East Meets West

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The camera was rolling, and the microphone angled to me; “can you say what do you think about Barack Obama’s congratulations to Serge Sargsyan?” “Does your presence here mean that you support Raffi Hovannisian for President of Armenia?” As a visitor, I don’t want to be for one candidate or another. The reporter noticed how I singled myself out, having come to Freedom Square to offer some oud music to the candidate, widely known as “Raffi.” He is said to be on his 13th day of fasting there in Freedom Square, in protest for better democracy in this country. If he can’t eat, he can at least hear some music.

I could say I didn’t want to be more shaven than the modal supporter, which is a 60-something working man in a worn cap, suit-coat, and 10 year old shoes. The truth is, once I gather the resolve to carry my oud over to the Square, there is no stopping to shave.

If, as Richard Avedon said, “charm is the ability to be truly interested in other people,” this man has it. Before I left, he knew my son’s names, how long I’ll be in Yerevan, what Dana’s in press novel is about, and where my grandparents-in-law were born. Perhaps this strength of charm left him with fewer organizational faculties, as his campaign is said to have been thin in that area. Yet this is the man who, speaking Armenian with a Fresno accent, surprised even the oligarchs, garnering over a third of the vote.

Raffi speaks

Someone pulls up a chair and we sit under the open tent: an oud-playing north-easterner with a quorum of Scots in my ancestry, and a Californian Hye. Raffi has a handsome, olive face that resonates with his California home, and, despite the fast, there is a bear-like quality about him. He explains the lyrics to me, and sings along to some of the tunes. I start out with a 10/8–a folk song in a 10 beat-per-measure rhythm that is relatively unknown to Eastern Armenians. He picks it out at once. The lyrics to “Voch me Dzagheek” say something like “no flower has such a fair scent as you, no mother, … ” “But of course there was a mother,” I say. Agreed.

Oud Tune: Voch Me Dzagheek

After a few tunes, Raffi’s son Garin, presents me with his book Family in Shadows (http://hovannisian.com/family-of-shadows/). A memoir high in gravity, low in melodrama, the book pulls you along and through historical horrors, the story of the Armenian Genocide, and of violence between brothers: including Eastern vs. Western Armenians, not to mention Turks, Kurds, Russians, …

California, Detroit, Watertown (Massachusetts), Manhattan–these are some of the places where former Western, now “Diasporan,” Armenians, like Hovannisian’s grandfather, settled after the genocide of 1915. When their descendants returned to modern, eastern Armenia, as Hovannisian and his family did around 1990, when this new nation was emerging from a colossal earthquake, they brought different dances, different rhythms, compared to what the eastern Armenians know. Many of the younger Armenians I’ve met don’t know what an Oud is, since it was traditionally more a Western Armenian instrument. One of my Bari Khoomp (dance group) friends sees my Oud–“ahh, you have a Lute!”. I explain that the lute, an instrument which he decided to acquire since hearing it played by Sting, is named after “Al’Ud” (Arabic).

I’ve run through most of my best Armenian folk tunes. “OK, play me a 7/8, that’s usually what they play when the music is over, and everybody goes home.” As we close, Hovannisian gives me a friendly bear-hug. I guess he hasn’t eaten for almost 2 weeks, but he only asks for more 10/8s. “And do you think you will return to Freedom Square?” asks the reporter. That’s a yes.

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All in the family

A mother brings in her mildly delayed infant with visual impairment, though it is the paternal grandmother who does most of the talking, and the questioning. What are the pros and cons of an MRI that will require sedation? They have had the child seen in Germany, and by several specialists in Armenia already. Standing behind, holding the child, the mother’s face tightens in an expression that says “don’t mind my tenacious mother-in-law.”

In a society where newly-weds typically move in with the husband’s family of origin, it is the relationship between mother and paternal grandmother that is most notoriously strained. The assertive grandparents at the visits I’ve witnessed do indeed tend to be fathers’ mothers. The parade for International Women’s Day a few weeks ago featured a side-walk skit, repeated at 3 strategic city plazas, that was a lament for Armenia’s Cinderellas, a cry for them to reclaim their identity.

Transformative theatre
. Christina, a psychologist, told me of a theatre project at a special, foundation-sponsored, school that emphasizes inclusion of children with disabilities. Some weeks after the class put on a play for the families, one mother told Christina: “my old difficult family is now a good family, and all this work that I have done, taking my disabled son to the physical therapist, to the psychologist, I now believe has been worthwhile.” Before the play, the paternal grandmother had said things like “we don’t want a boy like this, get rid of him, give him to the orphanage.” But after she heard the boy sing on stage, with an audience, and realized his capabilities, the grandmother changed her mind, and found a way to love him.

