Grand Canyon Misadventures

So on Friday afternoon I spoke with Sarah, a Columbia medical student who arrived at Zuni as I was leaving. 3 other Columbia students are at Shiprock (another IHS center nearby), and she informed me on Friday that they had a backcountry permit to camp Fri and Sat nights 5 miles from the rim inside the Grand Canyon, and were planning to hike down to the Colorado river and back to the campsite on Saturday. This was exactly the trip I had been wanting to do. Unfortunately by the time I got this message, it was too late to get to the Grand Canyon before dark, so we figured we would meet up with the group the following day to camp there Saturday night. I wanted to d the full hike to the river, whereas Sarah didn’t, so I went on Friday to camp on the rim and get an early start the next morning and Sarah was going to come up Saturday afternoon and meet everyone at the campsite (Eremita Mesa) on Saturday night.

Coming into the park as late as I did, I didn’t get a map or anything. I tried to contact the guys via their cellphone a few times, but it went straight to voicemail so I went to the Visitor’s Center first thing to get some information on the location of this campsite. I got there around 7:30am but it didn’t open until 8. I asked a shuttle driver about Eremita Mesa, and he had never heard of it but he did have the park guide in the shuttle that he gave me. I looked it over but didn’t see Eremita Mesa on any of the (skeleton) maps in it so I waited patiently outside the visitor center. At 10 till 8, a guy came out and started washing the windows. I figured he was going to open the doors at 8 when he was done. Finally at 2 minutes till I asked him if he was going to open them. (This wasn’t exactly Captain Eager-to-Help.) He pointed to the sign on the door that said 8AM, then showed me his watch, which said 7AM. Crap. Stupid Arizona doesn’t follow Daylight Savings Time, so right now they’re on Pacific time. I knew that, but since I’m now living in Arizona I thought I was on Arizona time. However apparently the Navajo Reservation does follow Daylight Savings, despite being 1/3 of the area of Arizona, so I’m actually on Mountain Time at work here despite being in Arizona. Blast. As I debated what to do a kind ranger came out to ask if he could help me with anything. He hadn’t heard of Eremita Mesa either (this was beginning to be a little suspicious.) I needed to go to the Backcountry office where they knew more, which also didn’t open until 8, and which was a shuttle ride away somewhere. Around this time Sarah called me to say that she had received a text message from the group with instructions to start at Hermit’s Rest trailhead and follow Hermit Trail to Eremita Mesa. The ranger said he wasn’t familiar with the Hermit’s Rest part of the park and that’s probably why he’d never heard of it. Fantastic. I got on the shuttle and set off, happy not to have to wait another hour.

An hour and a half later (the shuttle bus system is really painfully slow there) I arrived at the trailhead. There was a better map of this section of the park and some trail info on the trail marker. There was a Hermit Creek campground on it, but no Eremita Mesa, which seemed suspicious. However I figured that since we had the directions from the others, and they’d apparently found it, I would just follow the trail and at some point it would widen into a campground or there would be a sign. I tried to call Sarah, but had no cell phone signal. Also ominous here was the presence on the trailhead of a poster warning hikers to be careful in the Grand Canyon. The poster child for this was a medical student who had ran the Boston Marathon in 3hrs but who had died of dehydration while doing a day hike in the Grand Canyon. At least I had my tent and tons of water and food in my pack for the overnight, so I went with it.

I asked the first people I found if they had a good map. They did have a topographical map, and we didn’t see Eremita Mesa, but it didn’t have the campgrounds on it so it was hard to tell for sure. Finally a good ways down into the canyon I found some people with a good map, and Eremita Mesa was listed as one of the campsites. This was a big relief. However, on the map it was a big 3 square mile mesa with no particular established camping site, and it looked like it was off the Dripping Springs trail, which had branched off of the Hermit Trail near the top. Begrudgingly I turned around and started hiking back up out of the canyon with the 2 map guys (who had spent the previous 2 nights in the canyon.) Around 1pm I returned to the Dripping Springs trailhead and started following it out toward Eremita Mesa. At this point I had given up any hope of hiking down to the river, and was just hoping to find the camp and drop off my tent and heavy pack. At the end of the Dripping Springs trail however, rather than finding a wide open mesa with tents like I was hoping, I found myself on a ledge in the side of the canyon with cliff face above and below me, and the trail just ended. Now I was sure I was never going to locate Eremita Mesa or the group, and decided the best thing was to just hike back out of the canyon. I was worried about Sarah, since if she followed the directions she would end up down at Hidden Creek campground without a tent, but still had no cell phone service and wasn’t sure where on the trail she might be.

Amazingly, as she entered bright eyed and bushy tailed, Sarah found me on the trail just a quarter-mile or less from the rim, trudging dejectedly after the long, hot ascent in the brutal desert sun. I was really glad to see her. I convinced her that finding them was a lost cause and we decided to go back and camp on the rim again and just do a day hike on a different trail the next day. We consoled ourselves with cookies and a steak dinner, then camped under the stars which are really intensely bright there.

I was so focused on my misadventures, I forgot to mention how gorgeous the Grand Canyon is. I remember being taken aback by this last time I visited it, but I had forgotten just how stunning it is and was once again surprised. You always knew the Grand Canyon was a big canyon, but no one ever mentioned that it is a beautiful canyon too. It’s a series of stepped table-top mesas with intense reds, purples, and greens that, when looking across the vast expanse to the other side, blend together like an impressionist painting. (There was also a cool art exhibit at the canyon featuring different 1900s artists’ interpretations of the Grand Canyon that Sarah and I had seen the night before. Looking at the canyon certainly inspires one’s artistic side.) This made for a beautiful hike on the Bright Angel trail on Sunday. We didn’t push ourselves too hard, just enjoyed ourselves and left plenty of time to do the hard part which is coming back out of the canyon (it’s so easy going down that you could continue downward forever, but then you might get stuck down there, which is how people die). We got back to the rim pretty early in the afternoon and enjoyed an ice cream cone and the views a little more before getting in our cars to drive back, planning to get home in the early evening and be well-rested before work the next day.

I was really excited about going to Walmart (yes, I have never wanted a Walmart so badly. It’s sad, I know, but the alternative grocery here in Chinle is painful to shop at and you leave it feeling that you’ve wasted hours and yet still don’t have half of what you need.), so I found one in Winslow on I-40 and decided to take the only slightly longer I-40 route home so I could go to Walmart. I was making great time.

Just east of Flagstaff, an electronic highway sign warned of “high winds and blowing dust 30 miles ahead.” I plunged ahead, mentally preparing my extensive Walmart list. Winslow was the next big stop on I-40 after Flagstaff. 20 miles from Winslow, there was suddenly slowed traffic ahead on the interstate. Hmm, lots of people exiting here at Two Guns for some reason. I switched to the left lane to pass. Oh, there’s an emergency vehicle in the left lane. Must be an accident. I merged back into the right lane to wait my turn to pass the blocked lane. But then, we got waved off the highway and onto the exit. A large truck behind the police car was unloading and setting up flashing cones. I looked ahead to the detour we were being taken on…a full U-Turn across the overpass and right back onto I-40 westbound. But I didn’t want to go west, I wanted to go east! I needed Walmart damnit!

After trying to wait it out while reading a book parked on a dirt feeder road on the other side of the overpass rather than heading back west, the highway patrol came and told us we weren’t allowed to wait there. Of course I was almost out of gas, as I had been trying to push it to Winslow and make all of my stops at once. I had to go back to Flagstaff to get gas, and figured I might as well settle in for the wait. How long could it last? Fortunately Sarah and I found one another again and found a nice brewery where we just kept ordering another course every time we checked the highway report and found out I-40 was still closed. Finally around 10pm we decided that we might have to spend the night in Flagstaff. We found a cheap hostel but decided it was worth one more drive out of town to see if it had by chance opened. Fortunately we saw a steady line of heavy semi-truck traffic heading from the other direction, and sure enough the interstate had just reopened. Thank God. And I even made it to Winslow 15 minutes before Walmart closed. Thus ended the Grand Canyon saga and nearly all that could have gone wrong, and did.

