The Middle Way of Scouting

My son has recently joined the Cub Scouts, a part of the Boy Scouts of America (BSA), and his participation in this venerable organization is causing me some angst, forcing me to examine thoughts and feelings from my own Buddhist perspective. 

Firstly, BSA is an organization that does not have a stellar reputation for "inclusive" practices, having won a June 2000 Supreme Court decision allowing it, as a private organization, to exclude certain members based on non-Christian beliefs or homosexuality.  This is something that I'm not happy with and question whether I want my son being influenced by an organization that excludes members based on these criteria.

Am I attached to my beliefs, and therefore struggling with my views on the BSA?  I believe so.  Am I practicing "exclusion" by shunning an organization that does not follow MY beliefs?  Again, I think so.  Do I want my son to miss out on the myriad of "benefits" of scouting?  No.

So what I've settled on is the Middle Way, no organization is going to be perfect, or imperfect for that matter.  BSA is what it is, and my son should experience it for just that.  Critical decisions about membership and exclusion can be his to make when he's old enough to question them for himself.  Until then I will continue to examine and practice, but I'd like to hear from other Buddhists on this topic.

Lesson Learned

A lady peers out her window in a pro-Chavez Caracas neighborhood.  She was curious about the gringos outside of her house, but decidedly cold about it.

Back in Atlanta but not after a bit of drama leaving Caracas this morning.

I was notified last night by TripIt and Delta Airlines that this morning's early flight back to Atlanta was delayed by two hours.  Perfect, now it wasn't such an early flight and I could grab a good breakfast before the team and I left for the airport.

Arriving at the airport still three hours before the newly scheduled take-off I found the Delta ticket counter all but deserted.  This was odd because one would normally expect mayhem on a flight coming out of Latin America to the States.  No one was around except a lone agent.

My first thought was that the flight was canceled all together, but the agent said, "No, it takes off in three hours".  As I threw my bags on the scale he told me that I can't check in because the flight is already "closed".  Huh?!!

Apparently even though the flight is delayed and the airline goes to great effort to tell you this so that you will not be inconvenienced, in Caracas you still must check in at the scheduled time regardless of when the flight is going to depart.  I lost my mind as I stood there with bags in-hand not being able to check in on a flight that departs in three hours.  Luckily one of the members of the team that I was with is rather noteworthy and was able to convince the Delta Airlines Station Chief to contact the Venezuelan security to re-open the flight for us.

The learning point for me is not to get too cocky with information and familiarity when traveling.  Every airport is different, and they're changing all the time.  What you might think is reality in Atlanta doesn't count at all in Islamabad or Quito, regardless if it's a major carrier or not. Lesson learned.

Election Day

What do you do in Venezuela during Election Day?  Your options are pretty limited as everything is closed while the country votes its legislature.  Don't even think about drinking alcohol as the entire country has been "on the wagon" for the last three days,  I suppose someone doesn't want a bunch of intoxicated people participating in democracy, as if somehow the results would be different :)

A Word On Women

This is actually a little girl who was attending a street political rally, but I admired her attempt at being fashionable.

In the 90's I spent a lot of time in Venezuela and the one thing that was always a constant was The Question.  When you climbed into a taxi and the driver realized that you were not Venezuelan, the very next thing out of his mouth was the trivia question: How many Miss Universe have come from Venezuela? I forget the answer, but it was some outrageous number and clearly a point of national pride. 

Yes, the Venezuelan women, a mix of Latin and Caribbean cultures, were put together well.  Having said that, all of this "put together-ness" takes time and effort, an immense amount  I imagine.  The English phrase that gets bandied about for this effort is "high maintenance", and for years I've searched the Spanish lexicon for a similar phrase.  There isn't one.  The fact that there is no easy way to describe a woman (or man) who is fastidious about their appearance and spends inordinate amounts of time keeping it so speaks volumes about this culture. In other words, the attribute of being "high-maintenance" is so inculcated into the lives of so many Venezuelans that it's accepted as normal and does not need to be described, it just "is".

Shots From Today

Hanging out on the street looking cool

The Look

This little guy lives in what can only be described as a gated Socialist community.

A lone tree stands in the fog

Brothers I think

Uncle Simón

She wouldn't stop smiling.  Awesome.

This little guy was really shy, but we turned it into a game.

Caracas Emergency Department

A final word on moto-taxis.  No, this is not me on the back.  There are so many of these things whizzing around that an inspiring photographer could make a collection of shots like this.

Last night I toured a Caracas Emergency Department and I've come to the conclusion that most third-word hospitals are the same: short on supplies and long on sick people.  The entrance to the building had all the charm of an East German jail, complete with bars, a sleepy guard, stained tiled floors, and blinking florescent lights. Continuing through the waiting room there was the normal cast of the sick and sleeping laid out on cold metal benches oblivious to one another.

When I walked into the ER all I could see was rows of beds behind a single, long curtain.  Every patient had an IV drip, which I took to be a good sign, but my optimism ended there.  No gloves or masks for the staff, shockingly limited medications, blood-stained floors and sheets, and some of the worse X-rays I've ever seen. 

I spoke with some of my colleagues, pointing some things out and cautioning them not to judge too harshly.  The hospital staff was clearly doing the best that it could with what meager supplies the State had given them. I spoke with the attending physician, he quietly detailed of the nightly struggles to make due with what he was given.  The nurses sang the same tune, each day the staff had to make decisions about which patients got what was left of the dwindling supplies.  This was not a place to be sick, and I couldn't help but hearken back to my death-defying moto-taxi ride that morning.  If we had had an accident, this is where I would have ended up, possibly for good.

