Tuesday, July 31, 2012

A Three Hour Tour



(It was really only two hours)

After the great fun we had on the walking tour in NYC, Lisa found http://www.contexttravel.com - a company that specalizes in walking tours.  Ours was a tour of architecture called the Colors of Florence. It turned out to be just the two of us and Elizabeth Butler - our guide.  Elizabeth is from the US but has lived in Florence for the last 9 years studying art history.   In a surreal happenstance, her sister lives in Indy!  She was saying that she normally goes to the states in August and loves going to our state fair with her nieces.

The tour itself was fantastic.  She definitely knew her stuff.  It was great to go beneath the surface to learn special details about different buildings.  What follows are a few stories from our tour.

The picture above is the Basilica Santa Maria Novella.  It was built over literally hundreds of years.   There were even times when it sat unoccupied.  If you take a close look at the photo you can tell that it's truly a facade - the fancy white and green marble is only on the front side of the building with the rougher local stone in the background (see right side).  Also, if you look closely the facade has two different levels of detail on the top vs. the bottom half.  These were built in different eras with improved construction techniques on the top.  This church is quite a bit older than the duomo and you can tell that the carving skills were not yet developed as this is all inlaid marble without much carving.  This church, which now is firmly within the city limits was once in the countryside and even had a nickname "vineyards church" because it was surrounded by vineyards.

Next, we walked over to the palace of the Strozzi family.  They were another rich family that rivaled the Medici family in Florence history.  On the outside of their palace, there was a long stone bench that ran the entire perimeter of the building.  We learned that this bench was where all of the clients of the bank run by the Strozzi family would wait.  We also learned that our work bankrupt comes from the Italian 'banca rotta'  which means broken bench, a fantastic connection.  If you look at the courtyard above, there is a new type of marble - the grey marble.  At the time that the church in the first picture was built this type of marble was not available.  It's inclusion here led to the warmth and welcome of the palace.  Elizabeth also mentioned that the courtyard also served other important functions for the palace; there is a cistern beneath the courtyard that collected rainwater for use throughout the palace.






Next we headed over to the Piazza della Repubblica, which among other things is the site of a famous cafe called Caffè le Giubbe Rosse.  Founded by two Germans in 1900, it has been frequented by literati including Hemmingway throughout the century.


There were two tiny features that Elizabeth pointed out that would have very easily been missed.   The first (above) is a flood water marker.  In November of 1966 it rained almost non-stop for 60 days and Florence was badly flooded.  This was about three feet off of the ground, and closer to the river the water was even higher.  Famously, the bronze doors from the Duomo's baptistry were torn off of their hinges and carried away by the flood.  The flood cleanup was extensive and many young people (dubbed Mud Angels) moved to the city to aid in the restoration work.  Many of the techniques for restoring fresco paintings in use today were quickly developed after the flood out of sheer necessity.

The second tiny detail is this line cut into the stone near a fabric shop.  This was a government-sanctioned and protected measuring device (1m) so that customers could verify that they weren't being ripped off.


 Next, we headed over to the Piazza della Signoria where the current-day government is held.  There is a large building that included several details from medieval times including large holes in the roof line where flaming arrows or hot oil could be dropped.  One of the most beautiful parts of this Piazza is the gallery of sculptures overlooking the square.  The most striking sculpture is of Perseus holding Medusa's head and standing on her body.  We learned about bronze casting and the lost-wax technique used to form the sculpture.  The artist was lucky to be supported by the duke of the time which allowed him to practice and refine this art of bronze sculpture.


Right behind the sculpture gallery is the Galeria degli Uffizi - a famous art museum that boasts the best collection of Italian paintings in the world.  The picture above is from the walkway between the two large wings which looks out onto the river Arno. It was quite a beautiful scene in the late morning.