Chinle First Impressions

*There are 2 backlogged posts that are forthcoming, but for now I wanted to say a few quick things about my new home in Chinle, AZ, on the Navajo Nation, where I'll be spending the next month doing a general surgery rotation.

I arrived in Chinle late Sunday night, so I didn’t see much until Monday morning when I left home to go to work. Here in the big town of Chinle (by big I mean there is 1 real stoplight--only stop signs in Zuni, 3 fast food restaurants, a semi-sizeable grocery store, schools, and even a youth corrections facility—right by my house!) I actually live about a 10 minute drive from the hospital, although things are pretty spread out so that’s somewhat of an overestimate of the town’s size. The hospital itself however is about 5 times bigger than Zuni's.

This morning I opened my front door to go to work and got a big surprise: there was an unsaddled horse about 2 feet from me! It was just hanging out in my front yard with its buddy, trying to eat my mud (yah I don't really have any grass). It seemed a little ornery about my sudden disruption. On 2 subsequent drives through town in daylight I now realize that horses are just wandering around grazing all over the place.

Surprise # 2: there was ice frozen to my windshield from freezing rain overnight. I couldn’t find my ice scraper—I’m pretty sure I remember seeing it in the car while I was packing for this trip and saying “ice scraper, bah, I don’t need that for the desert in April!” and throwing it out into my parents’ garage. (Since I’ve been here it has now snowed on me 4 times.)

Just a brief description of my work environment, i.e. my supervisor: a general surgeon who started the day by telling me how he just returned from a weekend rally of some ultra-conservative group with pro-life and anti-immigration speeches by Rick Perry and Sarah Palin, who makes crude and feminist jokes all day long, who is an ex(within the last 5 years)-priest, and who is currently active in the Army and about to be deployed. I don’t know about medicine-wise, but the month promises to be entertaining.

National Park Grand Tour

Amazing, beautiful, incredible, breathtaking…as you read you might notice that I’m lacking sufficient adjectives to describe the scenery around here. I’ve taken several weekend trips already (to Chaco Canyon, Pagosa Springs, Wolf Creek, Painted Desert and Petrified Forest, El Malpais—see my photos for those places), but now I had a whole week of vacation to drive long and far to arrive at the biggest and best: Bryce and Zion National Parks.

I started the trip in Albuquerque, where Andreas met me for the weekend. I was pleasantly surprised to find that Albuquerque is a really cool city. We really liked Nob Hill and the University district, where there were lots of coffee shops, restaurants, and tons of people out and about. Specifically we had chosen Albuquerque to attend the Gathering of the Nations Powwow. This is an annual powwow attended by thousands of people from all different American Indian tribes across the United States and Canada. It was being held in the UNM football stadium, if that gives you an idea of the scale of this thing. Dancers from the different tribes were wearing the most elaborate of their respective traditional dress. Most were brightly colored and fully decorated and adorned with beads, feathers, bells, and fringe. The men from one tribe had huge feather headdresses, feather shields on each arm, and two large feather rings across their shoulders and low back. When they danced, it created a fury of flying colors and bobbing feathers.



On Saturday we drove out to Acoma Pueblo, or “Sky City,” as their casino is named. This is a mud-stone pueblo village that sits on top of a mesa and doesn’t have running water or electricity. It claims itself as the oldest continuously-inhabited pueblo in the United States, and the Acoma tribal leadership continues to live there today. They have a visitor center and give guided tours.



My first stop after Andreas left me on Sunday night was Mesa Verde, Colorado, the national park that has the largest collection of Anasazi (or “ancestral puebloans” as they are now being called) cliff dwelling ruins. There I got to take a tour of Cliff Palace and Balcony House ruins, ancient communities nestled into shallow sandstone alcoves in the cliffs on the sides of the mesas. This is pretty close to Durango, and there are beautiful snow-capped mountain peaks not too far away as well. I seriously doubt that these people wore nothing but loin cloths, as they are usually depicted because I bet it gets really cold in the winter there. It wasn’t even close to loincloth weather in late April either.



Next I camped at Arches National Park in Moab, Utah. This is an area with a huge concentration of sandstone arches which form naturally as the sandstone erodes, and there are dozens there, each a little different in size in shape. The scenery was beautiful, and I took a nice hike through the “Devil’s Garden,” a place where tons of weird sandstone formations have formed very close together.



I had to drive through Capitol Reef National Park to get to Bryce, and I chose to take a scenic road there which turned into a dirt road and eventually connected me (at the top of a switchback ascent up a near-cliff) to the paved scenic Burr Trail in Staircase-Escalante National Monument. This drive was unbelievable. First you drive alongside Strike Valley, where it looks like the earth’s crust was literally just pushed up in a big line. Then on the Burr Trail you drive through a twisting red-rock canyon and then up into some white sandstone badlands.



