Animal, Vegetable, Miracle by Barbara Kingsolver

I read this as part of my humanities seminar entitled "Evil Bananas". 

While I went into the class thinking that I may already be part of the choir,  I actually learned a fair bit about food systems here in rochester. This book however tended to grind on my nerves, if only for the cliched tone and ditzy voice. Kingsolver did pursue a cool idea though. She decided to try to eat a mostly local diet with her family for a year, and then write about it. This required first that she move from AZ to VA. Then she started a huge garden and even got some turkeys and chickens. 

The idea of eating local seems to provide a pretty tremendous environmental impact reduction, and not only because of transport. When people get food from people they know, there is direct feedback about how it is grown and how the land is used. People are then willing to pay more for a product that does not destroy the land. A close correlate to eating locally is eating seasonally. This requires re-learning many things about food storage, so that peppers from July and August can be safely eaten in February. This is exciting because my experiences of eating this way in Ukraine have left such a powerful impression on my food choices, and I will continue to make small changes toward eating and living in this way.

Even with all of the advantages of eating local, I have been unable to convince my roommate to give up bananas. This despite the monoculture approach, low wage labor, and huge transport costs. I guess in many respects we have become so accustomed to having food from all over the world regardless of the local season.

Beyond having geographic awareness food production, the level of processing is now clearly linked to the health status of everybody. The trend is simple: less processed = more healthy. Interestingly, choosing less processed foods often leads to more local foods.

Finally there was one small section that pretty persuasively argued against the use of GMO rice with vitamin A to solve the world blindness problems. The argument is that these areas need rice that can be re-planted, and not become slaves to a copyrighted genome that could be taken away in the future. It also argues that real solutions would improve the root cause of these nutritional deficiencies, which is poverty. Therefore local agricultural solutions, including the elimination of free trade agreements which saturate markets with super cheap staples, would allow local farmers to become part of the solution. Obviously this problem has many possible solutions, but I have begun to become convinced that simply dumping more free food, supplemented or not, is merely a patch, a lid perhaps, on the coming revolution.

The Unbearable Lightness of Being by Milan Kundera

Actually finished this book while I was in Bolivia in June

ironically and unfortunately appropriate for my travels

as I considered lightness and weight

and eternal recurrence

I began to read it again

and almost finished it for the second time by the end of July in Argentina

but not quite

but stuck in my mind

recurring as it were

are two particular phrases

"When the heart speaks, the mind finds it indecent to object."

Gears told me this on a run in May

and shortly thereafter got engaged

and then there is one particular phrase about music:

"While people are fairly young and the musical composition of their lives is still in its opening bars, they can go about writing it together and sharing motifs (the way Tomas and Sabina exchanged the motif of the bowler hat), but if they meet when they are older, like Franz and Sabina, their musical compositions are more or less complete, and every motif, every object, every word means something different to each of them."

This makes me wonder

about my friends who get married so young

and set about composing the opening motifs of their lives together

and about those who wait longer

already in the development section

many sharps or flats away from their home key

developing tension, reaching great heights

yet seeking resolution, tonality, and peace

assuming that sonata form can be applied to life

Return to medical school:

As my lack of blog updates indicate, the transition from South America to my introductory pharmacology course was rather abrupt and somewhat challenging. In fact I can't remember if I ever wrote a post about Chile. Since I'm already three weeks removed, I'll just give some general impressions as both my memories and Spanish skills fade away.

Viña del Mar reminded me of San Diego. If Argentina was first world, my first impression of Chile was that I was indeed back in the USofA. I again was lucky to find very kind hosts through CS and even had my own room in a high rise overlooking the Pacific. I explored a different direction each day on my runs and also enjoyed the large TV and cable coverage of the Olympics.

Valparaíso was really cool. Only. Few km down the coast from Viña, the modern high rises gave way to a Bohemian port city. A childhood of sailing novels came rushing back as I recalled how Valpo was a resupply stop for everyone from Cook to Slocum. Super hilly, but even more colorful. Each house seemed determined to outdo its neighbor with mural, fresco, or mosaic.

After three nights on the coast, it was time for Santiago. Definitely did not have enough time to get a good feel for this huge city, but I did go on a fascinating bike tour aimed at outlining the political divisions within Chilean society. It was a great review of the disgusting role that the CIA played in Pinochet's coup, but even more fascinating was how little has changed since Pinochet left office.

From Santiago it was a direct flight back to Toronto. Early Sunday arrival left me stranded a long way from the bus terminal, but some nice Albertians gave me a ride downtown. Then 5 hour bus ride back to Rochester.

Over the Andes into Chile

The tunnel at the top was really long

I took the opportunity to go to the bathroom in the back of the bus

we came out on the Chilean side just as I was walking back to my seat

no problem at customs, besides some raisins that I had

I decided to eat them all rather than throw them out

luckily I have intestines of iron after a summer of traveling

400grams of raisins does nothing

then 27 switchbacks down a very steep boulder field

super impressive that there used to be a railroad here

cool remnants of a covered track

though nowadays it doesn´t seem like it snows as much

the final 3 hours of the drive were a struggle to stay awake

warm afternoon sun and picturesque vinards in the Chilean central valley

the air gradually getting more humid as we approached the coast

smell more and more like San Diego

though temperatures like San Francisco

Viña del Mar reminds me of the Spanish coastline near Barcelona

I´ve decided to run a different direction for each of my four days here

On Thursday I´ll go to Santiago for my last two nights before returning to North America.