Not A Good Idea

All the rage in Caracas.  I like this shot, it reminds me of someone sneaking a glance at something that they shouldn't.

Today I did something that I swore years ago that I would never do.  I took a moto-taxi through the streets of Caracas trying to beat the traffic in order to get someplace quickly and meet a deadline.  For those that are unfamiliar with this mode of travel; one sits on the back of a small motorcycle, sometimes even wearing a cheap helmet, and the driver weaves his way at breakneck speed between the slower cars and trucks.  If you think this sounds stupidly dangerous, you're getting the idea. 

The moto-taxi "lane splits", or in other words rides between the lanes in order to by-pass traffic.  For those that are familiar with Latin America you know that there really are no lanes per se. I sat on the back as the teenage driver decided to show me his latest Moto-GP skills, ripping past cars, diving in front of trucks, and running red lights.  (If my mother is reading this…. it was someone else, not me).  I came out of the adventure unscathed, but a bit disappointed that I would allow myself to take such stupid chances.  One of the people on the trip remarked that it was a lot of fun to ride like that.  I couldn't help but think of the crass joke that compares motorcycles to prostitutes; both fun to ride, but neither necessarily a good idea.

Ensuing Crisis in Venezuela

A little girl helps her father campaign on the streets of Caracas. The upcoming elections will guide this country through the ensuing economic crisis. The pamphlet reads, "You Have The Power".

Venezuela; this is my third or fourth time here in the as many years.  There are things that I tend to forget and must re-learn upon each visit.  This morning's lesson came during breakfast: this country is devoid of all concept of personal service.  You can sit in a restaurant, and a very nice one at that, and wait an eternity for a refill on a cup of coffee.  Most places that I've stayed at the staff is standing by with an IV if you require a constant stream of coffee in the morning.  Venezuela, not so much. 

People have jobs here, and with tight, socialist labor laws they've been very secure in their employment. Secure to the point that there is no need to fill up your cup of coffee, no one is going to loose their job over incompetence.  Now enter 30% inflation.  Consumer prices are rising and businesses cannot keep pace, they are either going to have to cut costs (labor) or be forced out of the market.  This is the polemic that Venezuela is facing today, and the reason for my week-long visit.

The Buddhist Paramedic- Deepening Compassion

A mountain-top antenna extends skyward through the clouds and mist.

I was approached on Facebook by a Zen Buddhist priest who asked me about becoming involved in Emergency Medical Services (EMS) as a future vocation.  The conversation is still ongoing but its one that I'm very excited to have.  I can think of no other job that will deepen a Buddhist practice more so than EMS; I say that with a bit of a sarcastic undertone.

If you stay in EMS long enough you encounter terms like, "burnt-out" or "jaded", and I asked myself what exactly do those mean.  After some brief consideration the answer that I arrived at is a paramedic or EMT that has dealt with the world's sick and pseudo-sick for so long that they no longer can dredge up any empathy or compassion for their patients.  To be accurate, as a good friend pointed out, this is not only limited to EMS but also extends to nurses and physicians as well. 

Enter the Buddhist.  If you want to become physically stronger you have to stress your muscles so that they grow and develop.  Likewise, if you desire (ouch!) to become more compassionate you have to place yourself in situations where this emotion is stressed and tested: EMS.  The practicing Buddhist paramedic is tested everyday with the hoards of drug-seekers, EMS abusers, the pseudo-sick, people craving attention, uncaring medical staff, and of course uncaring family members.  Its a world that over time whittles away at one's compassion, and ability or desire to emotionally connect with patients. What better place for a Buddhist to find greater empathy and compassion?

Begging To Be Said

 A woman begs on the street of Istanbul.

Driving down the street this morning through a busy intersection in south Atlanta I noticed several high school-aged football players walking in between the cars collecting money.  Ostensibly they're trying to raise money for equipment, which I know is very expensive, or maybe a trip someplace.  Whatever the reason the players were walking past the waiting cars collecting money in their helmets.

What happened to car washes, bake sales or some other "productive" activity designed to raise money?  Since when did coaches start teaching their players to beg?  Let's face it, that's what these guys were doing. What sort of life-lesson is this imparting on the players? 

I grew up as an athlete so I'm intimately familiar with the valuable lessons learned from being a member of a sports team.  Never in my experience did any of those lessons include begging for money, regardless of how effective the technique may be.  Do the ends justify the means in this case?  Does the ability to purchase needed equipment outweigh the lesson that it's alright to stand on the street corner, next to the homeless, "will work for food" guy and beg for money? I would strongly argue that it does not.

3G and Ferrari

 The littlest ice-cream vendor, helping out her father in the market. Ding Ding

I'm heading out of El Salvador soon.  It's been a good trip, traveling to Latin America is a bit like coming home for me.  I found the country to be amazingly well-developed, a lot of work has been done since my last visit some years ago.  The highlights were finding an Apple Store in one of the large, modern malls, a Ferrari dealership is down the street, and 3G and Wi-Fi everywhere.

It's funny what we use as metrics for development.  In the past I've taken notice of a country's children.  In other words, if the children are clean, well-dressed (wearing shoes), and heading to/from school you can bet that that particular country is well on the road to future development.  On the other hand if the children are playing barefoot in a muddy street, wearing the same clothes day in and day out, well…

Now pretty much all of Latin America is fairly development so my metrics are changing; is there 3G, a Starbucks, a mega-bookstore, and restricted smoking areas. That pretty much sums up economic development in this part of the world. Hasta luego.

