Transiting Hanoi

Based on what I had read about drivers in Vietnam, it was hard to believe that the road from Cat Ba to Hanoi would be so tranquil and smooth. Only after entering the city did the melee of pedestrians, rickshaws, motorbikes, and vehicles hit hard with noise and congestion. Green, yellow, and red all mean go in a city where trash, people, and commerce fill the streets and sidewalks. It's the capital that is late-to-rise but parties all night in the distinguished, classy older sister kind of way. Despite the brain rattling city noise, Hanoi is incredibly vibrant and easy to navigate. We started eating and basically didn't stop except to drink mega smooth coffee drinks. We shopped for counterfeit Patagonia and North Face goods, as well as locally made products. We bargained a little but gave up easily, preferring to people watch instead. There were tourists of all shapes and sizes, many of whom were conducting adorable photo shoots involving gladiolas. Local artists sketched caricatures, Venmo accepting vendors sold snacks out of taped up styrofoam boxes full of dry ice, and uniformed officers in hammer and sickle service caps patrolled the alleys. The color and personality was everywhere. I can see why so many people love traveling here.

Vietnam's first emperor.

Hoan Kiem Lake on one side.

Divine egg coffee break.

Cashew fruit and motorcycles.

9:15am commuter train
cruising down Hanoi Train Street.

Naps and beers.

St. Joseph's Cathedral

Coffee and cats at Hanoi Coffee Station.

Grocery run.

Fruit bodega.

DHL will deliver anything. Towing pink propane tanks.

Margarine based cook-it-yourself meat platter.

Hoan Kiem Lake on the other side.

Ha Long Bay - Land of the Descending Dragon

Ha Long Bay had long been part of my dream vacation to Vietnam and I was determined to see it, even though my visa with its incorrect name tried to say otherwise. While I spent four days pounding the pavement in Seoul, Mark and the kids headed to Ha Long Bay, embarking on a multi-day boat trip that included sea kayaking, swimming, hiking, biking, fish pedicures, and squid fishing. All the things one does.

They visited floating villages and fish farms at the same time I found myself silent panicking, trying to find a random photo studio that the internet had produced. I already mentioned that Seoul has everything, but what I didn't mention was that while is true, you really gotta work for some things. I found the studio eventually in an alley, up six flights of broken, dark, stairs. There was no sign on the gray painted metal door which was cracked open just wide enough that I could see a man's silhouette against four panoramic computer screens. Initial creep factor was at 88% but I got what I needed and the photographer could not have been nicer.

Anyway, back to Vietnam. Ha Long Bay is famous for super tall limestone and karst formations that were in existence before water came and flooded the region, something like 500 million years ago. The deep turquoise water is warm and extra salty from the all the rock towers. There are 1,969 islands rich with hidden biodiversity of land, air, and sea animals. The UNESCO site no matter how you look at it is just... dreamy.

At first I thought I would miss out on it altogether since I'd be catching up with them on the tail end. But Mark rearranged plans even though he and the kids had had their fill. They were sore from kayaking, damp and chilled from the rain, and tired of the tour guide's history lessons. After a day of flying, driving, ferrying, and driving some more, I made my way from Seoul to Hanoi to Cat Ba Island and reunited with my family. Mark, Deets, and Margo enthusiastically participated in the same activities for my benefit, which made the experience so... extra. I got to share a beer with Mark on a sandbar, watching the kids collect seashells. Kayaking alongside the massive cliffs with Margo was even better than I could have imagined. I recognized the spot where Kong: Skull Island was filmed, acknowledging Deets' affinity for that movie and wondered how they managed to get such a big gorilla there in the first place.

😍😍😍

Pretending to think this was as exciting I thought it was.

So. Dang. Excited.

Fish farm. No safety rails.
I was terrified I'd fall in and get eaten by carp.
Apparently, one of the farm's guard dogs had recently fallen in.
He didn't make it.

credit: Mark
Ha Long Bay hike and scheming
how to take over the world.

 credit: Mark
Margo and I kayaking.

 credit: Mark

credit: Mark

Hacky sack on Cat Ba Island

First view of the bay from our hotel

An unexpected stay in Seoul

I don't know why I had such difficult time applying for my visa to Vietnam, but I did. For over a month I had to make multiple amendments in their online system and each time I hoped to appease the visa gods. I studied the "how to" guides and input all that was required, but they'd come back with changes that I would try to fix, even though the information was correct to begin with. Right before our flight, they finally granted it, but under the name of Emily Elizabeth Emily Schlink. (By this time, we had already outsourced Mark's and the kid's applications to a travel agency to do the work, something I would highly recommend.) I called the visa hotline operator and without hesitation he told me I'd be denied entry for sure. Applying and paying again was my only option, and it would take four days, provided I shelled out a hundred bucks for the travel agency to handle it. I had a very unattractive self-loathing pity party, cried a bit, but then got to work making new plans for at least a four day layover in Seoul, while the rest of my family would continue to Vietnam.

