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.