Appearences

I watched a protection detail ride past yesterday.  Four police motorcycles, a large client SUV and a police trail SUV.  I wondered which vehicle the client was in; it was pretty obvious.  My thought was that this was simply the appearance of security and had nothing to do with actually providing or achieving security.  The detail would have been better off dropping the police escort and letting the VIP drive around the city in his unmarked SUV.

Similarly, everywhere you look in San Salvador are uniformed static security guards armed with ill-cared for shotguns.  Even a casual observer could discern again, that the guards are only for appearance sake and have no effective use.  Unfortunately this is all-to common in Latin America, it is better to have the appearance of something, such as security, than actually achieving it.  My previous post on ambulances is another example of the same concept.

The concept of appearance can be extrapolated and used to explain many of the social and cultural aspects of Latin America.  Another example is the appearance of wealth.  A long time ago I lived in Santiago, Chile, and not far from my house was a massive grocery store with unspeakably expensive items imported from all over the world.  Each Saturday countless woman would shop the aisles filling their carts with the most extravagant items. They would then stop off at the coffee bar in the middle of the store to chat with their neighbors about the parties they planned to throw and peer into each others baskets.  At the end of the day they would leave the basket in the aisle and slink out of the store unnoticed by their friends, being totally incapable of purchasing any of the items they had selected. 

The Good People of Gringolandia

A Salvadorian lady sits behind her door and watches the world walk by

I try to have a chat with every taxi driver that I meet.  Not that they're any great fount of wisdom but they normally have some good insight into politics and the social condition.  Tonight's conversation went like this:

Me: "How's it going tonight?  How's business"?
Driver: "Slow"
Me: "Why's that? The weather"?
Driver:  "No, there's not enough money".
Me: "Oh, why not"?
Driver: "Mr. Obama isn't giving us any money".

The conversation abruptly ended there. What do you say to that?  I suppose I could go into a triad about American tax dollars belong to the American people, i.e. those who actually pay the taxes, but that will have fallen on deaf ears.  (I use "American" to mean the United States… so lets not nit-pick.  I'm fully aware of the technicalities.)

This is a common perception, at least in Latin America, that the United States is "rich", and has an obligation to give money to lesser-developed countries, like whatever one I happen to be in at the time.  I'm all for giving money for development, access, influence… something that benefits the good people of Gringolandia, but to just outright gift U.S. tax dollars goes against my grain.

Squad Cincuenta y Uno

I visited a Salvadorian health fair the other day.  At the entrance were two brightly colored ambulances set out as a static display with all of their associated equipment laid out for the public to view.  The two trucks looked brand spanking new and were marked "Emergency Advanced Cardiac".  Of course I was attracted to this scene like a hungry trout to a fly and rushed right over and started digging around, much to the consternation of the women running the display.

A couple of bags of IV fluid, a ratty cot that was jerry-rigged to lock into floor of the truck, and an automatic defibrillator much like you see in the malls in the United States but wrapped in plastic. One of the physicians/nurses(?) asked if I wanted to stick my arm in the automatic blood pressure cuff to see "what my number was" to determine how healthy I am. Really!!?

I'll admit that the ambulances from the outside were immaculate and very impressive, clearly nicer than what I'm used to in Atlanta, but given what they lacked in equipment would not even be allowed on the streets in the United States or Europe.  This is typical of much of the third world, parts of Latin America specifically; bright, shinny things that give the appearance of competency but with little or no substance underneath.  Someone invested a lot of money in a couple of spiffy ambulances but decided the capability or reason for them was secondary.  Why not take the same money and purchase the needed lifesaving equipment and stick it all on an old, beat-up ambulance? If I'm a seriously sick patient I don't care how nice the truck looks, only that I'm getting an advanced level of care in the back.

Maybe I'm being too critical.  Maybe they have all of drugs, monitors, airway kits, ultrasound, and other gadgets but just chose not to put them out on public display.  Having spent most of my life in and out of this part of the world and having worked in it's ERs…. I doubt it.  My regret was that I didn't take any pictures of the trucks to show my fellow medics in Atlanta.  They were seriously impressive.

Walking Through Oz

Salvadorian family walks through the neighborhood

Walking through San Salvador yesterday I was warned about roving gangs of youths that would rob tourists or other unsuspecting, lucrative targets.  This is a common practice throughout the world but is easily countered with a few simple actions.

• Find out where the high risk areas are, and avoid them.
• If you have a guide or driver, trust their judgment.
• Don't take valuables with you. Hiding them in what you think are clever areas, i.e., belly or waist pouches is a useless tactic.
• Stay in well-populated areas.  Don't get lured off.
• Stay together.
• Be aware of your surroundings.  If something doesn't feel right, it's not. Move back to safety.
• If you have a driver, keep the car handy, know where it is.
• Be purposeful in your posture, demeanor, and actions.
• Keep things tucked away; cameras, cell phones, wallets, watches.  If it's out there, it'll get taken.

Mi Cuerva

El Salvadorian beach near Puerta Libertad

It rained last night.  I sat in the tiny patio space that is part of the hotel, surrounded by hundreds of tropical plants, an umbrella overhead.  Under my feet were flagstones, wet with the warm rain.  It was a space that people strive for in their own homes and gardens, but few in North America ever fully achieve.  There is nothing contrived in the patio garden just hundreds of plants potted in whatever containers were available at the time. It was like sitting in a room made of vegetation, tight, intimate, and deeply personal.

