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New Year in Dubai- part 2

I’m back! While I should probably be studying for my upcoming Ob/gyn exams (practical exam tomorrow, written test on Friday), I thought I’d take some time this evening to get part 2 of my trip to Dubai up.

 

As I mentioned in my last post, people in the United Arab Emirates (UAE) have historically lived either on the coast or in land at oases. Most of the major cities- for example Dubai, Abu Dhabi, and Sharjah – are on the coast, but there are some cities that have grown up around oases in the desert.

 

During my trip to the UAE I visited Al Ain, the second largest city in Abu Dhabi and the fourth largest city in the UAE. Al Ain was built around an oasis: a source of water and thus agriculture in the desert. From groundwater and runoff from the mountains, farms were built where water was found. I saw a number of oases, all which were extensively planted with date trees. I did also spy one farm where they grew lush grass- animals did not graze this land, but I saw men cutting portions and carrying the greenery to livestock (I saw it being fed to goats).

 

Looking over the Al Ain Oases. Al Ain also has a truly world class zoo.

Looking over the Al Ain Oases. Al Ain also has a truly world class zoo.

 

Another oasis, this one at a historic homestead.

Another oasis, this one at a historic homestead.

 

One more- this one was next to the oldest mosque in the UAE.

One more- this one was next to the oldest mosque in the UAE.

 

At some oases I saw pens of goats, chickens, sheep, and doves (I believe these are used for falconry training). Camels, which survive with much less water in much harsher lands, were seen roaming the deserts and dunes along highways. As we drove from Dubai to Al Ain, I saw many camel farms as well as camels being ridden and camels loose in the desert. We also passed a camel racetrack!

 

Speaking of deserts…

 

A highlight of my trip to the UAE was going on a “desert safari”. My environmentalist side felt a little guilty, but “dune bashing” through the dunes in an area known as “Big Red” (technically in Sharjah) was a lot of fun.

 

Stunning scenary

Stunning scenery

 

"Dune Basing." Let your tires down to 15psi, and make some tracks.

“Dune Bashing.” Let your tires down to 15psi, and make some tracks.

 

The landscape of the desert is incredibly different from anything I’ve ever experienced. I tend to find peace and happiness in green, wooded, and wild areas, but the dunes posses a beauty that is unlike any other natural environment I’ve encountered. We went dune bashing with another friend of my brother (another native Sharjan), who has been taking people out into the desert on safari for thirteen years. Going out into the desert is what he does everyday professionally, but when I asked him what he did with his days off and his evenings he said he spent them in the desert. It’s where he’s happy and it’s where he finds peace- a sentiment I can understand. Nature, in many forms, is deeply soothing.

 

The UAE gets very little rain. The cities, which aren’t designed with rain in mind, handle even a small amount of rain very poorly, flooding with even the smallest precipitation. Likewise, the sand of the deserts quickly forms an impervious surface when wet, and water runs off into deep ravines known as wadis- dry riverbeds.  If you’re ever camping in the desert, resist the urge to pitch your tent in a wadi- with even a small amount of rain you and your tent may be swept away in a torrent.

 

As someone who is named after the geologist Charles Lyell I was immediately fond of the these deep desert ravines that showed how water had eroded through many layers of rock, exemplifying the theory of uniformitarianism. I also really enjoyed the scenery as we went “Wadi Walking” through Wadi Wurayah in Fujeira.

 

Wadi walking.

Wadi walking.

 

I hope this gives a scale of these Wadi’s... Some of these scenes really reminded me of Indiana Jones and the Last Crusade, though that movie was filmed at Petra in Jordan.

I hope this gives a scale of these Wadi’s… Some of these scenes really reminded me of Indiana Jones and the Last Crusade, though that movie was filmed at Petra in Jordan.

 
This Wadi is home to the tallest waterfall in the UAE- I haven’t found it documented, but it’s probably 15’ max…

 

Record breaking waterfall.

Record breaking waterfall.

 

This is a good time to point out one of the serious problems in the UAE- garbage and graffiti. Every inch of stone at this waterfall was covered in grafitti, as you can see. A more widespread problem is garbage. I was deeply saddened (and annoyed) by all the trash that was around the waterfall and at other beautiful places. Despite the big signs warning against leaving garbage, there was no end of detritus.  I saw people actively throwing cigarette cartons, bottles, and food wrappers throughout the Wadi and at the beach in Dubai. I found the litter in the dunes most demoralizing. People would camp and make bonfires and leave all of their garbage strewn about the site. There were very few expanses of unspoiled sand.

