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Back in 2013 I wrote a post about an accident I had with a horse which resulted in two broken metatarsals (the long bones in your foot). That post was about how healing takes time, and indeed, my foot did heal with time and patience.

Alas, it’s time to remind myself, again, that healing takes time…

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Goofing around on that fateful day…

A few weeks ago I was out mountain biking with a friend. The irony of the story is that while we pushed ourselves to try out some new skills and sessioned a jump for a while, it was the relatively tame trail back to the car that had me hit the dirt. I can’t tell you what happened (I didn’t hit my head, thank goodness, I just have no idea what happened!) but as my hip and fist collided with the packed earth I was acutely aware that I’d broken something in my hand. In fact, my first words were “I’ve broken my hand” (repeated 3-4 times).

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My X-rays from 2013 needed arrows for emphasis. No arrows needed here: Spiral fracture of the 5th metacarpal and fracture at the base of the proximal 4th phalynx.

The doctor who saw me in the local Urgent Care was confident that I could continue working with my injury. Sure- I couldn’t suture or do some specific physical exam maneuvers, but otherwise I shouldn’t be too limited; at least that’s what he thought. Looking back on it, it wasn’t a smart decision to work with a bulky splint on my freshly-broken dominant hand. Yes, my brain was fully functional, but I could only examine patients using one hand, could only type with one hand, and had to use my left hand to use the mouse and navigate my computer (a task that required a surprising amount of focus- I couldn’t “drive” my computer and listen to a patient at the same time). Despite adding in some extra breaks and a brief stint having a nurse work in parallel with me it became obvious that I couldn’t carry on with work as usual.

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When my patients saw me in this they often said “It looks like you need a doctor more than I do!”. Another classic was “You’ve been in the wars!”. 

While I’ve working in the New Zealand medical sector for just over a year, this has been my first experience as a patient.

In my last post I wrote a bit about the healthcare system in New Zealand, but I didn’t mention how it’s all paid for and provided. I am no expert on the NZ health system, and the whole system is certainly more complex that I could (or should) spell out in a blog post, but the core organizations are the DHB (the district health board) which uses government funds to provide health care, ACC (the Accident Compensation Corporation) which is New Zealand’s Universal no-fault accident insurance scheme, and some private coverage (either paid out of pocket by patients or by optional additional health insurance).

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The DHB pays for medical care which is needed as a result of illness while ACC pays for medical care (and more) that is needed as a result of injury. The DHB only covers healthcare for citizens and those with working visas 2-years in duration, so if you are travelling (or working in NZ for less than 2 years) and become unwell you are financially responsible for your own medical expenses. ACC, however, covers everyone in New Zealand. If you are travelling in New Zealand and injure yourself you have access to healthcare through ACC. You may have to pay co-pays (For example $35+ for a GP or urgent care visit, $45 for an X-ray, and $20+ for physio visits), but if you have a massive accident requiring a helicopter ride and a prolonged ICU stay, you won’t get a bill…

ACC doesn’t just cover medical expenses, it also functions as disability insurance. If you can’t go to work due to an injury, they will compensate you at a rate of 80% of your normal income after one week. If you can go back to work part time they will help subsidize your until you are recovered and back to full time work. They have return-to-work programs, and try to get people back into the workforce in whatever capacity and quantity they are able.

ACC helps with other things: if you can’t drive they can provide taxis, if you can’t keep up with your daily tasks they get you in home help, if you need physio and strengthening they subsidize therapies and gym memberships, if you need counseling they cover that.

Essentially, ACC is a massive, national, accident insurance policy that is paid for by levies placed on employers, workers, and vehicles. Does the system have flaws? Certainly, what system doesn’t? There are people who defraud the system, and people will complain about declined coverage, but as a clinician and now a client I am very impressed with the system.

The day after my injury I was seen at urgent care where I paid $120NZD to be seen (this would be much less if I had a 2-year visa and was thus entitled to healthcare in NZ) and $45 for an X-ray. I then had a splint put on and a week later went back in for repeat X-rays, evaluation, and a more permanent splint at no additional cost. I’ve since seen the hand therapist and visited a physio twice because of a pain in my hip that wasn’t settling with time- both with a reasonable co-pay. I worked for a week with my initial injury, but came to realize that I wasn’t able to doctor one handed and in a splint, so after talking with my boss it was decided that I’d be off work while I was in my current splint and limited to the use of my non-dominant hand. ACC promptly recognized my claim and called me to see if I needed help getting to appointments, help around the home, and what was appropriate compensation while I couldn’t work (information based on last year’s tax return). Thinking about what my ACC levy was last year and what it’s likely to be this year I suspect I’ll get about as much out of ACC as I put in. I’d be very happy if I hadn’t had to use their services, but I’m incredibly glad that a national accident insurance exists in NZ*.

I’ve extended my time in New Zealand through March but plan to return to the United States to work and live after that. As I start to mentally prepare myself to return to the US and think about working in a for-profit healthcare system, I find myself already missing the public health system in NZ.

5 years ago, when I broke my foot, even though I had medical insurance I ended up owing over $2000 out of pocket for a single, simple, medical encounter.

For one medical encounter where I was evaluated, X-rayed and given a walking boot and crutches the total bill was well over $5000USD. The old orthopedist who walked in and said “Doctor, heal thyself!” sent a bill for $2479, including global billing codes for evaluation and treatment of 2 fractured metatarsals (at $1027 a pop, or perhaps I should say a hair-line crack), despite needing no treatment other than protection in a medical walking-boot. My foot healed with time, and my hand will heal with time, but it is high-time that the US figures out how to provide affordable healthcare for its people.

(*This also has huge implications in “Treatment Injuries” and physicians are not sued for huge sums as they are in the US in the case of adverse outcomes, but that is more than I care to go into today!)

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My dad writes good get-well cards…

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Bell Birds Sing,

Are you listening?

Tuis ring,

Did you miss them?

The Sandflies may bite,

But the evenings are light,

Walking in a Kiwi Wonderland.

 

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Cathedral Gully on Christmas Day.

 

Merry Christmas!

 

The last three years in Utah we’ve had snowy Christmases (and they’ve had another this year!). Christmas in New Zealand this year was sunny and hot. With Jamie and Anastasia of AHSNZ I just spent a couple days in Kaikoura, a beautiful coastal town north of Christchurch. Kaikoura (Maori translation ‘Meal of Crayfish’), was struck by an Earthquake just over a year ago, and the main road that connects Kaikoura to Christchurch was only recently reopened.

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“Meal of Crayfish”

Kaikoura is a gem, with activities including scuba diving, fishing, whale watching flights and cruises, and opportunities to swim with dolphins or explore the coast on foot. We spent a great couple days camping, tramping (that’s hiking to many of your), kayaking, and wildlife spotting.

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Kayaking to visit one of the Seal colonies.

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Wildlife spotting: a Shag in the foreground and a Fur Seal in the background. Not pictured: the huge pod of Hector Dolphins we saw on our drive out of town.

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Tramping in the bush.

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The seabed rose up with the recent earthquake

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Exploring the raised seabed

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Not exactly roughing it- a delicious camp breakfast!

 

It’s not wintery, but New Zealand certainly is a wonderland…

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The beach at our campsite: a nice place for an evening drip after a hot day!

 

I’m not the first to rethink this Christmas classic. This Air New Zealand take is ‘Sweet As’.

 

 

I hope you all find some joy and fulfillment this holiday season, whatever season it is where you life!

 

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Post-Residency Update

5 months ago I finished my residency training in Family Medicine at the University of Utah in Salt Lake City. During my three years of residency training I posted to this blog three times- mea culpa! There definitely wasn’t a lack of things to write about in residency- and I regret not jotting down notes of stories to recount or emotions to unpack- but sadly my urge to write during residency faltered and was replaced with an urge to… survive.

 

Residency is hard. It’s wonderful, amazing, at times exhilarating and at times demoralizing, and it is definitely hard. There’s a reason people have written books (fact and fiction) about residency, and sadly there are also reasons why there is a deluge of mental health problems in residents [1-2]… I hope I’ll get back to writing about some of my experiences soon, but only time will tell!

 

In the 5 months since finishing residency I’ve done a lot! Historically, residency ends June 30th (or more precisely STARTS July 1st, so you finish X years later), and a few days into July I was winging off to Japan with my boyfriend to explore Japan. The motivation to visit Japan was the promise of a bike tour around Hokkaido, the northernmost island in Japan. For over a decade my brother has taken time every summer to tour Hokkaido by bike, and thanks to various academic obligations I’ve never been able to join him – until this year.

 

I’ll try and flesh out this adventure at some point in the future, but to cut a long story short, we biked and ate our way around 900km of Hokkaido in 10 days. It was exhausting (and as expected somewhat uncomfortable at times), but it was a wonderful adventure. We visited a historic soba house, took a tram up a mountain, visited a lavender farm, tasted expensive (and delicious) melons, feasted on delicious food, and ate more ice-cream than is probably reasonable…

 

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My trusty steed for our 900K adventure.

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Part way through a 76K day along the northern coast of Hokkaido.

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Quite a bit of our cycling was on nice bike paths.

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Stunning flower farm in Bie.

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One of our many traditional dinners.

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One of many not-traditional icecreams. Lavender flavored at the Lavender farm, of course!

 

In August I invited myself up to Canada to spend time with my friend and fellow ancestrally-minded MD, Don Wilson. He graciously put me up in Calgary, Vancouver Island, and his home reservation of Bella Bella. Not only did I get to tour Calgary, visit Banff, and see Vancouver Island, but I got to drive up to Port Hardy and take the ferry up to Bella Bella where I got to experience a bit of rez-life and the wonderful hospitality (and traditional foods) of the Heiltsuk people. The experience, and the wildlife, were incredibly memorable.

 

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Don and I enjoyed a great hike up Sulphur Mountain in Banff.

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They were all over in Bella Bella.

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I had the privilege of being invited out salmon fishing with a couple of the locals and helped the pull in hundreds of pounds of Silver, Chum, and Coho Salmon that was eaten, frozen, and smoked. Yum!

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“Old Sam” or “The Watcher”. Whatever you call him, he is striking. The men who took my out fishing also brought me to this island for a visit.

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Great Blue Heron

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A reason not to hike alone… This bear was out with her two cubs.

 

In September I took some time to travel back to New Jersey where I caught up with friends and family. I have loved my 3+ years in Utah, and think there’s a good chance I’ll be back in the Bee Hive State in the future, but New Jersey will always hold a place in my heart and may one day call me home.

 

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Cow and calf at my parents farm.

 

In between all these trips I would head back to Utah, a state which I love to call home. I have never regretted my choice of residency programs: I had wonderful mentors and a great education in a place that allowed me to savor every free moment I had. It’s the place where I learned to love mountain biking, the place where I rediscovered alpine skiing after a 13-year hiatus, the place where I learned that rock-climbing doesn’t play to my strengths but is worth a go anyway. The people are friendly, the academics are excellent, and the wilderness is world class.

 

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Cartwheels over Canyones… Capitol Reef is one of the “Big 5” National Parks in Utah. Definitely worth saving.

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Canyoneering in Arches National Park (Spot the person on rappel!). Another great adventure in another great Utah Park.

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Mountain biking in the Wasatch- one of the new hobbies I took up while a resident is slowly peddling uphill and then speeding down through single track faster than is probably advisable…

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It may just be marketing, but sometimes it certainly seems like Utah has “The Best Snow on Earth”.

 

So where am I now?

 

After a brief stint moonlighting in some Urgent Care clinics in Salt Lake City, I’ve moved onto the next chapter in my life as a GP (General Practitioner) in the South Island of New Zealand, not far from Christchurch. I’ve been interested in practicing medicine in New Zealand since early in residency, having had a great trip here before starting residency and then hearing from a couple of physicians who enjoyed their time as GPs in the New Zealand system. I’ve signed on for a year and will see where the future takes me!

 

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Mt Cook from the Hooker Valley Track.

 

I arrived in New Zealand mid-October and shortly thereafter spoke about Ancestral Health in Academic Medicine at the Ancestral Health Symposium New Zealand in Queenstown. I started practicing at the beginning of November and am just rounding out my first month of practice in New Zealand.  It’s exhilarating, interesting, and at times a little intimidating (as I imagine all new-graduates find their post-residency jobs).

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A bit of lunch-time exploration at AHSNZ

 

So that’s a quick update from me- I hope to get back into a swing of writing about life, medicine, and ancestral health. Watch this space!

 

  1. Mata DA, Ramos MA, Bansal N, Khan R, Guille C, Di Angelantonio E, et al. Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis. JAMA. 2015 Dec 8;314(22):2373.
  2. Yaghmour NA, Brigham TP, Richter T, Miller RS, Philibert I, Baldwin DC, et al. Causes of Death of Residents in ACGME-Accredited Programs 2000 Through 2014: Implications for the Learning Environment. Acad Med. 2017 Jul;92(7):976–83.