In Staircase-Escalante park I decided to stop to explore some slot canyons that I had heard about. This was made more interesting by the fact that today the wind was blowing 60+ mph, and the canyons had loose sandy bottoms. Yes, it was basically a sandstorm. I don’t think I’ve ever had so much sand on me or in me. I’m pretty sure I inadvertently swallowed a bunch (maybe that cleans out the intestines?) and clumps of it kept coming out my eyes the whole next day (that can’t be good for the corneas). Fortunately I found a good shower that night to wash the pound of sand off of me. Staircase-Escalante is almost all backcountry and much less developed than the national parks, meaning that there were some trail directions that started from the “trailhead,” which per directions could be found at the end of a turnoff 26 miles down a dirt road. There was a sign at 26 miles on the dirt road indicating the trail, but after that despite there being multiple dirt roads traced through the desert, there were no further signs. From my map it appeared that the road curved left, and that it would be obvious because if you stayed straight and didn't make the curve you would be on a "jeep trail" instead of a road. I thought that I had found that point when I dropped the civic over a 2-foot drop-off in the road and nearly got stuck (this is the day I tried to test the high-clearance offroading abilities of the civic. I tried to kill it, but it fortunately survived the test.) Once I got back up the small cliff I had driven down, I curved left like the map indicated and found a bunch of cars parked and some tents pitched and figured that must be the trailhead. No one was around to ask, so I figured everyone was on the trail and I tried to follow the directions (“follow the rock cairns from the trailhead…”). However there were no rock cairns in sight. Since I was looking for a descent into a canyon (obviously), I did a little route-finding and found a way down, eventually finding some of the promised rock cairns that I was able to follow the rest of the way into the canyon. I couldn’t find Peekaboo, the first slot (which was supposed to have a difficult-to-spot entrance 12 feet off the ground), but I found another canyon that seemed a perfect match for Spooky's description (started in a wide sandy wash, narrowed to a slot, and ended with a big choke stone and another wide wash). It was super-cool to be in a slot canyon where you were squeezing between narrow rock curves and touching both sides to get through. Since it was still early, I decided to walk on toward Brimstone slot, which was supposed to be a bit further and longer than the other two. After a long and windy walk through really loose sand, I found Brimstone for another fun slot exploration. This one didn’t end, but you basically couldn’t go any further without spiderman climbing skills because the ground level became too narrow to pass. In there I found a teenage boy and his grandfather (first people I'd seen), who marveled at how fast I had been able to explore the 2 canyons so far (I didn't feel like I was moving that fast, but I was walking a lot faster than the grandfather who was an older gentleman and I passed them on my way back out). They told me they were camping at the trailhead and confirmed their tent was set up there. They also told me I couldn’t miss Peekaboo, so I headed back the way I came past Spooky and started looking very closely above my head for Peekaboo. However, I found nothing, and turned back to look for the grandfather/son again to try to get them to point it out to me. When I found them resting near the entrance to Spooky, they looked confused. I pulled out my photocopied trailmap which the visitor center had provided. Well apparently they were confused because I was coming back toward them from a part of the canyon that wasn’t actually on the trail, and I hadn’t explored Spooky after all because somehow I had started the canyon in the middle instead of at the end. That's why I was going so "fast!" My “Spooky” was just the narrow part of the main canyon which I was supposed to cross when walking between the real Spooky and Brimstone. That explained why I never got to some narrow part of the canyon with a difficult-to-negotiate choke stone when walking to Brimstone… So I went back through my fake “Spooky” to look for the real Spooky. I found it (it was much longer than the narrow part of the main canyon I had explored before), and required some minor climbing to get through some narrow spots. So cool. I then turned around, retraced my steps to the (real) main canyon, and walked further up looking again for Peekaboo. Still no luck. I followed a trail with tons of footprints which led to rock cairns that I followed up over a ridge and out of the canyon. I decided it was getting late and I should forget about Peekaboo and just go back to the car, assuming I was now on the proper trail back to the trailhead that I couldn’t find the first time. I kept following the cairns until they suddenly ended. Hmm. I thought I recognized some landmarks near where I had parked the car so I decided to just continue walking toward those (ok, that was kind of dumb). After about 45 minutes of wandering about, I realized that I had not found my car after all, started to get nervous that I might get lost out here alone, and had to retrace my steps back to the end of the rock cairns, figuring I should just go all the way back to the way I came in and exit the way I knew, even though it was apparently not the correct trail. On the way however I found more footprints and rock cairns following a streambed wash, and decided to give those a try since obviously lots of feet had trekked through there, which ostensibly would indicate a proper route (although I'm now learning that it also means that lots of people have thought the same as me and made the same wrong turns). Suddenly I found myself in another slot canyon. I went through this one with a little less gusto since I was now unsure where I was and annoyed at the crappy trail directions, but at the other end I found myself 12 feet up a canyon wall…somehow I had entered the backside of Peekaboo. I now came down into the (real) main canyon again and followed it to some seemingly more reliable rock cairns all the way up and out…to a trailhead with an actual sign and lots of cars...that weren’t mine. Hmm again. Fortunately that grandpa/son were up there camping out at this real trailhead, and kindly took me in their car to find my car. It turns out my car was up what was marked on the map (but not the road) as a “jeep trail.” Way to go little civic. Now the people who were camped up there were back to their tents, and had been wondering where the heck my car had come from since apparently they realized that they were camping in the backcountry away from the trailhead and didn't expect anyone else to be there. In summary, a near disaster, but still a fun introduction to slot canyons.

I was going to drive up to camp at Bryce National Park that night, but I met some people in a gas station in Escalante who told me they had been there and it was too cold to camp so they’d come back down to Escalante. On their advice, I spent the night in Escalante and drove up to Bryce first thing the next morning. Turns out this was good advice, because close to Bryce there was a lot of snow on the ground. The farms had their irrigation wheels running, and the wheels and surrounding fields were covered with icicles. Bryce has a dense population of red sandstone “hoodoos” or little rock towers. There are observation points where you can look out over huge fields of them. I put on my warmest clothes and went on the figure 8 hike down between the hoodoos. Snow tends to make everything seem peaceful and mystical anyway, but the snow on the red stone hoodoos made the hike absolutely magical.



Finally I went to Zion National Park to spend my last weekend. This park is absolutely breathtaking as well. It’s called “zion” and lots of the mountains in it have religious names (like Abraham, Jacob, the organ, and the great throne) because they were named by preachers passing through the area. Looking at the magnificent landscape with its sandstone mountains towering around the canyon, it’s easy to see how these religious men would have seen it as a gift from God.



On my second day here, I decided to sign up for a canyoneering trip. Canyoneering is an adventure sport that involves setting up ropes to rappel down mountains/cliffs that are too steep and/or long to climb down, usually down into canyons. Canyoneering is really, really fun, and maybe a little addicting. I definitely want to do it again. So, if anyone would be interested, it’s better done in a group so that people can spot one another, and I really want to find canyoning partners for some future canyon explorations.

On the long drive back to Chinle on Sunday I noticed that I had reentered the southern side of Staircase-Escalante National Monument, and couldn’t resist stopping to do one more quick hike. The toadstools took me to sandstone towers (like hoodoos) which are topped with balancing granite stones (hence “toadstools”). This happens because the sandstone erodes away faster than the granite layer on top of it. The return hike once again seemed a little less clear than the way out there. I was following footprints and a potential trail when I came across a foreign couple that didn’t speak very good English. “End,” they said, pointing behind them from the way they came. I looked at them. “Stop.” “Trail End.” I got more confused, since the trail end was behind me and I knew I was now in the trail-middle somewhere. I shrugged and continued on. Half a minute later I arrived at a 10-foot drop-off and realized what they had been talking about. I was apparently not on the right trail, once again following erroneus footprints. It was also really windy there. I am now convinced that the entire (enormous) Staircase-Escalante is a windy black hole. (But a really pretty one.)

Zuni Dance Ceremonies

I think I mentioned in an earlier post that the Zuni tribe has really impressively maintained their traditions. I’m not sure what their religious calendar is based on, but the dates of their dances don’t make much sense to outsiders, and are often announced to the Zunis themselves with little advance notice. Their biggest annual celebration is usually held sometime in December, but I was lucky to catch some of the more minor events in April. During my month there, I attended 3 different religious dances from 2 different dance cycles. The three were relatively similar, but each was a bit different.

The afternoon dances are held in the original pueblo (Zunis have lived in this same pueblo for hundreds of years, except for a brief 20-ish year period in the 1680s during the Pueblo Revolt when they fled from the Spanish and stayed on top of Dowa Yolanne—Thunder Mountain—their sacred mountain mesa 5 miles away). In the center of the pueblo is a small plaza (smaller than a basketball court) that is formed between several original stone houses. To watch the dances, some chairs are set up on the edge of the plaza, but the majority of the observers sit inside the houses and watch out the windows, or sit on top of the flat roofs of the houses to look down into the plaza. The Zunis call this place in their old village the “anthill” or the “middle ground,” and believe it is related by the Zuni river, which flows (well just trickles nowadays) from the middle ground eventually into the Colorado River and into the Grand Canyon, to the “middle ground” where they emerged from the underworld in their creation story.

Although the society considers itself matriarchal, where the women hold the power and own the homes and land (although suspiciously domestic violence against women is a big problem here), only men participate in religious activities, only men enter the kivas (places for religious ritual), and only men dance. There would be anywhere from 20 to 40 dancers, 1 or 2 dance leaders distinguished by different dress, a drummer, and 8-10 mudheads. The drummer kept a basic beat, and the dancers moved in a slowly snaking circle-line stomping their feet to the rhythm. In the second cycle there were about 10 people dressed with long black wigs with bangs and low ponytails that I think were maybe supposed to be women.

The costumes were very interesting, and this was the most obvious thing that differed between the two cycles. They wore wooden masks painted turquoise with white and black facial features, and each person had a slightly different mask. The masks were attached to huge headdresses that covered the whole head and were made of pine boughs (like what you make wreaths out of at Christmas time) with a few feathers sticking out. They also had on lots of turquoise jewelry, like long necklaces with big chunks of turquoise, bracelets, and rings (sometimes 3-5 rings/hand). They wore white moccasin boots that came up to mid-calf, and had bells on their boots or around their legs that added to the drum beat as they danced. In the second cycle they had these flat discs pinned to the back of their necks with 3-4 long ribbons hanging down their back that reminded me of mums (you know from high school homecoming) and beaded leather pouches over their shoulders that hung down on their hips.

