A First of Lasts; My Third and Final Quarterly Report

April 19, 2018 – Day 284 of 371. I have crossed the threshold of nine months, moved through three new countries and returned to one old in two weeks, and have officially bought my return ticket home. All throughout this time, I have been continuously riding the wave that is this year and being sure to soak up every last drop. Below you will find my last reflection sent to the Watson Foundation prior to returning home. In it I describe my ever-growing deeper understanding of what this Watson Year truly means for me and what is coming up in my final chapter abroad.

“I was happy and knew I was happy, the happiest I’d ever been. Not blissful, joyous, angels-coming-out-of-the-clouds happy, but happy as in ‘a feeling of great pleasure or contentment of mind, arising from satisfaction with one’s circumstances.” Happy from hap, as in what happens—things as they turn out to be.” – Victoria Sweet, excerpt from God’s Hotel: a Hospital, a Doctor, and a Pilgrimage to the Heart of Medicine.

Watson, if there was a way to quantify how many times I have found myself walking down a street in Thailand, a Soi (alley) for that matter, feeling a grin creep across my face, bursting into a smile I literally cannot contain – emotions overflowing to the point where I can do nothing more than to raise my hands jubilantly in praise, admiration, and most of all, thanksgiving, this letter would not end. Rather, I will leave it to your imagination the imagery of a very blonde-headed Farang (foreigner) wandering the back alleys of Bangkok and Chiang Mai doing such things. That was me. I have walked these streets, whispered to myself, “I love this life” and realized again, and again, and again that, this. This life. This year. This World. Is. So. Good. Although I leave Thailand today, the emotions which grew inside me there will undoubtably continue as I transition onwards, along this rich and full life given to me. Watson, does it have to end? I mean this, this life, all that this year holds. I do not want it to end. I have asked myself these questions on numerous occasions in the recent weeks. I think the most beautiful thing I’ve learned in this past quarter is first, the realization that I do not want this to end, and second, the subsequent answer to myself, that no, it does not have to. In fact, it is quite the opposite: it will not end, but continue, as the movements and experiences of this year weave themselves into the life that is to come for me. It will permeate all walks of my life – within myself, my relationships, my career. I will be moved, just as I am now, by what has come (and thankfully what remains to come in these last three months). During my Third Quarter, I read God’s Hotel, by Victoria Sweet, who accounts her career at Laguna Honda Hospital, the U.S’s last Almshouse, a long-term patient-care hospital. In the process of her writing, she accounts both the historical origins of medicine, as well as the journey in which she undertook during her career, both personally and with patients. Finishing this book in the midst of all the emotions described above could not have been more perfect, and thus I am choosing to share a few of her quotes – not only has her writing stuck with me, but I deeply resonate with her words, finding the descriptions and the emotions of her experiences reflections of my own.

First, a brief recount of all things Thailand. Arriving to Bangkok, I gave myself a few days to adjust to the drastic time change, while finalizing future internship plans within the city and in the north. Soon after I took a trip to Krabi, Thailand to first see the southern part of the country. I wasn’t sure whether my future plans would bring me back south, and thus I tried to see all I could in the time I had. I had just written in my last report that I had been finding the importance in separating my life from my project; however, arriving in Krabi, I came to realize what I had just written was indeed the opposite of what I was experiencing. My eyes have slowly been tuned to look towards my project – of course in the hospital and in the ambulance, but they too have attuned themselves to the streets, the passer-by’s, the clinics advertising themselves to foreigners rather than to locals, the families of four all positioned on one motorcycle: daughter in front, dad’s arms wrapped around driving, mother holding with one hand, cradling their baby in the other. “Care.” The relationship I have with to that word, that people in these communities have to it, that this country as a whole has to it is no longer separated to a project day or not, a “project activity” or not; they are both, simultaneously. Each day I am called to the opportunity to both seek out the questions I hold within my project and the questions I hold within myself. Returning from Krabi to Bangkok, I had about two weeks on my own before starting an internship with a local organization. Having hoped to set up a few contacts with emergency services in the city, I continued to face a few setbacks and had to reorient myself. These two weeks turned out to be time for much needed preparation – intermixed with sightseeing and learning about beautiful Bangkok and beyond. As I would soon find, time to do both of these things would soon come to an end.

At the very beginning of February, I started working with a local organization that provided access to, among other things, hospitals within Thailand as a form of Medical Internship. Beginning in Bangkok, I spent two weeks in the Department of Surgery at one of the larger teaching hospitals in the country, named Thammasat University Hospital. Following those two weeks, I transitioned to the Department of Internal Medicine and Emergency Medicine at Sirindhorn Hospital, where I felt I really began to come alive in my comfort in seeking out new opportunities to learn from the doctors on call. Ending all too soon, I was able to get to know the local Thai coordinators, spend good time with them and their friends. It was during this time I felt like I was not only starting to meet people from here, but building relationships with them as well. Near the end of February, I traveled north to Chiang Mai – having first a few days to explore the city and surrounding mountains (boy, did I miss them!). I stayed at the most incredible hostel and met the most incredible people, who also would soon change my Thailand experience into what it is today. Later, I spent a week in a private hospital through the same organization; I got a glimpse of the private sector of health care, and then transitioned to a fourth Hospital in Thailand for my final two weeks of interning. During that time, I spent one week with nurses in the Department of Pediatrics and one more in the Department of Orthopedics. Throughout my time in Chiang Mai, and with the help of the new friends I created, I learned more about the rescue operation services, namely the various volunteer organizations who operate in the area. On two weekends, I joined the Pingnakorn Rescue Civil Defense Volunteer Corps. Waiting at a gas station, beside a friend’s stall of street food, we relaxed by a pick-up truck and waited for calls to sound off over the radio waves. I celebrated my birthday by making an offering at a local temple with good friends, spending a day at the hospital, getting a massage, running through beautiful landscapes, and taking a pause for some fun celebrating in the evening with new, now eternal friends. It all came and went so quick; I took a surprise trip to Bali, Indonesia, getting to see the sights of the islands, and really loving the brief, yet significant interactions I had with those who lived on the island and returned for one final week to welcome my sister on her spring break. Blasting through the north and south of Thailand, we were adventuring non-stop, but most significant was the opportunity to show her those who have imprinted something special on my heart. It meant so much to be able to share a large piece of what has made Thailand the way it was, and for her to see me “in my element” was a perfect way to close.

I had mixed feelings going into my internship. I was weary of being “stuck” with one organization for too long, as has been encouraged by you all, but was comforted in knowing I had set plans in the time ahead of me. What would I learn through a surgical room about patient care? And the community? That was tough, but soon I was able to find new opportunities in the ample access I had to health care personnel. My time in the hospital not only allowed me to see new aspects of health care, but it also gave me time to communicate with those who work on the “receiving” end. Ambulances bring patients, hospitals receive. Care doesn’t end in the ambulance, nor does it when the transfer to the Emergency Room occurs; it permeates into the hospital, throughout it’s corridors, back out the door, and far too often back in again. These weeks in the hospitals have also revealed a huge, but exciting new avenue of pursuit for me. Public health, specifically, with a global focus. I cannot wait to get started on my medical degree upon returning; however, the sights and questions that have come to me along this year have caused me to also seek out a deeper understanding of our Public Health, and the relationship we have to it. It excites me to be coming out of this year, with a new piece to the puzzle that I aim to fit into the journey ahead.

“A pilgrimage is a journey for spiritual reasons, but with a material goal—a shrine, a church, a mountain. It comes from the Latin word for pilgrim, peregrinus, from per ager, meaning ‘through the territory.’ A pilgrim, therefore, is someone who leaves home to travel ‘through a territory’ that is by definition, ‘not home,’ and so has the wider meaning of alien, foreigner, stranger…The pilgrim leaves home in order to experience being a stranger—speak a different language, eat different foods, encounter different expectations—to experience otherness as the other.”

Reading this first, the only word I could find was, yes, a thousand times, yes. Each day brings a new journey. I have learned that there are days I plan to be great, but turn out the opposite, and there are days that I expect to be long and slow, yet they turn out to be absolutely wonderful. On a Pilgrim’s Journey, or on a Watson, there is no telling what the day will bring – yet I do know that the next day comes, and the one after that too. Each day brings something new. At times that newness comes in the form of direct involvement with my project, and sometimes it shows itself to me in new friendships – some of which I long to return to. Still on other days, I find that quiet solitude I have come to know and love, perhaps via biking through back alley streets of Ubud, Bali seeing every smiling face look at you while you smile back at them, or on a solo trip north to run a half marathon and high-fiving other runners as we pass each other in opposite directions. How am I growing? Well, I think I am learning to live into this year for what it is – much more for what it is than what I want it to be, and it is through this that I find myself walking down that street smiling and throwing my hands in the air. My eyes have been increasingly opened wider to the people around me. To the man on the street I always go to for delicious food – the friend who affectionately calls me More (Doctor) as a nickname, or the other who says I am Uncle Marky-Marky after her pregnancy reveal. This quarterly report feels a little different than previously; there is no long list of the things I’ve learned, or numerous new questions that have come to mind. Perhaps that is because those initial things I was learning, I know I still am, and those questions I first posed still remain, but it’s the synthesis of it all that I am finding within these three months. A Pilgrim’s Journey indeed brings new truths, and leaves you with more questions, but as one continues, I think the Pilgrimage also teaches you to at times just move “through the territory,” “to experience otherness as the other,” but most importantly to live into the idea of hap, the Latin root of happy, “as in what happens—things as they turn out to be.” As the third major leg on my Watson Year closes, the third leg of my pilgrimage closes too. I walk away having learned to live into this, this life, this world. Perhaps too that will be one of the greatest gifts of all. The future will not always include plane flights to new, unforeseen destinations, to new cultures, new food, and new people. No, this life will include long hours in the library and hard nights in the hospital, but how wonderful it is to know I can carry this mindset with me as I continue along this year. To know I do not have to leave it at the gate when I cross back over to Europe now, or Tanzania later, or home in the now not so distant future. To have had my eyes opened to this, I am grateful, to you, Watson, for the opportunity, and to Thailand, and her people, who I believe truly helped open my eyes to see these things.

So, whats up ahead? Well, it looks pretty jam-packed to me, and that is so exciting! Leaving Thailand was one of the hardest goodbyes I have had to make, but I leave knowing I also get to return to a familiar place, and a family who helped begin this year for me. I am in transit now towards Copenhagen. With Visas ended in Thailand and the conference not beginning until next week, I have a few days in Transit through Europe as I make my way North. Landing in Vienna, Austria, I will see over a few short and sure to be fast moving days Vienna, Budapest, and Berlin, ultimately arriving in Copenhagen on the 15th of April and staying until the 21st. Leaving then for the UAE, I will first stay in Dubai and later to Abu Dhabi to get to know one of the major Emergency Rooms and Ambulance system within the city. On May 5th, I will depart for Tanzania, where I have planned the remaining two months of my time as a Watson. Beginning first in Dar, I will be involved at the Emergency Department at the National Hospital, and hopefully tap into the rescue services there as well. As time grows, I will move outwards through the country and north towards Arusha. There really are a lot of great things in the works – much of which I have reflected upon and wondered how so much has come together all at once. Thinking first that I just had better “luck” than the slower paced days of Denmark and some of Chile, but realizing more now it is the experiences from both of those places that taught me to pursue what I have in Thailand and what I am soon to do so in the countries to come.

The Watson is not only a Pilgrimage, it is a Way, a clear Way of life that pulls on the things you once knew, drags you both willingly and unwillingly all the same into the thick of it all, and yet still posits you on the cusp of something truly, inexplicably great: that is, everything else – life and all that it has yet to hold. Through these nine months I have ebbed and flowed between highs and lows, and just about every emotion in between. In the last three months, I have awoken each day with an energy I once did not know I had; I have, glanced at the world and wondered what the heart beat sounds like of my neighbor across from me, I have gazed out upon beautiful landscapes and asked myself how we all got so lucky to have this Place, and I have looked inwardly to myself and discovered more about myself than I could have ever thought.

“But no matter what the interior quest, the Way was a way of life, and what he wished for us was that, with the sound of our footsteps, whatever we were seeking would fill us to overflowing.…The thing about a pilgrimage is that there is no way to experience it except to do it. In that way it is very much like life….So nothing went by us too quickly; we were not tourists but actors in a landscape made to the measure of our footsteps.”

“We were not tourists, but actors in a landscape made to the measure of our footsteps.” My experience as a Watson could almost be entirely summed up into that final sentence. On some days those steps are quite small, sometimes they do indeed look like a tourist, but on other days they are big, they bound, even leaping at times into this world with people I never thought I would meet, with sights I never thought I would see, with questions I never thought I would ask. Watson, This. Is. So. Good.

Happy Spring from Copenhagen. I wish that you may be well wherever you find yourselves. Thanks for checking in.