 

On a day trip to Abu Dhabi I visited the Sheikh Zayed Grand Mosque, the largest mosque in the world outside of Mecca.  Most mosques are closed to non-muslims, but this one is open to the public… as long as you follow “Mosque manners”.

 

Sheikh Zayed Grand Mosque

Sheikh Zayed Grand Mosque

 

Mosque Manners

Mosque Manners

 

I obliged...

I obliged…

 

The Sheikh Zayed Grand Mosque is stunning. It is massive and beautiful, though the interior design is definitely not my style (perhaps I’m just used to the solemn interior design of churches, but I found the bright colorful baubles and chandeliers out of place). The flooring outside the mosque is marble, and when you take your shoes off (you’re not allowed in the mosque wearing them) the floor is surprisingly cool, despite the desert heat and sun, thanks to radiant cooling. Inside the mosque, bright carpet covers the floor, which is specially designed to be removable in pieces so that it can be regularly cleaned (in accustom with islamic rules).  There are also large digital displays on the wall with 6 times listed: dawn, and the 5 times at which muslims are supposed to pray throughout the day.

 

As you travel throughout the UAE, you see prayer rooms and mosques tucked away. Muslims are supposed to pray 5 times a day, and while they do not have to pray in a mosque or prayer room, it is preferred. These religious areas are labelled with women’s and men’s entrances, and I believe the “mosque manners” above apply to all. Certainly, muslims can’t always make it to a mosque to pray, and you occasionally see people get out a prayer mat, clean their hands and feet, and pray in a (relatively) quiet corner on a public street.

 

While out in Fujeira, we stopped at the oldest mosque in the UAE. It dates from the 1400s and is overlooked by 2 towers. The architecture is very unique.

 

The oldest mosque in the UAE. It has very unique architecture.

The oldest mosque in the UAE. It has very unique architecture.

 

As I mentioned in my last post, UAE law is deeply influenced by Sharia law, and Muslims may not eat pork (or drink alcohol).  Pork (and products with pork in them) is off limits and is kept in its own area in supermarkets. I really couldn’t get enough of these signs.

 

Look at the cuddly pigs on the wall!

Look at the cuddly pigs on the wall!

 

Also, while Dubai is a global city and quite tolerant, it remains relatively conservative in comparison to the western world. There are many requests for modest clothes (I awkwardly toured the Emirates Palace Hotel in Abu Dhabi  trying to conceal my flip flops), and public displays of affection are generally frowned upon if not expressly forbidden. (Also, weekends in the Muslim world are Friday and Saturday.)

 

No kissing (unfortunately I cut off the top right with the request that people wear clothes that cover shoulders and knees.

No kissing (unfortunately I cut off the top right with the request that people wear clothes that cover shoulders and knees.

 
Dubai initially grew along an inlet from the ocean known as “Dubai Creek”. As time passed, the creek became used as a port for traders. As trade increased, the decision was made to develop the creek further, and it was dredged and reinforced so that it could be used for major trade. The creek remains an important port, though it is no longer the dominant port in Dubai (this has fallen to the Jebel Ali Port).  Water taxis (known as Abras) shuttle people across the creek, and we took a trip across (for the cost of 1 dirham, about $0.27).

 

Abra

Abra

 

One thing you notice all around the UAE are pictures of the various sheiks that rule the emirates.  Large portraits are on buildings, signs, and posters.  Here’s just one example.

 

Sheiks

Sheiks

 

Part 1 of my trip to Dubai started with the Burj Kalifa, the tallest building in the world, so it seems appropriate that this post should come full circle.  I left Dubai on the morning of the 1st, after watching New Years fireworks. No picture I took can do them justice, so here’s a video of the show.

 

 

The Dubai fountains also featured heavily in the show. I only saw them during the day, but that’s another site worth seeing! (Talk about the land of excess!)