 

Last Week in the Hospital

For lack of memory about what I was going to post about
I´ll outline my day

0640 up to make and eat oatmeal
0725 out the door to catch the ¨trolley¨ which is an electrified bus. Runs on tires but has those antenae to pull down electricity from overhead wires.
I only have a 2 min walk to the bus stop, and the bus comes at the same time each day.
0735 get on the trolley but ask anyway to make sure it´s going to the hospital today. I once got on a clearly labelled bus without asking and it took me to a different place. I thought it was strange that the driver reached over to switch the sign not long after I got on.
0745 Arrive near the hospital, walk the final 200m up the hill while enjoying the predawn glow of east behind me.
0800 The meeting starts promptly to review difficult cases with all the residents and attendings.
0900 On some days there are different activities at 0900. On Wednesdays are generally M&M conferences and today´s was particularly interesting. It started with an overview of the case, clinical history, and pertinent lab values. Then there was a comprehensive review of the clinical decision making process. Finally, a resident from pathology presented the autopsy findings. Then everybody discussed the choices they made, and what they might do differently in the future.
1100 Mediamañana which means food and mate. Today was one of the attending´s birthday so there was cake for all.
1130 Rounds started, later than normal, so they went on past 1300. There is some of the quizing and challenging that you see on tv but not as much as I expected, or was lead to believe on my first day.
1330 Wonderful hospital lunch. You know how much I like these...
1430 collected my things and cought the bus back to the center to do two hours of Spanish hw.
1700 hour of internet to write this and finish up the honor board orientation powerpoint that I´ll help to present in less than two weeks.
1830 jog over to the big park to join the running club for a workout.
2100 home for dinner, more Spanish, then sleep before 2300

Interview Questions

Preguntas para médicos y enfermeros

Función:
Edad:

Pacient (iniciales):
Diagnóstico:

1. ¿Estaría dispuesto a compartir sus ideas sobre las decisiones clínicas en este caso?
2. ¿Hubo más de una alternativa de tratamiento en este caso? ¿Cuales?
3. ¿Qué rol tuvo en esta elección? ¿Qué grado de participación tuvo en la elección?

4. ¿Cómo se siente con respecto a la forma en que se tomó la decisión?
5. ¿Cómo ha afectado el costo de medicamentos y de exámenes complementaros la elección que hizo?
6. ¿Los resultados de la decisión terapéutica fueron satisfactorias tanto para la familia, el pacientes y los médicos? ¿Fué satisfactoria para alguno de estos en mayor medida?

Preguntas para pacientes y sus familias

Iniciales:
Edad:
Relación con el paciente:
1. ¿Estaría dispuesto a compartir sus experiencias sobre la relación con los médicos del hospital?
2. ¿Piensa que habían otras opciones de tratamiento? ¿Los médicos le informaron sobre otras opciones?
3. ¿Cuánta participación tuvo en la elección de tratamiento?
4. ¿Como se siente acerca de la forma en que se tomó la elección?
5. ¿Cómo ha afectado el costo de medicamentos y exámenes complementaros la elección que hizo?
6. ¿Esta satisfecho con el tratamiento realizado?

Tupungato and Uspallata

The last two weekends have involved social events on Saturdays, and solo bike adventures on Sundays.

The trip to Tupungato was poorly planned. Slept in late, ran, ate, then around noon decided to go.

Messed up the busses, and by the time I was on the rental bike, free on the road, the sun was setting beyond the vinyards over the Andes. Still got in 50km though and found some delicious raisins (since i didn´t have the ganas to drink or carry wine).

Uspallata however went much more smoothly. Caught the 0800 bus, rental bike headed up into the valley by 1100. Perfect sunshine, dark blue altitude sky, inca rock carvings, bouldering in another location, nap on top of a mountain. 11 miles downhill to end the day. I´ve got to figure out how to get this pictures off of my virus infected camera...

Olympiada

Last weekend, no, two weekends ago, I was invited by some 5th year medical students (they have six years here after HS) to attend their end of year camping trip. Since it is winter, it was going to be in a camp with cabins.

While it is impossible to describe the experience in detail without forgoing other equally valuable experiences, I wanted to share the essence of spirit that I understood.

A powerful generosity, willingness to share, patience to listen, and sense of community as this group of students so fluidly accepted me into their midst.

1600 they finished their exams for the semester, and we piled onto the minibuses (traficos)

1730 arrival

1830 tea

1930 fire

2030 icebreaker games

2130 wine and fernet

2230 start cooking asado

2330 dinner

0030 some students have a rock band

0230 hook up computer to start playing dance music

0500 I fold and go to bed while most continue dancing

1100 up and breakfast

1200 mountain hike

1700 parting words

what a weekend

Spanish Lessons

well it appears that during my month in Bolivia, I managed to claw my way back to where I should have been at the end of Spanish 101 at Haverford. My classes started this week and I´ve been labeled as B1 or ``threshold``. Certainly feels like a threshold. The threshold of being able to speak. But it´s good, i´m getting to the point where I can explain my way around any language barriers, and ask for clarification in spanish as needed. I have 90 minute lessons 5 days a week in the afternoons. Quite challenging as my natural inclination after lunch is to sleep. still not used to the 6 hour sleep nights. After class, I come home to run before homework before dinner before bed. But today, skipped the run to type some stuff up for my project and now I´m going over to a medstudent apartment for mexican tacos. I a group of 5 students who were rotating through the clinic in their last week before winter break. Now they are on winter vacation for two weeks, but like medstudents everywhere, vacation = studying for the next big exam.