-Mark

A Glimpse at Structure

27 January 2018 – 16 February 2018

Seven and a half weeks have flown by; they came in one door and went right out the other. I have finished an incredible week of exploring Bangkok and beyond, three amazing weeks at two different hospitals within the city, have moved to Chiang Mai, Thailand, a small city in the north of the country sitting at the base of the mountains. I have then spent a week there exploring and now am in my third week at the hospitals here. As I am now seven weeks (and counting) behind in an update, one post would go on for far too long to even know where to begin, so I will break things up a little. Coming to you first is my time in Bangkok traveling and starting at the Department of Surgery in Thammasat University Hospital. Having reported to you last about life moving a bit more slowly in January, I cannot say the same about now. I am so thankful to have had that time then, but to also now be on the move, daily, is truly wonderful. Having just written about moments along a Watson Year that drag and clunk versus the times that fly and sail, I can now so clearly see this playing out before me. We are sailing, full speed ahead. For each moment along this year, I try and give thanks, but especially now I feel I owe an extra word of thanks: to you, Watson, and to so many others, like you, reader, who continue to support me as I go. I have been this happy before, I know, but there is hardly a moment in each day that I cannot stop smiling. Perhaps a bit of the Thai Way is rubbing off on me, but the people I have met, the experiences I have shared with them and with myself has left me so fulfilled – both personally and with where I have hoped to see my project take me. New questions continue to arise and I love to engage in conversation with others as they come. I have been able to visibly see a change in the confidence I feel when approaching new situations and I can only sit here now with excitement to see where that takes me next.

Enjoy this read, detailing pt. 2 of my Thailand Journey and stay tuned for more follow-ups to come shortly!

Week 4: 27 January – 2 February

After a week spent planning for the road ahead, blogging to you all and finalizing all that lies before me in Thailand, I took some time to really get to know the beautiful and expansive city of Bangkok. There was no way I was able to see it all, but I had so much fun exploring all the different corners the city had to offer. To begin, I spent the day exploring the Grand Palace, which holds many royal buildings, as well as the Temple of the Emerald Buddha. I had wandered in and out of some places prior that displayed traditional Thai architecture, but nothing could compare to the intricacy and grandiosity of the Palace. The attention to detail in every piece of the temple constructed a breath-taking view from every angle. I spent some time along the river on a boat to catch in some sights and enjoy the sun and later spent a fun evening out celebrataing the birthday of my AirBnB host! Moving over early to the Friends for Asia House, I was excited to have a settled spot to live in for a few weeks, I took a day to settle and explore the nearby Weekend Market, called Chatuchuk. Having enjoyed my boat ride so much before, I went back to the river and hopped on a boat where you could get on and off any time you liked. This allowed me to stop at Wat Arun (The Temple of Dawn), Wat Pho (The Temple of the Reclining Buddha), the central Flower Market, and many other beautiful parts of the Old City of Bangkok. Wat Arun is a beautiful and famous temple within the heart of the city. Its white-tiled exterior beautifully reflects the sunlight that hits it. Every piece is symmetrical and looking at it casts one’s eyes continuously upward. Just across the way is Wat Pho home to a statue of the Buddha lying 46 meters long and 15 meters high. It is one of the highest class of royal temples in Thailand. The flower market was home to endless corridors of smiling faces and beautiful colors. People weaved flower necklaces, offerings, and bouquets. Later in the week I traveled across the city to Bangkok’s “Green Lung,” called Bang Kachao. As one of the last large green places in the city, further development of the area has largely been restricted. Renting a bicycle, I was able to explore through beautiful lofted sidewalks and roads (thankfully not falling into the marsh below). The week also included some rainy days, meeting new friends at the Volunteer House, a few nights out (annnnndd…one lost/stolen wallet (sad.)). On my last day of the week I traveled by train to Ayutthaya, the ancient capital of Thailand. First getting on the wrong train…I finally made my way and was able to rent a biculce to travel between all the ancient ruins. Mixed between temples, grand palaces, and ordination halls, these 700 year-old structures largely still stand to this day and reflect a beautiful history to the origins of this Country.

Week 5: 3 February – 9 February

I was so excited to start this week because I knew that it also meant starting my time in the hospital. The week began with a two-day orientation at the Volunteer House with the other volunteers and interns who had just arrived. There were six of us in total, four who had signed up for the medical internship and two others who would be teaching English. We worked with Aom, Manong, and May, the three Thai coordinators who work for the foundation and endlessly work behind the scenes to make our time there so great. We spent the day running through some need-to-know basics, toured a new temple and got to know each other a bit more. That first evening, I met up with Sarah Wells, who I had previously met a few weeks ago, for one more night before she headed back to the states. We cooked Shabu, where all the meat and vegetables come to you raw and you cook them together over a burner. It is a delicious and fun way to share a meal with others! With one more day of orientation, we continued where we had left off the day before, learned a few new Thai words and explored the market where it is far too easy to do some serious shopping there. Monday was Day 1 at the Hospital. The three other interns, May, and I took a bus, van, and shuttle across the city and through the campus to finally arrive at the Hospital. It was quite the trek, but allowed for a nice pause in the morning to get ready for a good day of work (and a nice nap in the evening on the way home!). I’ll hold off on the details of my time there until later when I discuss some project work, but our first week was awesome. Finding our feet beneath us on the first day, we were able to see many surgeries and get to know the hospital staff well. This really helped us during the second week as we returned and got to see and meet so many more awesome staff.

Week 6: 10 February – 16 February

As the weekend rolled around, I spent my Friday night with the volunteers in Khao San Road, a fun and hectic touristy strip within the city, and then trekked out of the city on Saturday and Sunday to Kanchanaburi to camp out in a nearby park as well as explore some waterfalls. Having had the time to do so in Chile, I was so happy to get back out, away, and in the woods again. At the campsite, everyone was so friendly, there was plenty of local food to eat, and the waterfalls were great for cooling off and swimming at their base. Beginning Week 2 at Thammasat University Hospital, we continued to see incredible surgeries. Benefiting from having walked around the surgery ward the week before, most people recognized us and often offered for us to step into their surgery room to see a procedure we had not seen before, like a C-Section, which will definitely go down as one of the coolest moments I have ever experienced! Also included in the week was a celebration of my Dad’s birthday from afar, exploring the University Valentines Day Night Market with a few resident Interns at the Hospital, the best hospital food I have ever had, and good evenings out after work at nearby food markets and out door eating spaces. One night I managed to see the Black Panther Movie, and it was amazing! (So far I’m keeping a good record on the new Marvel Movies released while I’m away – Rob and I need someone to talk to about it!) That Friday I went out with new friends to celebrate the Chinese New Year in Bangkok’s Chinatown District. Full of red, gold, plenty of fireworks, and even more people; it was fun to explore and experience that celebration!

Lastly, as the second week at Thammasat came to a close, I began to really appreciate the time I has having at the Hospital. I was up at the same time everyday, off to the same place, although still with enough unknown and new experiences to be had, and back home around the same time. I got to find a routine evening run and walk towards food, followed by a relaxing end to the week. All of these things put together, reminded me, as I have said before, how much I love structure. The structure has been nice: it gives me good direction for what I am doing each day and allows me to set my sights forward to the new activities and experiences to approach open the weekends. After so many years of school, you get quite used to the structure you had. Each new year you tweak it with new things as you leave behind old things, but your structure largely remains the same. For the most part, my Watson year has been the opposite of structure, at least in the way I have been used to it – and I think that is a good thing for me. It’s taught me to think on my feet more, to make a plan at a moments notice, and be prepared (and excited) for anything that happens, but…structure is still nice when it comes.

Picture Time!

The Temple of The Emerald Buddha, or What Phra Kaew in Bangkok

Every piece of the Temple stands littered in gold, covered in exquisite detail.

Next door, the Grand Palace mixes Western European and Thai Architecture.

On the water, the Temple and Palace together stand out amongst the rest of the city landscape.

Bangkok sometimes is called the Venice of the East. The canals and many Boat Taxis that run through them sure do make you feel like it is that way. (Check out this cool video, with low sound…unless you want to listen to a loud motor!)

Wat Arat, or the Temple of Dawn is absolutely astounding when you get up close to see the extraordinary symmetry.

Wat Arat Beauty Pt. 2

Bang Krachao, or Bangkok’s Green Lung, is a large green space in the heart of the city restricted to further development. Raised bike paths weave you through homes and neighborhoods in a quiet retreat from the bustling city.

Check out this time lapse taken by bike of some of the biking paths along the route.

Although I initially got on the wrong train to Ayutthaya, I enjoyed the views along the way

The Ancient Capital of Thailand holds much history to it, including this fallen Buddha’s head at Wat Maha That, now reclaimed by the natural world.

The Fallen Buddha’s Head and Me at Wat Maha That

Ayutthaya’s ancient and most holy temple: Wat Phra Si Sanphet. After centuries, it is amazing to see these buildings withstand the test of time.

I found the symmetry at Chai Watthanaram Temple to be the most beautiful of them all.

A weekend trip away to the Huay Maekamin Waterfall, brought me out of the city and back to some much needed nature.

The falls consisted of 7 flowing tiers that

This is just one of them, Tier 2.

The water was incredibly refreshing on a hot day!

Sunday Morning, I awoke to a beautiful sunrise over the lake below.

Sunrise Pt. 2

On my way back, I stopped at Death Railway. Much of the original lines for this railroad were built by WWII Prisoners of War

My last stop on the trip was a late lunch on the Khwae Yai River. These suspended nets were enticing for a late afternoon nap!

And now, a Project Update!

Within 2 weeks time, I got to see 27 surgeries ranging from minimally invasive cardiovascular surgeries such as Arteriovenous Fistulas and Grafts up to Open Heart, Aortic Valve Replacement Surgery. We saw what seemed to be everything in between: plastic surgery for cosmetics and injury, cancer and tumor removals, laparoscopic and open, multiple child births and even total uterine removal surgery. Having previously only seen a few minor surgeries at Vanderbilt during an undergraduate internship, it was really incredible to see as much as I did. Some simple (at times funny) observations I made for myself during this time: the OR is cold and there are many hours spent standing (don’t lock your knees!), but there is some really incredible work being done behind those closed doors. Above anything else, it seems like the Operating Room is what remains most hidden to the outside world in medicine. As patient’s we at least get a glimpse of our own treatment, and that may help us understand, in general terms, what it looks like or doesn’t for others; however, even if we find ourselves on the operating table, we are either asleep or restricted in viewing what is going on. On the inside, when you get the opportunity to see doctors, nurses, and aids working together for the patient’s benefit, you begin to see what a well orchestrated machine looks like. At Thammasat, the head surgeon, a resident, intern, and scrub nurse always surrounded the patient. By the patient’s head, a nurse or two monitor vitals and anesthesia. In other parts of the room, other techs help maintain order and medical students stand in different corners observing some and studying at other times. Doctors get to work, but never give off too serious of an aura: conversations were maintained, laughter sparks every once in a while, phones ring and nurses hold them up to the doctors ears. And then there is that one automatic sliding door. It separates the in from the out. Unbeknownst to the outside world, the tireless efforts of all involved create, at least endlessly strive to create, better lives for others.

In the time between surgeries, we often had the chance to speak with the physicians, nurses, and students about their work and the larger Thai Medical System. Through this we began to learn a little bit more about who pays what, or who doesn’t for that matter. Essentially, there are four different types of coverage. The first is what is called the “30 Baht System.” The name derives from the cost it takes to pay for one visit to the doctor, no matter what it is. Whether it is for a yearly physical or major surgery, the cost is 30 Baht for the patient. This equates roughly to one U.S Dollar. This system is provided for all Thai people, but others choose to use a different service where eligible, which often includes opting for a different hospital, such as a private one. For the most part, the 30 Baht system covers all the necessary things one may need, but there are limitations. As I learned, the limitations for this often fall more on the hospitals than the people. Under the 30 Baht System, the government will pay up to a certain amount of money. If a procedure costs more than this, then the extra cost will fall on the hospital where the patient is treated. This can make it difficult for a hospital, resulting often in reliance on donations and fundraisers. A recurring theme that echoed around different surgical practices was money. It is clearly on the mind of personnel here; specifically, how they can save money while maintaining the highest level of care they can give. An example of this was during a laparoscopic removal of a gallbladder. The doctor inserted a small bag inside the patient’s abdomen, and then later pulled out a gallbladder synched inside of it. Afterwards he pointed at the nurse across from him and said, “she designed this for the hospital. We can create hundreds of them at little to no cost, but if we were to order them externally, we could never afford it.” Innovation at its finest.

If a person is employed, then they are often covered under a social welfare system provided by the employer. Although similar to the 30 Baht Rule, the patient under the social welfare system does not pay anything. It is through this system that patients may opt for coverage at a private hospital and still revive full coverage by their employer. A third form of health insurance is the Governmental System, where any employee of the government, whether they are military or a teacher at a government school is funded and covered separately. Lastly, one can opt to be on their own with payments. This will either mean paying upfront in cash or through purchasing individual, private health insurance. What I learned through this though is that as a Thai National, there are plenty of options for coverage at little to no cost. Under the 30 Baht rule, it will likely cost more for the patient to even make it to the hospital than it will for them to receive coverage. As I continue to travel, and explore new systems of health, I am amazed at how many places have a system of health care that provides for their residents at little to no cost. It causes me to also reflect on the cost of health care back in the U.S and how often individuals face the dilemma of what they can and cannot pay for.

A few ideas that stuck with me during these two weeks of surgery were these: During our day with the plastic surgeon, he said, “Thai people don’t get cosmetic surgery in order to impress others, or look more attractive to others. They do it so that they may see themselves in a better way. I do this work because I want to help people feel better for themselves, for them to view the self as beautiful.” It’s hard to think that some people go to the point of surgery in order to improve their self image, but at the same time, to hear that this is the mission and intention behind this doctor’s work is inspiring. There is reason to it.

Birth is truly a miracle. On our day rotating with an OBGYN, we saw four different C-sections, each one producing, out of what seems like nowhere, new life, full of tears and screams, but nonetheless full of life. In my next post I speak a little further about the magnitude of life itself that continues to be revealed to me along this year. This was one of those moments without a doubt. At lunch that day after seeing the first two births, I wrote, “Some things are universal. Perhaps they are operated and performed in varying ways, like birth, but new life comes and is brought into this world everywhere. Far and wide, new life comes; that is something to celebrate.”

