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Wednesday, April 6, 2016

How Medical Care Works in Tajikistan

Joseph has reflux.  We didn't know that when he was a baby.  He didn't have any of the classic reflux signs - crying, slow weight gain, general unhappiness - and so I didn't wonder if he had issues.  A sleeping, happy baby is a healthy baby right?

When he got a little older, I noticed that he would make a strange gasping noise as he sucked his thumb.  I talked with the doctor - he also smelled like bile after the gasping incidents - and she said to see if he still made it after he stopped sucking his thumb - maybe he was just gagging himself as he was sucking.  He's stopped and it hasn't.

So back in November, I talked with the Regional Medical Officer about the reflux and Joseph got put on medication.  If it didn't work, let him know.  It didn't, so Joseph got another medication, at half dose (turns out little boy reflux medication is the same thing as adult reflux medication, just less), which also didn't work.  So then Joseph got a whole dose.  He thought this was very cool, and swallowed his 'capsule,' as he insisted on calling it, every morning with great aplomb.  His favorite trick was to do it without anything to drink.

That, unfortunately, didn't do the trick either.

So Joseph and I are going to London.

If we lived in America like the majority of Americans, we would go to a pediatric gastroenterologist.  If we lived in a large city, we would choose the one that accepted our insurance.  If we lived in a small one, we might drive an hour or so to a nearby city that was large enough to warrant a pediatric gastroenterologist.

But we live in Central Asia.  We also go to see a pediatric gastroenterologist.  Because reflux in Central Asia is the same reflux that happens in America.  But we just go see a pediatric gastroenterologist in London.  See how that works?

Going to London is a fairly involved process.  First, I have to abase myself before Brandon fifty times to apologize for leaving him with the rest of the children to galavant off to one of the most fun places in the world to be stuck in for a doctor's appointment.

Then we have to get plane tickets.  In Baku there was a direct six-hour flight to London.  It was great.  But we don't live in cosmopolitan Baku anymore and our direct flights to western Europe are: Frankfurt.  Once a week.  On Saturday.  Otherwise, if you want to to west, you go to Istanbul.  Thank heaven the embassy provides the plane tickets because it turns out that plane tickets with an open return date from Dushanbe to London are very expensive.  Very.

Next comes the hotel.  Which, thankfully the embassy also provides.  Turns out that there's a whole office in London dedicated solely to taking care of people who live in places where they can't get outlandish things like pediatric GI appointments, or root canals, in the capital city they live in.  It's great.

So Joseph and I are booked at the same hotel that I went to last time I was in London.  It was a very nice room, but I hope that this time my room does not have clear glass wall separating the bathroom and bedroom.  Because I'm not really a big fan of waiting to use the bathroom until Joseph's asleep.  Or showering only after bedtime.

And, of course, the doctor's appointment.  I guess pediatric GI specialists are very busy in London because we couldn't get a doctor's appointment until May.  But also, done by the London medical center (or centre?  After all it is London.  But the American embassy.  Which one?!?).

Then the credit card.  We only have one credit card right now - I'm not big on spending money I don't have - but the limit's a little low.  It's fine for every day spending, but maybe not for London medical spending.  I heard a recent story of a friend who went for testing and spent $15,000 on testing.  Just testing.  Not the room or other expenses.  Our insurance does reimburse the fees, but it takes a few months.  So, another credit card was in order.  Hopefully it will get here before May.

And last, but definitely least, child care.  There was a time once when Brandon pointed out that really it might be better for him to take any medevac'd child (this was a theoretical discussion) to London and we could just live our life like normal without any interruptions.  Then reality intervened and I'm going to London with Joseph because it turns out that Brandon has work to do and doesn't like dropping it in someone else's lap without fair warning.  So that still leaves us one adult down.

My housekeeper doesn't speak English.  Her daughters do (enough) and so they're always a babysitting team.  Anisa comes because she speaks English and Zarifa comes because in Tajikistan unwed young ladies don't go to people's houses alone.  This works well in the evenings, but not so well during the day when things like school are in session.  

Luckily a friend has a housekeeper who speaks fantastic English and is looking for some extra cash.  My (wonderful) friend was happy to loan her housekeeper and so the children will be spending their time with Mrs. Guli.  I don't have high hopes for jobs or school getting done with any consistency, but I'm pretty sure that nobody will die between the hours of nine and six, which is really what I'm looking for anyway.

So after we get the flight, hotel, appointment, and child care lined up, Joseph and I will go to London so that a doctor can spend (maybe) an hour talking to me about Joseph's reflux.  Then we'll hang out for a few days and come home.

Because that's how we get things done in Central Asia.

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