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Sunday, September 30, 2018

How to Take Three and A Months to Get a Medical Clearance

This week Brandon got an email from State Department's main medical office (MED).  It was pretty short, but it let us know that Sophia is officially cleared to be in Tashkent.  This means that she has access to the medical unit at the embassy and if there's an emergency, she can get medevaced. 

We put in the paperwork to renew her medical clearance at the beginning of June, three and a half months ago.  Seven of us got cleared with a worldwide, class 1, clearance within a week.  Sophia, obviously, did not.

Having a worldwide medical clearance is a very good thing to have in the State Department.  It means that you don't have any medical issues that can't be dealt with by the local medical unit.  I have hypothyroidism, but that's taken care of easily with blood tests and a Synthroid prescription. 

In the last few years, the definition also got changed to include chronic conditions that you can take care of yourself, even if the local medical unit can't help you with them.  I have a friend who had cancer, but was allowed to go to her next post after she arranged to meet with a doctor in Europe for the follow-up appointments. 

Having a class 2 medical clearance is not such a great thing.  It doesn't mean that you are absolutely banned from going anywhere other than first world countries, but it does mean that you have to be approved for specific posts.  It can be a real pain when bidding on jobs because you have to research the medical capabilities of every post you're thinking of bidding on and convincing State's med bureaucrats that those posts can take care of your issue.  It adds another complicated step to an already complicated thing.

So, back in June, I crossed my fingers when we turned in Sophia's medical clearance, hoping that she'd get a class 1 clearance.  After all, it's not like ADD is a particularly difficult issue to deal with.  She doesn't need any special school accommodations and she's on a stable dose of Ritalin, which can be prescribed by the doctor at post - just like my Synthroid is prescribed by the doctor at post.

Unfortunately, my finger crossing didn't work and Sophia's clearance paperwork got passed on to another office within MED.  After spending a week making multiple phone calls and emails, we finally got in touch with the case worker who was reviewing her case.  We talked on the phone and she laid out the issue, "I need to know that you have a way to get Sophia's Ritalin.  She doesn't have a current prescriber, and I need to know that you have one before I'll clear her to go to Tashkent."

We had been working with the doctor at post to get Sophia's Ritalin prescription while we were in Dushanbe and it had worked quite well.  But then the regional psychiatrist (RMO/P) went to her next post and a new RMO/P showed up.  When I needed a new prescription for Sophia, the doctor at post, also new, told me that I had to have the RMO/P refill the prescription.  I emailed her about refilling Sophia's prescription in March, and she told me to set up a digital video conference for her to meet with Sophia before refilling the prescription.

We left before we could do that.  So when I told the case worker about the RMO/P being willing to prescribe, she told me that we just had to get a new DVC set up and Sophia would be cleared to go to Tashkent.  Which was a good thing to hear, because we were less than a week from our departure date.

This is when things started going sideways.  I duly emailed the RMO/P and asked for the DVC.  She replied saying that she had no interest in meeting with us about Sophia - we were supposed to have Sophia meet with our pediatrician.  We replied that we had met with Sophia's pediatrician and what else did she need us to do?  Then she stopped responding to our emails.

At this point, the case worker had decided that, since the RMO/P didn't show any indication that she would prescribe, and we couldn't get Ritalin locally in Tashkent, we were going to have to find a country where Sophia could get Ritalin.  This decision was reached on July 5 - the day before we were supposed to leave for Tashkent.

We got in touch with people at the embassy in Tashkent and let them know of the the problem.  This wasn't good news to them because they were expecting Brandon to show up to work the following Monday and fill a hole that had been empty for several months already.  A few hours later - around two in the morning - we got an email from the HR officer at the time telling us to go ahead and come to post.  Sophia could come without a medical clearance, but that meant that she couldn't use any medical resources.  The email implied that they had worked things out with the RMO/P and that a resolution would come quickly.

That was not the case.

We made it to Tashkent and settled in to our new home.  A couple of weeks after we arrived, Brandon got called into the DCM's (second in command) office.  "Did you know," he asked, "that your daughter doesn't have a medical clearance?  I got a personal email from the RMO/P telling me that I needed to know that you were here at post with a child who wasn't cleared."  Brandon let him know the situation, and assured him that it was only an issue with a Ritalin prescription and nothing serious.  The DCM was relieved and commiserated about tangling with MED.  After you have been in the foreign service long enough, everyone has horror stories about tangling with the medical office.