In the second cycle each dancer was holding an ear of corn, and the dance leader had cornmeal that he was sprinkling on the ground and on the mudheads’ heads. This made me think it might have been a harvest dance, but unfortunately I really have no idea what the religious meaning and purpose behind the dances was.

The pattern of the dances seemed to be the same. There is some dancing, interrupted by a mudhead intermission, and finally some wrap-up dancing. The dances start anywhere from 3 to 5 in the afternoon and wind down around sunset. The “mudheads” are a select group of around 8 men who are topless with long wool blankets wrapped around their waists for bottoms. They rub mud on their chests and backs as a kind of paint, and they wear these ugly masks that cover their whole heads and look kind of like aliens from Mars and kind of like pigs with their noses squashed in. Apparently they are supposed to be like town idiots, and they serve as a warning of what can happen with inbreeding. (I’m not sure if that inbreeding part is true, that’s just what I heard.) They sort of use their comic relief to keep the village in line—they make fun of tribal leaders and issues that they don’t think are going well, and they also call out children who’ve been bad. They have this comic relief intermission in the middle of the dances where they do little skits. Everything’s in Zuni (almost every Zuni has a functional ability to speak and understand the Zuni language), so I couldn’t understand what they were saying, but it usually made the audience laugh. One of their skits involved dividing into 2 groups and playing a red rover-type game where they threw a ball and if they hit someone from the other team, that person had to switch to the other side, but their team could reclaim them by hitting them with the ball while they were crossing the plaza, and once or twice they just kept hitting this one guy and making him run back and forth and back and forth while everyone laughed. Most of the things they act out are done purposefully clumsily.

There are also night dances, usually on weekends, (which I didn’t get to see) which are held inside people’s homes. The people gather outside the house and watch the dances through the windows.

Crownpoint Navajo Rug Auction

Yes that's right: a RUG auction. A special monthly event just for people interested in buying rugs. Now you may not realize (as I had no idea before coming out here) that Navajo hand-woven rugs are apparently world-renowned. Some of the weave is so tight that they're practically waterproof. Now rug is a loose term, because you may not want to use something the size of a bathmat as an actual bathmat when it cost you $300+. Larger ones big enough to actually fill a living room floor are going for thousands.

Anyway I drove up to Crownpoint Elementary School for the rug auction. It was way more entertaining than expected. Hilarious in fact.

Some more background: No Navajos are actually buying rugs. I don't think there was one minority member in the whole bidding group. The average age of the bidders was about 70. I was definitely the youngest person there. Also if you get there early you get to actually see the rugs up close. While I looked at them and thought some were pretty and some not so much to my taste, other obviously serious old-timers were pawing through them and making sweeping comments about the value (or usually the lack thereof) of the rugs based on the artist, the pattern, or who knows what other mysterious qualities a proper Navajo rug must possess to be collector-worthy. I heard that some of the people are rug dealers from Santa Fe.

Finally after much anticipation and some Navajo tacos, the bidding began. The best part was that the auctioneers were 2 60-something year-old white cowboys. They were wearing their cowboy hats and boots and speaking with an authentic southern drawl. The bidding also went on in this almost unintelligible 90-mile-per-hour auction language, but was occasionally slowed and punctuated by comments by one or the other of the cowboys that began with "looky there," "man alive," and "I'll be darned" ... followed by "that's a real nice rug," or "that's a pretty little rug," at which point I sometimes had to bite my lip to keep from laughing out loud. And I'm from Texas.

Goodbye South America, Hello American Southwest

I'm not sure if I mentioned this in my last post, but that trip to Atacama was the last thing I did in Chile before I came back to the United States for (?) good. I'm now halfway through a one-month rotation at Zuni Indian Hospital in Zuni Pueblo, New Mexico, population 10,350 (only around 1,000 non-Zunis). The hospital is part of Indian Health Services, and is on the Zuni Reservation. Sorry for the delayed update, but I have no internet at home and working for IHS means that my computers at work are government computers, so all interesting sites, including my blog, are blocked.

A little about where I am: Zuni is about an hour south of Gallup, New Mexico (which is on I-40), and is just 15 miles from the Arizona border. It's beautiful red rock mesas with tons of running, biking, and hiking, but it is pretty much the middle of nowhere. The hospital has about 15 inpatient beds (which usually are mostly empty), OB delivery capacity, an ER, and an outpatient clinic. Anything surgical or complex gets taken by ambulance or plane to a bigger center. There are 14 doctors, mostly family practitioners who do everything from delivering babies, pediatric clinic visits with kids, taking care of people with chronic diseases in clinic, to urgent care/ER and admitting and taking care of hospitalized inpatients.

Zunis are Pueblo Indians, and the old plaza in town is the oldest continuously-inhabited place in the United States. Almost everyone still speaks Zuni as a first or close-second language, the majority live on the reservation, and they very seriously maintain their ancient religious and cultural beliefs and practices.

A few nice statistics I found on the Zuni tribe to give you a snapshot of the community I'm treating in the hospital (The wife of one of the former physicians, an epidemiologist, did all these stats):
-They have relatively high birth rates and they die young, so overall the population is young. 1/2 are age 25 or under.
-The death rate is 15% higher in Zuni than the US.
-The average age at death is 60 years.
-68% completed high school, 11% college, and 1.1% a graduate degree.
-Median household income $22,000
-41.7% families have incomes below the federal poverty level.
-Unemployment was 12% in 2003 (probably more post-financial crisis)
-Health
--The most common chronic conditions:
---High blood pressure (28% of the population)
---High cholesterol (21%)
---Diabetes (20% of Zunis, but 64% over the age of 60!)
And super high rates of complication from diabetes--3.2% of diabetics have had a foot or leg amputated, 8.7% are on kidney dialysis, and an additional 36.5% have chronic kidney disease on their way to dialysis
---Past or current alcohol abuse (20% of people, and 2x as many women as men!)
--Overweight/obesity is high among both children & adults compared to the rest of the U.S.:
---Adults 37% obese, 45% overweight, only 14% healthy weight
---Children 31% obese, 22% overweight
--Leading causes of death:
---20% alcohol-related (10 times the national average)
---16% cancer (most colorectal) (this makes up 23% of US deaths)
---14% diabetes (6 times the national average)
---13% injuries (including homicide, suicide, and alcohol-related accidents) (US total is just 4.4%)
---10% cardiovascular disease (US has 29%: Half the national average for heart disease and just 1/4 the national average for stroke)
---4% kidney failure
--20% of births are to teenage mothers (2 times the national teen pregnancy rate) ---For pregnant girls ages 16-19, 33% of the fathers of their babies were over 40 years old!!
--The health stats they do have going for them:
---Higher rates of breastfeeding than national average
---Lower rates of smoking

So that's where I am and what I'm dealing with in the hospital. I'll update when I return to internet again. Meantime I'm going to hit the slopes in Colorado for some final spring skiing tomorrow!

Forays across the border (Argentina & Bolivia)

1) I went to Mendoza, Argentina (an 8-hr bus ride from Santiago) for a weekend that just happened to be their annual Festival de Vendimia, or wine-harvesting festival (rated in Lonely Planet and other tourist guides as one of the top 10 festivals in all of South America). The festival was actually pretty community-oriented. They did have the most enormous parade I've ever seen which after finally getting started 1.5 hrs late, lasted seriously 3-4 hours! The major parade themes were horses, wine, and queens. Each district of Mendoza selects a beauty queen to compete for the festival title, and all 18 districts make a float to show off their candidate, most of which were covered with grape vines and/or wine barrels. Other than that there wasn't too much excitement. I ate all the Argentinian steak and drank all the Argentinian wine I could in 2 days, especially the region's famous Malbec.

