The last day of class...

Yesterday, we had our class party to mark the end of our English course. We asked everyone to bring food, and they brought a lot of food! We had all kinds of sweets, chips, cakes, pies and pasta salad! It was delicious, and there was a TON left over!
A couple kids brought balls to play with, so we played games like volleyball, basketball and knock out. We had the party on a playground that is very near the place where we hold lessons, so it was very convenient. The three hours of class time that day went by VERY fast!
We also gave out evaluations at the beginning of the class and 100% of the students said they would take this class if it were offered next year!
The local newspaper also did an article about us on Wednesday. We had a picture and a blurb on the front page, and then another picture and a whole article on the inside. You can find the link here:
http://www.auniao.com/noticias/ver.php?id=24724
It's in Portuguese, but you can google translate it!!


The advanced group of students (me and Carissa's class)


The teachers of the camp (minus Matt).


Playing Knock Out


The food!

Here are a few pictures of our students in the classroom! Madeline came in and took a bunch of pictures one day during class. She got a lot of good ones!

“Scrub in, you are performing this surgery”

This morning started out to be a day like any other. I woke up, got dressed, and walked to the hospital excited to see the removal of varicose veins in a 50 year old patient; however, when Dr. Timmy (the vascular surgeon I’ve been shadowing this week) saw me in the surgery room he asked me if I was prepared to perform the surgery with him. I thought he was joking and laughed it away but as soon as I stepped into the OR I realized that he was not kidding about having me scrub into surgery. He got one of the scrub nurses to take me into the wash room where she spent 15 minutes teaching me how to wash my hands up to my elbows. I never thought washing my hands would take 15 minutes, but the nurse showed me how to scrub my finger nails and the spaces between my fingers. She made sure I was scrubbed completely clean before she led me into a second room where I got to put on a scrub coat just like all the general surgeons. She helped me put it on because I was sterilized and was not allowed to touch anything except the patient and the sanitized green sheets around the patients. She helped me put on my gloves and tied my coat on me and at this point I felt really giddy and blessed that I was having an opportunity that not even medical students in America get a chance to be exposed to. When I walked into the operating room Dr. Timmy was waiting for me and re-explained the purpose of the surgery. He showed me the markings he made on the skin of the patient (something I saw him do yesterday) and he explained that he was going to remove every single one of the varicose veins. The biggest vein we had to remove was the great saphenous vein which extends from the bikini thigh region all the way to the ankle. After he explained everything and all the incisions the surgery began – and the people conducting this surgery were Dr. Timmy, a surgeon from Spain, a nurse, and me. The patient had varicose veins that covered both her legs completely so the doctors split up – one on each leg and I started out assisting the Spanish doctor while the nurse helped Dr. Timmy. I repeatedly told Dr.Timmy that I was not in medical school yet but he told me that he wanted to expose me to the medical world so I would work harder to get it. He said that he would have done anything to receive an experience like this when he was in medical school and he understood that the best gift he could give me was this experience so he told me to pay attention and start the surgery. The Spanish doctor started the surgery by making a small incision in the bikini area of the patient so that we could unveil the saphenous vein. During this process he held the scalpel and told me where to cut the patient (I surprised myself because my hands were not shaking as badlly as I thought they would be!) and then we started to dig through the tissue to find the point where a rubberband like vein existed. He then handed me strings that looked like sewing thread and scissors and showed me how to tie up the two areas of the vein so that we could cut it later. The surgeons always make sure to tie the regions that they want to cut before they actually cut it so that the blood does not squirt directly into their faces after they make the cut. After we tied the areas he gave me the scissors and said “corta” which means cut. I looked at him seriously shocked and he said be careful of the artery because if you accidentally cut it the blood will squirt directly on your face. So I prayed to the gods and made a cut exactly as he told me. The doctors were happy that I did that and began to trust me more during the surgery. To remove the saphenous vein, Dr. Timmy sent a long needle like tubing from the ankle and he pushed it into the vein until it ended up coming out of the bikini area of the thigh. He asked me to help him push the metal rod through the patient and this was an experience in itself. When the tubing goes through the patient you can see it move on the skin and it looks like there is a snake that is literally travelling inside the body of the patient. When the tubing popped up on the other side he had me cap it and then he told me to count to three so we could pull out the tubing. When the tubing was pulled out from the ankle the saphenous vein was wrapped around it. This was the first time I had ever seen a vein- I’ve read about veins, watched Grey’s Anatomy, and done my fair share of youtubing but seeing a vein outside the body is a unique experience in itself. The vein felt so rubbery and you could actually see the valves that were half closed and nonfunctional. He let me hold it and all the doctors were amused at how entertained I was by a vein that was seriously half a meter long. I could put my finger into the same tubing that held blood just moments ago and I felt so, so blessed to have that opportunity. Dr. Timmy told me to keep the surgery going and he asked me to pull out the veins with him. It was incredible because he knew exactly where each vein started and ended and would poke the skin at precisely the point where a tiny blueish-grayish vein would pop out. I was mesmerized and could not stop staring at how patient and quickly he worked. After all the veins were removed he wrapped up the leg with a compression wrap so that the bleeding would stop and then waited 5 minutes on each leg before he removed the wrapping and started putting tiny bandaids on each of the holes that he poked on the leg. He showed me how to put the bandaids using tweezer and told me to put them perpendicular to the wound. He gave me his bandaids and aided me as I put them on individually. Next, he asked if I wanted to suture the cut he made on the bikini to remove the saphenous. He did two sutures to show me how they were supposed to be done. First you have to connect the ends of the skin and then you wrap the suture thread around the scissors twice and pull to make a tiny knot. He made it seem so easy, but when it was my turn I couldn’t do it with the same technique that he did so quickly. It took me 30 minutes to get one suture into the patient the doctors were so kind that they didn’t even mind that it took me so long. They talked me through the whole process and wouldn’t let me give up half way. I had to make six knots on each suture and on the first knot I didn’t understand how the scissors opened (since it locked when you closed it) so the doctors made me step away and took a moment to show me how to squeeze the scissors so that it could unbuckle. It was only after the surgery that I realized that my white gloves were covered with blood and my scrub coat was covered with blood that squirted out when the doctor hit the artery instead of the vein. The surgery that started at 9 am ended at 1:15 pm and is an experience that I will remember for a lifetime. My first surgery was the removal of varicose veins and I think the experience made me feel more mature about the medical world. Surgery is an artform that requires patience but above all I think its something that requires humility and a lot of risk taking. It’s about breathing deeply and keeping your feet apart so that you don’t get a cramp in your neck from straining down so long. It’s all about the technique, but it’s also about keeping yourself sane by taking each cut one step at a time. It was in the OR today that I realized that being a doctor is more than merely cutting people open and saving lives. It’s all about the passion. After the surgery Dr. Timmy asked me to remember this experience when the path gets bumpy and when I have to spend late nights in the hospital during residency. He asked me to remember my joy in the OR when I have to study for my exams in undergrad. I think that’s why I am writing this long blog post, to remember forever my first day in surgery.