Brandon went straight from his office to the medical unit.  The PA who runs the unit said that she had gotten in contact with the RMO/P about prescribing Sophia's Ritalin, and the RMO/P had told her in no uncertain terms that she was not allowed to prescribe Ritalin herself.  When the PA asked what we should do, the RMO/P didn't have any reasonable solutions.  Or any solutions at all.

This went on for weeks and weeks.  The PA would contact the RMO/P, who wouldn't reply or offer vague answers or put her off.  Then there would be silence for a few weeks.  The PA would try to re-open the issue and the RMO/P would go through the whole cycle again.  Brandon didn't feel that we should contact the RMO/P personally because he thought that she was angry at us for coming to post without her blessing.  Weeks turned into months and we still didn't have a medical clearance for Sophia.  When we went off to our first horseback riding lesson, Brandon told Sophia not to break anything because she couldn't get any help from the embassy. 

In early September, we got a notice that the RMO/P would be visiting Tashkent personally.  I emailed about making an appointment and the PA asked if it was allowable for the RMO/P to meet with Sophia, even though Sophia didn't have a clearance and didn't have access to medical resources.  The RMO/P said no.  So I made an appointment for myself.  I figured that she couldn't refuse to answer me if I was sitting in the office looking at her and we could finally get everything straightened out.

At the same time, Brandon was putting in a request to extend in Tashkent.  Since Tashkent is a hardship post, you only have to stay for two years.  If you want to stay for three, you have to request to stay for the third year.  We try and stay wherever we are as long as possible, so extension wasn't even a question.  It was an assumption.

Everything seemed to be just fine for him to extend.  His boss was fine with it, the HR officer was fine with it, and the DCM was fine with it.  It was a happy party of agreement. 

Bidding season was getting ready to start and Brandon was already getting several emails a day about his position, as it was listed as becoming vacant in summer 2020.  Brandon let them know that he was planning on extending, so it wouldn't be a good idea to get their hopes up.  But he had to get his extension in before bidding ended otherwise his job would be given away.

Then the DCM called Brandon in to his office (again).  "I can't approve your extension," he told Brandon, "until your daughter has a medical clearance.  So see if you can get that cleared up and I'll be happy to send the memo to the ambassador."

The next day, the PA let us know that the RMO/P had finally given her a straight answer about prescribing - and the answer was no.  That afternoon we got an email from DC letting us know that Sophia was not cleared for Tashkent.

I reached out on Facebook for advice and heard from several other people who had had similar (or exactly the same) experiences with the RMO/P.  She flatly refused to prescribe any maintenance medication - stating that her job was only a "stop gap measure" and that "primary care comes from US-based physicians."  Which, as every single person on the thread agreed, was complete nonsense.  The job, according to the State department website, of an RMO/P "is a local resource available to help manage a child or adolescent’s mental health needs." Our previous RMO/P had had no problem providing Sophia's prescription initially and then had no problem letting the local med unit write the refills. 

It was very frustrating to finally understand that the RMO/P had never had any intention to refill Sophia's prescription and that she took three months to tell us that.  We had spent months waiting for some sort of resolution and praying that Sophia wouldn't get sick or injured.  We had waited and waited and waited for any kind of communication, even if it had been a no.  But instead we just waited on someone else's whims, someone who knew what her answer was from the very beginning and never intended to tell us.  I hope that we never are posted in the same country as this woman because I would have a very hard time not punching her in the face interacting with her reasonably.

So we were left scrambling for another solution and under a very pressing deadline.  I reached out to our former RMO/P, who also refused to manage the prescription.  Then I reached out to our pediatrician in the US, who wonderfully, mercifully, thankfully agreed to help.  I never thought that getting a prescription for a mind-altering substance could bring me so much joy.

