Going home..


After a whirlwind three months that included trips to Chile, Bolivia and different cities in Colombia, I am getting ready to come home in a few days.  As always, leaving Bogotá is bittersweet.  I miss my friends, and my family but I will also miss the city and all of the nice people I’ve met here.

I am posting a map of Colombia, so even though I’ve taken several trips – you can see that I haven’t really explored the country at all. (I’ve posted little push pins on the areas I have visited.)  I excluded Facativa and some of the closer towns since they are really just suburbs of Bogotá, and it would just clutter the map.

Map of Colombia, courtesy of Google Earth

As you can see – I haven’t explored the southern part of Colombia, or the pacific coast at all.  My Atlantic adventures have been confined to Cartagena.  So, I guess this means, I still have a lot of work cut out for me on my next visit(s).

map showing central Colombia

But I hope that readers have enjoyed reading about my travels, the people I’ve met and the things I’ve seen.  Now – I know this is a medical/ surgery blog but since much of the surgery I write about is in this part of the world, I think that including some of my experiences is relevant/ interesting for people who read the blog.  Once I get back home, I’ll post some more articles on medical quality control and standards – and more of my usual dry fare.

Afternoon at the finca, and a day at the market


We spent Saturday exploring Lerida and cruising around.

Ready for adventure

We stopped at several roadside stops to buy some local fruit before heading off to La Gaviota, a local finca owned by a Brazilian woman.

buying papayas

We bought some delicious sugar mangos, along with some sweet papayas and mandarins.

enjoying sugar mangos

La Gaviota, a finca in Tolima

Now, there are two kinds of fincas in Colombia; working fincas and pure vacation fincas.  A working finca is usually a farm or an orchard – often owned by a city resident but managed locally.  This allows people who live and work in Bogota to have a get-away place that also brings in income.

one of the lakes at La Gaviota

Some of these fincas have been in peoples’ families for generations and produce much of the fruit and livestock products (dairy, meat etc) that are sold in Colombia.

Other fincas are pure recreational homes, and as such, are primarily owned by wealthier Colombians though this is not always the case.  Fincas vary from modest cabin style affairs to elaborate, ornate mansions with swimming pools, tennis courts and private fully stocked ponds.  Since most working people can’t stay at their finca very often, many owners rent out their fincas part-time.  Such was the case with the lovely La Gaviota.

the pool, surrounded by fruit trees

The entire property has been planted with fruits and trees native to Brazil and the staff encourages visitors to sample the many exotic varieties.

Yaca, a fruit native to Brazil

There is a swimming pool, and several lakes stocked with fish.  There is also a hotel, and a restaurant, where they will prepare your fresh catch.  Like many of the numerous fincas that dot the landscape here, they welcome travelers and offer services at reasonable rates.  So we spent the sunny afternoon at the pool.

The next day, we went to the market in Lerida.   We bought some more ‘tipica’ or traditional Tolidense food called lechona from a very nice young man who helps his grandmother.

young man selling lechona

While I vary from vegetarianism to veganism in the states, I never hesitate to try another delicious typical dish when I am traveling – and it was marvelous; warm, savory and flavorful.

There are several variations of lechona, which is stuffed pork but the Tolidense version uses a base of garbanzo beans for the stuffing and comes with a sweet-flavored bread stuffing called insulso on the side.

lechona

The grandmother, also invited us to come to her house where she had other tolidense specialities for sale, including tolidense tamales.

with grandmother

There were other vendors selling panela which is popular sugar product here in Colombia, (and other latin American countries.)  It’s a staple, a form of unrefined sugar produced at the local sugar cane factories in the region.  (I particularly like panela in my coffee and tea.)

panela

We met and purchased several tamales from another vendor in the market, a very nice woman who was very happy to pose for the camera.  I am ashamed to say that I forgot to write her name in my little notebook because my hands were full with all of our great purchases.

homemade tamales

in Lerida


in the mountains on the way to Tolima

Most Americans have limited exposure to Colombia, and Colombian life.  Other than media reports about drugs and violence, the majority of people’s opinions about the country have been formed by one quintessential little film of the mid-80’s…

“Romancing the Stone” – yeah, that’s right – the silly little romantic comedy with Kathleen Turner and Michael Douglas.  “Is this the bus to Cartagena?” is a line I’ve heard many, many times from people asking questions about my experiences here.

