observations

April 25, 2014

I’ve given several examples of the Peace Corps cultural training that was brought to life by the Mongolians I have encountered: the students on the playground who put their backpacks on the bench, not on the ground; my host mom rolling down her sleeves before accepting a gift. I’ve often wondered if I would have picked up on these subtle cultural cues if they weren’t pointed out to me beforehand. But I’m starting to think I would have, eventually, because of the sheer number of other observations I’ve made.

Many years ago, I went to Italy with my mom. It was her first time abroad and she was shocked that there would be graffiti juxtaposed with the breathtaking architecture. Well, the buildings aren’t as nice to begin with but Mongolia has graffiti, too. What I’ve noticed, though, is that it isn’t where you’d expect it to be. In schools, there are great big murals in high traffic corridors and in secluded stairwells. There are no mustaches drawn on the people, no defacing of the landscapes, no initials carved into the paint. Is it Mongolian national pride that prevents these kids from leaving their mark? Is it respect for creativity? Is it just because I’m in a small town? I don’t know. But it continually impresses me.

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I have mentioned more than once that Mongolians delight in eating fat. What I haven’t mentioned is that, though Mongolians are on the short side, they otherwise come in all shapes and sizes.

So far as I know, I don’t know any Americans with kidney disease. Americans tend to be more private about chronic health problems, so it’s possible that I just don’t know this information about the Americans I know and have met. But I’ve had at least 6 Mongolians tell me they were receiving treatment for kidney disease. Honestly, I don’t know anything about it. Is it genetic? Environmental? A more broad diagnosis encompassing many ailments? I don’t know.

I’ve mentioned that personal space isn’t a thing here: people regularly hold hands or link arms while walking, rest their hand on your knee or thigh while sitting next to you, or reach across you to plug in or unplug their phone (rather than ask you to do it). In the workplace, I’ve mentioned how patients poke their heads in the doctor’s office to see what’s happening. And on a regular basis, I’ve had coworkers enter my office and come around to look at my computer screen while asking “what are you doing?” It’s less of an issue here since they likely can’t read English, but it’s a behavior that would never fly in my previous hospital jobs.

In America, there are all kinds of native accents; I lost my Boston accent after moving to San Diego at 13. Additionally, speakers of certain foreign languages (Russian, Italian, etc.) give us an accented English that is readily identifiable with their native language. Here’s something that I find very curious: I can’t hear a Mongolian accent. When Mongolians speak to me in English, it is clear that it isn’t their native language but that’s all I know. My M22 site-mate said that it was probably because we are in Mongolia and that when we meet Mongolians living abroad, we’ll be able to parse out their Mongolian accent, at least better than folks who’ve never lived in Mongolia. I’ll have to report back on that.

One observation that was particularly striking (haha!) is how Mongolians strike a match. Of course, we need candles for when the power goes out, which has happened 3 times last week. I should also explain that Mongolians often light incense and light candles when someone dies. (Just a few weeks after arriving at my site, there was a memorial to someone who had passed away. When I saw the dozens of tea-light candles on a table, unattended, in the Education Department corridor, I instinctively thought “Fire! Danger!” As far as I know, there is no fire department in Govi-Altai.) On such an occasion, Mongolians might give to their friends/co-workers a gift bag, including milk, incense, and a box of matches. The practice seems to be that when you receive matches, you promptly light one (be it in the office or the teacher’s lounge) and let it burn down as far as you can.

Now, it never occurred to me that there would be cultural variation in how one strikes a match so if I don’t explain it, you’d likely imagine it’s done the way you do it. First, it’s important that these are wooden matches, because this wouldn’t work with a match from a matchbook. Okay, so you have your wooden match, hold it from the end and hold the box in the other hand so that there is about a 30 degree angle between them, each 15 degrees from the vertical line, then strike down. Then you let it burn out, often rotating it to ensure the flame doesn’t extinguish prematurely.

I mentioned this observation to my CP and she asked how I strike a match. So, I demonstrated holding the box parallel to the floor so that I can strike away from me, and then I put my forefinger over the tip of the match and placed it on the strike surface. It was at that moment that she gasped. And it was at that moment when I realized my fingertip is where the flame would be in a fraction of a second and I totally and completely understood her fear on behalf of my finger. So, I’d never given it thought before, but now I realize that using a matchbook match requires the pressure of the fingertip on the match tip to create the friction necessary to ignite the match. This isn’t true with a wooden match and those are the only kind I’ve seen here, but since that’s how I learned to strike a match, that’s what I continue to do.