Tateegs (grandmas) In 1910, Protestant Missionaries in Asia Minor were funded by American industrialists, whose zeal was perhaps more related to manning their mills than to doing God’s will. Armenians, being Christians, were ready recruits to the cause. In 1914, my friend’s great, great, grandmother saw her parents and siblings proselytized, and then scooped away from their small village to Worcester Massachusetts. Since their conversion to Protestantism also converted them to New England mill workers, they fortuitously escaped the impending genocide of 1915. But the great grandmother remained behind with her grand-daughter, my friend’s grandmother.

The Turkish community protected this woman, the mid-wife, and her grand-daughter. In 1993, my friend’s father visited the village, and confirmed an elderly villager’s memory of his mother, the grand-daughter: do you remember a midwife? What was her name? Was there anyone with her? Oh yes, there was a little girl, the midwife’s granddaughter; and the midwife never let go of her hand; she held that little girl’s hand through every moment of her house-calls.

Now, in many villages, over half of the fathers are migrant workers at Russian factories, accumulating cash so their families can eat, leaving their wives at home with their mothers. I ask one 10 year old boy what he wants to be when he grows up. “A migrant worker” he answers. The doctors and nurses in the room, all women, laugh loudly and briefly at the irony of his response. Their daily work is an immersion in the worries and fears of families fractured by the migrant worker economy.

Oligarchs The wealthiest families often have fathers with government jobs: cabinet ministers, members of parliament. The business clans, with their high-fenced castles arrayed through and around Yerevan, are widely known as “the oligarchs.” They are identified not only by family names, but by license plates. One evening, passing through a desolated construction lot to get to another neighborhood, we noticed Jaguars, Audis, and Mercedes with either lots of 7’s or lots of 8’s on their plates–business meeting.

The skeptical citizens will tell you–“we have not a democracy here; it is oligarchy.” The oligarchs keep tight control of the government, and influence legal processes-judicial, legislative, executive–in order to stymy competition in their respective marketplaces. The incumbent President’s victory in recent elections (mid-February) is believed to have been a piece of oligarchy theatre; there is talk about the conspicuous number of absentee ballots that favored him, and about the failure of the European election-monitoring organization to call the foul.

February, 10PM–a cozy dinner party on Parpetsy street with some colleagues–academics, artists–and their families. During the party, news arrives via someone’s cell phone that the defeated Presidential candidate has announced a fast, and will sit in Freedom Square. We walk the few blocks to the square to witness. The candidate, sitting, silent on a bench, is surrounded by about 50 people. A clearing of about 5 feet, and an air of mourning, respect, surrounds him. Is it for him, or is it for the thousands of stolen votes, for the chance of real democracy that he has represented? Seeing our friends, the candidate rises at once, and crosses the gap to embrace them. They share a few words of consolation and encouragement; on their faces I catch a brief smile laced with sadness, stoicism, and love.

Aequanimitas

3/7/13 — Winding through the streets of east Yerevan, my host warns me, I might weep at the orphanage. Though I haven’t regretted the few times that I have broken down in front of a patient or family, Sir William Osler warned me, and generations of clinicians, to get their “medullary centres” a bit better controlled: Imperturbability is “largely a bodily endowment, I regret to say that there are those amongst you, who, owing to congenital defects, may never be able to acquire it … the physician or surgeon who … shows in his face the slightest alteration, expressive of anxiety or fear, has not his medullary centres under the highest control, and is liable to disaster at any moment … an inscrutable face may prove a fortune” No wonder they Knighted him. What a jerk.image We climb the eastern hillside, where the Urartu built their forts almost 3000 years ago, and come to the building entrance, which looks like that of any other 2 story building on this densely settled slope. But the sign on the door indicates that this is a project of the Order of Mother Theresa. Mother Theresa took a special interest in children. “No Photography” another sign says with a strike-through camera graphic. Sister Mikki greets us; she seems about 35, wears robes and a hair cover bearing the blue-on-white stripes of her Order, and has a brisk, joyful way about her. imageShe introduces us to two older residents, a 10 and an 8 year old boy sitting in newer (American) wheel chairs in an outer, 2nd floor “drawing room.” There’s a quiet, “Grandma’s house” feel to the place, with tiled floors, bas relief ceilings, wooden balustrades. We walk into sunny rooms, walls lined with knee-level seats, occupied by infants about 8 to 20 months old. Sister Mikki continually carries one or another of them, querying them, explaining things to them in her friendly way, eliciting magical, evanescent little smiles. As I walk in to the rooms I have the sense of having interrupted a conversation conducted in infant semaphore, as the alert residents face each other across the room. There is a luminous equanimity in their gaze, poised between expectation and curiosity. This isn’t the kind of equanimity that might come from following Osler’s advice “not to expect too much of the people amongst whom you dwell.” Here at the orphanage there seems to be enough love to go around. One or two infants have the persistent head-turned, “fencing” pose as a sign of their disability, or a flexed posture. About 15 infants in total, they all seem to have neurological problems, two thirds of these related to various forms of spina bifida with hydrocephalus (which typically go together). If one gets adopted, there’s a good chance it will be to an American home.

