Healthcare in Tajikistan

Falling victim to stomach illness is inevitable for American students coming to Tajikistan. The perfect storm of novel bacteria, copious amounts of cooking oil (including unfamiliar cotton- and flax-based varieties), and unfamiliar dairy products will tend to put newcomers out of commission for at least a couple days. When I first came to Tajikistan in 2009, my gastrointestinal performance was pitiful for about 10 days straight. Over the course of three stints adding up to almost two full years, my gut has assimilated to the country’s once foreign microbes and I’ve become so accustomed to Tajik cuisine’s oil-to-other-stuff ratio that I’ve adopted it myself, sometimes eliciting guffaws from friends and relatives back home.

I no longer seem to have much difficulty staying healthy here, and most other students adapt within a month or so. A far greater obstacle than staying healthy is negotiating local concepts of sickness and healthy living that don’t comport with our own.

If you admit to your host-family that you aren’t feeling well, you’ll likely be diagnosed with a slew of possible roots for your illness that you never imagined. While students might blame the unwashed hands of a cook at a restaurant, their host-families are likely to ask if you’ve consumed anything colder than room temperature (despite the widely acknowledged “dangers” of ice cream, it’s still immensely popular). One student’s rash (we all called it a heat rash) was blamed on eating too much watermelon. Blood pressure is believed to fluctuate on a daily basis, and people will miss a single day of work for self-reported hypertension. Leaving the house with wet hair will usually result in a talking-to.

It’s difficult to know how to respond when those around you are trying to be helpful with their advice, but following it would be inconvenient and ineffective. The best I’ve come up with is explaining American medical narratives as another “set of beliefs”, thereby framing medical explanations as fallible and culture-specific without demeaning theirs. Actually, the best I’ve come up with was probably telling my host-family that I built up a resistance to cold beverages, and “proved” this over an entire summer by freezing water bottles until they were half ice and drinking them at dinner in front of everyone. After healthy months the family was putting all their drinks in the freezer, too.

The most common prescription for ailments usually involves some kind of abstinence: stop drinking cold things, stop leaving the house without long sleeves, stop eating so much fruit. However, one of my favorite suggestions for an upset stomach (because I feel like it would make me throw up instantly) is to take a shot of salted vodka. In fact, even some more religious families who normally steer clear of alcohol will have a bottle of vodka in the cupboard in case someone falls ill.

Today in Dari class I received a lesson in anatomy that was completely new to me. I asked my instructor about folk medicine (literally called “Greek medicine” in Dari) in Afghanistan. To display its merits relative to Western medicine, my instructor began explaining the “four liquids of the head” and their properties: salty tears, poisonous inner ear fluid, sweet saliva, and foul-smelling nose juice. He told me that he once challenged a young doctor trained in Western medicine to account for the salinity of our tears. (As I started to ask if it wasn’t just so that our eyes don’t freeze over easily he quickly interrupted and told me to stop being impatient.) He gave the doctor a month to give him an answer, but the young man never could. My instructor then gave this doctor the lesson I’m about to recount below, and as a result was purportedly given free medical treatment and medications thereafter.

Tears are salty because the salt is needed to keep your eyes alive. You can remove eyes from someone’s body and place them in salt water, I was told, and they can be put back in and work fine. If you put them in fresh water they’ll die. Ear fluid is bitter and poisonous because it keeps creepy crawlies from entering your brain and making you crazy (“if it weren’t for that bitterness we’d all be dancing like idiots as we walk down the street”). Nasal fluids are sticky to keep the dust we inhale from reaching the back of our heads (I can more or less get behind that explanation). I don’t remember what he said about saliva being sweet, but he did mention that it’s an extra slippery liquid, which is important for digestion.

If language immersion is doing its job, you start responding in your target language involuntarily. The interesting side effect of language immersion in Tajikistan is the simultaneous cultural immersion. After living here for a while, you start following some of the local medical advice reflexively and uncritically. And sometimes, while it’s maybe just a placebo, saying no to watermelon, avoiding ice cream, or putting raspberry jam in your tea really seems to work.

By: Kramer Gillin

Program: Eurasian Regional Language Program

Term: Summer 2012

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