 

this is seriously worth watching…

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As an evolutionarily minded medical student, you can sometimes feel a bit alone in the crowd of conventionally minded medical practitioners and students.  I’ll admit that I’ve been repeatedly impressed with the interest that many of my fellow med students (as well as residents and even some attendings) show the ancestral/evolutionary ideas that I sometimes talk about, but most generally find an evolutionary approach to health and wellness interesting, rather than integral, in the consideration of health, wellness, and disease. 

 

I am not, however, alone.  There are a number of MDs and DOs who are interested in bridging the gap between ancestral health and western medicine.  There is a budding new organization of Physicians and Ancestral Health (with a winter meeting in February that I hope to attend), and there are other medical students who share a passion for thinking about modern medicine in the context of ancestral health. One such medical student is Angela Arbach, a student at Cornell Medical School currently doing research during a year long sabbatical between her third and fourth years of medical school, who I had the pleasure of meeting at the Ancestral Health Symposium in Boston in August.  There we had a long chat about our shared interest in evolutionary and ancestral medicine, as well as our specific areas of focus (she is passionate about women’s health and infectious disease).  I didn’t know it at the time, but Angela would soon be winging her way to Africa, where she would be involved in an international nutrition research project. When we recently caught up over e-mail I asked if she’d be interested in sharing her experience on my blog.  Her travels and observations are something that so few get to experience but so many could benefit from pondering. 

 

With out further ado: an ancestrally minded med student abroad.

Fresh from the Ancestral Health Symposium (AHS), after several days home in NYC and then a national boards exam in Philly, I was on a 4-hour bus trip to upstate New York to finalize plans for a research project in international nutrition.  A month later, I was on a plane to Northern Uganda: a nation in the global south, devastatingly resource poor, with an uncomfortably recent history of conflict.  [Check out the doc Uganda Rising, on youtube, for more history and a quick but imperative summary of colonialism in Africa].  It’s also a beautiful place.  From polychromatic garb to the giant layered sky underscored by the surrounding savannah, there is no shortage of images to appreciate.  The Acholi people, the dominant ethnic group of Northern Uganda, are still close to their traditional roots despite colonization and the recent influx of modern technologies.  When the English arrived, they left their development plans out of the north, making it easier to forcibly enlist Acholi men in the security forces.  And then, after independence (50 years, last month!), the north remained isolated and underdeveloped due to the LRA insurgency.  The Nile River, separating Acholiland from the rest of the country, only aids in this political and cultural divide.  For these reasons, an AHS-primed brain finds many cultural practices as fodder for rumination, along with prompts for contemplating our role in a global context.  Below, I will describe some of my earliest observations in this complicated milieu.

First, of course, the food.  It starts with starchy staples, mostly sweet potatoes, millet, rice, maize, sorghum, cassava, squash, and plantains.  These starches are used to scoop up, usually by hand, some combination of beans, peas, sesame seed paste, and, if you’re not incredibly food insecure, goat, fish, chicken, beef, or offal. The modicum of nonstarchy vegetables is nearly always cooked: the beans and meat stews are boiled with small pieces of tomato, green pepper, and onion, and a common side dish is boiled leafy greens.  I recently read an account of a Ugandan grandmother’s reaction to Western salads, laughing and asking how people can be healthy eating these raw foods since humans are not goats or cows.  The author explained how cooking all vegetables is a protective tradition, as soil and water is often contaminated by waste, but I wonder if there is more to it.  Fruit is eaten raw, however, and the most common fruits I see are bananas, oranges, jackfruit, mangos, avocado, passion fruit, and watermelons.  In terms of ferments, I’ve only heard of bongo (fermented milk) and the various alcoholic homebrews, usually from banana, maize, sorghum, or millet.

Example meals:  a plate of sweet potato and posho (stiff maize porridge) with a bowl of beans in a sesame paste sauce; kwan kal (stiff millet porridge) with boiled greens, tahini mixed in the green water; rice with a bowl of smoked goat meat stew.

fresh fish, sesame pasted greens, stiff millet porridge, sweet potatoes

One of my favorite meals, also an Acholi staple, is sesame paste mixed with mashed, cooked pigeon peas (dek ngoo) drizzled with dark shea nut oil (moo yaa).  Eat this by dipping in pieces of sweet potato or kwan kal.  These are typical lunches and dinners.

