azerbaijan

i arrived the baku airport at 3 am, and promptly fell asleep on top of my backpack. the only reason i had left it this long to visit azerbaijan was because the visas are notoriously tough and expensive to get. i’m sure many azeris and turks would disagree, but azerbaijan is culturally basically turkey version east. they do have their own language and customs, but both are very similar to the turks. unfortunately the most striking thing about azerbaijan is the audacity with which its narcissistic dictator ilham aliyev controls every aspect of civil society and people’s lives. most of the billboards contain just his picture, and anyone who voices dissent pretty quickly disappears. there is a huge, new ornate house of parliament in downtown baku that is never used, a complete sham. the father and now son tag-team have been in charge since the dissolution of the ussr. ilham’s father heydar grew up as a peasant in an exclave of azerbaijan called nakhchivan; i would love to visit that corner of the country someday. azerbaijan has tremendous quantities of oil money. because of the enforced hierarchy and cronyism, it thus also has tremendous economic disparity. there are luxurious glass, futuristically shaped malls that have been built for the oligarchs to buy their $10 000 suits, and there are three buildings shaped evocatively shaped like flames that house the state oil company. much of baku lives interspersed among oil wells, burning flares and reeking trailing ponds in the suburbs. the water of the caspian sea off the coast of baku glimmers with a layer of oil.

another major theme of the azeri national narrative is the conflict with armenia. azerbaijan lays claim to a large swath of land that experienced a secessionist movement in the late 80s and early 90s by its ethnically armenian majority, a movement which was supported by the armenian government. The area is now a de facto independent state called nagorno-karabakh, recognized as independent by no one but armenia. azreris see this as an illegal occupation of their land, and much of the international community passively agrees but is unwilling to do much about it, short of denying recognition of nagorno-karabakh. unfortunately this appears to be a complete obsession of the azeri government in the realm of international relations, such that it is basically the only issue that seems to matter to them. case in point – peruse their official websites for prominently featured diatribes of how terrible armenia is. it is impossible to travel directly between the two countries, indeed individuals who have ever been to armenia are prohibited from entering azerbaijan (two passports comes in handy).

in baku I mostly studied. i also visited the palace of the shivarashas, an ancient palace where the rulers of the area lived during antiquity. there were some very old minimalistic mosques there as well. i rode around on the soviet built subway, which has excessively deep stations and costs just 10 cents to enter. each station is a masterpiece of soviet era art, all is coated with a layer of black oil grime, and folks stare at the floor in complete silence. i also visited a restored zoroastrian fire temple called ateshgah, out in the oil well-sprinkled suburbs. azerbaijan was a hotbed of zoroastrianism (an ancient religion involving the worship of fire, still practiced today mostly in iran and parts of india) thousands of years ago; it is even postulated that this was where the religion originated, perhaps from burning oil seeping out of the ground.. these days the azeri population is officially entirely muslim, but they don’t seem to take it very seriously. women in baku don’t cover their heads, and alcohol flows very liberally. azerbaijan became known to the average european as a place that exists when it played host to the eurovision contest (kinda like europe’s version of american idol) in 2012 - this was held in an opulent purpose-built glass stadium called the crystal palace on reclaimed land in the caspian sea. speaking of reclaimed land in the caspian sea, the richest man in azerbaijan, ibrahim ibrahimov, is planning to build an entire city on an island which is being built as we speak, and the centerpiece is planned to be a tower which will be the tallest in the world. yes, the tallest building in the world is being built in baku, azerbaijan. mind blown, eh?

back “home” to israel through istanbul. a fascinating few days indeed!

saunaing!

in helsinki i stayed in the stadium that hosted the 1952 olympics, which has since been turned into a hostel. finland is terribly expensive – like everything is three as much as it should be. helsinki is really nice though, and is the northernmost capital in world, and also has the northernmost subway system in the world! speaking of subway, i ate every meal there because it was all i could afford. the main reason i wanted to go to finland was to go to saunas, and it was glorious! the first i went to was called yrjonkatu. it was a big indoor swimming hall, the oldest in the city. there are different days for the different genders, and everybody gets naked to swim laps. the main attraction though are the saunas, of which there are a few divided by level of intensity. you are not even allowed to go in unless you are naked. yes, some tourists came in with swimsuits and they were yelled at. old guys who seem like they live there continuously ladle water over hot rocks; the speed at which they do this determines how hot things get.

