism, so much as a statement against what Estonians (and the rest of the Western world) see as the Soviet Occupation of Estonia, beginning in 1940, before the front with Germany fell behind Estonian territory and predicated by the Molotov-Ribbentrop Pact, at the signing of which Stalin was present. She didn't really know how to react to this and we silently watched the fire for a moment. As a conciliation, I said, "well, either way, these demonstrations seem to me to have been paid for by someone, and that this is a case of politicians using people." She agreed with that, though probably had the Estonian politicians in mind.

The issue came up again, more recently in a rather amusing context. My friends Jeremy and Jenevieve, who are here on an English Language Fellowship from the embassy, organized an American Film Showcase at the local American Corner. Both because I like watching movies, and because I feel some degree of duty to participate in the local representation of the good side of American culture and society, I decided to help out. On Sunday, I presented Annie Hall and lead a brief discussion of it. On Saturday, we had showed Crash, the 2005 film about race relations in America. During the discussion afterward, perhaps the liveliest of all eight discussions we held, a young girl named Anna, stood up and said, "our government and youth groups like Nashi make a lot of actions about racism. Does your government also do things about this issue..." Given the vague Russian nationalism inherent in the group's name and what I percieve as the recent xenophobia directed toward Estonia, I was very curious to know what this girl was talking about. After the discussion was over, I asked her about the actions Nashi had lead against racism. She explained that she was referring to the recent protests against Estonian Fascism. I asked, "doesn't the name Nashi refer to the Russian nationality?" "No," she said, "Nashi refers to all the people who are joining together to solve these kinds of problems." In the context of a discussion of the movie, Crash, it seemed like a funny take on the meaning of racism.

A couple weeks ago, I had the opportunity to see another kind of protest altogether. Sveta, an acquaintance I know through the support group for PLWHA told me that people would be meeting on Sunday to hold a demonstration in protection of the regional library from "commercialization." When I got there, I was delighted to see what seemed like earnest and light-spirited political activism, of the kind I was used to participating in when I lived in New York.
When Sveta invited me, I mentioned briefly that I was interested, because I'm usually involved in political activism in America and I hadn't met many Russians interested in Politics. She said, "this isn't about politics. It's just for the interests of the people." This, I think, was an important hint to the way Russian society works: politics is the sphere in which corrupt politicians compete to grab dirty money. Everything else, including the public interest and any action related to it, is completely divorced, a different category.

However, this looked just like political activism in America...and I would say that the Samara government saw it as such as well. Though the police response to our thirty or so demonstrators couldn't compare to the thousands of riot police that come out for the meager demonstrations of "the Other Russia" in Moscow, what started as a pair of cops harassing kids for playing punk music unpleasing to the their ears over a loud speaker from his cell phone...eventually became an escort of two police trucks and two KGB cars (oops, I mean FSB, excuse me).

Considering the demonstration was unpermitted, though, I wouldn't consider the reaction bad at all. There was a TV journalist present who worried me more, because of her open suspicion of the foreigners present, asking me strange questions in disbelief that I was a foreigner. I was worried she was ready to report on the presence of foreign spies at the march (A friend of mine who works for the Moscow Times once advised me, "if you meet a regional journalist, run in the opposite direction as fast as you can." Apparently the guy on the right agrees.) At the end of the march, when we reached the the library under question, the demonstrators performed a little sketch about the need for interest groups to pay money for access to library materials.

One of the demonstrators, Tanya [see below], spoke really good English and I interviewed her, briefly, to get her explanation of the demonstration. I am trying to figure out how to make that file available here.

Last night, I met up with my friend Natasha. I have known her since my last trip to Russia in 2004, and have at times felt very close to her. She is fairly unique in Samara, in that she is an unmarried businesswoman in her late twenties. She has traveled around the world including trips to England and India, and here in Samara, seems to know everyone in the music world. She is particularly into trance, and likes to take ecstasy at raves.

Yesterday, we met up early in the evening and sat with some of her friends and her new boyfriend, who I was meeting for the first time, to drink beer and watch the sunset over the Volga from Ploschad' Slavy [Glory Square]. We chatted about life and music and a little bit about my work. In particular, we talked about empathy and its involvement in sustained happiness, as Natasha had just looked at my website and I guess read my training on empathy and behavior change. Her boyfriend Dima, asked if one can change one's own biochemistry by sheer force of will. I said something about changes in Serotonin that are associated with meditation. "I'm talking about something else," he said. A little later he joined me as I walked down the hill a bit to take a pee. As I stood, relieving myself, he asked me, "In general, how do you relate to HIV," he asked me. "Well, I fight with it, that's what I do," I said. "Because I'm HIV positive," he told me. "Seven years already. I think being happy is the key to staying healthy. I don't take any medicine or anything."

As we walked back to the group, the shadow of the horizon already spreading over the green blades of grass, we had a quick discussion of antiretroviral therapy and I gave a little speech about why I believe it is effective, and why sometimes happiness isn't enough support for the immune system in the war against HIV. As we approached our friends sitting on some sort of irrigation pipe, beer bottles lying on the grass around them, our discussion thinned out and dressed itself in vaguer and vaguer terms. As I sat down, I wondered if Natasha knew and if it was wrong of me to protect Dima's confidentiality, as I automatically do.

A bit later, as the night settled in, we decided to go to Podval [literally meaning Basement], the town's only rock bar, at which I am now practically a regular. There was an emo concert playing of a band from Kiev, called Marakesh. The lead singer was a stringy adolescent-looking kid in his early twenties. Dressed in black and with his long bangs hanging over his face like a wedding veil, he scratched out whiney songs in both Russian and English. He had an awful accent. We sat at a table and got drunk, eating dried fish and squid with our beer. I grew to really like Dima. At one point they passed around poppers for some reason. Dima took a big deep inhale and then sat in a stupor for five minutes.

The subject of drugs came up, and this lead to a discussion of heroin addiction and HIV. Natasha did know about, it turns out, and Dima told me that he had gotten infected by the bad heroin from Central Asia. It was profitable for Central Asians, he told me, to weaken the Russian race. We argued for a while about whether it was possible to infect heroin with HIV, so that all users became infected (it is not possible, because HIV dies in contact with air), but ultimately I didn't push too hard. This is a commonly accepted myth among heroin users in Russia.

Later on, Dima went to the bathroom and I was finally alone with Natasha. "Natasha," I said, "I like Dima a lot. Please just tell me you use condoms." A sad smile came over her face. I had seen this smile before. Months ago we were sitting in her friend's kitchen, when she got a text with some sort of bad news. She was suddenly very upset and tears started to creep from the sides of her eyes. Then she smiled this smile, and from her purse pulled out a little plastic bag with a pill in it. She put the pill on her tounge and looked up at me with her big sad eyes. That very same smile under them.

"Dan," she said. "I'm HIV positive too."
"Really? Since when?"
"Well, probably by now," she said.
"Have you been tested? Let's go get tested. You should know for sure. You should see a doctor."
"It's too early isn't it Dan? There's a window period of six months, right?"

And here I was getting all proud of myself for all these fancy trainings I'm doing. Recently I've been so excited about the upcoming two-day seminar I'll be leading in Saratov, a whole three day retreat planned around my seminar for all the organizations doing case management there. In the face of this reality, though, it all just seems so pallid, so foolish. How do you stop a thing like this from happening?

2007-04-26T12:15:00.000-07:00

Rusglish 4/27/07

Quite possibly the coolest email I've ever gotten:

Hi Dan,

It is nice to feel your fervour !
Make it in Russian, pls, as the seminar will be in local dialect.
--
All the best,

Michael

2007-04-22T13:34:00.000-07:00

Vesenoe Nastroenie - 4/22/07

I am now nearing the last two months of my time here in Samara, and I feel as though I have entered a new (and, I hope, final) phase. I finally sense some momentum behind my various projects. In fact I am now incredibly busy, trying to keep up with all the translations and various documents I need for all the things I am doing. I have found a renewed excitement for my research and am going to try and give it one last push to get some real, hard and useful data in my last 9 weeks. I'm now creating a panel of questions to be used for qualitative interviews, and am in the process of arranging interviews with up to three different groups (frequent support group participants, people living with HIV/AIDS engaged with the healthcare system, but not with any NGO programs, and people living with HIV/AIDS not engaged with the healthcare system, but in contact with NGO outreach workers). If I could conduct enough interviews to make a valid comparison, I think it would make a pretty interesting study. And if I can talk to a few doctors in the process, I will be quite delighted.

I'm also almost finished with preparing the third training, which I will be doing for the organization I'm now working with in Togliatti. This week, I created a Russian-language website to act as a mini-resource center for case management. It has all my training materials on it and some links to decent articles on relevant topics in Russian. I'm hoping I will be able to write a Russian language article about case management by the end my time here, in which I will mention this website.

