Saturday, December 27, 2014

Aziza

Aziza is a Moroccan restaurant known for cocktails, sous vide skills, and a Michelin star.

The decor was a beautiful deep red, with a lux blue surrounding the bar.  We all loved the bar light fixture, which looks blown out in this pic, but was a really fun shade of blue.


You can see the time and energy they put into cocktails on the bartender's face!


Goorin hats FTW.


Great to have Ryan as an addition to the SF crew.


The beautiful Laws girls.


Their cocktails were all pretty prep-intensive.  This one was a riff on a bloody mary featuring blended red bell pepper, rye, cocchi americano, and bonal.  The other drinks were equally inventive, including one featuring hickory smoke foam on the top.

We all opted for the twelve course tasting menu.  The mark of a truly flexible restaurant and talented chef, they do accommodate dietary restrictions in their tasting menu, which is awesome for the lady.

The first course was labeled "snacks" and was like a set of three amuse bouches.


Glazed carrots with sprouted lentils.


Oyster with cucumber, tumbo seeds, and a bit of green herb on the top.


Lisa had a fried broccolini, almost like a super light tempura, with a brussels sprout and a dab of harissa.  It is amazing to see what you can do with a very simple dish that has been cooked perfectly.


Brown rice cracker egg yolk emulsion with pickled onions and chive (Lisa's).


The same egg yolk, pickled onion and chive as Lisa's but on a cracker made of fried chicken skin.


Sunchoke fritter with brown butter powder and honey -- working the salty-sweet angle hard.  This was amazing and perfectly cooked.


Deep fried potato covered with osetra caviar, creme freche pearls, and micro parsley.


Another Lisa course: grilled avocado with blood orange, heart of palm, and tumbo seeds (a.k.a. vegetarian caviar).


Smoked trout sous vide with cucumber, trout roe, amazing chive oil, and horseradish sauce.   Lisa had a really yummy tomato lentil soup paired with this course, the picture was crappy, but the soup was awesome.


This was one of the big stand-out dishes of the night, and the picture just doesn't do it justice.  Under this blanket of potato puree was a lamb belly chermoula with the most amazing sous vide egg yolk.  It was fully cooked, had a texture of custard yet retained the bright orange color, sheen, and transparency of a raw yolk.  The dish was topped with in-house rice krispies for contrasting texture.


Not knowing exactly how they were going to follow the egg dish, we were a bit leary when the couscous arrived.  This one was vegetarian and featured winter squash, pumpkin puree, cranberry, almond and harissa.  Sometimes couscous is dry and gummy, but this was sweet, soft, and had amazing texture.  We learned this can only come from intense freshness: they make their couscous in house everyday, rolling it by hand.


Basteeya is a traditional moroccan meat pie, and is one of the stand-out dishes on the Aziza a la carte menu.   For the tasting menu, the duck pie was additionally dressed with grape gel, micro turnip and tarragon powder.  It was a delightful set of flavors, and crunchy goodness.


Sometimes vegetarians lose out with tasting menus, and even with restaurant food in general.  That wasn't the case at Aziza.  In fact, Lisa's nettle barley risotto pictured above was one of the other best dishes of the evening.  The shaved apple and fennel garnish on the top was sliced impossibly thin, so it's flavor didn't overwhelm the dish.


Quail, the second main course, was very beautiful.  The play of the electric green chive oil agaisnst the harissa broth balanced by the intense green leaves and pink quail was stunning.


Lisa's second main course was perfectly cooked mushrooms and cipolini onions with more potato puree and parsnips.  At this point, she was already full and crying uncle and so the smaller portion wasn't a big deal.


Beet braised in grape juice with goat cheese and honey.  It was surprising how much the grape flavor still came through after braising.  Goat cheese + honey = heaven.


Apple sorbet, matcha (green tea) crunch, and more impossibly thinly sliced apple that was lightly pickled.  OMG what an amazingly light but flavorful dessert, the pickled apple was the best part.


The second dessert featured a ganache made with olio nuovo (very first pressing of olive oil) ganache on the plate, topped with chicory, malted milk ice cream, almond, and chocolate.   It was nuanced with subtle complexity that you don't usually find in desserts.


Sugar bombs - a wonderfully light fried puff pastry covered in sugar.


Passion fruit gelee with hibiscus sugar coating, a pecan praline, huckleberry financier, and a chocolate truffle.

The night ended with a small takeaway of granola for each person at the table.  The granola was super yummy with a crunch fueled with buckwheat groats, more rice krisipes and a wonderful orange cinnamon tang.

The service was just as wonderful as the food.  Overall, we had an amazing time with great company.

Sunday, November 2, 2014

Kenya Consult

From time to time I get e-mails with iphone pictures of imaging studies to give second opinions on.

This one was particularly interesting so I thought I'd share.  45 yo man with 4 months of progressive weakness. Now with inability to move extremities, and a sensory level near the shoulders.

MRI as shown below (note these are phone camera captures from a lightbox, don't judge).

Post your answer in the comments, I will post the answer in the comments in a few days.


Thursday, September 25, 2014

2014 Kenya Recap

Coming to the end of another 4 week rotation in Kenya, as I reflect on what has been accomplished I'm quite pleased.



Our x-ray truck is finally operational and has visited several rural sites taking x-rays for many patients without major issues. The images are being uploaded to the PACS and are now ready for interpretation by radiologists. I've been waiting for years to write that sentence. 