Another doctor shared with us that he thought there needed to be more doctors who remain in Thailand to train, rather than go elsewhere. He spoke about how often people leave, learn elsewhere, and return not knowing the standard of practice in their home. This was an interesting take for me, and I have had difficulty remedying it in my head. As I am so clearly away from home with the intention to learn while I am away, it is difficult to think that one should limit themselves to their own home in the process of learning. What I am taking from it is this: it is important to train in where you will practice, but this does not mean to not engage elsewhere. Nor does it mean that one shouldn’t explore new contexts, practices, and cultures in the process of learning, especially within medicine. Western medicine and practice has permeated all forms of health care, and in many ways this is a good thing as the world strives together for greater, more universal access and coverage. Today the world collaborates around new, innovate ideas and techniques, and we are better for it as a whole, but I also question what is lost in the process. These ideas about global practices and similarities in medicine coincided with other thoughts I have had about the intersection between health and culture – about the outcome of such an intersection, for the individual, or the community as a whole. To say that one’s culture doesn’t effect your practice would be naïve, so I am left with many thought after those two weeks in the Surgery Department. Where does culture permeate the into the Operating room? What is threatened when we homogenize a practice? In each of my interactions this year, I am shown just how much we are shaped by culture. Every action we take is a result of where we have come from. I have to believe that this too exists in the operating room. It may not be in in the specific incisions or sutures performed on the operating table, but I believe it still exists. These are ideas I am still working with and I welcome any and all ideas you may too have about the intersection of culture in practices/procedures that have become standardized worldwide, such as surgery.

When I started these two weeks at the Thammasat University Department of Surgey, I was initially a little nervous about how I may explore the context of my project in the surgical room. After all, I had originally posed the question about ambulance care, not surgery, but at the same time I was excited to explore the question of care within community through a new lens. Care most definitely does not stop once a patient leaves the ambulance, or the hospital ward. It occurs in the OR, the recovery bed, the outpatient ward, the ambulance stretcher, and the bed back home. I am thankful for my time at Thammasat and for the opportunity to see the care behind the closed doors – to see where it continues, and to be shown that it is given in every corner by health professionals of all levels.

Bryant, Frank, Jessica and I snagged a selfie outside the Faculty of Medicine on our first day in Thammasat University Hospital

On Valentines Day, a few medical students took us to the University Valentines Festival/Night Market.

Alright…long, over-due update (part one) complete! Stay tuned, a few more are coming! As I hit submit on this post, most of you are likely fast asleep, but I know at least some of you are wondering what I am doing on this day! Today is my Birthday! Yippee! Leaving home, I was a little worried about what my birthday would look like while away. Where would I be? Who would I be with? All those fears have vanished here. Today has been great and will continue to be! I woke early to go to a temple with my two close friends here, we made offerings to the monks and received a blessing for this day and the year ahead. They both do the same on their birthday and wanted me to share with them in that practice today. I’m thankful they did! I spent the morning at the hospital, dipped out a little early after lunch, got a Thai Massage, and am enjoying an iced coffee as I submit this post. Later I will go on a great run and meet up with close friends for a fun night of celebrating. You create family where you go; I am thankful for the one I’ve created here and for their willingness to welcome me into it.

Morse (right), posted this in the morning after our temple visit. Gig is in the center. They’re both so great. Khob khun Krap, my dear friends.

Cheers to a pretty incredible year, and for the one coming up. It’s sure to be just as good. Until next time,

Mark

A New Start, A Restart, A Fresh Start

Friday, January 26, 2018: Sawasdee khrap! Hello! As I write, all of you stateside likely are finding yourself nearing bedtime, while morning has only just begun over here. After almost three weeks, I would have thought I would be adjusted to the difference of 12 hours, but it is very much still a process (in sleep schedules and in communication!). Thailand is wonderful. It is wonderfully hot and humid as well, but all things considered, I have really enjoyed these first three weeks. They have been a smooth transition, holding a clear focus on adjustment, sightseeing, and planning. As is typical, the first three weeks have not quite been what I was expecting them to be, but they have been good all the same. Learning to navigate the streets, communicate what I do and do not want in my food (and how spicy it should (NOT) be), exploring the awesome benefits of a Thai Massage, and learning about an entirely new culture in the land of smiles – I am trying to absorb all that I can and am excited for what lies ahead here in Thailand.

With the language barrier that I face here compared to my first two project countries, showing up on doorsteps, or receiving email responses for that matter, have been difficult, and thus have left me in a bit of a standstill in relation to how things were done during the first half of my year. Just before I left, I applied and confirmed an internship with various hospital systems within Bangkok and Chiang Mai, a city in the north. Over the course of 6 weeks I will work with doctors across different fields in four different hospitals. A week from today this program starts and essentially fills my time in Thailand to completion, save for a few short breaks and weekends in which I plan to get out and see new parts of the country. This is the first time I truly have a set schedule set up before me, rather than creating one on the spot once something has worked out. It both scares me and excites me. After having had to create and plan for what seemed like each new day, a weekly schedule with a set location sounds and feels really nice; however, after having grown accustomed to the solo scheduling, there remains some timidity about stepping into it. I think these are both good feelings to have.

Below I’ll detail exactly what these first three weeks have looked like.

Week 1: January 6 – 12, The Adjustment

Arriving in Bangkok, having nearly made it through 60 hours of travel (somehow I lived on the 5th of January for all of 8 hours). Leaving on the 3rd of January and arriving on the 6th, my body was a little shell-shocked and thus I tried my hardest to focus on an easy introduction to this place. Having a Nice AirBnB set-up I began to create a routine for my first few days. Breakfast pick-up at the 7/11 across the street, coffee next door, followed by setting out to explore a new part of the town. Experimenting with new street food, new parks, markets, and buildings, I tried my best to familiarize myself with a place that was and is becoming home. What I learned in the first few days: I have not missed the humidity, that I have really missed a good rain (I think it rained all of 3 times during the entirety of my time in Chile), that this city is HUGE, but definitely very friendly, and that street food (as everyone says it does) rocks. Near the end of the week I connected with a friend from Sewanee, who was on a brief vacation from her work in Bhutan with a foreign exchange program. (Yeah Molly Mansfield!) We celebrated a birthday of the friend she was with, and then set out towards the south of Thailand towards a town called Krabi. Arriving in a rainstorm, we essentially settled in for the night in the beach town of Ao Nang, a smaller area just a short drive from the main part of Krabi Town. Waking up to a sunny day on the 12th, we were greeted with beautiful blue waters, sandy beaches, (a lot of people), and towering cliffs. Taking a long tail boat (a long wooden boat with a large motor, long axel, and small propellor), we crossed the waters to a beach only accessible by boat: Railay Beach, and then walked through the small town of Railay to a second beach called Phra Nang. Boats washed ashore carrying kitchens with drinks, smoothies, roasted corn, and delicious Pad Thai. All was well. Afternoon thunderstorms led to good times with new friends and a fun game of cards. It was nice to have some beach time.

Week 2: January 13 – 19, The Beach

This week consisted mostly of my time in the south, while the ending contains my return to Bangkok. On the 13th, Molly and I traveled with a new friend we had made to the Tiger Cave Temple. There, we climbed 1237 steps through pesky monkeys to reach the top of the mountain. At the top we found an incredible 360º view of the land around us and a beautiful, enormous shrine to the Buddha. It was quite the climb, but every part was worth it once we saw what was at the top. Climbing back down we toured some other areas of the temple grounds, ate, and bartered our way to another site in the area, the Emerald Pool. Unsuccessfully bartering, and ultimately paying a steep entrance fee for foreigners, we discovered the Emerald Pool to be as was described – quite emerald green and tucked away in the jungle, but entirely overpopulated as one might find in a public pool in the summer. We tried our best to laugh off the experience and didn’t stay too long. We finished the evening in the night market of Krabi Town. On the 14th Molly and I signed up for an Island Sunset Tour that took us to a few beaches to swim, a spot to snorkel, a tour around a few iconic islands in the area, like Chicken Island (which seriously does look like a chicken), and a nice buffet at the end. The peak of the trip, however, was after dinner where we set back out on the water in the dark to swim with bioluminescent photoplankton. Memories of Planet Earth and biology labs sprang back to me and then I jumped into the water and experienced the real deal. Every tiny movement of my body caused hundreds of brilliant, blue lights to light up around me. The hair that I could see on my arms and head through my goggles glowed with small blue lights as it moved with the current. It was as close to magic as you could get. Having a sunny day in the forecast on the 15th, Molly and I rented kayaks and snorkeling gear. We paddled around for lunch and onwards to new islands we had not yet been to. It was so awesome to just stop and swim where we wanted, and then afterwards float out on the open waters. On the 16th we went to a trail I had read about, Hang Nak – which features a hanging ledge for an awesome photo, but also incredible vistas of the surrounding mountains. Pillar like towers of rock, dirt, and trees poke out of the ground all around you, and flow seamlessly into the waters edge. I learned that this area in geological terms is what is called a Karst Topography, a word I had often heard before…in Sewanee, which also is described as such. Knowing the two resembled each other, it was interesting to see such similarities; however, what was so cool about Krabi, was that it is one of three places in the world where this topography meets ocean waters. Hiking higher and higher we finally reached the top and were blown away at all we could see. We spent our last afternoon relaxing on the beach and soaking up the sun. Back to Bangkok on the 17th, Molly and I parted ways as she departed to Bhutan to continue work and I headed to my new AirBnB to feel like I really was begging my time in Thailand. Taking the next day to map out the rest of my time here, and the 19th at the immigration offices, I received an additional 30 days to my 60 Visa and ended the week feeling like I was all set for an amazing time.

Week 3: January 20 – 26, Planning Week

After having planned for the time ahead, I pictured this past week to be filled with meeting new people, exploring the topic of my project on my own and getting to know a little more about Bangkok, and Thailand’s larger medical system. Well, this didn’t quite occur in the way I had expected…shocker! At a bit of a standstill with hearing back from different groups, the week turned into a bit of further and prolonged planning. What it has allowed me to do is plan for new places I want to see in Thailand, races I hope to run, and beyond as I look forward to my last three months in my Watson year. Adding a return to Denmark for a conference and an additional country to explore before I end in Tanzania, the time to both settle in here and prepare more thoroughly for all that lies ahead of me feels good.

All of this of course comes with their own hesitations. Am I really being productive this week? Are you learning? This current week has both proven to be incredibly necessary, but at times slow. I found myself rereading a quote I had found early during my time as a Watson. In searching for tips from past fellows and their blogs, I came across a fellow from the 2016-2017 year. In crossing over his 8-month mark, he writes,

As a Watson Fellow, the past 8 months have flown; sailed out the window before I realized they happened. And they have dragged, clunking along like cinderblocks. And as I continue to travel, learn, and stumble, it feels like the best way to ‘make the most of my time’ is to just let it fly and clunk and do as it pleases. All the while accepting it for everything it is rather than judging it for everything it is not.”

So, Noah – Thank you for unknowingly guiding me as I travel, learn, stumble, fly, and clunk.

Coming up – Week 4: January 27 – February 2, Bangkok Touring

As I continue to allow myself to fly and clunk with the year – and as I was reminded by a friend who read my first quarterly report to “let the days carry me rather than try to carry the days” I plan to spend my last week before my internship getting to know this beautifully big city just a little bit more. There are countless temples to discover, markets to meander through, and stories and people to meet along the way. I have learned (and been affirmed) that often times much of my learning about myself and my project comes through these times. Things are surely to begin flying again soon, so I look forward to enjoy the slow ride as I learn more about what people call The City of Angels, that is, Bangkok.

As always, Picture time!

Very early on, I found my park to run!

Evening Light here almost always glows like this

Day 1 Views from Phra Nang Beach, Krabi

More Beach Views Boasting Towering Cliffs and Long Tail Boats

A Steep Look Up (towards the Tiger Cave Temple)

Buddha, 1237 steps above

Molly, Luida and Me at the Top!

These cute (but mischievous) guys were everywhere!

At the Emerald (turned public…) Pool

Island Views from our Boat Tour

Standing on Isola Tup as the sun began to fade

Selfie with the Chicken Island! (Can you see it?!)

We got some really great sunset afterglows

It happened again the next day!

Many nights we got to watch an awesome fire show

Hiking towards the top of Hang Nak

Molly and I at the top!

Hanging (on tight!) at Hang Nak!

Back in Bangkok, I hunt for delicious street food, like this pork.

And now…some Project Thoughts!

As I said above, I haven’t felt quite as productive with my project as I would have hoped, but that isn’t to say good thoughts haven’t been happening. I have stated before how I have found importance in separating my quest to learn about my project, and time to let myself “just see a new sight,” and I laugh at how I am coming to realize that seeing a new sight and learning about my project are so intricately related to each other that these days I find it much harder to distinguish much of a difference between what I am learning and what I am seeing. This makes me happy. Where I at first joked about how I was “studying” every time I saw an ambulance drive past me on the streets of Copenhagen, I now find myself with a heightened sense of awareness towards these situations and the sights around me.