Finally, a shoutout to my Greek friends. Why? Because Yanni is HUGE in Mongolia. His 20-year-old inspirational instrumental ballads are a staple at awards ceremonies and celebrations. Weird, yet comforting.

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Show Me a Peace Corps Volunteer

April 17, 2014

This isn’t mine, but I read each paragraph nodding my head in agreement. So many of my blogs are summed up in this PCV’s single blog entry that I feel it’s worth sharing.

Show Me a Peace Corps Volunteer.

But, you’ve come all this way, I should give you something of my own, too. So, I’ll just say, it’s strange being this close to the end. I actually counted–I have 20 more classroom days. That’s it.

I’ll need to buy dish-washing liquid soon and even if I buy the small bottle, I won’t finish it before I leave.

My ear doctor, and a few of her friends, comprise my newest English club. Due to the nature of their work, these conversations are more intense than the other English clubs. The pediatrician talked about a boy who had been scalded by boiling water. The ear doctor talked about removing a live tick from a patient’s ear canal; she drew a picture–it was HUGE.

Last summer, I accompanied my M22 site-mates on their flight to UB. I was at the airport to witness their entire departments, some 20 people,  come to see them off. It was 7am! There was a milk offering, vodka sipping, gift giving, and speech making. The sincere emotion of it was too much for me and it wasn’t even my goodbye.

In fits and starts, I’m thinking about my return to America. I started to create a LinkedIn profile, which was promptly put on hold on account of my unusual first name. That’s straightened out now, but I’m stuck on how to summarize this experience. Which, I guess, brings me back to this “Show me a Peace Corps Volunteer” blog that I’ve linked above.


staff

April 11, 2014

Twice a year, in the fall and the spring, staff members fan out across the country for Site Visits. This just happened in March, and it was during this visit that I realized that something was missing from this blog and I aim to correct that here.

When I received the invitation to serve in Peace Corps/Mongolia, I didn’t actively think about who I’d be working with. I knew I’d live with a Mongolian host family for PST, and I knew that in my permanent site I’d have Mongolian counterparts. But if I’d been asked to imagine who made up the Peace Corps staff in Mongolia, I’d probably have assumed they were American. Well, I would have been wrong. Key positions—Country Director, Director of Management and Operations, Director of Programming and Training, and our Medical Officers—are staffed by Americans. And they are supported by a staff of amazing, highly skilled, and effective Mongolians.

If you think about it, it makes sense that the staff would be Mongolian because of the language skills and cultural knowledge necessary to interact with the host families when placing new PCTs, HCAs when placing newly minted PCVs, not to mention Immigration, Police, Ministries of Education, Health, etc., and even issues of office space, transportation and lodging for group-wide PC events, and likely many more things I’m not thinking of. But, if I didn’t explicitly say that there’s a Mongolian to American ratio of 3-to-1, I have an idea that you’d think as I thought. But, I don’t just want you to know that there are more Mongolians than Americans on staff; I want you to appreciate them as I (we) do.

We had lots of Safety and Security sessions during PST, and again at IST and MST, and our Safety and Security Manager gives it to us straight. Being a foreigner in Mongolia makes us more noticeable, and could mark us as a target if someone was looking for one. Our DSS breaks down the difference between walking in UB vs. walking in our community or walking alone vs. walking in a group. She reminds us that we are here as representatives of the United States and that, as such, reacting to a situation as we would in the States (e.g., punching a guy in the face) would have serious repercussions for the reputation of Peace Corps in Mongolia. As we are a Peace Corps, first and foremost, we discussed conflict resolution strategies and ways to de-escalate a situation. But, training in itself is not a deterrent to crime, and despite vigilance on the part of most Volunteers, things do happen (I think pick-pocketing, especially in UB, is the most common). When they do, our DSS is the go-to person. One M24’s experience with harassment highlights the capability of the Safety and Security staff.

Besides Site Visits, one of the ways PC keeps informed of our undertakings is through the Volunteer Reporting Form (VRF). A few weeks after submitting my VRF in January, my Regional Assistant called me to discuss. Her ideas were specific and plentiful. They were things I hadn’t thought of yet, though they didn’t come from some generic “pool of ideas for PCVs” script; they were specific to my placement (in the Education Department) and my actual site (which schools, people, etc.).