The next day I turned in a new provider form, one that said that our pediatrician was willing to manage Sophia's medication, and copied every single person I had ever interacted with at MED.  The next day I followed up with promises to make personal phone calls.  That got a 'don't bother me - bother her!!!' email with the finger pointed at our original case worker.  So I emailed her, called her multiple times, called her the next day, tattled to the office manager about not getting a response, and emailed her again.  That finally got us a response, and the response that we wanted - the only reasonable response that it could be.  'Yes, she's fine.  I'm approving her for Tashkent [now leave me alone].'  I have learned through long experience that sometimes the only way to get the job done is to be the most annoying person ever so people will do anything to get you to leave them alone.

Our quest almost done, I got a message from a wonderful friend who had just gotten a job in the medical office the week before.  She offered to help move the rest of the process along, and did an admirable job of it.  A week after we had the first denial, Sophia was cleared for post.  Brandon and I celebrated for thirty seconds and then he started bugging everyone about getting his extension finalized.

This whole experience has shifted my view of people, ever so slightly, towards Brandon's.  I've always felt that people are reasonable and, if approached the right way, would work with you in a decent fashion.  He sees other people as entities dedicated to doing everything in their power to make your life miserable.  After the last three and a half months dealing with the RMO/P, I'm willing to concede the point.  At least when it comes to Dr. D.

Sunday, September 23, 2018

Eco Park

Saturday wasn't a busy day.  We didn't have any birthday parties, Brandon didn't have work to do, and our household chores weren't very many.  The weather has recently turned nice - upper seventies and low eighties - and the pool is gotten too cold to swim in.

So we loaded up the children and took them to a local park, Eco Park.  I haven't had very high expectations about the parks here in Tashkent, so we were pleasantly surprised with Eco Park.

The park was evidently built in the twenties, but it's been updated since.  It still has lots of nice, shady trees and pleasant walks.  It's nicely watered and reasonably taken care of.

There are badminton, tennis, and volleyball courts that can be rented out.  There are also two playgrounds - one for smaller children and one for older children.

I've seen lots of Soviet-era playgrounds and so was pleasantly surprised to find a pretty decent one in the park.  We had to pay to play, but I'm willing to pay $2.50 an hour for a decent playground and shady benches to sit on.

There's also a lake to walk around and several cafes.  We enjoyed a nice walk after playing with the children.

I'm sure we'll be back soon.

Wednesday, September 19, 2018

Living in Tashkent: Church

Tashkent is our fourth post in the Foreign Service.  It is also our fourth post in a Muslim country, and so it's our fourth post in a country where the Church of Jesus Christ of Latter-Day Saints is not recognized.  I'm not sure how I'm going to handle going to church in a country where it is recognized after spending more than a decade hiding out in the corners of the world that Mormons haven't infiltrated.

Since the Church isn't recognized, we are not allowed to proselytize, baptize, have a ward, have missionaries, or meet with locals.  Our records are part of the Central Eurasian first branch, with the mission president acting as our branch president.  The religious laws here are reasonably strict, so there's not likely to be a change in the status of the Mormon church any time soon.

So, we are home-churching again (for the third consecutive post).  Unlike Dushanbe, where we showed up without anyone else in the country, Tashkent had a group who were already meeting when we showed up.  We haven't found any other LDS expats, so for now it's all diplomatic families who meet together each week.

There are five families, so it's a bigger group than we had in Dushanbe, and when everyone is in attendance we have twenty-six (and three-quarters) people for church.  It's a big enough turnout that we have to squeeze in three rows of chairs behind one of the couches in our living room, and if another family shows up we'll have to get creative with the seating.

The group here does things a little differently than we did in Dushanbe.  We operate on a monthly schedule for just about everything.  We switch houses every month and the primary and Sunday School teachers switch monthly also, with couples taking the assignments for each month.  Our three young women also take turns each month to direct the music and eventually Kathleen and I will swap piano playing monthly.

This gives everyone an opportunity to shoulder the burden and take a break from shouldering the burden.  It works out well, especially with primary, as no two people want to be stuck with the kids while everyone else is in Sunday School together.  As we only have three young women, they meet with the adults and also take a turn teaching during their parents' month.  It's nice to take turns hosting church so everyone can get a break from setting up and taking down church each week.

