thanks sam

samantha died last week of complications from lymphoma - she was close to 10 years old and the best dog ever

obesity as a contagious disease

great article today in NEJM that is right at the intersection of human behavioral ecology and medicine - Christakis and Fowler analyze a social network and make an argument that obesity spreads horizontally throughout....
ah, if only i would have thought of a project like that while at michigan!

http://content.nejm.org/cgi/content/full/357/4/370

adiós mexico

Dollmaker in San Miguel de Allende

Teotihuácan

We left San Miguel on Friday morning July 6 and headed back to Mexico City for one last day. After arriving at the Central del Norte, we went straight to the bus marked "Pirámides" and started the 1 hour trip out to Teotihuácan - a perfect last day activity for Mexico.

As you probably know, this is one of the best archaeological sites in the world, with most of the buildings and pyramids still standing even though the site was deserted by the Aztecs years before the Spanish discovered Mexico. These sites near Mexico City are important because they represent the habitation of the area for thousands and thousands of years as the focal point for the population.
Plus, Pyramid of the Sun is the 3rd largest Pyramid in the world and, to Kryste's dismay, you can climb to the very top of it - sometimes even with the assistance of a handrail!

Anyway, here are some pictures of the site:

i dunno know

More posts coming soon...

more mexico and keys scuba posts coming soon.....

Dolores Hidalgo

Dolores Hidalgo may be the ugliest city in the world, or at least in Mexico...or at least in the state of Guanajuato...

Dolores Hidalgo is located about 30 miles north of San Miguel de Allende....about a 1 hour bus ride each way with no first class available (so while cheap - about $2 - also slow with many stops)....




The town can best be described as the land of exotic ice cream flavors (cerveza, avocado, cheese, etc), the bean market, and cheap pottery/ceramics. Oh, it's also the cradle of independence in Mexico as it is the sight of where Hidalgo started the march to San Miguel in the beginning of the revolution against the Spanish. You can read more about the history of Hidalgo and Mexican independence here.

Unfortunately, even with that claim to fame, there is not much in the way of historic or tourism interests here and the natural beauty of the town is lacking. The major historic site is the Hidalgo church and museum in the main plaza area.





Nonetheless, I did work in the ER here and found that it was worth the 1 hour bus ride each way from San Miguel in comparison to the other hospital site I was at. This is because there are medical students from the University of Leon at the facility, and, thus, the attendings here are a little more comfortable and acquainted with the role of a medical student.

Furthermore, Kryste and I did make a day trip out to DH to find hand painted plates for the house - which we did at won of the many many pottery/ceramic stores up and down the main strip of Dolores Hidalgo.


Of course, we couldn't leave without some strange ice cream flavors as well....

America!

I've been meaning to write this post for some time now - and what better time than July 4th for this topic?

First of all -- yes, I do realize that Mexico is in "America" - but having said that, let me assure you that when someone here says "American" - they are referring to a person or style from the U.S.

OK - now that I've given my blurb, let me get to my post.



There is an area of town, a strip mall really, that we call "America". Why? Because if you didn't know you were in Mexico - if you just saw the picture or landed from a space adventure in this strip plaza - you would think you were in Novi, Michigan or Carollwood, Florida - any suburban plaza in the U.S.

America is pretty close to Atascadero (our neighborhood) and has (1) a very modern, large Grocery store, (2)A megaplex movie theater with movies in English and Spanish, (3)A Sushi restaurant --yep... (4)A coffee shop - with a name in English (5) A McDonalds coming soon and (5)A number of clothing boutiques selling American style clothes at American prices (600 frickin pesos for a dress, come on!).

Anyway, we visit America about once a week - on America Day (aka Saturday or Sunday)...generally on America Day, we sit at the coffee shop and study Spanish, eat dinner at one the Sushi place or the Sports themed Mexican Restaurant and then head over to a movie at the megaplex - Ocean's 13, Fantastic 4 - all the stuff you would expect at home - plus the Spanish subtitles do help with the learning - really. It's nice to hit up the Gigante on the way home to grab all the groceries that we could live with but wouldn't want to live without for 4 weeks (but Cous-cous and Ivory soap are rare commodities - even lacking at the Gigante).

This place is apparently brand new - within the last 6 months. The construction was meant with a lot of - understandable - resistance from the local community. Plus, I don't think that it is just land availability or a coincidence that the plaza is very close to the upper class white part of town.

Nonetheless, America makes a good diversion and a nice place to study/take a break from the trip 1 time a week - but anything more would be nauseatingly to similar to home.








