medical

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.

If 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!

downtime

I remember that back during PST I made a daily schedule blog post. I never did that in my permanent site and I realize now why that’s been the case: things were so structured during PST that sharing my day-to-day life was possible. The reality in Govi-Altai varies greatly from week to week because there’s stuff that’s supposed to happen that doesn’t (or at least not when it’s supposed to) and there’s stuff that’s seemingly spontaneous (though I often think I’m just the last to find out and it happens to be at the last minute).

According to my schedule at my permanent site, I work 40 hours a week. I think this is unusual among Peace Corps Volunteers, but since I came from a 40-hour-a-week job, this part doesn’t faze me (except insofar as Peace Corps service was meant to be a break from the 9-5 life). Four mornings a week are spent in classrooms, so that eats up a chunk of that time. The rest of the time is divided up into teaching special classes, prepping for classes, or waiting to do one or the other. Currently, my CP and I are giving two-hour, daily English lessons to workers at the Courthouse, as we’ve done in the past for the Music Ensemble and the Power Station workers. I’ve also been giving sessions on creative writing (the students do little, if any, writing at all) for a competition that will happen next week.

Between the things that are happening, there’s a lot of waiting for things to happen. I can’t say whether that’s definitively true Peace Corps-wide, but I have a sense that it is. I’d make the case that this “wait time” isn’t really downtime, though, because we are always anticipating (even if history doesn’t give us cause) the next interruption. What this means is that after an afternoon at the office, having “accomplished” nothing, I feel mentally taxed. It’s not the same kind of waiting that you do at the Registry (DMV) because, when your name is called, you have no idea what’s coming.

I wrote before about leaving behind the comforts of home and how the cumulative effect leaves one feeling out of sorts. While that was mostly in the context of loneliness, I think the sheer number of hours that we have to fill (whatever our work commitment, after all, we live here full time) is what makes the absence of all that so prominent. We find ourselves with a lot of downtime to fill.

So, here’s a list of the ways I’ve filled my thousands of hours of downtime these last two years.

extra lessons – Perhaps the most obvious, especially for a TEFL Volunteer. We have regular Tuesday night English club, Thursday night movie club, and Saturday morning conversation club with the medical college ladies. I’m still going to the Vocational School two nights a week. In addition, there’s often an unexpected knock on the door, what Seinfeld would call a pop-in. I usually make time for them. Last year, one of these girls became a regular, showing up several nights a week for several months.

language study – I continue to study vocabulary every day. However, I’m sorry to say, my spoken Mongolian remains average. Clearly, I can manage with the day-to-day but I tend not to put myself in unfamiliar situations. And I never got a tutor. How did that happen? Well, I tried initially with my Mongolian English-teacher friend but we often reverted to English. Just as the students don’t learn English in translation, I couldn’t learn Mongolian in translation. Why I never got a Mongolian-language teacher, or just a non-English-speaking Mongolian, I can’t say. It sounds silly, but I didn’t even realize it was missing until these last few months.

socialization – either with other PCVs or with Mongolians. Here’s something that has surprised me: I expected to come to Mongolia and do a lot of socializing with Mongolians. I do some, of course, but not nearly what I thought I would. Now, given that I lived in my Boston apartment for 11 years and didn’t know any of my neighbors, apparently I was counting on some personality transformation to have occurred simply by being in Mongolia. But, just as I seldom invited guests to my home back home, I’ve not done it here. I have an open-door policy, to the point that I shared my dinner with a man whom I’m still not sure who he was or how he knew me, but those pop-ins, while more common here than in America, are still not so common (once or twice a month). And to be honest, since my days are pretty full, even the days that are full of waiting, I’m content to not have more frequent visitors.

blog – it would be a great oversight for me to not state the obvious. This is my 63rd blog post. Some of these take up quite a bit of that downtime.

books – at this point, I’ve lost track. But I know it’s somewhere in the 60-ish range. That’s a mixture of e-books and the real thing. It’s also a mixture of fiction, non-fiction, classics, contemporary, pop-culture autobiographies, a few trashy romance novels, and a few books set in Mongolia.

crochet – this won’t be on the average PCVs things-to-do list, but then maybe there isn’t an “average” PCV. Thanks to some yarn contributions from folks at home, and a score at the black market, I’ve been able to make about 40 handmade hats. I also taught my sitemate, Jerome, how to do it and a day later he had his own hat. Next up, teaching some Mongolians.