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A New Year’s Update

I struggled with the title of this post for a while. It’s a long time since I’ve written anything (for the blog), and I wanted the title to be catchy, edgy, maybe even with a touch of double entendre. Alas, my creative mind has failed me. Perhaps this is a consequence of writing nothing but clinical notes for the past 6+ months- a result of being in the intern year of my medical residency. There is no need for provocative language, crafted sentences, or grammatical subtleties in medical notes. On a good day, clinical notes are composed of brief and simple sentences. On a busy day, notes are often composed largely of sentence fragments and phrases. On a bad day, notes may largely consist of abbreviations and acronyms.

Residency: Where to begin? I suppose at the beginning.

I haven’t tried this on older, more seasoned, docs, but it can be a bit of fun to ask a young doctor about the first order they ever gave as an MD. I come from a generation of medical students that did not give orders as students (I may have written out a paper order on occasion, but these were never acted upon until cosigned by a supervisor), so on July 1st, my first day of my residency, I showed up at 5 am eager (and somewhat petrified) to start my first rotation on Labor and Delivery- never having given a “medical order” to anyone. That morning, a nurse snagged me outside a patient’s room and said “Oh, she’s having some heartburn, can you write an order for Tums?”

“Sure”, I said calmly- while on the inside I felt like a deer in the headlights, trying to think of anyway possible that giving a lady Tums might lead to her demise. I stressed, I fussed, and then- as many interns do- I consulted a fellow resident. “Can I just write this lady for Tums?”

“Sure- but she should already have them ordered in the admission order set.”

How anticlimactic…

For a lot of young doctors that I’ve talked to, that first order request is for Tylenol.

The story usually goes something like this: patient’s nurse sees new resident. “Hey- Mr. Smith in room 14 has a headache. Can I get some Tylenol?”

New resident “Sure… Give me a minute?”

New resident then scurries off to the work room to check the patient’s allergies, liver function tests, alcohol history, etc, etc, etc. Resident then checks dosing, route of administration, frequency, and scans a med list wracking his brain for anything that might cause an interaction… I have heard this story many times- plus or minus a consult with a fellow resident.

That is on July 1 (or perhaps the end of June, as many programs now jump the gun on the July 1 residency start date). Hop forward a few weeks and the same resident will likely respond to the nurse “Sure- need a written order or can you take this as a verbal?”

Back to July 1: As I mentioned- I started my residency on labor and delivery. As a family medicine resident my intern year is a mix of some obstetrics, a pinch of surgery, a dose of pediatics, a healthy whack of in-patient medicine, and a sampling of various other areas of medicine (as well as a consistent stream of out-patient clinic). I started on Ob- one of the most challenging and grueling rotations in our residency. I’ll admit that I was initially scared but ultimately pleased that my medical career started on labor and delivery. My days of shadowing and standing in the background were gone. As a medical student I was allowed to stand in the room during a delivery and catch the occasional placenta, but as an intern I was expected to manage a patient from admission to discharge, with a labor and delivery in between. As my skill set and confidence grew, so did my autonomy- I was really someone’s doctor!

Of course, claiming that title was something I was hesitant to do…

As medical students, some people introduce themselves as “Student Doctor So-and-so”. I found this verbiage absolutely ridiculous, and instead went with the line “Hi- I’m Victoria, a medical student on the team looking after you.” I often followed this with the pseudo-apology “I can’t write you a prescription for any of the good drugs, but if there’s something going on and you feel like no one’s listening to you, I promise I’ll listen.”

Back to July 1- Do I actually introduce myself as “Doctor”? Who do I think I’m kidding?!

Folks, I’m here to tell you that the “Imposter Syndrome” is real. On July 1, there was no way I was introducing myself as “Doctor”. Instead, I modified by student script and said “Hi- I’m Victoria- one of the residents on the team looking after you.” I’m pretty sure I never introduced myself as “Doctor” that whole first month.

For my second month of residency I moved to a community hospital where I was doing in-patient medicine. There, my attending physician (my supervising physician) heard my introduction and said “Your life would be much easier if you introduced yourself as ‘doctor’”. Innately, I hate this reality. Despite working hard for many years to earn a slew of letters after my name, I’m not comfortable with the reality that saying that gets me more respect.

I battled on for a day or two, with my attending introducing me to patients as a doctor and hissing over my shoulder “doctor”, when she heard me call the lab, introduce myself as Victoria, and then sit on hold for 5 minutes waiting for a result. It didn’t happen quickly, but bit by bit, either by repetition or by the slow growth of the belief that maybe- just maybe- I was actually “doctoring”, I started to become comfortable with the term. I frequently couch the introduction with “one of the residents”, but I’m now comfortable introducing myself as Doctor, and have even found myself briefly annoyed when someone introduces me to a new patient by my first name. Outside of a patient’s earshot I have no need for a title (unless it bumps me to the front of the line when calling in to make an appointment for a patient or if I call in for a lab result), but I’ve come to learn that while the title doctor may give you respect, it also gives your patient confidence in you- and that is something incredibly valuable.

And what of Evolutionary Medicine and Ancestral Health?

If you’ve read many of my old posts (save those on travel), you’ll know that I have a passion for evolutionary medicine and ancestral health. One of the reasons I chose the residency program I did was because I knew it was a place I could explore those interests. That being said- my ability to explore and practice that kind of medicine has been quite limited. In my 8 weeks of Ob I had 49 vaginal deliveries: not one of which was done in a non-conventional position. I’ve probably prescribed more probiotics than most, though how much good a bolus of pure Lactobacillus does in a gut that has been firebombed with antibiotics I’m not really sure. (Strangely people rarely seem interested in eating Kimchi to replenish their gut flora… )I’ve also probably prescribed as much Tylenol as everyone else, despite believing that fever is a symptom (and a useful infection-fighting one at that) of illness and not something that needs to be treated in-and-of-itself. I’ve had small victories, discussing the potential benefit of fevers with some patients and families, and having them agree that they don’t need or want their fevers treated unless the discomfort is such that they can’t sleep or rest. I’ve also had these plans thwarted by covering residents and nurses who can’t stop their desire to “fix a number” and “fix a fever”.

Clinic is a bit of a different picture. There I’ve recommended, sleep remediation (sans medication), exercise, and books such as “It Starts With Food” to a number of patients, and been pleased to have the occasional one come back reporting success with lifestyle intervention. I’ve also had occasional welcome surprises, as I meet new patients who (sensibly) CrossFit or embrace a high-saturated fat/whole food diet who usually look shamefacedly at their doctor saying “My family wants me to come see a doctor because they know you’ll tell me this is a bad idea…”. Connecting with those patients- ensuring proper rest in one, recommending Kerry Gold Butter to the other- is an unexpected but welcome pleasure.

6+ months in…

I’m 6 and a half months into my intern year of residency. I have worked harder, put in more hours, and been more stressed than I ever have been before (the stress of writing a PhD thesis was quite different). Having written (and then retracted, since it was a duplicate order) my first order for Tums, I have gone on to write hundreds more orders. I still get nervous with firsts, but my comfort level is rising. Yesterday I did a thoracentesis for the first time. One day I will inevitably run my first code- this thought terrifies me.

I have also made some wonderful connections- with fellow residents, nurses, and patients. I continue to believe that doctoring is about people, not just illness, and while some patients come through as just another case that is quickly gone from my mind once the discharge is dictated, others have forever shaped who I am as a person and a doctor.

And Utah- oh Utah. There is not a day I have regretted moving to this state or choosing this residency program. I work with great people who love what they do but also value having a life outside of work. I work hard, but have the opportunity and ability to play hard as well. In the longer days of summer I was taking evening hikes some nights after work. With a tank of gas and some motivation I’ve been able to put 1-day weekends to good use, and have explored many of the national and state parks. Now that winter has come, I’ve used my rare day off to take to my cross-country skis, and am in the process of rediscovering my downhill ski legs, having hit the slopes for the first time in 13 years.

So here I am- half way through my first year of residency. I’m a doctor, and I no longer feel like a fraud when I say that. Many of my academic interests have been put on hold, but I have faith that I’ll be back to them as time allows. I’ve learned a lot since I moved to Utah in June: about medicine, myself, and others. There is so much to learn, so much to think about, and so much to explore, in medicine, wilderness, and life!

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View from Little Cottonwood Canyon, near the summit of Pfeiferhorn.

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I have a rather embarrassing admission to make: when I first started looking at taking a trip to the Galapagos three months ago I didn’t actually know that the islands were part of Ecuador.  Two months ago I visited the islands. It was amazing, but other than one afternoon in Guayaquil on the way back to the states I really didn’t get a taste of mainland Ecuador.

 

But while touring the Galapagos on the National Geographic Endeavour I made friends with one of the naturalist guides who invited me to come back and visit him in mainland Ecuador.  Always a fan for adventure, and with only minor apprehension about spending 8 full days with someone I had barely spent 8 full hours with, I booked tickets to Quito and packed my bag.

 

The Galapagos Islands are amazing. They are unique, beautiful, and biologically fascinating.

 

A blue footed booby in the Galapagos, with the National Geographic Endeavour in the background.

A blue footed booby in the Galapagos, with the National Geographic Endeavour in the background.

 

Mainland Ecuador is also amazing. It is beautiful, biologically diverse, and inhabited by generous and kind people.  Ecuador has stunning biodiversity, spread over four distinct regions: highlands, jungle (Amazon), coast, and the Galapagos (600 miles due west of the mainland).

 

Quilotoa- more on this beautiful place later, but this is one of may beautiful spots that you can visit in the highlands of Ecuador.

Quilotoa- more on this beautiful place later, but this is one of many spots that you can visit in the highlands of Ecuador.

 

I landed in Quito, the capital, late in the evening on the first where I met my friend and started our adventures.  Quito airport is new, and located about an hour outside of the city.  There is a nice airport express bus that takes you to the old airport in town, from where we took a taxi to Plaza Foch- a popular touristic area of Quito (there’s quite a bit of night life in this part of the city, with un-Ecuadorian high prices).  It’s a fun part of town, and despite being a pricey place to eat and drink there are many affordable hostels.  The night we had a room at one called “The Magic Bean” (coffee was a theme).  Throughout the rest of our trip we stayed at various hostels, never making plans or reservations until we arrived.  Hostels were generally cheap: we paid $19-$40/night for 2 people, always with our own bathroom, and sometimes with breakfast or breakfast and dinner included.

 

My first morning we wandered around Quito, grabbed breakfast, and walked around Parque El Ejido, all near Plaza Foch.  Quito is in a valley, stretching from north to south (with the old colonial district in the middle, dividing “the North” (which is more prosperous) from “the South”), with mountains surrounding.  The weather in Quito is lovely, and fairly constant.  There’s no need for seasonal wardrobes in Quito-you can wear the same clothes year round.  Since Ecuador is at the equator, sunrise and sunset are fairly constant year round, occurring right around 6am and 6pm.

 

Around midday we headed to a bus station on the north side of the city and took a bus to Mindo.  Ecuador uses the America dollar as currency, and generally speaking things are very cheap.  Public transportation within the city allows you to cross town for $0.25 (12c if you’re a senior or child), and the ~2 hour bus ride from Quito to Mindo was a mere $2.50 (a good estimate on bus rides in Ecuador is ~$1/hr).

Our first destination was Mindo...

Our first destination was Mindo…

 

The trip to mindo took us winding through lush mountains.  Wikitravels recommended sitting on the right side of the bus for the best views and they were right.  The tops of these peaks were often in clouds, though we were at lower altitudes than we had been in Quito.

The trip to mindo took us winding through lush mountains. Wikitravels recommended sitting on the right side of the bus for the best views and they were right. The tops of these peaks were often in clouds, though we were at lower altitudes than we had been in Quito.

 

Mindo is a beautiful small town nestled in cloud-forest.  It is famous for the quantity and diversity of birds, and it is an increasingly popular tourist destination.  My travel companion had visited many years ago, when there were a few hostels in a small town. He was shocked at the number of hostels that are there now, with many more under construction.

 

We stayed at the Dragonfly Inn- definitely the most luxurious of our accommodations during our 8-day adventure, with an attractive and clean room for $50/night for two of us (breakfast included).  The inn is located on the main street, overlooking a small river.  Hummingbird feeders attract lots of hummingbirds, and you see other birds flitting about the trees at all hours.  While eating breakfast on the patio I saw at least 20 hummingbirds buzzing about.

 

These guys were flitting around all the time and were especially active in the morning.  The majority were this variety, though we did see others as well as a stunning yellow tanager.

These guys were flitting around all the time and were especially active in the morning. The majority were this variety, though we did see others as well as a stunning yellow tanager.

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Mindo has historically been a destination for birders, but it is increasingly becoming a hot spot for adventure tourism.  During our stay we enjoyed a hike up at the cascade waterfalls and a tour of the local chocolate “factory”.

 

The cascades at Mindo are about 7km outside of town, and you either hike up the dirt road to the cable car that takes you across to the trails or you catch a truck-taxi.  We opted for the latter option, setting up a return journey a few hours after we were dropped off (this ended up being a great set-up, as it started to pour as we finished our hike).  To access the cascades you take a ride on a generator-powered cable-car that takes you on a ~900m ride across a deep ravine.  Our car-operator would give any OSHA inspector a heart attack, as he opted to stand outside the metal cage as we zoomed along, hundreds of feet above the forest floor.