2) Contrast: Bolivia. I went to San Pedro de Atacama, Chile, in the middle of the Atacama desert. From there you can organize trips across the nearby Bolivian border to see lakes, salt flats, and other natural wonders. The most popular is a 4-day, 3-night trip to the salt flats of Uyuni. Unfortunately I didn't have enough time for that one, but I had heard that all the other sites in Bolivia were absolutely gorgeous and that a 1-day tour of some beautiful lakes was possible. One tour agency in San Pedro assured me it was. Then at the last minute they told me since I was the only one at the time who wanted a 1-day trip, that I would have to go with the 4-day trip, spend the night, and then return the following morning with another 4-day trip on day 4 headed back to Chile. The agency assured me this was no problem and that I'd be back to San Pedro by 11AM the next day, still plenty of time to explore sites on the Chilean side before my flight the following day.

Bolivia started out with a super-shady border crossing where the Bolivian border agent asked for $20 USD and put it in his pocket without stamping my passport or writing my name on his list of incoming persons. The "border" itself (see photo) was a tiny concrete building in the middle of the desert, punctuated by a nearby gutted school bus. About what you'd expect from Bolivia.





The trip was great though. We drove in 4WD jeeps through vast sweeping views of red and orange desert, streaked with mineral deposits of contrasting blacks, greys, and whites, where wild vicunas (more graceful cousins of the llama) occasionally wandered near the cars. We stopped at various alpine salt lakes which were turned by algae and minerals into stunning teals, purples, and reds swirling amongst dried white salt flats where flamingos and other exotic birds make their homes. We finished the day watching flamingos as the sun set over the already red-tinged Laguna Colorada.
At dinner I asked my driver how I was supposed to connect with the reverse-bound group the next morning. He had no idea I was leaving the group (first bad sign) but went to check and came back to tell me that I should be ready at 5AM and he would come get me when the cars arrived. A bit earlier than the 8AM departure the agency had quoted me, but all the better since I wanted to have more time to explore San Pedro and hadn't wanted to spend the night in Bolivia in the first place.
So the next morning I woke up and got ready at 5AM, but no one ever came. At 7AM everyone else got up for breakfast before heading deeper into Bolivia. When I inquired about what the heck happened to my ride, my driver and the other agency guy shrugged and seemed to think it was quite funny. At this point I was still pretty calm--it is Latin America after all so I expected some delay and miscommunication. Before leaving with the rest of the group, my driver told me that he had radioed to the other group and that they were "en route." Another group staying at my hostel (and by hostel I mean some crappy concrete buildings with no running water in the middle of the desert) didn't head out until an hour or so later because they had trouble with one of their jeeps. Before they left I asked their driver if he knew when cars usually passed going the other way and he told me 3-4PM. Hmmm. But he assured me that if my agency told me one was coming then it should be no problem. So I sat down outside by the road to be sure not to miss them. (They're now almost 4hrs late from 5AM).

At this point I am in the middle of the Bolivian desert nearly alone. The agency took off without leaving me any water or food (this was supposed to be an all-inclusive trip). 2 guys who seem to live and work at the "hostel" are still here, but their 1st language is Quechua. Close to 2hrs later I'm really starting to think that I might be staying in Bolivia forever, or at least another night until the next day's group from my agency shows up and I can demand to be taken back. I will certainly be a miracle if I make my afternoon tour back in Chile, and frankly I'll be lucky to make my flight the next afternoon (and if I miss that, I'll also miss my flight back to the States). I try to ask one of the hostal guys if he can use his radio to contact the supposed other group to see when they might expect to arrive. He tells me he can do this at 10:30AM (not really clear why he couldn't do this now, as there is really nothing better for him to do). I sit back down and wait for a car and/or a report. When it approaches 11, I ask again if it might now be convenient to radio. He says he already did, and no car is coming.

What!!?? (Well not like I didn't see that coming, but still.) However he tells me that he's already spoken to the agency in San Pedro and that his friend (who has zero Spanish speaking skills) is going to drive me to the border and the agency will send a truck to meet me there. OK. He motions to a 1980 jeep as the proposed means of transport. Around noon they've finally gotten the ancient clunker to start and I climb in, hopeful. These hopes are immediately dashed when I realize that my driver actually has no idea how to drive. Seriously. He's biting his nails nervously and has no idea when to shift gears. We're also driving about 5 miles per hour, a rate that I estimate will put us at the border around midnight. Of course this is assuming we actually get to the border, because the "roads" out here are basically semi-parallel tracks through the sand that are constantly crossing and diverging, and at every choice he looks really unsure which one to pick. The 2 times he exceeds his snail speed he nearly loses control around the curves and I picture my un-seatbelted body flung like a ragdoll around the car as we roll down a sand bank. So now I'm picturing myself either dying of thirst in the middle of the desert after Captain Brilliant gets us hopelessly lost, or suffering massive injury and possibly immediate death when the car inevitably loses control. I try to close my eyes and go to sleep so I won't see our constant near-death experiences, but like a moth to the flame I can't take my eyes off our impending doom. Oh, and I haven't mentioned the car's winning atmosphere. We're listening to Huaina music (this terrible terrible Andean-Quechua music where the singers purposely try to make their voices as high-pitched and grating as possible), and the guy has a pornographic postcard on the rearview mirror...of a blonde girl that looks exactly like me.

Like an angel of God the agency's truck mercifully appears after only an hour of this hell (still very very far from the border) and I'm transferred into a newer vehicle with seatbelts and someone who actually knows how to drive. For obvious reasons, I'm pretty livid. Anyway fortunately I got out of Bolivia with no major damage. I only arrived to San Pedro 4hrs after the agency had promised me, but given that those 4hrs were spent alone thinking I would never escape Bolivia, I can't be sure that 4hrs has ever felt so long. Next time I'll just stick to nice, safe Chile.

Earthquake in Chile

On Friday night at 3:34AM an 8.8 magnitude earthquake hit Chile 200 miles southwest of Santiago, closer to the city of La Concepción. I was sound asleep after returning exhausted and a bit ill from a trip around noon that same day when the shaking woke me. Even though I had never experienced even a small tremor before, my innate human instinct for survival must have recognized the earthquake as a dangerous event because despite my deep sleep I was instantly alert and I knew right away what was happening. I got out of bed. Although things were really shaking, I had no trouble standing up. (I was on the first floor of the two-story house where I live. People on the 4th and 5th floors of buildings told me that they fell trying to go down the stairs. Someone on the 25th floor said it was impossible to stand. Of note, the majority of people in Santiago live in high-rise apartment buildings.) However, at this point my survival instinct (and/or my lack of any earthquake experience or education) failed me because I had no idea what to do. I was thinking..."ok, it's an earthquake. Shit, what do you do in earthquakes?" I remembered being taught in school to kneel down in a ball on the floor and cover your head, preferably under something secure or against a wall with nothing above you, so that's what I did (although there were really no earthquake-friendly spots in which to hide in my bedroom.) Apparently, however, every Chilean knows that you are supposed to leave the building immediately if possible. Oops. The power went out. Next thoughts: "this spot doesn't seem very secure...why isn't it stopping? How long is it going to last? Are things going to start falling? Shit, what do I do?" I've heard in varying news reports that it actually lasted anywhere from 1.5-3 minutes, but I assure you those 90-180 seconds felt like an eternity.