What fascinates me so much about ambulance care, is that no one is external to it – that is, if you or someone you care about need help, you are going to want an ambulance, or at least someone with the training and qualifications to help you. (At least I think you would!) Thus, when I see ambulances drive by sirens blazing or idling in traffic, or when I walk past clinics or major hospitals, my mind is now constantly drawn to these questions. No, I do not stop and have a conversation with the person next to me every time an ambulance whirls by us, but every time my mind is centered back towards what I am exploring. I see an ambulance here in Bangkok, and my mind flicks back to those in Chile – to those in Denmark. What’s different? What’s similar? My mind darts across traffic, and how do you react here? In the response I received from my second quarter report, I read “One of the distinct characteristics of a Watson is that there is no end product, and in many ways this year is all about experiencing and leaving the concluding to a later date….I always say, the best Watson years are the ones where you come out with more questions than answers.” I have come to love that each day as I wake, I find myself asking new questions. Seeing new things and then asking, well, how does this relate?

What has most profoundly struck me here has been what I saw in Krabi, near the beaches. Walking around different parts of the town I found tucked in between hostels, restaurants, street food, and cheap merchandise vendors, nice, glass-filled buildings reading, “AO NANG MEDICAL” or “KRABI TOWN CLINIC,” and just below it would read, “International Insurance Accepted,” and “We Speak English.” Parked outside of these places were single ambulances. Each clinic I passed reflected the same, and there were plenty. The more I walked past, the more my heart sank a little. The ways these places advertised their services made me question who they are really there to serve? I was left with two main thoughts: perhaps the increase in tourism in the area has caused more health centers to rise up, and perhaps that too brings an increased level of access to healthcare for the local people who live in Krabi and around; however, at what cost? Do these clearly privatized clinics, who advertise a welcomeness to visitors, also care for those who live locally? Even for those who may not afford the same income levels as those who visit? It’s something still left unknown for me, and I look forward discussing these questions with the doctors I will soon be with during my internship.

Over here in Bangkok, I see ambulances as often as I did in Santiago. Similarly, they are almost always a different one than what I had previously seen. It seems like hospitals have their own ambulances for transport and transfer as well as emergencies. From what I have read, there also is a more central service as well, titled BES – Bangkok Emergency Services. At an open, public festival in the park where I like to run, I did see a medical tent with these ambulances stationed there. With the existence of both public and private sectors here in Thailand, I am interested to see how these services operate towards the greater community – who they serve, and who they perhaps do not. A new component to the overall system, which I am still in the process of searching for, is about the volunteer emergency services around the city. Originally labeled as, ‘body snatchers,’ due to their arrival on scene to transport a Dead on Arrival Patient, these services have evolved and matured. Now, they often receive calls and arrive on scene before a death has occurred, and thus are able to provide intervening treatment. Operating often in the night, these services frequently help provide for those involved in motor vehicle accidents; they operate entirely off of volunteer fundraising, and serve any who call.

Lastly, arriving in a new place also means adjusting, learning, and engaging with a new culture – a new way of life. With six months having come and gone in a flash, it still feels like I am starting over. I recognize the similar challenges that arrive, and feel like I slowly become more prepared each time. As it was in Denmark, and continued to be in Chile – I am loving the opportunity to see a new way of life, different than where I had been before, and ever more so from where I have come. As I pursue this year further, I am beginning to see this more clearly. Life happens here. There is community. People laugh; people cry. There is poverty and there is wealth, but community and communities exist and persist. It amazes me how many ways there are for people to come together, to engage. Gratitude is a big factor in your interactions here; you bow in greeting, always say thank you, and exchange a healthy round of smiles. Living in the Land of Smiles, I am beginning to feel those effects and the sense of welcome that comes when one smiles at you on the street or in a market. As I continue to pursue these questions of communities in the face of crisis and health emergencies, I am so thankful to have had the chance in these first weeks to be more observant in the Thai way of life. Knowing that I have only barely scratched the surface, I am thankful for the welcome and for having had the opportunity to begin.

ขอขอบคุณ, Khob Khun Khrap, Thank you, sincerely, and talk to you soon.

Mark

Second Quarterly Report – January 8, 2018

Two weeks in and I can’t seem to find where they went! I must say, what an amazing start it has been here in Thailand! Minus the adjustment to the humidity (still in progress), a lot of good things have happened; however, before I get into detail about Thailand, I want to share with you all my second quarterly report. I submitted this to Watson HQ on January 8, 2018 – which also officially marked my half-way point in my year away. That is a crazy thought! As I hoped before, I hope that you enjoy this, once again, rather raw account of my time in Chile: for all the good and bad, ups and downs it carried. From my long-winded and picture-filled blog posts, this one serves as a hopefully more brief (at least trying to be) synthesis of my second quarter. I hope you enjoy the read:

Hey Watson! First off, I can’t believe I am already writing to you again. How has six month come and gone this quickly?! As you know (from the many emails and phone calls – and many thanks for your patience with my stress) I have now arrived in Bangkok, Thailand. The day this report is due marks my third day here. So far they’ve looked like this – 1) accidental (but needed) sleep starting at 4:00 pm 2) wrapping up a blog post and park exploring 3) food experimentation, Tuk-Tuk (minor) rip-offs, and a Thai Massage! I must say, amidst the humidity and sweat that I was not prepared for, things have started off well. I realized that this has been my first arrival where I have not had someone meet me at the airport – and thank goodness I had the first two times! I still struggle knowing where to start, feeling pressure to make this letter, “perfect,” while knowing that whatever I write to you is just what I am supposed to write. Such is life with me, and emails from you in response to my previous report and near the holidays offer continued reassurance and confidence, that just by doing, I continue to do things, “right.”

So how about another three month update? Three months in Chile went by in a flash. As I was in Denmark, most of my time was spent in Santiago, the capital. I spent my first week adjusting, familiarizing, and planning. In my 2nd week, I faced far too many unsuccessful moves into AirBnB’s that just didn’t feel quite right. Ultimately finding a comfortable spot, I started trying to get in touch with various ambulance agencies. I walked around to hospital ER entrances, took note of the dozens of different agencies and looked into their locations. Trying my “knock on the door” technique after waiting on unanswered emails, I was met with marginal success and a day riding with one private agency. It was during my 3rd/4th Week in Chile that I found myself asking, “is this really what you want to be doing…you know, knocking on doors over and over to see what works?” I was discouraged at how often I was turned away, and I really started question what I was doing. It was during this time I emailed you about biking. I was searching, for something, anything that may change the pace of things and bring new energy into my time in Chile. Reflecting now, I more clearly see this moment as a period of avoidance – a running away of sorts. I think it took a pretty low, anxiety-filled moment, for me to realize that I was hiding and that I needed to revamp. So I did. I pushed hard with new agencies and booked a trip to the south in Patagonia – to let myself see a new place. In my 5th Week I had confirmed work opportunities with the local public ambulance service and headed south on a trek through Torres Del Paine National Park. I ended up hiking the trek with a Venezuelan, who really became a powerful and motivational voice for me (Thanks, Juan). The break continued to give me renewed motivation. Finishing, I got to observe in the ER at the local hospital in the South of Chile, followed by a return to Santiago for my first ride in the public ambulance service, SAMU. I had an incredible time, and was reminded that, yes, this IS what I want to be doing. Through my first day with the service I worked out some additional days to work with them. It soon came time to head back south (what I had planned to do by bike, I switched to bus). I headed to Concepción and checked out the hospital there. Speaking to a few physicians I found out how lucky I had been in Santiago. I was warned about lack of access because of being a foreigner without a professional degree. Again, plans changed. I turned my south-trek into a quick sight-seeing tour with a few stops only to return to Santiago for more opportunities with SAMU. I am so thankful I did. My opportunities working with them only continued to improve as people became more familiar with who I was. People began trusting me to work along side them and help out where help was needed. It was really special to feel that sense of welcome, especially after I had spent much time searching for it.

December and Christmas fast approached: I took one last trip up north to see the Atacama Desert and welcomed family for the holidays. I didn’t think this year would hold the same feeling of a winter break as I have always had with school, but I definitely ended up taking one, and know that it was good for me and my energy. Being back alone, I spent my least week in Chile focusing hard on my final reflections and preparations for Thailand. Watson, I really enjoyed what you said to us in our email about the holidays. Having had family, I most definitely felt the difficulty of parting ways, but mostly felt the strong sense of gratitude for having had the opportunity. In that final week, as you know, I was also met with the challenge of changing some major flight plans in a rather short time period. Though a difficult change, I know it was a strong moment of learning. This moment continued to teach me that no plans are certain, and that you must be okay with that. It taught me that you all at Watson HQ are there for me (us) when needed, and aren’t going to be disappointed in an honest mistake. Most importantly, it reminded me of the resiliency of friendship. I was met with grace after sharing with my friend that I would not be able to see her. Those few days both left me in a heightened sense of my solitude, yet at the same time, a strong sense of the connections I share with those I care about even though I may be distant from them. There’s always a positive, right? I think so.

Am I learning? Yes, I know I am. Have I answered that main question of mine – how do ambulances provide senses of security and well-being for the communities they support? Well, that I am still searching for. I now know this is not an answer so easily found. It takes time and is subjective. I think I originally thought I would get in the back of an ambulance and the answers would be lying right there as plainly as the patient on the stretcher. Let me just say, that is not the case. I am finding now that it takes a more attuned sense of awareness, both in my periods of work with the ambulances, and as I am out and engaging with others around me. Slowly, answers come and a more clear understanding comes into light. I now better understand that this too takes time.

But really, what have I learned? I mean, about me – the personal? Last time I told you I felt way too detail oriented and not enough people oriented. I am happy to have seen a a shift in that. Looking back at my blog posts and the way I have written about my project in comparison to how I did in Denmark, I can tell I focused much more on the conversation and experiences I had, rather than the structure of the system. Perhaps part of this comes in that I was able to speak the language of Chile…well not perfectly, but enough to maintain a conversation. It was so cool to see how my ability to communicate improved over time. From evening “intercambios” (Spanish – English exchanges) at nearby bars to navigating and communicating around the city, I found how much I wished I had focuses more in Spanish, but also how excited I am to pursue it further and improve upon my return home. That realization may be one of the most profound yet. Language used to minimally fascinate me, or catch my eye (ear); however, having engaged with so many people from so many different places, I am astounded by the way we communicate – or don’t because of a language barrier, and yet still, do in the midst of one. So, language and my desire to improve it was a major outcome from Chile. A second major outcome, came from my low moment where I found myself in that period of avoidance. I had a pretty hard moment during Week 4 that I now can more clearly attune to the likings of anxiety, self-induced stress. I have felt this before – in school and other activities. It’s a result of me trying to succeed by the means I think I am supposed to. Again, this year is eye-opening in ways I could have never imagined. These ideas of success I hold are not so easily attuned in this wild and amazing year. Watson, you are causing me to come to terms with the stress and anxiety I can cause myself, and you are teaching me to let some of that go. Writing postcards home I found myself sharing two questions from my time in Chile that I have more clearly found the answer to. They are as follows: “Have I missed something – I mean, are there things about this year and this project that I have not reached, tapped into, discovered?” And “Again, am I doing this right?” Well, Watson, what I found in Chile is that the answer to both of these things is a resounding, yes. Over and over, yes. Of course I’ve missed things. There’s simply no way catch it all, but in no way does that mean I am doing it wrong. That’s life; we miss things. Simply the fact that I am doing, reminds me that I am learning.

Where my greatest battle in Denmark was engaging with people, as noted above, my greatest battle in Chile was clearly with myself. Each place carries a new battle, right? In a sense, it excites me to discover what that will be in the next places and how I will choose to overcome. I continued to have new moments like the sunset in the Faroe Islands. Trips to Torres del Paine and the Atacama exposed me to new landscapes I didn’t know exist. Again, I continue to be affirmed in the importance in seeking out what enthralls you. Of course, for me, medicine does, and I have continued to be affirmed that this is the career I want to go into. Along this year I have thought much about what a future in medicine may hold. I know it takes time, and sacrifices are made, but I am being reminded now – it is important to seek out what else enthralls you. For me, that’s running and the landscapes of the wild. It’s fun to feel the same sense of excitement and wonder in an ambulance when I am finally getting involved as I do when I am out in the Atacama Desert looking at an extraterrestrial landscape and the clearest stars I’ve ever seen. And again, there is that intricate design you created in this year – the opportunity to explore the things you love, and discover new ones as well. My gratitude continues, Watson, thank you.

Alright, so whats up ahead? I have a few days here in Bangkok to get settled, familiarized and begin my networking. In Week 2 of Thailand, I head south to see some of the landscapes in the southern part of the country (and perhaps engage with some local health services). I will return for Weeks 3 & 4 to Bangkok on my own. I have made a good lead with one of the volunteer ambulance agencies and hope to solidify some time with this group while I am there. This third leg of my year, I have switched it up a bit. I chose to sign up for an internship in Bangkok and Chiang Mai. As I continue to ask, “what does it mean to be cared for?” And, “how do different systems of care provide that sense of security?” I am excited to explore the context of these questions in new departments and see where they overlap with what I have previously seen in an ambulance, as well as where they don’t. I’ll have three weeks in Bangkok, a week off and then three more weeks in Chiang Mai. I’m excited about the opportunity and the change of pace. I think it will be really good to have a set schedule and it sets my time in Thailand as a balanced mix between independent and organizational partnership. I will be working with the Friends for Asia Foundation, who have facilities in both Bangkok and Chiang Mai. I guess I will leave it there, Watson. I think that accurately sums up all the excitement that was the last 90 days. I said it before and I will say it again – Thank you for this opportunity and for your unwavering support as I continue to discern my project and myself in each new place I go.

And there you have it, 6 months down, two reports in, and onwards I go to the next adventure (there have already been some good ones!). New blog coming soon detailing my first few weeks here. Enjoy the end of January, and all the continued good things to come in 2018!