 

About 900m long, and absolutely stunning... A breathtaking way to reach a trailhead!

About 900m long, and absolutely stunning… A breathtaking way to reach a trailhead!

 

Once on the other side we opted to hike to the Reina Falls (there were a couple of trail options).  There were many small falls along the way, and we spotted many hummingbirds and flowers along our hike.  The final falls, Reina Falls, required a climb up a rather sketchy set of stairs.

 

One of the small falls along the trail to La Reina falls.  Everything was so green and alive!

One of the small falls along the trail to La Reina falls. Everything was so green and alive!

 

I loved these massive tree ferns.

I loved these massive tree ferns.

 

La Reina falls.

La Reina falls.

 

Heading back down the sketchy stairs after we'd visited the falls.

Heading back down the sketchy stairs after we’d visited the falls.

 

Alas, it started to pour towards the ends of our hike, so our cable-car ride back to the taxi was a wet one.  Had the weather been nicer, and had we had the interest, there are a number of outfits that offer canopy rides in the area.

 

A slightly soggy ride back!

A slightly soggy ride back!

 

We had lunch at a little café (trout is a regional specialty, and was delicious), where we had a long discussion with the café owner about the various challenges Ecuador faces when it comes to attracting tourists.  While we chatted (first in Spanish, then in English) the owner caught on to my interests in agriculture and food, and insisted on running to the market next door where he purchased a naranjilla and a taxo (banana passion fruit) for me to try.  Both have distinct and interesting flavors and are generally used for making fruit juice, for which they usually require some sweetening (“jugo natural”= freshly made juice, which is very popular in Ecuador.  A glass of some sort is usually served with breakfast and lunch).

 

Taxo (above) and Naranjilla (below)

Taxo (above) and Naranjilla (below)

 

In the afternoon we headed to El Quetzal Chocolate Factory (Factory is probably a bit of an over statement, as operations take place in a small shed and two processing rooms), where we went on a tour and learned how they made chocolate- bean- to bar (actually pod to bar).

 

Cacao trees have many pods on them at one time and they sprout directly from the trunk or branches.  They ripen at different times, and are red and yellow when mature.  The best beans grow at lower altitudes, so El Quetzal doesn’t use the pods from their plants in Mindo (somewhere between 1000 and 2000m altitude) for making chocolate.  Instead they use these for decoration and/or share the fresh pulp amongst the workers as a snack.

Cacao trees have many pods on them at one time and they sprout directly from the trunk or branches.  They ripen at different times, and are red and yellow when mature.  The best beans grow at lower altitudes, so El Quetzal doesn’t use the pods from their plants in Mindo (somewhere between 1000 and 2000m altitude) for making chocolate.  Instead they use these for decoration and/or share the fresh pulp amongst the workers as a snack.

 

 

Pods are broken open to acquire the beans, which are fermented, as well as the white pulp, which is cooked down into a thick syrup that they call Miel de Cacao.  I really liked the flavor, which had elements reminiscent of balsamic vinegar.  In Mindo the cacao beans are fermented and dried in a plastic-sided green-house- the smell is intoxicating

 

Beans ferment for a few days to a week, depending on the temperature.  They are wrapped in banana leaves to conserve heat.

Beans ferment for a few days to a week, depending on the temperature.  They are wrapped in banana leaves to conserve heat.

 

The heat from the fermentation process kills the "embryo" inside.  Initially these embryos start out purple, and they become brown as they cook and die.  Brown (dead) embryos make good chocolate (there's a reason chocolate is brown and not purple!).

The heat from the fermentation process kills the “embryo” inside. Initially these embryos start out purple, and they become brown as they cook and die. Brown (dead) embryos make good chocolate (there’s a reason chocolate is brown and not purple!). This one is on it’s way to being ready, but is still quite purple.

 

Once fermented, beans are laid out to dry.  Drying time depends on the temperature in the house. 

Once fermented, beans are laid out to dry.  Drying time depends on the temperature in the house.

 

Once the beans are dried, any bad ones are removed and the remaining beans are roasted and cracked.  The nibs are separated from the shells by a winnower.

 

The Roaster- Much like the fermenting and drying room, the smell in this room was intoxicating.

The Roaster- Much like the fermenting and drying room, the smell in this room was intoxicating.

 

This is what you get after you roast the beans: nibs and shells. Throughout the process we were encouraged the try the beans.  As someone who enjoys 100% cacao, I enjoyed nibbling on the nibs.  Not so for the other 3 people on the tour.

This is what you get after you roast the beans: nibs and shells. Throughout the process we were encouraged the try the beans.  As someone who enjoys 100% cacao, I enjoyed nibbling on the nibs.  Not so for the other 3 people on the tour.

 

Next, production moves into the first processing room where beans are ground.  Here the beans were either made into 100% cacao paste, or separated (with pressure) into cocoa butter and cocoa powder.  The thick chocolate paste, known as chocolate liquor, is then made into chocolate bars by adding sugar and extra cocoa butter.  The mixture is refined, conched (ground and processed for a long period of time- I believe over 24 hours), and then tempered.  El Quetzal doesn’t add any emulsifiers (such as soy lecithin), and instead relies on extended periods of conching and tempering to get a lovely smooth mouth feel and texture.  They make a few different bars with various amounts of sugar and some added ingredients, such as ginger, chile peppers, and coffee- all of which they grow in Mindo (they also ferment a potent, and delicious, ginger beer).

 

I could have spent a couple of days in Mindo, but the next morning we headed back to Quito so that we could catch another bus to Otavalo.

 

The route to Otavalo.

The route to Otavalo.

 

Otavalo is a (relatively) large city in Imbabura province that is largely inhabited by native people.  Otavalo is known for it’s large market (mainly selling locally manufactured textiles and leather goods), which has made the city and its people prosperous.  The market is open every day of the week, but the largest market is on Saturday.  We arrived on Friday evening, found a hostel (for $19/night for 2 people), took a brief walking tour of the market area, had some dinner, and called it a night.

 

The market in Otavalo, as business was winding down on a Friday night.

The market in Otavalo, as business was winding down on a Friday night.

 

On Saturday morning we woke up early to go to the Mercado de Animales.  This market is only open on Saturdays, and is where locals go to sell, buy, and trade all sorts of animals: cows, pigs, goats, sheep, llamas, chickens and assorted poultry, rabbits, and guinea pigs (known as cuyo). I’ve never seen so many pigs on leashes…

 

Early morning in the mercado de animales.

Early morning in the mercado de animales.

 

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Looking out over the cow section.

Looking out over the cow section.

 

Pigs on leashes!

Pigs on leashes!

 

Piglets on leashes!

Piglets on leashes! (I thought the spotted ones were very cute)

 

One of the few things I found in Ecuador that was actually more expensive than at home in the states was old laying hens.  Here I know farmers that get $2.50/bird for old laying hens, while they were selling well for $9 a pair in this market. “Galina” (hen), has more flavor than regular meat chickens “pollo”, at least according to my travel companion!

 

A woman wearing her baby and selling Gallina (old laying hens).  At $9/pair, these are more expensive than in the US!

A woman wearing her baby and selling Gallina (old laying hens). At $9/pair, these are more expensive than in the US!

 

Lots of Gallina: hens that have stopped laying eggs.

Lots of Gallina: hens that have stopped laying eggs.

 

Alternatively, you could buy pollo- meat chickens (I didn't catch the price).

Alternatively, you could buy pollo- meat chickens (I didn’t catch the price).

 

I asked if you could buy laying hens (what we would call pullets), and was told that no one would sell a good laying hen.  You could buy chicks though- I assume the brown paper bags on the side are for transportation once sold.

I asked if you could buy laying hens (what we would call pullets), and was told that no one would sell a good laying hen. You could buy chicks though- I assume the brown paper bags on the side are for transportation once sold.

 

Guinnea pigs are a traditional meat source in this part of the world, and were prevalent in the market.

Guinnea pigs are a traditional meat source in this part of the world, and were prevalent in the market.

 

A mix of guinneas and rabbits.

A mix of guinneas and rabbits.

 

People shopping in the Otavalo animal market.  It's kind of nice to be in a market where no one is trying to sell you anything.  It's pretty obvious that tourists won't be taking anything home, so you're left to wander around and people-watch to your hearts content.

People shopping in the Otavalo animal market. It’s kind of nice to be in a market where no one is trying to sell you anything. It’s pretty obvious that tourists won’t be taking anything home, so you’re left to wander around and people-watch to your hearts content.

 

Vegetable oil- the bane of my existence… I was sorry to see this guy selling vegetable oil at the animal market.  Why abandon lard! (They’re getting the “animal fat is bad for you, vegetable oil is good for you” story in Ecuador these days.  Also, while people cook most things from scratch outside of the big cities, there were lots of billboards marketing pre-made convenience foods as the way of the future. 

Vegetable oil- the bane of my existence… I was sorry to see this guy selling vegetable oil at the animal market.  Why abandon lard! (They’re getting the “animal fat is bad for you, vegetable oil is good for you” story in Ecuador these days.)  While people cook most things from scratch outside of the big cities, there were lots of billboards marketing pre-made convenience foods as the way of the future.

 

After leaving the animal market (and passing through the small black-market out front where people sold animals without having to pay the $1 fee for trading animals in the market) we headed back into town to check out the main market.  On market day, the central square and two main streets are full of vendors selling silver, leather goods, antiques, and clothing made in and around Otavalo.  I couldn’t resist coming home with a small collection of scarves (made of locally produced cotton) which I bought for $2.50-$3 each.  The main materials produced and used for textiles in the area are wool, cotton, and alpaca, and while most things are made in bulk on machines you can still find a few vendors that hand-make their own items.

 

I bought a few scarves from this young lady, who sold alpaca and cotton scarves, as well as wool hats that she knits herself (I somehow resisted the sponge-bob hat). 

I bought a few scarves from this young lady, who sold alpaca and cotton scarves, as well as wool hats that she knits herself (I somehow resisted the sponge-bob hat). She was very smiley while we chatted but became very serious when I asked her if I could take her picture.

 

I loved the colors of these locally produced wools.

I loved the colors of these locally produced wools.

 

Some general observations of the people in Otavalo:

 

The majority of people in Otavalo are indigenous Ecuadorians, and while they generally speak Spanish they also speak their own dialect of Kichwa.  The women frequently wear traditional embroidered blouses with matching ribbons wrapped around their pony tails.  They often wear hats, but will substitute a folded up blanket on their head to keep the sun out of their eyes in a pinch.  The women generally wear flat sandals or shoes, and have no qualms breastfeeding in public.  Babies are frequently worn in makeshift slings on mothers’ backs, and I didn’t hear or see an unhappy baby the whole time we were there.

 

A folded blanket doubling for a hat in the animal market.  Women will walk around all day with a blanket like this.

A folded blanket doubling for a hat in the animal market. Women will walk around all day with a blanket like this.

 

In the afternoon we headed to Cotacachi- another predominantly indigenous town- famous for leather work.  After meandering the main stretch and grabbing lunch (a delicious $7 per person “menu del dia” that consisted of traditional ceviche, plantain soup, a trout main dish, and strawberries with cream), we got back on a bus to make our way to Vale de Chota via Ibarra.

 

Valle del Chota is not a typical tourist destination.

 

Valle del Chota is a region in Imbabura province with a number of small villages and towns occupied largely by Afro-Ecuadorians.  Along with the Esmeraldas province, Valle del Chota is one of the two areas in Ecuador largely inhabited by black Ecuadorians (descendants of former slaves and those who escaped from wrecked slave-ships coming from Africa).  The villages in this area are generally rather poor (with some living in abject poverty).

 

Onwards to Valle de Chota

Onwards to Valle de Chota

 

Perhaps some would find a visit to Valle de Chota interesting because of the heritage of the people or to see the difficulties of living in poverty, but we came for another reason… While people in this area traditionally scratched out a living trying to do agriculture in a very dry environment, this area has now become famous for the production of something very different- futbol (that’s soccer for Americans) stars.

 

Despite being a mere dot on the map of Ecuador, this region has produced half of the players on the last two Ecuadorian world cup teams.  Players from these towns compete in Europe and around the world, and are internationally recognized as sports stars.  While I have no interest in soccer my travel companion is a huge futbol fan, so exploring these towns was of great interest to him.

 

We started our morning in Pusir Grande- the most impoverished place I have ever visited. The easiest way to get to this village is on foot over a large suspension bridge built in 2004.  In Pusir we spoke with a pair of older women who told us about life in the village.  It was not a pretty picture, with no real jobs, no real opportunities, and no real way out.

 

The bridge to Pusir.

The bridge to Pusir.

 

 

The view from the bridge is stunning, but the sights in the village on the other side take your breath away for totally different reasons.

The view from the bridge is stunning, but the sights in the village on the other side take your breath away for totally different reasons.

