Southern Uzbekistan Med Field Trip

Recently, I got to take a break from wearing surgical scrubs in exchange for business casual outfits while taking a work trip around southern Uzbekistan with my doctor colleague. Our task was to visit regional hospitals and private clinics to see what resources were available for Americans living, working, and traveling around the area, and to learn about future aspirations the medical facilities had in store.

Regional hospitals function in a unified network with computerized charting, telemedicine, and blood bank resourcing. When a patient has medical needs beyond the capability of their municipal hospital, they may be relocated to a bigger one within the region, and with relative ease. Their hospital mothership, the Scientific Center of Emergency Care, is located in the capital. Interestingly, though the capital feels like its population is busting at the seams these days, with massive construction projects and mind numbing traffic, Tashkent Region is far from having the most number of hospitals (198). Overall there are 2,696 facilities in the country. Ferghana has the most with 302. We managed to visit three in the Kashkadarya and Surkhandarya Regions, which share borders with Turkmenistan, Afghanistan, and Tajikistan.

Over three days, the good doctor and I got to meet with several hospital directors, all of whom had not just their administrative day jobs, but full loads of speciality patients as well. One was a neurosurgeon, another in vascular, and a few others from intensive care, cardiology, and plastic surgery. We walked through their emergency rooms, ICUs, radiology departments, laboratories, operating rooms, and even a dialysis department. In all three hospitals, the most common reasons people end up in the ER is from car crashes involving traumatic injuries, necessitating a multidisciplinary approach to patient management - telemedicine, they said, has been a godsend. Farming equipment and tool disasters were second. 

During a lunch meeting, over plates of shashleek, salad, and naan (Uzbek style), the vascular surgeon showed me pre and post videos of a man's nearly amputated foot from a scythe injury incurred out in the field. Amazingly, he recovered all function and nearly all sensation of his foot. On other topics that surfaced, I was told a blepharoplasty* would cost me 200 dollars, a nose job for about 350, and I could get a mammogram for about 15. Plastic surgery for medical tourism is by far the most profitable and sought after enhancement. I learned that one regional hospital successfully re-introduced several organ transplant surgical cases this past year, after a country wide ban prevented them for several years. Organ trafficking and black market sales got out of control, so all transplant surgeries were shut down. Regulation in the country is tight and limited, and loaded with bureaucratic red tape, but the doc seemed hopeful a measured start become to benefit everyone in need, and that patients won't have to leave the country to find care. 

During our all of tours, not a single one of them wasn't interrupted with dozens of phone calls along the way. It offered sobering insight to how busy they were - literally everywhere in this world, patient care simply never stops and it felt so familiar. Even in my clinic with a relatively small population, I can't remember a single day where we've had downtime. Like in the US, these nurses have heavy patient loads, work 12 hour shifts, and sometimes have to get creative with limited resources. Families often hang out on the hospital campuses with picnics and blankets to manage long wait times. Uzbeks have incredible patience and resourcefulness.

Any accident requiring emergency ambulance transport is required to go to their assigned regional hospital. Care is free, including for foreigners, though the notion of integrating health insurance is starting to take hold. Private clinics focus more on speciality care, but that doesn't mean they are without heavy duty surgical capabilities. One clinic in Termez has a cardiac bypass machine and will soon conduct angiography procedures, where as another on in Qarshi touts its reputation for bariatric surgery and weight loss clinics. Every private clinic we visited have robust dentistry, ENT, and endocrine services - getting one's thyroid function tests is considered routine, as is prescribing lengthy periods of time to recuperate in semi-private rooms. Though they require countless hours of logistical planning, many private clinics enjoy the stardom of visiting specialists from countries like Russia, Turkey, India, and South Korea.

Overall, the doc and I were reassured to see what kinds of care are available in this country and what has changed since the last time the health unit was able to step beyond embassy property. After the hustle of three days of hospitals tours and eight clinic tours, 2 hours of flying, and 16 hours of driving, the doc and I returned to Tashkent to complete the week seeing our own patients, writing trip reports, and catching up on hundreds of emails in our absence. I hung up my jacket and blouse and pulled out my worn, comfortable work jammies for another day of nurse life.

*eyelid lift

Medical folk hanging out in Shakhrisabz, birthplace of Temur the Great.
We're standing behind the Ak Saray Palace, builtbetween 1380 and 1404
when Temur was the man in charge.

Ak Saray Palace tree, good for sittin.

Endoscopy room, Shakhrisabz

Shakhrisabz hospital's collection of weird and unusual kidney stones.

Qarshi's Great Patriotic War (WWII) Monument at sunrise.

Red army stained glass, Great Patriotic War Monument

Nurses are the best, there's NO denying it.
Qarshi hopsital OR Nurses.

Qarshi hospital dialysis unit

Laparoscopic equipment and telemedicine towers in Qarshi.

Operating Room in Qarshi

Emergency room and head nurse in Qarshi.
This room is reserved for red triaged patients, the most serious kinds of injuries.