To stand within a circle of attentive orphans. One might expect the narrative behind the tears in this setting to be about shortage: tender, new, incapacitated human beings caught in an anonymous backwater. What moves me is the open-ness in these infants’ gaze, that seems to say “what next?” without a hint of anxiety or imprecation. My favorite image of equanimity (until now) was in the story about the Buddha, who upset his followers when his only response to a man who came, first to spit on him, then to throw himself down on the ground, was “what next?”image (http://www.dhamma.worldofwisdom.asia/2012/01/what-next.html#more )

Sister has arrayed the paper charts of the children on a table in the adjoining infirmary room. The infirmary’s glass-walled medicine cabinet has the commonly used seizure medicines sitting next to boxes of band-aids, gauze, scissors, creams and ointments: carbamazepine, valproic acid, phenobarbital. But the largest bottle, at the back of the upper shelf, is labeled “Holy Water from Lourdes.” The Sisters here are apparently among the many who believe in the healing properties of water from this part of France. Osler had an encompassing contempt for this kind of integrative medicine: “restrain your indignation, when you … discover accidentally a case of Warner’s Safe Cure in the bedroom of your best patient. … Curious, odd compounds are these fellow-creatures, at whose mercy you will be full of fads and eccentricities, … .”

She winnows through the charts with my host to see who must be seen, especially focusing on one who has been fussier than usual–is there an impending shunt obstruction? An Italian pediatric neurosurgeon is visiting next week. Though today this resident was calm, feeding a bit better. (In the end the visiting surgeon operated on two orphans during his visit, when he also brought to Armenia its first neurosurgical endoscope for performing 3rd ventriculostomies.) Sister Mikki has to leave before we do–one of her orphans is in hospital.

We did not see the other cadre of residents, the children with Down Syndrome, who tend to undress, and who in general have less need for a pediatric neurologist. But I feel an inscrutable, gravitational pull of the place across the shallow valley of Yerevan through my high windows on Parpetsy street. I think I will return.

Song:

I Don’t Know Your Name

Showing Up

7:30am; opening my eyes in our 2 room apartment, I see two great columns of crows out my window. Eighty percent of life, they say, is just showing up, and there they are, spiraling in the cold morning air over Nor Nork (also known as New Nork). As the coffee water boils they break out of their dance, and settle onto one of the cranes that hang over the half-finished buildings of Yerevan. They line up along the steel arms as the social rules of crows require, improving the skyline with the sincerity of their black silhouettes. My Burlington crows do the same, moving together en masse, then forming a line like points on a ruler. These Yerevantsi crows make me feel at home.

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And they aren’t the only ones. Thanks to Dana, surprising connections spring up from all directions: my first week here, I get into a cab, having called the cab number Dana gave me. The driver is chatty; he knows about my 3 grown sons, that Dana is a writer, that my mother-in-law is not well. Later, Dana & I arrive to an already-full yoga class, but the teacher smiles, she will find a place for us. One evening we go to the weekly meeting of comic artists–“Drink & Draw”–at the library a few blocks away; there is a chair, a pencil, some blank paper ready for me. (I appointed myself official oudist, as there was no competition for this office.) On Sunday morning, friendly faces greet us outside of the 500 year old church walls, and we find the seats that are held for us. After the service (lots of singing), a lovely older lady puts one arm around Dana’s shoulder, eyes shining with the fullness of her affection, and in a word, tells me how she feels about Dana: “Chamach!” I couldn’t agree more.

It’s as though I’ve been showing up for years. If there is ever a question of how I got here, I mention that my sons’ names are Nishan, Tavid, Aram. My new friends seem to appreciate the roots of my sense of belonging. So, my phone is starting to ring, and only occasionally is it a wrong number, giving me that passing “11th finger” feeling. The caller sounds insistent, so I pass my phone mutely to Dana, my pioneer, my connector. She explains the situation to the caller. There is a nor person at this number.

Dancing is one of those ultimate ways of being present, though it hasn’t always been encouraged. It is said that during Soviet times, dances, like other expressions of national identity, were suppressed, a sort of cultural “sensory deprivation.” As though they could prevent children from learning them, erase them from community memory. Each town had its own dance, their celebration of home, of being together.