Amazingly, the community has been very successful in keeping out big business - or at least tacky construction - within the heart of the town. Not even a Starbucks here. But there are a few places I will post about later......

The Markets in San Miguel de Allende

Mexico is a land of markets. In Mexico City there are countless markets - in San Miguel de Allende, the finite number of markets and their ability to actually be counted - is just a function of the relatively smaller size of this city.

Nonetheless, there are a lot of markets here.

First of all, you have the Mercado Ignacío Ramirez and the virtually linked Mercado de Artesanías. This is the major market in the center of town and is located just North, off of the Plaza Civica which is across the street from PACEMD.



The upper red thumbtack is the end of the artist market, the middle red thumbtack is the beginning of the vegetable/fruit market.




This is the market we visit almost everyday - to buy vegetables, fruit, chicken, and in other small things we need for dinner or for the day. Things are fresh and cheap in this market - plus there is nothing hidden like in the Grocery Store. For example, Kryste stumbled upon a truck full of cow carcasses today parked just outside the entrance, complete with skulls and bones. In addition, next to the chicken breasts were the left over chicken heads to use for broth. Still a fun place to go and just no comparison in terms of freshness to a Publix/Kroegers, etc.




In addition to the food market, the Artist/Craft market seems to stretch endlessly - moving via a series of stalls from building to building.







Now, don't think this is the only major market. Only 1-2 miles west at the corner of San Rafeal and Guadalupe is another major market -- Mercado de San Juan de Dios. This market has similar items to the big market described previously but is also the place to go for clothes and household materials - think Target/Walmart with a series of stand alone stalls instead of aisles. The stalls stretch out of the building and run for blocks north all the way to the corner of Insurgentes - essentially almost linking this market with the Mercado de Artesanías discussed briefly above.



The far left thumbtack (far west) is the San Jose Market. PaceMD is Yellow and the other market previously described is marked by the two diagonal red thumbtacks.

Okay, that's the two major markets that are always present but in addition, there are some rotating markets as well.

First of all there is the Tuesday Market which is in between the large modern grocery store in the plaza we refer to as "America" (more on that in another post) and our neighborhood - Atascadero.



The location of the Tuesday Market is the second red thumbtack from the bottom.
You can tell two things from this GoogleEarth image -- (1)It's not a Tuesday, because the area would be packed and (2) This is before the strip mall - America - had been built (no office depot yet).


I would describe the Tuesday market as something akin to a U.S. Flea Market, although I can't really see what the difference is between the cheap goods - shoes, pirated DVDs, pets, etc - sold at this market compared to the San Jose market - but people who live insist that there is, indeed, a difference. One of the strangest things to me about this market is how crowded it is - on a Tuesday morning - not a holiday.








Those are the markets you can find on the map. But, it seems like a market appears every other week in the Civic Plaza (for example, this week is the book fair and two weeks ago was the campos craft fair -- crafts from the surrounding areas). If not in the Plaza Civica, then in the mostly American run Instito Allende (this week there is a craft fair and there was also one on the weekend of Los Locos).

Plaza de Toros

The Corrida itself is just not for me - bullfights are kinda gruesome. But, here in Mexico and most Latin-American/Spanish areas of the world, the bullfight is considered a ritualized art form and any aspects of cruelty imply are not culturally recognized. Well, maybe if the bull didn't have to be drug out of the cage before the fight due its fear of the toreo and the crowd, maybe then I could buy all the guy-risking-his-life hoopla. As it stands, it seems more like an overblown way to kill a bull with some added entertainment. Now, the running of the bulls here in September (or of course the large running of the bulls in Spain) IS something I would like to see someday..

Having said all this, I do like the excitement surrounding the meere mention of a bullfight and the artwork is very nice as well. Thus, I thought it would definitely be worth checking out Plaza de Toros here in San Miguel just to see the arena and maybe some associated art/architecture. If there was a bullfight here, I would probably even go hang out around the Plaza just to see the buzz and maybe score some cheap prints or something - but there isn't one in town until late July.

Anyway, we walked over to the spot on the map that had the stadium drawn and marked. Then we walked around the block and back around again - never finding the actual Plaza. Keep in mind this a pretty large place - easily spotted first on the Google Earth and tourist maps of San Miguel - how could we not find it?

Turns out, the whole block has a huge wall built around it and the arena is simply not observable from the street. Finally we found one relatively small door that opens on the day of a bullfight and was worn with old fliers announcing upcoming events. I don't see how they contains something so big behind a wall....but they do.