We concluded our tour with a beautiful view of the Ponte Vecchio. As you can see, it's a very old bridge that is actually lined with shops, and has a walkway across the top.  This was built by Cosimo I de' Medici so that he could walk from the government building, through the Uffuzi, across the river to one of his palaces on the hill.  In 1593, in order to establish the prestige of the bridge Cosimo banned the butchers that had set up shop along the bridge.  They were quickly replaced by gold merchants, who remain on the bridge to this day. 


The elaborate wooden security doors that completely cover the glass storefronts still exist to this day. Many of them have a small peephole that allows a look into the shop from the street.



Overall it was a fantastic tour and an opportunity to see many things we wouldn't have otherwise noticed.

Saturday, July 28, 2012

July Kenya Wrapup


This trip to Kenya has been excellent.  We made some good progress for the short three week visit.  It's never enough, but it's more than nothing. 

We've been waiting and working on trying to get our mobile X-ray system up and running.  We're currently hung up on getting design and radiation protection finished.  It then will take 8 weeks to actually build the body for the truck.  So, it's looking doubtful that it will be on the road before the end of the year. 


From the informatics/coding portions of my work, we're getting a lot closer to establishing an electronic results feed from our system into the AMPATH medical record system.  I was able to make sure that the X-rays from the truck can be uploaded to the system easily by the workers at the hospital at the last minute, on the last day, which was really sweet.

Working with the registrars continues to be one of the great pleasures of my trip to Kenya.  I gave them a total of about 4 hours worth of lectures that I had prepared.  Their thirst for knowledge continues to be quite strong and it's great to work with them.  One of the major projects that I'm going to be working on when we get back home is fundraising for an endowment to support travel and lodging expenses for Kenyan residents to visit the states.  Let me know if you'd like to donate - we'll start soon.

One of the unexpected pleasures from this trip was finding a new bond of friendship with Val.  It's usually hard traveling with people, but this trip has been absolutely easy.  I was worried that we wouldn't have much to talk about, but conversation was effortless.  Will have to add another friendship to those solidified in Kenya. 

I can't wait to come back, maybe sometime before next July?

Thursday, July 26, 2012

2012 Kenya Unknown Case #3

9 yo male with history of exophthalmos.  


Non-contrast orbital CT scan.









Contrast Enhanced Orbital CT





Sunday, July 22, 2012

Nakuru Safari



Safari is an important part of a trip to Kenya - especially first trips.  Because we didn't have much time this go-round I decided to take Val (my chairman) to Lake Nakuru for a short weekend trip.  It's not far from Eldoret and the road between here and there is pretty good.

We had a nice trip, it only took about 3.5 hours.  On the way into the park we were greeted by the usual assortment of baboons, monkeys, antelopes and birds.

The place where we're staying, Lake Nakuru Lodge, is nice.  Especially because it sits on a hill overlooking the park and the views are fantastic.

Last night after our evening game drive we had about an hour before dinner was served.  We spent time on the porch to Val's room drinking white wine and chatting.  Looking over the park to the cliffs on the far side we could see fires from houses on the cliffs flickering like fireflies along the hills.  The stars at night were also quite nice, especially compared with Indianapolis.



We've seen some great birds - I don't have many pictures of them because I'm traveling light without my telephoto lens as I'm continuing on to Italy.  Val has taken tons of pictures so she may be able to fill in for me.

It turns out that the hotel only has a very low electified fence that is quite easily conquered by the baboons.  This has led to some interesting encounters.  One out-right begged Val for food, one tried to steal my camera, another tried to break into my room via a sliding glass door opened for ventillation, and countless others have danced across the porch and pulled tiles from the roof trying to scale it.  I got some pretty good video of them playing outside my room - will upload when I get back to better bandwidth.



On our early morning drive, we were treated to two rare finds: we saw a leopard (my first good look ever) and we also saw a single lion try to take down a cape buffalo.  When the lion's friends didn't close in quickly the buffalo went on the offensive and chased the lion away.  It was pretty amazing to watch.

We topped off our late morning drive with an amazing symphony of pelicans flying in formation over the van repeatedly.  I shot some video of this and hope to also get it edited and posted soon.