Before we arrived, the group would have a pot luck lunch together each week, but the group leader left before we arrived (we inherited their house, which is now the Mormon house).  The new group leader took a poll and everyone heartily agreed to limit the pot luck to one Sunday a month which is something I'm much happier with.  Because sometimes I just like to eat leftovers on a Sunday followed by a nice long nap.

We've also established a monthly Relief Society ministering meeting, which so far has consisted of us going out to dinner to celebrate birthdays.  I'm glad that the new guidelines are more flexible and we can be happy knowing that we are in compliance while staying out much too late eating sushi together.  The Young Women are also invited to these meetings, as Young Women are now part of the ministering program.  Kathleen is quite happy about this arrangement.

As there are three Young Women in the group, we also hold Young Women twice a month.  Sophia is the lone girl over the age of four, so she gets to be a part of Young Women, something that she is quite happy about.  So far we have plans for a musical number, an outing to the opera, and a macaron cooking class.

It's great to be part of a well-functioning group (and not have a husband in charge of making sure it functions).  I was talking with another group member about being part of a small embassy community.  "The embassy feels like a ward," I told them, "and the church group feels like family."  I'm glad to have such wonderful family here in Tashkent!

Sunday, September 16, 2018

Not a Baby Any More

Today William padded over to me while I was making brownies.  He lifted his chubby arms beseechingly to me, "Mommy! Mommy! Up!"  A few days ago I caught him coloring on the floor with a green marker.  I looked at him, he looked at me, and then he put the cap on the marker, got up, and handed it to me while looking fairly abashed.  When we fold our arms to pray before dinner, he looks around at all those pairs of arms quietly folded and quickly folds his own.

My baby isn't a baby any more.

I've found that I don't see my children grow up gradually.  I see them as a baby or a toddler or a little child or a big child or a young women for years.  And then one day, my perspective shifts and they've moved on to the next stage.  I stop seeing them, treating, and expecting them to act as a baby and everything changes at once to toddler.  Yesterday they couldn't be expected to talk and today they are. 

William has been our baby for the last year and a half, but now we don't have a baby anymore.  He can feed himself (not with silverware and not soup), he gets up and down stairs without any hesitation, he lets himself out to play in the yard, he often does what I ask him to, he tries to repeat whatever I tell him, and he makes faces that he finds to be very, very funny.

I've found after having a few children that my favorite child stage is eighteen months to three years, and William has only reinforced that preference.  He is mostly cognizant of what is going on and is starting to communicate, but he hasn't become willful yet.  I love the stupid, unknowing, innocent gaze of a toddler and their wholeheartedly delighted smile and laugh when you please them.  I love how snuggling into my shoulder with a blanket makes everything in the world right again, and they are endlessly delighted by reading Where the Wild Things Are every single night.

Having a child who is right on the edge of bursting into full young womanhood helps me appreciate my sweet little toddler even more.  I know that soon enough he will be straining to grow up and become part of the adult world and for now I am happy to delight him with a second brownie followed by a tickle at bedtime.  And also, that oldest daughter can help with the dishes while I'm singing a second song to William before putting him to bed.

I used to be so anxious for my babies to grow up because I needed them to become something other than another burden in my already-full load.  But now the load has been shared around and I can enjoy savoring the sweet innocence of toddlerhood.  Soon enough it will only be a memory, so I'll hold on tight as long as I can.

Thursday, September 13, 2018

Uzbek Campsite Reconnaissance, or My, How Close Kazakhstan Is!

Katheen's contribution:

This past Monday was Labor Day, and Mom decided to take us all into the mountains for campsite reconnaissance and a picnic. The Uzbek mountains are not as close as the Tajik ones were, so it’s a bit of a drive to go hiking. Mom had seen this nice lake (actually a reservoir), and wanted to check it out. Once we got close to the lake, we saw the dam. It was huge, and we thought we were pretty close to some awesome campsites. We found this winding road, and we went up and down, hoping to get close to the lake.            

But any side road was either part of some local’s dacha complex or led to a lakeside village. Turns out, Uzbeks are a lot like Tajiks. Wherever there’s a nice lakeside spot, there is bound to be a house. Now, we found plenty of not lakeside campsites, but Sophia had been hoping for a lakeside campsite, and apparently, Joseph agreed. When we drove out of the last village, Joseph was almost in tears. “Stupid Uzbeks!” he fumed. “We wanted to go camping!”