 

Pusir Grande- Absolute poverty- there really isn’t much for me to say.

Pusir Grande- Absolute poverty- there really isn’t much for me to say.

 

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From Pusir we took a taxi to Juncal.  The taxi was driven by a local young man who was excited to have some tourists visiting his area.  When he heard our reason for visiting he told us that he would take us on a detour through his town of Carpuela, where he proudly pointed out the houses of family members of various famous soccer players (the names meant nothing to me, but my companion was excited).  Carpuela was definitely better off than Pusir, and conditions continued to improve as he hit Juncal (though I would not call the area prosperous).

 

In Juncal we had a traditional lunch of Fritadas (fried pork served with a couple types of corn and potatoes).

 

Fritadas

Fritadas

 

We then walked through town, eventually meeting up with a group of young boys who found a couple of out-of-towners very entertaining.  They took us down to the river and regaled us with stories, attracting more young boys with their shouts and laughter.  I spoke to them all with my basic Spanish, and as each new boy showed up they asked me “Conoces Libby?” (Do you know Libby?) Apparently they have a visiting American teacher named Libby.  The boys were also fascinated by how my friend and I could be together because my Spanish was so bad… For some reason they had a hard time believing that he was fluent in English.

 

These guys were great and full of life.  Maybe one will be a famous soccer star some day.

These guys were great and full of life. Maybe one will be a famous soccer star some day.

 

I spotted this girl watching us on our walk back to town. Only the boys came up to us to say hello.

I spotted this girl watching us on our walk back to town. Only the boys came up to us to say hello.

 

Under the bridge- this is where some of Ecuador’s best soccer players grew up, with this field being the training ground for World Cup players.

Under the bridge- this is where some of Ecuador’s best soccer players grew up, with this field being the training ground for World Cup players.

 

On our way back through town we stopped to watch some Ecuavolley.  As the name suggests, this is a variant of volleyball, invented in Ecuador.  The game is played with a soccer ball (it’s hard enough to afford one ball, you might as well use it for multiple sports), and is played three-a-side.  During my stay in Ecuador I watched a number of these games (my companion is an avid and accomplished player).  At this game, and throughout our stay in Valle del Chota, I stood out like a sore thumb (as did my relatively pale Ecuadorian friend) but while our presence drew some interested looks we never had any issues and were frequently offered assistance (because surely we were lost!).

 

A street game of Ecuavolley.

A street game of Ecuavolley.

 

It looked like fun. I'd certainly like to try it out!

It looked like fun. I’d certainly like to try it out!

 

In the afternoon we again headed back to Quito.  While we easily navigated Ecuador by bus, we always had to return to Quito to start a new adventure, with it acting like the hub of our travel wheel.  We again spent the night in Plaza Foch, before heading south to Quilotoa (changing buses in Latacunga- the capital of the Cotapaxi province).

 

The roads to Quilotoa...

The roads to Quilotoa…

 

Quilotoa is a beautiful crater lake in an area sparsely populated by native people.  Due to it’s growing popularity as a tourist destination, the locals have moved from their old village which was located about 1km down the mountain and are now living up at the edge of the crater where you can find many hostels and small cafes or stores (every building is a café, store, or hostel, as all the inhabitants make their living from tourism).

 

One of the many hostels in Quilotoa,flying the Incan flag.

One of the many hostels in Quilotoa,flying the Incan flag.

 

 

My friend had visited Quilotoa 15 years ago, when you had to hire a truck to take you up the dirt road and the only thing at the top of the crater was a small adobe hut.  In the last few years the government has paid for the construction of a nice new road to the village as well as the construction of a handicapped-accessible viewpoint and a maintained trail down to the lake.  With these changes, tourism continues to increase, though there weren’t many other visitors during our stay.

 

This nice wide trail is a relatively new addition to the landscape at Quilotoa.

This nice wide trail is a relatively new addition to the landscape at Quilotoa.

We opted to stay at one of the first hostels we saw- a recently constructed large chalet with beautiful large rooms heated with wood burning stoves.  At almost 4000m (12,841 feet) and exposed to the elements, it’s windy and chilly in Quilotoa and we were certainly appreciative of the stove in our room and in the common area.  For $20/person we not only had a room, but also had a dinner and breakfast that we shared with the other visitors (including four Indians who are on a months-long journey culminating in a trip to the FIFA World Cup in Brazil and a young Japanese woman on a solo year-long trip around the world!).

 

In addition to running a hostel, the owner of this establishment makes and sells wooden masks.  In the back you can see him wife tending to the wood-burning stove.

In addition to running a hostel, the owner of this establishment makes and sells wooden masks. In the back you can see him wife tending to the wood-burning stove.

 

We got to Quilotoa in the early afternoon.  We had lunch at a small café associated with our hostel (a $4 menu del dia consisting of a bowl of lima bean soup, a plate of chicken, potatoes, and rice, and a glass of fresh-squeezed juice) and then headed to the crater.  Despite a bit of concern that we may not make it down and up the crater before dark, we headed off down the trail.  There we chatted with a local guy who was maintaining the trail.  I figured that these guys must be used to tourists, so I asked him if he would take a picture of us with my digital camera.  My assumption was wrong, and I don’t think I’ve ever seen someone have so much trouble taking a picture.  Eventually there was success, and while the picture may be crooked, and you may see only part of the crater lake, our smiles were certainly genuine.

 

My travel companion is a photo instructor for National Geographic, a skill that definitely came through in some of the pictures that he took with my camera!

My travel companion is a photo instructor for National Geographic, a skill that definitely came through in some of the pictures that he took with my camera!

 

It probably took us about half an hour to make it to the bottom of the lake, and I’ll admit that a couple times I found myself concerned about our ascent up the steep path, especially with the added difficulty of catching our breath at altitude.  At one point we passed a local giving a tourist a ride up the trail on a horse, but we declined his offer to come back and get us from the base.

 

The lake at the base of the crater.  The colors of the lake are amazing, and changed with the angle and intensity of the sun.

The lake at the base of the crater. The colors of the lake are amazing, and changed with the angle and intensity of the sun.

 

At the bottom of the crater you can rent Kayaks for $2.50/hour, but they had shut-up shop by the time we got there.  There is also a very basic hostel on the shore, which provides a bed and breakfast for ~$12 a night with access to a pit toilet.  There are no wood-burning stoves in these rooms, but it was much milder down in the crater than up at the rim.  We found a young local down at the hostel, and we chatted to him a little bit before starting our hike back to the rim.  He said it takes him 25 minutes to hike back up, though I’m sure it took us well over twice that.

 

On our return hike we opted to take a different path, rather than the maintained trail.  It was very challenging, but the views on this hike up and down were absolutely breathtaking.  The water is a stunning blue, with the color changing dramatically depending on the light.  The water is brackish and full of minerals, as verified by my hiking partner who bravely took a sip, and I’ll admit I would have loved to of taken a dip had it been earlier in the day.

 

This llama was hanging out on the side of the caldera as we hiked back up.

This llama was hanging out on the side of the caldera as we hiked back up.

 

After our hike we visited one of the small shacks that served food.  We had coffee and struck up a conversation with one of the locals.  My companion asked a lot about how the village had changed since his last visit and I asked a lot about life in Quilotoa.  We learned that people are getting married much earlier now than they had previously- now sealing the deal as early as 14 or 15.  We learned about their marriage traditions (BIG parties) and that most people have about 8 children.

 

The clothing of the native people living in Quilotoa was notable different from that of the people living in Otavalo, which makes sense since the weather is much more severe.  Hats are popular for both genders in both locations, though the preferred style is quite different in each place (and I noticed that many of the hats were adorned with peacock feathers in Quilotoa, a style I hadn’t noticed in Otavalo).  I also noticed that while most women in Otovalo wore flats, all the women in Quilotoa wore heels.  When I asked the guy about this he replied in Spanish that “they just like it… though it does make them too tall”.  We spoke to everyone in Spanish, but the local language in Quilotoa is another dialect of Kichwa.  We were told that they can understand the dialect from Otavalo, but that it’s different.

 

We had a great time chatting with this gent.  As we drank coffee in the corner, women cooked dinner on the burners behind us while men played cards.

We had a great time chatting with this gent. As we drank coffee in the corner, women cooked dinner on the burners behind us while men played cards.w

 

I asked about childbirth for the local women and was told that some chose to have their children in hospital while others give birth at home with midwives.  During my time in the Andes I was struck by the prevalence of nail clubbing.  This is one of those things that medical students learn about in med school, and rarely see (I had a couple patients with clubbing in my clinical years).  The condition was prevalent amongst people that I saw in a number of places in Ecuador (I pathologically started staring at peoples’ hands), and I started to wonder if there was a genetic predisposition in these populations or if it was a result of life at altitude (it’s a condition associated with chronic hypoxia).  Just a random observation that I would love to explore further: you can take the girl out of the lab, but you can’t take the scientist out of the girl!

 

There is a trail, the Quilotoa loop, that goes around the lake.  It takes about 5 hours and is apparently quite challenging.  We would have loved to tackle it, but unfortunately we had to get back on the road by midmorning the next day, so we only had enough time to head out-and-back along one side of the loop for a couple of hours in the morning.  The views were stunning, and I hope to get back one day to hike the entire loop.

 

One of the many beautiful views from the loop.

One of the many beautiful views from the loop.

 

And this is what you see when you look out the other way.

And this is what you see when you look out the other way.

 

From Quilotoa there is one bus a day to Latacunga, but you can easily catch a local taxi to the nearby town of Zumbahua at any time.  From Zumbahua busses run much more frequently or you can catch a ride with someone heading to the city and provide them with some extra pocket money.  That’s what we did, as we were quickly ushered into the cab of a small truck as we headed towards the bus.  At the end of the trip our driver asked for $2 or $3 total (I think it would have cost us about $3 on the bus), having got us there in record time (I was holding on with white knuckles to anything I could get my hands on as we sped around tight mountain curves.  While I was having multiple minor panic attacks my companion happily chatted to our driver- he’s used to this mode of transportation from when he travels home to see his parents in another part of the highlands).

 

Speeding down twisty mountain roads in the front of a truck had me grabbing on for dear life...

Speeding down twisty mountain roads in the front of a truck had me grabbing on for dear life…

 

These are typical houses for the area around Quilotoa.

These are typical houses for the area around Quilotoa.

 

From Latacunga we caught a bus back to Quito, and again headed to Plaza Foch to find a hostel.  That evening we took a walk through colonial Quito, which was lovely.  Quito was colonized by the Spanish in the mid 1500s, and as such has a lot of history.  Of note, we visited La Iglesia de la Compania de Jesus, aka la Compañía, where we had a tour and caught part of a baroque concert of sacred music (it’s always interesting to visit religious places during holy week!).

 

One of the many beautiful colonial period building lit up in Old Quito.

One of the many beautiful colonial period building lit up in Old Quito.

 

The following day I explored Quito alone, visiting the botanical gardens in Parque Carolina and reading a book and people watching in Parque El Ejido.  I also got to meet up with a friend of a friend who is a native of Quito, and I really enjoyed getting a different perspective on life in Ecuador, especially hearing a different take on the current president (talk of Rafael Correa stirs up strong feelings in many Ecuadorians I spoke with).  In the evening I headed to the airport, and sadly left Ecuador behind.  I certainly hope to return again soon!

 

There are a couple of general things that I think are worth noting…

 

Coffee, Bananas, and Chocolate- I’ll admit that I was excited to return to a country that is well known for these three delicacies.  I’ll also admit that I was somewhat disappointed by the lack of these things in Ecuador.  I don’t know if all the bananas are exported (they are a major source of revenue for the country), but I ate more bananas in the airport lounges to and from Ecuador than I actually did in the country.  There was plenty of other fruit, but bananas weren’t plentiful (at least not at this time of the year).  Likewise, with the exception of El Quetzal chocolate in Mindo, I didn’t see any good Ecuadorian chocolate.  Manicho, the quintessential Ecuadorian chocolate, is a milk chocolate and peanut candy bar, and while that was prevalent I did not see any dark chocolate for sale to the public.  While Ecuador produces high quality chocolate beans, it appears they are sent out of the country to be processed and turned into expensive Swiss (or Belgian or whatever) chocolates.  Likewise coffee is a major export for Ecuador, yet the coffee section in the supermarket I visited was an abomination of Nescafe and instant coffee!

 

Coffee selection- Are all the good beans exported? Where’s that delicious Ecuadorian coffee I was looking for?!

Coffee selection- Are all the good beans exported? Where’s that delicious Ecuadorian coffee I was looking for?!

 

Food- The food in Ecuador was generally outstanding. By far the best of any of the countries I have visited in the last few months.  The ingredients are fresh, food is simple, and food is a central part of community and family structure.  People eat out a lot, but at simple places that are serving one of two basic ‘dishes of the day’.  Some of the best meals I had cost a couple of dollars and consisted of rice, potatoes, and meat.  Ecuadorians also really love soup, and the soups that frequently preceded our main dishes were generally outstanding.  With the exception of strawberries after one lunch, desert did not seem common.