After it stopped I was really freaked out. I'm not sure if I was more freaked out than other people because I had never experienced an earthquake before, or less freaked out because I had never experienced an earthquake before and therefore had no idea that I had just felt an 8.8 magnitude one. Most likely the latter. From what I figured at the moment, this was how those normal and frequent earthquakes in California go. Therefore trying to think logically, I decided A)that I was silly for being scared, B)that calling my parents in the middle of the night was a foolish idea especially since no one outside of Chile or Santiago for that matter would even know that a small earthquake had happened the following day, and C)that earthquakes are random events so now the danger was over and I had nothing left to fear. So I got back in bed to go back to sleep.

Since it was actually a Friday night, many people around Chile were out carreteando(partying). People who were in clubs have various reports ranging from thinking it was a party trick, or that they were suddenly really drunk and maybe someone slipped something in their drink, to not even noticing. Here at my own house Salo (the 21 year-old Chilean daughter) was the only one home (her mother and brother were on vacation in Brazil), and she was drinking with 5 friends on the patio. (I'll also add that she had been on vacation since I arrived in January until a day or 2 before and then had been away from the house all day Friday, so I had never met her at this point.) After the earthquake they got concerned about me being alone and came looking for me. This turned into quite an adventure because they had all been drinking, one of the girls was really drunk and completely hysterical, and they insisted that I join them in sitting outside in the freezing cold because they were scared to go back into the house for fear of it collapsing with an aftershock and figured I should be scared too. Cell phones weren't working and everyone was really worried about their families and unable to contact them. We were able to listen to radio reports from one of the cell phones and learned the magnitude and epicenter of the earthquake but not much else was known about the state of destruction. Although I then realized it was more serious than I had thought, I still didn't realize exactly how bad it was since everything around us looked completely normal (sans electricity). I again put on my logical thinking cap and concluded that if literally nothing had fallen in the house with the original 8.8 earthquake, and aftershocks were by definition less forceful, then the house should be able to withstand the aftershocks too. (Having no engineering or geology background I'm not sure if that is technically correct, but it makes sense to me.) Therefore after consoling them for awhile I went back to bed. (Aftershocks were still strong enough to wake me up again that same night and the following morning.)

The next day when I woke up the power was back and I immediately checked the news to see if there was any report (and was still not entirely convinced there would be). When I realized that the earthquake was front-page on every American news provider, I called my parents. It turns out they had heard a few minutes before and had been unable to contact me. (Phone lines would remain jammed with intermittent service for the next 2 days.) When I went looking around my neighborhood, literally everything was normal. No houses or buildings had collapsed. Normal normal normal. There's a tiny bit of damage to tile roofs (not a good building material for earthquake zones I've concluded) that you can see in the photos. All the photos of the outsides of buildings are from my neighborhood. Now having talked with coworkers and friends, there are cases of people's homes being destroyed enough so that they had to leave. Mostly this is due to something like the hot water being out of function or a leak, and some areas were without electricity for nearly a week. According to a friend who is a civil engineer here, some of the buildings look normal on the outside but are partially collapsed on the inside. The pictures I posted of the cracks on the inside of the buildings are all from the hospital where I work, and look very similar to a coworker's photos of damage to her apartment. There are cracks running through the middle of walls, and lots of corners and junctions are separated by an inch or 2, including the entire old and new building in the brick wall photo. However, no one I know knows anyone here in Santiago who died or was injured. According to news reports 30 of the 700 estimated dead were in Santiago.

One of the big disruptions was to travel. Several bridges fell, cutting off highway travel between Santiago and regions to the south. There was also fairly extensive damage to the airport terminal in Santiago and the airport closed for several days. February is typically vacation month for all Chileans, but school and work was supposed to restart for the majority the week after the earthquake and many people were en-route back to their homes in Santiago and were left stranded around Chile and the world. My house mother (Mónica) and brother (Andres) were two of those stranded in Brazil. They ended up having to spend the night in the airport in Brasil for 3 or 4 days before getting back to Santiago (the temporary Santiago airport is in a tarp apparently). When they first found out about the earthquake, someone from Santiago called them and said there was an 8.8 magnitude earthquake and then the call dropped. Before they were able to reconnect to get the rest of the information, Mónica says that she heard 8.8 and remembered the destruction of an 8.0 earthquake 25 years ago, and immediately assumed that Santiago was leveled and everyone she knew was dead. Creepy thought.

Life since the earthquake has been eerily normal. The fact that so little damage or death actually happened is testament to the success of Chilean building codes, and is even more impressive given the potent comparison we have so fresh on our minds of the recent destruction in Haiti (where the actual earthquake was 500 times less powerful). However the destruction and chaos in regions to the south is the only thing on the news here, and accounts of where people were when the earthquake hit or of people they know whom it affected are nearly the only topics of conversation. The feeling here is one of solidarity and nationalism, and many Chilean flags are suddenly taped to the outsides of buildings and homes. An overwhelming outpouring of local people are donating money and food. The barrier for these resources getting to people in the south is certainly a lack of organized distribution rather than a lack of people willing to give. Many people are organizing small donation drives and projects but I'm not sure that they have the means to know where the most need is or to get the items there. There are also many people, like myself, who want to go and volunteer but don't know where to go or what to do.

An interesting dimension of the disaster is that Chileans are very traumatized by the military after living through the 15-year military dictatorship which only ended in 1990. That is likely the reason that President Bachillet delayed so long in using National Guard resources to respond to the emergency and to the anarchy. Since the earthquake, helicopters have been flying intermittently over Santiago and I have heard people make comments about how they hate hearing that noise because it reminds them of the dictatorship.

The chaos and anarchy itself (in the south, not here in Santiago) reminds me of New Orlenas post-Katrina. Given their strong national pride, Chileans are quite disgusted to see their fellow citizens acting that way. I think they may feel even more of a bond with the people perpetrating the anarchy than US citizens felt towards people in New Orleans, since during Katrina's aftermath many expressed the sentiment that New Orleans was an island of culture distinct from the greater United States and that such barbarity wouldn't have happened elsewhere. However, it may be a lesson that when groups of people experience extreme situations together, regardless of their nationality or location, they resort to means that seem absurd and desperate to those of us not experiencing the extreme emotional and psychological impact of the disaster and its subsequent mob-effect on people's behavior.

Medically speaking, there really aren't many earthquake-related injuries to treat. The majority of the deaths came from tsunamis that hit the coast and carried people out to sea entirely rather than leaving them injured. In Santiago there are almost none. The hospital here did nearly close for 4 days while operating in emergency mode due to the President's declaration of a state of catastrophe. This meant that all the patients able to leave were discharged and all elective non-emergent patients were canceled to make room for the arrival of emergencies. However since nearly no one arrived, this actually meant that the hospital was nearly empty and all the staff were standing around talking to one another with nothing to do, an impressive waste of resources.

I did have one patient in Santiago who was directly injured by the earthquake in a mountain town an hour or 2 away. Apparently a wall fell on the patient who had various broken bones including a skull fracture. In addition a huge cut stretching across the entire forehead had been hastily stitched up in what I can imagine were less than ideal conditions, and the cut was infected (which compounded with the skull fracture basically provided direct access for the bacteria to enter the brain, hence an emergency). Neurosurgery took the patient to the OR to clean the wound and repair the fracture and plastics then closed the wound. However, when we opened the wound we found a huge stone close to the size of a ping pong ball stuck in the skull! Obviously when whoever had sewed up the patient, they didn't have the time or perhaps even light or water to explore the wound well and had sewed it up with this rock still inside. It was crazy. When I figure out how to get the photos off my cell phone I'll post them. Care for this patient did make me think a lot about the resources that are needed in disasters like this, and the patients that are going to start returning to the hospital with infections and other complications from injuries that were not able to be properly treated in the immediate aftermath. Many patients who are injured by things collapsing on top of them are severe trauma patients needing ICU care, ventilators, and several surgeries. They will probably continue to need revisions of their surgeries for months to come. Usually traumas happen on a small scale like a car accident and injure only a handful of people at a time, and ICU and trauma care are definitely limited resources. Therefore a big influx of need concentrated in one area like occurs with the earthquake presents a significant problem, especially when the roads are cut off limiting transport of victims out of the area to other trauma centers.