Take care,

Mark

Am I Really Already Leaving?

Thursday, January 4, 2018: And just like that another month has come and gone in whirlwinds of excitement, great experiences through my project, incredible landscapes seen, and most of all, welcoming family to Chile! I write to you now on a plane journeying across the Pacific Ocean. It’s almost hard to comprehend where I am right now. I left yesterday from Chile, only feeling like I was heading out on another excursion, yet to realize along the way that I had truly left. It’s hard to say goodbye to a place that you have grown fond of, sights you see everyday, customs you have newly become accustomed to; however, it is probably the most common occurrence along this year. Time continues to move, and so do we – to new places, new friendships, new sights to see, new things to learn, and new customs to accustom. To say that it is already 2018 blows my mind. In my head it means a lot of things – It means that I am essentially half way through this year. It means that this is the year that I finish the Watson Fellowship, and it is also the year I begin Medical School. Surely, 2018 has a lot to hold! I am excited, and nervous all the same. I hope that as you read this, you too face new fears and new excitements as you step into the new year with all that is to come. I want to give you guys one last update from Chile before I change paces a bit over in Southeast Asia. This past month was incredible; it began with wonderful, continued work with SAMU, the public ambulance agency, involved a trip to the driest place in the world, welcoming family for Christmas and seemingly parting too soon, and lastly welcoming in the new year as I took some needed downtime to reflect on where I have been and plan for what’s up ahead! Take a look:

Week 10 – (December 9 – December 15):

I spent a solid amount of this week working with SAMU again. Following the weekend, I joined medics on Monday and Tuesday, ventured out to a private helicopter agency on Wednesday, and spent my last two days with SAMU on Thursday and Friday. To have had such a full week with SAMU was really incredible. It was rewarding to know the work I had put in to get in touch with this agency had paid off, that I was taking part in the good work they were doing, and learning so much as I go. (As always, I’ll elaborate a little more on the project sides of things below following the pictures!) Oh, and Cory and I went to see Star Wars: The Last Jedi. It was epic.

Week 11 – (December 16 – December 22):

As it was our last weekend together, Cory and I set out on one more adventure. I had read about an awesome hike east of the city in the Andes in an area called El Cajon de Maipo. The hike would take us through El Morado Natural Monument up 5 miles to 8,500 feet and at the foot of El San Fransisco Glacier. We had a beautiful day walking through the valley that had been carved so many thousands of years ago by the very same glacier we were looking at that day. We ended our evening in the apartment ordering a well-earned pizza. On Monday the 18th, I took a flight to Calama, in the north of Chile, followed by a bus ride to San Pedro de Atacama. San Pedro is situated within the Atacama Desert, a massive desert that is also the driest place in the world. People often say that the landscapes you see there are seemingly extraterrestrial because of how unique they are. It’s safe to say they aren’t wrong. I had set up some tours before I arrived and had a full two days ahead of me. During my first day there I went out to the Altiplanic Lagoons, which are two beautiful blue lagoons that lie beneath tremendous volcanos. Following, we drove over to el Salar de Atacama, the largest salt flat in Chile. There we gazed at pink flamingoes wading through the briney water searching for food. In the afternoon we went to the Cejar and Piedra Lagoons where we could float like one does in the Dead Sea due to the high salt concentration. After, we went to Los Ojos de Salar and the Tebinquinche Lagoon to watch the sunset. The day was filled marveling at wonders of the world I once did not know existed. It was a day for giving thanks. The next day started quite early with a 4:30 am departure to El Tatio Geyser situated above 14,000 feet. There we walked along the 80 plus geysers and watched as the sun rose over the mountains and reflected beautifully against the rising steam. In the afternoon we went to El Valle de la Luna, named literally for its lunar-like landscape. We walked along mountains made entirely of salt and got to sit one last time for sunset. Knowing it was my last night, and not knowing when I may be back there, I rented a bike late that evening and biked away from the city on my own to find a quite place to sit and gaze at the night sky. I had heard the stars in Atacama are some of the clearest in the world. Again, people weren’t wrong. I got to continue practicing with my camera and I got to marvel at the creation in front of me. It was a perfect ending. The next day I busses back to Calama and ultimately flew back to Santiago. The 21st was a preparation day…for family! Mom, Dad, and Mary Kate had made their way down to Chile for a little Christmas Holiday! With many anxious jitters I did my best to pass the time until their arrival on the 22nd. Finally, I saw them walk through the airport exit and all was so well. We pushed through heavy traffic and finally arrived at our AirBnB. Tired from a long day we mostly relaxed, grab a quick bite to eat next door, and called it a night. We were just happy we were all together.

Week 12 – (December 23 – December 29):

This is really where the Family week began! After settling in our first night, we woke on the 23rd to hike back to the San Fransisco Glacier. It had been such a beautiful hike for me and Cory, I wanted them to see it as well. It did not disappoint the second time. We hike, picnicked, Mary Kate and I went up ahead and ran back to catch up with Mom and Dad – all of it was such a good time. Returning to Santiago, we refreshed and headed out to dinner at El Camino BBQ, a Texas-Style BBQ restaurant with a Chilean twist (we almost lost Dad on the metro). On the 24th we packed out bags, hopped in the rental and drove towards Valparaiso! Arriving and settling, in we walked to Le Pató, a yummy corner empanada restaurant. Afterwards we walked the beautiful streets, and did a little grocery shopping. We went back out to eat at La Paparazzo, one of the few restaurants that seemed to be open on Christmas Eve; however, it turned out to be exceptional (especially the Pisco Sours!). Christmas morning started out as it must, Mary Kate and I yelled from our beds asking if Santa had arrived only to be classically told that we need to prepare ourselves for disappointment. Much to our surprise (as always), Santa found his way down the pacific coast and dropped off two stockings! (Santa must have known I needed new socks, boxers, pens, and books – so thank you bug time, Santa!) Mary Kate and I went on a Christmas run, we drove up along the coast and found these enormous sand dunes to climb. We ended our day with family dinner and card games that took us late into the night. It was perfect. On the 26th we spent one more day out in the old part of Valparaiso. First venturing to 21 de Mayo, we took in a beautiful view of the City from above, did a little shopping and continued to wander the beautiful, artistic streets. In the evening we went to La Concepción, a second restaurant that perfectly ended our last evening together. On our last day, the 27th, we drove back to Santiago, strolled through the Central Artisan Market for a little more shopping and then onwards to the airport. It came and went so quickly. The 28th and 29th could have easily been spent in a state of isolation and loneliness after their leaving, but I couldn’t stop thinking about how thankful I was for having had the opportunity to be with them. It perfectly closed out my time in Chile and made me feel like my time there had culminated so well.

Week 13 – (December 30 – January 5 (2018!!!)):

Following family week, my sights were set on taking the time I had left to solidify more plans in Thailand, and also do some “closing up shop” in Santiago. I ventured to Valparaiso once more by bus on New Years Eve to spend the night with a friend named Felipe, who I had previously met and spent time with. Valparaiso has the largest firework show in all of South America. The show lasted for a full 25 minutes, with boats set out along the harbor launching hundreds and hundreds of fireworks into the sky in synchronized fashion. I welcomed in the new year in a new place and had so much fun doing so. Thankfully I found a bus back the next day – when I arrived to the bus station, almost all bus agencies were no longer offering rides to Santiago. On the 2nd I did my last load of laundry, and on the 3rd I set out on one last run, one last lunch, and packed my things. Leaving that evening, it was time to say goodbye. This week also presented an unexpected piece of stress. Originally, I would not be en route to Thailand as soon as I am doing so today. I had originally planned a trip to Mexico City, Mexico for a brief stop-over to see a close friend, Clementina, and her family for a few days before continuing onward. Only realizing in this week that Mexico is one of the fellowships no-travel countries due to State Department Warnings, a quick change of plans had to be made. Though much sadness was expressed on all sides, I learned a lot in this week about the power of friendship and its resiliency. Tearfully telling Clementina I could not come, I was welcomed with grace and understanding on the other side. So Clem, public shout-out goes to you on this day. Thank you for being my friend, for always understanding, and for showing me such a true example of the power of friendship. Mexico will wait, but I can’t wait to visit when I do. This experience also helped me realize how much I have improved at changing plans on the whim. I am pretty sure if this had occurred in my first week away, it may have crippled me. It’s awesome to be able to recognize such a difference.

Pictures: (There’s a lot!)

Starting our hike and seeing the mountain in front of us, Cory and I knew it was going to be a good one.

About 6 out of 8km in we came across a beautiful lagoon. A perfect spot for a picnic.

At the top, water rushed out from underneath the glacier!

Driving to the Altiplanic Lagoons, beautiful purple and yellow flowers blossomed everywhere.

Check out this series of flamingo flight!

At the Tebinquinche Lagoon, it almost looked like a field of snow!

Sunset was incredible through the desert haze.

Sunrise the next day at El Tatio Geysers.

The Great Dune in El Valle de La Luna.

Standing next to the Great Dune with the Salt Mountain Range behind me. These mountains block sand from overwhelming the city of San Pedro

Sunset in El Valle de La Luna (I promise I’m not that tan…)

I sat down to watch it fade away.

One of the many pictures I captured in the desert that night. Absolutely stunning.

Family has arrived!!!

Family pic mid-hike in El Morado Natural Monument

Mary Kate and I hiked up to the glacier (a lot had changed in the week since I had been there!)

Christmas Morning Stockings in Chile!

Selfie on top of a giant Sand Dune

Seemingly jumped off a cliff.

But in reality, we were exactly what this mural says, SO full of happies.

A final goodbye at the airport; sad to say goodbye, but so thankful for the time we had!

Project: (As if I was never going to get there!)

The last bit of time I had with SAMU was really great. Just as I had felt in Denmark after visiting more regularly, it felt really great to be more recognized among the other medics who worked there. It helped in conversation and in gaining more opportunities to ride in different ambulances on different calls. As much of this post involved either travel, family time, or Thailand prep, here is what came to mind in my last week of working with SAMU.

After having responded more frequently I began to notice a challenge that the ambulances face here: the traffic. At certain times during the day it is terrible, and the hardest part is that many cars often do not move. I asked the medics I was with about this, and they shared that one of the reasons why there is not much of a respect for ambulance lights and sirens is that there are always ambulances out on the streets with their lights on; however, very few are actually using them for anything urgent. I can verify this. Ever since my arrival in Chile, I always saw ambulances driving around the city and almost all of them had their lights on – kind of like you may see a tow truck in your home town. At first I thought, wow, there are a lot of ambulances out here transporting people, but later I found that the lights are a normal part of an ambulance driving. For SAMU, this poses a difficulty. As they are one of the few services that respond to emergency calls, their lights and sirens do signify something. They encounter problems with traffic because much the general driving population has become too accustomed to an ambulance with lights behind them. Of course, some cars stuck in a long line of traffic truly have no where to go, but there are still others who seemed to not move at all, even with sirens blazing right behind them. To me, this was discouraging. Not so much towards SAMU or anyone on the healthcare side; they can not control the actions of those around them, but in terms of a general community awareness towards the needs of others. Being at the end of my time in Chile, Its easy to look back on my time there in full and compare it to what I saw in Denmark. This may be one of the largest contrasts I saw – the difference in community reaction towards an ambulance. Its hard to pinpoint exactly where this difference comes from, and I would be naïve to say I have the answer, but I definitely think it’s a response that is conditioned. For example, the fact that all drivers in Denmark must be CPR certified to receive a license I think creates a stronger condition of awareness towards an emergent situation, but its hard to say. If Copenhagen were the same size of Santiago, its quite possible that due to traffic congestion, the same problem would exist there as well.

Early in the week we responded to a call pretty far across the city. Blazing across town we arrived at the location we had been advised to respond to, but there was no patient to be found, nor any person nearby flagging us down. This is frustrating, especially when the nature of the call sounds serious, but again, is out of the control of the ambulance drivers. If a person calls, hangs up, and has given an incorrect location, theres not much that can be done. En route we saw out of the windows huge plumes of black smoke not too far away. As we crossed over freeways, fire truck sirens rang out around us. Having not been able to find the patient and not receiving new information, our ambulance turned toward the smoke. Where I had been disappointed in the way I saw the community react on the streets I was blown away at the scene of the fire. A factory had burst into flames. Having trouble finding the entrance, a pickup truck flagged us down and then told us he would guide us there. Half driving on the sidewalk and half on the wrong side of the road, we weaved across traffic and finally arrived. We were the only ambulance on scene, but there were what seemed to be hundreds of firemen. Mostly standing from afar, we remained to treat any potential injuries. Luckily, there was none more than a few cases of overheating. As we stood, I learned about the fire service here in Chile. All are volunteers. I was blown away. Looking at all the firemen, all the gear they were using, and realizing that this was a collection of volunteer servicemen, all of whom most likely had other jobs, who had left at moments notice to drive across town and put out a fire. Watching them work, systemized and efficiently, a certain amount of respect grows for such strong efforts. Further, at the scene of the fire, more people showed up. From what seemed like every direction, people came pouring in carrying bottles of water. I have become so accustomed to people walking down the subway or at intersections selling you a bottle of cold water on a hot day. But here were people who had clearly gone to the nearest market and purchased as much cold water as they could. They then began walking around handing out bottles to everyone they could reach. It was really an astounding scene to watch. Essentially the community had responded in full to this event. Volunteers who had signed up knowing what they may get, and others who saw the smoke and came towards it to help. I was really moved by that scene and the collective cooperation that occurred there. It was a good call to finish the day.