These walls and are actually very common here - it's not infrequent that you will be walking down the street and someone will open a tiny door and when you glance in, a large space is revealed - maybe a school or a soccer field.

the only sign of the large Plaza from the street....

W.A.S.P International Convention? Nope, ¡just the Biblioteca Publica!

The Biblioteca Publica in San Miguel de Allende is located just west of the Plaza Civica. It's in a really ugly yellow building but it makes a nice place to study as it is just a short walk across the plaza from the PACEMD/MedSpanish building. Thus, we spend a decent amount of time there.

The nice thing about the place is that it's got a huge outdoor patio with a coffee shop and cafe. Plus, there is a movie theater off the courtyard (Santa Ana Theater) that plays independent films 2Xs per day for 50 pesos a person. In addition, it's one of the few locations around town that has free wireless internet (also check the Instituto Allende on Ancha de San Antonio).

There are a few annoying things about the place as well.
First, if you visit the library you should go knowing that this is an English language collection - the second largest biblioteca de ingles en la país.
In addition, it's the gathering spot of all the U.S. and European people who have moved here or relocated for a long period of time - so it's going to feel like you are back home...but an even more annoying version of back home. This is a back home filled with ping-pong ball people just bouncing through life and flopping into San Miguel. Also not a place to go to hear Spanish. So, just know those things going in and if you can get past that, the library isn't a bad place to study and get cheap food/coffee.

Upstairs from the library is the headquarters of the English weekly, Atención.

http://www.atencionsanmiguel.org/links/bibliotecasma.html

La Biblioteca is indicated with the central red thumbtack, pacemd with the yellow and the house with the red marker to the far right (east)

Mexican Pharmacies

One of the more interesting things here in Mexico is the number of drugs available without a prescription - basically everything that is not on the our controlled substances list can be bought by anyone at any pharmacy.

This means that antibiotics, heart medicines, diabetes pills, and other common chronic drug regimens can be purchased during a trip to the market. No benzos or opiods but plenty of other medications to allow people here to deal with many problems on their own.

Of course, this also means that medications are a lot cheaper here (except for some of the big gun antibiotics). For example, I can purchase my month long supply of allegra for less than $20. Many U.S. health insurance companies won't even cover Allegra these days due to the availability of the similar (but for me and many others, less effective) Claritin over the counter. Anyway, the old Blood pressure meds and DM regimens are certainly cheaper, as are the old generation and generic antibiotics.

The good thing about this system is that people with very little money can treat common conditions much more easily. It's not too hard for a women to figure to use a sulfa to tx her urinary tract infections if she gets them a couple of times, or if her sister/mom etc has had them as well. Same goes for mom's treating ear infections with some amoxicillin. The problem of course is that many things are mistreated and of course there is less preventive medicine in this model.

For example, in the emergency room this week I saw a women who tried to treat a bladder infection with an antibiotic that only covers gram + organisms (most bladder infections are a different type of bacteria). So, the infection spread to her kidneys. Since she was pregnant, this became a relatively serious infection likely requiring hospitalization and IV antibiotics (at least in the U.S).

Of course this would throw the economics of medicine in the states out of control as well if these drugs were over the counter - think of all the office visits for med refills and relatively common prescriptions/common problems. Anyway, the argument, of course, that those of us trained in medicine in the U.S. would make is that while it is more costly to have these frequent office visits, it is also the only way to rule out more serious problems and keep up with immunizations and other necessary prevention/health maintenance issues.

Anyway, arguments aside, I will enjoy my $15 Allegra while I'm here, my ability to grab some antibiotics to keep away the Monteczuma's Revenge, and other simple stuff that even with my level of training, I can select the appropriate medicine for treatment. Different world.

Night time in San Miguel de Allende

This is a busy place at night - especially Thursday - Saturday (but certainly any night one can find places to dance, places to just hang out, or movies at the library or the mega cinema by gigante (he-gone-te)....anyway, the all-purpose hang out is at the Jardin in the center of the Principal Plaza. Every night features mariachi bands, tourists, and locals just sitting on the benches eating the fresh fruit pelatos (Popsicles)

La Gruta - The Hot Springs near San Miguel

Natural hot springs – man made structure. Each room contains a warmer area of the spring. The final room is definitely spa/Jacuzzi temperature. 15-20 minute bus ride from the corner of Casa de la Luz and Hidalgo (or about a $10 cab ride). There are about 3 different sets of springs on the outskirts of town - each catering to a slightly different crowd. There is one spring that has water slides and other installations for kids - but I think we will probably have to make a trip there as well. The coldest spring is probably around 80 degrees Fahrenheit.