The hat that started it all.

the mundane – certainly, just as at home, we have to bathe, do laundry and grocery shop. It’s only worth mentioning because we never know how much of our downtime these things will occupy. Will the shower house have an hour’s wait? If so, would I rather wash in my tumpun? Will I find what I want at 2 stores or 5? Knowing that I may visit 5 and still not have found what I wanted. Ger dwellers could add chopping wood and fetching water to this list.

a 6000-piece puzzle – I’m quite proud of this one. This time last year I gave up my floor for a site-mate puzzle party. Little did I know that it would take 2 months to complete. It was worth it, though.

sporcle – I almost wish I was never introduced to this quiz website. How many times have I said “just one more” only to realize it was one in the morning? I’ve wasted a lot of time doing really stupid quizzes, just for something to do. BUT, I’ve also learned all the countries of the world, so there’s that.

TV shows, movies, podcasts, music – I do more of this media consumption than I would probably like. Sometimes I can multi-task with one of these while I prepare dinner or make hats or write blogs. But sometimes it’s a solitary, sedentary activity. Ho-hum.

exercise videos, a la P90X – I probably should have started this sooner since I’ve gained back about half of that PST weight loss. We had a rather mild (for Mongolia) winter, and there are some hikes in our future.

Our 5-hour hike last September. We found TREES!

instrument – I really wish I thought to do this. Mongolia has some really interesting traditional instruments that are alive and well. Why did I never consider learning the morin huur?

creating videos, poems, songs, etc. – this is another that falls into the category of things I didn’t do with my downtime. But, other PCVs have and I’d like to share a few with you.

• If you’re curious about ger life, and I know I am, I’d recommend this 2-minute video from a current M24.
• For a PCV twist on an American anthem, an anonymous volunteer re-wrote the lyrics to American Pie. Incidentally, that’s my site-mate Jerome’s blog; for those of you who will miss my Mongolian chronicles, I can recommend his for a good chuckle.
• If poetry is your thing, I point you to a current M23 who alternates poetry along with prose on a regular schedule.

I leave you with the thought that I’m somewhere around the 100-day countdown to my Close of Service. How will I spend it?

stats

In my pre-Peace Corps life, I worked in the Department of Biostatistics and Computational Biology at the Dana-Farber Cancer Institute in Boston. Having started as administrative support, I had my hands in a lot of things involved in keeping the department running smoothly. The job was a good fit for me because I’d always been interested in data and, even if I didn’t always understand every detail, I could understand the big picture. Plus, I’d gotten an A in my statistics course at San Diego City College. (That’s doubly impressive because it was a condensed summer course.) We had a good team and I know some of them are reading this and to them I want to say, Hello!

In honor of my statistician friends, DFCI friends, and others like me who’ve long been interested in how things break down, I’m devoting this blog entry to the statistics of my blog. For the non-statisticians, consider this a behind-the-scenes entry.

Launch date: 30 APR 2012
Number of posts: 48
Number of comments: 205
Most comments award goes to: Cousin Priscilla, whom I’ve mentioned before, and who remains as awesome as ever.
Number of Spam comments I’ve had to delete: 5,253. Sounds unmanageable, but the site identifies them, and I can delete batches at a time.
Number of views: 7,844
Date with highest number of views: 22 MAY 2012, 154 views! This was entirely due to an article that appeared that day on Boston.com about my love affair with Hubway that would be cut short by my move to Mongolia. The article included a link to the blog.
Number of people who’ve subscribed via email: 19. The first was quite a surprise, Justin from high school. How are you, buddy? The rest are a blend of family, one-time work colleagues, Peace Corps people, and a handful I have no idea who they are. Well, you are all welcome to these pages.
Number of blog followers: 35. These are people who have their own blog, and their blog follows my blog. It’s like our blogs are friends with each other. Most of these are unknown to me; a handful are fellow PCVs.
Number of countries from which people have accessed my blog: 66 countries from 6 continents!
Number of countries with 10+ views: 23

It’s no surprise that the US has had the most visitors. It also makes sense that Mongolia has the second most, since 1) I’ve met a lot of people since I came here, and 2) we are required to give our blog addresses to Peace Corps staff so they can monitor what we put out there. Third place goes to the tiny country of Singapore, where my college roommate lives. Some of the clicks have come from links on her blog. And 5^th place goes to Greece, where Anna, my high school bestie, is checking in with my goings-on.

