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Posts Tagged ‘Travel’

One month ago I broke my hand. I’m back to work now, but as I mentioned in my last post I ended up taking disability time off because I wasn’t able to doctor effectively with only one hand.

 

I’ve mentioned it before on this blog, but my dad is a pretty good sport, so the morning after making the decision that I’d be taking some time off work I gave him a call and said “Come visit!”.

 

Without hesitation, he did. Within 24 hours he was on a plane and winging his way to Christchurch. We had a fantastic visit, which I have dubbed “The Broken Hand Tour”.

 

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I picked my dad up at the airport early afternoon, and without any break took him directly to the Canterbury Agricultural and Pastoral Show (or “A&P show” as everyone knows it here). I had spent a few hours at the show last year and had loved it, and it was great to share the experience with my dad. It has all the classic “Farm Fair” things”: animals, classic tractors, fair-food, etc. but also some wonderful kiwi-extras. There are pens of ewes that are lambing, sheep-herding competitions, (I believe there are shearing competitions but I’ve missed these both years), and I love the mix of wares for sale in the expo hall where you will find “the most efficient possum trap” for sale in a booth next to children’s bouncy toys. There are rows of fleeces on display, and lots of silver cups for the champion merino fleece. Both years I’ve loved watching some of the wood-chopping competition, and this year got to see the Jiggerboard event, where competitors make notches in a large trunk which they then stand on to make more notches, ultimately placing three steps before chopping half-way through the top of the trunk before repeating the process on the other side and removing the top of the trunk. (You can see the various ax events here)

 

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The Jiggerboard Ax event: It’s impressive to watch these guys in full swing standing precariously on boards resting in notches they just cut.

 

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Prize winning Merino fleece.

 

This was actually my dad’s third visit to see me in New Zealand, having come over once in the summer to explore and once in the winter to ski. I’d been hoping to get him back for a trip down to Stewart Island (Rakiura), so when he agreed to a last-minute visit I quickly put together plans to do just that. I planned out a southern route, down along the southeast coast, through the Catlins and then over to Stewart Island and then returning through an inland route.

 

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Our loop. Not pictured, the Ferry ride over to Oban on Stewart Island.

 

We set out the following day (after a visit with my hand therapist) and made our way to Dunedin, the second largest city in the Southern Island. We stopped in Oamaru, the “Steam Punk Capital” of New Zealand, where we visited the Steam Punk Headquarters and had lunch at a brewery. Oamaru is an interesting city, with some beautiful old architecture and an interesting vibe. I’m not sure how much the steam-punk scene has changed Oamaru or how much the steam-punk scene just fit in there, but it’s cool, and definitely worth a visit if you’re in the area. If you visit the actual Steam Punk HQ (on Humber St), make sure you spend time in “The Portal”.

 

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From there we stopped in Moeraki, famous for its boulders on the beach, where I spent last New Year camping in the bush and exploring. While other visitors were busy posing by the boulders we spotted a couple dolphins playing in the surf. We made it to Dunedin in the evening in time for a stroll around the octagon and train station before turning in at the Law Courts Hotel.

 

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Moeraki Boulders. This pic is actually from my New Years trip when the skies were blue…

 

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Classic Dunedin architecture

 

The next day we headed off (in the rain) into the Catlins, the sparsely populated south east corner of New Zealand. We spent two days visiting sites such as Nugget Point and multiple waterfalls while spotting birds such as the Royal Spoonbill and various gulls, shags (cormorants), and oyster catchers. On the afternoon of the second day we made our way to Invercargill and spent a couple hours in Queen Park before heading to the southernmost town on the South Island, Bluff, from which we caught a ferry to Stewart Island.

 

 

Stewart Island is 30km south of the South Island and you can get to it by a catamaran ferry or small airplane. It has one town, Oban, with under 400 fulltime residents. The main industry historically has been fishing, and while fishing and aquaculture are still significant enterprises, the main industry these days is tourism. I’ve wanted to visit Stewart Island partly to see some of the cool New Zealand birds which I hadn’t yet seen. New Zealand is famous for birds, but sadly many are quite limited in number and habitat because of introduced predators and habitat loss. Stewart Island is a good place for seeing birds, and Ulva Island, a smaller island within an inlet on Stewart Island, is a predator-free island where native birds are thriving.

 

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The view from our Airbnb across Paterson Inlet: great for watching storms roll in. 