 

This plate of Menestras (beans or lentils) with pork cost me ~$3 just around the corner from the pricey Plaza Foch.

This plate of Menestras (beans or lentils) with pork cost me ~$3 just around the corner from the pricey Plaza Foch.

 

Potatoes are frequently served for lunch and dinner. They're a traditional crop, and there are varieties that  grow in the harsh Andes climate. They look quite a bit different to what you get in the store in the US!

Potatoes are frequently served for lunch and dinner. They’re a traditional crop, and there are varieties that grow in the harsh Andes climate. They look quite a bit different to what you get in the store in the US!

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Corn generally looks quite a bit different as well.  I don't think Monsanto had anything to do with these ears!

Corn generally looks quite a bit different as well. I don’t think Monsanto had anything to do with these ears!

 

Street food was common, cheap, and delicious.  I generally break a lot of the “food safety” rules when traveling, and I very happily ate food from street vendors while in Ecuador.  Common options are grilled plantains with cheese and mango with salt.  Fruit is commonly sold in plastic sleeves as snack food, and you can usually get a bag of grapes, apples, pears, citrus, or rambutans for $1 a bag.  At one point I saw Avocados being sold on the street at 10 for $1.  Not exactly your typical street food, but what a bargain!

 

Plantains grilled on the street.

Plantains grilled on the street.

 

Maduros con queso- sweet plantain with cheese.

Maduros con queso- sweet plantain with cheese.

 

Green mango with salt. Another popular street food.

Green mango with salt. Another popular street food.

 

Rambutans- A curious looking fruit!

Rambutans- A curious looking fruit!

 

Rambutans- I hadn’t had these before, but they are very tasty!

Rambutans- I hadn’t had these before, but they are very tasty!

 

 

Bags of fruit were also commonly sold on the bus, as were ice creams, chips (plantain, potato, and cassava), peanuts, and all kinds of snacks.  At various bus stops vendors would hop on the bus toting their wares, hoping to make a dollar or two before hopping off at the next stop.  You could even get whole meals sold in this way, such as fritadas sold in little plastic bags with wooden forks.

 

Juice-fresh fruit juices, or “jugos naturales” are very popular and often included as part of a meal.  Common flavors are blackberry, pineapple, naranjilla, guanabana (soursop), and tree tomato.  They’re frequently sweetened, but you can ask to have them with minimal or no sweetening.

 

Tree tomatoes, aka Tamarillos- Solanum betaceum.

Tree tomatoes, aka Tamarillos- Solanum betaceum.

 

Money- Ecuador has used the American dollar as currency since 2000.  I used more $1 coins during one week in Ecuador than I have in my entire lifetime in the US.  Things in Ecuador are cheap, so small bills are preferred, and people frequently ask you for small and exact change.  In addition to the US bills and coins, there are also Ecuadorian coins that correspond to the nickel, dime, and quarter.

 

Transportation- public transportation in Ecuador is cheap and fairly reliable.  You can traverse the length of Quito (a lengthy ride) for 25c, and get most places by bus or taxi for very reasonable prices.

 

I usually just relaxed and watched the scenery go by as we rode the bus, but from time to time I would do some light reading- such as this article on the prevalence on fatty liver in children... Longtime readers will understand my interest in this topic!

I usually just relaxed and watched the scenery go by as we rode the bus, but from time to time I would do some light reading- such as this article on the prevalence on fatty liver in children… Longtime readers will understand my interest in this topic!

 

A parting suggestion: VISIT ECUADOR.  It is a beautiful country filled with generous and kind people.  The environment is diverse and fascinating, the food is delicious.  It’s easy to get to from the US, it’s easy to travel on a very limited budget, and you’ll never run out of things to see.  It’s definitely helpful to speak Spanish (or to travel with someone who does), but some of the tourists we ran into had very limited Spanish and seemed to get by just fine.

 

The Galapagos were fascinating, but I fell in love with Ecuador when I visited the highlands.  I’ve now seen two of the four regions of Ecuador, and I can’t wait to go back again… There’s so much to see and do, but perhaps next time I can make it to the Amazon!

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If you’ve scanned through your radio dial any time in the last six months you’ve almost certainly heard the song “Wake Me Up” by Avicci on one of the pop stations.

 

It caught me at the perfect time when I heard it last September. Finishing med school, not sure where I was going to go for residency, being forced to think about what I want to do/where I want to go with my career…  The line “I can’t tell where the journey will end, but I know where to start” really captured my place in time.  I still do not know where the journey will end, but at least now I know that my pursuit of further training in clinical medicine, academics, and research is taking me on a journey to Utah.

 

Back in September another line, “Hope I get the chance to travel the world, but I don’t have any plans.” was also really apropos.  Graduating in January, but starting residency in July, left me with six free months in which I planned to “travel the world”.  But 3 months before graduation I still didn’t have any concrete plans.

 

That didn’t stop me from talking … I knew I wanted to spend a couple of months in Australia and New Zealand, I was dreaming of going to the Galapagos, and I was talking about visiting friends in Belize, but after the three months of rotations and interviews that filled my schedule, my calendar was bare.

 

My dad (and Groupon) changed that.

 

Back in September a travel deal to Turkey came through Groupon that seemed almost too good to be true: 6 days, 6 nights, a number of meals, all transportation (round trip airfare, an internal flight, and ground transportation), and entry into a number of sites all for $1300?  I’d never done an organized tour before (now I’ve done two- this Turkey trip and a tour of the Galapagos), but it seemed worth the risk for such a reasonable amount of money.  After a bit of agonizing over dates, we chose a week, booked the deal, and I finally had some solid travel plans.

 

I’ll admit that Turkey was never on my “to visit” list (not that I really have one, though there are a number of places I’d like to see).  My brother and father visited a number of years ago, and my father’s interest in the culture and history was piqued, and his enthusiasm made me keen to see some of the country for myself.

 

The tour, which was run by Friendly Planet, was booked as “A Taste of Turkey”: just a quick stay, in which you saw a number of the historic highlights on the western coast of Turkey.  For the price, I wouldn’t have been surprised if I’d found the tour a bit lacking, so you can imagine my surprise when the tour was really 1st class!

 

I’m not going to write out a blow-by-blow description of our trip, but I wanted to share some thoughts and some pictures that I acquired while travelling this part of the world.

 

Our journey started at JFK airport, where we travelled with Turkish Airlines to Istanbul and then on to Izmir.  As I’ve been travelling quite a bit of late, I’ve been taking note of the various airports in the US and around the world.  I hate to admit it, but Biden’s comment about LaGuardia (and by extension, many US airports) being like a third-world country is pretty much spot-on.  I wasn’t overly impressed by the Istanbul airport on our brief layover on the way to Izmir (though having our bags checked all the way through and going through customs at our final destination was nice), however on the way home I was absolutely wowed by the Turkish Airlines lounge in Istanbul. Talk about luxury!

 

Once arriving in Izmir we were picked up by our guide and taken to Kusadasi.  There were ten of us in our group, which was a great number. At a number of our stops we saw big 50-person busses, and I frequently thought how fortunate we were to have such a nice, small group.  We also absolutely lucked-out with our tour guide.  Isa has 26 years of experience guiding, and is deeply knowledgeable about the geography, history, biology, and religious-importance of the various places that we visited.  He’s actually written books on these subjects, and is truly a thoughtful guy.

 

One of the reasons our trip was so affordable is that we were definitely visiting during the “off season”.  In my book that’s an advantage.  We didn’t have to fight the cruise ship-crowds to see the various sights, and we got to stay in pretty nice, fairly empty, hotels.

 

The first day in Kusadasi we were left to our own devices.  Having taken the red-eye flight, most of us took naps, and then my dad and I took a walk along the Aegean sea, eventually stopping for a beer and a coffee.

 

The next day we started our morning with a trip to the House of Mary- a Catholic and Muslim shrine- near Ephesus.  The area is steeped in history, and while the identity of the original inhabitants on the site will never be known, it has earned pilgrimages from three popes.

 

The House of Mary in Ephesus

The House of Mary in Ephesus

 

The next stop was Ephesus, an ancient Greek city that has undergone (and continues to undergo) a lot of excavation.

 

Ephesus- Much of this was under earth until relatively recently

Ephesus- Much of this was under earth until relatively recently

 

There was marble everywhere in Turkey. I learned that when it comes to columns, the whole Dorian/Ionic/Corinthian denomination wasn’t as simple as my 7th grade history teacher had led me to believe.

There was marble everywhere in Turkey. I learned that when it comes to columns, the whole Dorian/Ionic/Corinthian denomination wasn’t as simple as my 7th grade history teacher had led me to believe.

 

This is the one of the theaters at Ephesus.  These are at all the ancient sites and it should come as no surprise that the acoustics are excellent.

This is the one of the theaters at Ephesus. These are at all the ancient sites and it should come as no surprise that the acoustics are excellent.

 

The most famous structure at Ephesus is the library of Celsus.  It’s amazing to think what was going on in other parts of the world two thousand years ago while civilization was thriving here along the Aegean. 

The most famous structure at Ephesus is the library of Celsus.  It’s amazing to think what was going on in other parts of the world two thousand years ago while civilization was thriving here along the Aegean.

 

Ephesus (and other sites) was literally crawling with cats.  While people don't keep pets in their house in muslim culture, there are large populations of well fed cats in some public outdoor spaces.  They've actually made a documentary on the cats of Ephesus!

Ephesus (and other sites) was literally crawling with cats. While people don’t keep pets in their house in muslim culture, there are large populations of well fed cats in some public outdoor spaces. They’ve actually made a book on the cats of Ephesus! And of course they have a facebook page…

 

In the afternoon we stopped by the remnants of the Temple of Artemis, one of the Seven Wonders of the Ancient World.  There’s not much of it left (when it comes to marble, the inhabitants of this part of the world have been great believers in the principles of reduce, reuse, and recycle!), but it was interesting to see.  Here, like many places, there were buildings (or ruins) from many eras of human civilization.

 

The lone (massive) column at the Temple of Artemis- one of the seven wonders of the ancient world.

The lone (massive) column at the Temple of Artemis- one of the seven wonders of the ancient world.

 

The following day we headed to Pergamon, where we visited the acropolis (ruins, ruins, and more ruins), and then to my delight we had a bonus trip to the aesclepion.

 

Views from the acropolis.  Acropolis is a general term for a fortified area typically built on a hill.  The views were fantastic.

Views from the acropolis.  Acropolis is a general term for a fortified area typically built on a hill.  The views were fantastic.

 

While today these views look out over plains, when this area was originally developed it was on the sea.  The harbor has since silted up and the sea is now miles away.

While today these views look out over plains, when this area was originally developed it was on the sea.  The harbor has since silted up and the sea is now miles away.

 

Fun with arches- there is lots of stunning architectural structures that have stood the test of time (and many that have been reconstructed).

Fun with arches- there is lots of stunning architectural structures that have stood the test of time (and many that have been reconstructed).

 

Walls- These areas were inhabited for many generations.  In this picture you can see the precise construction of the Hellenistic Era in comparison to the more patchwork areas built in the Byzantine era.  Interesting to see how knowledge/technology is lost (The Helenistic era started around 300BC while the Byzantine era started around 300 AD and stretched for more than a millennium.  Sadly, the best preserved artifact at Pergamon, the Zeus Altar, was removed by archeologists over a hundred years ago and now resides in Berlin, Germany (though there is no doubt the Turks would like it back!)

Walls- These areas were inhabited for many generations.  In this picture you can see the precise construction of the Hellenistic Era in comparison to the more patchwork areas built in the Byzantine era.  Interesting to see how knowledge/technology is lost (The Helenistic era started around 300BC while the Byzantine era started around 300 AD and stretched for more than a millennium.  Sadly, the best preserved artifact at Pergamon, the Zeus Altar, was removed by archeologists over a hundred years ago and now resides in Berlin, Germany (though there is no doubt the Turks would like it back!)

 

The asclepion at Pergamon was not on our original itinerary, and I was excited to hear that it was added thanks to renovations at other sites.  Asclepions were Greek and Roman healing temples to the Greek god of medicine and healing- Asclepius.  The one in Pergamon is particularly historic because it is where Galen, a prominent Greek physician and scientist lived and practiced.  Over the years I’ve had a bit of interest in medical history, so this was a cool bonus stop!

 

An underground walkway at the Asclepion in Pergamon.

An underground walkway at the Asclepion in Pergamon.

 

While we’re on the subject of Asclepius and medical history, lets take a quick look at the caduceus.

 

A Caduceus (picture taken at Ephesus).

A Caduceus (picture taken at Ephesus).

 

Even if you don’t recognize the word caduceus, you’d probably recognize the symbol: two snakes entwined around a rod (sometimes topped with wings).  You might recognize this as the US Army Medical Corps insignia (or the insignia of many medical organizations).  This is inappropriate,

 

The caduceus was the staff carried by the God Hermes, and holds no medical significance.  On the other hand, the rod of Asclepius, a god of medicine and healing, would be an appropriate medical symbol.  Indeed, many medical organizations do use the rod of Asclepius as their symbol.  While the caduceus is certainly an interesting symbol, if you want a mythologically appropriate symbol, you want a staff with only a single snake wrapped around it.