Endoscopy, Termez

Emergency room, reserved for trauma patients, Termez

More kick-ass nurses (and a few doctors), Termez Neuro ICU

Cardiac bypass machine, Termez

Foreign doctors with upcoming visits to private clinic in Qarshi.

Termez: Heavy on Highly Rated History

Forget about those men who think about the Roman Empire. In Uzbekistan, it's the Macedonian Empire that men (and women) think about. More specifically, they think about Alexander the Great, whose empire reached parts of Uzbekistan over 2,300 years ago. Ye old Sasha set up a city called Kampirtepa near present day Termez, on the Amu Darya River that runs along the border to Afghanistan. Today you can walk on top of its archeological leftovers, a convenient half hour drive from the city. Carved rooms, stairs, and pottery remnants are easily seen throughout the site. It was marvelous thinking about what the resident's daily lives were like back then - did they have as much fun as much as we were having, looking at rice paddies and river life, enjoying the faint breezes of autumn? Sure, why not?

The name Termez means "place of transition" and it fits because although the majority of the population has Muslim roots, there are traces of Persian, Turkik, and Buddhist roots too. Equally not far from the city, is a Sufi religious site called the Al-Hakim At-Termeziy, a complex containing a mausoleum, mosque, museum, and gorgeous walking space with manicured flowers. My colleagues and I greeted a Sufi priest on his way to sing and bless his followers, and he responded with a hearty "Go Joe Biden!" and fist pump. On that same day, President Biden would later meet up with the Stans' presidents (Uzbekistan, Kazakhstan, Kyrgyz Republic, Tajikistan, and Turkmenistan, aka C5+1) and everyone was excited about it. We stopped by the Kirk Kiz (40 Girls) Fortress, where, according to a nice man in a white hat theorized, that 40 girls from all over the region might have studied in female only madrasa. Or, perhaps the fort was for 40 girls conscripted to fight intruding nomads. Either way, the community has been taking care to restore the 9th century fort.

We walked through farmed cotton fields to visit the Buddhist Stupa of Zurmala, and later to Fayoz Tepa, the remants of a 2,000 year old monastery. Our guide, a man with leather skin, freshly dyed black hair, and set of gold teeth unlocked the sacred dome housing a tchotchke-adorned stuppa. Now, if presenting lengthy and vague history about ancient monastery rooms and clay ingredients in Uzbek was a competition, he would have taken first place. My poor colleague gave up trying to translate on my behalf, which was okay because I had stopped listening. We finished the Buddhist tour by driving to another monastery on a nearby hill. Rustam and I ran into all of the tunnels and rooms making dumb jokes about ancient plastic bottles of water that were left behind. Hanging out with him on archeological sites was like going to the bar with your bestie and your favorite song comes on. His energy and enthusiasm was so infectious.

The town of Termez itself is lovely, green, and quiet. We enjoyed the typical Uzbek cuisine of meat kabobs, bread, and pitchers of chalap (drinkable yogurt with minced tomatoes, cucumbers, dill, and carbonated water). I learned that one never simply orders shots of vodka, but it is custom to order the table an unopened bottle which must be empty at the end of the night. I also learned that Yanni is still hot and beloved around here. Back to back videos of his orchestra playing at historic places like Petra and the Taj Mahal washed over us as we ate a savory, lamb neck dinner at the Golden Barrel one evening. We heard his music on the radio and in the grocery stores. There was lively talk about whether he'd ever do a comeback tour. I'd be down, and I bet Sasha would fully approve too.

Walking around the top of Kampirtepa with Rustam.

Entrance to Kampirtepa. Green = Afghanistan

Pottery remains at Kampirtepa; Amu Darya river.

Buddhist Stuppa of Zurmala

40 Girls Fortress (Kirk Kiz)

A nice man in a nice hat.
Kirk Kiz Fortress.

Rustam running around Kara Tepa, 
Ancient Buddhist Monastery.

Hello Afghanistan.
Hiking Kara Tepa in espadrilles was not planned.

Kara Tepa Corridors

Guide and Fayoz Tepa resident rat catcher.
Entry to see the stuppa is through this tiny door.

A very nice stuppa.

Hiding from the sun. Fayoz Teppa History lesson,
going on about 90 minutes by now.

Kitchen view of Fayoz Tepa.

I'm in a monastery tunnel! SO EXCITED.

Country border photo op with Dr. Rustam.

Yanni baby! Golden Barrel restaurant.

Cycling in Slovenia

For our final activity in Slovenia, we spent the last week riding bicycles from the Julian Alps to the Adriatic Sea. We hired a company called Visit The Good Place to do the logistical planning of bike fitting/issuing, hotels, routes, and luggage management. All we had to do was nag the kids to ride at least 20 minutes every day in anticipation of toughening up their butts. For eight weeks, the kids would sigh, fake smile, and get on a bicycle, probably thinking I was the worst. In the end, our persistence paid off, because they crushed over 300km and their butts were in fine shape. Deets even said thank you for it, rediscovering his love and talent for climbing mountain passes and bombing down them. Margo learned the best skill of all: how to minimize effort on the bike by drafting. She got so good at conserving energy and riding in the peloton, I wouldn't be surprised if she gets recruited to ride for the professionals. 