 

Unfortunately, the weather during out trip wasn’t ideal for really exploring Stewart Island, but we did get out on a guided night tour on the day of our arrival and saw kiwi in the wild. The Southern Brown Kiwi are doing well on Stewart Island (in part due to predator control and programs such as dog kiwi-aversion training). We saw about 5 on our hour-long patrol of the airstrip. They really are funny looking creatures. As my dad said “Proof that God has a sense of humor!”. Or proof that funny things evolve in the absence of predators!

 

The next morning, we spent hunkered down in our Airbnb watching storms roll over Patterson’s Inlet. When the wind would die down, Tuis would flit around the trees around the balcony and a Kaka, one of New Zealand’s resident Parrots, would stop by. In the afternoon, the weather settled enough for us to have a stroll around town, and we had a wonderful dinner at the Church Hill Restaurant (the Stewart Island Salmon was delicious).

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The next day, despite the rain, we set off on a van-tour of the island and learned the history of the island and its inhabitants. In the afternoon, we hopped on the Ulva Island Water Taxi, and after a quick briefing from the captain “It’s going to be very bumpy”, we took the short ride over to Ulva Island. I’d checked out various options online, including self-guided tours and multiple commercial options, and ended up asking Peter from Sail tours to take us round. He’s been on Stewart Island since 1969 and has a wealth of knowledge about the human and the natural history of the area. I was very excited to see a number of Saddlebacks, as well as Red Crowned Parakeets and Brown Creepers- birds I hadn’t yet spotted on Stewart Island. (I like birds, and I’m enjoying learning the New Zealand birds, but by no means am I a “birder”.)

 

 

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While Ulva Island has been cleared of predators, it’s not just for the birds… It’s good to give Sea Lions a wide berth. 

 

The seas were so rough on our second day on Stewart Island that none of the three scheduled ferries back to Bluff were attempted. We were scheduled on the 8:30am ferry the following day, which thanks to the cancelled ferries the day prior was quite full. We made it across the Foveaux strait safely, though the crew were kept busy helping a number of passengers who weren’t comfortable on the rough crossing. The boat was called Stewart Island Experience – and some passengers had rather more experience than they probably wanted!

 

To complete our southern route we drove back up through Invercargill and along Lake Wakatipo, skirting around Queenstown, and stopping at the Gibbston Valley Winery before making it to Cromwell where we spent the night.  On the last day of our Tiki Tour* we stopped at the High Country Salmon Farm, where they raise King Salmon in freshwater lakes (specifically in hydro canals outside of Twizel). We had a late, yummy sashimi breakfast before heading to Lake Tekapo to see the classic (though now seemly always crowded) views of Aoraki Mt. Cook. We finally completed our loop back to the Christchurch area via the inland scenic route.

 

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In the last 14 months I’ve used most of my free-time in New Zealand to explore the South Island, and I’ve seen quite a lot of it. There are always new things to see and explore, and in New Zealand there seems to be no end to the natural beauty. I always feel lucky when I have someone to enjoy it with!

 

*A classic kiwi-name for a sight-seeing journey

 

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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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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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I recently visited the Galapagos (more posts and pictures coming soon).  During that trip I brushed up on some of my Darwin knowledge- in a lecture on board, with some books in the ship’s library, and reading The Voyage of the Beagle on my Kindle. I just got back from a very different trip (visiting family in the UK), but again I managed to brush up on some Darwin, this time by visiting the place where he lived, worked, and died- Down House.

 

Down House, the home of Charles Robert Darwin (1809-1882) for the last 40 years of his life, is in the village of Downe in Kent.  Here Darwin conducted many experiments, and wrote most of his scientific work (On the Origin of Species by Means of Natural Selection (1859) being the most well known).  I am certainly a Darwin enthusiast (some might say a Darwin stalker…), but I expect that even those who have only a mild interest in Darwin, history, evolution, or science would enjoy a tour around this historic site.

 

Down House is located in the village of Downe (the Darwin’s kept the traditional spelling after an “e” was added to the village to distinguish it from the county Down in Ireland), and it has had a number of renovations since it’s initial construction in the early 1700s.  The Darwin’s acquired Down House in 1842, when Darwin and his wife (and first cousin) Emma (nee Wedgewood) wished to escape the hustle and bustle of London with their growing family (at the time they had two children and were expecting a third).  Darwin, in his characteristically frank style wrote, “It is a good, very ugly house, with 18 acres.”, though I think many today would disagree with this assessment!