The first time I saw something like this was at the home of my Spanish language professor in Monterey, California.  He had a small deck that was part of his 2nd floor apartment and he had turned it into a tiny tropical rain forest.  It was really only large enough for two people to sit in, a Mexican terracotta chiminea glowed off to one side, the air smelled of wood smoke.  Plants surrounded you on all sides and covered you above as well.  Hundreds of plants thoughtfully arranged, but with no detectable pattern like the random growth of the forest.  I've always marveled at that tiny space that my professor called mi cueva, and have seen it replicated countless times but always in Latin America. Somehow the gringo mentality, or at least mine, is too contrived to achieve the randomness of nature.

I sat last night, a glass of Cabernet in my hand and feeling the rain come down around me.  It was a very magical yet familiar moment that brought me back many, many years to my professor's cave.  What a great moment.

El Salvador

 Two brothers pose for a photo

I arrived in El Salvador yesterday and have only taken a few shots with my camera.  I consider it a success that I actually have my Nikon D200 with me on this trip considering my recent track record of leaving it behind

Landing at Comalapa International Airport outside of San Salvador I was immediately struck by two things.  Firstly the country seems to have done well embracing the eco-tourist industry.  I saw few business travelers but loads of backpack totting tourists intent on finding spirituality amidst the breathtaking landscape of El Salvador.  I wish them luck in their wanderlust.

The second thing that caught my attention is the plethora of church missionary groups running around in their uniform-like, matching t-shirts.  They were everywhere, bright-eyed with a tinge of apprehension, ready to spread spirituality and to help the helpless.  I questioned from an economist point of view which the two groups contributes greater to the Salvadorian economy?  I suspect its a fairly close.

More later.

Notes From The End Of The Earth

Not dead fish from the oil spill.  Caught legally in Turkey

OK flog me now.  I've been in southern Louisiana for the past six weeks working on the BP oil spill.  I was originally brought down to do some executive protection, which soon transitioned into some fairly high-level project management.  I didn't bring my camera with me, so for six weeks I slogged around the largest man-made disaster in the history of the planet and didn't take a single shot. What an idiot!!  I vow that I'll never make that mistake again.  This, from a guy who takes his Nikon D200 with him to the grocery store in Atlanta.

So, what did six weeks in Louisiana get me?

• Louisiana's greatest gift to American pop-culture… the drive-thru daiquiri bar.
• The media is completely biased in this event.  It's the perfect storm for them: foreign business entity, environmental disaster, great visuals, a besieged area of the country, perceived mismanagement, biblical proportions. Can't lose.
• This is the laboratory for the Incident Command System. It works, and works well.
• The Louisiana Parish Sheriff sits at the right-hand of God.
• BP is hemorrhaging money and wants this spill stopped worse than anyone.
• The Cajun accent sounds suspiciously like a down-east Maine accent.
• The Louisiana weather, like south Florida's, is some of the most awe-inspiring in the world. 
• An alligator will come out of the water to eat a marshmallow off the toe off your boot.  The issue is, what will it eat next?
• A grilled shrimp po-boy is the food of choice here.  It's all about the french bread, and don't forget the Abita.
• Magellan makes the best fishing shirts in the world. Every boat captain is wearing one.

Pajamas In Business Class

 A mannequin in an Istanbul storefront.  Children are dressed up in these princely costumes and paraded through the streets by their parents.

Alright, I'm a travel snob.  I admit it.  I believe that if you're going to get on an airplane, train, or even bus and travel for several hours that you should take a shower and maybe get out of your pajamas beforehand.  I was flying business class yesterday coming back from Milwaukee and was (un)fortunate enough to sit next to a 20-something girl who looked like she had just crawled out of bed after having the flu for a week; disheveled hair, under-shirt, cellulite over-flowing her pajama bottoms, and cheap rubber flip-flops. She sat in the window seat making all manner of bodily noises, feet propped up high on the bulkhead, and attempted to drink the plane out of vodka and cranberry.

I'm all for being comfortable while traveling but I'm going to at least be presentable. My yardstick is, what if I meet my parents in the airport?  That's a good enough standard…high for most if you knew my mother but that's a different story (kidding Mom). Nevertheless, walking out in public shouldn't be a grunge competition.  Take the time to look presentable, if for nothing more than a courtesy to your fellow travelers who have to endure your charms for several hours.

Off to New Orleans this afternoon.

For God's Sake, Stop!

My EMT partner told me a story last night of a call that he ran a few days ago.  His patient was a 12-year old girl with abdominal pain… she was two months pregnant.  Looking on, her mother…25-years old, and also her grandmother…37 years old.  I'm at a loss, you do the math.

Veteren

 We get called to a "Difficulty Breathing" patient at an Atlanta bus stop, only a mile or so from where we are in the ambulance.  These calls I normally encourage the EMTs to take, as its more often than not well within their scope of practice.

When we arrive an old, apparently homeless man sits on a bench with an oxygen mask on his face.  He's being cared for by the Atlanta Fire Department that arrived moments before.  He's thin, worn, deeply tanned.  His grey hair streaks down past his shoulders, aged tattoos color his emaciated arms. He tries to speak under the clear plastic mask that is covering his nose and mouth.  "I want to go to the VA", he wheezes out.

"You're a veteran?", I asked him.  "Damn, straight", a bit of swagger now in his voice. I look at the EMT and motion to her that I'll take this call. We help him into the back of the ambulance, collecting up his used oxygen cylinder that he's been towing around the city behind him on a little aluminum dolly.  It's empty.

In the back of the ambulance I fix his breathing issue and motion to the EMT to drive to another hospital but take our time about it.  We set off.

My new friend spent several years in the post-Vietnam era Army, having served in Europe during the Cold War.  I introduced myself as a retired "Army-guy" and then the conversation began.  We talked about places that we had known, units that we served in, and friends that were all-but forgotten.  It occurred to me that my friend probably doesn't get this sort of attention very much.  Then he told me… he's been thinking about killing himself.