I was about done, but Dad wanted to go a bit farther. We drove until we got to this gated place with lots of semi-trucks. Dad got out and spoke to a guy in uniform. Turns out, it was the Kazakhstan-Uzbekistan border! None of us had our passports, so we drove back home. Now, we can say we have driven to Kazakhstan. We hope you also have an interesting Labor Day!

Tuesday, September 11, 2018

Operation Steal Kay Kay’s Heart

Kathleen has asked to contribute to the blog.  I warned her that she wasn't going to earn fame and glory because this blog will never go viral, but she still wanted to write for the blog.  She'll be periodically contributing, which is whenever she feels like it.  Blogging is not a required activity in our house.

Edwin is a very secretive person. He mostly keeps to himself, but has some interesting schemes. One of these is to get William into Kay Kay’s heart. To make William appear to the best advantage, Edwin dressed him in a velvet jacket with a tie and loafers. At first, the scheme didn’t appear to be making any progress. But this week, Kay Kay started to notice William.
And why did Edwin want William in Kay Kay’s heart? Edwin adores William, and likes the attention that William gets around the world. But Kay Kay seemed more interested in 4-month-old Timothy, so Edwin devised this scheme to get William in the limelight of Kay Kay’s heart. We hope your brothers’ schemes are successful.

Sunday, September 9, 2018

Why having two cars is probably a good thing

Last week I used the car.  Right now we only have one car, and in fact we've only ever had one car for the entire duration of Brandon's and my marriage.  We technically owned two cars while in language training for Dushanbe, but since they were on two different continents, I don't think that counts.

When I use the car, Brandon can't use the car.  This mostly doesn't cause problems - he gets a taxi to work, he catches a taxi to come home.  But it wasn't that simple last week.

I spent the morning at horseback riding with the children.  The lesson went long, so I went home, stripped off my sweaty riding clothes, changed into regular clothes, and headed to the embassy for a medical appointment.  I had a few (non-emergency) things to discuss with the FSHP which took awhile.  I was finished around 12:30.

The plan was for me to get a taxi home and leave the car keys with Brandon, who had a dentist appointment in the afternoon.  So I met up with him and we walked out to get me a taxi.  Tashkent has a really great app, MyTaxi, which allows me to set up the pick-up and drop-off point when ordering a car.  I searched for a taxi, but there were none available.  I searched again, and again, and again.  No taxis. 

We thought about flagging a taxi off the street, but Brandon wasn't confident in my ability to correctly direct the driver back to our house.  Tashkent taxi drivers are simply people who drive you places, not people who know how to get where you are going.  If you don't know the directions to your destination, you're usually out of luck.  It doesn't help that our road has two names and is about a quarter of a mile long in a small neighborhood so nobody knows of it.  We spent two hours one night convincing a delivery driver that yes, our house really existed.  Nobody knows our road unless they actually live on it. 

The next logical answer was to have Brandon drive me home.  We live the same distance to the embassy here as we did in Dushanbe - three miles - but the speed limit is slower and there are almost ten times the number of stoplights.  Instead of taking 15 minutes, it takes about 25 minutes to drive home from the embassy. 

This would have worked fine on a normal day, but Brandon's dentist appointment was at 2:30, and he had to leave by 2:00 to get there on time.  In addition to his dentist appointment, he also had to get cash out at the cashier.  We were in the process of buying a car from someone leaving post, and they wanted the money in cash.  Their flight left Sunday night, and this was the last day Brandon could get cash out.  Unfortunately, the cashier was closed for lunch and didn't re-open until 2:00.  It was 1:15 when we realized this. 

So Brandon went to his office to finish a few things.  I had some lunch since I wasn't going to be getting home any time soon.  Then I texted the housekeeper to let her know that I was going to be gone for quite a bit longer and told her to go home when her work was done.  Next I texted the Russian teacher to let her know that I would be missing my lesson, but to go ahead and teach the children their lessons.  After that I texted a friend and cancelled our play date for that afternoon.  And finally I called Kathleen and let her know the situation: 1. I would be gone for several more hours 2. Make sure everyone was somewhat behaved 3. Don't kill anyone. 