Today started with the weekly literature review, which is like PBL without a timer. Presentations are supposed to be short but drag on and on without visual aids. My attention drifts after about 3 minutes. I´m scheduled to do a presentation on the 26th of July. Trying to decide between IUDs or 

Then rounds with one of the teams. One poor woman had metastasized breast cancer that had invaded her liver. Amazing to actually see the distended veins on her abdomen as the blood found a collateral route back to the heart. She is on a morphine drip with her husband at her side. Thankful that he was asked to leave the room while we examined her on rounds. There is no hope for life, but our team will strive for ultimate comfort and quality during her last days in our hospital. 

While listening to the lungs of a longtime smoker, I heard crackles for the first time in real life. Hard to remember the dire consequencees of pulmonary edema as the excitement about actually hearing a sign rushed through me. Also greatful that my repaired stethescope works well. The diaphragm is somewhere in the Buenos Aires airport as when my bag was searched, they didn´t close the pocket that had my disassembled stethescope. After searching in vain for a replacement here (they only have litman parts), I cut out the bottom of a yogurt container and attached it with a rubber band. I should take a picture. Everyone said ``look, an american, functional but without style``.

Okay, well 25 minutes after the time I was invited, i should probably think about leaving. It took me a while to get used to this alternate sense of time, but now that I´m used to it, it´s kind of nice. there is extra time built in everywhere for whatever you want, like updating your blog for instance. should have done spanish hw instead i´m afraid

vehicles

i´m collecting pictures

but never seem to have my camera cord when i get to a computer

i´ve really enjoyed observing the vehicles here

many familiar brands

but with small diesel engines

german buses 

and french sports cars

also some really nice motorcycles as july seems to be the only really cold month

tried to take the same bus home yesterday that I take to the hospital in the mornings, only to find myself in a neighboring town.

I had dosed off and the bus had changed numbers somewhere along the way!

I guess i´ll go back to asking about everything instead of trusting what I read

oh well, the upside was that I found a railroad along which I can potentially run out on the flat side of town

okay, back to spanish studies

should write a post about my project also

okay, all that and more coming soon

the best hospital food ever

literally

each morning I see the truck back in

piled high with farm products

carrots, potatoes, chickens

then about 7 hours later

when I go with the residents to eat lunch

amazing

baked chicken with carrot sauce and a side of polenta

roast beef with brocoli and a side of cheese ravioli

so many others but i´m getting hungry again just writing about it

obviously i´ve suspended my vegetarianism while eating as a guest

the food schedule has taken some adjustment

i have to eat breakfast before 0700 to catch my bus

lunch is at 1400 at the earliest

then dinner is not till 2200 or later

this means i´m not hungry for breakfast because i´m still digesting dinner

i feel full during my run in the evening

and then i´m nearly starving again by the time we finish making dinner after ten

all completely worth it though

this has got to be the best i´ve eaten since leaving Ukraine

I think i´ll quickly recover the weight that I lost during my week of diarrhea in Bolivia

other things i´ve seen that i´m trying to embed into my medical knowledge

A person with hemiparalysis caused by chagas disease. Chagas is a protazoa spread by the kissing bug. Memory key is Tom Cruise likes kissing = trypanosoma cruzi. Tom Cruise also has a fat neck = megaesophagus and talks a lot of poop (megacolon). Lesions are normally in the heart but this person had them in her brain. Immunosuppression caused by HIV was a contributing factor. She presented with delayed gastric emptying and gastritis.

Megaloblastic anemia case in an alcoholic where perniscious anemia was suspected but the labs were unavailable to confirm. The residents seemed to relish the challenge as they sat down to solve the case with the history and clinical signs that they had available while they waited for the blood work (autoantibodies to intrinsic factor and folic acid levels) to come back from the lab in a different hospital. The other suspect was chronic folic acid deficiency as a result of alcoholism.

Cobalamine = B12, necessary for DNA synthesis and many other reactions.

Sjogren´s syndrome is an autoimmune disease that attacks exocrine glands that make tears and saliva. Memory aid is stoic sweeds who never cry and have dry vaginas.

Arthritis associated with Crohn disease. I don´t really understand why this happens. More antigens get into the body, and somehow this makes the body more likely to react agaist itself...? How does this fit with the hygene hypothesis? Mr. Gears?

Lots of lupus. Inflammatory disease with antinuclear antibodies. That´s about all I know so far.

Pneumococcal vaccination adverse event in an adult. I refrained from mentioning at that moment that the vaccine had been developed at the University of Rochester.

Also interesting, a cellulitis rapidly diagnosed and for which were prescribed antibiotics. What is this mixed up with sometimes?

Mendoza morning rounds

vacation part of the summer over

project started yesterday

pretty intense, preview of third year

Spanish way over my head, but improving rapidly

hospital before 8 in time for morning rounds, where I seem to get a lot of questions becuase I don´t blend in well

seem to get a lot of them wrong or look stupid because I mix up my words when answering the question

like the three characteristics of graves disease which was tossed to the medical students this morning

I remembered hyperthyroidism, but got really tripped up trying to explain that the antibodies acted as receptor agonists on the TSH receptors. The other two are goiter and orbitopathy (Retroorbital fibroblasts secrete GAG in response to cytokines such as interferon gamma and TNF alpha secreted by TH1 cells). Yes, they use UptoDate...which I hop on in the residents lounge to answer the lists of questions that pile up in my notebook.