 

I had a ton of food adventures during the four weeks including:
  • Making yogurt with Patrick and Wendy
  • Granola with Jess (fruit after baking, doh!)
  • Making Jon Laws' pickled green beans with Jess
  • A Lebanese feast prepared by Jess
  • Cucumber pickles with Patrick
  • Three amazing meals with Jane who makes everything look easy
  • One 'oven surprise'
  • Ugali that actually tastes like something edible at a Moi's Brigde choma zone (pictured above)
  • Brie and Peppered salami imported from Nairobi
  • Chili paneer from Siek Union
  • Dinner at Sanjeel complete with cheese nan and tandoori paneer 
  • A fabulous send-off dinner complete with a pumpkin cheesecake by Jess and Katy
Overall, I'm incredibly grateful for the opportunity to travel to Kenya, bring new services to patients, and have an amazing group of friends. 

Friday, September 19, 2014

Kenya Mobile X-ray Unknown Case


Our mobile X-ray truck continues to work well, which is incredibly exciting.  Today, our first patient had a really good, interesting X-ray.  

37 yo with history of Tb that was treated.  She successfully finished her course of treatment, but has persistent chest pain, which is worse with coughing.

The clinical officers here had never seen a finding like this and would have missed the diagnosis, which changed treatment.  

Leave a comment with your diagnosis :-)

Saturday, September 13, 2014

Roller Coaster Ride


It's been an exciting week on the x-ray truck. Last Friday we felt that we had sorted out all of the engineering issues and the truck was ready for general use. 

On Monday we moved the truck to AMPATH center in Eldoret and began taking x-rays of patients in earnest. We took x-rays of 9 patients and were feeling pretty great. 

Tuesday we returned to AMPATH center and only had one patient just before lunch. After exposing the patient, the CR reader malfunctioned and refused to work. I was heartbroken.

You may recall that we have two sets of equipment for the truck. The reader that we are currently using is our backup.  Last year the primary reader feel down in the truck and was damaged. It initially worked, but failed shortly after I left last year, so we've been using the backup.


Interestingly, both the primary (humpty dumpty) and the backup failed in the exact same way. Suggesting that maybe the trauma that the first reader suffered was a red herring. 

Wednesday I picked myself up by my bootstraps and Patrick and I investigated the primary reader. We are lucky to have a very good service manual and a sweet diagnostics program on the laptop.

We identified that the rollers that move the x-ray plate (kind of like film) were not moving.  After investigating many options - blown motor, seized or dirty rollers, and many other parts of the device we found the voltage parameters for the roller motor in the service manual. When we measured the voltage we realized that the motor was not getting any power. We traced the motor connection back to a set of fuses, one of which was blown. 

Let me explain something about Kenya: shops here are much different than in the US. They tend to be locally owned and randomly supplied by unreliable distributors.  There is no Home Depot or Lowes, no amazon.com. The hardware stores tend to be very specialized (one is best for bolts, another for metal, another for wood).  There is a local walmart equivalent, but there is certainly no guarantee that even a simple fuse would be easy to find.  So, finding even a simple fuse could take weeks for the uninitiated.

Luckily, I have a secret weapon: Patrick. Patrick has lived and worked in Eldoret and has solved so many of these challenges that he knew exactly which store could help us. We dropped by just before lunch; 10 minutes and 60 shillings later ($0.90) we had two new fuses plus several backups.

We took the fuses back to the workshop and installed them. Both readers sprang back to life and worked flawlessly.  It was hard to contain our excitement. 



Friday, the truck made a successful visit to a rural clinic (Turbo). Joe was also working at the clinic and it was great to be able to read X-rays for him.  We were able to x-ray another 8 patients. The truck made it to and from the clinic without troubles.  

Stay Tuned: next week we are looking forward to traveling to a more remote site with rougher roads to see how things fare. 

Sunday, September 7, 2014

The Little Generator That Could



I spent most of the first week working on the X-ray Truck.  I'm happy to announce that Patrick has the biggest engineering challenges related to generator.

The power issues and X-ray machine errors boiled down to a generator that couldn't respond fast enough to the short and hard power requirements of the X-ray machine.  Patrick tells me that the technical term for this is power factor correction.  Most people solve this with a much larger generator (heavier, more fuel, etc) than is required based on initial calculations.  We were stuck with the existing generator vs making major truck changes, so we made this generator work.  

The two most important fixes were: proper setting of the generator governor, and installation of a 1500W immersion heater that allows us to load the generator prior to firing the X-ray machine.  Patrick did a really beautiful job rigging up the heater so that the heater is engaged by the radiographer immediately prior to firing the x-ray machine just by pushing a small button near the doorway.

We're going to test patients at AMPATH centre tomorrow, and then roll out into the field.  We still face many logistical challenges regarding uploading and storing images, but we're making important strides.

Tuesday, September 2, 2014

Some Things Change, Others Not So Much

Change

Nairobi has a Porsche dealership close to Ole Sereni
The new international terminal at JKIA is built and it looks beautiful - lots of glass, open architecture.

Not So Much

Passport/VISA line is still super disorganized even in the new beautiful building.
The early flight from Nairobi to Eldoret is very early.
The Kenyan Registrars are amazingly engaged learners.
I still have amazing friends in Kenya, it's a wonderful place to be.