Later in the week I went with one of the doctors I had been working with to see the helicopter he worked for. It is a private company that stations a few helicopters across the country. There are not many rescue helicopters in Chile, and only about 50% of them are publicly run. Learning about the helicopter there, the private service who operated it and the costs it requires to maintain, I found myself thinking a lot about the state of health care in Chile and the effects it has on prehospital treatment. I responded to a call later that week to a woman who had fallen and injured herself on the bus. Arriving on scene, the medics asked which insurance she had. After learning that her insurance was private, they then asked which hospital she would like to go to, rather than taking her to the one main emergency room in the city. Watching this transition struck a chord in me. It was the first time I had more directly seen the difference in the wage gap that so clearly exists in Chile. We transported the patient to the nearest private hospital, which just so happens to be 200 meters down the road from the public one. It was difficult for me to accept that this is life for a lot of people – this difference in care. For so much time, I had been seeing and learning about a public health system here in Chile that was capable and accessible for everyone. And I still think this is true, but the transfer of care differs for people, and that was what I found to be hard. I was uplifted to know that SAMU was accessible for all people, and further that their resources provided them with the capabilities to respond appropriately, but it was hard to know that their treatment may differ following due to their socioeconomic status. It is true that this occurs as well in the States and in many, many other parts of the world, but this having been one of the first times it was laid out so clearly in front of me, it leaves me searching to understand and learn more about where these differences exist in each place. For example, in Denmark, one could also pay for private insurance and a private hospital, but most often these hospitals were for things such as surgery, while urgent treatment was always delivered to the closest capable emergency room.

Of the many calls I got to respond to, one called us to an elderly woman’s home where we treated her for a fall. She had clearly broken her wrist and needed to be transported to the hospital. I thought a lot about her fall, what possible events may have lead up to it, and what this means for her moving forward. I thought about the stories in my own life of my great-grandmother falling and the events that eventually led to her loss of independent living. In Atul Gawande’s book, Being Mortal, he speaks a lot about these moments in elderly patients, and how so often a fall is the first step along a long and difficult road ahead. As we age and face complications with our health, it becomes increasingly hard for us to recover back to the same level we had previously been. Seeing this in Chile, again first hand, made me think a lot about what this would mean for this patient’s life. There’s no way to know for sure. Having finished Gawande’s book in my last weeks in Chile, I have thought a lot about the battle health care providers face in confronting the elderly. No matter how good a response system a country or community has, we still are unable to fix the complications that come as we age. We have learned to better manage these complications, but by the time an ambulance arrives, often the damage has been done. It makes me wonder what we can do. Given that so often the calls an ambulance responds to is for an elderly, I think a lot about what can be done to reduce the frequency in which ambulances are needed for the elderly. There’s no easy answer. As I transition to Thailand, I will be interested to see what I find in relation to this problem. Perhaps it is systematic, but perhaps it too is cultural.

One day we responded to a large factory fire.

As the medics on call, we stood a little farther removed ready to step in if needed.

It was a pretty hectic scene but amazing to watch, especially after learning that all firemen are volunteers.

A picture of one of the private rescue helicopters based in Santiago.

Near the Altiplanic Lagoons, I was surprised to see an ambulance drive by, so I snapped a pic and they gave me some peace signs!

Phew! If you made it this far, I congratulate you! That was a lot, but I appreciate you sticking around (even if it was just for the pictures – they often tell a lot). All this goes to show that so much good has happened in my final month in Chile. As it was in Denmark, a sort of bumpy start ended in a fantastic ending full of project, friends, family, and new sights. I am so grateful. As I finish this post, I am starting my third day in Thailand. It’s the morning of the 8th, but still the 7th over there for you east-coasters. For me, today I cross the 6-month barrier. Wow!

Soon to come: A Second Watson Quarterly Report!

Happy new year to you wherever you may find yourself on this day! As always, thanks for following along, here’s to the next adventure!

– Mark

Feeling Good at Five Months!

Friday, December 8th, 2017: Five months ago today I made my way to the airport and boarded a plane to Copenhagen, Denmark, beginning this incredible journey I am on. Two weeks from today I get to welcome Mom, Dad, & Mary Kate to Chile, and one month from today I will be stepping foot into Thailand and celebtreating 6 months on the road! That alone is some awesome stuff. How am I doing, you may ask? Honestly, really great, and that feels so great to be able to say! Ever since that first little dip in my first month in Chile, things have seemed to continue to trend in the positive direction and I am so happy to be able to say that to you guys, and it feels even better to say this knowing what I had planned two weeks ago when I last wrote to you all, was completely turned upside down with a change of plans (something I am learning is quite the norm). To have changed so quickly and still feel so good about where I am and what I am doing gives me confidence and hope. For the same to have happened four months ago, or probably even one for that matter, would be a different story.

So whats been going on?

Week 8: (November 25 – December 1)

On my first day of the week I spent another day observing with SAMU, alongside a different crew of people. As Saturday’s tend to be in other walks of life, so was this Saturday at SAMU’s base – a little slow. Talking about it with the medics and paramedics on call, I learned that weekends are often a little slower because there is a known lull in the hospitals, and many often wait to call until the week unless it is something truly urgent. Even with the lull, we got to run a few calls. Reflecting on my time in the ambulance in Denmark, I feel the same rush when we pull out of the station, flick the lights on, and speed down the road, but there sure is something that adds to it when you look out the window and see all the traffic you are weaving through. In Denmark, based off of the station’s location, we often traversed quieter roads.

Initial plans for the most of Week 8 consisted of beginning my trip down through the South of Chile, or my “South Tour” – I had it all planned: Concepción, Temuco, Villarrica, Pucón, Panguipulli, Valdivia, Puerto Montt, Castro, and ultimately a return trip to Santiago the day before family arrived. As I sit here in El Parque Bicentenario, 2 miles away from my apartment in Santiago, you can see how these plans have clearly changed. On Monday, the 27th, I took a bus from Santiago to Concepción, located about 6 hours south of Santiago along the coast. I was picked up by a guy close to my age who I had met on Couchsurfing. He offered give me a ride and tour of the city. I met back up later with him alongside one of his friends to watch a local showing of a movie about an American Missionary who became involved with Revolutionaries during the Pinochet Dictatorship. It is called Cabros de Mierda. Even though there were times I definitely did not pick up on all the words, the message rang loud and clear, and it felt good to have learned a little more of the history here.

That Tuesday I attempted to get in touch with the hospital in Concepción, but was met with a few regulation barriers I had not encountered before and was more or less turned away. Leaving, I was wary that I may be running into similar barriers in some of the other places I had planned on going to. Changing plans that day I took a bus out to visit Ramuntcho, a fairly hidden, but beautiful beach about an hour outside of the city. That evening I got to speak with Alvaro’s (the friend I had made) mother, who works in internal medicine at a smaller hospital outside of the city. My last day in Concepcion I explored a little more with Alvaro and then hopped on an evening bus to Temuco. At this point I had already made some adjustments, canceling some cities and deciding to just go ahead and hop over to Pucón, and thus my stay in Temuco consisted mainly of a quick bite to eat and a bed to sleep on before catching the morning bus over to Pucón. I had planned Pucón to be set aside for a little time adventure-tourism. Arriving in the city, my hostel host helped me find the right tour agency and I quickly signed up to climb El Volcán Villarrica. The Volcano that overlooks the city sits at just over 9,300 feet and is currently the most active in South America. That following day, December 1, I awoke for a 6:30 am departure. Our team was small, a German, two Brits, two Chilean Guides, and I set out towards the mountain loaded with gear for the day. We summited around noon and managed to pass some larger groups also hiking, which gave us some extra time at the top. On one side opened up a vast landscape of blue skies with volcanic peaks spotted around, and on the other a giant crater, billowing with smoke and the occasional lava spurting up! Thinking back on it, I realize I have never seen lava before, let alone stand on top of an active Volcano! It was so cool. What took us 4 hours to climb managed to take only 40 minutes to get down, as we donned thick pants, a slick diaper apparatus and a sled strapped between our legs. We raced down the mountain through carved out channels using our ice axes like a kayaker would paddling on a river to stabilize and brake. Maybe it reflects the success I faced in a Kayak, but I had my share of close encounters and one full-fledged wipeout (yes, I got it on camera).

Week 9: (December 2 – December 8)

To start off Week 9 and finish my last day in Pucón, I met up with the two Brits from the day before. We planned to trek out to Las Termas Geométricas, these awesome Thermal Pools we had heard about. Trying to save some money, we tried to get there on our own instead of with an agency, only to end up probably spending 1000 pesos ($1.50) more after our last bus connection was privately run by a few people who clearly knew they had a monopoly on the transport (our bargaining did not work), but we enjoyed an incredible day in the 20 different pools they had, which ranged from 35 – 45º Celsius (95 – 113º Fahrenheit). The water is collected as it flows out of the mountain and collected into pools which then uses gravity to fill up the rest of the pools below the collecting tanks. To meet the right temperatures, they mix the thermal water with the creek that runs through the canyon. Apparently, as it comes out of the mountain, the waters temperature ranges between 70 and 80º Celsius (158 – 176º Fahrenheit) – more than enough to cause some serious damage if you touched it. Even at 45º C, you can only manage a few minutes before needing to leave.

The next day I took a bus from Pucón to Puerto Montt where I continued onward that day on a second bus to Castro on the Island of Chiloé. I met a woman named, Angélica, who was a mutual friend of someone I met here in santiago. She offered for me to stay with her. We shared a meal and explored the city by car at sunset. The next day, my plans took one final change, I heard back from some of the doctors I had worked with in Santiago with SAMU. Having permission to work with them more, I knew that I both needed and wanted to return for more chances to observe, work and learn. Knowing my time in Chiloé was cut short, I took the day to see the city and hopped on a bus that would last for 15 hours en route back to Santiago.

Wednesday I went to work with SAMU, and spent a full day with them, hopping on a few different trucks when a new call would come in across the radio waves. I returned again on Thursday to do more of the same, but with a different crew. Having returned to the same base a few times now, I have begun to feel much more comfortable there, and it is clear that others now recognize my face, and at least have an understanding of why I am there. This has definitely helped being able to ride (and talk) with more people! It sure does feel good.

And today I am writing to you. Having had a nice morning, I ran through this beautiful park, returned for lunch and now have walked back out here to sit in the same place, write, and reflect. It’s a good day.

(Up-Ahead) in Week 10:

Coming up ahead I will go back to SAMU on the Sunday and Tuesday (and hopefully be able to confirm some more time later in the week as well. On Wednesday I am going with on of the doctors I worked with to another group he is a part of, AireRescate, a private helicopter rescue service. So, there are more good things to come, and I look forward to I sharing with you all!

Some Pictures!

Standing at the center of the beach in Rampuntcho, an awesome cove to find.

At the very end of the beach was this island with one tree still standing on it, I loved it!

My last day in Concepcion, we ran across a kid in an ECU sweatshirt. He said he didn’t know what it was, but cool for me, as that will become home for the next 4 years!

My first night in Pucón, I got to sit by the lake and watch the sun set against the Vocano I was about to climb.

You can tell, I was quite happy to be there.

Starting our ascent, we stopped for a first round of photos.

Below us were other groups making the same trek.

Standing on top of the Volcano, we peaked over the ledge into the smokey, gas filled crater.

On one side the crater, and the other, a beautiful view.

Selfie with our awesome hiking team!

Our guides captured one last shot of us on the rim of the crater before descending.

At the bottom, I had to throw my hands up in excitement and accomplishment.

A few hours later in the day I looked back at the same volcano I had just climbed and saw this!

And at night, I was able to capture lava in the crater illuminating the smoke above it (Glad I already climbed!).

Entering Las Termas Geométricas, we were blown away at its beauty.

Red, wooden paths weaved through the canyon taking you ever deeper (and warmer) to more hot springs.

Steam rose from below us in the collection pools of 75ºC Water.

At the end was a pretty awesome waterfall (which was most definitely not heated!).

In Castro, I walked along the Ocean Fjord and gazed at the palafitos, houses built out over the water on stilts.

Project Reflections:

As I come out of traveling a good bit and seeing new places within Chile, while also managing to have the time back here in Santiago with SAMU, my thoughts from my last post continue to swirl in my head. In Concepción, I bounced some of my ideas off of Alvaro’s mother, who worked in a more rural hospital, while living in a larger metropolitan city. She too recognized the differences between small and large towns but wouldn’t go as far to say what the relationship between health and community may be in these places. She recognized though, that at times it was easier to communicate with patients and families where she was because often there may be a little more time, which she maintained is important in establishing a significant line of trust. She spoke about how from her experience in larger, more busy hospitals, this can be hard, and that although you are providing care, the decreased amount of conversation with both patient and often family can be a challenge.

Hiking the Volcano I got to talk with the guides about rescue operations on the mountains that they guide. One of the members on our team asked why our guide was carrying a metal pole, and he shared that it was to create a tether in case there was a need to perform a rescue from a fall through a crevasse. I later learned that in the instance of a medical emergency, it is up to the guides to perform the rescue operations, and that there would not be more help coming except for when they had returned from the mountain. For this reason, every guide must pass a certain certification to be the guide on the mountain, which includes training such as high angle rescue, but also basic first aid. In one sense, it seems like care is not really there, or at least it’s not “covered” by the town, local service, etc., but thinking further, I came to realize that the care is still being provided, but rather just being deferred to each agency by the rules and laws that are set in place. I was happy to be able to tell so clearly that my guides knew exactly what they were doing. That was reassuring, and speaks to the success of their service. Pucón has an extremely large tourist base, both of local Chileans and foreigners who come for the Volcano and the many other outdoor adventure activities nearby. With such activity, also comes risk for injury or accident, which is why I found it to be interesting that it was the guides who were responsible for providing medical intervention when necessary. I never saw an ambulance in the city, though there was a local hospital. I saw the fire station, which consisted of volunteers. There was a central station, but firefights lived in their own homes and would report in the case of an emergency. It reminded me of Sewanee, and many other small towns in the States that do the same.