The conversation turned sad and grave.  I struggled with so many things that I want to say to him.  I want to help, to listen.  In the back of my mind I made a note to let the hospital staff know, maybe they can do something for him.

In the end, I ensure that he's comfortable in the ER room.  I shake his hand and give him a subtle, little salute.  He smiles and thanks me.  Later that night I watched him exit the ER, dragging his new oxygen bottle behind him into the night.  I wish him well. 

Faces Of The Past

 

 A Turkish woman permitted me to photograph her.  I loved the serenity on her face.

I had this discussion with a physician friend of mine the other day.  The great thing about being a paramedic is that we get to see our patients in their natural environments versus having them all packaged up and brought into the ER for those to treat. Almost every call that I get I end up entering someone's home, it's an extremely personal thing and one that I give great reverence to. More times than I can count I've desperately worked on a very sick man or woman while they lay in their own bed; looking over my shoulder I can't help but notice the pictures of the dresser.  They are all the same; photos of my patient when they were in the prime of their life, healthy and happy; often times I see images of the loved ones that are standing in the room with me frantic about their sick or dying mother, father, grandparent.  For me this is a privilege, something deeply personal not easily dismissed or forgotten.

Medicine Atop A Byzantine Church

  A bin full of plaster faces for sale at a roadside tourist stand.

I toured a Turkish hospital the other day, and as I walked around I spent some time with my feelings.  The government-run hospital was crowded and a bit run-down, supplies were short but the staff was doing the best that it could with what little it had.  Nasal cannulas and oxygen masks were in short supply, so they lay draped over old, blue O2 tanks waiting for the next customer.  The lunch cart made its rounds with pots of colored liquid being ladled out onto trays.  Patients lay on ancient looking aluminum beds in the hallways and rooms; it looked like what I envisioned an eastern bloc hospital to look like during the Soviet era.

My initial emotion was something just shy of contempt.  I wondered why a modern nation had such an antiquated emergency department.  Over time I softened and realized that they were practicing the best medicine that they could given the resources that they had to work with. The Turks are desperately trying to upgrade their emergency medical capabilities, after-all that was the purpose of the conference that I was lucky enough to attend. 

I found out later that the construction of the new hospital was on hold because the intended site sits atop the ruins of a Byzantine church.  I suppose that's not an issue that we have to deal with here in the United States.  I wish them luck.

Random Thoughts From Turkey

 A Turkish woman sells bags of oranges at the site of some ancient Roman ruins.  At first I didn't like the fence between us, but now think it adds something to the photo.

I spent the last week exploring parts of Turkey, country where I have very little experience.  Most of my time was spent in the south along the Mediterranean Sea, but I was able to eek out a couple of days in Istanbul as well.Here are some general observations as I sit in Paris' Charles De Gaulle Airport (CDG) on my way back to Atlanta.

• The first thing that comes to mind is Turkey is the cleanest country I've ever seen.  I watched a man collect up a random piece of trash on a subway car, exit the car at a station simply to throw it away in the garbage bin, and then reenter the car to continue his journey.

• Turkish is an evil language that resemblances no other form of communication used on this planet. I felt like a complete foreigner, unable to conjure up even the most basic of phrases.

• The history of Istanbul is staggering.  I should have read "Istanbul For Dummies" before I arrived.  

•  The towns along the Mediterranean are replete with oddly dressed Russian tourists.  I felt as if I were thrust back into the 1970's.

• Turkish men are oddly pear-shaped.

• Everyone wants to sell you something.  It's starts off with a innocent shared experience of tea and then progresses to more pricey items.

• Turkish Airlines cornered the market on turquoise leather seats.

• Turkish food is very good but you may have to struggle to find a good bottle of wine. 

• Taxis are way over-priced, but in they are all relatively new and painted the same shade of "taxi-yellow".

• Turkey is a progressive Muslim country, which I thought would be a good model for others to strive towards. People simply practiced their own beliefs and let others do the same, always being respectful toward one another.   

Foggy At CDG

 An Istanbul market, lots of spices and strange foods.

I wrote this post, but failed to post it earlier:

Its a familiar feeling when I travel, but one I readily forget as soon as I return home.  I board an airplane, have a meal, fall asleep, and wake up in a foreign land.  My mind is foggy, even though the sun is up it's still 1:00 a.m. in my head.  I debate whether I should try to sleep some more or acquiesce to my new time zone and start on the local version of caffeine. 

Paris - Charles De Gaulle Airport (CDG), a monument to modern, glass and steel architecture.  It's a cross-roads and people from all over the world move down the carpeted terminal, stepping over those that are not moving quite so much.  I feel as if I'm the only one that does not speak French, highlighting the fact that I should have paid better attention in high school french class.

The French seem intent on selling you either a bottle of wine, cologne, or chocolate, lending credence to their reputations as world-class romantics.  Duty Free, I've decided, would be a good place to bring your wife on a weekend get-away. Having said that, it took me twenty minutes and several stops to find a toothbrush. I guess the French have their priorities.

I'm off to Istanbul (IST) in a few hours, more to follow.

The Quickening

Michael Jordon used to speak of being "in the zone", the perfect game where superior performance came effortlessly, everything just clicked.  On occasion I have those workouts where it can only be described as magical.  Yesterday's was one of those.  A 12-mile run through the woods in the rain, only the sound of the water falling from the trees, the route partially hidden by mist up ahead.  Zen practitioners call it being "in the moment", when you're there and there's nothing else, and also "everything else".  The senses are alive as you become part of the forest, you are your environment not separate from it.  It's an experience that is difficult to put down in words, at least for me, but once you feel it you crave it's return.