In general, like most things, Colombia is nothing like the movies.  Especially this one, since it was filmed in Veracruz, Mexico.

just outside Lerida at Sunset

But Lerida is that Colombia – the hot, humid, tropical Colombia that people think of after watching that movie.  It isn’t jungle-like here, of course,(that’s further south) but it’s an ancient city with stone buildings and some cobblestone streets interspersed among newer construction; but Lerida has the unrelenting heat and steaminess that people generally picture (and fail to find in Bogota.)  My guide tells me that the city wasn’t quite so hot – until most of the trees were removed when the streets were paved.  It makes sense since the neighboring cities (with thick tree-lined streets) are noticeably cooler.

It’s an interesting city – and more than just miles away from Bogotá – more like decades.  Life is a bit more traditional here, but that may be just the heat, and the ancient appearance of much of the buildings contributing to that perception.  Lerida was first ‘discovered’ in 1538 by Spanish conquistador Sebastián de Belalcazar who was amazed by the richness of the land, but it wasn’t officially ‘founded’ until 1777, which actually makes it technically one of the younger towns.  But as you wander the town, you see that people are still living in many of the original buildings – updated and modernized, of course.  But the original architecture with high ceiling and spacious rooms offers the advantages of cooler temperatures despite relentless sun.

As a mentioned in a previous post about Cali – motorcycles are the preferred method of travel in the warmer climes; relatively inexpensive, and good on gas – you see motorcycles just about everywhere you look; with entire families on bikes.

family on motorcycle in Lerida

Women in high heels, babies pressed between bodies, toddlers riding up front, even women riding ‘side-saddle’.

Coming from a society where motorcycles are used more as a statement than a viable mode of transportation; it takes a minute to adjust to the scene of so many bikes – it’s not a convention, they aren’t ‘bikers’, it’s just another day of running errands and going to work.

line of motorcycles

For more posts about my visits to Medellin, click here.

Road to Lerida, part II


As we pass into the valley, and the town of Honda, the whole topography changes.  It’s less West Virginia and more eastern Tennessee – in the summer.  The temperature has become hot and a bit humid.  The land is more flat, and as the land straightens out, so does traffic.  We can finally accelerate to 50km/h for the remainder of our journey.

drive to Santa Marta? no thanks..

(It’s this limited speed that makes the road signs for Cartagena and Barranquilla (1150+ km) so terrifying, yet correspond with other visitors stories about 20 hour bus rides).  But the view is so interesting, and I have great company, so it makes for a pleasant drive, especially once we escape the industrial traffic.

it be corn, but it’s not Iowa..

Even the mountains here in the valley are different, the ones that are visible in the landscape are more like hills, with exposed rock crevices.

My ‘guide’ for this trip just amazes me with the breadth and knowledge he has of this area of the country.  As we pass different outcroppings, and tiny towns – he knows a bit of folklore, facts of interest or history on each one of them.  We travel through places that seems a million miles and twenty years from the sophisticated enclaves of Medellin, Bogotá or Cali.

In the Colombian state of Tolima, we drive through the small city of Caldas.  This seemingly unimportant but bustling town is actually one of the more important towns in Colombia’s history.  When scientific explorers (Spanish) first came here they found an amazing bounty of plants, flowers and fruits.  Many of which are only found in Colombia.

They also found gold here (and in the neighboring towns such as Mariquita).  It was their treatment of the native population in pursuit of this shiny metal beneath the nearby mountains that led to a local uprising (and eventual revolution – leading to Colombia’s independence).

Modern day explorers also made important discoveries in this area of Tolima, near Caldas:  large pockets of natural gas.