Our final game drive took us to see the waterfall at the edge of the park.  It was probably about 30 stories tall and quite easy to access and photograph.  We drove up to the top of baboon cliff, where it was raining slightly and the small structure was occupied by very loud people smoking :-(  Otherwise the views were fantastic. There weren't any other big animal sightings but we had a good time taking pictures of the numerous birds.

This was definitely my best trip to Nakuru, and Val had a fantastic time.

Saturday, July 21, 2012

Dinner with the O'Mearas


I was lucky to have an invitation to have a home-cooked meal from Patrick and Wendy O'Meara.  Patrick is an engineer who has been working on the design and fabrication of the mobile X-ray truck.  Wendy is one of the co-field directors for research at AMPATH on the facutly at Duke.

Luckily, I had a bar of dark chocolate Santander (Lisa's favorite) to take as a gift for my hosts, it was well received as good dark chocolate is hard to find in Kenya.  For dinner, they shared salad from their garden, tasty beef stew made with slow cooker imported from Scotland, and a whole-grain bread that includes spent grain from Patrick's home brewing. 

Yes, I said home brewing.  Apparently when they moved to Kenya six years ago they decided that they needed to start learning to brew if they were going to survive.  Kenyan beer, while refreshing and quaint for the occasional visiter, it looses it's luster quickly.  It would be akin to drinking Budweiser and nothing else for years on end.

Over the past six years Patrick has definitely had some practice.  I was able to enjoy a wonderfully made IPA, which put a nice cap on the week.

The salad was particularly nice because I thought that it was an impossibility for my trip.  Lisa and I had lots of salads and even picked a dinner restaurant based on salad before I left.  Typically vegetables that need to be washed before cooking are a bad idea in places where the water can be suspect.  Wendy went all out with the cleaning process to ensure that I wouldn't get sick.

After the general formalities - what do you do here etc - we had some great conversations about places to hike, travel, and food.  It's obvious that Patrick and Wendy care about food quite a bit so we had a lot of stories to share.  They showed me some large blocks of exotic salts from their recent trip to Nepal and shared some peppercorns that had a strong orange note.  The one salt was a dark-brown almost black color and apparently had some sulfur content which gave it a pungent odor.

Oh yeah - and their pup is ridiculously cute, lives indoors and doesn't smell badly like most kenyan dogs.


It was the second special dinner of the week, life doesn't get much better.

Friday, July 20, 2012

Val's Arrival and Dinner at Abuya's



I'm very pleased to say that Dr. Jackson - the chairwoman of our department has joined me in Kenya.  While she is quite well traveled, this is her first visit to Africa.

The residents and radiologists greeted her warmly.  They had even moved up their week of exams in order to spend more time with Dr. Jackson.  After the welcoming gathering we were treated to a tour of the department and other areas of the hospital with the two chief residents - Daniel and Lois.

The following next evening, Dr. Abuya and his wife hosted a wonderful dinner of three courses.  We started with a tasty vegetable-pea soup, then enjoyed a range of entrees from chapati and rice to fried chicken and mutton curry.  For dinner we were joined by Dr. Kimutai and several of the registrars: Cornelius, Grace, Mary, and Lois.  After dinner we were treated to an array of beverages including: coffee, tea, tusker, tusker lite, kingfisher orange fruit wine, tropical strawberry cooler, and sparkling soft red wine.




The after dinner conversation was an affirmation of both side's commitment to continued partnership and exchange.  Everyone had a great night.

2012 Kenya Case of the Week #2



Longstanding history of urinary incontinence.

Monday, July 16, 2012

Pinetree Gardens



So I have to say that other than the taxi/transportation issues, Pinetree Gardens is a pretty fantastic place to stay.  The people that work here are super friendly.



The food is tasty - especially these magic fried potatoes that they make for breakfast.  Usually with some curry or tasty sauteed onions.  The rooms are clean and comfortable and the grounds are quite pretty and welcoming.