Off to Turkey today; Istanbul, Antalya, and Side

Affirmation

Haitian girl looks back at the camera and smiles.  I've said it before, but the Haitian people surprised me in their beauty, resilience, and spirit.

 
In the Port-au-Prince airport I ordered a Bloody Mary prior to boarding my morning flight back to the States.  The Haitian girl at the restaurant wasn't sure of the exact cost, but thought that it was $6.00.  I paid and contently walked back to my table with a mediocre Bloody Mary in my hands.

Ten minutes later the girl rushed over to my table, some distance away from the bar and apologetically thrust into my hand the $2.00 that she apparently over-charged me for the drink. I immediately gave her the $2.00 and thanked her for her honesty, a small price to pay for the affirmation that she bestowed upon me.

The Paramedic Process

Another Haiti photo.  I'm not sure if the scale was discarded of not, but it stood alone in the hospital street, seemingly neglected.

I've done eight straight nights on a 911 ambulance, and have spent a little time reflecting on my paramedic sprint.  I don't remember their faces, and less so their names, but I remember their ailments.  65-year old man, hypoglycemia and profoundly diaphoretic; 56-year old man, severe asthma attack that I fixed in three minutes flat; 67-year old man with new onset a-fib that I diagnosed by feeling his radial pulse; a twenty something man that I knew was lying to me about drug use just by looking at his dilated pupils.  After each run I would review the call in my head looking for mistakes, and there were plenty. I'd see a new medication that I had to look up, a symptom that I didn't catch, a blip on a 12-lead that was significant. Everything got looked up after the fact on my iPhone full of medical applications, mentally filed away for the next time that I see it.  I was intent on each run making me a better medic.  Being a paramedic is a process, I'm, seeing that now.

Seeing

  Also from Haiti.  A woman walks along the street carrying her child closely to her.  The little feet sticking our from the blanket make me sad in a way.

In the very early hours of the morning I sat parked in an ambulance at a truck stop and starred into the window of the late-night restaurant.  I had little else to look at aside from my watch, counting the hours until I got off from work and could go home to my own bed. 

Through the window I watched a very heavy-set African American woman, dressed in the cheap, red uniform, push a broom across the floor. If I were any place else I wouldn't have given it a second thought, but here I was a captive audience and couldn't help reflect on what I was witnessing.  Dozens of questions flashed through my mind as I watched the thirty-something woman go about her manual tasks.  Was this where she envisioned fifteen years ago that her life would end up?  What does she dream of, aspire to, or has she resigned her life to where she is now? I couldn't help myself and tried to recreate her life in my mind, I wanted to project myself into her reality.  What were her disappointments, her victories?  What motivates her?  Where, if at all, would she go back and change her life.  Above all, was she happy? The questions kept coming and coming as I watched her through the grimy window.

I suppose my lesson was that everyone has a story, a life, a past, and a present.  I for one am guilty of going through my days at times oblivious to those around me.  I see people but I truly do not "see' them; the man crossing the street with his young son or the woman pushing the broom late at night.  I suppose in many ways this is why I like 911 so much.  For a brief moment in time it's just me in the back of the ambulance with another person, a chance to get to know someone on a deeper more compassionate level, other than just simply seeing them.     

Not A Good Night For Humanity

 A photo from Haiti. A daughter watches over her father while waiting outside of the hospital "Emergency Room" tent in the heat of the day.

A 911 call came to us last night, respond to a convenience store only a few blocks from where my EMT partner and I were sitting.  Within moments as we arrive to find four squad cars rocketing in and out of the parking lot, one of the officers is eagerly motioning for us to come inside and attend to the patient.  I remember thinking that these guys are amp-ed up, this level of activity is normally reserved for gunshots.

An older Asian woman sits slumped on a stool with an obvious laceration under her eye.  She's in quite a bit emotional and or physical pain.  The story goes that a man came into the store, got himself a large cup of hot coffee and threw it onto the attendant's face.  He then viciously punched her in the eye, grabbed the money out of the open drawer and fled through the front door. 

As my EMT treated the lady I couldn't help but be moved by the degree of violence and inhumanity that had just taken place.  Why would anyone do this and moreover, what was going through their mind?  A question that I've wrestled with lately is, does everyone in the world consider themselves "deep-down a good person", conversely are there people that simply know that they are at-root evil and devoid of humanity and kindness?  How can someone commit such a barbaric act and still view themselves as a "good person"?  Sadly,  I realized my answer last night.

Transitions

IV bottles hang from a tree branch.  Below, an adolescent boy lays dieing on a make-shift cot.  I couldn't bring myself to shoot the the boy.

Coming home from a deployment is often difficult, especially when you wake-up in some desperate third world country and find yourself going to sleep that night in your own bed at home.  The shock of abruptly moving between the two environments is often dramatic and catches many people by surprise. Aside from your dusty luggage you arrive home still emotionally invested in your previous environment.  For me, I find myself being a bit quiet, withdrawn, hyper-sensitive to sights and smells, and with an overwhelming sense of being "off-balance". 

I often counsel people that I work with to spend a night in a place that is in many respects half-way between the two; a place where they can decompress, have a world-class shower, a solid meal, and slowly turn the lights back up.  Only slightly in jest, a good bottle of wine is also a great help.

Triage Notes

Now a common sight on the Haitian streets.