Back in Santiago, my past two days with SAMU have been really great – both in learning more about what rules and regulations are in place and for more direct observation and experiential learning. On the systematic side of things – I have mentioned before how many different agencies I see around the cities, at hospital entrances, and through researching online. It’s hard to tell exactly who does what. SAMU always and will always be the main resource when it comes to responding to medical emergency. There are other services, such as HELP that respond to emergency situations, but only to those who subscribe to their service. HELP ambulances are easy to pick out, as they are all the Box-Style large trucks you may find in many cities within the U.S. SAMU uses the van style, like Denmark, and also many like the ambulances that work in and around Sewanee. One of the paramedics I worked with yesterday reiterated to me wheat I have heard from others. He said that SAMU does really good work (and that is something I have been able to tell), but there just arent enough trucks running at a given time. Another told me yesterday that in their opinion, other private services may come with the bells and whistles of fancy equipment, vehicles, etc, but SAMU and those who work within it, are strong and successful because of their experience. When it comes to emergency care, namely prehospital care and interventions, you are given a limited amount of resources on an ambulance, (no one is about to start surgery in the back of a moving vehicle), which means that the care given though useful and helpful with the right equipment relies much more on the competencies of those who work in the trucks. I asked about the drawback the service faces with a limited amount of trucks in service. What happens if there is a really busy day, or a very large mass-casualty incident where the public service meets its capacity. One would hope that private agencies in these moments wouldn’t focus on profit, but you never know. I learned that there is a mandate in place that requires private agencies to assist when called upon. The same mandate goes with the helicopter services. There are some private and some public, but when called upon, the private services step in as well.

In the past two times with SAMU I have been able to respond to car crashes, chest pain, falls (some major), elderly care, and even a helicopter rescue (though I didn’t get to ride in the helicopter, just assist in the transfer form helicopter to hospital). All of these things have been so good to see and be a part of. This year, the big questions I ask myself and seek to discover are ones such as:

“What do ambulance services around the world look like?”

“How do they operate?”

“In what ways do they give care?”

“In what ways do they not?”

“What’s the relationship between these services and the community?”

“What is the community response like?”

Its not as if the patient lying there on the stretcher is about to look up at me and tell me all the answers to these questions, (although I definitley at one point thought it might look this way). For me, I am learning more and more every time I get to step inside another ambulance, in a new place, with new faces, and new surroundings. As we speed away to different scenes, its interesting to take note of the faces of bystanders – some nonchalant, others who seem to be disturbed that you are there, and of course, still others who breathe a sigh of relief at your arrival. I have felt a mix of feelings while being on scene, at times feeling like I may be getting in the way, and at other times feeling like I am actually being of really good use, but at the bottom line, I know I am learning through these experiences.

A photo of the first ambulance crew I worked with at SAMU!

Base 20: Where I work and observe is located in the center of the city and adjacent to the Emergency Hospital.

Our Doctor loaded into the helicopter to pick up a critical patient.

(In this last statement, I am going to talk about my last call which describes my experience of watching a patient in Cardiac Arrest. Though I think what I will share is more than appropriate, I just want to disclaim that in writing, I am trying to reflect as best as I can the events I observed – but if this is something you’d rather skip through, then scroll on to the bottom for some sledding videos going down the Volcano!)

My last call I took part in yesterday was the helicopter response. Sitting in the base, one of the paramedics hopped out the door and said, “Vamos, el paciente está in PCR.” Meaning, “let’s go, the patients in CPR.” I should note, however, at the time I didn’t know what PCR was. The ranslation of the acronym didn’t click for me, but I followed along and soon we were really picking up our pace. Running up stairs and down corridors we entered the final one to the helipad. In this hallway, our ambulance crew joined a large team of what looked to be a mix of doctors, nurses, and technicians. In this chaos I was beginning to recognize that the situation was rather grave. As we exited to the helipad, the helicopter was just landing – some took to climbing the ladder and others went around on the ramp. The pilot waved one of the paramedics to come out and help open the door and get the patient out. It was then I realized what was going on. The patient had gone into Cardiac Arrest and CPR was being administered. As best as one can, with all the people around trying to aid the patient, they transferred them onto the hospital bed. Quickly, there was a doctor on top of the patient continuing compressions and we were wheeling away. It’s a hectic scene: things get in the way, a bag falls off the bed, theres a scourge of people there, but only so many attending directly to the patient at a given time. Whisked through corridors, others look on, some enter the elevator and we walk around to wait at the bottom, whilst more onlookers, patients and health care providers look from afar at the scene until the patient is finally wheeled into the trauma room behind closed doors. More doctors enter and there’s probably over 20 people in this small room. We, the ambulance crew, back out and the door closes behind us. Their work was finished, care had been transferred, rather seamlessly, but simultaneously with great chaos. It was interesting to sit with the paramedics after. For someone who is in this line of work, these are not necessarily the newest of sights. With emergency care comes trauma; it’s inevitable, but it doesn’t mean that it becomes normal, or that it should ever become normalized. I could tell that through observation and conversation after that call.

For me, this was the first time I’ve seen a patient in this state. In training during my freshman year and while working for Sewanee EMS I responded to calls where patients had already passed away. The work of a medic in these situations, no matter what one tries, would in no way resuscitate life, but CPR is different. Here you have this body, this life, both living and dead in the same moment. Naturally, this patient is no longer living, but with external compressions, blood still flows through their body, and with puff of oxygen, that blood still provides the life giving nutrients a body needs for cells to survive and for the brain to function. These are essential, but also are at this point artificial, and at some point if a natural heartbeat does not return, then these artificial mechanisms will cease as well. The image to me isn’t necessarily haunting; to an extent, I can expect that there will be more of these occasions in my years of training and work to come. It’s not so much that we should expect death at any moment, but within this field of work, one must be prepared to step into the face of it when it arises, whenever that time may be. Life, at times, fails. That is life, and it’s the role of a health care provider to sustain, nurture and improve life. I could see that play out before me in yesterday’s events. The rush, the chaos, all of it comes as a result of the desire to sustain life. The frustration, the anger, or the sadness is not so much at what is seen, but at what one feels they cannot do.

My blog is titled “Discovering Life Amidst Emrgencies” and when I first applied for the Watson, my title was, “Emergency Calls: A Communities Reply.” In this year away, I departed hoping to see the intersection between Health Care Provider, Patient, and Community. Of course, there on that helipad, the community of Santiago is not going to be there, nor in the trauma room, but the amount of people I saw pour into that room in the hopes of giving even the slightest bit of aid, speaks volumes to me. Perhaps every place I go will have scenes like this, and if so I give thanks for that. For the people within the community that will pound on a chest for close to an hour because they believe that someone isn’t supposed to die that day. It is a somber thing to recognize that death occurs all around us, but it is also incredibly uplifting to know that there are those within our community, here and elsewhere, that are willing to do anything they can to nurture, sustain, and maintain life.

Thanks for listening to at times some rather raw reflections, as the holidays near, I hope that you all may find time to rejoice and give thanks for the lives we live, and for those out there each day working to sustain it.

Cheers and talk soon,

Mark

P.S. Enjoy these sledding videos (including my wipeout!)

An excerpt from one of my initial rides, at times the camera gets a little off course, but cool to watch the descent!

I hope you can all laugh with me as my excitement quickly turns into fumbling and one final snow covered flop! Happy December from a face full of snow!

Halfway through Chile (and 1/3 through this year?!)

Buen Día! Hi, hello, how are you? I sit here in the center of Santiago, realizing I have crossed over my halfway-point in Chile, and am looking forward with much excitement. I too am looking backwards to my time here thus far: the ups, the downs, the stalls, and the incredible moments I have had in the midst of it all. In our short list of guidelines, our pamphlet titled, “Getting it Right?” there was one point I wasn’t sure when or how it would occur. The header reads, in bold, “Maintain your independence,” followed at the end by, “Recognize style signs off project avoidance (it happens) and find the source.” In the time since we last spoke, I found myself in a low point. Before leaving for this year, I reflected on what “Project Avaoidance” may look like. In my head, I often thought it meant living the “touristy” life, traveling without thought of what you were given the chance of doing with a year away in the world. What I didn’t realize in May or June during my preparation was that “Project Avoidance” can happen anywhere, even when you are waking up in the same place. So, to be honest, amid Week 3 / Week 4 here, I found myself pretty avoidant, frustrated with my direction, and frankly, a bit lost. This had me fairly agitated with myself; wanting to break free of a cycle that I felt I had put myself in. And now, two and a half weeks later, it feels so incredibley good to say that I have been there, and to know that I have worked in a way that has (or at least continues to) bring me out of that place. This moment, which came right in the middle of my last blog post to you all, has also helped open my eyes to something I originally was trying to deny: these feelings likely will come and go in each new country I travel to. Leaving Denmark, feeling like I had faced many challenges of adjustment, I felt like I had moved past the road block phase. Hitting halfway in Chile, and hitting road blocks about the same time I hit them in Denmark, I now see it is likely I will face these again. But, with each moment I experience, I also move forward with one piece more of experience, and growth that helps prepare me for the next challenge I may face. This is growth, and I am thankful for it.

So whats been going on? Well, I’m going to save you (and myself) from writing out each day; instead, I’ll give an account of each week. My first post updated you all with Weeks 1 through 3, see below for Weeks 4 – 7!

Week 4: October 28 – November 3:

Week 4 was where I hit my low. In the week prior, I had come up with a new idea to explore my project. I began to think about how cool it would be to see Chile by bike, using biking as a mechanism to get from place to place, and exploring the context of my project in a new way, different than before. I started planning hard at the end of week 3, through the weekend and into week 4. I went bike shopping, started doing research on places to go, making a budget, etc. It all seemed really good. Reflecting now, biking through Chile is still something I want to do, but in the time since this idea, I have come to a better realization that I may be spending too much time biking alone, and not enough time with the people of Chile. Reflecting more now, this intermitant period of searching for a bike came out of what felt like a lack of success in pursuit here in Santiago, and a diminished motivation because of it; however, things took a turn near the end of the week and I felt like I had flipped the switch, finding myself back on track.

I spent a day with Ambulancias Santiago, a private ambulance agency here in the city (more thoughts on this to come below). I officially booked my tickets to thailand, setting a final date here in Chile, and a beginning day for Thailand, and I began the Visa Application for Thailand. Introduced myself to more people in the world of EMS here in Santiago, and learned more about a company called ACHS. To finish out the week and begin the next, I took a bus to Valparaiso, a beautiful town about two hours west along the coast, which is actually listed as a UNESCO World Hertiage Site!

(Oh yeah, and I celebrated Halloween here in Santiago! Using what I had, I managed some sort of Cowboy/Indiana Jones look, but ended up still being asked if I was McCauley Culkin (or Kevin McAlister) — apparently that movie is a favorite down here, and once my last name is discovered, the joke never ends!)

Week 5: November 4 – November 10:

The start of Week 5 began in Valparaiso, or Valpo, full of beautiful graffiti art and friendly people. A friend I had met in Santiago offered a free bed in his house where he lives. Meandering through the streets, the weekend was mostly spent wandering, wondering, and appreciating where I was. Returning to Santiago, I switched up housing once again continued my work from the previous week. I had a few meetings with people at Hospital Soltero Del Río, the largest public Hospital here in Santiago and at SAMU, the public ambulance agency for Chile. At Soltero del Río I actually found myself featured (briefly) in a promo video! You could call me an, “extra,” and I definitley felt out of place but was happy to join in!

On Wednesday the 8th, (my 4 month Watsoversary!) I received an approved Thai Visa and I headed to the airport! A result of last week left me taking some initiative on travel plans, and I had booked a 10 day trip down south to Punta Arenas, Puerto Natales, and Torres Del Paine National Park! I planned for the first half of this trip to be some time off in the park, and the second half to be used exploring some other health systems in the smaller, more isolated towns of Southern Patagonia, Chile.

I had planned a 5-day, 4-night trek in Torres Del Paine, on a trek called, “The W,” which consists of the front half of the Park’s trekking Circuit, “The O.” On the 9th of November, I spent my day preparing. I need to reserve two campsites that I couldn’t online, rent a camping stove, some trekking poles, and buy food (plenty of food)! In the midst of all this, I met a guy named Juan, a Venezuelan who was also traveling through Patagonia. We came to find that our trekking days lined up, and we ran into the same reservation issues. Soon enough, it became unspoken word that we would be trekking together.

(These next days I will give you a play-by play, just because they were so incredibly awesome. Each day I also found myself hiking with a thought in mind. Some were thoughts that just came to me, others were quotes that returned to me as I hiked. I’ll list each days thought here too.)