In a lot of ways, a Peace Corps Volunteer has a lot of autonomy on the job. For our day-to-day work, we report to our HCA, and, so far as I know, outside of Site Visits, there is little communication between our HCAs and PC/Mongolia. Additionally, PCVs do work in the community, which may be entirely off our HCA’s radar. For me, along with this autonomy comes the sense of not knowing where I fit in the grand scheme of PC/Mongolia. I know I’m not a “bad” Volunteer, but I often wonder “am I doing enough?” and that’s only sometimes in comparison to other PCV’s accomplishments. Usually, it’s in the context of thinking that I should be using my downtime more effectively and/by integrating into the community more. My Regional Assistant was able to share with me other PCV’s challenges and perceptions so I know I’m not alone in these thoughts.

My Regional Manager visited this past Site Visit (my last Site Visit). Her visit was more conversational; still covering all the bases, but without the checklist. She let me talk, asked follow-up questions, and let me talk some more. I doubt “make PCV feel good about herself” is in her job description, but these talks inevitably have that effect on me.

I can’t emphasize enough that these staff members are not merely translators so that you can communicate with your CPs, etc. They are genuine liaisons who facilitate these conversations. They can give us the cultural perspective that helps us re-frame our experiences. They provide focus when we can’t see the Gobi desert for the grains of sand. They are our advocates, our motivators, our champions.

And that makes sense too, because if we succeed, Mongolia succeeds.


medical

April 1, 2014

Knock on wood; I’ve been a healthy person. It’s not something I’ve taken for granted; many a Thanksgiving my health has topped the list of things for which I am thankful. But, living in a developing country presents new challenges and managing even a run-of-the-mill cold may require more effort here than at home.

The two Peace Corps Medical Officers (PCMOs) in UB are responsible for our well-being. During PST, they give numerous trainings covering general health concerns and those specific to Mongolia. Topics covered include: alcohol (including the alcohol content of different drinks, alcoholism, alcohol as a means of escaping or coping), mental health (including the warning signs of depression and the methods of coping), dog bites, healthy eating (to the extent possible in soums with few vegetables), medications (which to use for which symptoms, what’s available in our individual med kits, what’s available by request from the PCMO), and sexual health issues (including sexual assault, alcohol and sex, Sexually Transmissible Infections and how to prevent them, and exploring the reasons people engage in sexual activity). That’s not an exhaustive list. Outside of trainings, our PCMOs also take care of in-country vaccinations, flu shots and annual physicals. When something goes wrong while we are at site, they make the decision to get us to UB so they can examine us in person. And if something goes really wrong, they make the decision to send us to Thailand for treatment. They are available 24/7 via an emergency number; of course, we are advised to troubleshoot non-emergency issues on our own first.

The Health Manual answers basic questions of symptoms and preliminary treatment and allows us to triage the more serious issues to the PCMOs. My first experience with the Health Manual was shortly after my arrival at site. I had an earache which isn’t something that I’m prone to getting. The earache was mild and short-lived so I never bothered with contacting the PCMOs about it. But I learned from the Health Manual that “for some inexplicable reason, a few Volunteers will develop excessive earwax during their time in Mongolia.” And it was true! For a while I was thinking to myself, “where’s all this ear wax coming from?” But since it wasn’t cause for concern, it wasn’t worth mentioning. I imagine it has something to do with the different climate and altitude and it’s probably further proof that I’ve adapted since over the 22 months here (wow!), my earwax has returned to “normal” levels.

The med-kit contains a medley of over-the-counter meds, a pair of rubber gloves, water-purifying tablets, rehydrating salts, condoms, an ace bandage, gauze, generic band-aids, bug spray, sunscreen, well, here’s a picture.

med_kitIf we need a resupply of things, we can request via phone call or email and they’ll mail it to us at site. I’ve gotten PCMO packages in 2 days!

The PC/Mongolia Cook Book I’ve touched on briefly before. But let me highlight the best thing about it, and where it differs from other cook books I’ve owned. This cookbook has recipes which only use ingredients we can get here. Other recipe books wanted fancy ingredients that I didn’t know where to buy or would only use a portion of before the remainder would spoil. This cook book is divided into two sections, Hungry Hudoo (for the Volunteers living in the countryside with fewer options) and Posh Corps (for the Volunteers in UB and those of us who have more variety). What this means is that I can make any of the Hungry Hudoo recipes and many of the Posh Corps recipes (except for the fact that I don’t cook meat or have an oven). But, armed with this cook book, I’ve learned to make: vegetarian chili, ginger tofu, black bean burgers, lentil burgers, any bean falafel, risotto, curry carrot soup, tomato soup, corn chowder, sweet and sour beets, peanut sauce, hummus, tzatziki, tortillas, no-bake cookies, rice cooker cake, and best of all, rice cooker brownies!!!