Not all emergencies are created equal.  The triage area of the Haitian hospital I've been working at is a busy and often ugly place.  An elderly lady is vomiting frank blood into a clear plastic bag, a man has large pieces of his face missing and is bleeding badly onto a filthy rag.  Next to them an agitated twenty-something man sits clutching a slightly angulated little finger… I know it was angulated because I looked REALLY closely.  Mr. Hurt Pinky is motioning for me to treat his finger, his eyes beam impatience and frustration that he is not being promptly taken care of.  "Why am I not at the head of the line?" I don't speak Creole so I point to the lady with the bag-o-blood in her feeble fingers and raise my hands in the international "are you serious?" gesture.  He backs down… for a few minutes.  This is "triage"… isn't that a French word, similar to Creole, that means bags of blood and missing faces come before hurt pinkies?

Not The Sole Providence Of The Strong

 A mother holds her child in one of the hospital's pediatric tents

Again, last night I worked in the hospital's emergency room, my task was to suture lacerations as they came in; I was certainly not at a loss for work.  I trolled the triage area looking for anyone with a bloody dressing; a quick examination and I would usher them into my little work area within the tent.

Sitting on the pew-like benches was a tiny girl atop her father's lap.  She held a stained piece of cloth over her forehead with her own hand.  She couldn't have been more than 5-years old.  As I took a gentle look I silently prayed that I would be able to stick a Band-Aid on it and send her happily on her way.  This was not the case, she had a 4 cm "lac" to her forehead that was going to require a few interrupted sutures.  I cringed at the thought of having to cause this innocent little girl further pain in her life. 

I took them both back into the tent and laid her down on a worn cot so that I could get a better look using my headlamp, often the only light source that we have at night.  She was stoic, unafraid, staring at me with a look of curiosity, almost daring me to assault her bravery.  I wanted to sit a bit with her before I had to inject her with a syringe of lidocaine which is often the most painful part of the procedure.  We smiled at one another, she played with my light, and I patted her on the head.  The interpreter explained to her that it was going to sting a bit, but try to remain still.

She closed her eyes as the steel needle sunk into the gaping wound,  not so much as a wince.  Her face remained calm and passive almost as if she were asleep.  Her bravery penetrated me, this 5-year old girl, in the face of something that would make me cringe, laid there determined to be brave. 

It took only a few minutes to place the three sutures, but not even so much as a whimper.  In the end I touched her forehead and told her "finished"; her eyes fluttered open… a smile from me to her. Little fingers reached up to explore the new dressing.  Her father thanked me and he scooped her up in her arms and disappeared down the dark street.  Bravery is not the sole providence of the strong.

Moments For The Soul

A bit of commotion in the ICU tent early in the evening as some of the American staff were scurrying around.  A young boy, maybe ten or eleven, had taken a 10-foot fall onto the ground; upon further investigation it became a 50-foot fall.  In the center of maelstrom were two Americans, an ex-football player now trauma surgeon and an anesthesiologist; both were desperately attempting to obtain needed laboratory results in order to get the boy into emergency surgery.

An ancient hand-litter was found abandoned in the corner;  the surgeon and I hurriedly carried the boy through the obstacle course of patients, beds, tents, and doorways into the operating room. Along side the litter the boy's father struggled to keep up; his calloused hand resting on the tiny chest. A panicked voice in the dark muttered, "son, son, son" over and over again trying desperately to communicate with his little boy.

To describe the operating room would be it's own post, but suffice it to say the only word that I can find is, "medieval"; only a handful of dim florescent lights, stacks of disorganized supplies, and a few pieces of dysfunctional equipment.  The boy was dying. 

A Haitian surgeon appeared while the boy was being intubated and "put to sleep".  The new arrival could plainly see in the American's eyes that he was "assisting" on this one.   With only a single patent IV line an incision was rapidly made in the little boy's abdomen, fluid erupted from his belly in staggering amounts.  I left, there was nothing more I could do, it was in the hands of the surgeon.

Hours later I learned that the boy had died.  The surgeon, standing by himself in the street's shadows, was clearly alone within his thoughts.  What struck me was the emotional investment on the part of the burly American, a man who likely had faced death and dying countless times in his life. My image of the quintessential 'trauma surgeon', the gods on earth that are the definition of stoic, precise executors of their science/art was immediately burst.  A moment that has become a part of my soul for the remainder of my life.

Rules To Live By

A young Haitian girl stands outside one of the hospital pediatric tents.

There's an art to living on top of people, one which I suspect actually gets taught in naval submarine schools and fire academies.  My existence for this trip to Haiti has been highlighted by the return of communal sleeping conditions to my life, something that I've not experienced since my days in Special Forces. I fear that I've grown accustom to 5-star hotel suites with multiple flat screens and ocean views. Those that know me are laughing right now.

The group that I'm with on this trip is camped out in a small, open room with 15-20 thinly mattress-ed metal frames placed within a foot of one another. My personal space extends from my bunk to 6-inches on every direction; I am the master of my kingdom.

The first and really only rule is to be overly considerate.  Here are some things to think about:

• No unnecessary banging around of things during sleep hours.  Even the slightest rustling of stuff can be annoying to those that are trying to sleep.
• iPods can be heard by neighbors, also typing on keyboards.  Take it elsewhere.
• Be mindful of your neighbor's kingdom… no border excursions however unintentional.
• Keep your things packed and neat. You're not setting up house - it's temporary. 
• Flush the toilet.  Even if there's no water in the tank, that's what the big barrel of water and bucket are for sitting right next to it.  The water goes in the bowl, not the tank. Also, in most third world bathrooms- the paper goes in the trash not the bowl.  Get used to it.
• Learn to love cold water bucket showers. Close your eyes an imagine a tropical waterfall.  It lessens the shock.
• Personal hygiene.  It's not a competition to see how nasty we can all be. Wash yourself, especially your hands as often as you can.
• Pick-up communal spaces, and especially don't leave stuff for others to have to deal with.  Leave it cleaner than you found it. Pack it out baby!!
• Pitch in, pitch in, pitch in.  Someone has to take the trash out and sweep the floors. You know it needs to get done.  Don't ignore it.
• Keep valuables secured.  You never know who will come strolling though your living spaces, and  other cultures look differently upon opportune acquisitions than we do in the west.
• Share electrical outlets.