Last weekend I took a fun little trip to Saratov, the next big city down on the Volga. It is a quaint little town, nestled between some small hills and the Mighty Volga. I went with my three German friends to visit their colleague there, who works for the Goethe Institute. It was quite fun, and, needless to say, I learned a good bit of German. At the top of one of the hills behind the city sits Park Pobedy [Victory Park] the city's obligatory ode the Soviet Union's defeat of Germany during World War II (or the Great Patriotic War, as Russians refer to it). In addition to the gigantic memorial shown below, there was a permanent exhibit of all the military technology of the Soviet Union, from the first tanks used in WWII to the helicopters and planes used to invade Afghanistan. There were missile launching trucks and gigantic bombs. It was easy to forget that the purpose of all this million dollar stuff was to turn human flesh into unusable mush. I'm glad I'm going to become a doctor not a soldier.From below this monument, you can look out upon some amazing views of the city and the Mighty River Volga (including her longest bridge which links Saratov to nearby Engels).Many couples were getting married on the particular Saturday we were at this vista point, and they almost had to wait their turn to take pictures in front of the city scape and release doves into the immense, cloudy sky.All in all, it was a nice little trip, and I ended up killing two birds (not doves) with one stone, as I managed to arrange for myself a meeting with a PSI representative there who was very excited about using me for their case managers there. In fact, I will probably be returning in early June for a two day seminar of my design for all the case managers they work with in the city of Saratov.

Spring is here and I have been enjoying the changes it has brought with it. Certainly all Samara's young people are out and about gulyat'-ing [literally meaning to walk, but colloquially meaning to hang out], and I must admit to having a bit of a veseniy nastroenie [literally, spring mood, usually a reference to the seasonal desire for companionship]. More importantly, I have been watching some of the most wonderful sunsets over the Volga.

This evening, I went to gulyat' with a friend of mine and her sister and brother. They were running late in meeting me on Pushkin Square, so I sat, looking out over the hill descending down to the bank of the Volga, and watched the horizon flare up in front of me. Breathing in the crisp spring air, clean and shivering from the day's brief, chilly showers, I could feel the immensity of the sky under which I sat; I watched as its churning layers of gigantic, sweetly flavored clouds dwarfed the icey grey waters of the river below them; the reds and oranges and violets stretching from me to infinity made the dark brown forests on the opposite bank seem to hide themselves shyly, to quietly bow in reverence. It was a wonderful moment. I tried to stretch it out and savor it, to notice each moment pass, each breath try its best then disappear.

I'm a sucker for things like drama and catharsis. I have always sought out moments of transformative importance. I cannot say if these ten minutes I spent this evening will succeed toward that end, if this sunset will serve as a symbol of some transition to a new life, one with purpose and discipline and payoff. Perhaps it was nothing more than a nice sunset, that very same phenomenon that is going on constantly as the earth's shadow sweeps across it's surface, seen by millions, unnoticed by most.

Who knows? I liked it, anyway.

2007-04-02T12:35:00.000-07:00

Coming Round the Bend/Anxiety - 4/2/07

The moon hung low and full tonight over the aging concrete buildings along the Volga River embankment. Her full, white eye was engaged in a silent staring contest with Mercury, floating low above the opposite bank. Both shone unblinking silver light into the spring night air. The dim glowing cityscape hugged the river's curve north around the Zhiguli Mountains, lying low and invisible below the scant stars and deep purple night. I spent an hour this evening walking along the naberezhnoi [embankment], unloading to my parents over the phone about how dissatisfied I am with what I have to account for the last seven months here. It was a beautiful night, but I couldn't enjoy it. I was too weighed down by the feeling that I'm wasting a once-in-a-lifetime opportunity.

Now that I officially have only three months left, I feel acutely the need to try to somehow make this fellowhip worth its salt. I have had some relative successes of late at being productive. A little over a week ago, I finally gave my second training, the one I had been preparing about burnout. It seemed to go pretty well, despite the fact that I stumbled over my Russian during the powerpoint presentation. The two case managers asked the woman I work with at PSI to ask me about giving the training to the staff psychologists at the family center where they work. The coordinator of the case management program also gave the thumbs up on me doing three more trainings in my remaining time here. Earlier that week, I had also been told that another CM program funded by PSI in nearby Togliatti had been asking about me and that I should do the first training there. (Why this had only gotten back to me just now is one of those Russian questions that's better left without an answer.)

Last week, I volunteered for a language camp that reminded me of both the satisfaction and the tiredness of having a full-time job. I ended up falling in love with the kids who ranged from a five year old, who could shyly sing a song in french about a family of tortoises, to a pair of cynical fifteen year-olds, with whom I analyzed lyrics to a popular song by Fall Out Boy. The star of the week for me was a hyperactive seven year old who looooved it when I held her upside down in the air and tickled her stomach and such. By the end of the week, she had mastered the sentences, "I want to go upside down, please," "I want to jump, please," and "I want to sit on your shoulders, please." She could even add "again" appropriately to them.

Now that I am back to answering only to myself for my time, I am quite a bit anxious. I must struggle to bring to fruition all of the promising semi-offers of a week ago. I am also now trying to prepare the bases for two publishable articles, one in a Western journal of medical anthropology, and one in a Russian language journal on health promotion. I am particularly anxious, because this is by no means the first time in this grant period that I have had a bunch of ideas and a handful of promising leads toward meaningful engagement in the community; almost none of them have come to fruition in the past, both out of my own lack of initiative and that of others.

After an hour on the phone with my folks, my brother finally managed to cheer me up. "Look on the bright side," he said. "You're alive. You have five senses. Breathe deeply." As he said this, I looked up at the rows of colored lights above one of the fancy new buildings hanging over the Volga and saw them glimmer. I watched dust blow across the little square in which I was pacing. I looked out across the wordless, ponderous river, and saw the faintest strip of violet along the horizon, hanging over the dark forest on the right bank. Slick, silvery chunks of ice slowly floated quietly by in the night. And I was brought back to a nice moment, to a momentary feeling of belonging.

2007-03-11T05:53:00.000-07:00

A Poem - 3/11/07

This year slithers slow like a snake,
each scale moving quickly along the sand
soon to be shed and left for dead,
as I slide upon the next.

I look inside, deep below the tasty layers of my ribs,
and what do I find,
a ticking clock,
a push and pull,
that goes round and round
circulating and cycling,
without direction

There is never a moment so heavy as walking out of a movie theater,
to discover this life is your own

and nothing can be done to hold it in place,
to put it down in celluloid silhouettes
dripping with the sweet melodrama
chopped up and strung together for all to see and understand

My father advised me:
patience – old age comes

I am left to wonder,
what is on his cutting room floor,
how many of his scales slipped away
without meaning

And I love him so.

2007-02-19T15:06:00.000-08:00

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.

2007-01-20T10:26:00.000-08:00

Uncollected Thoughts - 1/20/07

I can't grab onto a thought anymore,
can't make one sit still long enough to spit out.

They flit around like butterflies,
wings glistening in brand new light
their perfect painted patterns viewed in strobe relief,
burning only a memory onto my mind's screen

Ideas spring into the air
and are dashed apart each moment anew
flash in the dark,
and ashes slip through fingers
that type only as fast as they can.

There are many things I have wanted to do since getting back to Samara from my trip to Siberia and Mongolia. Just one of them was to write down every amazing thing I saw, to write in detail about what felt to me like a great adventure. That feeling is one I do not have much living here in Samara. This is something I realized in my travels, that my life in Samara no longer feels like travel, but has a bit of the comfortable elements that feel a bit like a home, familiar friends, rituals, geography, language. When I was on the last days of my trip, in Mongolia, sick and tired and cold from the unsanitary food and the horseback ride in the countryside, I longed to get back to the relative feeling of home I have in Samara. I felt spiritually renewed and ready to get back and attack my project with new energy.

Now, settling back in, I see that the feelings of home and comfort I have here are a double-edged sword. Not feeling like an alien frees me up to explore and participate in life here in ways I could not as a mere tourist. However, at the same time, the feelings of familiarity are based on having set rituals and established relationships based on a certain level of productivity, one that became unsatisfactory to me back in December. In December, I did not really accomplish much and spent the entire month procrastinating work on my next training, one I have yet to complete (though I have a good draft in English, I will translate this weekend).

This first week back, I have been struggling to reinvigorate my life here with the sense of spiritual renewal I had on my trip. I have started meditating, and have had conversations with two or three key liasons to my work here about my desire to do more, to restrategize so as to more effectively share the lessons of my experience in the Bronx. I have pledged to myself that I will finally decorate my room and spend less time on the internet. I hope to remember that peace and tranquility begins within us, if it is to be found in this chaotic world.

All these changes are proving difficult to make. I believe the relational psychoanalysts have it right in seeing the self as largely a product of the way we internalize our relationships to others. As much as I wish to somehow change something within myself to make me more productive, to better be an agent of change, I am dependent on my relationships to the people around me, and many of the people I work with in Samara have come to expect a certain degree of productivity from me. It also does not help that I will be leaving in another week for a mid-project seminar in Moscow and then for two weeks in the States for additional med school interviews.