 

An appropriate medical symbol, the rod of Asclepius.

A more appropriate medical symbol: the rod of Asclepius.

 

Later in the day we stopped by a co-op where women make and sell traditional Turkish carpets.  There we learned how these pieces of art are traditionally made (complete with natural food diet and traditional silk processing), and even learned how to tie the traditional double knot.

 

Wool colored with traditional vegetable dyes.

Wool colored with traditional vegetable dyes.

 

You want carpets? We got carpets!! (They were stunning, and lovely to walk around on barefoot.)

You want carpets? We got carpets!! (They were stunning, and lovely to walk on barefoot.)

 

The next day was an interesting combination of legend, history, and modern tragedy.  We started the day visiting Troa (the city that has been dubbed Troy).  Like many ancient cities, Troy was originally on the coast, but silt has left it stranded miles from the coast.  There have actually been 9 levels of construction at the site known as Troy.  Archeologists believe that level VII is the level that was in use during the time of the Trojan war, but the structure of the city walls makes the likelihood that a giant wooden horse was used to smuggle soldiers in very unlikely.

 

Nevertheless, the Trojan Horse is alive and well at Troy.  A large wooden horse is a popular photo op for tourists, and the large plastic Trojan horse from the recent Hollywood movie resides in one of the local towns.

 

Silly tourist...

Silly tourist…

 

After visiting Troy we took a ferry across the Dardanelles to Gallipoli.  I have never been to a modern battleground and found the experience very sobering.  The memorial to the Australian and New Zealand Army Corps (ANZAC forces), the various graveyards, and the open air mosque and memorial to the Turkish 57th regiment were all very moving.  My knowledge of history is incredibly lacking, but visiting Gallipoli and this part of the world inspired me to read more about World War I than I have since high school

 

Strong words from a great leader (Ataturk) on a memorial at Gallipoli.

Strong words from a great leader (Ataturk) on a memorial at Gallipoli.

 

The open air posque and memorial to the Turkish 57th Regiment.  The story of this regiment, and why they no longer have a 57th regiment, is a sobering story well worth a read.

The open air posque and memorial for the Turkish 57th Regiment. The story of this regiment, and why they no longer have a 57th regiment, is a sobering story well worth a read.

 

Trenches- The Trenches for the ANZAC and Turkish forces were literally 20 feet apart.  There are stories of the forces throwing supplies (chocolate and tobacco) back and forth between the sides, as well as heartbreaking stories of gallantry and honor on both sides. 

Trenches- The Trenches for the ANZAC and Turkish forces were literally 20 feet apart.  There are stories of the forces throwing supplies (chocolate and tobacco) back and forth between the sides, as well as heartbreaking stories of gallantry and honor on both sides.

 

By the end of the day we reached Istanbul, the final stop on our tour.

 

Over the next two days we explored many of the famous sites around Istanbul- The Blue Mosque (aka The Sultan Ahmed Mosque), Topkapi Palace, Basilica Cistern, Hagia Sophia, the spice market and the grand bizarre.  Recognizing my father’s interest in religion and history, our guide also showed us the slightly less well known Suleymaniye Mosque.  I won’t go into detail (you can search these places on Wikipedia if you’re interested), but the architectural sights were awe inspiring (while I found the market and bazaar overwhelming!)

 

Basilica Cistern- This massive cistern used to be an important water source for the city and was filled by aquaducts (today it holds only rain water that trickles through the roof).  Built between the third and fourth century, and with massive structures built on the ground above it, the cistern is a real marvel.  

Basilica Cistern- This massive cistern used to be an important water source for the city and was filled by aquaducts (today it holds only rain water that trickles through the roof).  Built between the third and fourth century, and with massive structures built on the ground above it, the cistern is a real marvel.

 

 

Topkapi Palace- The detail in the palace was beautiful, 

Topkapi Palace- The detail in the palace was beautiful,

 

More splendor at Topkapi palace.

More splendor at Topkapi palace.

 

The Hagia Sophia is interesting for many reasons.  It is big, it is beautiful, and it was completed in 537 BC, after only 5 years of construction!  It was originally an Eastern Orthodox Cathedral, briefly a Roman Catholic Cathedral, and in 1453 it was made into a mosque.  It remained a mosque until 1931 when Mustafa Kemal Ataturk declared it should be a museum (Ataturk was certainly a remarkable and interesting man, and someone I would like to learn more about).  

The Hagia Sophia is interesting for many reasons.  It is big, it is beautiful, and it was completed in 537 BC, after only 5 years of construction!  It was originally an Eastern Orthodox Cathedral, briefly a Roman Catholic Cathedral, and in 1453 it was made into a mosque.  It remained a mosque until 1931 when Mustafa Kemal Ataturk declared it should be a museum (Ataturk was certainly a remarkable and interesting man, and someone I would like to learn more about).


Inside the Hagia Sophia

Inside the Hagia Sophia

 

One of the amazing murals.  These were covered with plasters when the cathedral was converted into a mosque and are being restored now that the structure is a museum.

One of the amazing murals. These were covered with plasters when the cathedral was converted into a mosque and are being restored now that the structure is a museum.

 

Oh, and remember the cats at Ephesus? They were in the Hagia Sophia as well...

Oh, and remember the cats at Ephesus? They were in the Hagia Sophia as well…

 

The iconic Blue Mosque

The iconic Blue Mosque

 

Truth in advertising- the inside of the Blue Mosque is rather blue!

Truth in advertising- the inside of the Blue Mosque is rather blue!

 

In comparison, the Suleymaniye Mosque was quite pink!

In comparison, the Suleymaniye Mosque was quite pink!

 

Like when I visited a mosque in Abu Dhabi, I had to cover my head when I went into the mosques.  Unlike at the Sheikh Zayed mosque, I did not have to to don a full robe.

Like when I visited a mosque in Abu Dhabi, I had to cover my head when I went into the mosques. Unlike at the Sheikh Zayed mosque, I did not have to don a full robe.

 

The Spice Market- If you’re a fan of Saffron, the Spice Market is apparently the place to get it!

The Spice Market- If you’re a fan of Saffron, the Spice Market is apparently the place to get it!

 

A traditional Turkish delicacy- Turkish Delights.  Authentic stuff is made with Honey. 

A traditional Turkish delicacy- Turkish Delights.  Authentic stuff is made with Honey.

 

Wildlife-

 

I am, without a doubt, an avid naturalist.  This trip was definitely focused on history and culture, but there was still some interesting wildlife to see.  I was intrigued by (and sad to be a little too early to sample) the wild figs, and enjoyed the display of spring flowers.  There were some interesting birds to spot, including pelicans, flamingos, and perhaps the coolest one for me for me- Storks.

 

They come to Turkey in the spring to nest.

They come to Turkey in the spring to nest.

 

So there you have it.  Our “taste of Turkey” (and our taste of Turkish Delights) definitely hit the spot.  I’d love to go back, though there are so many places I’d like to visit I can imagine it will be a while before I revisit Turkey, but you never know.  It is important to recognize that not everything was “sweetness and light”.  In Istanbul there were many Syrian Refugees begging on the streets, and there is certainly plenty of civil unrest in some parts of the country, with many people unhappy with the corruption of the current Prime Minister (it will be interesting to watch where this all goes in the near future).

 

“I can’t tell where the journey will end, but I know where to start.”

 

My plans to travel the world (well, at least to travel for six months) started with a Groupon to Turkey.  Around that starting place I fit in a trip to Belize, the Galapagos, and England.  Tomorrow I head back to Ecuador to explore the highlands with a new friend, and later in April I head to Australia and New Zealand.  When I finally get back to the US I’ll pack up my belongings and drive across the country to Utah.

 

“So wake me up when it’s all over

When I’m wiser and I’m older.

All this time I was finding myself,

And I didn’t know I was lost”

 

Oh- that Avicci song? Those words aren’t his.  They belong to Aloe Blacc, and his version of the song is beautiful.

 

 

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Go West, young woman

I am no longer Schrödinger’s resident

 

A week ago today the verdict arrived.  I am Utah bound to pursue residency training in Family Medicine.

 

I am thrilled.

 

I fell in love with Utah when I travelled there for a wilderness medicine elective last spring.  With scenery like this, can you blame me?

 

Alpine pic of the day

River pic of the day

Desert pic of the day

Moab- More than expected

 

That wasn’t my first trip to Utah, as I had previously visited Salt Lake City for the first Physicians and Ancestral Health symposium.  Knowing some ancestrally/evolutionary-minded physicians in Utah and at the institution I am heading to definitely played a role in my ultimate decision to make Utah my top choice for residency.  Add in excellent clinical and academic opportunities, on top of happy and interesting faculty and residents, and I know I’ve made the right choice.

 

I’m really looking forward to this exciting new chapter in my life, though not before I get in a couple more months of travel and adventure! (I head back to Ecuador on Tuesday!)

 

Desert Solitaire by Edward Abbey has been on my "to read" pile since my time in Canyonlands last spring. It has now been bumped to the top of the list.

Desert Solitaire by Edward Abbey has been on my “to read” pile since my time in Canyonlands last spring. It has now been bumped to the top of the list.

 

 

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It’s Match week.

 

If you know a fourth year medical student (or recent med school graduate like myself), you might have noticed them looking a little frazzled this week.

 

I’ve written previously about “speed dating for medical students”, where I briefly discussed the process by which recent (or pending) med school grads find their first jobs as interns and resident physicians.  The process starts when students apply to programs in their specialty (or specialties) of choice, at the end of the summer.  Pretty soon (hopefully) offers to interview come in.

 

Interviewing is an educational, though stressful, experience.  You get to see how different programs and different hospitals are run, you get to hear about life as a resident from new young doctors, and you get to meet fellow applicants who aspire to specialize in the same discipline.  Throughout the interview season you develop a bit of a patter- you come to expect some questions and you recognize what are the interesting elements of your personal story that people want to know about.  Interestingly, at least to me, very few people were interested in hearing about my PhD research.  Rather, they wanted to know how I intended to use my skill set in my future career.  “Where do you see yourself in 5 years.”

 

Of course, it’s kind of hard to say where you see yourself in 5 years when you don’t know where you’ll be in 6 months.

 

New physicians are assigned their internship and residency positions through a process called “The Match”.  By the end of the interview season, a student creates a rank list, in which they order the training programs for which they would be willing to work. This list must be eventually be finalized and “certified” (this year the deadline was 9pm EST February 26th).

 

Students aren’t the only one’s making rank lists; programs rank applicants in the order in which they want to employ them.  Once the student and program lists are certified, they are sorted by an algorithm designed to fit a theory that won Alvin E. Roth and Lloyd S. Shapley the Nobel Prize in economics.  You can read more here.

 

Once lists are certified and the deadline has passed, computers whir and crank to determine where students will be heading come June.  Students and programs get the results this week: “Match Week”.  The process starts on Monday, when students get an email answering the question “Did I match”.  At this point, residents are much like Schrödinger’s cat- simultaneously matched and unmatched, hanging in limbo until the email is opened.

 

I’ll admit that, despite being someone who tries to remain rather cool, calm, and collected (ok, that’s a lie, but I try not to worry about things that are outside my control), I experienced a significant amount of stress leading up to Monday.  Blame it on the fact that last year I was in the room when a generally very competent future physician received a “you did not match” email, but I couldn’t help myself from running through the series of events that would see me unmatched (I didn’t rank that many programs and all it takes is being one slot too low on each programs rank list and you find yourself scrambling for a supplemental offer).  Fortunately, Monday’s email brought me good news, and I am now on the eve of finding out where I will spend the next 3-4+ years of my life.  I, along with the majority of med students around the country, will be receiving my match information tomorrow at noon EST at a match ceremony at my school.  At this point I know I’ll be headed to 1 of 7 programs in 1 of 6 states…

 

Have stethoscope, will travel...

Have stethoscope, will travel…

 

Schrödinger’s resident is matched, tomorrow we’ll know where. Stay tuned!

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I’ve been fortunate to do some pretty amazing travel in the past, but the journey I just returned from has certainly stolen the show. 

 

As an evolution nerd, a Darwin enthusiast, and a lover of the natural world, a trip to the Galapagos was truly an experience I will never forget.  I’ve wanted to visit the Galapagos for a long time*, and while I had thought about visiting in my 6 months off between med school and residency I only booked the trip about a month ago.  My father (also an evolution nerd, Darwin enthusiast, and naturalist) and I travelled with National Geographic and Lindblad Expeditions on a trip to the Galapagos aboard The National Geographic Endeavour (named in honor of the first vessel that Captain Cook used in his explorations – the one that landed on the eastern coast of Australia; Cook never visited the Galapagos).  I’ll just start by saying the company, the experience, the ship, the crew, the staff, the naturalists, the whole package- were all first rate.  It’s a top of the line option for visiting the Galapagos, and it really shows.