Ít ended up well though, next patient had an ulcer and I answered a question thrown out about how often antibiotics should be applied to the wound (only if infected because they kill healing skin cells) and the attending was impressed.

so yeah, super fun, great review, and the residents are really helpful and awesome

they said they´ll help me get my project done no problem

but that first I should come out dancing with them this weekend

so yeah, guess I should update my blog

but even more awesome

I saw my first natural birth yesterday

seeing the first breath of life and the baby go from blue to pink was amazing

I got goosebumps allover
couldn´t think at all when asked what APGAR stands for (appearance(color), pulse, grimmace (reflex), activity, respiration) 

or whether to suction mouth first or nose first (mouth).

Lots to learn, but it is all very relevant. Back to feeling like there are not enough hours in the day, not rushed or stressed, but pushing the pace nicely.

More to come later. Off to go find a modista or costurera to add some more pockets onto this white coat I bought down here.

besos

Arrival in Buenos Aires

$160 surprise reciprocity fee
ouch
another disadvantage to flying I guess

but immediately met with nice people
a lady on the bus offered to pay for my trip to the center with her
fare card, since i didn{t have any metal money.

then when i got off the bus, a gentleman helped me find the best place

to buy a SIM card and waited while I installed it to make sure it
worked.

Then the bus driver of the second bus made sure I got off at the right
corner and told me which way to walk

then I have the most amazing host from couchsurfing, a pretty cool use
of social networking. He{s a second year medical student who loves
soccer. I just try to be the ideal guest, cooking, cleaning and
staying out of the way of his pharmacology studies.

and today, first full day in Buenos Aires, absolutely wonderful.
slept in, first run in a week through giant parks with giant statues
what strikes me the most about the city is how well everyone dresses
it definitely makes people more attractive, as much as i hate to admitt it
people take pride in their appearance here and it shows
i{ll need to upgrade my wardrobe for sure

there is also some Paris flavor
lots of dog poop and sidewalks that smell like pee
but also wonderful bakeries and ice cream shoppes
flower ladies, bocci grampas, chess parks, and so many monuments

after enjoying my first warm shower in a month
the weather here is ideal. 60s in the day, low 50s at night. I{m sure
it{s too warm for me during the summer, though maybe not?
I stopped by the Argentine AAA to get a road map
so that I can follow along on my bus journey tomorrow (BA -- Mendoza)

joined a Spanish tour of an amazing little cemetary
Could understand most of the stories, but some key words went over my head.

stopped into a whole in the wall where the afterwork croud was
enjoying 40oz beers, and convinced them to change the channel to the
Spain Portugal game. Initially there was resistance because they were
watching a division II Argentine game, and so we were flipping back
and forth between both games. But then some more of their friends came
in who were more excited about Spain than Chicagolitos, and I got to
watch the whole second half, OT and the shootout. Espana! they
deserved to win for sure. hoping for Espana Alamania final.

tomorrow I{ll by my bus ticket and find some more varieties of dulce
de leche. tried the ice cream and the candy but would love to try the
pure stuff, on bread I guess.

Happy Birthday Brother Silas!

My host took me out to one of his soccer games, and I had a very poor
showing. Legs absolutely flat after my first run in a week this
morning. Also not used to the style of play, always pushing forward,
lots of dribbling. Got megged at least twice. My pride is wounded and
I felt bad representing the entire USA. Hopefully I{ll get a chance
for redemption in Mendoza. I{ve got to show them that we really can
play futbol.

then I made them fajitas with zuchini
I get super hungry by the 10pm dinner time
think I had 8 fajitas...

Last week in Riberalta and South Bound

after realizing that the best way to travel this land is motorcycle
(I{m serious dad, we{ve got to do SA on bikes)
i postponed my lovely dusty 6 day sprint bus trip from northern
Bolivia to Mendoza, and bought an airline ticket from Santa Cruz,
Bolivia, to Buenos Aires, Argentina. this route still required two
overnight bus trips, but will give me an extra 2 days in Mendoza plus
2 days to explore Buenos Aires. All this justification because i feel
like a wimp for skipping out on the land journey.

Last week in Riberalta was a blur. Diarrhea cleared up with Cipro,
thanks everyone for the advice. A couple more trips out to my host
family{s ranches, including a day of vaccinating cattle. I will miss
the people, but the heat and dust and mosquitos can stay up there
while I head down to winter.

First leg to Trinidad was smooth, but then the buses were all leaving
early from there due to rumors of protest bloqueados along the road to
Santa Cruz. So I caught the latest bus I could, which was only at 5pm.
Of course there were no problems, so I arrive in the largest city in
Bolivia with nowhere to stay at 1am. With no other ideas, decide to
call my couchsurfing host for the following night and see if she was
still awake. Luckly, Brazilians dont seem to go to bed early, and upon
arriving at the compound of Brazilian students, it was apparent that
nobody was close to going to bed at 2am. They were all in Santa Cruz
because the tuition is much lower than in Brazil. Mostly medical
students, but also pilot students, graphic design and some others.

I was the first to bed at 3am, and the first up at 9. Then off to
explore Santa Cruz. Really charming center for such a large city. I{ll
try to post some pictures once I get to Mendoza.