In the meantime, my two conversations about my need to restrategize seem to have borne some small fruit. Berries, really. Katya, who works at PSI and oversees the case management program, and I agreed that we would go over the language of my Burnout Syndrome training on Monday and Tuesday of this week. Lyosha, who leads the local support group for PLWHA seems to have done some talking on my behalf, because within an hour or so, his girlfriend (who is trying to organize a group in nearby Togliatti and with whom I had planned to meet sometime this coming week) and Olga, his co-leader in the group (with whom I had talked about doing a training on coping strategies for PLWHA) called to finalize plans. So, now I have three things set in stone for the coming month and a half.

I'm reading a lot about the history of the Soviet Union these days. In particular I'm finally getting around to reading Remnick's "Lenin's Tomb," which is excellent. In it, I've come across the following wonderful quote by Andrei Sakharov, nuclear physicist, turned dissident and human rights activist:

"Other civilizations, perhaps more successful ones, may exist an infinite number of times on the preceding and following pages of the Book of the Universe. Yet we should not minimize our sacred endeavors in the world, where, like faint glimmers in the dark, we have emerged for a moment from the nothingness of unconsciousness into material existence. We must make good the demands of reason and create a life worthy of ourselves and of the goals we only dimly perceive."

This seems to me the perfect summary of what ethics should be in the post-modern era. I'm sold. Too bad he did not survive to lead Russia through perestroika. God only knows how much healthier this country's civil society would be had he not died.

I'm off to dance the night away at an all night party with four dance floors. Woo Hoo.

2006-12-14T02:32:00.000-08:00

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.

2006-12-07T22:06:00.000-08:00

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.

2006-11-11T06:15:00.000-08:00

The Client-Centered Approach and the Me-Centered Cultural Gap - 11/11/06

So, this week has been enormously eventful, on both sides of the Atlantic. As all of you know, in the States, the Democrats swept the mid-term elections and took control of the House and Senate. Rumsfeld retired. I think we can all be proud of the level of functioning of our democracy, whether you are a staunch supporter of the American Left or not.

Here in Russia, the process of democracy continued to erode at its own slow and grinding pace. A new election law that has already passed its first reading in the Duma has been ammended to remove minimum turnout requirements, thus eliminating the legitimacy of voter boycotts. The law removed the ballot option of "against all" and allowed the government to strike candidates from the ballot that are deemed "extremist" by a court (which as I mentioned in a recent post was defined by another new law on extremism to include "public slander of a government official related to his duties"). More importantly, the new Borat movie, "Cultural Learnings of America for Make Benefit Glorious Nation of Kazakhstan" was literally banned from Russian theaters: the first instance since Perestroika of a non-pornographic film being banned.

The good news is that I'll actually get to see the movie, because I'm taking a quick trip back to the States for med school interviews. My top choice school invited me to interview next Friday, and since med schools have rolling admissions, I jumped at the chance. I have since arranged two other interviews. Only after all was arranged did I find out that none of these schools actually have rolling admissions policies. Oh well, I can't wait to consume a good slice of pizza/some greasy diner food/Thai food/good coffee and use a washer and dryer.

The other main event for me this week was on Wednesday when I conducted a training I have spent the last week and a half developing on counseling skills. For the last month and a half, I have been working bit by bit with the Tzentr Meditsinskoi Profilaktiki Goroda Samary, the Samara City Center for Profilactic Medicine, who has formed a small case management program with funding from Population Services International (PSI). So far, I have had two aims for my work with them: to learn about what the program is already doing and to introduce myself as someone with valuable experience and an earnest desire to help.

This work has been made difficult by the absence of any precedent or clear pretense for what I am doing here. Somehow, even though I had been preparing my trip for over a year back home, no one had told the people in charge or working in the program that I was coming. My main point of contact with PSI is the volunteer coordinator. It is not a large organization in Samara, but somehow, from him to the head of the organization to the woman working with the case management program, the message never got to the program itself that a young, idealistic case manager was coming to town to help out. Ultimately, I was introduced to the program by the head of PSI, Samara at a round table on case mangement, at which I ended up speaking. Since then, I have had to start from scratch, making efforts to meet with the leader of the program, the case managers and the outreach workers.

This awkward introduction, the often-present sensitivity of Russians to those from currently "dominant" countries in the West and the language and cultural gap have all made this early period very difficult. I have been trying very carefully to walk the thin line between being here to volunteer my time, effort and experience, and being here to tell them how to do their job. While I do hope to help them improve their program, I do not want to come off as though I think I know everything, just because I have spent a year in a functional program in New York. Indeed, I am sure that I do not know how hard it is to do what they are trying to do in the context of Russia, where social services are merely a vestige of the Soviet sytem that have been robbed of their funding, there is an almost non-existent civil society trying to fill in for that gap, and most of their clients have insurmountable needs to begin with. Furthermore, the extreme vulnerability of the populations they hope to serve (commercial sex workers and injection drug users) must make the work enormously trying for the workers on the ground.

In any case, the culmination of this early period came on Wednesday of this week, when I conducted a training I offered to prepare on "the Psychological Aspects of Case Management." Since I have still been unsuccessful in seeing the case managers actually work with clients, it was difficult for me to assess the appropriate level of the training. Furthermore, since it was only agreed upon as an experimental, one-time, hour-and-a-half training, I wanted to try to cover as much theory as possible, in leu of trying to go into detail into any one topic (which would be ineffective if it were an isolated event). So I decided to try to introduce the basic principles of the client-centered approach, and to do a few basic excercizes to see how they would translate into practice, in the hopes that this would pique enough interest to go into more detail later in further trainings. At the meeting in which I had volunteered to do the training, I asked the case managers if they were familiar with Maslow's theory of the hierarchy of human needs (commonly referred to as Maslow's pyramid). They said they had not, so I figured that would be a good place to start.

I spent a week developing a PowerPoint presentation that described the hierarchy of human needs, the gap that often exists between the goals of the program/case manager and those of the client, the use of reflection and empathy to help people learn more about their own wants and feelings and the 'stages of change' model of behavior change. I prepared two excercises which would give the audience practice using empathy and reflection and evaluating a client's readiness to change his or her behavior, a hand-out on the basics of building trust and relationship with a client and an evaluation form for the training. I went over all the materials [see me preparing them, below] with a couple native Russian speakers and made sure that everything made sense. I was set to give the training for what I thought would be an audience of 10 to 15. Oh, and the whole thing was going be in my shoddy Russian.

As it turns out, there were only five people that showed up on time (within 15 minutes of on time, that is), and one of them left before the first excercise. The theory part went well [see right], though I think it was probably quite grating on the ears of the attendees to hear me massacre their language and to slowly go over what they could read on the screen in a few seconds (I also did see one of the two case managers have a whole conversation by text messages during this time).

When it came time for the excercises, however, everyone seemed kind of stunned. Since there were only four people present, we decided for the pairs to take turns. No one wanted to go first. I had to pick. The scenario was fairly simple: the first person was supposed to describe a situation in which she felt happy, sad, angry or scared, and not to talk about how she felt initially, only about the situation. The second person was supposed first to reflect what the first person said back to her, in order to indicate that he was listening and that he wanted to know more, and then to express empathy, by guessing how the client was feeling in this situation.

First, the case manager, who was supposed to describe the situation, began to describe her feelings before she even got to the situation (thus eliminating the purpose of the excercise -- to practice merely guessing what people are feeling without trying to advise them). Then, we tried it again with a different emotion, and the outreach worker (who was playing the clinician), simply began advising her about what to do (though he had excellent, sympathetic tone and gestures). After a brief discussion about their attempt, the second pair did not want to go, and said that they got the idea. I didn't want to push, so continued with the material about behavior change. During this time the director of the program arrived with a guy who is the driver/outreach worker.

When it became time to do the second excercise, the program director volunteered to go first, but her partner (the driver/outreach worker), who was supposed to play the part of the clinician was completely unclear of what to do. Gauging that he was not the only one in the room unprepared to practice the new theory with the excercize I decided it might be useful if I gave an example. So I sat down with the program director (who was playing the part of a commercial sex worker new to the industry) and set about attempting to assess her interest in moving toward less risky work.

So there I was, having never specifically worked with a commercial sex worker (at least not with the goal of reducing her risk of HIV infection -- all my clients were already positive), role-playing with the director of the program, trying to ask open questions and express empathy in Russian [see above]. Even though it only probably went on for about three minutes, it felt like forever. After this, people were already tired and ready to go home, so we just discussed it a little and people started to get ready to go.

Reflecting on it now, I am so filled with doubt. I honestly cannot get a get a sense of what, if anything, I managed to accomplish with this training or if it was at all useful to these workers. They told me that they found the whole thing interesting and helpful and repeated this on their evaluation forms. However, I can't help but suspect that they were just humoring me, that they see an enthusiastic kid from a different country trying his darndest to be helpful and nobody wants to tell him that he looks like an idiot with unrealistic ideas. On all three of the evaluation forms that I got back, the participants said they were completely ready to use the skills from the training in their work.

The woman at PSI who works with the program was present for the training and told me the next day she thought it was useful, but that the people in the program have a long way to go before they can really use these skills with clients.

This, indeed was clear. First of all, the program right now isn't even set up to do any of the longitudinal kind of work in which counseling skills really pay off. As the program is designed now, they see the client once or twice, refer them to a bunch of doctors, maybe a lawyer, and that is it. That is their contact with the client. They make goals on their service plans and then they accomplish the goals. But the goals are all short term: refer client to a doctor; refer client to rehab.