 

In many people’s minds, the Galapagos are inexorably linked with Charles Darwin and his theory of Natural Selection.  Darwin visited the Galapagos, on HMS Beagle, in 1835. Darwin was aboard the Beagle for 5 years, but he only spent 5 weeks in the Galapagos of which only 19 days were on land!  Nonetheless, the observations he made there and the samples he collected were important ingredients for his future theory.

 

Tagus Cove- One evening we stopped in Tagus Cove- an area where Darwin landed.  There is graffiti in this cove, as it was traditional (until recently) to leave the name of your boat on the cliffs (some are amazingly high up).  The earliest inscription we saw was from 1836, the year after Darwin visited.

One evening we stopped in Tagus Cove- an area where Darwin landed. There is graffiti in this cove, as it was traditional (until recently) to leave the name of your boat on the cliffs (some are amazingly high up). The earliest inscription we saw was from 1836, the year after Darwin visited.

 

Most of the walks we took on this cruise were rather relaxed, but this evening’s hike was a change of pace, and we made good speed up a steep trail.  Looking back, we could see the Endeavour and a large pond that Darwin wrote about in The Voyage of the Beagle.  Alas, while he was hoping for a refreshing dip in some fresh water, he was frustrated to find that this pond is brackish.

 

A [disappointingly] brackish pond.

A [disappointingly, at least for Darwin] brackish pond.

I recommend the Galapagos chapter of The Voyage of the Beagle (Chapter 17).  It is a delightful and quick read, and if you have an e-reader you can find it for free online.  The Voyage of the Beagle was a travel journal of sorts, and while Darwin was the naturalist aboard The Beagle (well he was eventually, he didn’t start that way but eventually replaced the original Naturalist) he first became famous as a travel writer (his theory of evolution didn’t make him famous until quite late in life, and strangely his book on Barnacles wasn’t a big seller…).

 

Over the years, the Galapagos became a popular stopping point for ships.  While there is very limited fresh water, it was a good place to replenish food.  Early visitors introduced goats (a species that quickly flourished on the islands, wreaking havoc on endemic creatures) and the Galapagonian tortoises were particularly popular as well.

 

There are a number of species that are uniquely Galapagonian- the tortoise being a prime example.  These giant creatures at one time roamed the islands in great numbers, but their populations were decimated by humans in ~150 years.  The tortoise had two great misfortunes- first, they apparently taste pretty good (Darwin wrote of roasted tortoise breast “Gaucho style” being quite tasty, and was complimentary of tortoise soup (from medium sized animals), though he found nothing remarkable in the rest of the animal).  Perhaps the greater misfortune for these giants is that they can survive for ~2 years without food or water.  In a time before refrigeration, when fresh meat was almost an impossibility on long sea voyages, tortoises could be stashed on boats for ages until they were finally consumed.  I admit to being rather bad about anthropomorphizing animals, but I can only imagine that being kept in the hold of a ship for over a year before being killed and eaten was a rather unpleasant end.

 

A Medium Sized Tortoise- Perhaps this is a good soup-sized tortoise?

A Medium Sized Tortoise- Perhaps this is a good soup-sized tortoise?

 

These giants are believed to live over 200 years, though it is hard to be sure since we haven’t been studying them that long.

These giants are believed to live over 200 years, though it is hard to be sure since we haven’t been studying them that long.

 

The tortoises on different islands are considered different sub-species (though where you draw the line at species vs. subspecies or variety was a common quandary during our tour of the Galapagos) and some have gone extinct due to human harvesting, competition (with things such as introduced goats), and decreased hatching (because of damage to nests due to introduced species).  One of the most famous Galapagos Tortoises was “Lonesome George”, the last of his kind- a subspecies of tortoise that inhabited Pinta Island.  While a number of attempts were made to breed George and “save” his kind, none were successful, and he died- the last of his kind- in 2012.

 

Lonesome George had been living at the Charles Darwin Research Station on Santa Cruz Island since his discovery in 1971, and for many years was the center’s most famous denizen.  We visited Santa Cruz, and the Charles Darwin Research Center, during our cruise, and we got to see the conservation efforts there.

 

The National Park manages 97% of the land of the Galapagos (only 3% is habited). The Charles Darwin Research Center does a lot of research, but only the national park can change policy and initiate change in the park.

The National Park manages 97% of the land of the Galapagos (only 3% is habited). The Charles Darwin Research Station does a lot of research, but only the national park can change policy and initiate change in the park.

 

Eggs from different subspecies are hatched and reared in captivity on Santa Cruz (and there are two other tortoise breeding centers elsewhere in the archipelago).  When they are large enough to be released they are tagged and released.  These efforts have generally been very successful and the tortoise population is recovering nicely.  While they claim the number painted on the babies backs are for identification purposes, I secretly hope there is some illicit tortoise racing going on after hours!

Eggs from different subspecies are hatched and reared in captivity on Santa Cruz (there are two other tortoise breeding centers elsewhere in the archipelago). When they are large enough to be released they are tagged and released. These efforts have generally been very successful and the tortoise population is recovering nicely. While they claim the number painted on the babies backs are for identification purposes, I secretly hope there is some illicit tortoise racing going on after hours!

 

After his death, Lonesome George was sent to NYC where he was preserved by experts at the Natural History Museum.  The current celebrity at the Charles Darwin Research Center is a much happier tale.  When conservation efforts were initiated, there were only 14 tortoises of the Española subspecies- 12 females and 2 males.  While conservationists hoped to build the population from these animals, the females were not interested in the males.  In an attempt to save the subspecies, a global search for a male of their kind was initiated- seeking out giant tortoises in zoos and private collections around the world.  Eventually a male was found in the San Diego zoo, and after some negotiating “Diego” made his way back to the Galapagos.  Now, having fathered over 1000 offspring, Diego is known as “Super Diego”, and the subspecies is doing well!

 

The conservation of the Galapagos Tortoises seems to be on the road to success, which is wonderful.  The Charles Darwin Research Station has also had good success breeding and reintroducing some subspecies of Land Iguanas.  In fact, the breeding program at the research center has now been closed because the efforts were so successful.

 

These cuddly guys (land iguanas) have had a hard time on some islands, but with restoration and conservation efforts they are now dong well.

These cuddly guys (land iguanas) have had a hard time on some islands, but with restoration and conservation efforts they are now dong well.

 

There were slim pickings for the Land Iguanas on North Seymour. These guys like to eat prickly pear cactus, but were taking to the trees to find some greenery in this sparse environment.  One of the naturalists we were with said he had never seen Land Iguanas so high in trees before.

There were slim pickings for the Land Iguanas on North Seymour. These guys like to eat prickly pear cactus, but were taking to the trees to find some greenery in this sparse environment. One of the naturalists we were with said he has never seen Land Iguanas so high in trees before.

 

Lusher pastures for this land iguana near Urvina Bay.

Lusher pastures for this land iguana near Urvina Bay.

 

You may not know it, but about 30,000 people live in the Galapagos.  While 97% of the island is National Park (for which you need a permit and a naturalist to visit- no more than 16 tourists per naturalist), there are a number of inhabited areas.  At the end of our cruise we visited Santa Cruz, where the Darwin Center is, and San Cristobal, from where we flew back to the mainland.  In Santa Cruz we took a walk through town, and it was fun to stop at the fish market and see the catch of the day.  Humans weren’t the only interested customers!

 

Pelicans at the self-serve bar

Pelicans at the self-serve bar

 

A bit more anthropomorphizing... I imagined this Sea lion waiting for his number to be called at the deli counter.

A bit more anthropomorphizing… I imagined this Sea lion waiting for his number to be called at the deli counter.

 

The Sea Lion was given a hunk of fish and the fishmonger kept the pelicans back with a fly swatter so he could enjoy it!

The Sea Lion was given a hunk of fish and the fishwife kept the pelicans back with a fly swatter so he could enjoy it!

 

The Galapagos are part of Ecuador, and until fairly recently were not inhabited.  Initially, colonists were “gifted” land, as encouragement to come and live in the Galapagos, but now there are significant efforts to curb immigration.  When we were in Santa Cruz we headed up into the highlands to see tortoise in the wild (they much prefer to be in the highlands with lush vegetation and more water, but the females come out of the highlands to lay eggs- an unfortunate habit, since the smaller females were more desirable fodder for hungry sailors, and were much closer to the ocean than the large males who stayed in the highlands).

The tortoises in the highlands like to relax in ponds such as this one.  They will drink gallons of water when they visit, but can go years without water in hard times.

The tortoises in the highlands like to relax in ponds such as this one. They will drink gallons of water when they visit, but can go years without water in hard times.

 

At first I was confused by the shrubbery this tortoise had acquired, but after seeing them wallowing in the weed-covered pond all became clear.

At first I was confused by the shrubbery this tortoise had acquired, but after seeing them wallowing in the weed-covered pond all became clear.

 

Unfortunately, this method of hiding didn't save tortoise from hungry sailors.  Darwin writes how sailors would flip these hiding beasts over and carry them off to the ships for storage. Darwin also wrote about his attempts to ride these massive creatures!

Unfortunately, this method of hiding didn’t save tortoise from hungry sailors. Darwin writes how sailors would flip these hiding beasts over and carry them off to the ships for storage. 

 

While we were in the highlands we visited a plantation where a family grows coffee and sugar cane.  Both grow well in the Galapagos, and while we visited we learned how people traditionally processed sugar (into molasses and alcohol) and coffee.

 

Sugar Cane processing- This isn’t how the family processes sugar today, but this is the traditional method.  Sugar cane is fed into the press and juice comes out the bottom.  On this plantation half of the sugar cane juice is made into molasses and half is made into alcohol!

Sugar Cane processing- This isn’t how the family processes sugar today, but this is the traditional method. Sugar cane is fed into the press and juice comes out the bottom. On this plantation half of the sugar cane juice is made into molasses and half is made into alcohol!

 

Diabetic Warbler?- This Yellow Warbler really liked to hang out on the sugar cane press!

Diabetic Warbler?- This Yellow Warbler really liked to hang out on the sugar cane press!

 

Hooch- this was the open vat where the sugar cane juice was fermenting.  The final product, after it was passed through a still, was… rough.  There's a reason people age rum!

Hooch- this was the open vat where the sugar cane juice was fermenting. The final product, after it was passed through a still, was… rough. There’s a reason people age rum!

 

Coffee- Having had an introduction to traditional coffee processing methods in Belize, I got a review in The Galapagos.  Here you can see the unroasted cleaned and uncleaned beans.

Having had an introduction to traditional coffee processing methods in Belize, I got a review in The Galapagos. Here you can see the unroasted uncleaned and cleaned beans.

 

I took a new camera with me on this trip and certainly had some fun with shots like this...

I took a new camera with me on this trip and certainly had some fun with shots like this…

 

We got to try coffee beans, sugar, coffee, sugar juice (delicious with a squeeze of lime), and hooch (ditto).  While I certainly took lots of pictures in the Galapagos thing, the only physical product I’m coming home with is some Galapagonian Coffee.

 

Admission time- Label something “Evolutionary” and I am 27% more likely to purchase it.

Admission time- Label something “Evolutionary” and I am 27% more likely to purchase it.

 

I have a lot more to write about, and many more pictures to share, but this seems like a good stopping point for now.  I’ll get the next post up ASAP, but it may be a bit of a wait since I head to the UK tomorrow for a quick visit with family.

 

Me and my old new-friend. Unlike Darwin, I didn't try and catch a ride (though you can see why he tried!)

Me and my old new-friend. Unlike Darwin, I didn’t try and catch a ride (though you can see why he tried!)

 

*While I have always been keen to visit the Galapagos, I have also been somewhat wary.  There is no doubt that humans have done a lot of damage in the Galapagos.  While the bulk of this damage was done by early visitors who purposefully introduced a number of hardy species, tourists certainly have the potential to damage the environment, spread seeds, and introduce species or disease.  That being said, done correctly, tourism can be an incredible force for good in the Galapagos.  A lot of damage has been done in the past 200 yrs by sailors, settlers, and visitors.  Progress is being made to repair these damages, with money coming largely from tourists.  If humans were to now abandon the Galapagos, the endemic species would be pushed out by species that have already been introduced. Well-regulated tourism, appropriate management of the land, and conservation efforts can help preserve the Galapagos. They are certainly a wonder worth saving.

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Yesterday I posted some thoughts and pics from my recent adventures in Belize… Here’s round 2!

 

In yesterday’s post I mentioned going on a photo shoot of the twin cities with NICH (the National institute of Culture and History).  One of the stops on our tour of San Ignacio was the old hospital.  This hospital was closed about 7 or 8 years ago, with a new hospital now operating on the outskirts of town.  The old hospital now sits in disrepair, slowly disintegrating.  Being a medically-minded person, I found this stop on the tour very interesting.

 

The abandoned walk in clinic.

The abandoned walk in clinic.

 

 

Live Birth Registry- A sign of the times.  This explains how you register the birth of a baby delivered at home.

A sign of the times. This explains how you register the birth of a baby delivered at home.