-Advaita

Francesinha: Not for the weakhearted.

What is francesinha?? Ridiculous meal typical of Portugal (specifically Porto)... I had one the other day, and it is unlike anything I’ve ever had! It is a White bread sandwich with ham, roast beef & chorizo on the inside and on the top the sandwich has melted cheese with a fried egg, then the entire concoction is doused in a special sauce and served with yummy crispy, greasy fries swimming in the indeterminable red sauce. It's a heart attack on a plate, but I've never welcomed clogged arteries so gleefully. Here are photos and a recipe, for anyone who dares try this at home.

http://www.food.com/recipe/francesinha-super-indulgent-portuguese-sandwich-370897

Puppy pix

Puppies!!

The most rewarding experience I have had while on Terceira has been my involvement with the City Kennel. The kennel holds up to 26 dogs, though in very poor conditions. The dogs are kept indoors all day without walks or baths and are in obvious need of human interaction and socialization. The dogs—ranging in size, breed, gender, age, and personality—are all very friendly and adorable! I am going to try and post pictures in a minute :)

- Claudia

"Urgent Care" Patients

I have really enjoyed getting to know all the doctors and nurses in the urgent care/emergency department these past few weeks. Something I found interesting was the universal-type health care provided for people on the island. On a slow afternoon in urgent care, the doctor I was with finally received a patient file- the first one in literally an hour. After about twenty minutes, I asked why he wouldn’t call the patient in. He replied that because health care was free for everyone, many people came in with very petty cases, such as muscle cramping or a cough. By making people wait an excessive amount of time in the waiting area, those who had serious medical problems would stay to see a doctor and those who had come in “just because” would leave. After he told me this, I began to realize that the majority of people who came in had very minor problems. Most of these patients did not even have to have anything prescribed to them- simply bed rest, fluids, etc. Because of this, I realize why many of the doctors and nurses often look frustrated with some of the “urgent care” patients.

GI + Endoscopies + Colonoscopies = Pretty interesting stuff

This past week I have spent my time in GI and was pleasantly surprised to find that it was quite interesting. I spent most of my time in the endoscopy lab with the nurses and Dr. Paula. Typically our day began around 9am and ended around noon. The GI unit itself was not very busy due to most of the doctors being on holiday. The nurse that I spent most of my time with was Nurse Gilda who did a spectacular job of tackling English so that I could understand what was going on. The doctors and nurses on GI had such a great relationship! They seemed to really value each other's opinions and worked really well as a team. They were especially good about helping one another find the appropriate words in English to describe the situation or procedure.

Patients were normally positioned on their left side with their knees bent. Local anesthetic was given (Lidocaine) via a lubricant that was put in and around the anus as well as on the scope. Most patients were above the age of 60. In the Azores people normally get their first Colonoscopy around 60 years of age unless they have a family history of polyps or some other GI disease. I was really surprised that patients were only given a local anesthetic during the procedure because in the US they give general anesthesia. I saw several Colonoscopies. Each colonoscopy I saw had either a biopsy of tissue or a polypectomy. These were really interesting to watch and were also quick. Inserting the tube throughout the whole colon took the most amount of time and seemed really uncomfortable for the patient despite the use of local anesthetic.

This is a before and after of a polyp found in the colon of a 73 yo male

The actual device used to remove polyps

Something else that was really interesting was watching an endoscopy. Much like the Colonoscopy, patients were given a local anesthetic via an oral spray and then with a Lidocaine lubricant. A plastic tube was then strapped to the patients mouth to stabilize the scope. Patients were laid on their left side as well. The endoscopy I observed was on a 65 year old male who was an ex-smoker with esophageal cancer. He had been diagnosed 6 months prior. The idea of this particular endoscopy was to expand the esophagus via an angioplasty. Dr. Paula fed the balloon into the esophagus while the nurse expanded the balloon. Unfortunately they could not expand the balloon to its full capacity due to the risk of perforation. Dr. Paula then chose to end the endoscopy because the scope was still to pass through the opening.

After endoscopies and colonoscopies in the lab, Dr. Paula visited her various patients on the GI unit. While on the floor I got to meet many nurses who were at first shy about speaking English but opened up quickly. They described the unit to me briefly and said that it was generally slow. I did get to meet a 16 yo female who was diagnosed with Crohn's Disease when she was 8 years old who was not taking care of herself. In the past 4 months she had lost 5.5kgs which the doctors and nurses were concerned with because she was already very thin. She did not seem to care about the weight loss and when told that she needed to make sure she got enough calories in her diet she said she was fine. Unfortunately my contact with patients was limited due to the language barrier. It really made me relate to patients that we see in the US who do not speak English as their first language...

I was also able to see a liver biopsy which was pretty amazing. First the area was cleaned with betadine and draped with a sterile draping. A sterile field was then made on top of a medicine cart where the doctor put on a sterile gown and gloves. The nurse set up the field for her and put out her supplies. The doctor percussed the intercostal space on the right side of the patient to locate the liver which gives off a dull sound rather than tympanic (which is indicative of air). Local anesthetic was used to numb the area. A needle was then inserted just above the selected rib in the intercostal space. Saline solution was injected into the space, the needle was then inserted fully, and the syringe pulled back on to create a vacuum. A string of liver about an inch long was removed and placed in a biopsy container. I was really surprised by how quick and easy the biopsy was. The patient was then instructed by the nurses to remain supine for 24 hours.