The next day I left the Brazilians having made some new friends, and
headed out to the main road. Turns out none of the buses going to the
airport would make any stops. they were all express. So I got on a bus
headed the right direction, and got off as close as possible to the
airport. This left a two mile walk, and despite the many offers from
passing taxis, I had time, so I enjoyed a bit of exercise. Palm trees
and warm breezes reminded me of Hawaii.

Before I knew it, I was on a plane to Buenos Aires. Month in Bolivia
went really fast.
Not fully processed yet.

My first sunburn in Bolivia

How did a readhead forget his sunscreen?
Well I woke up with diarrea for the third time in three weeks (more
about this later). After cancelling my ride to 0600 soccer practice, I
went back to sleep till 0800. I woke up to a bustle of activity. I
decided that I needed to get out of the house despite my GI
difficulties, and packed up my bag to go to the library. As I was
walking out, I realized that my host dad and some friends were headed

out to the ranch with the swimming hole. They asked if I wanted to
come. Host dad said he was worried that my stomach would get bad on
the drive or while we were out in on the range, but if I wanted to
come I could. I said that´s okay, I´ll sit this one out. They drove
off and I immediately changed my mind. So I ran out after them but
they were too far down the street to hear me. So I flagged a mototaxi
and said "catch that truck'' in completely unconjugated Spanish. He
seemed to understand, but we couldn´t make up any distance with our
5hp motor. Eventually they slowed for a corner and we cought up.
Everyone had a good laugh at my indecisiveness.

Now the diarrea. What gives? My wáter is filtered, then zapped with
UV. My food is the same as everyone elses. So why do I get sick and
nobody else does? I've managed to stay hydradated during each 24 hour
stint, so it´s more inconvenience than anything else. But it does put
me in a poor mood when I can´t exercise (no bathroom at the soccer
field and no good places to stop on my running routes). Oh well, I
can´t say that germ theory carries much weight here. I was handed a
knife straight from cutting raw chicken with which I was supposed to
cut up some oranges. I decided to wash it first, but of course I
washed it with river wáter which was probably more dirty than the
chicken. Small things like this are why I keep getting sick.
Advantages to host family are the language opportunities. The
disadvantages are giving up all control of diet and privacy. Worth it?
Yes.

On the way back from the ranch, I got in the truck and put on my
seatbelt out of habit. There was a 10 yr old kid next to me and after
studying me for about 2 minutes, he decided toput on his seatbelt as
well. Point.

-----------------------------------------------------------------------

Post from June 16, 2012
I´ve been going to 0600 soccer practices and then I got invited to
play in their game on Sunday, but today I woke up with Diarrhea for
the second time in three weeks. I´ve got to stop accepting everything
that is offered to me. Im pretty sure it was this weird green drink
made with sugar cane that got me, probably made with unboiled water,
offered to me by my Spanish teacher´s mother. It´s poor form to turn
down gifts, but it also sucks to spend a whole day feeling crappy.

Why is it called toilet paper

if you can´t put it in the toilet?

Last night
after tucking in the mosquito net all around my bed
I realized that I had forgotten to set my phone alarm
which was charging across the room

I decided that I hadn´t had any problems with my watch alarm yet, so I could just trust the one
but my intuition knew
all night I tossed and turned because I only had one alarm set
and I had been invited to soccer practice with a local team at 0600
and of course, it turns out I should have set two
because somehow during the night
I reset my watch to east coast time
and I wake up to my new friend sticking his head through the window
and admonishing me for being asleep
we were already 7 minutes late for the 0600 soccer practice
super embarrassed, I rushed into the bathroom to put in my contacts etc
yet somehow spaced out putting the toilet paper into into the bin next to the toilet
I realized my error just after the last wipe
and contemplated reaching in to correct my error, before deciding that just this once couldn´t hurt
besides, every second was making us later
luckily, it all flushed (not even sure what the reason is behind the practice)
and besides
it´s that super brown triple recycled toilet paper that practically disintegrates in humid air

turns out it was full sided scrimmage day
and because we were late
we were both subs
my buddy didn´t even get into the game
because he had to go to work at 0730
I feel super bad

I did eventually get out onto the field, as one of the central defenders
playing in old running shoes
on a field covered with dawn dew
I made some silly errors
but I also prevented at least two goals
and they didn´t score while I was on the field
so they invited me back for tomorrow
I´ll probably set 3 alarms just to be safe
I just hope these shoes hold together for another week
after surviving 500 miles and one rough snow shoe race
theyre tearing on both sides, and soccer puts a lot of torque on them
would by another pair, but...

running short on cash after buying an airline ticket to Buenos Aires
decided the six days that I would have been on buses between here and Mendoza can be better utilized in preparation for my research in Mendoza. It will be good to find a host family and get oriented a few days before I start at the hospital. I´ll save the land journey for another time. Perhaps by motorcycle dad?

Speaking of motos
I´ve gotten a lot more comfortable as a passenger, as with the increasing heat, I´ve opted more often to take a mototaxi than walk when I need to get accross town. Yesterday, I piled on one along with half of my host family. Never thought that 5 people could fit on an 8hp moto...

Riberalta 2 two

My running options are a balance between dust and dogs. The roads with
lots of traffic have dogs that dont bother to get up when I go running
by, but I end up inhaling tons of dust and exhaust. On the other hand,
nice quiet roads have dogs lying where youd least expect, waiting for
something to chase and bark at. Now that Im familiar with the

mortality rate for rabbies, I think Ill stick to the dust and fumes.
Its not that much at 6am anyway.