the next day i met up with my classmate kady and her boyfriend adam, who were also in town to sauna, and we took a bus out into the forest to visit another sauna. this one was a traditional outdoor smoke sauna. it got even hotter, such that we all had painful sunburn-like reactions for days afterward. it was beside a lake, so after a minute or two in the sauna which was about the maximum we could handle, we jumped into the lake. saunas are probably one of humanity’s best inventions!

lithuania -> estonia

for my spring/passover break I decided to travel to a bunch of countries I hadn’t been to before – namely the baltics (lithuania, latvia and estonia), finland and azerbaijan! I first flew to kyiv, ukraine for a short stop before continuing on to vilnius, lithuania. the three baltic countries of lithuania, latvia and estonia have really made impressive strides. 20-some years ago they were soviet backwaters; today each of them is a thriving, very westernized, capitalist democracy and member of the european union. and they are still cheap! in vilnius i mostly studied, but also wandered around the old city, and across the river into an area known as uzuipus, which describes itself as an independent country. The independence movement has satirical component to it – their mascot is a clown playing a trumpet, and they stamp passports with a uzuipus stamp on april fools day. but apparently some people take it seriously as well. lots of big malls in vilnius. i was also going to meet up with a medical student friend oresta in lithuania but she had an exam that day so unfortunately it didn’t work out.

then i took the bus north; it made a quick stop in riga, latvia to pick up a bunch of drunk study abroad british college students. the end of the road, tallinn, estonia was really great. it has one of the more impressive ancient walled old cities in europe. saint olaf’s church in the old city was the tallest building in the world for over 100 years during the middle ages. these days estonia is literally the most connected country in the world to the internet, and it is also the home of skype and pioneered things like letting people pay their bills online. estonia is also a showpiece for libertarians – after the soviet era they implemented a flat tax as recommended by milton friedman. during the recent recession they were one of few countries to slash government spending rather than increase it, and they are the least endebted country in europe. there are also some interesting relics of the soviet past in tallinn. the hotel viru still stands downtown – it was the first skyscraper in tallinn, built in the 70s by the soviet government as the only place where visiting tourists were allowed to stay. every single room was bugged! another soviet edifice is the linnahall – a gargantuan, crumbling cement platform on the harbor about the size of two city blocks, which was built for the 1980 moscow olympics - the sailing events were held in tallinn. beneath it is a large auditorium which is locked up and never used. it and its graffiti juxtapose poignantly with the surrounding gleaming glass buildings. all three of the baltic countries have their own unique ethnicity and language, but each also has substantial numbers of ethnic russians in the east. 25% of estonia, for example, is russian. apparently they’re all a little on edge about russian aggression, vis a vis events in ukraine. from tallinn i hopped on a 2 hour ferry ride across the gulf of finland to helsinki!

weekend in egypt!

one weekend last january i decided to take a little vacation down to egypt to get away from it all! (and study for step 2 on the beach). for $50 i stayed in the 5 star all-inclusive movenpick resort in taba, just across the border from eilat, israel. unfortunately tourists are staying away from egypt right now due to the political instability. and even more unfortunately just after the time i was there a bus full of korean tourists was blown up right at the border. it was special to be back in "masr" (egypt) after living there for a semester a while ago, although the luxury of the resort life in taba is nothing like real egypt. the buffet food was the best i've eaten in years! the movenpick hotel is a 5 minute walk from the border. and a pleasant surprise was learning that if you stay in taba, foreigners don't need to pay any visa fees or taxes on either side of the israeli-egyptian border, fees which otherwise are quite prohibitive. wish i would have known about this earlier!