Unfortunately there is not a typical day on the GI unit over the summer. Like most of the hospital, the GI unit is "slow" during the summer because many people leave Terceira for holiday. Nonetheless, when the unit became excessively slow, or all the nurses and doctors were charting for several hours I was able to go home. They were all very welcoming! I have seen hostility between nurses and doctors in the hospital (like all hospitals) and was glad to be on a unit where everyone was generally friendly. I do however not think that Dr. Paula knew her nurses names which kind of bothered me. When she addressed Gilda she would just call her nurse. This could be a cultural thing but it still made me a little uncomfortable.

Dental Clinic

During my internship I have had the opportunity to shadow two of the three doctors at the dental clinic in the hospital. It has been extremely interesting and I have enjoyed seeing the differences and similarities in protocol, procedure, and treatment between what I have seen here and back home. Conversation with one of the doctors led me to discover that up until the 1970's there were no dental schools in Portugal, only medical schools that graduated students specialized in oral care and dental surgery. Now that there are dental schools there are two different health care professionals that specialize in oral care. You have medical doctors who go to what I understood to be six years of medical school and then specialize to provide oral surgery and care. Then there are dentists graduated from dental schools both in Portugal and other countries. I've enjoyed reaping the benefits of my improving Portuguese and have been fascinated in the differences in health care. With the health care system being such a prominent issue in the states I believe that everyone, even if you don't plan on pursuing a profession in the health system, should be aware of all the possibilities that could be the future of our health care system.

Perception

For the past couple of weeks I have been able to meet an incredible group of people here on Terceira and the other islands. One of the things that fascinates me about trips like this is that you are able to touch the lives of many people while at the same time come in contact with different ways of life, opinions, and ideologies. While this trip has reinforced some of my opinions, I have and will continue to learn more about how other people choose to live their lives.

My grandpa has always said that it is smart to listen to others and take what they have to say into account, but it is intelligence to use that knowledge to either reinforce your opinions or to reevaluate what you had previously thought. In reference to what Madeline said about the smoking here on the island, I cannot say I agree completely. I do not smoke, nor would I advocate smoking however I believe that we must really consider our perception on the individual life around us. One of my professors at UNC spoke of how perception is a lens of individuality. The culture in every corner of this world is its own and people choose to live their lives with the knowledge and environment they have grown up with. We cannot say that it is hypocritical to smoke whilst advocating for the safety of our world without acknowledging our cultural bias. Smoking is more commonplace but we cannot compare the individual decision to pollute our bodies with the tremendous lack of consideration for our future generations when we throw trash on the street. Yes, it might be funny for an environmentalist to pollute their body while trying to de-pollute our world, but there are many things that people in the U.S do that they would consider funny or even completely irrational.

But that in itself is the beauty of travel. We meet others, others that we would at home never dream of meeting and our bubbles of perception intersect.We all strive to better this world in our own way whether it be with medicine, politics, advocacy, or any way we see fit, but what is important is that despite any differences in ideologies or culture, we are all in hope for a better future.

Save your body... then the environment

Last night at the Atlantis Project discussion with Sarah we spoke about the different projects around the island to promote green living and being environmentally friendly through reusable energy and initiatives on the Azores islands. Something that I noticed during the discussion was the amount of people smoking cigarettes. How can environmental engineers and/or environmentalist in the Azores ask the islanders to be environmentally friendly when they themselves can not or will not take care of their own bodies?

From my time in the Azores I can honestly say that 85% of the population smoke cigarettes. Smoking like pollution does irreversible damage to our bodies and affects us on a personal and direct level whereas pollution in the environment may take decades to show lasting effects. It is silly in my opinion for people to promote saving the environment when they themselves are polluting their bodies. I believe it is hypocritical and that the environmentalist who smoke should first consider the similarities between smoking and polluting the environment.

I am all up for saving the environment... but I believe we should first save our own bodies. Yes this is a rant but I believe smoking is a type of pollution not only for the environment but also for our bodies.

I feel like I'm on Cloud 9- Literally!

Our first day in Faial started at 9 am. We woke up to a pleasant surprise because the lady who owned the house (who lived upstairs) came down and brought us cornbread and cold coffee without sugar. It was not the best thing in the world, but she it was kind enough for her to bring us anything. The day was absolutely gorgeous and we decided to use the tourist guide to help us plan our day. We decided to start our day by going to the caldeira, which is basically a volcano that has collapsed on itself. It was a massive crater that literally looked like a huge meteor had come down and impacted the earth. To get to the caldeira, we had to take a taxi to get all the way to the top of the island, this was the point where there were clouds…literally I was in a cloud. We got out and we couldn’t see anything except for the pale white cloud. I have never been in an actual cloud before (fogs don’t count!) and it was so unique and so cold. The cloud was incredibly misty and though it was a gorgeous 80 degree day inside Horta (the city we lived in at Faial), up here in the cloud I was freezing cold. We decided to climb and go around the caldeira so we could grasp the whole thing, and our long trek began. I thought climbing Mount Brasil was bad, but climbing the caldeira was not only incredibly trecherous (as in one wrong move you could fall into this pit) but also very, very exhausting. The worst part was, the higher we got, the colder I got (I was definetly not prepared for this and was wearing shorts!) After a trek of about an hour ( the notice board said it would take 2 hours to get through the whole thing….that was a LIE), I definetly could not do it anymore and I felt like it was pointless since the cloud was not clearing and all we saw was white with every step. So we split up into two groups- one group would continue the trek, the other would go down and wait ( I was obviously in the second group!) So me, Katrina, and Anya started our trek downwards and it on our way we ran into a German brother and sister who were making the trek too. It’s very interesting to note how different the English accent is in Germany, and we all talked on our way down and got to know each other. Just when I thought the trek up would be bad, the trek down was even worse. We got off the trail, so even though something looked like grass if you took a step onto it there would be a pitfall right below your feet. I was worried I would get my ankle twisted, and by the end of it I was crawling down this steep hill because I couldn’t walk it. It was like a taste of being on the show The Amazing Race! Once we got down, the cloud started clearing and we could finally see into this massive crater. It was the MOST BEAUTIFUL and serene thing ever. It was so green and lush and inside this massive crater there was an even smaller crater- a point where the volcano collapsed! I never knew such beauty even existed (and I am not an outdoorsy kind of girl) but imagine the grand canyon, only all green….and deeper…that is the Caldeira. Who knew such beauty could exist in the middle of the Atlantic??? After about a zillion pictures, we decided to take a taxi because we were so hungry and head down to Horta….while our other friends Matt, Aleks, and Jenny made the trip across the caldeira, a feat that took them 4-5 hours…what troopers!