I have yet to find a hill, so occasionally Ill do some intervals
between telephone poles. When I get back to my host familys compound,
I stretch out and do core work in and around the stockyard of giant
cement pipes. I practice my new Spanish words in an Arnold
Schwarzenegger accent while doing pushups. This makes me feel much
tougher than I am.

I already explained a bit about the meatyness of my diet, but there
are some other food groups. Among the vegetables of note is yucca
root, though as a health care worker, I dont think it qualifies as a
vegatable. It reminds me of potato, and it is often put into soups.
Fruits really outnumber veggies here, and I can only name about half
of all that Ive tried.

I arranged Spanish lessons with a local high school teacher. She
teaches vocational skills in the school here, and Im working on
replicating the system that we used in Peace Corps language school.
Its been difficult without such quality materials though. Most
language materials are based on reading and writing, and the PCs was
specifically based on speaking and understanding. I can only remember
about half of the cool exercises that we would do. Its been difficult
to teach these exercises to my teacher in a language that I barely
speak. As in Ukraine though, many of my largest breakthroughs are
coming outside of the classroom, with the abuelitas in the markets,
the moto taxi drivers, and the kids I live with.

As for the soccer, Im super happy for Ukraine/////
They beat Sweden today, barely, and I cheered them all the way.
However, I think that FIFA needs to crack down on faking injuries by
making the actors stay off for at least 5 minutes if they go down with
an injury, real or imagined.
In this respect Ukraine was embarrasing. I recognized much of the
latino attitude toward soccer, in that contact equals fall equals
foul. The France vs. England game demonstrated soccer on a higher
level and also showed that it is a real contact sport. Not every fall
was called yet the ref did a great job keeping things under control.

Back to mototaxis. Theyre everywhere. Thats all. Im sure Ill remember
what I was going to write about as soon as I leave this cafe.

Riberalta 2

Yes, I did recover my backpack from the airline office downtown upon
my arrival, and yes, my GI is functioning normally again.

My days have settled into a nice pattern of dawn run, meaty breakfast,

Spanish lesson, Eurocup, Spanish homework, meaty dinner, tv, sleep.
Not only have I abandoned vegetarianism for the summer, I can´t even
remember a single meal since I arrived in Riberalta last week that
didn´t have some meet in it. Oddly enough, my newly gained anatomical
knowledge has come in quite handy, and makes eating various organs
less disgusting somehow. I will say that I am not a fan of tripa or
pansa (cow small intestine and stomach) though I did manage to finish
what was served to me.

Well internet time is up. Off to watch France in the cup!

Getting to Riberalta, Bolivia

well my arrival was as choppy as this dust caked keyboard

I´ve been systematically eliminating each internet cafe due to extremely sticky keyboards.. I don´t think they´ve ever been typed on. The only three keys that are loose are the ones used to play the first person shooter games that are taking over the world.

So the plan seemed simple. Chinese turboprop from Cochabamba to Riberalta over 800+ miles of forests. The flight stopped in Trinidad, as planned, and I hung my head out the door to feel warm rain. There was an ancient DC-3 on the side of the tarmac and the rusting skeleton of a crashed Boeing 727 flashed by beneath us about a half mile from the runway.

The next place we landed looked like Riberalta. There was a large river, small town and lots of jungle, so I got of the plane, watched my bag being taken off the plane, and then stood on the side of the grass field waiting to be allowed to go pick my bag up after the drug dogs went through it. In the mean time, the plane I had arrived on, one of only two flights per week, took off. Finally we were waved over to pick up our bags. Mine was gone! I showed them my baggage tag and everyone started laughing. My baggage tag said Riberalta, and this was Guameryn, they explained. Not too bad, I thought, because I had everything essential in my carry on, but I sure don´t want to loose my backpack. I started to ask about a place to stay while waiting the 3 days for the next flight, but they laughed again and explained that Riberalta was only 60km from Guameryn. So I went to the autostop (where people go to fill their cars with passengers), and completed the last part of my trip by car. Cost an extra 70Bolivianos which is about $10. A tax for not asking the most simple question I guess. It was especially funny to my host family when I retold the story later that night. Good practice laughing at myself anyway.

Gastrointestinal acclimatization

I just got through the obligatory day of diarrhea that occurs when you stop being super uptight about eating only cooked things. Think it was a tomato that got me, washed, but washed with unboiled water. 

Spanish is easier than Ukrainian in terms of structure, but still requires that I memorize a large number of words. Definitely frustrating when I stumble upon an impasse created by my lack of vocabulary and hear at least 4 different ways of saying what I need to say in Ukrainian. Long ways to fluency.

Got a ticket into the Amazon basin for tomorrow. Let's hope that this mefloquine does what it's supposed to. Other than that, Bolivia is absolutely beautiful. Amazing mountains, altiplano and I'll let you know about the jungle.

Time to make some chicken soup!

Cochabamba Tour, 1 June, 2012

"Don't say your're from America", he warned, "some people will take that as arrogant because we're all from America". I remembered hearing this one other time, perhaps when going through customs on my way into France. The point is well taken, as I'm sure a South African can't simply claim all of Africa as his nationality. Still, it's really stuck in my head since Ukrainians never say spoluscheni shtatakh ameriki, it's just too long and difficult to pronounce, even if you are Ukrainian. But I'll work on changing my ways. I think E.U. will work, even though in my head, I just think of the European Union.