 

Down House as it is today, with a very excited tourist.

Down House as it is today, with a very excited tourist.

 

Over the course of his 40 years at the house Darwin enlarged it not only for his growing family (he and Emma had ten children, though only 7 survived to adulthood), but also for the comfort of his servants.  Writing to family he said “It seemed so selfish to make the house so luxurious for ourselves and not comfortable for our servants “. One of Darwin’s many interesting (and noteworthy) traits was his humanism.  He was an avid abolitionist (a disagreement with Captain Fitzroy on this subject almost got him kicked off the Beagle), a kind “master” to his house staff, a loving and involved father (an anomaly in Victoria times), and supporter of the humane treatment of animals.

 

Today the name Charles Darwin calls up images of a great scientist, a deep thinker, and a major contributor to human knowledge.  However, this certainly wasn’t the future his family imagined when Charles was a youth.  As a boy he received a classical education at Shrewsbury School.  This was not an education that paired well with young Charles’ interests of beetle collecting (then a national craze), chemistry, and shooting.  His father, a respected physician, is reported to have said “You care for nothing but shooting, dogs, and rat-catching and you will be a disgrace to yourself and all your family.”.

 

After his mediocre performance at Shrewsbury School, Darwin was sent to Edinburgh to follow in his father’s footprints and become a physician.  Alas (or fortunately, for the future of science), Charles could not stomach the brutality of surgery in the era before anesthesia, and he returned home after less than two years.  He was next sent to Cambridge to earn a degree so that he could enter the clergy (entering the clergy was a common career path for men from good families with a penchant for natural history).

 

While Darwin did complete his degree at Cambridge, he never went on to study for the clergy, as he was recommended by a mentor to accompany Captain Robert Fitzroy on the Beagle. Darwin wasn’t the first young naturalist recommended for the job (he actually wasn’t on the boat as the naturalist, though he did later rise to this position, his “job” on the ship was to act as Fitzroy’s companion- a gentleman that a captain could talk to amongst a ship-full of burly sailors).  While his father did not support this decision he did eventually let young Darwin (he was 22 at the time) depart on this adventure at the recommendation of Charles’ uncle Josiah Wedgewood.

 

The expedition aboard the Beagle was meant to last two years, but it stretched into a five-year endeavor.  Darwin’s observations during this travel were instrumental in shaping his thinking and his future.  It is rather fascinating to realize that Darwin’s 5-year, around-the-world journey aboard the Beagle was the only travel he ever undertook.  He returned to England in October of 1836, married in January of 1838, and in September of 1842 took his growing family from the strictures of London to Down House where he would spend the rest of his life.

 

Once at Down House, Darwin preferred to correspond with friends rather than travel back and forth to London.  He was a prolific letter writer- spending the equivalent of thousands of pounds per year on stationary and postage.  While it does seem that Darwin was a bit of an introvert, this insular life was largely a result of ill health.  Once an active and lively young man with a penchant for exploring and shooting, he was plagued with illness after his return from the journey aboard the Beagle.  His symptoms, which were present in varying degrees for the rest of his life, included a number of GI problems, palpitations, and extreme fatigue.  There have been many theories about this illness, ranging from Chagas disease to Chronic Fatigue, including lactose intolerance, Crohn’s disease, and psychosomatic disorders.  Whatever the cause, this illness debilitated Darwin, and at Down House he developed a schedule around his symptoms- working when he could and resting when he must.

 

The Sandwalk at Down House, also sometimes known as the Thinking Path, was where Darwin would walk three times a day (health permitting).  There is a walk down around the property with a loop in the woods, and Darwin would walk laps on the circuit deep in thought.  He would kick rocks from one side to the other to keep track of his laps, as his mind was usually on matters other than his number of "reps".

The Sandwalk at Down House, also sometimes known as the Thinking Path, was where Darwin would walk three times a day (health permitting). There is a walk down around the property with a loop in the woods, and Darwin would walk laps on the circuit deep in thought. He would kick rocks from one side to the other to keep track of his laps, as his mind was usually on matters other than his number of “reps”.