-Advaita

A side of empathy served in cardiology

Sorry it has taken me so long to blog. I have been really confused about the blogging and have my own blog so if you have a tumblr...def follow me. Here is an insight on my life so far though! There are apparently only 3 hospitals in the Azores which are a group of 9 islands. There is one in Terceira (which is where I am currently living), Sao Miguel, and Faial. This week I am in the cardiology unit and the doctors I am shadowing are Dra. Rute (pronounced Ruth) and Dr. Schneider. Dra. Rute is the sweetest doctor ever and she took me to the room where they do the cardiac stress test. The cardiac stress test is basically where doctors make patients walk on a threadmill at different intensities and then chart and record the ECG to see if there is any abnormalities. Then Dra.Rute took me on her patient rounds and that was when I realized that I feel very isolated and distint on this island. I don’t understand a word of portuguese, if that wasn’t already clear on the my first blog, but the fact that i DON’T understand portuguese really impacts my shadowing experience in the hospital. When I shadowed a neonatologist in India, I could understand the emotions and the interactions that were occuring between the doctors and the patients, however, here I just feel so lost all the time. I feel so helpless because I am always lost in translation. I can only imagine the extent of trouble that immigrants who travel to America face when they have to go to the grocery store or even see a doctor. I am grateful I can speak English to my friends back in the Residencia and that there are a few doctors who can communicate with me, but what about the people who come to America from parts of India that can’t speak English or people who come from remote African countries? I feel like this shadowing experience is great for me because it is putting me in the place of the immigrants who come to America, and in this way it is showing me the importance of empathy and humility. As a future doctor, I think it’s important to understand multiculturalism (somebody at the hospital asked me if I spoke Indian today……) and furthermore, even more important to understand where the patient is coming from- in terms of culture, language, and family. This program is the true definition of immersion because everyday I learn something new in Portuguese and everyday I crave to communicate with the people around me. So i guess i can say, today in cardiology I was served with a side of empathy.

-Advaita

The Unknown Known

Deep in the heart of the island of Terceira there lies one of the great known unknowns. It is, at least on the surface, nothing spectacular - so much so that it is not even identifiable on any maps one may come across when looking at the island. Its location is discreet - in an unassuming corner of a field surrounded by grazing cows and corn fields. And yet what lies in the gaping holes beneath this hallowed grassy area is something only very few Azoreans know about and it is perhaps one of the best well kept secrets on the island.

Gruta dos Balcões is the name of this very special place which lies in the Freguesia of Biscoitos. Like the other Grutas on the island it is a labyrinthine network of tunnels which criss cross each other - ascending and descending - with lava carving out magnificent patterns and structures within the walls of this geological masterpiece. Its beauty remains in almost pristine condition - unharmed by humans - with crystals glistening on the sides of the walls and strange fungus spreading itself across the walls. Occasionally shards of light illuminate this dark, damp cavern - helping to delineate between the sharp rocks and the thick earthy red coloured mud.

An air of mysticism and intrigue will undoubtedly come to define ones experience of the 4km of caves which have so far been uncovered by a combination of Portuguese and Spanish excavators. Excavators are confident that more lies beneath and one would assume that it is merely a matter of time before more of this remarkable part of Terceira is discovered. In which case, this great unknown may well soon become the great unknown known.

How to make a complete arse of yourself in public...

So this weekend, I managed to find myself in embarrassing situation after embarrassing situation, and I'm not sure I'll ever recover from 2 of them in particular.

The first happened on Saturday. We went out for the day with one of the government workers, who wanted to take us mountain walking, but the weather was too dangerous, so instead he chose to share with us his other passion: caving. He took us to a huge labyrinthine cave system in the middle of the island; a system of lava tunnels which extends well over 4 km in length, and which is not open to the public due its being largely unexplored, and dangerous. With no helmets, and just a parafin lamp to guide us, we followed Jose Antonio into the darkness, at times crawling through the tiny tunnels, hoping he had memorised a route in the underground maze. At times, I had to go first to see if the tunnel was viable (one of the downsides of being thin), and on one of these occasions, I found myself in quick mud. Underground. In the middle of God knows where. I sank up to my neck before I managed to pull myself free in the dark. When we eventually found out way out, we emerged through a tiny hole, barely visible, into the middle of a field. The farmer standing a short distance away looked pretty surprised to see a girl/yeti-like creature emerging from the apparent ground in the middle of his field. I was CAKED in an inch-thick layer of mud all over, and probably didn't even look human. We then ended up driving to a nearby public area with toilets, and I had to brazenly walk through a group of tourists, as if I looked completely normal, and strip down to wash off the now solidified mud. Excellent. We also then had to go to Jose Antonio's house, to sneak some of his wife's clothes for me to wear rather than walk through Angra looking like a mythical creature. Unfortunately, his wife must have been a little bigger than me, so I had to walk back through Angra holding the trousers up with both hands.

Incident #2 was last night- another one of the government worker's is a dancer in a local folklore group, and so he took us to watch his group dance in Sao Sebastiao. This was all very fun until I found myself being dragged (literally kicking and screaming) to the dance floor, and being made to dance a traditional Azorean folklore dance with 12 random, sweaty, 50yr old, drunken men wearing traditional costume, in front of a very large audience. Half of the bloody island was there filming it. I would like to point out at this point that I actually wasn't that bad- but sadly one of the men I was supposed to be dancing with couldn't count to 3, and so danced in 2, so we ended up just stumbling around for a while, until another man came over to relieve me of the drunken man with a bad B.O. problem. My life mission is now to find the films of this, and destroy them. If only I could wipe the image from my memory...