My time line is starting to sort itself out. I'll go ahead and splurge on a $100 flight up to Riberalta this Tuesday, since I have all of my stuff, some presents for N's family, and a care package from V to get up there. It's amazing that the bus would take more than two days while the plane takes less than two hours including a stop. I guess there really are many mountains and rainforests in the way. I'm excited for the flight. Hope I get a window seat.

Explored more of Cochabamba today. High points included fresh squeezed orange juice, 1400 stairs up to a giant statue of Christ, and a tour bus trip where I understood at least enough to turn my head the same way as everyone else…

Bus from La Paz to Cochabamba, May 30, 2012

After my huge night of sleep, I decided to have a more relaxing day. Went down for the continental breakfast (which was amazing with fresh milk and papaya), and then back to my room to look up some words that I really need to know. I've also decided that I need to quickly get a beginner's grasp preterite, present indicative, and future indicative so that I can express myself effectively.

The bus ride was wonderful. Things that happened in incomplete sentences include:

-bus broke down

-neighbor is first grade teacher and used baby Spanish to tell me about her family and her son's medical education.

-stopped at roadside pension and had an amazing bowl of soup.

-went downhill for 50km on a road that my dad would love to take his car on

-arrived in Cochabamba just at sunset and was met by an amazing amount of generosity. 

It appears that V is staying with a neighbor while I am here. I am left feeling slightly guilty as I can't figure out a way to repay all of this kindness. The only thing that I can think to do is take a package up to Riberalta for V's brother. And help V dig a compost pit. And maybe clean the house while she's at work. Actually, I'm sure the reason she moved out of her house is probably complicated and culturally motivated, but I know that I must accept before I seek to understand.

So now I've got to decide where it makes more sense to study Spanish. Here in Cochabamba there are some Spanish schools which are used to teaching foreigners. Up in Riberalta I would be mostly on my own. There are advantages to both. Also, having seen the quality of the roads and landscape, I am less excited to take a bus at the end of June all the way from the northern side of Bolivia to my project site in Mendoza, Argentina. Next time I have internet (which is when I'll post this), I'll investigate a few other modes of transport. Rivers are navigable in the north, and there are trains in the south, so I may be able to get to the Argentine border without a bus. The Argentine roads are supposed to be pretty good. Primero, Castellano...

La Paz

the closer the airplane was to landing in La Paz, the friendlier everyone got
people love coming home

0330 arrival left me wondering what I was going to do till the buses started running, but an Israeli woman offered to share her cab to the hostel where she had made reservations. seems some people plan things more carefully...

set my watch alarm to get 3 hours of sleep, not wanting to miss too much of my first day
woke up to an amazing view of a city oddly reminiscent of Tbilisi
steep slopes, mountains in the distance, suffocating traffic, entrepreneurship everywhere

once I embarked on my first mission (buy SIM card for cell phone)
I started seeing even more parallels to Ukraine and Georgia
Lada automobiles, cobbled streets, few traffic laws, minibuses where other passengers pass your money up from the back and then pass your change back to you.

I would say that there are a few more smiles than I am used to
perhaps due to the consistently sunny weather
and an abundant harvest of avacados, mangos, papaya and other things I have yet to identify


A friend from a Quaker foundation was kind enough to show me some sights in the afternoon, but once the sun set, I crashed and slept for 11+ hours. Have been trying to remember all of the adjustments that my body must be making for the altitude, but whatever they are, I´m sure that lots of sleep will help.

Off to find the bus station and a bus to Cochabamba!

A Place to Stand by Jimmy Santiago Baca

Perhaps the last book in English that I read for a while.

A wonderfully written account of Jimmy's triumph over a broken prison system.

A bit depressing, but like music in a minor key, somewhat more powerful than "happy" books.

Had my last exam of the year this morning.

Hope I passed all of them.

Packing this evening.

Philly tomorrow for reunion at HC.

Monday morning flight to La Paz.

Getting excited.

Things I learned from an alcoholic adult patient

Always ask if my patient would consider a trial of abstinence.
Also offer to set up an appointment with an alcohol specialist or family counselor.

Also important to fully explore the family and social context of my patient's drinking.

Things I learned from an adolescent patient

I should avoid conversation until I've finished washing my hands, and can turn and make eye contact with my patient.

If I need to take any notes, be clear whether or not my patient is supposed to see what I am writing. In general, try to refer less to notes.

Memorize the HEEADSSS adolescent screening outline to make sure that I don't miss any key areas.
- Home
- Education/Employment
- Eating/ Exercise
- Activities + Relationships
- Drugs, Cigarettes, Alcohol
- Sexuality
- Suicide
- Safety (+spirituality?)

Address confidentiality before asking about relationships and drugs. Then make those conversations as concise as possible, with many open ended questions, allowing my patient to take them as far as she wants.

Eat, Love, Pray by Elizabeth Gilbert

A bit of a lighter book. Very clear tone and well articulated. Got me to think a lot about the place of mindfulness in western culture. How much of life should be spend pursuing comfort and pleasure and how much needs to be focused on developing wisdom? I tend to agree that I learn most from situations in life that are often least comfortable. Also finished this book a few months ago, but just now getting to the blog post. 

Over the weekend, paced a friend to a PR in the Rochester City Half Marathon. Made me want to get in shape to actually race one. This morning I'm up early to study Spanish. Haven't managed to get through this introductory textbook yet, but I really want to keep chugging until the day I leave (27 days from now!).