 

Down house wasn’t only Darwin’s home, but also the place where he conducted many experiments – on pigeons, barnacles, orchids, and weeds- work that was instrumental in supporting his theory of natural selection.  Of course Darwin was not the first person to suggest that species were mutable, but he was the first to convincingly propose a cogent mechanistic theory and support it with various lines of evidence.  Both he and Alfred Russel Wallace appreciated the implication of Thomas Malthus’ commentary on populations- that sooner or later populations were checked by famine and disease- and both men independently came to the same theory of natural selection based upon the pressures exerted by nature.  However, it was Darwin who first wrote about the theory (though he did not publish it) and who collected extensive evidence to support the theory.

 

The Hot House at Down House.  A collection of orchids and carnivorous plants are maintained here.  This is where Darwin hypothesized that the orchid Angraecum sesquipeda was pollinated by moth with a long proboscis.  This was discovered to be true, 21 years after Darwin's death.

The Hot House at Down House. A collection of orchids and carnivorous plants are maintained here. This is where Darwin hypothesized that the orchid Angraecum sesquipeda was pollinated by moth with a long proboscis. This was discovered to be true, 21 years after Darwin’s death.

 

The Kitchen Gardens.  Not much going on this time of year, but in summer these beds are full.  This is where Darwin did experiments on pin-eyed and thrum-eyed primroses.

The Kitchen Gardens. Not much going on this time of year, but in summer these beds are full. This is where Darwin did experiments on pin-eyed and thrum-eyed primroses.

 

The remnants of some of Darwin’s experiments can still be seen at Down House.  His hot houses (heated by composting manure!), where he maintained large numbers of orchids and carnivorous plants, are still maintained, as are the large kitchen gardens where he studied primulas.  A reconstruction of “The Worm Stone” that Darwin and his son Horace used to study the action of worms is in the garden, and English Heritage, who maintains the house, continues to dig experimental weed plots similar to those that Darwin constructed to study the succession of plants.

A reconstruction of "The Wormstone".  I was being optimistic when I took this pic, and hoped that I wasn't actually taking a picture of the septic system...

A reconstruction of “The Wormstone”. I was being optimistic when I took this pic, and hoped that I wasn’t actually taking a picture of the septic system…

 

Throughout my visit to Down House I was overcome with a feeling of awe.  I grew up with a deep respect and affection for Darwin- my father is a huge fan, to the point where my brother’s middle name is Darwin.  Being the second born I received an equally nerdy though significantly less well known middle name- Lyell.

 

Charles Lyell was a geologist (I actually wrote about him briefly in my first blog post!) and a well-respected scientist.  He was a mentor for Darwin, though it took him a while to come around to Darwin’s theory of natural selection.  He eventually did, and it was Charles Lyell and Joseph Hooker who presented Darwin’s and Wallace’s papers On the Tendencies of Species to form Varieties and On the Perpetuation of Varieties and Species by Natural Means of Selection to the Linnean Society in 1858. It was a thrill to see Darwin’s portrait of Lyell in his study, as well as various volumes of Lyell’s books in locations throughout the house.

 

Visiting Down House certainly increased my understanding of this great man, and also increased my respect for him.  He was a humble man, a hard-working man, a loving father, and a great mind.  He was also a troubled man- plagued with illness, profoundly concerned by the implications of his theory, and deeply scarred by the loss of children he loved.

This is a picture of Downe Church (not mine) where Darwin would walk every Sunday.  Darwin lost faith in religion after the death of his first daughter, and while he would walk his family to church on Sunday he would not enter the church.  This is where his wife, Emma, is buried (Darwin is buried in Westminster Abbey).

This is a picture of Downe Church (courtesy of wikicommons) where Darwin would walk every Sunday. Darwin lost faith in religion after the death of his first daughter, and while he would walk his family to church on Sunday he did not enter. This is where his wife, Emma, is buried (Darwin is buried in Westminster Abbey).

 

Darwin’s work on natural selection is a classical example of the scientific method.  As a naturalist, especially during his time aboard the Beagle, he made a number of observations.  These observations led him to a hypothesis (natural selection) that he then researched extensively.  He was not purely a “great thinker”, who came up with a theory, but also a patient and meticulous experimentalist who painstakingly showed that species were mutable through pressures of nature.

 

Sometimes in science, medicine, and certainly in the paleosphere we get stuck on an idea or a theory.  We latch on to something that just “makes sense” or fits in nicely with our current way of thinking, and we start to accept it as fact.  Seeing how hard Darwin worked to build evidence to support a theory, which on an intellectual basis was so obvious, reminds me how important it is to not stand on theory alone, but to work diligently towards better understanding through rigorous science.