Lovely weekend, lovely teaching

Our last Monday of teaching today, aghh! Only two proper days left of teaching now, then we're having a party on Thurday :) If the weather's nice we're hoping to go to Monte Brasil and maybe have a barbecue with all the students, should be goood.

Will be sad to finish teaching them all, I feel I've got to know each of them pretty well, a really nice bunch of people. I was a little nervous at the beginning as we really didn't anticipate the age and level differences we would encounter in our classes, but now I am just so proud of them all. Also proud of all of us teachers, I feel we all came together so well and the students really seem to have responded to us, their English has definitely improved without exception. Plus we have had almost no drop-outs! We must be doing something right.

Was going to write a bit about our weekend courtesy of Hugo, Ana and Henrique, but have just been reading Anya's post which my thoughts echo exactly :) I think possibly Saturday was the best day yet on the island, had a really lovely time.

So today I did a lesson on the British monarchy. Was pretty fun, and gave me an excuse to feel teach them a bit about where I come from and get the class to see a bit of English culture... they seemed pretty into it, ended the class with a pro/anti monarchy debate which got quite heated! Was really impressed with them all, they really got to grips with the subject and got all their points across well!

So yeah basically I'm a proud proud teacher :D

Hey, this is Anya again. I want to tell you about the most amazing Saturday I've had thus far. As I told you some of our students are adults.  I think it is really cool because adults don’t usually have easy access to learning like kids do. The kids here learn English in school, but it is a recent development and a lot of the adults here now want to improve their English skills but don’t have the opportunity. 

Some of our students (Hugo, Ana and Henrique) told us that because we were being so kind to them by volunteering our time to teach the English course, they wanted to pay us back by taking us on a tour around the island.  IT WAS SO FUN! They showed up at 9:15 to pick us up for a full day tour of Terceira.  He had a big van from work that fit 9 people so off we went.  He started by driving along the coast; showing us picturesque views of Goat Island, and some of his favorite unexplored caves.  We went to Praia, Serra do Cume, Algar do Carvão, Furnas, Lagoa das Patas, the Biscoitos Beaches and the Wine Museum.  I can’t do the beauty of these places justice with words so I will just post pictures of them below.  What I want to try to explain is how kind they were to us.  Hugo knows a lot about the different types of plants, animals and land formations so he was constantly explaining all of it to us as scientifically as he could in English.  Ana is so sweet. She let us borrow rain jackets for Algar do Carvão, let us use her nice camera all day to take pictures, offered us water all the time and was just great company for the trip.  Henrique is cool too.  He enjoyed being the DJ for the car ride and played us tons of cool Portuguese music; it definitely livened up the van. 

I will tell you about three of my favorite moments from the day:

1) We were walking on the trail around the Furnas, admiring the steam that was billowing out of the holes in the fenced area.  It was clearly forbidden to go into that area and all of the sudden Hugo jumps the fence and starts walking toward the steam.  We were laughing because we were literally standing right next to a sign that said do not climb over the fence and sort of worried that some sort of park ranger would come out and yell at him.  We turn to Ana and she goes “The funny thing is, he put up that sign.” We figured well if he was the one to put up the “don’t jump over the fence” sign and he says it’s okay to jump the fence well then, it’s okay to jump the fence.

2) I jumped from a rock platform into 20 feet of cold, Atlantic water.  Another favorite part of the day was when I jumped for the first time; there is that thrilling feeling, a moment of uncertainty before you drop into ocean and it is absolutely exhilarating.

3) As we were driving away from the caves toward the wine museum we ran into a herd of cows crossing the road.  The roads are rather narrow so it is rather difficult for cows and a giant van to fit on the road at the same time. The cows start walking toward the van and passing us in a semi-single file line. Unfortunately they weren’t as thin as they thought they were and one of them ran right into the side of Hugo’s van.  We waited for the herd to finish passing then he got out to check the damage.  The farmer was coming up in a tractor behind the cows so Hugo said something to him as we passed, trying to explain to him how the cow bumped his van.  The farmer started to explain but before he could Hugo goes “ehh it’s no problem.” And that was that. We were joking that in America it would be “I’m going to sue your cow.” In England it would be “I’m sorry” “No, I’m sorry.” “No, I’m sorry”… but in the Azores it’s just “No problem.” LOL

After our day of tourism they dropped us back at our dorm so we could change and we met them and a group of 12 other students in the town square then walked to dinner. It was really great, Hugo organized the whole dinner and everyone chipped in to cover our meal.  We eat pretty cheap here most of the time so this was really a treat.  Not only was the food amazing but the people were too.  It was fun to hang out with everyone outside of the classroom and it was really touching to know that they all liked us enough and appreciated what we were doing enough to pay for our dinner and spend their Saturday night hanging out with their "teachers."  Most amazing feeling ever J!  After dinner we went down to the beach with them and listened to a Brazilian band while drinking caipirinhas.

This is our last week of teaching. It has really been a very rewarding experience.  I will post a more comprehensive reflection later this week when it is over.  I think I'm definitely going to miss it though, especially the students.  I was certainly scared going into the program.  I was afraid that we would fail and not teach them anything, but after talking with some of the students this weekend I know that they are really grateful for the program and have enjoyed the class a lot.

 

Dog Pound

Since our boss in the government internship also happens to be a veterinarian, we have gone out into town to do various jobs. Currently, he’s treating a horse with pneumonia, which had been sick for months, but the owner didn't call until a couple of weeks ago. In the same estate, he treated another two horses for deworming. It’s funny to see the way these horses react every time they see him. They all gallop away as far from the gate as possible whenever we pull up.

We have also gone to the dog pound a few times now. The conditions of the dog pound are not good at all but the greatest problem is the size. There are only 26 cages, some of which are doubled. That doesn't seem like a problem until I mention that they receive 80-100 dogs a month and only 150-200 are adopted every year. So there are many perfectly good dogs that have to be put down because they can't find a home for them. Obviously the oldest and weakest go first but it’s heartbreaking every time. Pitbulls have the worst luck of all because it costs more to own a pitbull because of their aggressive nature hence they are often overlooked. One of the days we were there we had to put down four dogs one of which was a beautiful, perfectly healthy pitbull around 4 or 5 years old.