In the next town, of Mariquita – gold mining both recently and in the past, has shaped the town.  It was the uprising here in Mariquita against the Spaniards and their gold mining efforts that shapes this town’s history.  Further gold exploration in more recent history has also caused problems – my guide tells me that the tunneling and excavations have caused major subsidence problems, with homes disappearing into sinkholes.  (As someone who lived in the Monongalia Mine area of West Virginia, I can well image the scene.)

Marquita is also home to a historic church – and the “Milagro senor de la ermita.”

Church services were actually in session when I arrived, so I didn’t many pictures.  (I took the one interior picture from a little alcove so I wouldn’t disturb services while my companions lit candles).

Church in Mariquita

The state of Tolima is famous for it’s tamales  – which have little in common with the Mexican version.  Mariquita itself is famous for having excellent tamales tolidense so we stopped at a place off on a side street which was recommended by the locals, called “El Tamalito” en San Sebastian de Mariquita.  The tamales were, indeed, delicious.

The owner, Mr. William Naffati has been making tamales for over 20 years.  He lived (and worked) in Bogotá for 40 years before coming back to Tolima (where his family is from) 2 years ago.  He states that he makes the ingredients for 200 tamales at a time, in huge metal VATS.

William Neffati, in the kitchen

He states that the secret to the rich flavor of the tamales is due to three key oils: chicken, pork and another which he’s keeping a secret for now.  Then the meats and vegetables are slow cooked for a minimum of four hours before final preparations.  He reports that during the course of a weekend he will prepare and sell over 1200 tamales.

Now this next part of our journey probably deserves its own post – but since I am using borrowed internet to post this – it will have to do.

Lastly, as the sky darkened we passed Armero, a ‘lost town’ that was destroyed in the November 1985 volcanic explosion that spewed rock and lava throughout the area.  The official death toll was 24,000 but locals estimate that it was higher.  As the lava rained down on the town – it burned and destroyed many of the buildings, and their charred and abandoned structures remain – as a memorial to the site.


My guide and my traveling companions know a great story about this town too.  As the volcano rained death down on the 29,000 residents of Armero, and a sea of mud/ sludge began to destroy the town, somehow, despite being in the center of the storm of rock and lava, the local hospital (which did sustain heavy damage) was spared.  Not a single one of the hospitalized patients (who were on the second or top floor of the building) were harmed.

what remains of the hospital today

I guess when you consider the devastation to the area, that would make the hospital of Armero the second miracle of our journey.   I’m not usually so sentimental, but looking at the town, it’s hard not to be.

Ruins at Armero

Unfortunately, it was getting dark as we came through, so I couldn’t get any photos. (But we came back through the next day – and I managed to get a few.)  We didn’t get out of the car because the structures are unaltered and are considered unsafe.  I would have loved to crawl around them a little bit, but I try to take good advice.

The guide

My guide for our trip is Mr. Alvaro Palacios, an adoption attorney.  Last year, when I was writing the Bogotá book, I was renting a room in one of the apartments  he and his wife own.  After being there for six months – we became pretty close.  Especially since once my roommates returned to their home countries, I was alone (sometimes lonely, when l had enough time to think about it) in the apartment.

Mr. Alvaro Palacios

But they always made me feel safe and secure in the fact, that they were next door, and that someone would notice if I didn’t show up one day*.  So I came to very much enjoy talking with the Palacios, their daughter, Camila and their son, Alvaro who was a medical student at the time.

Dr. Alvaro Palacio

In fact, that’s the reason they’ve invited me along – we are heading to Lerida to visit their son who is doing his intern year at the hospital here.  (In Colombia, all doctors have to do a ‘social service’ year working and training in underserved areas.)

Road to Lerida, part 1


Had a wonderful Thanksgiving with some delightful friends yesterday.

I went to the operating room this morning with Dr. Alberto Martinez – but we will save that for later.

This post is for my good friend, Steven Morrisroe who always tells me to devote more posts to ‘everyday life’.  He’s been a big supporter of my work – so Steven – I hope you enjoy this.