I also had one patient here who's from one of the coastal regions hit by the tsunami and his entire village got washed away. Everyone he knows is dead. (And he himself said it just like that, as if it hadn't sunk in yet.) The only reason he's alive is because he was here in Santiago for a scheduled plastic surgery which he sold all his possessions to finance (all those former possessions are also washed away to sea so ironically he would have lost them all and all of their value had he not sold them for the surgery).

Finally, patient #3 has a bunch of stitches in a cut about 8 inches long on his leg from a piece of furniture falling on him during the earthquake, but no broken bones. That about summarizes all the patients I've personally seen with earthquake-related experiences. And it's not for lack of seeing patients, I'm seeing plenty. They just don't have earthquake problems.

Just this week the Universidad Catolica began organizing groups of doctors to head to the affected regions to provide medical support. One group of 14 left Tuesday and I am on a list to be called when the next group departs. However, the groups are waiting to get requests for help before departing, and those requests seem to be scarce. Most of the need is for engineers and psychologists. I spoke with a friend who's working with the first group currently and apparently there are very few earthquake-related patients even in the south. With the chaos in the region there is a physician shortage to carry out normal work like managing chronic disease, so this is more the type of need the first group is alleviating. If I do end up going, I'll update with a firsthand account of the conditions.

Timely for my post of the earthquake report, this morning two strong (7.2 or 6.9 depending on the source you look at) and lengthy aftershocks hit within 5 minutes of one another while I was working on the 2nd floor of a very busy clinic. It was quite different to experience it in the middle of the day amidst the mass hysteria and panic of others. People were screaming in the hospital and running out of buildings and refusing to reenter. At this point whether the first earthquake directly affected people or not, we all have frightening scenes and images in our memories from the news, and then it only takes one or 2 people panicking to start a mass group psychology effect. Again, I'm really experiencing the power of other people's panic to infect those around them and create a mob that's reduced to the level of the reaction of the most extreme individual within the group. Also while I didn't run screaming, I felt quite a bit of anxiety and fear after the tremor so I must admit that I have more PTSD from the whole experience than I thought.

Patagonia/Torres del Paine National Park

I just finished (arrived back in Santiago on the morning prior to the earthquake) a 5-day trekking and camping trip through Torres del Paine National Park in Chile's southern Patagonia. The towers (Torres) are iconic, you have probably seen the photo before without realizing it. I got into the airport at 2AM, but due to waiting for the rigid bus schedules it was 6PM before I started hiking in the park. Somehow lack of sleep and long days of travel can make your legs feel as tired as when you have been working them for days straight! I set up camp at the base of the Mirador (lookout) over the Torres just as it was getting dark. The next day I was rewarded for rushing into the park with what I am told was the 2nd perfect weather day of the whole season (since October). I got to see the Torres without any cloud cover perfectly reflected into the small lake below. It was amazing. Some crazy German actually got in the lake for a swim (it was no more than 40 degrees air temp). I was trying to decide if I felt colder or warmer watching him.

Later that day I teamed up with McKay, my hiking partner from the previous day, and detoured off the typical "W" trek into the Valle del Silencio where usually only climbers go. We got the trails almost to ourselves (a real luxury since most of the trails on the W are crowded due to the route's international popularity) to see perfect views of the mountains along the valley and the back side of the Torres. The trails back here were fun since they climbed over boulders, loose smaller stones, and sometimes lingering snow patches (a few of which you could sink thigh-deep into!).


The next day the route followed sky-blue Lake Nordenskjold with beautiful reflections of the hills and mountains to the base of the middle prong of the W: Camp Italiano. The weather was a bit overcast today and seemed to be promising rain by the afternoon, with some fast-moving and threatening clouds covering the peaks and some high winds. The Cuernos ("horns"), probably the 2nd-most-famous site in the park, did finally peak out of their afternoon cloud cover for a nice view though, and after parting with McKay at Los Cuernos lodge I made it to Italiano with some Australian friends without any serious rainfall.

The next morning I got an early start to head up into Valle del Frances. It has a bunch of glaciers and snow-capped peaks, but today it had strong winds, gusts of rain, and some light hail...fortunately by starting out early I managed to get a brief glimpse of most all the peaks at least once as they peaked in and out of the clouds. By the time I was leaving the valley, most of the people who were going to start up the valley were giving up and turning back because of the worsening weather. Finally I moved camp over to the windy Paine Grande on the shore of the Caribbean-teal Lake Pehoe with views of a glacier-capped mountain and the Cuernos, where despite all indications otherwise my tent made it through the night without blowing away.

The park is actually amazingly well-serviced for a national park in the ostensible wilderness. Along the popular W and circuit routes you can actually hike from refugio to refugio and stay in beds with meal accommodations if you so desire. There's even a 5-star hotel in the park, although not on the main hiking trails. I had decided to camp, but the last day brought me to a paid campsite on the property of one of the refugios (Pehoe) rather than an independent campsite like where I had been camping up until then. After 4 days of cliff bars and peanut butter sandwiches, I was starting to think that the exorbitant price of $20 for a camp dinner at the refugio might actually be worth it. I went inside to see what they were serving, and saw an unidentifiable square that I assumed was meat (the menu said turkey) on top of a pile of vegetable slop and decided that my sandwich actually sounded more appetizing. Now it's just pathetic that they take such advantage of their monopoly and let their quality drift so low that a starving camper doesn't even want their hot meals, especially since they're located at one of the spots in the park that's linked to a well-traveled highway/boat supply chain and should be perfectly capable of bringing in fresh ingredients for $20/pp.

On the final day I did decide that since breakfast included eggs and only cost $11, it would be nice to start out a day of hiking with some solid energy. I then set out to hike the last prong of the W to see Glacier Gray, a huge glacier that flows off several mountains and breaks directly into Lake Gray, which consequently has some icebergs floating in it. I was able to get fairly close, and it was definitely impressive. However, at this point the blisters on my heels that had started on day 1 were definitively painful and I abandoned some former ideas about continuing on to the John Garner pass to see the glacier from behind and instead decided it was time to end the tour. I also realized that my stomach was feeling a bit funny, which I can only contribute to the runny green eggs that I paid a small fortune to eat for breakfast. I should have listened to Dr. Seuss.

Even though I was completely exhausted and not feeling well and thought I didn't want to see any more of the park, I still got excited on the Catamaran ride out by the perfect views of the Cuernos and Glacier del Frances from the lake. It really is a stunningly beautiful park.



Finally I stayed at the Erratic Rock in Puerto Natales, a hostel so great I decided to stay 2 nights just to relax a bit after the trek. There I met Alex, a scientist who does research in (nearby) Antarctica who made me well-informed for my final tourist activity: a visit to Isla Magdalena in the Strait of Magellan to see thousands (seriously) of cute penguins! He was also great company for my numerous attempts to try the prevalent and inexpensive Centolla (Patagonian King Crab) which I really really wanted to enjoy, although the aftermath of those damn $11 eggs kept ruining my $5 king crab. It was still pretty delicious going down, even if eating made me feel sick afterward.

Public Hospital in Santiago

(OK so my blog posts got a little delayed and this happened 3 weeks ago but anyway...)