Luckily, Margo had a friend who had been posted there, a classmate whom she'd said goodbye to this past summer. During our 7 hour layover, we took a train into the city for them to reunite. By coincidence, their apartment was across the street from my chosen hotel, not far from Seoul Central Station. This meant we'd have a more convenient time navigating a foreign city containing 9.7 million people, 14,000km of city roads, and a 10km spaghetti maze of underground walkways built to manage the city's wind. Korea sits in a Siberian high pressure system that results in cold, wet, wind in the winter, and hot, sloppy, gusts in the summer. The ambiance and throngs of people was a lot to take in, but the organization, timliness, and efficiency of the city was impressive. Uzbeks could take a few lessons from the Koreans.

We finessed navigation by trialing Google Fi, dropping pin locations, calling our friends, yelling over the roar of the train station trying to find them. We were seemingly in the same spot only they were upstairs and we were downstairs. (Wifi is everywhere in Seoul, but we wanted to see if Fi was worthwhile. It is.) Once we surfaced from the underground, found them, walked at a slant through the soul-cutting wind, and into their apartment on the 28th floor, the girls spent their time holed up in the bedroom giggling, and the rest of us ate a feast of homemade food to celebrate the occasion.

Their time was much too short and it made my heart hurt to make the girls say goodbye again. Mark and the kids got on the airport train and we went back through the underground concrete labyrinth to the city. Before parting ways, our friends plied me with tips on visiting Seoul: everything can be paid for electronically except for bus fare. Naver is better than Google Maps. If I don't like the coffee shop I'm in, there are at least a hundred more on the same street and many of them are themed: dog and cat cafe, 2D cafe, art cafe, bike cafe, even a poop cafe. If I could dream it, Seoul probably would have it. Shopping is a serious sport here. I spent a lot of time feeling overwhelmed by the sheer volume of stores.

The most popular thing to do in South Korea is to visit the Demilitarized Zone, reachable only by organized tour. I thought it might be cool to wave at North Korea, like I had done with Afghanistan and Turkmenistan, but on the only day I could have gone, I managed to sleep in until noon by accident and ignored two alarms. I can't remember the last time my body needed a reset like that. I spent my time doing things the kids probably would not have enjoyed. I toured the World Cup Stadium and Museum, the Kimchi Museum, the Templestay Korean Buddhist Center, and I went to several breweries and cafes. I put myself through my own personal hell of walking for miles, a nod to Mark's famous family death marches. The weather was so, so, so, so, cold, and I got tired of wearing 17 layers of clothes, but it would be a disservice to not experience the famous "Seoul, My Soul" megacity. Donning my speed skating balaclava and royal blue 1980s neck gator, out I went.

Seoul filled view from my friend's apartment

ordering up taiyaki, a fish shaped pastry filled with red bean paste

they LOVE Christmas here.

They also love Park Ji-sung. I love him too. 
He played for Manchester United for 7 seasons. 

Photos at the World Cup Stadium  metro station.

Kimchikan Museum
kimchi is considered a UNESCO intangible cultural heritage

Templestay Buddhist Center

Drinking VERY nice things at Seoul Brewery 

Dogs at the dog cafe.

Swipe the credit card, pick your birth year animal, 
crack the red ball open with a mallet
and read a parable or some advice.

HBAF Almond Store.
Savory, sweet, spiced, seaweed,
no almond left unflavored. 

So much facial care to shake a stick at.

Boiled pond snails - olgaengiguk 

Sharing a snack of tteokbokki,
thick rice pasta noodles in spicy red sauce.

 

Korean blood sausage - soondae.

A Stint in Astana

Every year around Thanksgiving, Foreign Service stress levels fluctuate as direct hires wait to hear news about handshake offers (onward assignments, jobs) from future posts. Bidding season is like mandatory dating, and every employee has to do it about once every 2-3 years. It starts around September and lasts about 2 months. Bidding requires the churning out of resume submissions, applications, and interviews for jobs located all around the world, followed by awkward flirtations of "I like you, do you like me?" or, "If post were to offer you a handshake, how likely would you say yes? 100 percent? 90? 30?" Neither side is ever willing to fully show their hand because no one wants to be stood up. Abandoned at the altar. Put in a bind. Left hanging.