I even I found a 1 mi running route that is quite a bit safer and less scary than running near IU house.  This route even has beautifully maintained sidewalks for a good portion of the way!  I guess that's what you get for staying close to the massive "state lodge" - the house where the president stays when he visits Eldoret.

Sunday, July 15, 2012

Breakthrough Weekend



This weekend I elected to stay in, hang around Eldoret and get a few things done.  Saturday morning the last remnants of jetlag woke me up early around 0730.  I had a tasty breakfast and sat down with a hot cup of chai out on the beautiful terrace to get some stuff done.  The whole thing is a long story - but I've had a goal for some time to transfer results from my X-ray system into the electronic medical record system here.  It's been in the works for about three years, and I had a big breakthrough on Saturday.  It's not completely done yet, but it's a whole lot closer than I've ever been before.  Pretty freakin' exciting. 

Saturday evening was great too - two dinners out with new friends (and a few old friends).

The small bit of sadness in the weekend is that one of my new friends, Julia just left.  She was here for a year working on Tb with Jane Carter.  Julia is moving along to start medical school at Stanford.  It was a lot of fun getting to know her over the past few days (raccoon eyes).  After dinner, as a last hurrah for Julia - we went dancing at Spree, for about an hour.  It was quite warm in the basement despite air conditioning and the dance floor was packed (as always).  At the end of the evening we welcomed the cool night air over our sweaty-dance-floor-infused bodies. 

Sunday has been pretty chill.  I had a nice prolonged breakfast with my pinetree colleages and then got a bit of work done before lunch.  I helped Julia finish up some last minute house chores and packing before seeing her off.

My Chairman (a.k.a. my boss) comes in on Tuesday - so this week should be filled with excitement as well.

Friday, July 13, 2012

2012 Kenyan Case of the Week #1

From 2012 Kenya
From 2012 Kenya
Young boy with progressive headaches. May have had some sick contacts. Comment to diagnose....

Thursday, July 12, 2012

Karibu Kenya 2012


I was happy to make it to Kenya with minimal drama.  A bit of advice for anyone buying international plane tickets with a credit card - you have to present that exact card at the time that you check in or they won't let you on the plane.  Luckily they were able to refund my entire flight and charge a different card.  Apparently it's some kind of lame security measure.

For this trip the IU house is completely full, which means that I've been shunted over to the Pinetree Gardens.  It's a hotel that's down the road from IU House, about 1 mile from the hospital.  The room is nice and clean and I have lots of windows.  I had hoped that I would luck out and get an actual hot water heater but it's instant heat.  I have my own bathroom, and someone makes my bed every day, so how can I really complain?  One other benefit to the hotel is that breakfast is served, rather than the on-your-own biscuits and peanut butter.  Today I had a tasty omlette and some kenyan tea which would not have happened at IU house.


So far on the project front I've made some progress.  Plans for the mobile X-ray truck are coming along slowly.  This week we've been working on accepting the petrol generator that will power our X-ray equipment at sites where power is unavailable.  There are some technical issues with the generator that we're trying to get the vendor to sort out.  At the same time we're working on finalizing the design for the truck body.  Once it's finalized then production shouldn't take too long.  I'm hoping that it will be done in time for some folks who plan on visiting in September.

I've also made some pretty good strides with some of the programming tasks that I need to complete.  I'm definitely rusty in the coding department so it's been interesting trying to re-awaken those skills.

The picture at the top is from one of the things that I find endearing in Kenya.  It's a piece of corn that is roasted on the side of the street over charcoal.  The corn here is very different from corn at home.  It's kind of a cross between field corn and sweet corn.  It tastes like popcorn and is very chewy.  Most people that I've suggested try it don't really like it but I think it's good.

This weekend I think that I'm going to stick around Eldoret and get some work done.  One other good thing about staying in the hotel is that they serve meals throughout the weekend which is something that definitely isn't the case at IU house.