the taba border zone has an interesting history. the sinai peninsula was occupied by israel from 1973 until 1982 when it was returned to egypt following the israeli-egyptian peace treaty. there was a very popular israeli hotel built in the 70s just across the border, now the taba hilton. upon the return of the sinai to egypt both sides wanted the hotel, and the united nations had to arbitrate an agreement. it ended up going to egypt, but it was stipulated that the egyptians may not charge israelis an entry tax to go to the taba hilton. the hotel remained very popular among israelis due to its casino, but in 1994 the hotel was bombed and collapsed in its entirety, killing many, and israelis have generally stayed away since. and it was bombed again in 2004. it has since been rebuilt, but i vote the movenpick as the better place to stay in the border zone.

it was great to get a little sunburn and luxury in egypt in the middle of january! anyone at msih reading this - get yoself down to taba next weekend!

another day in the northern west bank

one day during march a big group of my medical school colleagues took a self-planned day trip in a bus up to the northern west bank cities of qalqilya and nablus. great to see these kids wanting to see life from the other side. we were joined by some medical professionals from the u.s. first stop was qalqilya, a palestinian city which is 95% surrounded by israel's separation barrier. there is just one road in. major problems from a public health perspective, as the surrounding townsfolk now need to travel hours to get to the clinic or hospital, trips that used to take them 5 minutes. sometimes the one entrance to qalqilya is shut completely by the israelis for hours or even days at a time. we visited the only united nations relief and works agency (unrwa) hospital in the west bank, where the director of the hospital welcomed us with the customary long-winded speech and selection of sweets, and gave us a tour of the facilities. unrwa provides free healthcare to palestinians, provided they can get to the facilities, which often is the insurmountable obstacle. generally speaking, the challenge for healthcare in palestine is that it is disjointedly provided by a slew of intergovernmental and non-governmental organizations that do not integrate particularly well with each other. that and the barriers to access created by restriction of movement. qalqilya is host to palestine's only zoo, a profoundly sad place. during the second intifada in the early 2000s the animals were starving to death despite the best efforts of the committed zookeeper. one day a grenade exploded and startled the zoo's giraffe, who subsequently hit its head on a metal beam and died. the zookeeper became a taxidermist out of necessity, and today one can see the stuffed animals whichwere alive in better days gone by. vice news did a piece on these stuffed zoo animals.

next we headed east to nablus. unbeknownst to anyone on the bus, our tour guide had lined up another host, a palestinian liberation organization (plo) guy who had spent much of his life in israeli prisons. upon arrival in nablus we picked him up and were taken to the top floor of city hall, where we had a red carpet meeting with the mayor, who is also on the plo's executive committee. he waxed poetically on the need for equality as well as peace, commenting and answering questions on current peace negotiations, while triple-life sized portraits of arafat and abbas looked down on us and the city of nablus spread below us. after all the unplanned formalities, we finally got the chance to wander around the streets of nablus, sampling its specialty desert kunafa, and peering into its secluded ancient courtyards and hammams.

shabbat in jenin

one saturday while we were living up in the galilee we decided to make a little trip to the city of jenin in the west bank. jenin is at the northern tip of the wets bank just across the border from afula, but the only people who ever visit are israeli arabs from the galilee who go to visit family. jenin was a hotbed during the second intifada; half the suicide bombers during that uprising came from jenin. during that time the city was occupied by israel with heavy tanks and artillery and a lot of people died. we wandered the bustling streets for some time, and had a meal of assorted salads on a rooftop restaurant overlooking the city.

one of the more interesting institutions in jenin is the freedom theater. there, an acting troupe seeks to resist the occupation through art rather than violence, and seek to guide the children of the jenin refugee camp through acting as therapy. its founder juliano mer-khamis, who is both jewish and palestinian, was unfortunately assassinated by a masked gunman on the streets of jenin in 2011. much speculation surrounds the motive for his death. too bad that the good guys usually seem to die too soon in this part of the world.