 

Though sometimes controversial in the US, Darwin is well loved in the UK.  He had a distinguished funeral at Westminster Abbey and is interred near the monument for Sir Isaac Newton.

Though sometimes controversial in the US, Darwin is well loved in the UK (and is featured on the ten pound note). He had a distinguished funeral at Westminster Abbey and is interred near the monument for Sir Isaac Newton.

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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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I have spent only 5 of the last 25 nights in a bed (4 different beds, to be precise). At this point I feel a touch claustrophobic in bathrooms and feeling clean is certainly a novelty.  My Wilderness Medicine elective is over and I have had an exceptional visit in Moab (more on that in another post). Tomorrow I head to the mountains of Colorado for one last stint in the wilderness before heading back to New Jersey where I will start a radiology elective on June 3rd.  From a month in the wilderness to an elective spent in dark, windowless rooms- the change in environment couldn’t get much more extreme (which is saying a lot, coming from someone who has gone from alpine camping to desert camping in the course of 3 weeks).

 

This is the final installment of “Pic of the Day”, at least for the Wilderness Medicine Elective.  I may not be able to resist a “Pic of the Day, Moab edition”… we shall see.

 

For the desert portion of the course we headed to Canyonlands National Park, specifically The Needles District of the park.  We spent 4 nights in 3 different sites, hiking up to 12 miles a day with heavy packs.  I found this portion of the course the most physically demanding, but at the end of the day it was unquestionably my favorite section.

 

I’ll write details in future posts, but for now: Pic of the day- desert edition.

 

Day 1- Canyonlands

 

The geology of Canyonlands (actually, the geology of much of Utah) is stunning and fascinating.  This is in the needles are, near Lost Canyon, where we spent our first night in the park.

The geology of Canyonlands (actually, the geology of much of Utah) is stunning and fascinating. This is in the Needles District, near Lost Canyon, where we spent our first night in the park.

 

Day 2- Perspective

 

Looking back at Lost Canyon as we hike out to Elephant Canyon, our next campsite. From many vantage points in the park you could see the snow capped La Sal Mountains.

Looking back at Lost Canyon as we hike out to Elephant Canyon, our next campsite. From many vantage points in the park you could see the snow capped La Sal Mountains in the distance.

 

Day 3- Druid Arch.

 

Before we packed hiked our big packs out to Chesler Park, we took an early morning park out to Druid Arch.

Before we hiked our big packs out to Chesler Park, we took an early morning hike out to Druid Arch.

 

Day 4- The Joint Trail

 

Probably one of the coolest trails I have every hiked, winding through a narrow slot canyon.

One of the coolest trails I have every hiked, The Joint Trail winds through a narrow slot canyon.

 

 

Day 5- Sunrise and out.

 

We left camp at 4am for the 3+ hour hike out.  I led the group of 19 by head lantern for 2 hours before stopping on a bluff to watch the sun rise around 6am.  Pre-dawn hikes are something I will be adding to my repertoire.

We left camp at 4am for the 3+ hour hike out. I led the group of 19 by head lamp for 2 hours before stopping on a bluff to watch the sun rise around 6am. Pre-dawn hikes are something I will be adding to my repertoire.

 

I did not expect to fall in love on this trip, but I have certainly fallen in love with the desert.  I don’t know when I’ll be back, but I hope it is soon…

 

Chesler Park.

 

Chesler Park

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Into the Wild

No- this isn’t another post about books (though I did enjoy the book of this title by Jon Krakauer and I love the soundtrack by Eddie Vedder).  Rather- I wanted to let you all know what I will be up to for the next few weeks.

 

Wilderness Medicine is, well, kind of what it sounds like- providing acute medical care in various outdoor environments.  Being an outdoor person, this was an area of medicine I’ve been rather interested in exploring.  My school doesn’t offer a Wilderness Medicine elective but many schools do, and they generally welcome students from other schools.

 

A number of months ago I set to, looking at a number of Wilderness Medicine electives offered by other schools and organizations.  There are quite a few options, but one, run my U Mass, really caught my eye.

 

I should interject at this point to say that, due to the timing of my PhD defence, I started the clinical years of medical school half a year off schedule with most students. Unfortunately, that meant that when I started looking at wilderness electives, I was a bit behind the eight-ball timing wise.