The God of Small Things by Arundhati Roy

I'm writing this book up over three months after I finished reading it.
It did not stick with me the way that many other books that I've read have, and therefore I think I may have missed some of the beauty or art inherent in the author's creation. For some reason it simply did not resonate with me.

It also may have been the setting in which I read the book, often while falling asleep. I used it to separate myself from the pressures of my day and allow my mind to settle before sleep each night.

The incest that occurs near the end of the book surprised me, and left me thinking more about how so many cultures have developed taboos against incest. The actual level of inbreeding necessary to perpetuate genetic abnormalities is pretty high, needing to "self-cross" multiple generations sequentially. How did we develop such an aversion?

A day in the life

Well I'll just tell you about today (while I sit in a rather dry lecture about how health prevention guidelines are made)

0645 wake up and get some breakfast
0730 meeting with 3 other classmates about the 5k race that we're organizing. Race on April 14th so getting down to crunch time.
0800 lecture on immunology and how our body defends itself from bacteria with flagellum.
0900, another lecture, which I've forgotten at the moment.
1000 out for a run in the beautiful sun along the Genessee river.
1100 library for studying
1200 honor board teaching session where I proposed bringing the honor code back into the hands of the students. It's so much easier to prevent change than make change.
1300 lecture on breast cancer
1400 lecture on colon cancer
1500 lecture on preventative services (that i'm sitting in now)
hope to be out by 1630
then I'll play violin with E (we're working on Prokofiev)
1830 will call Bolivia to arrange my host family for the first half of the summer
1900 will go volunteer with a dr. and two other students to provide health screenings at a local homeless clinic.
2100 home and eat dinner.
Then study a bit of spanish, do a little cleanup and go to bed.

Not sure if it's a typical day, but certainly not boring

RETHINKING SUBCULTURAL RESISTANCE Core Values of the Straight Edge Movement by ROSS HAENFLER University of Colorado–Boulder

What does it mean to resist?

I thought this was fascinating.
So many of my heroes achieved great things through civil disobedience and nonviolent resistance to the status quo.
How many times can you turn this around?
Is it bad to resist certain things simply to protest?
Is resisting desire (for instant gratification) the root of all success?

Just finished biochemistry/genetics for the year.
Was a very humbling final exam that made me aware of the limits of my memory.

No to tackle a very long to-do list before I head SE for some biking.
Springtime is here!

babies and differentiation

Neonatology.

The study of neonates.

Neonates = very small babies, newly born.

Four of us visited the acute care unit

and had the privilege of being taught how to examine a very small baby

his femur was the same length as my index finger

magical life

how do cells do that?

that's my job to describe actually

on genetics/biochemistry final this friday...

Where did winter go?

I have been horrible at keeping this blog up to date. It's not because there's not enough to write about, but rather because it has not become part of my routine and the demands on my time tend to eliminate anything that is not part of a routine.

Today I'm attempting to get my bike back in working order after perhaps waiting too long to replace the chain. Put a new chain on last week, and now it's skipping when I try to go up hills. Luckily we have a wonderful community bike shop in town staffed by volunteers. Just find the parts and they'll help you keep your transportation in working order. And that's just what they've done! The bike is ready to go. Now will go spend the rest of the day in the library before heading out to see an Amerks game this evening.

Assumptions vs. Directed Questions

It was the first day in PM&R and my partner and I were assigned to interview and examine a 30 yo male. Let's call him Leroy. Right away upon entering the room, we started trying to piece together what was going on, because it seemed odd to us that somebody only 30 should have had a stroke. The interview went rather well, and we both felt that we had obtained a complete history Leroy.

The interview was however, remarkable for how many times my partner and I were surprised by our patients answers to our questions. In fact, the answers surprised us so much in some cases that there were seconds of awkward silence because the question had been framed in a manner that anticipated an answer other than what we got. This was embarrassing at times, but more importantly, it could have easily led to misunderstandings or complete omissions because a patient might feel it's easier to just give an answer that is more expected by the way that a question was asked.

The first one came when we asked about where Leroy had gone to school. I think our question was "when did you finish school?". Now I know it seems obvious that the question is loaded with assumptions, but we slipped over this first hurdle easily. "2003". Quick math. Wow, seems that it took Leroy a while to finish school. "Where did you go?". Leroy- "Arkansas State". Oops, apparently Leroy finished college, and played DI football while majoring in business. Why did that surprise us so much? Perhaps it was the fact that Leroy is unemployed, obese, and African American. How much did we stereotype and then ask questions that fit the stereotype but not reality?

Our next line of questioning was about Leroy's family. "Do you live with anyone?" Leroy - "my cousin and his friend". Do you have a partner, male or female? Leroy - "yes, my girlfriend lives across town with three children". Now for some reason, we both assumed that perhaps they were not his children, but kids from an earlier partner. Then we asked some more about how he got along with his girlfriend's kids. Leroy -"They're my kids". We both paused. Why was this so surprising? How had we made so many assumptions?

We both felt confused after the encounter. We are supposed to use everything in the room to give us hints about who our patient is and what ails him. Yet here every clue we had lead us astray. Perhaps we simply forgot about pre-test odds, and they idea that a hint does not guarantee a corresponding etiology. The solution is obvious: assume nothing. Yet is this possible? Is there enough time to ask about everything without using your other senses to make assumptions and apply reasonable judgements?

The answers to these questions may become clear with more clinical experience. For now, we have decided to apply the lessons of cultural sensitivity more carefully. Mindful listening only works well with mindful questioning.