And, in between the pockets of time, families impatiently wait, combing through if-then scenarios such as "if you are offered Iraq and not Italy, then we have to send the kids to live with Uncle Paul and Aunt Cloris on the farm." Finally, the offers are made and hopefully accepted, creating a perfect commensal relationship of timing, location, opportunity, and job satisfaction. Everyone is happy, the employer, employee, and if applicable, families. Facebook blows up with next-post announcements and requests for friends/family to save-the-dates for future travel.

Mark did his bidding last year, so we have known for a long while that we will head to Astana next summer. Not sure if we will stay there for 2 years, or 4 years like we will soon do in Tashkent. However, that decision will need to be made a short 6-8 weeks after we arrive there, and along with it, our own mess of if-then scenarios. Probably the most important scenario is based on our kids' education. If we stay 4 years, then Deets will be able to attend high school in its entirety. With Margo, we'd have to find at least a 3-year posting after Astana to make sure she gets the same opportunity. I know it's not that big of a deal because in the end, the kids will graduate and go on to be respectable adults. But like most parents, we too, agonize about making smart childrearing decisions.

Anyway, because of the Thanksgiving holiday, and that Astana lies a mere 1200 miles north of Tashkent, we took an opportunity to visit the city and a couple of schools with the kids. We signed up for tours at the British and QSI International schools to see which one might suit them best. My takeaways from the visits were such: they could attend a brilliantly modern school that follows the IB program, requires uniformity, believes that competition is the key to success, and has an app for anonymously reporting bullying.

Or, they could go to a school with a love affair with a Mark Rothko palette, toffers AP classes, promotes individuality with personalized approaches to learning, and allows kids to redo exams or tests until they master the skill. I am conflicted about snobbery and endless do-overs and much as I am about the tenant of sameness versus unique expression. Kids at the British school rarely go outside in extreme weather, whereas QSI students get daily fresh air even when its -20F. That day, we watched British school kids filing out of the auditorium in total silence and nary a glance at us, whereas QSI kids hung out in the cafeteria playing music and asked us questions as we passed through.

After school visits, we learned that Astana has many, many malls. Locals enjoy high fashion, brilliant white lighting, and nearly exclusive use of electronic payment. If we had been able to access wifi more easily (Uzbek SIMs don't allow for roaming or long distance, and Kazakh SIMs require a full registration process), the trip would have been virtually stress free. Taxi services are cheap and robust, but drivers don't take cash and they require online ordering. So, we were at the mercy of free wifi to coordinate pick up and making a run to meet the cabbie when we'd invariably lose internet connection. However, we were delighted to see that nearly all drivers obey traffic law and that de-icing trucks were in abundance. Astanans (Astanians? Astanites?) take winter preparations seriously. You have to... or you die.

On the personal front, I am trying not to make issue of the fact that Astana is famously cold (come on, it's only the second coldest capital in the world), nor that Wikipedia describes the landscape as very flat, versus what, regular flat? Regardless if we stay 2 or 4 years, I will have no choice but to put on my big girl long underpants. I will learn to embrace the itch of wool, the suffocation of a balaclava, and sad, flat hair from chronic hat wearing. Semi-arid steppe isn't flashy, but I am certain I can still find many stories to tell. If I don't die from exposure first.

Me warming up while
everyone else sweats in Bayterek Tower.

Bayterek Tower

A very nice bridge.

Morning after the first snow.

First snow of the season.

Circus/UFO

Bayterek Tower and red light frownie face.The monument

represents a tale about the tree of life and magic bird

of happiness: the bird, named Samruk, laid her egg in

the crevice between two branches of the tree.

Sunrise over the Ishim River.

Southern Uzbekistan Med Field Trip

Recently, I got to take a break from wearing surgical scrubs in exchange for business casual outfits while taking a work trip around southern Uzbekistan with my doctor colleague. Our task was to visit regional hospitals and private clinics to see what resources were available for Americans living, working, and traveling around the area, and to learn about future aspirations the medical facilities had in store.

Regional hospitals function in a unified network with computerized charting, telemedicine, and blood bank resourcing. When a patient has medical needs beyond the capability of their municipal hospital, they may be relocated to a bigger one within the region, and with relative ease. Their hospital mothership, the Scientific Center of Emergency Care, is located in the capital. Interestingly, though the capital feels like its population is busting at the seams these days, with massive construction projects and mind numbing traffic, Tashkent Region is far from having the most number of hospitals (198). Overall there are 2,696 facilities in the country. Ferghana has the most with 302. We managed to visit three in the Kashkadarya and Surkhandarya Regions, which share borders with Turkmenistan, Afghanistan, and Tajikistan.

