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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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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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