On the 10th we took a bus into the park, followed by a ferry ride across Lake Pehoe to El Refugio Paine Grande Camping site. Given the reservation trouble, I had two nights reserved here. Setting up camp, Juan and I settled in, fixed lunch, and prepped for the days adventure. We then hiked along the “W” trail up towards El Refugio Grey Camping, where we had intended to camp had there been space. Instead, we took some time admiring Glacier Grey from afar, and then walked back to camp to fix dinner (and have a hot shower). We ended the day totaling around 30km. – “Tell me, what is it you plan to do with your one wild and precious life?” – From “The Summer Day” by Mary Oliver

Week 6: November 11 – November 17:

On the 11th, we woke up trying to decide what to do knowing we had another night in the camp, and we ended up going back up to Grey (and a little bit beyond) as we heard there were some incredible swinging bridges to cross and a very up-close view of the glacier. Safe to say it was worth it. The night ended with a beautiful view of the mountains surrounding us. Another 30 km in total was covered. – “May you always remember the paths that bring you back…back to the important places.” – From The Important Places, by Dad to Forrest, 1986

On the 12th, we packed up camp for the first time and carried our gear to the next campsite about 10 km away, called Campamento Frances. It was a little rainy and we were worried about our hike later in the day. After setting up camp we trekked upwards to Mirador el Británico. The trek brought us up along El Río del Frances and inbetween Cerro Paine Grande and Cuerno Principal finally upward 900m to Mirrador Británico. On top of the lookout, we found ourselves almost completely surrounded by incredibly immense mountains, and were overwhelmed at their grandiosity and beauty. Hiking back down, we finished an incredible day back at Campamento Frances, eating and talking. We finished the day at 25 km. – “Today I walked among Giants,”a thought that seems like it may be a quote from somewhere, but one that stuck with me as I fixed my eyes above me.

On the 13th, we packed up camp and headed along the trail to our final campsite, Campamento Central. What ended up being a long 16 km hike up and over hills, we finally arrived at camp with beautiful weather. The next leg of my day was solo, as Juan decided to stay back to address some blisters. I headed up the mountain to take a look at Mirador de las Torres. A strong hike upwards along Mt. Almirante Nieto and alongside El Río Ascencio I arrived at the towers. Albeit half covered in clouds, these looming giants were an incredible sight to see, and I was blown away at their size. Hiking back that night, I realized how taxed I felt after a long day. At camp, Juan and I ate food and shared the last bit of Pisco we had brought with us along our journey. I quickly slept. The day totaled 38 km. – “Know that whoever God prays to, he asked them to help him make something of worth. He made you. He made you and was happy, you make the Lord happy.” – From “Closer” by Anis Moijgani, though directed in his poem to people, these were my thoughts to the mountains before me, the Giants I walked with.

On the 14th, Juan and I woke up at 2:30 am, ate a little bit of food, packed some meals, and set out on the trail by 3:00 am. Our goal: make it to up to Mirador de las Torres by Sunrise. With about a three hour trek in front of us, we hiked mostly in silence through the dark. With one hour to go, and with the first break of dawn, we began to hear the world wake up. We turned off our headlamps, clearly saw the trail ahead of us and listened to the birds as the world came back to life. It was something special to witness. Ascending to the base of the towers just as sunrise officially broke, Juan and I nestled in among some rocks to combat the wind. Las Torres were in full view, as intermittent fog and clouds swept through. It was cold, but the two of us were too mesmerized to move. We stayed for almost two hours. Hiking back, we had a pretty easy day afterwards, sitting in the sun drinking coffee, we finished a 22 km day. A tired bus ride back to Puerto Natales brought us to the end of our trek. I returned my gear (got a 10% discount because the rental guy thought I looked like McCauley Culkin and he wanted a picture – we agreed to take one with a discount! … No Kidding!) In the evening, Juan and I met at the one local brewery in town. We ordered a Kilogram (that’s 2.2 pounds) of fries, topped with bacon, chicken, cheese. Some would call it gross, we would call it the best thing we’d ever eaten (the beer was good too!). Parting ways, I couldn’t help but reflect on the how grateful I was to have hiked with Juan, for a new friend made along this journey, and for his wisdom that he shared with me. I’m already starting on his book reccomendation, Extremes: How Exploration Transformed Medicine in the Twentieth Century by Dr. Kevin Fong. – “Look to the Dawn, let the sunshine carry you. As long as your heart is pure, you will never make a mistake.” – Advice from Gerald Smith to my sister, later shared with me.

The remainder of my week was split between Puerto Natales and Punta Arenas. I spent the next two days at the Hospital. I got the opportunity to spend time in the Emergency Department at the one Hopsital in town. Although an isolated place, this public hospital was really nice. It excited me to spend time there, especially knowing I was returning to some time in the Santiago Public Hospital System.

During my one day in Punta Arenas, I signed up for a Penguin Tour. A boat ride out to Isla Magdalena, I got to walk through the island and look at thousands of little Penguins. You couldn’t ask for better. On the boat ride back we saw two whales traveling together! A late-night flight brought me back to Santiago, concluding an incredible 10 days, both for my project and personally.

Week 7: (pt. 1) November 18 – November 24:

Now this week has only just begun, but it has gotten off well. After taking the weekend to re-adjust, I spent Monday at Hospital Soltero del Río in the Emergency Department. It was quite the contrast to what I had seen in Puerto Natales. Tuesday I began this blog posts, and Wednesday I spent the day with SAMU, the public ambulance service in Chile. Today is Thanksgiving! I nice morning off, and an afternoon finishing this post, I am going to share a Thanksgiving meal with Cory and his family who are in town. Though it will be different not being with family, I am thankful to spend the holiday with others. No matter where I am, there is much to be greatful for. Saturday, I have another day planned with SAMU!

Picture time! (These will mostly be of my trek in Torres Del Paine)

Views of Cerro Paine Grande on the Ferry Across Lake Pehoe, Day 1Views of Cerro Paine Grande on the Ferry Across Lake Pehoe, Day 1

A fuller view of the mountains from Lake Pehoe, Day 1Mirador Lago Grey, very windy, and very awesome, Day 1.View from above Swinging Bridge #1, Day 2Juan and I in the middle of Swinging Bridge #2, much longer and higher! Day 2View from our final lookout near Glacier Grey, an excellent spot for lunch, Day 2Campsite Views at Refugio Paine Grande, our tents are the two most left orange ones, Day 2Panoramic View of our hike up towards El Británico, Day 3A beautiful view of Cuerno Principal in El Británico, Day 3Standing within El Británico, surrounded by Giants, Day 3El Británico, looking out of the valley we hiked through, Day 3Sunset outside of Campamento Frances, I am rocking Day 3 trekking hairJuan and I set out on Day 4’s Trek to our final campsiteSolo hike up to Mirador de las Torres, although half-covered, they were incredible, Day 4Juan and I are hunkered down at sunrise. With the wind we think it was somewhere in the low 20’s, Day 5Cold, but proud and happy to be where I was, Day 5My epic pic from Mirador de las Torres, Day 5The clouds began to break as the sun continued to rise, Day 5But more clouds would always roll in. A farewell selfie, with the final thought, “I will see you again,” Day 5Penguins in Isla Magdalena!More Penguins, they were so awesome! This guy (or gal) popped out of their nest to grab grass to fluff up the nest for their eggs. We learned that each penguin shares an equal load.

A larger view of the island; all their nests are little burrows. There are so many of them! As we departed by boat, we turned back for one more view of the island.

Project Time!

Coming out of weeks 3 and 4, some new thoughts and observations have come to my mind that I have enjoying thinking more deeply about.

First, a relflection of my time with Ambulancias Santiago. Early in Week 4, I spent a day with Ambulancias Santiago, a private ambulance agency based out of Santiago. I got in the ambulance with a Paramedic and a Driver, sitting in the middle seat up front with them, we headed out on the streets. As I would discover, the work these medics were doing were mostly making transports, rather than responding to 911-calls, or the equivalent. That being said, we barely took a break all day. The majority of our patients were individuals who needed dialysis treatment. Running between homes, hospitals, and dialysis treatment centers, the two guys I were with did their work. Perhaps my feelings were a mix of what I was seeing and what I had already been feeling in the week, but I was a little off-put. To me, it just seemed like a taxi service with a bed. There was not a whole lot of “care” being given, except with the help getting in and out of the truck. I did enjoy my time though, and many of the patients asked who I was, which I was happy to share with them who I am and what I was doing.

After my time in Torres del Paine, I spent a few extra days in Puerto Natales, the nearest town. I learned that a new hospital had just been built, and I decided to go see if the ambulance station was there — nothing was showing up on Google Maps! Arriving, I found the station in the back, it was the SAMU service for Region XII of Chile. Meeting the Director, I explained a little about who I was and what I was interested in learning – due to size and time limits, she took me upstairs to the emergency department to be introduced to some of the doctors there. I ended up spending my time in the Emergency Room for the afternoon and returning the following day for more time there. As I spoke about in Denmark, most who visit the ER are not what you see in movies, or Greys Anatomy for that matter. We attended to both children and adults – anywhere from potential broken bones, to larger chronic illnesses. I hopped around from doctor to doctor whenever a new patient came in, and listened to the way they spoke and worked with patients. Something stood out to me here; everyone took time to stop and say hello to each other. There was importance that lay in saying hello, a handshake, or a hug. No one was left un-greeted when I new health care provider entered the ward. Hospitals are always busy, and there almost always is a tension that runs through the air like radio waves. At least, in my experience, I have felt that tension – the buzz in the air. In Puerto Natales, that buzz seemed relatively minimal, if not non-existent. I liked it. To me, it felt how it should be – centered on interpersonal relationships, connection, and of course, giving care as best as one can.

Returning back to Santiago, and going to Hospital Soltero del Río, the largest public hospital in Santiago and in Chile — and likely one of the largest in South America, I was struck with many differences that left me thinking. Perhaps it is because one hospital was less than two months old, and the other has been around for decades, and perhaps too it is because one cares for 20,000 people, and the other 6.5 million. These things are surely to have an affect, but the tone was different. One thing that did remain at least, was the interaction among staff. Handshakes, hugs, and the typical Chilean greeting, a kiss on the right cheek was still passed around. Again, it seemed to me that it helped lighten the load and tension that filled the air. I spent most of my time in La Sala Reanimación, which is a room in the ER with patients who are in more critical condition.

Leaving, I had many thoughts swirling in my head. What made the far south of Chile so different than here? Was it purely because of the size? Is there more funding given to Puerto Natales because it’s the only hospital, or that there are many tourists who come south, and given that this is the only hospital, there needs to be sufficient levels of care? Does the aspect of community care reflect better in smaller places? In my mind, that seems to contrast with your typical notion of “Standard of Care.” For the most part, (not to over-generalize too much) small, rural towns are more often associated with less access to quality care, while large cities are often considered to have better access to quality health care. This is largely a reflection of resources, and is an ongoing debate in the medical community about how to better provide care to rural communities. This being said, in my experience, both before and during this year, I have begun to take note of the space and interactions within these large and small cities. It at least has been more apparent to me that individuals in smaller towns share a greater sense of community, while larger cities often come with a loss of community. Again, this is an over-generalization, and should in no way be taken as fact, but it is true that a community of 6.5 million looks different than that of 20,000 or less. In the Faroe Islands versus Copenhagen, I witnessed the same. In a large city, it is quite easy to feel invisible – I have felt it before, and perhaps you have too, but in smaller communities, your presence is more noticed, for good and for bad. So I am left asking, what’s the relationship here? Small towns typically share less access to health care, and in my personal observations, often a greater sense of community. On the other hand, large cities share more access to health care, but at times the loss of a greater sense of community. Surely, there is not a direct correlation between these two things, but it has left me wondering. Do the way communities associate with each other have anything, if at all, to do with the level of health care access? Most of these are just thoughts spinning in my head, and in no way do I have an answer to any of it at the moment, but I wanted to share. What do you think? Have you ever noticed the same in the places you have lived?

Lastly, a reflection on my time with SAMU yesterday. First of all, it was awesome. The funniest moment was when I responded with two medics to a car crash and one looked at me and said in Spanish, “Go see whats wrong with that guy over there.” And there I was, with a blank expression on my face, thinking – “what?” I did my best, but was thankful to have some help when it came. I hopped around on two ambulances yesterday, one was a basic life support, which had only a driver and a paramedic (which actually translates to a Basic EMT for those in the States) and an Advanced Life Support Truck, which had a Doctor, driver with paramedic training, and a third paramedic with a bit more advanced care training. The day ranged from responding full lights and sirens through the busy streets to the scene of a car crash to transporting a patient from the public to private sector. We took a patient with a suspected MI (heart attack) directly into a Cath Lab to find the blocked artery, and we witnessed the team of doctors, nurses, and technicians rejoice as they found the blockage, only to jump back into action when the patient began to downtrend. Leaving, the prognosis was not good; a cold, but truthful reminder of what occurs both here in Chile and around the world every day. Our finite resources ultimately are matched against an incredibly complex system, our bodies. The new book I have started is called Extremes: How Exploration Transformed Medicine in the Twentieth Century. Reading this book, and reflecting what I observed with SAMU & Hospital Soltero del Río, my last thoughts are these: To what extent can a Doctor give adequate care? To what boundaries do they reach? And what can they breach? In the last century we have pushed these boundaries further than we ever imagined we could; yet still, the medical community faces its limits. And lastly, with those limits, how does the role of the community or the family fit into the picture when we reach those limits?

As you can see, much of these are questions left unanswered, and many are open ended, but I believe it is a reflection of the many great things I have seen in the past three to four weeks, and how my mind is beginning to become more attuned to where I am, what I am seeing, and how it all fits together.

On this Thanksgiving Day, I have much to be thankful for. For all the absence of family and familiar faces that this year may bring, I have been given this incredible opportunity to witness and ponder the thoughts written above. This is something that I have great gratitude for. So again, thank you, Watson, and thank you, readers. Thank you to those who have helped bring me to where I am today, and thank you for continuing to support me along this road. I wish you the best of time with your family and friends. Eat some extra turkey for me!