The tenth most visited country was The Netherlands, which deserves mention because one day I got a postcard from Amsterdam from I guy I’ve never met, who found me via my blog and decided to reach out.  Thanks, Mike! Hope you liked my return postcard 🙂

Top post: this is the Home Page/Archives, which is the most recent post I’ve written, but since it constantly changes, the post with the most reads could really be any one of them… The next most clicked on entry is the first one, about my reasons for applying to the Peace Corps. That’s probably as it should be because I never did complete the About page which is the page with the most clicks. Sorry.

Top search: to Mongolia with love. Haha! Looks like some people need to bookmark that.

It’s also been searched as “tomongoliawithlove” “tomongoliawithlove.wordpress” “from Mongolia with love” (which was in contention) and “frommongoliawithlove”. The search for “love Nickerson Mongolia” was clearly for me. The searches for “love in Mongolia” and “Mongolia love blog” are less clearly for me. Again, haha! There’ve been multiple search attempts using variations of “Peace Corps” + “blog” + “Mongolia” + “2013”.

The search for “affection in Mongolian families” linked the person to one of my personal all time favorite blogs, and I hope the searcher was satisfied with my assessment. I’m sure the person who searched for “negative Peace Corps experiences” was disappointed; deservedly, trying to get skewed results like that, shaking my head. Finally, I hope the person who searched “how are Mongolians similar to Americans, how are they different” was enlightened. And, I hope he/she, and you, keep visiting for more stories.

Language Update, 1 year later

MST gave us the opportunity to have an informal language assessment. All of the language teachers Peace Corps provides are friendly, speak clearly and at a slightly slower pace than normal conversation, and allow us the precious time to finish our thoughts. In that way, these aren’t like regular conversations with everyday Mongolians. I subjected myself to it because I needed validation that my Mongolian language has improved over the last year. Another reason was because I wanted that confirmation to motivate me to redouble my efforts at language study. Without further suspense (insert drumroll here), I advanced by TWO levels!!!—from Novice-High (the minimum proficiency required by Peace Corps) to Intermediate-Mid.

The language assessment was a conversation between me and the tester. We covered the basics: where I’m from, where I live in Mongolia, where I work and what I do. She asked how far I live from work and I told her it was about a 7-minute walk. She asked me to tell her about my apartment and had a follow-up question: what floor do you live on? I didn’t hesitate: Bi neg davxhart amdardag—I live on the first floor. She asked about my hobbies and I said I make hats and she asked, “how many hats did you make?” I wanted to answer “When I was in America, I made…” but I realized I didn’t know that grammar point, so I fumbled my way through but she got the gist (90 vs 15). She asked how many people live in Boston and I answered 500,000—though I’m not sure of the accuracy of that number, it’s what I’ve been using. I told her Boston is a small city (because in my mind it stretches the 3 miles from the North End to The Fenway), then she wanted me to compare it to the million people in UB… I didn’t know how to explain the nuance of “Well, Boston includes Dorchester, Southie, Charlestown, East Boston, JP… so, in fact, it’s much bigger than 3 miles.” But, I understood what she was asking and will leave out the 3-miles bit from now on. At the end, she invited me to ask her questions. I started with “Where are you from?” and expressed surprise that she was born in UB and had lived her whole life there. I asked what languages she speaks and she answered “Of course, Mongolian, also Russian, and a little English.” I asked her if she thought English was difficult. She was emphatic that it was. She wrote the word “light” on a piece of paper and said, in Mongolian, “Why?!” I just shook my head in acknowledgment… the madness of English.