Over three days, the good doctor and I got to meet with several hospital directors, all of whom had not just their administrative day jobs, but full loads of speciality patients as well. One was a neurosurgeon, another in vascular, and a few others from intensive care, cardiology, and plastic surgery. We walked through their emergency rooms, ICUs, radiology departments, laboratories, operating rooms, and even a dialysis department. In all three hospitals, the most common reasons people end up in the ER is from car crashes involving traumatic injuries, necessitating a multidisciplinary approach to patient management - telemedicine, they said, has been a godsend. Farming equipment and tool disasters were second. 

During a lunch meeting, over plates of shashleek, salad, and naan (Uzbek style), the vascular surgeon showed me pre and post videos of a man's nearly amputated foot from a scythe injury incurred out in the field. Amazingly, he recovered all function and nearly all sensation of his foot. On other topics that surfaced, I was told a blepharoplasty* would cost me 200 dollars, a nose job for about 350, and I could get a mammogram for about 15. Plastic surgery for medical tourism is by far the most profitable and sought after enhancement. I learned that one regional hospital successfully re-introduced several organ transplant surgical cases this past year, after a country wide ban prevented them for several years. Organ trafficking and black market sales got out of control, so all transplant surgeries were shut down. Regulation in the country is tight and limited, and loaded with bureaucratic red tape, but the doc seemed hopeful a measured start become to benefit everyone in need, and that patients won't have to leave the country to find care. 

During our all of tours, not a single one of them wasn't interrupted with dozens of phone calls along the way. It offered sobering insight to how busy they were - literally everywhere in this world, patient care simply never stops and it felt so familiar. Even in my clinic with a relatively small population, I can't remember a single day where we've had downtime. Like in the US, these nurses have heavy patient loads, work 12 hour shifts, and sometimes have to get creative with limited resources. Families often hang out on the hospital campuses with picnics and blankets to manage long wait times. Uzbeks have incredible patience and resourcefulness.

Any accident requiring emergency ambulance transport is required to go to their assigned regional hospital. Care is free, including for foreigners, though the notion of integrating health insurance is starting to take hold. Private clinics focus more on speciality care, but that doesn't mean they are without heavy duty surgical capabilities. One clinic in Termez has a cardiac bypass machine and will soon conduct angiography procedures, where as another on in Qarshi touts its reputation for bariatric surgery and weight loss clinics. Every private clinic we visited have robust dentistry, ENT, and endocrine services - getting one's thyroid function tests is considered routine, as is prescribing lengthy periods of time to recuperate in semi-private rooms. Though they require countless hours of logistical planning, many private clinics enjoy the stardom of visiting specialists from countries like Russia, Turkey, India, and South Korea.

Overall, the doc and I were reassured to see what kinds of care are available in this country and what has changed since the last time the health unit was able to step beyond embassy property. After the hustle of three days of hospitals tours and eight clinic tours, 2 hours of flying, and 16 hours of driving, the doc and I returned to Tashkent to complete the week seeing our own patients, writing trip reports, and catching up on hundreds of emails in our absence. I hung up my jacket and blouse and pulled out my worn, comfortable work jammies for another day of nurse life.

*eyelid lift

Medical folk hanging out in Shakhrisabz, birthplace of Temur the Great.
We're standing behind the Ak Saray Palace, builtbetween 1380 and 1404
when Temur was the man in charge.

Ak Saray Palace tree, good for sittin.

Endoscopy room, Shakhrisabz

Shakhrisabz hospital's collection of weird and unusual kidney stones.

Qarshi's Great Patriotic War (WWII) Monument at sunrise.

Red army stained glass, Great Patriotic War Monument

Nurses are the best, there's NO denying it.
Qarshi hopsital OR Nurses.

Qarshi hospital dialysis unit

Laparoscopic equipment and telemedicine towers in Qarshi.

Operating Room in Qarshi

Emergency room and head nurse in Qarshi.
This room is reserved for red triaged patients, the most serious kinds of injuries.

Endoscopy, Termez

Emergency room, reserved for trauma patients, Termez

More kick-ass nurses (and a few doctors), Termez Neuro ICU

Cardiac bypass machine, Termez

Foreign doctors with upcoming visits to private clinic in Qarshi.