My reason for writing on this topic is that over the last 2 weeks I’ve had some experience with the Mongolian hospital in town and realized that I never really posted about our medical care here. So, now that I’ve done that, I’ll recount my experience.

Around the beginning of March I had a cold, nothing serious. The symptoms were a shallow cough, which morphed into a sore throat, before settling into a runny nose accompanied by sneezing a week later. I’m well familiar with Upper Respiratory Infections and back home I’d suffered through far worse symptoms before finally going to my Primary Care doc only to find I’d had walking pneumonia or bronchitis. I wouldn’t say I have a high tolerance for pain or am averse to medical treatment, but just that I procrastinated until I couldn’t any more.

But, with this particular cold, on a Tuesday night after English club, I felt a double earache coming on, the right side worse than the left. And, since I’m less familiar with these than the URIs, I consulted the Health Manual. I learned that earaches after colds could be a middle-ear infection, and that complication included a ruptured eardrum with the possibility of temporary hearing loss. As the pain was getting worse, I started freaking out a little (as much as I can freak out, which, to look at me, maybe you wouldn’t have known). I didn’t call the PCMO emergency number because, I reasoned, there was nothing they could do, or advise me to do, that would help immediately. I decided to call first thing in the morning.

It was a difficult night trying to sleep. The pain was worse when lying down. Sitting up didn’t help much, but it was an improvement. I’d taken Tylenol, which didn’t seem to make a difference, and I was worried about taking too many so I didn’t take any more. It was nearly 3am that I couldn’t stay awake anymore and tried to sleep.

When I awoke, the first thing I noticed was that there was no pain. Well, that wasn’t entirely true, but it was a 1 or 2 vs. a 5 or 6 (on that 1-10 pain scale) so I was relieved. I could tell there was moisture in my ear, and sure enough, a cotton swab (and my pillow) showed a slightly bloody fluid. I assumed a ruptured eardrum, but my hearing, though muffled, was still there. Big sigh of relief!

Long story short, after gathering the information, the PCMO (who, just a few weeks prior, had visited our very hospital) authorized me to visit the Ear, Nose and Throat doctor (which not all hospitals here have). Oyundar, the otolaryngologist, examined my ear, said, in English, “no puncture,” and reported back to an interpreter in UB who relayed the diagnosis to the PCMO. The PCMO then allowed me to be treated by the doc. That first day, when she inserted a 2-inch long strip of gauze, that had been dipped into a solution, into my ear, oh, joy! The remaining pressure I’d felt was relieved. And when I’d removed the strip of gauze 2 hours later, I could hear! It wasn’t permanent, meaning it blocked again when I blew my nose, but it was promising. I noticed that night, while lying in my bed in the absolute silence of night, that there was a bit of high-pitched ringing in my right ear.

Over the last 2 weeks, I have made 8 visits to the hospital. It’s pretty crowded in the lobby, where the registration window is, but I don’t have to register. Registered patients are given laminated, numbered tickets, just like you were at the deli. The ENT’s office is on the second floor, across from a pediatrician’s office, at the end of a corridor. One morning I counted 30 people waiting in the hallway. There are benches to accommodate 8-10 people. I wait alongside them, one day for nearly an hour, but once the doc knows I’ve arrived, she ushers me in and the visits are pretty routine. The door’s two glass panels are covered with opaque film, so waiting patients often poke their heads in to see what’s going on. During the third visit, the otolaryngologist charged me 10,500 tugs (about $6) to cover the total number of visits.

There hasn’t been any ear pain since that first night, and the ringing in the ear is gone (or, at least I can’t hear it anymore). She originally said 5 visits, so for the last 3 visits I’ve been asking, in Mongolian, “tomorrow, I don’t come, right?” But, she kept saying to come. Finally, today she wrote a prescription and we had to get the PCMO on the phone again, along with the translator. Turns out, she wants me to use steroid ear drops for the next three days. The PCMO approved this. She also wanted to give me an aloe injection. The PCMO rejected this. The doc and I were able to communicate using a sort of Mong-lish, and I understood that I am to take 2 drops every 8 hours, and return in 3 days. I took my script to the pharmacy and paid the 7,000 tugs (about $4) and remembered to ask for a receipt, my first time asking in Mongolian, so that Peace Corps can reimburse me.

I’ll be home in ~3 months and I look forward to hearing your voices in person!