Then I read a book.

At two, Brandon got the cash, and then we both went to the car.  I (poorly) navigated him halfway across town, getting us to the appointment only ten minutes late.  We had no idea how long everything would take, so I spent two hours watching old Soviet movies (it was a very strange experience watching the peasants singing and bringing the harvest in and realizing that I was in a place where they were the good guys) and reading while Brandon had filling stuffed into his tooth roots. 

And then, finally, I got to go home - only five hours after I had intended to be home.  The children were all intact, the house looked fine, and William was very relieved to see me. 

I've debated the past few months whether or not we really needed two cars.  I know that I'm very happy that we will have them, but my miser side has insisted that it's a poor use of resources.  But after Friday, I'm pretty sure that I can tell my miser side to quit complaining.

Wednesday, September 5, 2018

Impressions of Tashkent from the window of a car

We've had the car for a few weeks now and have done some, but not much, exploring of Tashkent.  We've been here eight weeks now and my house definitely feels like home, but the city still is a foreign place.  Dushanbe was small enough that it was pretty easy to get to know a good portion of the city, but Tashkent definitely will take a bit longer.

When we first got here, I would look at the map and estimate how long it looked like it would take to get to a place in the city.  But there's something funny about the scale because it usually took three times what I thought it would take.  What looked like a five-minute drive in Dushanbe would turn out to be a fifteen minute drive in Tashkent.  It took a while to get used to that - there was hardly anywhere in Dushanbe that took fifteen minutes, much less half an hour.  Drive for half an hour in Dushanbe and you could be at the head of your favorite hiking trail.

I've never had to navigate a large city like Tashkent before.  Cairo was enormous - it took two hours to get to a wedding that was only halfway across town - but we hardly ever ventured outside our neighborhood, which was small enough that we could walk most places.  Baku had terrible traffic - it could take Brandon over an hour two drive three miles home from work - but it wasn't a very big city.  There were areas further out, but we stuck to a pretty small area and it was pretty easy to get to know that area.  Dushanbe was just small.  It had two major roads and that was about it.

But Tashkent is a big city - in fact, it was the third largest city in the former Soviet Union.  I've discovered that one of the major reasons it is so big is because a whole lot of people live in houses (I have no idea what the percentage is, so I'm sticking with "a whole lot").  There are definitely Soviet-style apartment buildings, but I've been surprised at how many houses there are.  If you look at a map, it looks like there are significantly more houses than apartment buildings, so that makes for a much more sprawling city.

Uzbek houses have a feature that I really enjoy - the outside-the-gate yard.  In Dushanbe and Baku, the houses were all in walled compounds, with the walls going right up to the street.  It made for very private houses, but pretty ugly roads.  Here in Uzbekistan, the houses are still all in walled compounds, but almost all the houses have a yard outside the gate.  Some foreyards (my very own term) are practically forests and some are carefully tended with lovely flowers and carefully trimmed shrubs, but they make walking and driving through neighborhoods very pleasant.  Unfortunately our foreyard is just grass.  But all of our yard is just grass, so I guess it makes for easy maintenance.

While driving around Tashkent, I've also noticed that the roads are very wide.  Usually there are four or six lanes.  This makes traffic less troublesome to deal with, especially since everyone isn't double-or triple-parking like in Baku.

And the reason that they aren't double- and triple-parking is because there are lots and lots of parking lots.  I've never lived in a city with so many parking lots - the bazaars have parking lots, the grocery stores have parking lots, the malls have parking lots, the water parks have parking lots, and there is always ample parking on the street.  I had friends in Baku who hired drivers just so they didn't have to park their cars because parking is so terrible, so I'm very happy to not have to stress about parking once I finally get to wherever I'm going.  You people in America may laugh, but you never realize the beauty of parking lots until you live in a place where they don't exist.