returning to israel from jenin turned out to be an adventure in itself. we took a taxi to the crossing, but palestinian registered cars cannot cross into israel so we got out to walk across. we discovered however, that though we walked into the west bank earlier that day at the same crossing, it was illegal to cross by foot in the other direction. so we had no choice but to catch a ride with someone in their car. over the next two hours as twilight fell, we begged people in cars to let us cross the border with them, to no avail. one of my classmates eventually became so exasperated that he walked toward the crossing, waiving his hands in the air and protesting in hebrew, despite the disapproving yells of the israeli soldiers who had their automatic weapons trained on him. eventually we convinced him to relent. we finally were able to convince an older arab gentleman to let us into his van for the crossing. while we waited he told us that he had been in palestine to get some dental work done: it is much cheaper in the west bank than in israel. our van was pulled aside for a "secondary inspection" - because we were in it. now we realized why no one wanted to give us a ride. apparently the only foreigners who cross this border are activists. we were all interrogated and patted down, and then directed to a holding area, where we sat for another 2 hours while they closed all the windows on the van and pumped it full of a gas, the identity of which was unknown to us. strange times at the border. we profusely thanked our driver for taking two hours out of his evening to help our sorry selves. just another day in palestine.

family medicine - in circassia!

i did my 6 week family medicine clerkship with five good friends in galilee, northern israel. we lived in an apartment on the ha-emek hospital compound in the town of afula in central galilee, and each took buses to different places with different primary care physicians. afula is the largest town in israel's jezreel valley, and is just down the road from megiddo, posited by some as the place where the world will end. it is also in the shadow of mount tabor, believed to be the site of Christ's tranfiguration. i got really lucky, as i was placed with a friendly doctor who loved to teach in a very unique town called kfar kama, one of just two circassian towns in israel. the circassians are an ethnicity who originated in the north caucasus -- what is now russia around the area of sochi. coincidentally the winter olympics occurred in sochi during the time i was there. these people lost the circassian war to russia in the 1700s, and some small numbers were resettled by the ottoman empire in what is now northern israel. they were warriors back in the homeland, but settled into an agricultural lifestyle in the middle east. they have held on to their religion, sunni islam, and retained their unique culture and language, called adyghe. they also speak hebrew, arabic, and more english than average, which was another reason i was happy to be there. there are only about 4000 circassians in israel, split between two towns. they marry only other circassians. the men serve in the israeli military at the will of their elders; women cover their heads, wear ornate dresses and basically control the place. the women are seriously empowered, and many are highly educated. the teenagers still get acne and the elderly still get hypertension.

circassian society is rather insular, so being in a family medicine clinic provided a remarkable glimpse into their culture which otherwise might never have been possible. there is only one clinic in the town, and just two physicians, each of whom has been working with the community for years and knows everyone in town. on one occasion we learned that an elderly man had unfortunately passed away, so we left the clinic and walked down to his house, which is an unspoken obligation of the clinic staff. half the town was sitting in the home mourning, men in one room and women in another; kids playing outside. the mourning period lasts for 3 days. they passed around cookies and strong coffee and i was the only one who took any. oops.

my preceptor also staffed another clinic in a small moshav, which is similar to a kibbutz (both are small, communal zionist agricultural communities. kibbutzim are completely communal - i.e. communist, while in a moshav each family takes care of their own finances). the moshav was called ha'zorim, and was in a valley just southwest of tiberias. it was started by holocaust survivors, a group which still make up the majority of its population. we would typically go there later in the evening for a couple hours, and a really nice nurse would prepare biscuits and hot tea without fail. i'd draw blood while the family doc caught up on local gossip in the vernacular.

one evening we rented a car for my friend mayuri's birthday, and drove up a mount carmel overlooking haifa, where there is a string of druze towns. the druze are an insular pseudo-islamic ethnicity and religion. we got countless plates of salad and wandered the freezing streets. it actually gets quite cold in corners of the middle east during the right time of year. another evening we took the bus up another big hill in the other direction to the arab city of nazareth, where we ate at the oldest and most expensive restaurant in town, and sampled some coffee which has been constantly brewing for the last 70 years! we then realized that we'd missed the last bus back, so spent half the night in the only establishment that was open - a dry shisha-sports-bar, trying to figure out how to get home on our budget. family medicine - fewer dull moments than you'd expect!