On the plus side of taking this kind of tour, the company moved all of our bags every morning, so packed several cases of wine to bring back to Tashkent. We used an app that kept us on our personalized route, and we got to see many fabulous towns, rivers, and views, at the pace we wanted. The bikes they supplied were fantastic, and I am now partial to gravel bikes. Bike culture in Slovenia is amazing too. We felt safe on the roads and the trails, all of which were in good condition. I learned how to manage loose gravel better on this trip and crashed only once. We had mostly good weather too.

On the minus side, we had to repack all of our junk every morning which got tiresome and SO smelly.  Every time someone would unzip a bag, I'd have to brace myself. There was not enough time to get anything washed except for scrubbing the essentials in the shower or sink. I'm pretty sure I was the only one who bothered to hand wash my bike shorts. Some of the routes ended up being too difficult for the kids' grandfather so he had to travel with the bags a few times. On the day it rained, we had no choice but to ride on, though this was actually not so bad. I had never seen Mark so happy, the kids learned how to manage wet weather, and it wasn't too chilly (when we were moving). Breaking for lunch, on the other hand, ended up being uncomfortably cold and I had to fight the urge to drink an extra glass of wine.

After the mountains, we rode into Italy for parts of the ride, through vineyards, and tree logged hills. Nearing Koper, a shipping town the Adriatic Sea, we rode through fields with signs warning of land mines. According to a Landmine and Cluster Munitions Report, they were remnants from World War I, II, and the War of Independence from Yugoslavia in 1991. Although the country has since reduced the vast majority of the antipersonnel mines, some are still present for training and research purposes. Slovenia has such a chill vibe, it's strange knowing the country has gone through hell and back. The signs were sobering reminders.

Once we arrived to the sea, we celebrated with gin and tonics and ice cream. The kids played on an inflatable swim playground in the Adriatic and we watched the 29th European Handball Festival competition. The city partied so hard into the night, making for some very grumpy Schlinks the next morning, but at least we didn't have to drive.  The tour company took and our mess of stuff back to Ljubljana. We also experienced an impressive amounts of traffic- we'd been warned that beach hungry Germans and Frenchies clogged up the highways in the summer forcing everyone to add several hours of travel time. On our last night, we celebrated a family dinner for Deets' 13th and Mark's 46th, eating steak at Restavracija Špajza, the place our Tour de Slovenia pals recommended. The next day would entail overnight flights, a family locked out of the house, and eventually completing six loads of decontamination dirty laundry.

from the Alps...

Schlink fam

Kranska Gora to Bled
hundreds of km of exclusive bike trails

hydration break

Lake Bled; credit: Deets

catching the next leg of the trip

psyching ourselves up for rain riding

pretending it wasn't annoying AF to be soggy

the one and only time we had to walk our bikes

Soca River Valley + Downpour + Bikes = fun?

hydration break in Italy

discussing the benefits of drafting

"beware of mines - do not enter"
outskirts of Koper

recouping after a bike vs curb

to the end

my cycling fools

Grant, Slovenia: Village at the End of the Road

Curious to experience what was on the other side of the Julian Alps, we rented an Airbnb in the village of Grant, population 24. There are no services and the closest grocery store is an hour drive down the mountain in Tolmin. Padlocked Virgin Mary statues and Catholic shrines were everywhere, with LED candles and fresh flowers, contrasting the rural mountainy feel of log homes and farm animals. But, what really caught my attention were the automatic external defibrillator signs posted along the single lane roads. I was only allowed to stop once to take a picture, while everywhere else we went, the camera was glued to Mark's face. I guess AED signs just aren't cool. 

Most days, we would drive down to swim in the Soca River, visit more waterfalls, and occasionally hit up a super old castle and WWI mountain top trenches. We also visited the Skocjan and Postjna Caves, each famous for different reasons. Skocjan, because it's the largest known underground cave in the world, and Postjna for its underground train (and first in the world) and Olm habitat. Also known as baby dragons, they are tiny, blind, and territorially aggressive salamanders that can live up to one hundred years. I think they look like tapeworms with arms and legs, but the kids think they're cute. So much so, they bought stuffed Olms and named them after famous Slovenian cyclists.

On the days we stayed home, we read, napped, hot tubbed, watched the entirety of The Good Place, and fantasized about retirement. In fact, that was a big reason why were vacationing - to investigate towns where we might want to live and could afford. We want decent access to things like outdoor activity near or in the mountains, fresh water, a yard, medical care, and my most recent request: near a highway. I can handle windy mountain roads most of the time, but I would prefer to not be nauseated every time I drive. Dreaming BIG here, is that asking too much?

too many people tried to turn left to find Grant.

shed behind the house

hiking up to Veliki Rascovec summit

like father like son
Great Soca Gorge - right off the road, no hiking required!

electricity and fire management

Tolmin Gorge

more gorge (Soca)

and another. We never got sick of the looking at clear water everywhere went went.

the only place we were allowed to take photos at Skocja Cave: the exit

Kozjak Waterfall

outside the park.

the hike I did NOT take

tripod gathering in Grant