 

A number of months ago I sent an e-mail to the organizers of the U Mass Wilderness Medicine elective enquiring if they took students from other schools.  They replied, kindly informing that they did but that the course usually fills up a year in advance (and it runs from the end of April for three weeks).  Somewhat disappointed, I set up my schedule for the remainder of fourth-year medical school, sans wilderness medicine elective.

 

Fast forward to three and a half weeks ago when, out of the blue, I got an e-mail from the program coordinator asking me if I was still interested in the Wilderness Medicine elective.  After some frantic shuffling of my schedule I was able to say yes, and have been hustling to get myself prepared ever since.

 

Bags are packed and I'm ready to go (both under 50lbs, though I'm getting close).

Bags are packed and I’m ready to go (both under 50lbs, though I’m getting close).

 

Tomorrow morning I leave New Jersey to head to Salt Lake City (and to think- I was there less than 3 months ago).  After spending a couple days meeting up with friends and seeing the sights of SLC, I meet up with the students, residents, fellows, and faculty who will be participating in the Wilderness Medicine elective.

 

The main reason I was particularly interested in the U Mass elective was because it is a 3 week elective taught almost exclusively IN the wilderness (unlike some other programs that do a lot of classroom-based learning and then have excursions into remote areas).

 

The elective is broken up into 3 components, an alpine section, a river section, and finally a desert section.  In each we receive faculty taught lectures, participate in scenarios, and hear (and give) student lectures (my topic is diarrhea and communicable diseases).  I’ll write more when I return, but this is what I know for now.

 

The alpine section

 

We head up into the Wasatch Mountain range where we set up a base camp that we will be living in for the next 6 days.  We snowshoe in with all our gear (apparently about 50lbs in our packs, plus pulling sleds, and then camp on snow for the next 5 nights.  Here we learn how to live in the alpine environment, the basics of mountaineering, avalanche training, how to lift and move patients with spinal injuries, as well as attend lectures on topics relevant to the alpine environment.

 

The river section

 

After snowshoeing out of the mountains we have a day to recover in Salt Lake City before heading to the Green River for the river section of the course.  Over the next 5 days we raft down the river (camping on the banks each night) and learn about water-associated injuries (drowning, of course), as well as other injuries and illnesses that occur in the bush, including fractures (and improvised splints), dislocations, wilderness dermatology, mammalian injuries, and evacuations.

 

After a transition day in Moab (where we can apparently opt to participate in outdoor activities of our choice, or perhaps enjoy a needed day of R&R), we then head to the desert portion of our course.

 

The desert section

 

Having had a chance to check out Moab, we head to Canyonlands National Park.  Here, we hike into the desert (in smaller groups, so as to decrease our impact), and set up camp for 4 days.  We meet daily for lectures on topics such as snakebites, heat illness and injuries, communicable diseases, wilderness toxicology, and other relevant topics while also learning skills such as orienteering and mass casualty training.

 

Throughout the course, in addition to many lectures, we participate in 12 “scenarios” which further train us for practicing medicine in the wild.  There will be 12 medical students, 4 residents, and 2 Wilderness Medicine fellows, as well as faculty.

 

I’ll be interested to see what happens when it comes to camp dinners.  They asked if anyone had “dietary restrictions”, with a special shout-out to vegetarians.  While I’ll be willing to eat things that I usually don’t consume (rice and beans, for example), I really hope I’ll be able to largely avoid processed foods, grains, and vegetable oils… we shall see.  I’m also a little nervous that I’ll get some foul looks for my choice of footwear.  The packing list suggests bringing hiking boots (or maybe hiking shoes) for the desert and river portion: I have neither, and imagine that trying to get some and break them in would not be a good idea (not to mention that I am kind of opposed to thick soled heavy hiking boots). Instead, I have my minimalist trail running shoes and my vibrams… I’ve climbed a 13er in Colorado with them, hopefully I can hack it carrying a heavy pack!

 

Up Matterhorn in Colorado, happy in my VFFs.

Up Matterhorn in Colorado, happy in my VFFs.

 

So there you have it- starting Monday morning (maybe sooner) I’ll be off the radar for large chunks of time (though you wouldn’t know I was on the radar with the frequency of my blog posts).  When the course is done, my best friend will be picking me up in SLC and I’ll be heading back with her to Colorado for a vacation before coming home to start a radiology elective in June.  On the way back to Colorado we plan to spend a couple days in Arches National Park- since I’m sure my appetite for the outdoors won’t yet be sated.

 

More posts to come!

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