Brandon and I are divided on the driving here in Tashkent.  He feels that the driving is worse than Dushanbe, and I think it is better, but it's probably just different.  There are speed cameras so there isn't as much speeding as in Dushanbe.  But there are a lot more lights and turning left often is a bit of a scramble as everyone is trying to cross three lanes of traffic.  There are definitely fewer pedestrians crossing at random points, which is nice.  And since almost all of the roads have medians, nobody tries to pull the ridiculous red-light behavior that drove both Brandon and me insane in Baku.

I think that Tashkent is going to take a little bit of time to get to know.  But we plan on staying here long enough that by the end I'll wonder how I ever felt like I didn't know this city well enough to feel right at home.

Sunday, September 2, 2018

Root Canal

Two weekends ago, Brandon's tooth started hurting.  Our family has been blessed with remarkably good dental health - neither Brandon nor I got any cavities until after we had been married (I blame Utah's lack of water fluoridation), and none of the children have ever gotten cavities.  When we were living in DC before going to Baku, Brandon had a close call with a potential root canal, but our good dentist in Baku was able to fill the tooth and avoid the full workup.

But when Brandon came home from work one Friday and mentioned that his tooth was hurting and then woke up Saturday with it hurting even more, I knew that our streak of good luck had ended.  He took a lot of pain medication to get through the weekend and Monday morning visited with the med unit to discuss who to see about teeth.  

Dushanbe had one dental clinic that was sometimes okayed by the med unit and sometimes banned by the med unit (the issue was sterilization of instruments), so I wasn't sure what Tashkent had to offer.  The FSHP recommended a place to get the tooth checked out, but cautioned Brandon about getting anything too drastic done.  "You should be okay with a filling or a cleaning, but I probably wouldn't recommend a root canal.  That should probably be done in London.  You're never quite sure how good they are at those things here."

Brandon called the clinic and he was able to get an appointment for that day.  He made it there after some hairy driving (turns out that Google maps is a lot less useful when it doesn't give directions) and met the dentist.  

Brandon has been speaking Russian for two decades, but he was happy that dentist spoke English.  The funny thing about foreign languages is that that you learn vocabulary based on what you need it for.  So he knows lots of Russian terms about religion and labor issues, but knows no words for things like horseback riding or dentistry.  He stayed very far away from any dentists' offices in Ukraine; one of the branches on his mission met over a dentist's office and they would often hear the children screaming while they were meeting on Sundays.

So when the dentist led off in English, he was happy to continue chatting with him in that language.  

"So, what is the problem?" the dentist started out.

"Well, my tooth is hurting."

"All the time? Or only when you eat?"

"All the time."

"Sounds like you've got pulpitis. You're probably going to need a root canal.  Mind if I take a quick look?"

Brandon got into the chair an opened his mouth so the dentist could look over his painful tooth.  The dentist prodded, poked, and then pulled out a needle.  He poked Brandon with the needle, started some serious digging, and then pulled out an even longer needle.  Before long the digging turned to drilling, and the dentist was no longer taking a quick look.

Later, Brandon told me that he knew by that point that he was halfway to getting a root canal.  He also knew that the med unit had told him specifically not to get a root canal in Uzbekistan.  But, as he told me later, "What was I supposed to do?  They had my mouth wrenched open, I had been poked by several needles, and the drill was making some serious inroads into my tooth.  It's not like I could hop up, thank them for their time, and make a quick getaway.  So, obviously, I stayed and got a root canal.  Maybe if we had been speaking Russian, the dentist would have been able to communicate better, but it was too late to worry about language differences."

I know that root canals can be quite expensive - thousands of dollars in the US - so I took a deep breath before asking him the bill.  

"Now remember, this is just for the root canal," he cautioned me, "I still have to get the filling and crown done."  When he told me the total - 118,000 som - I did some quick calculation and came up with $148.  Not bad, considering.  Then I did another calculation and realized that I had the decimal off - it wasn't $148, it was $14.80.  It cost less than getting McDonald's for our entire family.  

Brandon still had two more appointments before he was restored to full dental health, and in the end he had to lay down a whopping 594,000 som for a root canal, filling, and crown.  With the exchange rate, it ended up being $74.  

So we'll see how the root canal ends up long term.  A few weeks out, Brandon is feeling fine, so I figure it's working out pretty well so far.  And at $74 a pop, we can probably get it done again if we need to.