However, there is hope for the future. The City Hall has a plan to construct a bigger pound within the next couple years. A better facility means there will be more space for more dogs as well as an area for them to run around freely. Currently, the only way they see light of day is if we give them a bath or take them for a walk. Other than that they are just waiting to see what happens with their uncertain future. Whether they will be one of the lucky few that will be adopted or one of the many that will be put down. And if they are adopted, try not to be part of the 20% that are returned.

Travels within the islands!

Meredith- Education
This last week has been very busy! Last Thursday we left for another island in the archipelago, called São Miguel. São Miguel is the largest island in the Azores and it's capital city, Ponta Delgada is also the largest city.

Since we are staying in the residencia in Angra and paying for that, we were able to stay at the residencia in Ponta Delgada for no additional cost! It was a great deal! There are a lot of things to see in São Miguel, so we all chipped in to rent a car for 2 days. It ended up being 13 euros per person.


All of us squeezed in the car (except the driver)


On a beach in a town called Mosteiros in São Miguel


Cows crossing the street


The day that we had the car, it was very cloudy out. So we went to the first landmark in São Miguel, Sete Cidades, and it was literally a HUGE cloud. We could have been at the end of the earth. You could not see a THING. Then we drove to a tea plantation, but since it was Sunday, it was closed. :( That was disappointing. Then we went to Furnas, which is a town that has all these underwater boiling lakes. Its really crazy! People will bring pots and dig a hole and bury the pots in the ground and then cover them and cook food for 5 hours and it actually cooks!



The pots that are cooked in the ground at Furnas

We went to a restaurant in this town that sells that food, but it was 13 euros for a plate, so I decided not to get it. Yes-- I am cheap. We also saw the lake called Lagoa do Fogo, which is a lake at the bottom of an extinct crater.


Lagoa do Fogo

After that, we drove around São Miguel some more and saw some beaches and other pretty places.

A beach near Capelas (in São Miguel) with volcanic rock

There were 2 other highlights of the São Miguel trip: Harry Potter 7.2 and the MALL. It was so nice to be able to have civilization!! There was McDonalds, Burger King, chinese food. But I did not find iced coffee. However, I did hear that there is a coffee shop (American) in the American base, I would LOVE to get an iced coffee from there.


Burger King


Harry Potter!

We have also had a lot of progress with our class. Being a teacher is soo interesting. The students in our class have started to feel comfortable enough with us that they will write really personal essays. We have gotten essays about self-image, family deaths, future plans and even their own behavioral disorders.
This students have a lot to say and I am so proud of them and the way they express themselves. There are some 14 year olds that are very wise beyond their years. It is great to be able to encourage and talk with them.

We only have one week of class left! That's crazy! I will be home 2 weeks from today! I am excited about being back at home. I like Terceira a lot and I am having a great time, but I also miss home!

Random Azorean Dancing

Here is a video I took of some traditional Azorean dancing that was happening in one of the side-streets here on a Sunday night.

Imperatives

So after a cloudy but great weekend on São Miguel, we're back to teaching for the week - our third week out of four! Weird how fast it's gone by.

This week so far my class' main focus has been imperatives, modality and advice. I'd be lying if I said that all had been as smooth as week one - in my intermediate class, most of the students are teenage boys, which at times is a real test of my ability to keep the students fully engaged. They tend to lose concentration pretty quickly so I have to change the activity every ten minutes maximum, and they are constantly prodding and distracting each other. So I've decided to split them up as much as possible. I just get the impression that a few of them have got a bit too confident with the routine and are starting to try and throw their weight around a bit. I think this week so far I've learnt a lot about finding the teacher's balance between friendly face and authority figure. All good practice :) and they're very sweet really, bless 'em.

On Tuesday, after explaining the grammar for the imperative, I got them all to call out a command to me for practice, to which one little sod responded 'kill yourself'. Hmmm. It's correct so I couldn't moan too much, just told him to maybe think of a nicer example. Basically, as well as from this example I have reasons to suspect that this particular kid obviously spends waaay too much time with his PS3.

But overall everything's ticking over nicely, still loving Terceira and having a lovely time :) yayyyy

Harry Potter & São Miguel!

It is interesting how many of the friends I have made in Terceira were worried that we Americans would love São Miguel over Terceira. Yes São Miguel is more modern (there is a mall and a theater) but there is something magical and beautiful about Terceira... its become a home away from home.

While on São Miguel we did many fun and exciting things despite the fact that we were unable to see any of the lakes. We rented a car and drove up to Lagoa do Fogo (Lake of Fire) and Lagoa das Sete Cidades but were unable to see anything because both lakes were covered by clouds. The interesting thing about the lake is that it is a twin-lake complex where one side is green and he other is blue. CRAZY!?!?! But like I said we did not get to see it because of the clouds. Despite not being able to see the lakes the drive up the mountains was amazing and getting out and standing at the edge of which should have overlooked Lagoa do Fogo was crazy! The wind was so intense that after standing outside for 10mins our clothes were drenched from the cloud around us. Breathtakingly awesome in a different way.

Food cooking in the hot spring pits at Furnas

We were however able to visit the Furnas which are hot springs. All around the Furnas there were pits that people put food in, cover, and let cook for several hours. The whole area smelled of sulfur and eggs... believe me when I say getting a face full of sulfurous steam in your face is not pleasant. Most of the day was spent driving around and enjoying the view of the coast. The beaches near Vila Franca were clean and sandy white. I was surprised to see white sand because the archipelago was made from volcanoes.

Warning sign at Furnas

Our main reason for visiting São Miguel was to watch Harry Potter Deathly Hallows Part 2 which did not disappoint. Yes there could have been certain things added and deleted but over all I was very pleased with the end result. Something strange about the movie was that halfway through the movie there was an intermission for about 15mins! Who needs an intermission when a movie is less than 2.5hrs!?!?!?! Needless to say I was agitated that the movie was put on pause and also with the fact that we had to watch it in 3D. The 3D glasses made everything really dark in an already dark theater and dark movie... kind of silly. But our tickets were only 7 euro which was a GREAT price.