Second of all, it became clear during this training that the case managers have some pretty judgemental attitudes toward their clients. When I asked in the beginning, why clients don't often reduce their risk behavior on their own they replied "laziness." Everyone in the room at the time agreed (except me).

And then of course, I never expected this training to be anything but an introduction to these ideas in the first place.

But I can't help but wonder if I'm even on the right track here. I noticed a duality in the way the participants answered questions that keeps coming back to me. As part of the introduction, I asked, "What do our clients often want?" Their answer was automatic, "They want to recieve better medical services." "They want consultation about how to lower their risk." As though the clients simply want what we are giving. When I said that in my experience, people (especially people in the commercial sex industry or with drug habits) often are more worried about making sure there is food on the table, a roof over their heads and drugs in their arms, they agreed and said that they didn't think clients really want to have a better, healthier lifestyle, that they were too lazy. Of course, I went on to try to explain that laziness is actually just what it looks like from the outside when we are not psychologically ready to do something. Who knows if they were in any way convinced. Who knows if I even really believe that, through and through. I had written these questions into my introduction specifically to get a sense of how they viewed their clients. It was interesting to see, because it was as if there was a switch that flipped off, the second I recognized out loud the reality of clients' lives. Suddenly their official capacity was not required and they were free to place the onus on the clients.

I worry that the switch simply flipped back on by the end of the lecture so that their agreement with the principles of empathy and the client-centered approach to behavior change was simply acquiescence to what they saw as a new form of official rhetoric. That this will have no bearing on their work with their clients. I am worried that no matter how many trainings I prepare, no matter how many suggestions I make to enrich the quality of service to the clients, the program will keep going just as it did before I got here, because I am not an Authority, so what I say does not matter. In a system as vertically oriented as the vestigial Soviet social programs, this is to be expected. I worry most of all, however, that they are right to ignore me, that their clients cannot really be helped in the way that the funders of the program and I hope, and that my vision for this program, seen from across such a wide cultural gulf, is actually just a mirage, a reflection from the depths of the abyss that lies between me and a true understanding of the clients this program serves.

Before I left for here my therapist in New York said something to me that I found very helpful. He said, "bravery is not running into a burning building to save someone's life without fear. That is the myth we have about bravery. Taking on dangerous tasks without fear is just stupidity. Bravery is running into a burning building to save someone's life despite the fact that you are terrified out of your wits." I'm not saying that it is brave for me to continue to try to help this program. But it helps me to keep in mind that it is a good thing that I have so many doubts. That these doubts are what keep me from being an idiot.

For now, I feel at least that this was a good place to start. If nothing else it will help the people working in this program to get a sense of how I see case management and to trust that I mean well.

For tonight, I'm just excited to go home for a week so I can get a fricken haircut.

2006-11-01T10:46:00.000-08:00

No More Elections (for Mayor of Samara) – 11/1/06

And just a few days ago I was so hopeful about democracy in Russia because of the results of the mayoral election...

Then, on Monday, The Moscow Times reported that a new political party had been formed, called "A Just Russia." It is the new "opposition party" created by the merger of three old parties that had a couple people in the Duma, the Party of Life, Rodina and the Pensioners' Party. As a result, Russia now effectively has a two party system. At the formal announcement of merger, Mironov, the leader of this new party declared boldly,"We will follow the course of President Vladimir Putin and will not allow anyone to veer from it after Putin leaves his post in 2008."

That's quite a strong statement of opposition. This guy Mironov ran in the last presidential election, and said, "i'm not running against president Putin, i'm running with president Putin... because when our leader goes into battle, we can't let him go alone." He is, quite clearly, the biggest Kremlin puppet around. After reading this article, I went back to check for which party Tarkhov had been the mayoral candidate (somehow this had not occured to me to be important, before), and it was the Party of Life. So, basically, the victory I described was that of one Kremlin stool over another.

This was a real killjoy. My excitement about the democratic process was shot out of the sky.

But today, it got buried deep in the ground. The Moscow Times reported today that the Kremlin is pushing forward a new bill that "would allow the abolition of elected mayors in big cities -- the only powerful officials still outside the Kremlin's direct control." The justification? "'Public officials answer to the public for providing services,' Mokry, chairman of the Duma's Local Administration Committee, said at a news conference. 'If that is not being done properly, then the state has an obligation ... to take the responsibility onto itself.'" I thought the People were supposed to be the ones who bear that obligation. I guess I had it backward. Silly me. The name of the guy being quoted, Mokry, means 'wet' in Russian. I wonder if it also means 'slimey.' Looks like I am back in the camp of the Russia cynics.

This move to the cynics' camp was helped by the fact that on Tuesday, I got a shtraf [a ticket], for crossing the street. I'm not joking, these police officers apparently had some quota to fill so they stopped their car in the street in front of Samara's biggest mall, MegaCiti. There is a place in the street [see left] which still technically does not have a crosswalk, even though there is a concrete path on one side of the street that connects to a concrete path on the other side, which quickly turns into a crosswalk that goes through the parking lot. There are no signs anywhere instructing pedestrians to do anything (let alone not cross here). The police did not direct the group of people I was walking in not to cross, but after we crossed asked four of us (all students) for our documents. He then gave us official shtrafs (rather than taking bribes which is what they usually do). It was very surreal. This path connects the University to the mall [see right], so something like 10 people cross the street in this location every minute. Wave after wave of people crossed the street right in front of the police officers while they were giving us tickets.

This was just another stark example of the way the legal system works in Russia. Technically, almost everything is illegal, so the government can choose when it wants to enforce what law with whom. This can be motivated by politics (as in the case of Khadarkovsky), by the desire of an individual official to make a career for himself (as in the case of the FSB agents that have visited my friend Susie twice at work now to see if they could catch an American not properly registered "on Russian soil") or by lack of an understanding of what better to do (as in this case). This will now be the case even for mayors just doing their jobs.

Oh, well! Look at these pretty pictures I took on a bike ride I went on the other day.

2006-10-28T09:51:00.000-07:00

The Elections (for mayor of Samara) - 10/29/06

[this poster reads: "The City Against Corruption, a Societal Action. Corruption, it's poverty; Corruption, it's lawlessness; Corruption, it's a crime. -- Note that there is no indication anywhere on this poster about what activities this organization does or how anyone can get involved. It is probably just a concerted effort by one or more of the incumbent's opponents to agitate discontent within the city.]

Hello dear readers. I’m back, and ready to write again. I’ve gotten very busy with my project, with a trip to Moscow, with applications to medical schools. All this time, I’ve been meaning to write about the local mayoral elections here in Samara, and now they have already happened... well, I will give a brief description anyway. I’ll even try to build suspense before telling you who won.

What was most fascinating to me about the elections (especially given the entrenchment of my political thinking in the American two-party system) was the number of well-funded candidates. There were supposedly more than twenty candidates on the ballot, and at least five or six had huge, ubiquitous campaigns. What was fascinating about this was not that so many people or parties would think they have a chance at the mayorship, but that they would have funding to do so. No one I know here donates money to or even vocally supports a political party. Most young people seem not to care the slightest bit, and the people I have talked to who do care about politics (mostly people above college age) don’t seem to believe it makes any difference who wins (I asked my friend what kind of platforms people were running on. He said “I think their only platform is corruption, all of them”).

My friend Misha, a doctor here in Samara, gave me a rundown of the election. Almost all of the money in this election, he said, comes from oligarchs and the mafia. The oligarchs want to keep their names out of the papers and so they prop up shadow candidates. Some oligarchs even have a handful of candidates that they are propping up. He told me that this is partly evident in the biases of the different media outlets that are owned by various oligarchs or mafia fronts (he even made me a chart, which I have since lost, unfortunately).

The campaigns themselves seemed to me to clearly reflect this assessment. The campaign of Evgeniy Grigoriev, for example, was a clear response to the pervasiveness of the mafia and oligarchs. His motto [see right] was, Pora Navesti Poryadok Bez Vorov I Oligarkhov, meaning It's Time to Bring Order without Criminals and Oligarchs! Misha told me that he knows Grigoriev through friends of friends and that he was, in fact, a former KGB agent who lived in Western Europe during the Soviet Era. He speaks all European languages perfectly and, “probably was responsible for the destruction of much American property in Europe.”

On the surface, most of the campaigns resembled American grassroots campaigns with one important difference: there were no grassroots. There were young people everywhere, wearing colors, passing out fliers, waving flags, chanting chants and marching down the streets [see left]. However, all held a look on their face of complete and utter indifference. They were all just working to get some extra cash. A friend of mine worked on one campaign. I asked, “do you care if your candidate wins?” She said, “To tell the truth, it doesn’t make a difference to me.” My personal favorite youth movement mimicry, of those that I saw, was an aktsia, in which a marschrutka (mini-bus) dropped six or seven cheerleaders off by a busy bus stop, all dressed in pink shirts reading “Belashev No 1." They walked passively up to the bus stop and then began chanting, “Belashev Nomer Odin!” “Belashev Nomer Odin!” and pumping their pompons into the air. They were followed by a young man, wearing the same shirt and passing out fliers. They walked about 20 meters chanting and then got back into the marschrutka and went off.