Clinic, mid-day; a delightful 3 year old boy walks in with his mother and grandmother, plants himself in the middle of the room, and closes his eyes tightly. Periodically, he opens his eyes, looks around, but he is remarkably tenacious, and keeps them closed for most of the 30 minute interview. The mother’s and grandmother’s concern is of new onset stuttering. He is otherwise fine, but he had not wanted to show up for this doctor-visit, so he is making us disappear. There are some gentle suggestions from my very talented pediatric neurology host to avoid physical punishment in general (?did the stuttering start after one such punishment?), or verbal corrections of the stutter.

There’s a grain of truth in the boy’s disappearing experiment. In a famous, horrifying neurobiological study, repeated in many variations since, a handful of kittens’ eyes–left or right–were covered for a few weeks. When tested later, they lost sight in the formerly covered eye, and the corresponding parts of their little, seeing brains had withered away. Experience is a food that is passed in a bucket line upstream to our brains.

Often enough, the blindfold is taken off, and vision returns. Now, the dances of Armenia’s villages are making a comeback. People are gathering them, teaching them, performing them at work, and in parks, when the children’s soccer game is over.

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8PM: At the Bari Hoompe (dance group) the men accommodate my un-trained feet, take me into their line. Arms locked behind our backs, shoulder-to-shoulder, we wheel, hop, skate, and leap over the wooden floor. [I wanted to bring you along too so I took a sound recording:Barighoomp ]. They don’t seem to think it’s too late to learn. I’m just glad I showed up.

Sides’chun for now!

What’s in the Black Bag?

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Clinic, a small Armenian village. She cracks her hands, practically every minute of the day, so much that they have become swollen, the knuckles sore. I believe that she will permanently injure her joints if this continues, and so does her mother. With an interpreter, and her primary doctor standing by, I ask her a few questions–who is worried about this? (mom); why? (bad for my hands). Her solemn gravity matches that of the 11 who came before her. Though initially, in the dissociation which drives this self-destruction, she is unclear on whether or why the habit troubles her, she does come around, and says that her knuckles hurt. She has tried to stop, but cannot.

I am conferring with the generalists at this rural clinic. They want to know: what would I do? She is the last patient of a day when the news has passed through her cold gray town: there is an American doctor–bezheeske; he is seeing patients with the doctors at the polyclinic. And so her mother brought her.

The 4 hours and 12 patients could have been back in Vermont: parents concerned about their children’s tics, or their angry, un-disciplined ways, or their headaches, or reading problems. My medical training put very little in my black bag to address these problems, and yet I have carried it all the way here, as though it was a talisman. Such a scene had some potential to evoke one of my greatest fears: that I would suddenly discover myself to be a naked emperor on parade. imageRemembering the pivotal scene from The Wizard of Oz (“pay no attention to that man behind the curtain!”), my best response to this fear is to be my own Toto, who with a single gesture pulls back the curtain, reveals the charlatan, and impels honesty onto the scene.

“I want you to tell my son to stop hitting his sister, maybe he will listen to you, since he doesn’t listen to me” says one mother. I can see the logic of backing up this mother, but I also doubt the bargain will sustain: the boy hears me, agrees to try harder, until … More important than his accountability to me (“that American doctor will be disappointed with me if …”) are his expectations of himself (“how will I handle my mean sister? Maybe I will do something different …”). As far as I know, when the problem in the clinic boils down to personal habits, the ethics come down to how and whether I can support better self-regulation, the patient’s best expectations of herself. This is how my “inner Toto” insists that I redeem trust: pills and tests only when doing something different isn’t enough.

imageNow, my focus is on her, the girl who is doing her best not to crack her hands during the visit, under her mother’s eyes. She says she wants to be a surgeon. I ask her to demonstrate the maneuver, just once. A low-pitched, crunching sound comes from the core of her hands, and resonates through us, nurses, doctors, translator, mother, like a wave. She looks down, like she has just done something wrong. My translator, a Yerevan medical school graduate, now steps in and deftly executes a time-honored maneuver of medical interviewing: “So, tell us, what are the 4 things the doctor said to do?” On 4 fingers, they recount:

1) Massage–have the masseur wish for you that you will stop cracking your hand joints.
2) Pray-add your hands, your wish to stop hurting them, into your prayers.
3) Re-image–when you are going to sleep, think of yourself as a person who does not crack her hands.
4) Substitute–the moment you have the thought of cracking your hands, think of a different, more gentle, movement to make.

It was the best I could find in my black bag.

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Black Bag Blues