Surprisingly enough I did not LOVE São Miguel the way that I thought I would... I had heard many good things about it but in the end Terceira is still my favorite island. Rest assure Azorean friends that if I ever come to find myself living in the Azores or buying a cozy shack... it will NOT be on São Miguel. Like all larger cities there is more crime and sketchy people. Never would I walk alone at night in São Miguel. Even walking with 2 other girls back from the bar to the Residencia we were followed by a car with 4 boys yelling profanities at us... we walked with a purpose on and eventually they drove of. This is something that would never happen in Angra. Larger cities just attracted scummier people. Next to the Residencia in the "projects" there was "Turists are terrorists!" spray painted on the walls... which was kind of unnerving.

In the end after a good 3 days in São Miguel I was happy to come home to Terceira... my new home away from home.

The West End (of Europe)

The West End in London is known for its lavish displays of theatre and drama. That sheer drama was encapsulated, albeit not on the same par as a dramatical version of 'Wicked' or 'Oliver', by a solitary rock which drifted in the middle of the Atlantic ocean near to the coastline of North-West Flores. On first impressions, there was nothing spectacular about it - it looked just like any other rock or islet which drifted by the side of the coastline yet the significance behind it helped to elevate this seemingly insignificant piece of geology to a whole new level - it was a symbol: that of the furthest most Western point in Europe.

There have been disputes in the past between those living in Flores and mainland Portugal as to what is the furthest most Western point in Europe. To the casual foreign observer, such a dispute would appear to be something trivial. And yet, this rock has come to define not merely an island but an entire continent. Behind this rock lies both history and pride and as one woman from Flores explained, the uniqueness of the rock and the its significance is something which brings about an element of jealousy from their mainland counterparts.

Unassuming it may be yet this rock is a bridge between East and West and an island and its people. It is often said that the best things come in small packages and for the people of Flores, this rock for them is no exception.

it's not all fun and games

Recently I've been going around with a vet, who is also responsible for checking conditions of food storage etc in public areas around the island. This morning we went to a large supermarket to verify that the fish and meat is all kept correctly, and that the areas are cleaned up properly, and as we were driving home, we came across a large Alsatian lying in the middle of the road. He'd clearly been hit by a car going pretty quickly, and he couldn't move. We lifted the dog into the boot of the car, but Jose Antonio (the vet) said we'd have to drive him to a surgery and put him down, as there wasn't the money to operate to save him.

This is the 2nd time this problem has been mentioned to me- last week I went down to an abandoned dogs kennel to walk the animals there- and the vet there told me the same thing- that Terceira has a big problem with animals which are surplus to requirements, and despite being relatively healthy, they are put to sleep just because no-one has a use for them. Apparently, the situation nowadays is much better than it used to be- the Camara Municipal is taking steps to intervene and get animals fixed to prevent further cases happening in the future, but for now, there still seem to be many domestic animals who are abandoned- if they're lucky, these animals end up in the kennel, where they at least get food (although most are put down, rather than adopted), and the rest just wander the streets until it by a car. It was a great shame to see all these magnificent animals looking so miserable, and the sound of the slow raspy breathing of the dying animal by my side in the back of the car on the way back to Angra this morning served as a reminder that being a vet here is not all fun and games, taking dogs for a run or playing catch with them.

Weekend in São Miguel

Thursday until today has just flown by!  We left Thursday night for São Miguel and are leaving tomorrow (Monday) morning.  My grandparents are from this island, so I was personally very excited to visit and really enjoyed my time on the island :)  Friday we spent the day walking around the city, which is very different from Angra.  Angra is a pretty small and older looking city, whereas Ponta Delgada is more developed and modern.  Luckily we've had pretty beautiful weather in Angra, and of course while we were here for only a few days we weren't as lucky!  The most important sites (Sete Cidades, for example) are absolutely impossible to see if there is even a tiny bit of fog :(

Despite the not-so-good weather today, we still had a fun day driving around all day.  We were able to see Lagoa de Fogo for a few minutes before the fog rolled in, and it was beautiful.  We also stopped by the Furnas, where there are natural boiling hot springs! It was pretty crazy.  I was also very happy to stop in Capelas, the town that my grandmother is from.  We weren't able to find her home, but I got to see the town, and we spent some relaxing time at a nearby beach after.  Altogether, São Miguel was definitely a beautiful place to stop, but I wish I had more time here!! I will no doubt come back and spend a LOT more time on this island someday when I make back all the money I spent here c(=  Anyways, I'm starting to realize how much I actually feel like Angra is home, because I really miss it!! Can't wait to be back in our cozy residencia, going to the familiar cafes by the marina, relaxing on the beach... and teaching english too, of course!

Being a part of the Atlantis Project means that we participate in an academic discussion each week. Every week, we meet at a cafe with a woman who majored in Portuguese studies and will be starting a graduate program in Portuguese studies at Brown University in the fall. She grew up in Terceira and speaks Portuguese fluently, so that, along with her schooling, gives her a lot of perspective and knowledge of Portuguese issues.

Each week we have readings and discussion questions to thing about. This week, we discussed the EU's economic situation and the phenomenon of European identity-- whether a European identity is likely or possible. It was all very enlightening, seeing that I do not know much about European current events.

This weekend, all of us (except 2) are going to the island of São Miguel. Many of us are leaving on Thursday (tomorrow) and returning on Monday! We are very excited for this adventure, not only because we get to see another island, BUT we get to see Harry Potter!!! There is so much to see in São Miguel and I am really looking forward to seeing and doing everything!! :D

Please Call Stella

I’ve never spoken to a woman called Stella and in all probability, barring a flood of women called Stella suddenly springing out of the freguesias in Terceira, I won’t be doing so in the very near future. Nonetheless, if one day I happened to bump into a woman called Stella on this island or any of the others in the archipelago I would at least feel confident about one particular element of our conversation: her intrigue surrounding the English accent.

What it is about this accent still continues to confound me. Is it the rolling of the Rs? The delivery? The exaggeration? Whatever it is, it has a powerful almost mystical charm about it which doesn’t fail to deliver.