dek gnoo and moo yaa, with stiff maize porridge rice on the right

Breakfast is varied.  Some skip it, especially if they live in poverty and work all day (sure, call it a “feeding window, or just malnutrition).  Milk tea and milk instant coffee are very popular, with a milk-to-water ratio of 1:1 loaded up with table sugar.  The milk here is delicious– largely local and grassfed, it tastes so rich and sweet (a Ugandan colleague’s wife, who lived in the US for a year, told me “American milk doesn’t taste like milk”).  Millet porridge is served in some schools for breakfast.  A popular drink for children is milk, fermented or fresh, mixed with some kind of grain (I’ve heard millet or corn).  More common outside of the north, but still present here, is katogo:  stewed plantain or banana with offal or groundnuts.  Groundnuts are very similar to peanuts, and people buy them roasted for breakfast or snacking.  Groundnut stew (similar to a mild peanut sauce) is common elsewhere, but sesame paste stews are more common here.  Overall, the food variety is less than other places I’ve traveled, and the dishes are quite plain with little spice or herb additions– low food reward, perhaps.

That all sounds wonderful, but I left out a big part of the common diet:  wheat, vegetable oils, and soft drinks.  All new additions to the food tradition, sometimes supplanting old foods.  Indian influence means chapati and samosas are common street foods, cooked in vegetable oils, of course.  Loaves of bread are becoming a staple, as well, and some people eat it with a schmear of sesame seed butter for breakfast.  I was happy to discover how common eggs are, but if I eat out, they are always fried brown in veg oil.  So it goes.  Within the ubiquity of food insufficiency in a context of very limited healthcare, I fear the implications of substituting already meager dietary items with these industrial foods.

Modern staples: vegetable oils, toilet paper, and soda

Walking around, I see people in positions that could be in Gokhale’s book.  The women work hard– constantly bent over to cook, wash dishes, do laundry, and clean floors (brooms are 2-3 feet long and made from reeds, mops are rags that you move with your arms).  They stay bent at the waist with perfectly straight backs, motivating me to keep stretching the hammies…

Women at work

 Some of these chores are done squatting, too.  Otherwise, the women can be seen transporting heavy objects on their heads, from 5 gallon jugs of water to sacks of grain.  This is all done with a baby wrapped to their backs.

I could be wrong, but perhaps these practices are the reason I see less postural kyphosis in the elderly ladies.  Also, I should mention that gyms are nearly nonexistent, and the only time I see running is when people get caught in the rain, are playing football (soccer), or are white people doing aid work or research (that’s me! But my research involves too much time at a desk).  Strenuous jobs are the norm, and most people don’t have cars.  Walking and bicycling are the rule.  Most of the footwear I see are thin sandals (minimalist), and it’s common to see barefooted people walking around, especially outside the towns (poverty).

About 100 years old, but I’m told these are still made in some villages

The lack of street lamps, along with daily power outages, and the fact that the vast majority of homes don’t have access to electricity, means that people generally experience natural darkness as the sun sets.  I’ve been heading to bed much earlier, especially since I cannot sleep past 5 or 6 am due to the roosters.  If I go to bed early enough, I often wake up in the middle of the night for an hour or so before a “second sleep”.  One of my colleagues (a Ugandan) does this, too, but I cannot generalize beyond us.  He and his family sometimes take a little siesta after lunch, too, which I can certainly get behind.  I can also check off items from the recent MDA post on hormesis.  I already mentioned the exercise and calorie restriction, and sunlight exposure is a given in a country on the equator.  Also, without modern conveniences such as electricity and hot water heaters, all showers are cold showers!

Another topic I want to touch on is Acholiland’s continued tribal culture.  Traditional dance and music is at the heart of this.  I frequently hear drums in the distance as I walk, and I’ve seen groups of students in universities meet up for dances in the grass.  For more on the healing power of traditional music and dance, track down the 2007 film War Dance, an incredibly beautiful but heartbreaking story about school children in Northern Uganda.  I have yet to read my book on the history of the Acholi tribes, so the majority of my info is from conversations with Ugandan friends, one of whom is the designated leader of his clan.  The presence of tribal culture is strong, the sense of belonging is crucial, and excommunication from your clan is considered a punishment worse than death.  Clan leaders are still called upon to resolve disputes or offer advice.  [See the Al Jazeera documentary, Bitter Root, for how these traditional practices lead to reconciliation, rather than retribution, for former abducted-children-turned-rebel-soldiers, taking the justice system from the hands of the government to the realm of tradition].  Distant relatives are sometimes described using nuclear family nouns– the son of your grandpa’s cousin’s kid is your brother– and everyone feels a sense of responsibility and goodwill towards other members of their clan.  This sounds like ubuntu, the topic of Frank Forencich’s talk (Africa reference?) at AHS, which I missed because I had to run back to New York that day.  I should mention that everyone here was thrilled when Obama won, and they often cite that sense of brotherhood they get from him, along with his more skillful way of taking care of the poor.