Watching

I've spent the last several nights working in a Haitian emergency room along side some very talented and caring physicians and nurses.  Last night an unconscious man was brought in by car and carefully laid on a stretcher outside our rain-soaked tent. Dressed in mud-soaked jeans and a worn t-shirt he had simply collapsed while crossing the street. His family brought him to us.  There was no neurologic function, his blood pressure was very high, and his heart rate was slow; all indications that he had burst a blood vessel in his head.  There was nothing that we could do for the man.

The family listened intently as the news was passed through a Creole translator.  They asked if there was some machine that we could put him on, some medication that they could procure that might give him a chance to come back to them. "We're sorry, there is really nothing we can do".  The family went away to get some other clothes so that their father/friend/husband didn't have to die in wet jeans and a soiled t-shirt.

He lay there and I watched.  All night, breath after breath… I watched.  I watched as the man took his last breath, nothing more than a small gasp really.  It stopped raining; I left the tent to get some coffee.

Happines Has Many Forms

What makes people angry?  Lately I've encountered more than my monthly quota of angry people, and have had to endure their rants and raves about everyone in their life that has caused them grief. I listen to stories of liars, cheats, idiots, and thieves as the tellers recount their woes, blaming the world for all of the ills that have effected them.  I attempt to offer counsel, but it's evident that the grieved do not want it.  Instead they're happy to wallow in their own mud hole, as if it gives them a raison d'être; their life is defined by their own anger, they don't seek nor even desire peace.

Happiness, it seems, comes in many forms.  Maybe to some, attention seeking through anger is their form of true happiness, giving them the peace of being surrounded by consoling and attentive "friends". They reach out with their anger like a fisherman casts a line hoping that someone will pay attention and offer the attention that they are looking for. I can't do it. I can't find the compassion within me yet to allow myself to strike at the line and be netted into their world of drama. Instead I ignore, telling myself that this is truly what they need, my inattention is therapeutic for them. That, it appears, is the lie that I tell myself.

Restraint

 A drainage cover on a Chicago street.  Not particularly interesting, but I like the colors.

I know an explosion when I hear one, and that was an explosion. Within a few minutes,  a wail of sirens in the distance as the firetrucks and ambulance approach.  My neighbor's car has spontaneously caught fire and clouds of black, greasy smoke rise above the rooftops.

My first thought is to drive around the block and ensure that everyone is alright, both my medical kit and my camera pretty much stay in my Jeep just for this reason.  When I arrive the fire department is already working on the car, and everyone, it turns out, is just fine.  I watch the blaze, instinctively wanting to reach for my camera but 'am halted by the fear of trampling on the sensitivities of my neighbor. I project myself into his place, how would I feel if my car were engulfed in flames and my neighbor was happily shooting photographs of it?  Yes, restraint is called for; I let my camera lie.

How is my neighbor any different than anyone else that I take photos of?  I make my way into their world, often uninvited, and proceed to shoot their moments of great emotion, loss, elation, pain, happiness, etc.  I'm not good at that, I believe that I'm far too sensitive of others feelings to impose myself.  This is why I would make a lousy photojournalist.

Coffeebreak

 I'm in "my office" this morning known to most people as Starbucks Coffee, and while this is my office, Barnes & Noble is "my church".  I come here to read, write, edit photos, and watch people, the last is my most favorite pastime. 

This morning people are lined up three-deep at the counter ordering every sort of caffeinated concoction, feeding the American coffee culture.  This fascination with coffee is not something that we necessarily share in large degree with the rest of the world.

Many years ago I was living in Santiago, Chile doing the bidding of Queen and country, and in Chile, like most LATAM countries at the time, coffee came in tiny cups that looked like they were part of a little girl's tea set. The Chileans just didn't eat much of a breakfast so the idea of morning coffee was a bit foreign to them.  Coffee was something that allowed them to stay up into the wee hours attending dinner parties.

Down the street from my apartment, not far from the U.S. Embassy (a brilliant idea) a Dunkin Donuts prepared to open for business; this would be the country's first, and I can't describe the excitement that streaked through Santiago's ex-pat community.

On the first day that the shop was open I steered clear because the line was outrageous.  Ex-pats wanted a taste of home, and Chileans were morbidly curious as to what the excitement was all about. From all accounts it was an authentic Dunkin Donuts and the Americans, especially those from the northeast, were beside themselves with glee.

The very next day I made sure that I was first in-line when the door opened in the morning.  I strode in all giddy and excited to have my first massive styrofoam cup in well-over a year of American-style joe.  I placed my order, however the Chilean attendant frowned and told me that the coffee wasn't hot yet, pointing to the urn positioned underneath the brand new brewer.  I politely asked him how that was possible, as "The coffee comes out hot", I exclaimed .  He tapped the metal urn and said, "No, todaiva no".  It then hit me, he had left last night's coffee in the urn and had simply turned on the hotplate and was waiting for it to get hot.  Yea, I can see we still have a ways to go.