I spent 1 week with the Digestive Surgery team at the Sotoro del Rio public hospital in Santiago. This hospital felt more like where I worked in Peru than America, although I think it was a bit nicer than the public hospital in Peru. Basically it's a really really old building, which alone would make it feel dirtier and less state of the art than the exact same thing in a new building.

Some highlights:

All patients share rooms here. Interestingly contact precautions (where one patient has a very contagious and difficult to treat infection that you in theory would not want to spread to the other patients, so you usually try to isolate that patient from the others) do exist. However, they consist of putting a little handwritten sign above one of the 6 to 12 beds in a room designating that patient as needing contact precautions. However there is not an extra sink or alcohol gel dispenser next to that patient to remind doctors and nurses to wash their hands between touching that patient and the next. Just the sign. Even more hilarious, we had a patient in the ICU with active tuberculosis (a very contagious airborne disease, it's precautions generally require that the patient be in a room with negative pressure ventilation so that the air doesn't mix with the air other people breathe and that everyone who does enter wears a tight-fitting airproof mask). In the ICU there are only 4 patients to a room, but there was our patient with raging tuberculosis sharing a room with 3 other patients (but with a sign over his bed saying that he needed airborne precautions, so I'm sure the germs weren't reaching the other 3 since they had the sign to protect them).

All the patients know what's going on with all the other patients in their shared rooms. In a way this gives them a kind of support family, but it also ruins any chance for patient privacy, that golden ideal of American medicine. In one of the rooms we had 5 of the 6 patients, and all of them were on bowel rest and couldn't eat or drink anything. (Generally in GI/digestive surgery, patients have to be on very strict diets for several days or longer after surgery as their guts slowly recover function and are able to digest normally again. This is usually a somewhat rigid progression from nothing by mouth to only water to broths and jellos and then to bland foods like chicken, rice, and potatoes before being allowed to return to a normal diet.) In the public hospital anyone can wander in and out at random, and many people come in and sell things like newspapers and magazines to the patients. It seems a woman was also coming in to sell homemade empanadas (fried bread filled with cheese, red meat, and grease--generally on the far end of the diet spectrum for a post-GI surgery patient, like they probably should wait a couple weeks to eat one). Well we come in for afternoon rounds and discover that all our NPO (nothing by mouth) patients are buying empanadas on the sly from this lady. Then they all start denying their guilt and pointing fingers at the other patients. One of the patients had a huge swollen belly from pancreatitis, and another one was emaciated and skinny from a long bout of illness. The skinny guy points at the guy with the swollen belly and goes "look at his belly, he's fat from eating all the empanadas! He ate them all!"

Finally, sanitation is also questionable. Just like people selling things can wander in and out, so can animals and bugs through the open doors and windows. I saw a stray dog in the cafeteria one day. Someone told me that a pigeon--those rats with wings--had once flown into the OR (what we want to be a super sterile and germ free environment). We also had 2 patients in the same room with open wounds (their wounds had gotten infected so they had to be left open to heal from the inside out), and I noticed numerous flies buzzing around that room which I can only guess were landing in their wounds, definitely not contributing to the clean healing process.

Oh, and the waitlists I mentioned in a previous post: Somehow there is no real incentive to work in the public hospital. When putting in lab and exam orders, you have to go find a nurse or a tech and take them by the hand to make sure they actually do their job and the test gets done. Also most of the tests only happen 1 or 2 mornings a week, and the rest of the time the doctors who do them are seeing their private patients who pay more instead. Anesthesia also refuses to start a case beyond 1pm in the afternoon, so even if the surgeons are willing to squeeze an extra case into the day, the OR won't be working so they can only do morning surgeries. All of this results in many patients sitting in the hospital (see first paragraph for the cesspool of infection that's likely to be) for weeks on end waiting for procedures and tests that never happen. One guy got admitted with a bowel bleed and a blood count of 15% (has lost so much blood he basically should be dead), but couldn't get scheduled for a colonoscopy to look up there and see/fix what was causing the bleed for at least 2 weeks. However, patients are more likely to get the procedures done if they're hospitalized than if they're an outpatient, so they prefer to waste their time and the hospital's resources by sitting in a hospital bed waiting for the tests. One of our patients had a less emergent indication for a colonoscopy, but since she couldn't get it for another week either we sent her home to have it done as an outpatient. (Also even though she had less need than the first guy I mentioned, we couldn't trade their places on the first-come first-served list so she would have gotten hers first.) Since that kicks her off the inpatient schedule, she'll probably wait months to get it done, if ever.

Lake District Weekend

Before going to the public hospital, I decided to take a 3-day weekend to see Pucon in the Lake District of Chile. This is a region several hours' drive south of Santiago where there are multiple (surprise) lakes and many picturesque volcanoes. I got a recommendation from some American friends to check out Pucon, the "adventure capitol" of the Lake District sitting on the shores of Lake Villarrica with a view of the snow-capped Volcano Villarrica nearby.

I took a night bus out of Santiago on Fri after work. (P.S. the bus station I chose was the first time in Santiago that I felt like I was in a developing country. It was packed with people hauling around what appeared to be their whole lives' belongings making it impossible to move around or to find the right bus, and within the 30 or so minutes I spent there--way too long--I tried to help some man who was gushing blood from a head wound, tried to avoid a woman who was standing alone and literally wailing in a psychotic manner, and eventually and thankfully found sanctuary on my bus.)

I got to Pucon a little too late to catch the morning bus to the national park I was hoping to hike that day, so instead I decided to rent a mountain bike and go see the Ojos de Caburgua, supposedly twin waterfalls (hence "eyes") about 15km outside of town. I was thinking a little gentle cycling was just what I needed to take it easy before I climbed the volcano the next day, which everyone had said was a very strenuous climb. However I must admit that I have never really mountain biked before, and I now have a new respect for the sport. Going up those hills is freaking difficult. I made it to the waterfalls which were indeed beautiful. There were actually 3 of them flowing down 1 side and also a short one on the other side of the clear blue pool they flowed into. It was making it back to town that got a little questionable. Especially when my chain fell off the bike shortly after starting back to town and I couldn't shift gears anymore...

The next day I had to be at the tourist office at 6am to take off for the volcano ascension. I was rewarded for my previous day's efforts to "take it easy" mountain biking with very sore quads. We strapped on all sorts of fabulously stylish bright yellow plastic gear, helmets, and crampons, and started walking in a single-file line through the snow up the side of the volcano. I think this is the most popular activity in Pucon with nearly every tour agency offering a trip, so this was not exactly a one-on-one with nature encounter. Stretching above and below us were long lines of tourists which forced us into a nice easy pace. The volcano isn't within any particular mountain chain and is one of the tallest things in the area, so despite all the tourists around me I still felt pretty peaceful enjoying the great views of the lakes and other volcanoes in the distance and hiking through the snow. Apparently they often get rainy overcast weather, so we had lucked out with a perfectly clear day. By 11:30am we were choking on sulfurous fumes at the edge of the crater. Then came the fun part: we got to sit down in snow tubes and literally slide all the way down the volcano. We picked up a lot of speed on these but had our ice picks to throw behind us as brakes just in case. I felt like a little kid back in elementary school--another slide!? Pretty please! It was really fun! Finally, I finished off the afternoon with a nap in the sun on the lakeside beach. It was a lake, but there were blue waves and plenty of people sunbathing, kayaking, and boating to make it feel like an ocean beach.

My last day I made it to Huerquehue National Park to do a hike up to 2 huge waterfalls and 3 gorgeous lakes. Each of the lakes was a beautiful crystal blue-green. Oddly, the one named "Green Lake" was the least green of the 3. All in all it was a beautiful escape from Santiago, and I wish I could have stayed in the area longer.