Gee.. it doesn’t look that far..

The road to Lerida – part I

The most effective and efficient way to travel in Colombia is by plane; flying to Medellin or Cali is an exercise in ease – by the time the coffee carts comes around (yes, Colombian airlines take care of their passengers), it’s time to sit up your seats and prepare to land.

Not really going to Siberia (been there, done that!)

But the roads are notorious for being poorly designed exercises in endurance and frustration.  It’s something Santos has pledged to address – outlining a massive overhaul of Colombia’s infrastructure, which is desperately needed.  Despite being one of the major roads to this part of the interior of Colombia – it’s a two-lane road, hugging a hill on one side, and a dramatic cliff for the other for the majority of the journey.  While mom-and-pop restaurants and mini-markets dot the roadside, along with tiny houses and laundry lines – this is a heavily trafficked major route for the transport of goods across the country.  There are produce trucks, heavily laden pickups, buses, even several car haulers with brand-new Japanese cars all crowded together with more tanker trucks than I’ve ever seen in my life*.  At one point, I looked out the window at the road ahead and it was all semi-trucks as far as the eye could see in both directions.  It makes this little road as crowded as peak traffic in Bogotá.

this picture is actually from Honda, when traffic finally thinned out..

So much so that what should be a swift and picturesque journey becomes a six-hour crawl as the speedometer stays markedly fixed at less than 30 km/h (yes, that’s kilometers).  The only exceptions being quick bursts of pulse-raising, dare-devil maneuvers as we attempt to pass another in a seemingly continuous line of tanker trucks as we head into another blind and narrow hairpin curve.

passing, but you can’t see the motor cycle passing us..

We settle back into the agonizing crawl, behind more semis.  The line only broken when we attempt such feats as the double pass – passing a tanker truck on the far left as it attempts to pass a slower moving, more heavily laden truck. But at least, it breaks up the monotony and frustration of breathing diesel fumes and enduring the smell of hydraulic breaks being tested by the continuous grade.

this is actually a truck wash hugging the cliff

But don’t get the wrong idea – it’s still a beautiful journey and I am enjoying it immensely.  I just want you to be able to picture the chaos and flurry of activity amidst the serene surroundings.

Once you pass just outside of Bogotá – you are in the country.  Most of the trip is up and over a mountain pass – with a breathtaking view of what must be the Grand Canyon of all valleys.. It’s astounding lovely, but I was unable to get a photo of the massive verdant green valley with rivers and lakes scattered below.  It looks so much like West Virginia, that I have to remind myself where I am more than once.

Where am I?? (Answer: just past Honda)

After twisting and turning for hours – we emerge in the valley below and arrive in the city of Honda..

*My tour guide informs me that the reason there are so many tanker trucks is that despite having ample oil reserves, Colombia does not have a single oil refinery, so all the oil produced travels on this very road to be exported to the USA for refining.

In the OR with Dr. Diego Pineros, cardiac surgeon


Dr. Diego Pineros, cardiac surgeon

Spent an enjoyable morning with Dr. Diego Pineros in the operating room at Clinica San Rafael, watching him operate on a four-month old girl. Surgery went well, with no intra-operative or post-operative problems.

Spent the remainder of the morning talking about cases, the history of cardiac surgery and seeing patients.

Like many of his counterparts here in Bogota, Dr. Pineros spends his “leisure time” in ways we might not expect. Right now, he is coordinating and arranging for his surgical team to fly to Tolima (300 miles away) to perform several pediatric cases over the weekend. The team will spend several days to make sure their little patients are well on the road to recovery before returning to Bogota, and to another full week of surgery.  When asked about this, Dr. Pineros quickly shrugs off any praise – stating, “they need surgery, and there is no one [at that hospital] to do it.  It’s hard on the families that travel to Tolima [from outlying rural communities] for care.”

Dr. Diego Pineros

Cardiac Surgeon, Clinica San Rafael