That’s my account so far, but remember that some of this information came from people who may want to tell the foreigner something interesting, rather than common, and then that data is filtered through my biased brain.  And of course, I can’t talk about these things without sprinkling in some political, economic, and social issues facing the Acholi.  An ancestral health picture is nice, but it’s not complete.  Acholi tradition has been undermined by forced migration into internally displaced peoples camps for over a decade, ending merely a few years ago, preventing the practice of many cultural rituals.  They were without land, independence, and other means to continue traditional livelihoods.  On a few occasions, I’ve been able to informally talk with Acholi elders.  They never fail to remind me how the IDP camps destroyed their peoples’ culture and morals, as well as fostering drug abuse, rape, and disease.  And yes, the foodways and hormesis sound great, but people are starving here.  Naturally active livelihoods are awesome, but not when they are the result of extreme gender inequality where women have no choice.  It’s sweet and heartwarming that man-on-man handholding is so common– brotherhood, right?  But it’s scary that the same affection towards your wife is risqué, or that you could be killed or imprisoned if you engage in love outside the bounds of heteronormativity.  Blame it on the proximate lack of education, former colonialism, or widespread Christianity, but it’s happening.  And let’s not start on the infectious diseases, government corruption, illiteracy rates, motor vehicle accidents, and lack of good healthcare.

So what can we learn from these people, a group so geographically close to the Hadza, Batwa, and Karamojong, close to some of the earliest human remains in the archaeological record?  The answer seems largely irrelevant.  We have a lot of the answers we need about diet and lifestyle.  Perhaps this is a case where we should ask:  what can we give of ourselves?  The ancestral health community has gained a lot from the study of indigenous groups, so what can we do in return?  How will we enable empowerment and protect culture?  American health trends have a global effect, so how can we be the example of doing this in a positive way?  Why was the apropos panel on Reclaiming Latino Health so under-attended, compared to the lamentable, stale debate on… potatoes?  Were we fighting with the Pima to protect their water?  Has anyone heard of the Decolonizing Diet Project?  And for the egocentric: more preservation of cultural heritage means more research opportunities to figure out the perfect post-workout meal…  I mentioned missing Forencichs’ talk, but when I read how greatly he inspired people, I looked him up and found this relevant post.  Adele Hite, a speaker at the symposium, gave a list of ways to become more involved than just frequently-commenting-on-blogs.  Her examples largely involve the USA, but I don’t see why our scope cannot transcend self-created national borders.  This already happens in research and blogging, so why not in action?  Involvement in other cultures demands care and scrutiny (you want to avoid dead aid), but I think this community is smart and thoughtful enough to create a significantly net-positive effect.  We’re crafty people, and we’ve already accomplished so much.  Some organizations are doing exciting, ancestral-health-minded things, like this medical clinic in Burundi.  They started a native foods garden, along with the administration of agriculture education programs, to combat widespread food insecurity that took place after the civil war and genocide– a nice solution to what many food aid programs stick a bandaid on by creating relationships of dependency using their culturally inappropriate bags of wheat and jugs of vegetable oil.

I’m merely a student, so I cannot provide all the answers, but I hope the bulk of my career will work on these issues.  I think this community is also up for the challenge, as evidenced by the last symposium.  The blogging about micro/macronutrients is dying down, and our focus is getting bigger:  public policy, remarkable research projects, interventions, activism, creation of med student electives, and the introduction of evolutionary health into workplaces and grand rounds.  I’m not saying that global issues and cultural preservation need to supplant the other amazing endeavors born from the synergy in the ancestral community, but I look forward to more attention to these topics.  They are not tangential, but fundamental, to progress for us all.

Angela is a medical student at Cornell in NYC. If you’d like to read more of her observations (with less focus on ancestral health) you can check out her travel blog, I highly recommend it!  

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