Immediately upon learning of my two-level increase, I realized that if I were to improve another two levels by Close of Service, I will finish Peace Corps service as an Advanced-Low speaker of Mongolian. But, knowing that I put in minimal effort (limited to vocabulary study) this past year, and since I plan to really study and speak more over the next year, my goal is Advanced-High. There it is, in writing, for the world to see. Four more levels—ZA!

spring

Prologue

I tried to write this blog entry about leaving winter behind and welcoming spring, but this is nothing like the spring I know. For so many years, spring to me has meant the first blossoms on the magnolia trees at St. Leonard’s Church and Peace Garden in Boston’s North End. It meant throwing the windows open, welcoming in that change in the air. It meant being able to walk home from work: Comm Ave through the Boston Commons, if I wanted some quiet time, or Newbury St and Faneuil Hall if I wanted to people-watch. A few years ago it meant watching my high school classmate run in the big race: in my boisterous excitement, my camera lens only caught the pavement as I tried to snap his photo while holding my homemade sign. Last year it meant finally(!) getting to ride Hubway again.

Since arriving in my permanent site 8 months ago, I’ve nurtured this tie to my hometown with Matty in the Morning podcasts and Robert B. Parker Spencer novels. I haven’t romanticized living in Boston, though. I remember the day I understood what my big sis was talking about when she visited us in San Diego and said how nice it was that people walking down the street said “hello” and looked you in the eye, after I’d moved back to Boston and that didn’t happen. They all let their guard down when the Sox won the Series in ’04—strangers high-fiving and giving hugs—but it didn’t last. I well remember the day I tripped going up the escalator at Ruggles Station, completely ignored by my fellow rush-hour commuters. The people irked me, but I never held this against the city.

This time next year, I’ll be doing what my M22 site-mates are doing now: making preparations for Close of Service. I honestly don’t know where I will end up. Coming into the Peace Corps meant a chance to start over, twice, and this wasn’t lost on me during the application stage. Before I was even officially invited to serve, I looked forward to my post-Peace Corps life, with two years’ experience living and working abroad, and what kind of growth that could mean for me, personally, and where, literally, that could take me. There’s a chance I won’t go back to Boston for good, but Boston will always be my home.

And now, back to the blog: The Winter that wasn’t

I promised an update when “real” winter came… but it never did, not to my aimag, anyway. Now this may seem strange to those of you who recall my frozen toes that didn’t defrost for 3 months, but I’ll remind you that that incident occurred in UB. So, winter—as I feared it to be—definitely came to UB. And I’ve seen photographic evidence among my PCV friends, whose frozen eyelashes and beards left no doubt, that winter definitely came to other parts of Mongolia. But here in the Southwestern aimag of Govi-Altai, we’re well into spring now and aside from a few days here and there during January and February, I never felt that the regular negative temps (in both C and F) were unbearable.

Spring here sort of seems to me like winter-in-reverse: during November and December, I kept waiting for the deluge of snow, but there was never more than an inch or two at a time, and it often melted by the end of the day. (A curious observation is that our snow, when it comes, generally comes overnight.) During March and April, what winter we did have kept asserting itself in fits and starts, but by then its attempts weren’t worrisome. I haven’t worn my Mongolian winter boots since sometime in March, and though I haven’t packed away my winter coat, it wasn’t needed for most of April. This has all fluctuated, of course; there was a day at the end of March that was pleasant enough for just my Boston hoodie, and there were a few snow days in April.

I was mentally preparing for the heat in my apartment to be turned off in March. It would have been unpleasant, for sure, but nothing like waking up in a ger in winter when your overnight fire has long since burned out; I wouldn’t have felt justified in complaining. The heat burned on into April, though, and I was back to opening my window to let in some fresh air, whenever the wind was calm enough to not bring the dust inside. Over the last few weeks, I’ve adopted a new trick: leaving the apartment door open. Since that outer room has no heat, the cooler air wafts in, but there’s no wind and therefore no dust. Now it’s early May, and the heat is STILL on, with outside temps in the 50s/60s F.

The mountains here are back to brown with just patches of snow taunting the sun, but I’ve seen patches of green grass crop up in unexpected places that makes me smile. So, naturally, that’s what I’m looking toward.