Belashev’s “youth movement” also included pro-Belashev graffiti [see below]. It was not the only campaign to do so, but again I was impressed by their 'youthfulness' (that graffiti says “We Believe in You” “You’re Super”).
I assume the anti-Semitic graffiti on this poster for Matveev [see below] was actually self-motivated and not a part of anyone else’s campaign [the detail below says Kandidat na post Glavy Samary, or "Candidate for the post of Head of Samara," someone has added ot zhidov, meaning "of the kykes"].

I asked most of my college-aged friends what they thought about the elections and it was hard to get an opinion. Most seemed to think it did not matter. I did get one of my friends, a college graduate, to explain that she was in favor of the current mayor (because of something having to do with new orphanages; I didn’t quite understand), but a couple of my other friends leaned over to me and said that everything she was saying was pure bullshit, that I shouldn’t listen.

One friend said specifically that it did "not matter because no matter what, the current mayor will continue to be mayor." He has been mayor for ten years, was his reasoning, and people don’t care enough to change things. Indeed, this opinion is backed up by the fact that Limanskiy, the incumbent was the candidate of United Russia. Indeed, all over Russia, United Russia is rapidly entrenching its role in the government through a combination of political machine/patronage-type tactics, gaining control over the media and limiting the movements of opposition party organs.

The power of United Russia was evident when after the first round of elections, Limanskiy did not come in first. Because Russian law requires a majority vote and not just a plurality, a run-off election was required between Limanskiy and Tarkhov the candidate who received the most votes in the first election. Suddenly posters everywhere showed Limanskiy with various celebrities from Moscow. The governor of Samara Oblast’, who had previously been at odds with Limanskiy, was now featured shaking hands with Limanskiy in huge billboards all across the city. At one point, I was in a car with a friend who explained that there were increased numbers of police checkpoints around the city to ensure control of the huge number of Muscovites that drove into town to help bring Limanskiy back to power.

Samara, indeed, is important (though by no means key) to United Russia. I have been told that the highest concentration of rich people (by percentage) is actually in Samara, not Moscow or St. Pete. I’ve also been told that Samara has the third highest cost of living in Russia) and that nearby Togliatti has the highest concentration of mafia. Indeed Samara region is an important industrial region. One of the world's largest fabricated aluminum operations (owned and operated by Alcoa) is in Samara. There is also at least one oil and gas company centered here and Togliatti is the center of the automobile industry in Russia.

So it will be interesting to see what happens, now that Limanskiy and, by extension, United Russia, lost the mayorship of Samara.

Yes, last week Limanskiy lost to Tarkhov, a politician who either briefly was the governor of Samara oblast’ for a brief period or merely ran for governor many years ago, depending on who you ask (this was during the chaos around the 1991 putsch). His campaign was a relatively less visible one, though it was certainly there. His signs said simply, Tol'ko Tarkhov, meaning "Only Tarkhov." It is popular opinion that Tarkhov was elected merely because people were sick of the corruption of Limanskiy and think that new blood is better than nothing. Indeed, Tarkhov has even said publicly said something to that effect, that people did not vote for him, so much as they voted against Limanskiy.

The fact that United Russia, despite all its efforts to consolidate power, lost this election should give pause to all the Russia cynics out there. Indeed, the headlines are bad, and getting worse, it seems. The Moscow Times reported today that proposed ammendments to a law on extremism "[expand] the definition of extremist activity to include public slander of a government official related to his duties." Yet another way for United Russia to clamp down on dissent. But the people of Samara have had enough and decided to replace their government, and no one made them do it nor prevented them from doing it. I do believe that this is what we call real democracy, and people here seem encouraged. My Russian teacher, who says she doesn't like to talk about politics, was excited when the subject came up. She agrees, something new is afoot.

Now that the elections are over, the people who hang posters in this city can go back to advertising things like this new album by the band “Drugly Cats.” It's called, “Blowjob Mother Fucker Sex Machine.”

2006-09-23T03:03:00.000-07:00

Soviet Paradise, New Apartment, Cold Victory - 9/23/06

You should see it, the lavish pavilion in front of our new apartment; it’s the pinnacle of Soviet urban planning. In the post-revolution center of the city, it lies in front of an impressive, well known apartment building on Prospect Lenina [see above background right, that's where we live]. Walking through it’s greenery late yesterday morning, I could imagine myself back in the time when it was just designed and built. The air is fresh and sweet and the warm, angled sunlight makes every living thing look as though it were dancing on the inside. Babi [old women, literally grandmothers] stroll down the pavilion’s verdant, bench-lined walkways, their gold teeth shining in a smile, their granddaughters pulling them forward by the arm as they skip along ahead. Its bright, floral circles and well-kept soccer and basketball courts [see left and below] bring the drab, quarter-mile long, 9-storey apartment building, along which it stretches down to human size. The old men gossiping on benches are shielded from the bustling traffic of Prospect Lenina [see right] by carefully planted rows of evergreens. Their square, tinted glasses reflect the sun’s overzealous rays.

This is the socialist paradise we are all working so hard to bring about. Sure, it is only apparatchiki who live alongside this little strip of heaven, but soon we will bring this way of life to all Soviet citizens, to the workers who built it as well as the planners who organized it. We are almost there. You can see it. You can taste it. You can feel its air brushing up against your cheek

This pavilion is still an idyllic place, but now it is only oil industry businessmen (and foreign researchers on government exchanges) who can afford such luxury. Our apartment is a comfortably large, recently remodeled two-bedroom apartment with a living room, satellite television and, soon, DSL. It is not in the style known as ievroremont [euro-remodel], but has some nice new appliances. (Of course the podezd [entryway and stairwell] is decrepit and smells strongly of urine and the elevator occasionally doesn't work, but that's virually unavoidable in Russia)

This wonderful apartment, for me, comes with a tinge of guilt. We are paying half the money for twice the space we would get in the still gentrifying neighborhoods of Brooklyn. But, our apartment is costlier than that of anyone I know in Samara. Everyone who learns how much we pay think it is an astronomical price (about $700 a month for the whole apartment). But they also could not imagine looking for an apartment in this neighborhood. My friend Olya and her husband who helped us find the place, for example, are starting a family in a slightly smaller apartment, a fourty minute bus ride from the city center (here). Most Russians have difficulty understanding how two kids in their early to mid twenties would be able to afford such an apartment, let alone why they would want to. It is unusual for Russians to spend time living alone between the home of their parents and the home of the family they start. This is the result of both cultural norms and economics. If they do, it is usually time spent in an obshchezhitie [the word meaning dormitory but also youth hostel].

The fact of our luxurious living situation only exacerbates what I have found to be already a difficult dynamic. I wish to represent my country as accurately as possible, explaining both its strengths and its weaknesses, but I do so in a country that has been saturated for the last few decades with Americans singing their own praises, through cold war propaganda campaigns like Voice of America, through foolhardy economic advisors in the chaotic Yeltsin’ years, through the zealous foreign aid or religious missionaries that have been streaming in since, through the wealthy business advisors that now come and spend their conspicuous wealth, and, perhaps most importantly, through imported American cultural products which depict American life, for the most part, in the terms of its own ideological paradise – that of a rich, well functioning, freedom-loving market economy and liberal democracy.

Certainly those living in America do benefit from high quality service provision, relative transparency in both business and government, and some meaningful opportunities to affect the policies of their government, and it is easy to appreciate those things here where socio-economic and political arrangements are still in constant flux. However, many Russians, especially young ones see America as a paradise where all are rich enough to afford the flashy goods and services they see on MTV and in shows like the Sopranos. I am often asked if life in America isn’t ‘better’ than life in Russia. How can one compare entirely different ways of life? Well, the life expectancy is higher (if you don’t live in an urban high poverty area), but the literacy rate is lower… One student was truly surpised when I told him that, indeed, there are poor people in the United States too.

If America ‘won’ the Cold War we now have a cold victory. The warmth and joy that we all saw when the Berlin wall fell has now dispersed.

The Soviet paradise that our pavilion once represented has crumbled. The pavilion remains, but there is no rational scheme in which to fit it: paradise is a place far, far away; toward which one cannot hope to achieve rational progress. Marxism-Leninism provided a plan, a rational schema, which might someday literally extend our paradisiacal pavilion down the extent of Prospect Lenina and, ultimately, through the rest of the city. The current power structure is not built upon any ideology. For better or worse, as the United Russia party entrenches itself into the organs of the government, its only coherent policy platform is to bring (its version of) order where there is chaos (along vaguely nationalist lines). Much like the American left, there is a vacuum of ideology. And, much like those on the American left, the average Russian is left without any coherent, rational strategy toward its goals. For many Russians, the path from here to paradise is not a matter of strategy, but one of geography.

