Friday, August 22, 2008

Taking Chai

Last week I attended a meeting with representatives from several Afghan health organizations committed to developing a medical plan to respond to disasters that hit the country. Considering the earthquakes, droughts, pest infestation, brutally cold winters and military devastation that regularly affect a sizeable portion of the population, a disaster response plan is imminently reasonable. So said an eloquent representative from one of the agencies, and he then began to expound on details and initiatives crucial to the nationwide coordination of a medical response. I was impressed, as I have found it rather unusual that an Afghan official actually takes control of a project and pushes his countrymen to produce policy and procedures beneficial to the population. Unfortunately, I wasn’t impressed for too long, as shortly after he began his disquisition, he stopped and said that he would like to say more about organizing a medical response program for the country, but as his tea (served to everyone several minutes prior) was getting cold, he must sit and drink it now.

I knew that the taking of chai, as tea is known here, is an important custom at meetings in Afghanistan. I was unaware, however, that a warm cup of the beverage took precedence over the promotion of improved public health for the country.

Upon entering an office or residence or meeting in Afghanistan, you invariably will be offered a cup of chai. The tradition is testament to the Afghan custom of hospitality. Along with the chai, you usually receive a small piece of candy or a dish of nuts. The taking of chai is common and important in many Middle Eastern and Asian cultures, and oftentimes true business cannot be comfortably discussed until initial greetings and chai are complete. Chai is so much a part of the culture that an office or ministry in Afghanistan typically has one person appointed to serve the drink at meetings.

I first encountered the concept of the “chai boy” in Turkey, when I visited an uncle who is a civil engineer and was managing the construction of a freeway around the city of Izmir. I went to the worksite with him one day and sat for a meeting between him and a few Turkish contractors. Shortly after discussions began in the double-wide trailer that served as his office, a Turkish man who looked thirty-five years old entered carrying a tray laden with one cup of chai for every man in the room. I watched as this same man waited for us to finish our chai, after which he retrieved the cups and disappeared.

After the meeting, I asked my uncle why that employee didn’t stay for the discussion. My uncle, confused, asked which man I referred to. “The one who brought in the tea,” I answered.

“You mean the chai boy?” my uncle responded.

Not familiar with the term or occupation, and not yet ready to believe that a thirty-five year old man could actually support himself serving tea to engineers at a construction site, I responded, “Yeah, I guess. Your employee who brought in the tea. What’s his position here?”

My uncle looked at me as if I had just questioned the precepts of Euclidian geometry. “Ron,” he said, “That guy is the chai boy. That’s his job. To serve chai.”

At the meeting last week, a Ministry of Health chai woman charged us with chai and candy shortly after proceedings began; and when the gentlemen who suddenly found himself unable to continue with the important task of creating public health policy for Afghanistan due to a cup of rapidly cooling chai, a quick-thinking fellow Naval officer summoned the woman, somehow gesticulated the request for a fresh, hot cup of chai to the table post-haste, and then quickly served the chai to the health official who, obviously bolstered by the steaming brew now below him, took a quick sip of the just-delivered beverage and then continued on with a rather impressive proposal for mitigating the medical plight of Afghan victims of national disasters.

Another recent incident illustrates as well the propensity for Afghans sometimes to value their chai above important matters at hand. Last month I went with an American pediatrician to examine and vaccinate at his home the infant son of a very high-ranking Afghan politician. My colleague and I completed the exam, and then began to examine closely the infant’s medical record as past vaccinations were not well-documented. We hadn’t seen the record before we arrived at the politician’s home as the child’s mother maintained the chart, and we weren’t sure we would see the child again during our tenure in Afghanistan; so we wanted to review and update the record properly.

The politician’s housestaff included a young man who had recently graduated from Kabul Medical University, who told me that he hoped to matriculate to Canada soon to begin a residency in neurosurgery. He was a relative of the boy, clearly affectionate with the child, and grateful for our examination. A few minutes after we began reviewing the medical record, however, he began to shift uncomfortably in his seat. I noticed that the child’s mother had left the room, and I assumed that she had moved to the kitchen to prepare the inevitable chai. Apparently the budding neurosurgeon knew himself that chai now awaited us, as he allowed us only two or three more minutes with the record before he became so agitated that he quite literally jumped to his feet and exclaimed “Please, we must finish here! It is now time for chai.”

Canada is part of the British Commonwealth, a collection of people who, like the Afghans, take their tea pretty seriously. Still, I think that a Canadian neurosurgeon, given the choice between a taking tea break or properly documenting a patient examination, would probably choose to complete the medical record according to established standards. I’m not sure if that young Afghan physician will ever undertake surgical training in North America, but if he does he will quickly learn that if he wants chai during the workday, he’s going to have to wrap the beverage cup in a cardboard sleeve and enjoy his drink on the go.

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