As I muse over some muesli I observe how our friends over the pond often sit and listen in awe as extracts from newspaper cuttings or magazines are read out in the Queen’s English whilst others desperately attempt to mimic these foreign sounds with a sudden adjustment of their facial expressions or a dramatic change in the tone of their voices. They stress and strain their mouths repeating vowels, letters and words over and over again like a broken record. Seconds, minutes even hours go by as ‘Stellas’, ‘Bags’ and ‘Slabs’ fly around the rooms permeating the humid Azorean air. And we eventually come to reach the point when the very meaning of the extract and the very items themselves which are at the very heart of the mere seven lines – ‘the fresh snow peas’, ‘the blue cheese’ and ‘the toy snakes’ – become lost, when all that matters is the pronunciation – nothing more, nothing less.

It’s a love-hate relationship for our American compatriots but one which they will continue to indulge in – the pull, it seems, is too great to resist.

Hitch-hiking around Faial

This weekend a couple of us went to visit Faial- it's a stunning island, and in many ways, strikingly different from Terceira. Amongst the Azoreans, it's also famous for being the place where the 'best' Portuguese is spoken, i.e. they don't have a particularly distinctive accent, and the language there is much closer to that of Coimbra in the Centre of continental Portugal. This meant that in comparison with the conversations I've been having here- chatting with Faialense people was a breeze, and it was great to be able to just relax and talk with the locals about life on the island.

Like most of the islands, the public transport system leaves a lot to be desired, and we were determined not to fork out a load of cash for taxis all of the place, so on the whole, we hitch-hiked. This was wonderfully easy if you a) spoke Portuguese, and b) were girl wearing reasonably short shorts...
Three of us walked right round the Caldeira (the volcano crater), which took well over 3 hours, but provided fantastic views across to Pico, but ten after that, we still had to get back to the city of Horta. We walked several kilometres along the road before any traffic passed, but eventually, a pick up truck went by, and we jumped into the back (which was filled with sand and cement), and stood clinging on as we whizzed by the fields at about 40km/h, trying not to let go and fly out onto the road.When the truck stopped, we found ourselves by a bar, went straight on in and sat down to a nice cold drink, before continuing our walk across the island.

Over the next 2 days, we managed to catch rides from 6 different people, including one 80 yr old farmer with a tractor-come-truck which only had one gear, but it certainly proved a good way of meeting people. It was the openness of people both in Faial and Terceira that really struck me- in England, people would generally be suspicious of a group of kids trying to cadge a free ride, but here, they were so obliging and just wanted to know more about us and what we were doing in the Azores.

Looking forward to hitching around Sao Miguel this weekend and meeting people along the way!

A difference in practice...

I’ve only been in the hospital 7 days but already I have noticed quite a few differences in that way nurses and physicians practice medicine. Now I will confess that I have been pampered at UNC Hospital with all the bells and whistles of technology and therefore I must try really hard not to pass judgment on how things are done in a different country. That being said… the nurses and doctors here do not seem to have a concept of contamination or transmission of disease via blood. YES they know disease may pass through blood products… but for some very strange reason they do not wear gloves in normal everyday handling of blood.

Countless occasions I have seen nurses start IV’s without gloves. They iodine the skin and retouch the area with bare fingers that have not been washed. They also do not wear gloves when removing IV’s as well. Now according to the nurses, they can feel the vein better without gloves… while this makes sense I still believe it is unsafe to handle needs around patients without the use of gloves. I for one am not up for accidently sticking myself with a contaminated needle. Another example is with blood transfusions. One of my friends became severely anemic and required multiple blood transfusions and platelets. Of the 5 or 6 nurses in charge of her care over 3 days, only one nurse worse gloves when hanging and taking down old bags.

My third example is from the operating room. YES the doctors where gloves for surgery… so please do not think otherwise. My 2^nd day in the OR I got to observe a hip prosthetic replacement surgery. There were 2 orthopedic surgeons that removed the old implant and put in a new ball and socket. I have never seen doctors be so brutal to a patient’s body. Removing the implant took a lot of work and there was quite a few blood splatters on both surgeon’s faces. To my surprise the surgeons did not have glasses on or a plastic shield over their eyes. On multiple occasions the circulating nurse had to wipe blood off of their foreheads and around their eyes.

I feel like I am being very critical about this topic on blood, but I do not think it is safe practice not only for the patient but for the nurses and physicians. As health care providers we must also take care of ourselves and protect ourselves from unnecessary contamination. Perhaps it is health costs or the fact that gloves are not part of protocol for the hospital or regions. Maybe they are not concerned about such things as we are in the US? Standard of care is different all over the world and it is interesting to see and experience different ways of practicing medicine… I look forward to seeing other differences as well as similarities!

Madeline - Hospital Internship

How many students does it take to teach English?

Hey, this is Anya and I’m going to talk about teaching. For those of you who don’t know, the summer English course that we set up is completely new. We have never done anything like this and really weren’t sure what to expect.  We started with 30 students, ages 13-44, who got divided into three groups based on a diagnostic test.  We expected that some of the students would dropout or stop coming because who really wants to do English grammar for three+ hours everyday over summer vacation? Apparently the answer to this question is: the students of Terceira. Not a single student has dropped out and since the first day we have actually added 6 people!  There is a lot of work that goes into the lessons (roughly an hour of planning for every hour of teaching) but I think it is definitely worth it. The students that I am teaching are beginners and while they have had some exposure to English, they still don’t know all the basics. At times it is difficult to work with beginners because we don’t speak Portuguese but we manage to find creative ways to teach them the new vocabulary sometimes relying on pictures or charades.  I really admire the students’ commitment to learning English.  When we asked them why they wanted to learn English many of them have told us that they want to be doctors, work in tourism, be journalists or travel. I have a newfound appreciation for anyone who manages to learn English as a second language because it is much more challenging than I ever realized.  Some of the biggest challenges so far are with pronunciation.  They have a lot of trouble making the “th” sound so that is something we practice daily.  Also, today they had difficulty distinguishing between “this” and “these” so we will be doing more work on that tomorrow.

In summary, I love the internship.  I wish that we had some sort of grant so that we could have more materials for the school, but again this is only the first year so that is something that next year’s group should certainly look into.  I also really love the island and the other people on the trip.  Life here feels much slower paced than in the US so it will be quite an adjustment to go back to the states.