Perhaps my perspective is merely skewed, because I am an American, but I see ample evidence that it is not around me in the reactions to my being an American. The other day, my American roommate and I were drinking a beer in the square catty-corner to our apartment building [see right], chatting about our experiences here, our hopes, our fears, etc. There were groups of teenagers all around us drinking beer and enjoying the ever-so-slightly-cool sunset of what is turning out to be a babi leto [Indian summer, literally grandma’s summer]. There was group no more than ten feet away from us that at one point clearly noticed that we were speaking English, but did not approach us to talk. The dusk turned into twilight and the twilight turned into night [see below]. As the teenagers passed by us on their way out of the square, one of them said, not directly to us, but in clear, hesitant English, “Russia.. is the.. best in.. the world!” I stammered out, “Ya.. soglasen” [I agree].

It is becoming increasingly difficult, as my time here slowly fades from tourism into a life, to hold such reactions in their rational context, and not to be simultaneously saddened and annoyed. I could not imagine being so unwelcoming to guests in my country. I would hold my friends to an equal ethical standard. Is it condescending of me to not take offense by such antagonism? Or would it just be callous of me to take such a comment out of its broader geopolitical context, and then go home to my fancy new apartment to leisurely work on my prestigious, self-structured and self-glorifying research project?

I’m not sure, but I’m sure glad I can.

2006-09-13T07:45:00.000-07:00

The Pendulum - 9/13/06

The day before yesterday, I was overwhelmed with anxiety and homesickness. I felt out of place, like I had made a huge mistake in coming here. I watched the movie version of RENT and cried my eyes out it made me miss New York so bad. I would like to say it was cathartic, but I was still anxious and homesick yesterday.

But, today... today I am great. I woke up early this morning to go to nearby Togliatti with Sasha, the director of PSI, Samara. There was a krugliy stol, a round table on case management. They were delighted by my presence and asked me to speak before the podium. Though Sasha speaks excellent English, I refused his translation services, except for a few words during my speech (almost entirely off the cuff). People seemed engaged and asked a number of questions. Afterward, during the conclusionary coffee, I was told by a worker at the Togliatti's case management program (whom I had actually met, since she was an alum of the USRVI, the year that I spoke at the orientation) that I should speak to the woman in charge of the entire organization about getting involved. Later, this woman approached me. I spoke with the directors of both of the case management programs PSI is funding in the Samara area, the one in Togliatti and the one in Samara. They both seemed interested, perhaps even eager, for my involvement.

In the car afterward, I asked Sasha, "Moi rech -- eto bylo Normalno," (My speech, was it okay?) "Luchsche chem Normalno," better than okay, he said.

I am now, because of this, quite excited. I went home and wrote out a detailed plan for my initial work with these programs. I had written three quarters of a blog posting about how homesick and anxious I was. Instead of posting that, I will list a couple of great things that have also happened: I am taking private Russian lessons with an excellent professor at the university; I am involved in a peer education theater group and may be performing RENT in St. Petersburg in October (as Collins, in Russian); I was interviewed on live TV on Saturday for my opinion on national flags; I saw a martial arts festival on Saturday; I was warmly forcefed all evening Saturday night by my very pregnant friend, Olya (to the right) and her husband and husband's friends; Olya is helping me find an apartment to rent with the other American girl here and we viewed an excellent one near the center of town with great views and lots of space; having a lot of fun playing charades with my friends, called krokodil in Russian (see below).

More analysis to come, but for now, just a thank you to the world for being so good to me.

2006-09-04T05:56:00.000-07:00

Order and the Public Good in Russia - 9/4/06

There was an article is the last issue of Foreign Affairs entitled, “Russia Leaves the West.” In it, the author argues that the attempts by various Western advisors and Russian political leaders in the nineties to bring the Western way of life to Russia and to include Russia in the political institutions of the West were unsuccessful; that Russia, now growing rapidly due to high gas and oil prices, is now self-confident enough to step out on its own and throw off what it perceives as the shackles of Western limitations on the power of state actors.

Indeed, this seems true when you consider some of the high-level goings on of late: the jailing of Yukos CEO, Mikhail Khadorkovsky and the subsequent behind-closed-doors buy out of Yukos by the state oil company Gazprom, the new law that requires all non-governmental organizations to reregister and show how each and every dollar is spent and that prevents any international organization from funding political activities (and almost prevented them from existing).

However, when you walk around small and medium-sized cities, this seems too broad a stroke. Across from the university where I live is a brand new, shiny, western-style mall called МЕГА–СИТИ (Mega City transliterated into Russian), complete with a Body Shop, a Sephora, a food court and a fancy new fountain (pictured at right). The floors are so clean you feel a tinge of guilt walking on them. Looking around inside it, you could be in any United States suberb, were it not for the extreme thinness and angular features of the young women (and, of course, the Russian tongues twisting around inside your ears, ringing the occasional familiar note).

Most overlooked by this analysis is the obsession of Russian marketers with the English language. No shiny, blinking new sign is complete without at least one English word. Far from the center of the city, in the maze between the main traffic corridors, one can find a restaurant whose name is entirely English and not even transliterated into Russian. (the one pictured below says "Second Hand: Aut Let iz Evropi" I'm not sure what an Aut Let is, but I guess they have them in Europe)

English, it seems, is a signifier of coolness and high quality. Its position as the lingua franca of the West cannot be ignored. While those in power may be seeking to unburden themselves of the promises their predecessors made to Western reformers in exchange for assistance, the relationship of the general population to the idea of the West is not as uncomplicated as “on” or “off,” “in” or “out.”

There is an advertisement above a great number of urinals in Moscow. In it, three men are standing at adjacent urinals, apparently finishing up their business. One turns to another and says, “Sir, we at Oxford learned to wash our hands after using the toilet.” The second man says in response, “Ah, but we at Harvard learned not to wash after the toilet.” (A rather strange notion, it seems to me.) Then the Russian man says to the audience, “And we in Moscow don’t think about this, because every self-respecting man uses Sanitelle gel for the hands.” The ad is entirely in Russian, except for the brand name, which is French, I suppose. However, both Anglophones use the transliterated word, “sir,” suggesting that they are actually speaking English. To me, the comparison to Brits and Americans suggests a sort of inferiority complex; as though we are constantly insulting Russians with our superior quality products that we continually export from the West.

While there are some substantive differences in quality, it seems to me that the biggest difference is in marketing (see photo at right, which is an ad for a marketing company called "Marx;" more ironic than a hipster). If there is one thing we are good at in the West, it is selling each other crap. We have spent the last fifty years figuring out clever ways to create demand where there was previously none. I was discussing this with my Russian friends this weekend and I learned an excellent new Russian expression “iz govna sdelat' confeti,” which translates roughly as “to turn shit into confetti”.

To be fair, part of the reason the Soviet Union fell apart was the effect the substantive differences in quality had on Soviet citizens' understanding of their society. And markets, in addition to creating excessive demand for goods and services, also more successfully fulfill the needs of some (not enough) of its participants, by encouraging creativity in ways we easily forget on the American far left. By leaving decisions to decentralized competition for limited resources, we are encouraged to be creative about ways to give others a sense of satisfaction, and hence convince them to give up their money (even if that satisfaction is fleeting and at the expense, sometimes, of the public good).

I believe an essential understanding of this dynamic is still missing from the everyday thinking of Russians, 15 years after the collapse of the Soviet Union. When the other Fulbrighter and I arrived, we were picked up at the trains station by a young Russian lady who works at the university's office of international affairs. She told me she had briefly been to Berlin and was amazed at how everything was “in order.” “Russia,” she told me, “is too big a country to keep in order.”

The word for order in Russia is poryadok. A common phrase that is used like the English word, “okay” or the phrase “it's all good” is “vsyo poryadkie”, litterally “all is in order.” There is a word, “poryadochny” that is often used to describe Putin and emphasize that he is a good leader. It indicates a link between the concept of order and some intrinsic quality in the person given that adjective. Order, as created by an external authority, it seems is still an important concept to Russians in a way it is not to Westerners. Everyone, for example, Russians and foreigners alike, is required to register with the government, every time he or she enters a new city, and you cannot get a cell phone number without presenting a properly registered passport.. In many buildings (not just state ones), one needs to present identification to get a propusk, a pass which allows one to enter. And (goddamnit) I was not allowed to take photographs in the supermarket in the fancy western mall.

But market economics, which Russia now officially espouses, is all about disorder. Markets work because individuals, and firms that behave like individuals, struggle to make order where there is none. The only successful, sustainable strategy given disorder is to cooperate with others to create stable arrangements that will allow all participants to succeed. Given, there are certain public structures necessary for the kind of cooperation we expect in a modern society, and public institutions are necessary to allow for any kind of justice or fairness to exist in real terms. But the essential orientation required for markets to work is that of individual seeking behavior in the face of disorder. With each market actor looking for some higher authority to place things in order, markets are bound to fail to provide goods and services in sufficient quantity and quality. At the extreme would be market failure. At the moderate degree to which most Russians expect some external source of authority to create order, we simply have a situation where the highest quality goods come from abroad.