 

 I didn’t take any chemoprophylaxis for malaria (I’ll admit I didn’t even think about it, though I have had Hep A vaccines- something generally recommended for travel in this part of the world).  Interestingly (disturbingly?) the CDC [http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-3-infectious-diseases-related-to-travel/travel-vaccines-and-malaria-information-by-country/belize#seldyfm533] and NHS [http://www.fitfortravel.nhs.uk/destinations/central-america/belize/belize-malaria-map.aspx] disagree about malaria risks in Belize.  The CDC says Cayo, where I spent most of my time, is an area where chemoprophylaxis is advised, while the NHS says it is a low risk area with no need for prophylaxis. Hmmm….

I didn’t take any chemoprophylaxis for malaria (I’ll admit I didn’t even think about it, though I have had Hep A vaccines- something generally recommended for travel in this part of the world). Interestingly (disturbingly?) the CDC and NHS disagree about malaria risks in Belize. The CDC says Cayo, where I spent most of my time, is an area where chemoprophylaxis is advised, while the NHS says it is a low risk area with no need for prophylaxis. Hmmm….

 

 I spotted this cot in the abandoned hospital, and immediately recognized it as a Cholera Cot.  These are one of the things doctors learn about in med school but will never see in the US.  Cholera causes MASSIVE fluid loss by diarrhea.  Cholera cots are designed with a hole in them so a bucket can be placed under the patient to measure fluid loss. Replacement of fluid and electrolytes with Oral Rehydration Therapy is amazingly effective for this otherwise very deadly disease.

I spotted this cot in the abandoned hospital, and immediately recognized it as a Cholera Cot. These are one of the things doctors learn about in med school but will never see in the US. Cholera causes MASSIVE fluid loss by diarrhea. Cholera cots are designed with a hole in them so a bucket can be placed under the patient to measure fluid loss. Replacement of fluid and electrolytes with Oral Rehydration Therapy is amazingly effective for this otherwise very deadly disease.

Confirming my suspicion, I saw this plaque on the wall in another room.

Confirming my suspicion, I saw this plaque on the wall in another room.

 

 

 

There’s definitely a push to teach kids about healthy living.  I thought this mural on a school wall was much better than the USDA food pyramid, but maybe that’s just me… Unfortunately, I saw kids eating a lot of junk food in Belize- candy, chips, and Coca-cola are ubiquitous in Belize (note- there is no Pepsi in Belize- they were run out years ago. Bowen and Bowen [http://en.wikipedia.org/wiki/Barry_Bowen] dominate the beverage industry in Belize).

There’s definitely a push to teach kids about healthy living. I thought this mural on a school wall was much better than the USDA food pyramid, but maybe that’s just me… Unfortunately, I saw kids eating a lot of junk food in Belize- candy, chips, and Coca-cola are ubiquitous in Belize (note- there is no Pepsi in Belize- they were run out years ago. Bowen and Bowen dominate the beverage industry in Belize).

Despite the abundance of junk food, the children in Belize are very active and generally appear to be thriving.  I joke that Belize is very much a country of free-range chickens (they’re everywhere) and free-range children (they’re everywhere too).  You frequently see young children out playing on their own, babies and small children being cared for by siblings, and small kids walking home alone from school in their uniforms.  They’re an active bunch (perhaps because few, if any, have home computers or smart phones?), and find opportunities to play everywhere.  School yards are generally rather bare, but you’d often see kids playing with old tires and barrels.  I’ll admit that I found their love of play mesmerizing and inspiring.

 

These kids were on break outside their school in San Ignacio.  I watched at another school where kids sprinted outside to take advantage of a ten-minute break between classes.  They spent the time sprinting up a construction embankment (not a “Caution” tape in sight).

These kids were on break outside their school in San Ignacio. I watched at another school where kids sprinted outside to take advantage of a ten-minute break between classes. They spent the time sprinting up a construction embankment (not a “Caution” tape in sight).

 

More “free-range” kids.  These girls kept running up to this painting of Jesus and giving him hugs.  There have been a lot of missionaries in Belize over the years.  Pentecostals, Nazarenes, and Mormons have all tried to make inroads into this culture.  I went through customs behind a group of young Mormon missionaries.

More “free-range” kids. These girls kept running up to this painting of Jesus and giving him hugs. There have been a lot of missionaries in Belize over the years. Pentecostals, Nazarenes, and Mormons have all tried to make inroads into this culture. I went through customs behind a group of young Mormon missionaries.

 

Dogs are also generally left to be “free-range”, often with tragic results.  It’s rather heartbreaking to see the starving, mangy dogs all over the streets.

Dogs are also generally left to be “free-range”, often with tragic results. It’s rather heartbreaking to see the starving, mangy dogs all over the streets.

 

And now for something completely different…

Xunantunich- There are a number of Mayan Sites in Belize.  Xunantunich (sounds like zoo-nan-tune-itch) is just across the river from my friends’ house.  Not only did I visit to see the archeology, but the 1-mile trek up the hill to the entrance became a favorite walk when I had spare time.

 

You have to take a ferry across the river to get to the site.  The ferry is hand-cranked, and carries pedestrians, cars, and horses!

You have to take a ferry across the river to get to the site. The ferry is hand-cranked, and carries pedestrians, cars, and horses!

 

Xunantunich grounds are about 1 square mile, and contain a number of structures.

Xunantunich grounds are about 1 square mile, and contain a number of structures.

 

El Castillo (The Castle) is the tallest structure on the site and the second tallest structure in Belize.

El Castillo (The Castle) is the tallest structure on the site and the second tallest structure in Belize.

 

It’s a great climb to the top of El Castillo.

It’s a great climb to the top of El Castillo.

 

You get beautiful views of Guatemala and Belize on the climb up.

You get beautiful views of Guatemala and Belize on the climb up.

 

From the top of El Castillo you can see how many of the structures line up.  Many Mayan sites are lined up with a north-south and east-west axis.  At Xunantunich, El Castillo is at the center of these two axes.

From the top of El Castillo you can see how  the structures line up. Many Mayan sites are lined up with a north-south and east-west axis. At Xunantunich, El Castillo is at the center of these two axes.

 

Like most of the archeological sites I visited in the Yucatan, Xunantunich has a Ball Court.  It’s interesting to think what games these courts may have been used for [http://en.wikipedia.org/wiki/Mesoamerican_ballgame]…

Like most of the archeological sites I visited in the Yucatan, Xunantunich has a Ball Court. It’s interesting to think what games these courts may have been used for

There are a number of beautiful restored friezes on El Castillo.

There are a number of beautiful restored friezes on El Castillo.

 

There is a significant Belizian Defense Force (BDF) presence at Xunantunich.  It is very close to the Guatemala border, and there have been problems with people illegally coming across, mugging tourists, and then running into the jungles.  On one of my morning walks one of the guards used my scent to practice with his German Shepherd trained for tracking(!!), and you frequently saw soldiers with big guns patrolling the roads and ruins (though initially a bit intimidating with their big guns, a number of them were very chatty when they realized I was a frequent flier on their territory).

 

 

Belize’s wildlife and wonder.

 

My friends took me on a few cool road-trips while I was visiting.

 

I snapped this on our trek from Succotz to Placencia, as we travelled on the Hummingbird Highway- yes, this is a highway!

I snapped this on our trek from Succotz to Placencia, as we travelled on the Hummingbird Highway- yes, this is a highway!

 

 The roads in Belize often leave a lot to be desired.  A good 4X4 vehicle is frequently needed!

The roads in Belize often leave a lot to be desired. A good 4X4 vehicle is frequently needed!

 

I snapped this as we took a walk in the Guanacaste National Park in Belmopan.  Here we saw (and more notably heard!) Howler Monkeys, which I think should more accurately be called Roaring Monkeys!

I snapped this as we took a walk in the Guanacaste National Park in Belmopan. Here we saw (and more notably heard!) Howler Monkeys, which I think should more accurately be called Roaring Monkeys!

 

I spotted Toucans a couple times in my travels around Belize.  I saw this pair on a walk down from Xunantunich.

I spotted Toucans a couple times in my travels around Belize. I saw this pair on a walk down from Xunantunich.

 

I also spotted leaf-cutter ants a few times.  I particularly like the little fellow toting a flower.  It’s impressive that these teeny little ants actually beat a path into the grass as they work.

I also spotted leaf-cutter ants a few times. I particularly like the little fellow toting a flower. It’s impressive that these teeny little ants actually beat a path into the grass as they work.

 

On my first day in Belize we headed into the jungle to walk around the grounds of a herbalist.  We saw a number of medicinal and edible plants there, including this Cassava.

On my first day in Belize we headed into the jungle to walk around the grounds of a herbalist. We saw a number of medicinal and edible plants there, including this Cassava.

 

 

And this Ginger… (I also was excited about the lemon grass, Keffir lime leaves, and the promise of Galangal)

And this Ginger… (I also was excited about the lemon grass, Kaffir lime leaves, and the promise of Galangal)

 

Bananas grow with abundance in Belize (this pic was taken in someone’s yard, but we also drove through miles of a banana plantation on our way to the coast).

Bananas grow with abundance in Belize (this pic was taken in someone’s yard, but we also drove through miles of a banana plantation on our way to the coast).

 

Life is abundant in Belize.  It almost seems as though this Orange Tree has more epiphyte biomass than Orange Tree!

Life is abundant in Belize. It almost seems as though this Orange Tree has more epiphyte biomass than Orange Tree!

 

Speaking of Oranges… Talk about something you probably wouldn’t see in the states.  These workers were catching a ride as this tractor sped down the highway laden with oranges.  This sight was by no means unusual.

Speaking of Oranges… Talk about something you probably wouldn’t see in the states. These workers were catching a ride as this tractor sped down the highway laden with oranges. This sight was by no means unusual.

 

Traffic rules (well, rules in general) are pretty lax in Belize.  There’s no such thing as vehicle inspection, and most of the vehicles would not be deemed road-worthy in the US.  I saw more cars without brake lights than I saw with.  It’s not abnormal to see cars with a paucity of lug nuts.  Shocks are a luxury, and carrying capacity is only limited by your imagination.

 

A pretty typical Belizean vehicle (check out those rear tires!)... It would be fun if the vehicles came with biographies (I think many make it to Belize after being written off in other countries).

A pretty typical Belizean vehicle (check out those rear tires!)… It would be fun if the vehicles came with biographies (I think many make it to Belize after being written off in other countries).

 

The per capita GDP of Belize is 1/5 of the US, and the standard of living is very low.  People live in very crude houses- often just one or two rooms for a rather large family.  While touring San Ignacio with Hector Silva (check out my last post for more on this interesting fellow) we stopped to chat with this woman… Check out the family’s living situation- you can see their feet from the outside (I suppose it makes sweeping easier), and their sink is outside their window, draining directly onto the ground below (warm running water is a rare luxury in Belize).

 

 

WindowSink

Chatting to us over the kitchen sink.

 

Despite the very basic way of life in Belize, people there seem genuinely happy.  There certainly are hardships, but families seem strong and supportive, children well adjusted and happy, and life is generally good.  Animals don’t get the care or attention that most of us have come to expect (I mentioned the dogs above, and horses are frequently very malnourished and scrawny), and I hope that with time and tourism there is greater respect for the environment.

 

I do hope to return to Belize again in the future.  It is a nice treat to visit a warm and sunny place during the depths of winter, and there is a lot to learn and appreciate in Belize.

 

NB- playing in the jungle isn’t without risk.  When I visited the Yucatan as a college student I discovered that I am acutely sensitive to Black Poisonwood, also known as Chechem.  In Mexico I developed blisters on my legs when I unwittingly came in contact with the plant, and despite being very aware of the tree when I visited Belize 8 years ago I still somehow came in contact with some and again got blisters.  On one of my morning walks up to Xunantunich I went off the beaten path and down an overgrown 4X4 trail.  It seems that I again got in contact with Chechem, and developed a chemical burn on my neck (no, it’s not a hickey, I promise!).  The traditional remedy for this is topical application of sap or tea made from the bark of the Gumbo Limbo tree.  While I was in Belize I used this remedy, and it did seem to help, especially on my arms where I got a rash (I believe) from walking under a poisonwood tree while it was raining (as I said, I appear to be acutely sensitive).

 

 

A Chichem induced chemical burn on my neck.

A Chechem induced chemical burn on my neck.

 

There are other notable risks of visiting Belize.  I saw a number of public notices touting that Belize has the highest rate of HIV in central America.  I also saw public notices warning about the prevalence of Chagas disease.  In some areas of Belize, the risk of Leishmaniasis is significant, and a friend of the friends I was staying with recently had a cutaneous lesion.

 
I was sorry to leave Belize (especially because a storm hitting the east coast delayed me in Houston overnight!), but I am excited to be getting ready for my next adventure.  Tomorrow morning I head to Ecuador, and on Saturday I head to the Galapagos! For a Darwin enthusiast, this trip is an opportunity of a lifetime, and I will endeavor, while aboard the National Geographic Endeavor to experience the Galapagos to the fullest (and hopefully share my experience here).

 

 

Mural

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