As both history and the contemporary state of the world attest, this is an extremely difficult balance to reach. States must be able to step in and create those public goods necessary for cooperation, justice and fairness. But their scope must be limited, so that we each must free to find creative solutions to the world's problems, and thus build order from the ground up, without needing the state's approval. In the West, those in power have simply given up on the idea of fairness, it seems. In Russia, the consolidation of the ruling United Russia party and many of the recent moves by president Putin to limit the mobility of opposition parties indicates an ambivalence toward the limitations of scope of state order. Certainly this is not a return to the Soviet state. No one in the United Russia party is a true Marxist to my knowledge. But, there are still arrangements in place on many levels of society, which require individuals to gain approval from higher authorities, and Putin's emphasis on state approval for political activity seems to reenforce that emphasis.

As much as Russians want to live like Westerners in terms of the quality of products they consume, it seems they are stuck in a sort of triangular struggle. They would like fancy things, but must import them from the West. They would like to take pride in their own ways of doing things, but are constantly comparing homegrown products to superior (and superiorly marketed) Western things. They'd like to improve the quality of homegrown things, but must deviate from their own way of doing things (in which they take pride) in order to do so.

I must say, though, it is nice to be able to buy a fresh loaf of French bread in a shiny new supermarket with English names everywhere. It makes me feel at home almost as well as Russian hospitality.

2006-08-29T01:21:00.000-07:00

Culturally Embedded Understandings - 8/29/06 - 9/4/06

On our last night in Moscow we had a "closing reception" for our "orientation," which consisted of snackfood and wine at the American Center in the main library in Moscow. There were only about ten people there that were not directly linked to our program (including the American Center staff). After a speech or two, we were instructed to mingle with the non-Fulbright guests. Two other Fulbrighters and I ended up in a conversation with an American diplomat who had been in Moscow for only seven weeks and, as far as we could tell, had no specialty either in Russian language or culture. He proceeded to impress upon us how different a Russia we were going to be in than the Russia of cold war days. I briefly said something inane about the difficulty of understanding the cold war as seen through its impact on the daily lives of Americans, given that as a youngin' I only read about big events like McCarthyism, Cuban Missile Crisis, Bay of Pigs, etc. His response was to go into a bit of a tirade against "intellectuals" who compare events in the West like McCarthyism to the atrocities of Stalinism. I could not help myself, and had to point out that a better comparison would be with the number of civilians killed by right wing dictatorships propped up by the U.S. via the CIA over the last century. Given, such a tally is not easily available, and would probably be still quite a bit smaller than the number of people killed by Stalin's purges. However, it does complicate the post hoc analysis of the cold war.

In any case, the diplomat kept repeating his central point, that "those were ideological times," when it meant "if you don't agree with my ideology, I'll kill you." Indeed, the cold war and World War II were about ideology. But what is the Iraq war about? I asked him. He said, "that is really more of a traditional war to protect our country's interests." I'm not sure what that means. The sense I get is that, despite this man's extensive travel, he still uses the word "ideology" the way the words "terrorist" and "nationalism" are used; i.e. to signify the wrong-headedness of members of an 'other' culture. We are not "Ideological," we are "protecting our own interests" which are of course well grounded in "Reality." We are simply involved in a "conflict" to protect homeland, as any "patriot" would do. They are "idealogical," "nationalist" "terrorists." It is a linguistic trick that delegitimizes the recipient of the adjective without need for any complicated argument or reasoning.

This, of course, is not new. But, it was especially disturbing coming from a diplomat, someone who obviously has seen much of the world. It bothered me, in particular, because it indicated to me the extent to which I must be seeing everything here through biased eyes, despite my best efforts to identify those biases.

In an earlier post, I wrote that Russia's is a history of "what if's?" What country does not have so many turning points in its history, which one may wish had been a turn to a different direction? What if JFK had not been shot? What if Nixon had been put on trial? What if the Supreme Court had not stopped the recount in 00? And so on and so forth.

So much is different here, it is easy to forget how much is the same. I look at the crazy lay-out of Samara, which I recently described in an email to a friend:

"It's old and tiny decrepit buildings, its mess of small dusty streets. The green that seems to grow in the small spaces which the central planners forgot to include in their machinations. It could be any city in Russia, I think. A thin clutter of advertisements spewing into the streets, collecting into small shopping centers that look new and western, here and there. The rest of the city is old. It's been this way probably for a hundred years. There are the big Soviet, apartment buildings (my dorm is one of them), but mostly the central part of the city is composed of these old one- and two-floor wooden buildings, with the decorative, carved window dressings."

It could be any city in Russia. But, it could also be Oxford Mississippi. The disjointed mixture of old and new is not unique to Russia. The large Soviet apartment block buildings look not unlike the projects of every American city built in the sixties and seventies. The green growing in seemingly random, chaotic sprawls. Does that not happen in every city to some extent?

Indeed, Russians are poorer than Americans, this is true. And the state has certainly had a different role in society in the last century. However, many things, I'm sure, must be the same. This is perhaps why I'm here. To see what sticks when I turn everything around, and look at it from a different angle.

I simply hope that I succeed in doing just that, and not seeing simply a different, 'other' world, the kind that might require its own separate lexical categories.

2006-08-28T01:34:00.000-07:00

Some Random Observations Cobbled Together from E-mails-- 8/28/06

Moscow is a crazy place. It's like transposing Las Vegas onto the typical American image of Old Soviet Russia. Huge, austere Soviet government buildings that are now hotels with shiney new signs. Old, dirty, decrepit Soviet-style apartment buildings everywhere, but interspersed with enormous neon malls. There are rich men, richer than the rich in America, with gorgeous dolled up young women (with a style referred to by an American gender-studies student as "hyper-femininity" [see right]). The rich men for some reason carry little leather purses that look like miniaturized brief cases. The ex-pats call them "murses." And there are enumerable poor old ladies, who have to sell flowers or cucumbers at every train stop, because their pensions disappeared during the transition. Scabbed up drunken brutes swerve through the streets. Well-off teenagers, out on the town and dressed to the nines, fill the shopping centers.

It is a place that impresses upon you the importance of history. And the Russians' is a history of "what if's?" What if Stalin hadn't taken power? What if Krushchev hadn't been deposed and his reforms had been successfully carried out? What if Gorbachev had tried perestroika before glasnost instead of them both at the same time? What if the transition planners working with Yeltsin' had focused more on gradualism? What if Khadorkovsky hadn't been jailed and his attempts to build civil society had been successful? What if HIV prevention works?

This weekend we went on a big excursion away from Moscow, though, which was pretty nice. Fulbright rented us a big bus and took us around three golden ring towns (Yaroslavl', Kostroma [pictured at left], Plyos), which were all nice. The tours were grueling and always incorrectly timed with eating so that we were all hungry and grumpy half-way through them, but I was still able to appreciate the enourmous Volga, the ancient churches, the quiet struggle of the Russians. We even went into this ancient cathedral on Sunday and got to see a small service. I felt horribly invasive, but it was beautiful to see. Made me want to be an anthropologist. It was so amazing to see the richness of the church's rituals, the chanting, the paritioners lined up for prayers to be whispered in theeir sake, each one bowing to touch the ground before crossing herself and kissing one of the icons, the long robes and arcane gestures. I imagine the same things being done centuries ago when the church was the center of peasant life and this beautifully architectured building, its intricate designs, painstakingly wrought by hundreds of believers, and these rituals were each peasant's only portal to a different world, one without hard labor, dirty food, disease and death. It all makes perfect sense. I can also understand why the revolutionaries of the enlightenment must have been so angered by this arrangement: that hundreds of paupers should scrape and save to donate to the church, sacrificing so the priests (and nobles) could live richly.

The town Plyos [below] is tiny, quiet and beautiful. Hadn't really been changed much in decades. We saw a museum of Russian folk life that was impressive not because of the excellent exhibit, but because of the heart-felt interest you could see in the two guides' eyes as they explained how derevnie (meaning village but also with connotations of ancient) Russians used to live. One woman was showing the house that her grandfather had built. She had three or four golden teeth and made us some wonderful traditional Kasha. Then we walked around and saw the beautiful Volga, the biggest river in Europe. I wanted to build a raft and just float all the way down it to Samara. Instead I'll be taking a 14 hour train on Wednesday. I can't wait to get there and get my life there started.

2006-08-28T01:31:00.000-07:00

The Humanities -- 8/23/06

I have been in Moscow for three days now. It’s been more of a shock than I expected. I expected to feel overjoyed at the wonder of constantly seeing new things. I have a bit of that wonder, but mostly I just keep feeling slightly surprised and out of place. Some part of me, I think, feels that this is some big mistake, that this is not the adventure I bargained for, but instead a rehashing of past adventures. The monstrous, dilapidated apartment buildings, the enormous public spaces, the ever-present fragrance of gasoline (which seems to have a unique quality in Russia as though it were mixed with a dash of rose water) and that fragrance’s counterpart, the stench of cigarettes seem all too familiar.

I am also overwhelmed by the difficulty of immersion in a foreign language. I’m staying in a dorm with five other Community Service grantees, with whom I spend 24 hours a day, and seven English Teaching Assistants, of whom I also see plenty. All of these kids speak better Russian than I do. Almost all of them majored in Russian in college, so I am at a significant disadvantage. Fortunately, there will be no big competition to win. But, because they all speak Russian so well, the (well-meaning) ‘orientation’ coordinator decided that no translator was needed for our two site-visits to Russian NGOs yesterday. After five straight hours of being talked at by Russian professionals excited to have an audience, and having to laugh along with jokes that I alone did not understand, I felt completely drained. It occurred to me that I had failed to include in my list of fears, compiled while preparing for this trip, the fear that I might have a lot of difficulty with the language.

Today, we had an amusing lesson in ‘cross-cultural’ education. It was by a pair of professors at Moscovskiy Gumanitarniy Universitet (Moscow University of the Humanities). It was intended to be a workshop, but instead was a three-hour lecture (in English) on multiculturalism that was really appropriate for a middle school audience. It was truly absurd. Probably unlike any experience I have had before. It consisted of all varieties of cliché and irrelevant anecdote. I believe the central point was that people from different countries have different points of view and different ways of looking at things, and hence one must avoid stereotyping when one visits another country so as not to degrade into chauvinism. Basically, it was a sort of meandering ramble on the foundations of a multicultural society, obvious to anyone who grew up in one. However, the professor who kept hammering in the point about not being chauvinistic revealed his own chauvinism by continually interrupting his female co-instructor to a degree that would be humorous were it not sad and frustrating. The irony of this lecture was that it was, indeed, a lesson in cross-cultural education, in the sense that we were all clearly witnessing an educational experience from another culture. I was impressed by the ability of my cohort to play along. All giggles and looks of horrified boredom were saved for after the lecture was over.

I would ordinarily pass this off as merely a couple of bad lecturers, but this was something different. This was not a situation, it became clear, in which they had been trying to keep the material simple enough for our level but merely missed the mark. Nor was it a lack of preparation. The presentation was rife with bizarre overheads about the need for a holistic approach to global education that focused on systems instead of disconnected facts. Though they both had doctorates, the professors’ thinking was simply not well developed. As condescending as it sounds to come to such a conclusion from one encounter, this is consistent with a comment made by one of my fellow Community Service Grantees who grew up in Belarus: that while Soviet science and engineering was excellent, the Humanities and the Social Sciences had been stilted by Soviet censorship.

Furthermore, it seems to me that even in the private sector, Russian society is still in the process of developing mechanisms for incorporate feedback on the quality of work. Indeed, one of the major difficulties the Soviet Union had during its decline was the enormous cadre of Soviet managers needed to monitor quality, given the lack of price signals and the guarantee of employment. Feedback on quality is a difficult thing to build into the softer disciplines of academia even in the West, where universities benefit from low systemic corruption and, for better or worse, a highly competitive private sector surrounding it. I imagine it is even more difficult to incorporate feedback into contemporary Russian academia, still reeling from the transition.

Of course, this is a cursory observation and even more cursory of an analysis. I worry that I am being overly critical of everything I see and do, because I am in another country. I am often amazed by how dirty all the buildings are in Russia (outside the center of Moscow, of course), however, it is hard to say if they are any dirtier than the projects of Brooklyn or the south Bronx. A better comparison, perhaps, in terms of its relevance to quality of life is that of the subway system in Moscow to the subway system of any city in the U.S. I am always amazed by the Moscow Metro. The stations are clean and well lit. They often have high marble ceilings and beautifully decorated walls. The trains run every 90 seconds (and always on time!!!!) and go almost everywhere in the city. You practically never have to transfer more than once (I’ve found only one instance). I read in Lonely Planet’s once that more people use the Moscow subway every day than use the subways of New York and London combined. And I would believe it. The trains, which, as I’ve said, run every minute and a half, are always as full as any train in New York, and more full during rush hour. It is a truly humbling experience to be a part of the masses of human flesh that pour into the stations’ escalators at every moment of the day, pushing and shoving. It is like being a grain of sand in a tired, sweaty hourglass.

With regards to being overcritical, I fear I may get myself into some trouble. During our briefings at the Embassy, we were told that one grantee got into trouble last year, because people in her small town read a blog in which she made critical statements about her environs (likely no more critical than this posting). Another Fulbrighter (a scholar) was actually deported for speaking in favor of a particular ethnic autonomy movement and wearing an orange pin (playing into Putin’s paranoia that Fulbrighters are here to incite some sort of Russian version of Eukraine’s Orange Revolution). It seems reasonable to assume that this blog may one day be closely examined with oversensitive eyes. If any Russian is reading this and wondering, let me assure you that I love Russia. That is why I am here. I love Russia and want to learn about its language, culture and customs as well as the problems it faces going into the uncertain future. Just as I am critical about the way Americans face their historical legacy, I may, at times, be critical about what I see here. Do not let that fool you into thinking that I have anything but love for the Russians and their nation.

Indeed, as uncomfortable as it is to have to adjust to being so far away from all the people I love, I am incredibly excited to get this year of work and study rolling and to settle into Samara in one week. I will simply need to work on being patient with myself and take everything one step at a time.

2006-07-09T14:08:00.000-07:00

Idealism Notwithstanding, an Introduction:

"I have fought the long defeat and brought other people on to fight the long defeat, and I'm not going to stop because we keep losing. Now I actually think sometimes we may win... [People] from our background -- like you,... like me -- we're used to being on a victory team, and actually what we're really trying to do... is to make common cause with the losers. Those are two very different things. We want to be on the winning team, but at the risk of turning our backs on the losers, no, it's not worth it. So you fight the long defeat."

-Paul Farmer in "Mountains Beyond Mountains" by Tracy Kidder

Hello. Welcome. How's it going?
My name is Dan.
Nice to meet you.

This blog will be the chronicle of my adventures as I spend the next ten and a half months as a Fulbright Community Service Fellow in Russia. It will also be a place in which I scribble down my musings on politics, economics, philosophy and social justice, so bear with me. With hope, you will be entertained.

I have derived its title from two sources very central to what I will be trying to accomplish with my time there. The first source, as is quite clear from the epigraph above, is a quote by one of my greatest personal heroes, Dr. Paul Farmer, founder of Partners in Health (PIH), a non-governmental organization which partners with highly oppressed communities to develop community health programs with the same standards of care that one would expect from a medical center in the developed world. I find his work and his ethics quite inspiring.

The second source is an essay I recently wrote for medical school applications explaining my reasons for applying. Eventually, I will figure out how I can put a link to it here. For now, I will simply say that it is about the difficulty I had, working as a case manager for people living with HIV/AIDS in the south Bronx. In the essay, I describe a client with whom I worked whose circumstances were tragic and entrenched. I describe my futile and draining (and, hence, foolhardy) efforts to change them. Ultimately (as it is a personal statement and a capstone lesson is required), I learned that "idealism notwithstanding, I am only as useful as the skills I possess and the energy I can harness to them." Knowing about and being inspired by the work of Paul Farmer, PIH and other social justice heroes does not allow me to effectively partner with those for whom the political and economic systems in which we live mostly provide misfortune. I must become skilled in an area or areas needed the misfortunate, and I must overcome my own psychological and social barriers to doing this work.

In this blog, I will describe my adventures (and misadventures) in trying to simultaneously apply the skills I have and develop those skills further in a context abound with potential misfortunate partners. As I have it planned, I will be helping to develop a case management program for people living with HIV/AIDS (PLWHA) in Samara, Russia. PLWHA in Russia face extraordinary stigma. Most people in Russia do not realize there is an epidemic there, though it is the fastest spreading AIDS epidemic in the world. The average Russian does not understand the transmission of HIV or the difference between HIV and AIDS. Furthermore, since the epidemic has been driven mostly by intravenous drug use, many PLWHA face the combined stigma of being HIV-positive and being a drug user. A well-researched Human Rights Watch report (I need to figure out this linking thing) has documented that many doctors and nurses in Russia are verbally abusive to HIV-positive patients and refuse to treat them.

My hope is that the case management program with which I will work will be tool to help PLWHA overcome this stigma and get the medical care they deserve. I also hope to use this program to empower PLWHA to become involved in the decisions made by politicians that affect their lives.

While in Russia, I will also be doing some research. I will be taking a close look (through literature review, interviews, surveys and, of course, participant observation) at the interactions both local and international non-governmental organizations have with other sectors of society. I would like to see how they are viewed by and what influence they have on government, the healthcare establishment and members of the communities targeted by their programs. In particular, I am interested in seeing how they may be facilitating "community consultation," a role prescribed for them by the UN General Assembly during their "Special Session" on AIDS in 2002.

As a foreigner, my social capital will be skewed. To some, I will be an unwanted outsider, trying to intrude with my imperialist Western ways. As an American this will be amplified not only by the recent global upturn in anti-Americanism, but also by the recent tensions between the U.S. and Russia over the Orange Revolution in Ukraine and various subsequent events. To others, I will be a powerful asset, with a working knowledge of how things are done in a community that has been facing the virus for 25 years (and the backing of the U.S. State Department).

It is hard to predict how discrepant my experiences will be from what I now expect. I am sure that many of the things I expect to see both from what I've read and what I experienced in my previous two months in Russia will be confirmed. But, then, one cannot travel without encountering as many surprises as fulfilled expectations. I do suspect it should be interesting.

So read on, stay tuned, etc.